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Objectives: To determine the correlation between the primary implant stability quotient and the implant percussion sound frequency., Materials and Methods: A total of 14 pigs' ribs were scanned using a dental cone beam computed tomography (CBCT) scanner to classify the bone specimens into three distinct bone density Hounsfield units (HU) value categories: D1 bone: >1250 HU; D2: 850-1250 HU; D3: <850 HU. Then, 96 implants were inserted: 32 implants in D1 bone, 32 implants in D2 bone, and 32 implants in D3 bone. The primary implant stability quotient (ISQ) was analyzed, and percussion sound was recorded using a wireless microphone connected and analyzed with frequency analysis software., Results: Statistically significant positive correlations were found between the primary ISQ and the bone density HU value (r = 0.719; p < 0.001), and statistically significant positive correlations between the primary ISQ and the percussion sound frequency (r = 0.606; p < 0.001). Furthermore, significant differences in primary ISQ values and percussion sound frequency were found between D1 and D2 bone, as well as between D1 and D3 bone. However, no significant differences were found in primary ISQ values and percussion sound frequency between D2 and D3 bone., Conclusion: The primary ISQ value and the percussion sound frequency are positively correlated., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objectives: Bioactive surfaces were designed to increase the interaction between the surface and the cells. This may speed up the biological stability and loading protocols., Materials and Methods: 36 patients with D3-D4 bone density were recruited and allocated into two groups. 30 bioactive (test group) and 30 traditional (control group) surfaced implants were placed. Insertion torque value (Ncm), insertion torque curve integral (cumulative torque, Ncm), torque density (Ncm/sec), implant stability quotient (ISQ) measured at three timepoints (baseline (T0), 30 (T30) and 45 (T45) days after surgery), and marginal bone loss (MBL) at 6 months of loading were assessed., Results: The mean ISQ and standard deviation at T0, T30, T45 were respectively 74.57 ± 7.85, 74.78 ± 7.31, 74.97 ± 6.34 in test group, and 77.12 ± 5.83, 73.33 ± 6.13, 73.44 ± 7.89 in control group, respectively. Data analysis showed significant differences between groups in ΔISQ at T0-T30 (p = 0.005) and T30-T45 (p = 0.012). Control group showed a significant decrease in ISQ at T30 (p = 0.01) and T45 (p = 0.03) compared to baseline, while no significant change was observed in test group. Due to the stability of the ISQ value ≥ 70, 26 test group and 23 control group implants were functionally loaded after 45 days. Conversely, due to the ISQ < 70 at T45, four test group implants and one control group implant were loaded after 90 days, and 6 control group implants were loaded after 180 days. Neither insertion torque nor ISQ at baseline were correlated with bone density (in Hounsfield units). There was no significant correlation between cumulative torque and ISQ at baseline. There was a significant positive slope in the correlation between torque density and ISQ at baseline, more accentuated in D3 than D4. This correlation remained significant for the test group in D3 bone at day 30 and 45 (p < 0.01 in both time frames), but not in D4 bone, and it was not significant in CG., Conclusions: The bioactive surface showed better behavior in terms of implant stability in D3-D4 bone quality in the early stages of bone healing. Clinical relevance This study demonstrated that the transition from primary to secondary stability is improved using bioactive surface, especially in cases of poor bone environment (D3/D4 bone)., (© 2024. The Author(s).)

Objectives: Compare bone density changes and initial implant stability following sinus augmentation with autogenous bone (AB) vs. fresh frozen bone (FFB)., Materials and Methods: Randomized, prospective, split mouth study. Sinus augmentation executed using either AB or FFB. Dental implants were inserted after 6 months of healing. Implant dimensions and insertion torques were recorded. Prostheses were delivered 6 months thereafter. All patients had computerized tomography (CT) scans 1 week (T1) and 6 months (T2) after initial bone grafting. Third CT (T3) was taken 12 months after prosthesis delivery. Data from CT scans was used to analyze bone density at each period., Results: A total of 15 patients (8 males, 7 females) following bilateral sinus augmentation procedures, were included. Mean age was 54 ± 5 years (range 48-60 years). All patients had 3 CT examinations. The initial augmented AB density was higher than the initial FFB density. Nevertheless, density differences between the two groups were not statistically significant at any time frame. At T2 density of both grafts showed a statistically significant increase. A significant increase from T2 to T3 was noted only for the FFB group. Implant insertion torque was significantly higher in the FFB group. Insertion torque ≥32 N/cm was achieved in significantly more patients in the FFB group., Conclusion: The use of FFB for sinus augmentation is a reliable option of graft material. The newly formed bone quality performance, evaluated by CBCT density, is as good as AB, allowing predictable initial implant stability and osseointegration. Unnecessary morbidity associated with AB harvesting is thus avoided., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To present a classification and assess the presence and degree of cortication of the sinus floor utilizing Computerized Tomography (CT) scan images., Materials and Methods: One hundred CT scans, of patient who required a sinus augmentation procedure (SAP), were evaluated and classified according to the Type of sinus floor cortication (SFC). Type 1: sinus floor showing similar or higher density than the surrounding cortical areas. Type 2: sinus floor showing less density than the surrounding cortical areas. Type 3: sinus floor showing no cortical bone. Type 4: sinus floor showing the fusion of sinus floor bone and native crestal bone., Results: The SFC were present in 31, 41, 18, and 10 cases in Type 1, 2, 3, and 4, respectively., Conclusions: This classification based on the level of cortication of the sinus floor is clinically useful as a method of determining if the dental implant can be placed simultaneously or not with the SAP, or can be placed even without a SAP., (© 2016 Wiley Periodicals, Inc.)

Objective: The aim of this study was to investigate the influence of different bone tissue characteristics of implant sites on changes in marginal bone level and implant stability over time., Material and Methods: One hundred and one implants were inserted in 41 patients. Cortical bone thickness of the alveolar ridge was measured on computed tomography (CT) images. Histomorphometric and microtomographic analyses (microCT) were performed in bone specimens obtained by using a trephine bur, at first drilling. Implant stability quotient (ISQ) measured by resonance frequency analysis (RFA) was registered at implant insertion. Implant stability quotient was measured also at the stages of uncovering, loading and at the 1-year follow-up, when standardized periapical radiographs were taken to measure the marginal bone level (MBL). Descriptive statistics, Spearman's rho correlation and multiple linear regression were used for data analysis (P < 0.05)., Results: Comparison between groups of higher and lower values of ISQ changes and between groups of higher and lower values of MBL changes revealed no differences in histomorphometric and microtomographic parameters, according to non-parametric comparison tests, (P > 0.05). Bivariate correlation also showed no association among these microstructural parameters and the outcomes evaluated. There was no correlation between cortical thickness and MBL changes (r = -0.029; P = 0.832) and between cortical thickness and ISQ changes (r = 0.145; P = 0.292)., Conclusion: Microstructural bone characteristics of implant sites have no effect on changes in marginal bone level and implant stability as measured by RFA. Bone morphology cannot predict implant treatment success over time., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Bone density examination (BDE) using preoperative cone beam computed tomography (CBCT) might be used to predict primary implant stability in implant patients., Purpose: The aim of the study was to validate a novel CBCT scanner in vitro with regard to BDE in preoperative scans and to analyze the in vivo correlation of CBCT scan results with primary implant stability measurements., Materials and Methods: A CBCT scanner was validated in vitro with regard to spatial uniformity and linearity of CT numbers (Hounsfield units, HU) by using a series of phantoms and plastic and hydroxyapatite specimens of various densities. Forty-nine patients (27 female and 22 male, mean age 55.6 ± 9.8) were scanned prior to and 1 to 6 months after the placement of 155 dental implants of different lengths and diameters. Mean and peak insertion torque (IT) in Ncm were registered during implant placement. Resonance frequency analysis (RFA) measurements in ISQ units were performed after placement. The second scan was used to export and superimpose the exact positions of bone and implants into the first scan. Virtual probes with the same length as the actual implant were automatically placed at the implant sites, and mean HU values were measured in a 1 mm-wide circular corridor from the tip of the threads and out., Results: The in vitro validation showed high uniformity and linearity of CT numbers (HU). The clinical study showed significant correlations between bone density and ISQ, mean IT, and peak IT, respectively., Conclusions: The WhiteFox CBCT scanner measures bone density with high accuracy. There is a correlation between bone density and primary implant stability as assessed with IT and RFA measurements. The findings suggest that BDE may be used as an additional feature in treatment-planning software to estimate primary stability at predetermined implant sites., (© 2013 Wiley Periodicals, Inc.)

Background: Primary implant stability is important for successful outcomes after uncemented total ankle replacement (TAR). However, the influence of patient-specific bone density on TAR performance is poorly understood, especially for implants that rely on press-fit for stable primary fixation. Our goal was to evaluate how bone density influences implant-bone interfacial micromotions in 3 press-fit tibial component designs by sampling from a TAR preoperative planning database using finite element analysis (FEA). Methods: FEA was conducted in 4 TAR patients with relatively low-density (n = 2, lowest 10% of a sample including 58 patients) and average-density (n = 2, midrange of sample) bone as assessed from deidentified patient CT scans. Three tibial implant designs were evaluated: a bone-sparing resurfacing implant, a cortex-sparing anterior approach monoblock stemmed implant, and a distal-reaming modular stemmed implant. Implants were inserted into tibia geometries obtained from the CT scans. Press-fit implantation was modeled first, followed by loadings from the stance phase of gait, and the associated micromotions were computed from the FEA output. Results: In general, patients with average-density bone had FEA predicted lower micromotions than patients with low-density bone. FEA suggests that implant fixation features had less influence on micromotions in patients with average-density bone, with peak micromotions ranging from 2 to 23 µm (3.1 ± 1.3 µm average micromotion). For patients with low-density bone, interfacial regions are predicted to experience micromotions exceeding the bony ingrowth threshold of 50 µm only for the resurfacing implant. Conclusion: We investigated the influence of bone density on implant-bone micromotions with varying primary fixation features using FEA. The model predicts that micromotions are less in average-density bone, regardless of implant fixation features. However, both stemmed devices showed lower micromotions in less-dense bone, albeit with the corresponding clinical trade-off of requiring more tibial bone removal. Clinical Relevance: The results presented here implicate the complementary role that local bone density plays in the primary fixation stability of uncemented TAR. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of regular implant drills to osseodensifying drills used in clockwise and counterclockwise motions on bone dimension change and primary implant stability. Materials and Methods: A total of 40 bone models were made (20 × 15 × 4 mm) from porcine tibia to represent implants placed in soft bone. Implant osteotomies were prepared in the bone models using one of the following techniques: (1) regular implant drills in a clockwise direction (group A), (2) regular implant drills in a counterclockwise direction (group B), (3) osseodensifying drills in a clockwise direction (group C), and (4) osseodensifying drills in a counterclockwise direction (group D). Bone-level tapered titanium alloy implants (4.1 × 10 mm) were placed following osteotomy creation. The implant stability quotient (ISQ) was measured after implant placement. Each bone model was scanned with an optical scanner to convert to Standard Tessellation Language (STL) files before and after the osteotomy creation. Presurgical and postsurgical STL files were superimposed, and the dimensional changes were measured at 1, 3, and 7 mm from the crestal bone. Histomorphometric analysis was done, and bone-to-implant contact percentage (BIC%) was calculated. Results: There were no significant differences in ISQ values (P = .239) between any of the groups. Histomorphometric analysis showed implants in group D had significantly higher BIC% than groups A (P = .020) and B (P = .009). The amount of bone expansion decreased with distance from the crest (P < .001). Groups B (P = .039) and D (P = .001) showed significant expansions at all levels compared with group A. No other statistically significant differences in dimensional change were found between groups. Conclusion: Both regular and osseodensification burs used in a counterclockwise motion contribute to expansion of bone dimension compared to conventional drilling methods. [ABSTRACT FROM AUTHOR]

Some evidence supports the influence of implant macro-design on primary stability. Additionally, tactile perception can be used to assess implant stability when placing the implant. This research aimed to quantify the primary and secondary stability of three implant systems with two different macro geometries (cylindrical and conical) determined based on the insertion torque and the implant stability quotient (ISQ) at the moment of implant placement as a function of implant-related factors (length, width, dental arch, and implant location in the arch), intraoperative factors (bone density determined subjectively by the clinician's tactile perception), and patient-related factors (age, gender, and bone density determined objectively based on cone beam computed tomography (CBCT). Methods: 102 implants from three implant systems with two different macro geometries (conical and cylindrical) were placed in 53 patients. The insertion torque, the ISQ at the implant placement (ISQ0), and the bone quality according to the clinician's tactile sensation were recorded on the day of the surgery. After a three-month healing period, the ISQ was re-evaluated (ISQ3). Results: The cylindrical implants exhibited significantly higher insertion torque and ISQ values at the moment of the surgery and after three months compared to the conical implants. The cylindrical implants also showed significantly lower indices of tactile evaluation of bone quality during the implant placement surgery. However, no differences were demonstrated in the bone density measured objectively using CBCT. (4) Conclusions: The cylindrical implants achieved the highest values for primary stability (Newtons × centimeter (Ncm) and ISQ) and secondary stability (ISQ after three months). The insertion torque was the variable that most influenced the ISQ on the day of the surgery. The implant location (incisors–canines, bicuspids–molars) and the implant macro geometry were the variables that most influenced the secondary stability (ISQ at three months). [ABSTRACT FROM AUTHOR]

Background/Objective: To ensure that implants are able to support prosthetic rehabilitation, a stable and functional union between the bone and the implant surface is crucial to its stability and success. To increase bone volume and density and excel bone-implant contact, a novel drilling method, called osseodensification (OD), was performed. To assess the effectiveness of the osseodensification drilling protocol versus the conventional surgical technique on implant stability. Methods: Bone Level Tapered Straumann implants were placed side-by-side with both OD and subtractive conventional drilling (SD) in 90 patients from CESPU—Famalicão clinical unit. IT was measured using a manual torque wrench, and the Implant stability quotient (ISQ) value was registered using the Osstell® IDX. Results: According to the multifactorial ANOVA, there were statistically significant differences in the mean IT values due to the arch only (F(1.270) = 4.702, p-value = 0.031 < 0.05). Regarding the length of the implant, there were statistically significant differences in the mean IT in the OD group (p = 0.041), with significantly lower mean IT values for the Regular implants compared to the Long. With respect to the arch, the analyses of the overall ISQ values showed an upward trend in both groups in the maxilla and mandible. High levels of IT also showed high ISQ values, which represent good indicators of primary stability. Conclusions: OD does not have a negative influence on osseointegration compared to conventional subtractive osteotomy. [ABSTRACT FROM AUTHOR]

Many studies have been exploring the use of bone graft materials (BGMs) and mesenchymal stem cells in bone defect reconstruction. However, the regeneration potential of Algipore (highly purified hydroxyapatite) and Biphasic (hydroxyapatite/beta-tricalcium phosphate) BGMs combined with bone marrow–derived mesenchymal stem cells (BMSCs) remains unclear. Therefore, we evaluated their osseointegration capacities in reconstructing peri-implant bone defects. The cellular characteristics of BMSCs and the material properties of Algipore and Biphasic were assessed in vitro. Four experimental groups—Algipore, Biphasic, Algipore+BMSCs, and Biphasic+BMSCs—were designed in a rabbit tibia peri-implant defect model. Implant stability parameters were measured. After 4 and 8 weeks of healing, all samples were evaluated using micro-CT, histological, and histomorphometric analysis. In the energy-dispersive X-ray spectroscopy experiment, the Ca/P ratio was higher for Algipore (1.67) than for Biphasic (1.44). The ISQ values continuously increased, and the PTV values gradually decreased for all groups during the healing period. Both Algipore and Biphasic BGM promoted new bone regeneration. Higher implant stability and bone volume density were observed when Algipore and Biphasic BGMs were combined with BMSCs. Biphasic BGM exhibited a faster degradation rate than Algipore BGM. Notably, after eight weeks of healing, Algipore with BSMCs showed more bone–implant contact than Biphasic alone (p < 0.05). Both Algipore and Biphasic are efficient in reconstructing peri-implant bone defects. In addition, Algipore BGM incorporation with BSMCs displayed the best performance in enhancing implant stability and osseointegration potential. [ABSTRACT FROM AUTHOR]

To evaluate the insertion torque at the equicrestal and subcrestal positions of three implant designs in synthetic polyurethane blocks simulating different bone conditions. Materials and Methods: Overall, 72 implants with three different designs (two conical and one cylindrical) were inserted at equicrestal and subcrestal positions (–2 mm) into polyurethane blocks simulating the anterior (0.32 g/cm³) and posterior (0.48 g/cm³) regions of the maxilla. The final insertion torque of all implants was measured using a digital torque meter, and the results were evaluated and statistically analyzed. Results: For all implant systems, insertion torque decreased significantly when placed at the subcrestal position (P < .05), except for cylindrical implants placed in the bone blocks with high cancellous density. The implants with higher body conicity and square threads had higher insertion torque values than the cylindrical and conical implants with a lower body conical angle and trapezoidal threads. The implants inserted into higher-density blocks showed greater stability. Conclusion: The different implant systems lost insertion torque in a nonuniform manner at the subcrestal position and varied according to bone density. Implant design significantly influenced the initial stability at the equicrestal and subcrestal positions, especially in lower-density bone. [ABSTRACT FROM AUTHOR]

Background/purpose: Implant stability is crucial for successful osseointegration. Marginal bone level is considered an important indicator of long-term implant success and stability. The purposes of this study were to investigate 1) the effect of age, gender, bone density, implant length, and implant diameter on insertion torque (IT), primary implant stability quotient (ISQ), and secondary ISQ, 2) the impact of age, gender, bone density, implant length, implant diameter, IT, and ISQ on marginal bone loss (MBL). Materials and methods: Ninety patients who needed implant therapy were enrolled and overall 156 implants were installed to support single crowns. IT and ISQ were recorded for all implants during surgery and ISQ measurements were performed at follow-up visits. Age, gender, bone density, implant length and diameter were also registered. Radiographic evaluation of MBL was performed postoperative immediate (baseline), 3, 6, 9, 12, 18, and 24 months using digital periapical radiographs. Results: Age had little effect on IT and primary ISQ (P > 0.05). Generally, males had higher IT and primary ISQ, but no significant differences between genders were detected. Bone density showed significant effects on IT and primary ISQ. Correlation analysis revealed high positive correlations between IT/bone density and primary ISQ/implant diameter. Significant impacts of bone density and IT on MBL were found. Conclusion: Implant diameter had a more profound impact than length on IT/primary ISQ. Bone density played a considerable role in IT/primary ISQ determination. Bone density and IT had more impacts than primary ISQ on MBL.

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Research regarding bone density assessment using cone beam computed tomography (CBCT) in low bone density regions is sparse. This in vitro study aimed to evaluate the predictability of CBCT for low bone density regions and its correlations with primary implant stability when placing tapered design implants with a stepped osteotomy. Eighteen porcine mandibular condyles were used as simulated low bone density regions. Hounsfield units (HU), obtained via multislice computed tomography, and gray values (GVs), obtained via CBCT, were measured 3 times at 1-month intervals. The maximum implant insertion torque (MIT) and implant stability quotient (ISQ) were recorded as the taper design implants were placed using a stepped osteotomy. Hounsfield units and GV were measured as 335.05–803.07 and 389.98–906.40, respectively. For repeated measurements of HU and GV, the intraclass correlation coefficients were 0.989 and 0.980; the corresponding value for mean HU and GV was 0.768. Bland-Altman plots showed a mean difference between HU and GV of −78.15. Pearson correlation coefficients revealed a strong correlation between HU and GV (r = 0.91, P <.01). The mean ± SD values for MIT and ISQ were 36.44 ± 6.64 Ncm and 80.85 ± 2.03, respectively, but no statistically significant correlations were found with GV and HU. Within the study's limitations, GV showed similar bone density estimation compared with HU in soft bones. Tapered implant placement with a stepped osteotomy achieved stable primary implant stability in soft bones. However, these in vitro results need to be approved in further clinical studies. [ABSTRACT FROM AUTHOR]

Introduction: Quality and quantity of jaw bones have been previously classified in literature using different methods. Imaging modalities such as computed tomography (CT), successfully determine bone density of jaws. This study aims to establish the role of cone-beam CT (CBCT) in determining the density of cortical and cancellous bones at different jaw sites. Materials and Methods: Eighty-three possible implant sites in healthy patients were evaluated using NewTomGiano CBCT machine. Cross-sections were obtained and cortical and cancellous bone densities on different aspects of the virtual implant in terms of Hounsfield unit (HU) were determined using New Net Technologies software version 6.1 and were classified according to software from D1 to D4. Data were entered into SPSS software (version 19.0) and were statistically analyzed. Results: The mean HU showed the highest value for cortical and cancellous in the anterior mandible (mean HU 1874.01 and 1131.73, respectively) followed by the posterior mandible (mean HU 1789.20 and 872.95, respectively) and least in posterior maxilla (mean HU 1068.26 and 830.04, respectively). Maximum D1 bone type was found in cortical bone and D2 bone type was noted in cancellous bone area. Males showed very highly significant cortical bone thickness (P < 0.001) whereas females showed more cancellous bone thickness but the results were nonsignificant. Conclusion: A high degree of concordance between different regions of jaw bones with a strong correlation between the four bone types was obtained. Bone density plays a pivotal role in determining the prognosis of the implant. CBCT has proven to be beneficial in bone density analysis. [ABSTRACT FROM AUTHOR]

Implant stability is crucial for successful osseointegration. Marginal bone level is considered an important indicator of long-term implant success and stability. The purposes of this study were to investigate 1) the effect of age, gender, bone density, implant length, and implant diameter on insertion torque (IT), primary implant stability quotient (ISQ), and secondary ISQ, 2) the impact of age, gender, bone density, implant length, implant diameter, IT, and ISQ on marginal bone loss (MBL). Ninety patients who needed implant therapy were enrolled and overall 156 implants were installed to support single crowns. IT and ISQ were recorded for all implants during surgery and ISQ measurements were performed at follow-up visits. Age, gender, bone density, implant length and diameter were also registered. Radiographic evaluation of MBL was performed postoperative immediate (baseline), 3, 6, 9, 12, 18, and 24 months using digital periapical radiographs. Age had little effect on IT and primary ISQ (P > 0.05). Generally, males had higher IT and primary ISQ, but no significant differences between genders were detected. Bone density showed significant effects on IT and primary ISQ. Correlation analysis revealed high positive correlations between IT/bone density and primary ISQ/implant diameter. Significant impacts of bone density and IT on MBL were found. Implant diameter had a more profound impact than length on IT/primary ISQ. Bone density played a considerable role in IT/primary ISQ determination. Bone density and IT had more impacts than primary ISQ on MBL. [ABSTRACT FROM AUTHOR]

Some evidence supports the influence of implant macro-design on primary stability. Additionally, tactile perception can be used to assess implant stability when placing the implant. This research aimed to quantify the primary and secondary stability of three implant systems with two different macro geometries (cylindrical and conical) determined based on the insertion torque and the implant stability quotient (ISQ) at the moment of implant placement as a function of implant-related factors (length, width, dental arch, and implant location in the arch), intraoperative factors (bone density determined subjectively by the clinician’s tactile perception), and patient-related factors (age, gender, and bone density determined objectively based on cone beam computed tomography (CBCT). Methods: 102 implants from three implant systems with two different macro geometries (conical and cylindrical) were placed in 53 patients. The insertion torque, the ISQ at the implant placement (ISQ0), and the bone quality according to the clinician’s tactile sensation were recorded on the day of the surgery. After a three-month healing period, the ISQ was re-evaluated (ISQ3). Results: The cylindrical implants exhibited significantly higher insertion torque and ISQ values at the moment of the surgery and after three months compared to the conical implants. The cylindrical implants also showed significantly lower indices of tactile evaluation of bone quality during the implant placement surgery. However, no differences were demonstrated in the bone density measured objectively using CBCT. (4) Conclusions: The cylindrical implants achieved the highest values for primary stability (Newtons × centimeter (Ncm) and ISQ) and secondary stability (ISQ after three months). The insertion torque was the variable that most influenced the ISQ on the day of the surgery. The implant location (incisors–canines, bicuspids–molars) and the implant macro geometry were the variables that most influenced the secondary stability (ISQ at three months).

Background: Dental implantology has witnessed substantial progress in recent years, driven by a growing emphasis on optimizing bone regeneration around dental implants. Nanoparticles have emerged as a potential tool for enhancing osseointegration and bone tissue regeneration. Materials and Methods: This human clinical trial enrolled 60 adult participants requiring dental implants. Patients were randomly assigned to one of two groups: a control group receiving conventional dental implants, and an experimental group receiving dental implants with nanoparticle-coated surfaces. Radiographic imaging, histological analysis of bone biopsies, and implant stability assessments were conducted at three and six months post-implantation. Results: Histological examination of bone biopsies revealed a statistically significant increase in new bone formation in the experimental group compared to the control group at both three and six months (P < 0.05). Radiographic assessment demonstrated a 25% higher bone density around nanoparticle-coated implants (P < 0.01) at the six-month mark. Implant stability quotient (ISQ) measurements indicated a 20% greater stability in the experimental group (P < 0.05) at the same time point. Conclusion: This human clinical trial provides strong evidence that the incorporation of nanoparticles on dental implant surfaces enhances bone regeneration and osseointegration in a human population. [ABSTRACT FROM AUTHOR]

Abstract Background The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation. Methods Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months. Results a significant difference in terms of time of surgery (p

Introduction: Implant stability is influenced by bone density, implant design, and site preparation characteristics. Piezoelectric implant site preparation (PISP) has been demonstrated to improve secondary stability compared with conventional drilling techniques. Osseodensification drills (OD) have been recently introduced to enhance both bone density and implant secondary stability. The objective of the present multi‐center prospective randomized controlled trial was to monitor implant stability changes over the first 90 days of healing after implant bed preparation with OD or PISP. Methods: Each patient received two identical, adjacent or contralateral implants in the posterior maxilla. Following randomization, test sites were prepared with OD and control sites with PISP. Resonance frequency analysis was performed immediately after implant placement and after 7, 14, 21, 28, 60, and 90 days. Implants were then restored with single screw‐retained metal‐ceramic crowns and followed for 12 months after loading. Results: Twenty‐seven patients (15 males and 12 females; mean age 63.0 ± 11.8 years) were included in final analysis. Each patient received two identical implants in the posterior maxilla (total = 54 implants). After 1 year of loading, 53 implants were satisfactorily in function (one failure in test group 28 days after placement). Mean peak insertion torque (40.7 ± 12.3 Ncm and 39.5 ± 10.2 Ncm in test and control group, respectively) and mean implant stability quotient (ISQ) value at baseline (71.3 ± 6.9 and 69.3 ± 7.6 in test and control group, respectively) showed no significant differences between the two groups. After an initial slight stability decrease, a shift to increasing ISQ values occurred after 14 days in control group and after 21 days in test group, but with no significant differences in ISQ values between the two groups during the first 90 days of healing. Conclusion: No significant differences in either primary or secondary stability or implant survival rate after 1 year of loading were demonstrated between implants inserted into sites prepared with OD and PISP. [ABSTRACT FROM AUTHOR]

Background: The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation. Methods: Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months. Results: a significant difference in terms of time of surgery (p < 0.005) and in implant stability at 4 months (p = 0.024) on the study side, while a non-statistical significance in terms of bone density was detected (p = 0.468). Conclusion: The piezoelectric implant site drilling protocol seemed to be a reliable and repeatable technique. Despite the limited sample size and lengthier operative time, the piezoelectric inserts enhanced bone quality and implant stability. Clinical trial registration Current Controlled Trials (ClinicalTrials.gov) https://clinicaltrials.gov/ct2/show/NCT05512273; the date of registration: 23/08/2022. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this prospective cohort study was to evaluate primary and secondary implant stability values of implants placed into healed free fibula-reconstructed mandibles. The secondary objective was to investigate whether a correlation existed between primary implant stability and the quantity of cortical bone-implant contact and of cortical fibular bone in contact with the implants. Materials and Methods: The study participants are patients enrolled in a registered trial (No. CTRI/2012/07/002764). Patients with healed segmental mandibular reconstruction by means of free fibula flaps were chosen to undergo implant-supported dental rehabilitation. Preoperatively, computed tomography (CT) scans were used to measure the quality (density) of bone in Hounsfield units (HU). Implant stability quotients (ISQ) were obtained at the time of implant placement (primary), as well as 6 months later (secondary). The amount of cortical bone-to-implant contact (CBIC) was measured from postoperative panoramic radiographs using image analysis software (Image J). A paired t test was used to compare the mean primary and secondary ISQ values. Pearson correlation was used to determine the relationship between primary ISQ and CBIC. Statistical significance was set at the 5% level (P < .05). Results: Of 54 patients (156 implants) who were enrolled, 35 (104 implants) were assessed. The reasons for exclusion were as follows: 11 patients (34 implants) had inadequate preoperative CT documentation, 7 patients (16 implants) had unreadable panoramic radiographs, and 1 patient (2 implants) had partial necrosis of the flap. The mean primary and secondary ISQ values were 78.1 (SD = 4.3) and 77.8 (SD = 4.6), respectively (P = .348). The mean density of cortical fibula bone was 1,344 HU (SD = 93.6). The mean CBIC was 3.7 mm (SD = 1.4). The study results showed a positive correlation between CBIC and implant stability (r = 0.274, P = .005). Conclusion: This study showed no differences in primary and secondary ISQ values of implants placed into the fibula. Implant stability quotients correlated positively with CBIC. [ABSTRACT FROM AUTHOR]

Introduction: There are several factors that greatly influence implant stability with implant design being a paramount factor; however, few studies investigate its impact. Aim: To investigate the implant stability in relation to two different implant designs, a cylindrical shaped single‐threaded design (CS/ST) and a tapered shaped double‐threaded design (TS/DT) using resonance frequency analysis over the first 8 weeks after implantation. Materials and Methods: Twenty‐eight implants were randomly allocated using computer‐generated random numbers into two groups and were placed as single tooth implant in the posterior arch in human jaw as specimens. iCAT™ CBCT scan (Hatfield, PA) was used to determine the bone density according to Misch's Bone classification. The osseotomy sites were prepared and implants were placed with guided surgical template by inexperienced surgeons which were prepared with the same implant planning software (3shape® implant studio). The implant stability was measured using the resonance frequency analysis Osstell® ISQ (Osstell AB, Sweden) on the implant level over the first 8 weeks at three different time intervals. A mean implant stability quotient (ISQ) value was recorded at each measurement time points. The first ISQ of each implant recorded at the time of implant placement were considered as baseline and were the so‐called primary stability. Results: All 28 dental implants were analyzed. A similar pattern of implant stability changes was observed in both implant designs. A significant decreased was found at the first 4 weeks after implantation (p < 0.05) before ascending to maximum cumulative stability by the eighth week (p < 0.05). Between the two groups, TS/DT group had a higher mean ISQ values than that of the CS/ST group at all three observation periods but did not reach statistical significance (p = 0.69). Regarding different types of bone, TS/DT showed a significant difference in mean ISQ values in D4 bone. To date, all 28 implants are in function with no failure/and or complications. Conclusions: The difference in implant design did not significantly influence the implant stability. TS/DT shows superiority over CS/ST when placed in D4 bone and offer a significant advantage due to their positive bounce back of the ISQ values by the eighth week after implant installation. Clinical Trial Registration: TCTR20211020005. [ABSTRACT FROM AUTHOR]

The purpose of this study was to systemically analyse the effects of photobiomodulation therapy (PBMT) on implant stability and postoperative recovery. Electronic searches on MEDLINE (PubMed), Cochrane Library, EMBASE, and Web of Science were completed independently by two researchers in February 2021, and a manual search was performed for the references of the included articles. The primary outcome was implant stability. The secondary outcome was postoperative recovery, including postoperative pain, recovery of peri-implant hard tissue (marginal bone loss and bone mineral density), facial swelling, and peri-implant clinical parameters. Twenty studies were finally obtained (17 randomised controlled, and 3 controlled clinical studies). Meta-analysis revealed that PBMT increased implant stability at 10 days after insertion (MD 2.27, 95% CI: 0.40 to 4.13, P = 0.020), and reduced marginal bone loss at 6 months after insertion (MD −0.16, 95% CI: −0.23 to −0.08, P < 0.001). However, no significant improvements were noted in implant stability two weeks (P = 0.070), three weeks (P = 0.090), six weeks (P = 0.050), and 12 weeks (P = 0.080) after insertion. Qualitative analysis suggested that PBMT could not alleviate postoperative pain, increase bone mineral density, or improve peri-implant clinical parameters. It was effective only in reducing facial swelling. This study suggests that the effects of PBMT on implant stability and postoperative recovery may be limited. [ABSTRACT FROM AUTHOR]

Primary implant stability can be evaluated at the time of placement by measuring the insertion torque (IT). However, another method to monitor implant stability over time is resonance frequency analysis (RFA). Our aim was to examine the effect of bone type, implant design, and implant length on implant primary stability as measured by IT and two RFA devices (Osstell and Penguin) in an in vitro model. Ninety-six implants were inserted by a surgical motor in an artificial bone material, resembling soft and dense bone. Two different implant designs—conical connection (CC) and internal hex (IH), with lengths of 13 and 8 mm, were compared. The results indicate that the primary stability as measured by RFA and IT is significantly increased by the quality of bone (dense bone), and implant length and design, where the influence of dense bone is similar to that of CC design. Both the Osstell and Penguin devices recorded higher primary implant stability for long implants in dense bone, favoring the CC over the IH implant design. The CC implant design may compensate for the low stability expected in soft bone, and dense bone may compensate for short implant length if required by the anatomical bone conditions. [ABSTRACT FROM AUTHOR]

• The high stress concentration, derived from implant can lead to marginal bone loss. • The implant body shape, thread diameter, and profile influence stress transfer. • Primary stability and photoelastic analysis of stress distribution were evaluated. • This work can help the clinicic to select dental implant for different bone condition. This study aimed to evaluate and compare the stress distribution and primary stability of three different designs of dental implants. 24 implants Neodent® were used (n = 8): G1 – Alvim CM; G2 – Drive CM; G3 – Facility, submitted to insertion torque (IT) and pullout test, on 20 PCF (0.24 g/cm3) and 40 PCF (0.64 g/cm3) polyurethane blocks. For the stress distribution, by means of photoelasticity, axial and oblique loads (model at 30° inclination) of 100 N were performed, for reading and quantifying the fringe orders. According to the distribution data, a parametric or non-parametric analysis was performed (α = 0.05). The IT was lower in G3 (p < 0.05) compared to G1 and G2, in 20 and 40 PCF polyurethanes. In the pullout, no difference (p > 0.05) was observed between G1 and G2, in both 20 and 40 PCF polyurethanes. In the comparisons between polyurethanes, higher values (p < 0.05) were obtained in the 40 PCF for IT and pullout. In the axial loading, lower stresses were observed in the cervical third and higher stresses in the middle and apical third of the implants. With the oblique inclination of the models, higher stresses were generated in the opposite side of the load, in the cervical third of G1, followed by G3 and G2. The results allow to affirm that G1 and G2 exhibit high primary stability and satisfactory stress distribution. Although G3 generates stresses comparable to other implants, its indication is limited in low density bones. [ABSTRACT FROM AUTHOR]

Bioceramic tetracalcium phosphate (TTCP) is used as a surface modifier on the implant surface and the clinical studies on this surface modification are still limited. The objective of this clinical study was to investigate short-term implant stability of titanium implant surfaces being modified through sandblasting and acid etching (SLA), followed by TTCP sintered bioceramic anchoring. A total of 20 patients who had single tooth space were included in this study. Surface modification by SLA plus with TTCP on Ti implants with a diameter of 4.0 mm and lengths of 10 and 11.5 mm were placed. Implant stability quotient (ISQ) value was measured immediately (ISQ0) and one month (ISQ1), two months (ISQ2), three months (ISQ3), and four months (ISQ4) after implantation. Subgroup analysis was defined to location (maxilla, mandible) and bone density (soft or hard bone). Statistical analysis was performed using Friedman test and Mann–Whitney U test. The mean ISQ values with standard deviation at the different time points of ISQ0 to ISQ4 were 60.03 ± 14.12, 53.48 ± 15.24, 58.91 ± 14.43, 63.14 ± 12.22, and 63.50 ± 13.61, respectively. The results showed significant differences between the ISQ1 and ISQ3 groups and between the ISQ1 and ISQ4 groups. On the other hand, there was no statistical differences between the maxilla and mandible as well as between soft and hard bone types in all implant groups. TTCP/titanium implant showed favorable stability in short-term ISQ values over 4 months. The locations and bone types demonstrated no effect on implant stability. [ABSTRACT FROM AUTHOR]

The term bone quality is not clearly defined and depends on many factors, such as bone density, bone vascularity, bone metabolism and other factors that may affect implant outcome. The assessment of bone volume and bone density is most common in planning the treatment of dental implants. Bone quality is an important predictor of primary implant stability, which influences the future implant osseointegration. Numerous classifications have been described for the evaluation of bone density. The most commonly used has been the one proposed by Lekholmu and Zarb. For the objective evaluation of bone density, conventional computed tomography (CT) or Cone Beam Computed tomography (CBCT), have been proposed. Both methods are reliable for the measurement of bone density, but preference is given to CBCT, due to the lower radiation doses, greater comfort for the patient and the lower prices. Pre-operatively defined bone density is a good indicator of the future success of implant therapy. In addition to the bone density, vascularity of the jawbone is an important factor of the quality of the bone for the osseointegration of dental implants. Laser Doppler is a simple method that can determine the vascularity of bone during implant insertion. The development of modern diagnostic methods for assessing the quantity and quality of the jawbone has enabled easier implant planning and has provided a secure outcome. [ABSTRACT FROM AUTHOR]

This study compared two modalities, crestal ridge splitting (CRS) and Osseodensification (OD) concerning implant stability, marginal bone level, and bone density. 20 patients were randomly divided into the CRS group (10 patients, 10 implants) and OD Group (10 patients, 10 implants). The CRS was performed using piezoelectric surgery while in the OD group Versah burs were used. Records of Implant stability quotient (ISQ) were obtained immediately after implant insertion and at four and six months. Moreover, marginal bone level and bone density were evaluated via postoperative cone-beam computed tomography (CBCT). Clinically, the OD group showed increased postoperative ISQ scores at all observation intervals (p≤0.001) compared with CRS one. Moreover, postoperative CBCT images of OD participants revealed lower marginal bone loss and higher bone density (p≤0.001). Following implant placement into the narrow alveolar ridge, the osseodensification modality displayed enhanced implant stability, increased bone density, and decreased marginal bone loss compared to the crestal ridge splitting one. [ABSTRACT FROM AUTHOR]

Background: Following free fibula flaps (FFF) reconstruction of mandibular defects the patients need an early dental rehabilitation to regain their masticatory function and enhance their feeding and nutrition. Methods: This study included 10 patients, with mandibular defects previously reconstructed with FFF that span the area between the two mandibular angles. They received a full arch fixed restoration supported by four implants using a pilot drilling guide to perform a flapless operation. The stability of the placed dental implants was assessed along with the changes in bone density. Results: There was a statistically significant increase in stability after 3 and 6 months, and there was a decrease in density after 6 months. The patient satisfaction improved over the follow‐up period. Conclusion: The All‐on‐Four technique is reliable and economic for early functional rehabilitation of resected jaws reconstructed with FFF; however, further studies are needed to investigate the changes in fibula bone density over time and with function. [ABSTRACT FROM AUTHOR]

Successful osseointegration is achieved by the primary and secondary stability of dental implants. The primary stability of any successful dental implant is dependent on the quality and quantity of bone. Besides the experience of the surgeon and bone-implant contact (BIC)at the time of implant placement is equally important. Similarly the high insertion torque helps in obtaining primary stability. Several techniques have been introduced to enhance the bone quality and quantity in an attempt to achieve primary implant stability. One commonly used technique is under preparation of the osteotomy site by use of a drill that is one size small than the implant diameter. However undersized osteotomy compromises the healing between the bone and implant and hampers secondary biological fixation. Osteotomes have also been used in an attempt to increase the bone width buccolingually and improve the peri-implant site bone density. However studies have reported that there was only an increase in bone density at the periapical area with no influence on the lateral margins and primary stability of the implant. The associated trabecular fracture with osteotome bone condensation may further damage the osteocytes and cause extension microfracturesand delayed healing. Finally,the success of implant therapy relies largely on the stability and mechanical durability of the prosthesis delivered to the patient. As such several modifications, reinforcements and techniques have been suggested over the years to optimize the same. The latest in line is the non-subtracting osteotomy by specially designed Densah burs. This article aims to review the theory, advantages and disadvantages of this technique as compared to traditional osteotomy. [ABSTRACT FROM AUTHOR]

This study compared piezoelectric (PE) and conventional drills (CD) for maxillary aesthetic zone implant insertion. This was a prospective split-mouth study. Implants were divided into two groups. Beds were prepared with CDs in group I and PE in group II. The implant stability quotient (ISQ) of the mechanical implant stability (MIS) was measured intraoperatively. The ISQ of the biological implant stability (BIS) was recorded at postoperative second and fourth months. Marginal bone loss (MBL) and bone density (BMD) were measured in the first and second years after prosthetic loading. The osteotomy time was also documented for both techniques. P values <0.05 were considered significant. Sixty implants in 30 patients were included. PE provided a significantly higher ISQ. All values were above 70 throughout the follow-up period. The mean of the ISQ for MIS was 63.78 ± 1.03 and 73.89 ± 1.05 in group I and group II, respectively (p = 0.003). PE needed significantly longer osteotomy time with a mean of 11.99 ± 0.839 min. The BIS quality had high stability in group II and medium stability in group I throughout the study period. Its values decreased in both groups. Group II had a lesser percentage of decrease. However, it was significant only at time intervals between intraoperative and two months' postoperative (p = 0.004). MBL and BMD demonstrated insignificant results. The implant site preparation with PE devices should be preferred to CDs whenever possible, because they seem to enhance implant stability and osseointegration, especially at the initial stages of healing. [ABSTRACT FROM AUTHOR]

Purpose: There is no quantitative gold standard instrumentation to assess the quality of implant osseointegration. The purpose of this exploratory study was to evaluate the response of two devices (one based on resonance frequency analysis, the Osstell device, and another that analyzes the percussion energy response, the Periometer) to assess the primary stability of implants embedded in artificial bone models. Materials and Methods: Standard implants were placed into polyurethane blocks of varying densities, and the two mechanical devices were challenged to test the specimen block series. Both analysis of variance and regression analysis were used to examine the output from each device over each series of specimen blocks as well as to directly compare outputs between the two devices. Results: The stability of the implants increased with the foam density for solid block specimens. Linear regression analysis showed significant correlation between the two instruments for testing with monolithic blocks ( r2 = 0.984). Both devices also indicated that a hybrid block with the greatest density at the top provided the best implant stability versus a hybrid block with relatively low density at the top of the block. However, resonance frequency analysis readings seemed to be more dependent on the density of the top layer of the hybrid blocks. Conclusion: Osstell and Periometer readings were in good agreement for monolithic blocks, and they were reasonably consistent when blocks of hybrid density were tested. [ABSTRACT FROM AUTHOR]

Purpose: Current methods for the evaluation of alveolar bone quality and dental implant stability have been shown to provide inconsistent results. The aim of this investigation was to validate a novel diagnostic device (BoneProbe) for the objective classification of alveolar bone during dental implant surgery. Materials and Methods: A metal cylinder (diameter, 3.5 mm) split into six segments was used as a sensor that could be positioned in implant sockets and expanded while the force needed to expand the site was recorded. Simulating all surgical steps, implants were placed into polyurethane foam materials (n = 100 implants) and human cadaver bone (n = 110 implants). Bone quality (cortical bone thickness, trabecular bone density, drilling resistance, implant insertion torque, compressive testing) and primary implant stability (Osstell, Periotest) were evaluated as reference data. Results: In polyurethane foam, significant correlations between all parameters (Pearson correlation coefficients) and a significant influence of the different polyurethane foam materials on all measurement results (multiple analysis of variance with Pillai trace) were found. In general, in human cadaver bone, weaker correlations between the different measurement techniques were seen (Pearson product-moment correlation). With the exception of compressive testing and radiographic assessment of trabecular bone density, all methods were able to differentiate between mandibular and maxillary bone. Conclusions: Based on these in vitro results, it appears that intraoperative testing of alveolar bone allows for a reproducible classification of bone quality. Because the proposed system is independent of any specific implant design, this device could be used for establishing a universally valid bone classification system. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of implant geometry on primary stability and on peri-implant bone loss in an in vitro model using the Periotest and Osstell devices. Materials and Methods: Screw-type implants of various diameters and lengths were inserted into bovine bone blocks of different densities, and the primary insertion stability was recorded. To study the influence of implant geometry on implant stability with different levels of peri-implant bone loss, implants were inserted into acrylic resin blocks to mimic osseointegration, and different amounts of the peri-implant acrylic resin were removed. Measurements with both devices at each millimeter step yielded the threshold for the least detectable attachment loss. Results: The predominant factors influencing implant stability were bone quality and attachment loss. Implant type and length exerted some influence on implant stability values, while variations in implant diameter produced only minor alterations in the measurements. In simulations of peri-implant attachment loss, implant stability decreased more dramatically for the shorter and narrower implants. The inclusion of more variables in the analyses resulted in less focused measurements. Conclusions: The results of this study clearly show that the outcome of implant stability assessment depends on environmental factors such as bone quality and implant geometry. While the authors do not recommend the use of the Periotest or Osstell devices for a comparison of the stability of two individual implants, both should be useful to monitor the state of an individual implant over time. [ABSTRACT FROM AUTHOR]

One of the most important factors that affect osseointegration is the primary stability of the implant. Dental implants inserted at the posterior region of the maxilla exhibit the lowest success rates as the low density bone in this area often jeopardize rigid fixation of the implant. Many surgical techniques have been developed to increase the primary stability of an implant placed in low density bone, such as bicortical fixation of the implant, undersized preparation of the implant bed and bone condensation by the use of osteotomes. A new promising technique, named osseodensification, has been recently developed that creates an autograft layer of condensed bone at the periphery of the implant bed by the aid of specially designed burs rotating in a clockwise and anti-clockwise direction. The purpose of this review is to emphasize that implant primary stability is strongly influenced by the surgical technique, to quote and briefly analyse the various surgical procedures laying weight to osseodensification procedure.

Fifteen consecutive patients aged from 18 to 60 years, considered eligible after clinical and radiographic evaluation, were allocated in 2 groups (flapped and flapless) that underwent delayed implant placement protocol with SLActive and measurement of stability (ISQ) by the Ossetll device. Marginal bone loss (MBL) was estimated by cone beam computed tomography (CBCT) during three different periods of time. The mean values of implant stability and marginal bone level significantly decreased after 8 weeks, while ISQ and MBL significantly increased or remained unchanged after 24 weeks, compared with baseline data. Apart from one patient, who suffered from transient numbness following surgery, spontaneously and completely resolved 3 weeks later, no serious complications were reported throughout the study. These results demonstrated that ISQ and MBL were affected by many factors (age of the patient, bone density at the recipient site and functional implant zone where the traumatic and ischemic zones were highly affected during the 2nd and 3rd follow-up appointments, respectively). [ABSTRACT FROM AUTHOR]

The use of osteotomes as a technique for densification and expansion of the residual ridge is one of the most widely used procedures to achieve adequate peri-implant bone quantity and density. The aim of this study was to evaluate the influence of time and the elastic deformation of peri-implant bone in the primary stability of implants placed using osteotomes. In each of 10 fresh fragments of cow rib, two implants were placed using osteotomes. The insertion torque and initial implant stability quotient (ISQ) values were measured. In the control implants, the immediate removal torque was measured, while in the test implants, after 15 min of placement, ISQ values were measured again, and the removal torque was measured. There were significant differences between the ISQ values and between the insertion torque and removal torque at 15 min. The ISQ values (perpendicular/parallel) increased between the initial moment (64.4 ± 9/70.3 ± 5.9) and 15 min (66/71.4 ± 6.4). The removal torque at 15 min (12.4 ± 5.8) was lower than the insertion torque (15.9 ± 5.9). Compression of the trabeculae in contact with the implant placed using osteotomes was observed, as well as a greater number of trabecular fractures in the implants placed using conventional drilling. There is an increase in ISQ values of dental implants placed using osteotomes after 15 min of placement. [ABSTRACT FROM AUTHOR]

Background: The implant design and the surgical technique are important parameters that can be modified to improve the implant primary stability. The aim of this study was to evaluate the role of the apical part of an implant on the implant stability of implants placed in Type II dense bone by novice and experienced clinicians.Methods: Implants with a progressive thread design (3.5 mm diameter, 11 mm length) were used. A total of 80 osteotomies were prepared in dense bone samples (quality Type II) by two clinicians with different levels of experience (novice and experienced) under the same surgical protocol. Two experimental groups were prepared. In the test group (apical stability), 40 implants were inserted with only 3 mm of the apical portion of the implant within the bone and without lateral contact between the residual implant length and the osteotomy walls. In the control group (full implant stability), 40 implants were inserted with full contact between the osteotomy walls and the implant surface. The stability of both groups (test and control) was evaluated using a resonance frequency analysis (RFA) (implant stability quotient [ISQ] values). Statistical comparisons between the groups were performed using the Kruskal-Wallis test with Dunn post-test for multiple comparisons.Results: The results did not show statistically significant differences (P > 0.05) in terms of primary stability between implants placed by novice or experienced clinicians in dense bone. The control group showed significantly higher ISQ values compared with the test group (P < 0.001). The apical implant stability contributed to ≈ 30% and 43% of the entire implant stability for novice and experienced clinicians, respectively.Conclusions: The apical portion of an implant plays a fundamental role in the entire implant stability and is independent on the clinician's experience. However, precise implant site preparation to guarantee apical implant anchorage is recommended. [ABSTRACT FROM AUTHOR]

Background: There are no studies that have assessed the implant stability quotient (ISQ) values of narrow diameter implants placed in artificial dense bone blocks at varying drilling speeds (DSs). Purpose: The aim of the present in vitro experiment was to compare the performance of OSSTELL and Penguin devices to evaluate implant stability at DSs of 800 and 2000 rpm. Materials and Methods: A total of 360 osteotomies were created in dense artificial bone blocks at DSs of 800 and 2000 rpm. Dental implants from three manufacturers (group‐1: NobelActive implants, Nobel Biocare, Yorba Linda, California; group‐2: Zimmer, Eztetic‐Zimmer implants, Zimmer Biomet Dental, Palm Beach Gardens, Florida; and group‐3: Astra Tech implant system, Dentsply Sirona, York, Pennsylvania) were randomly placed in these osteotomies using an insertion torque of 15 Ncm (60 implants/group). Implant stability in all bone blocks immediately following implant placement was evaluated using the OSSTELL and Penguin devices. ISQ values were presented as means ± SD. Statistical significance was set at P < .05. Results: There was no significant difference in the ISQ values obtained from the OSSTELL and Penguin devices for implants in groups 1, 2, and 3. There was no significant difference when ISQ values obtained from the OSSTELL device were compared with the Penguin device for narrow diameter dental implants placed in dense bone blocks with osteotomies performed at 800 and 2000 rpm. ISQ values showed statistically significant higher values for OSSTELL compared to Penguin device. Conclusion: The OSSTELL and Penguin devices are reliable for the assessment of implant stability in dense artificial bone. Implant design and site‐DS does not seem to have a significant impact of implant stability in artificial dense bone blocks. [ABSTRACT FROM AUTHOR]

Introduction: Osseodensification is a technique that aims at bone preservation and compaction either through nonsubtractive drilling or implants with a special thread design. This can increase quantity and density of periimplant bone. This review represents a summary and a critical appraisal of the studies regarding osseodensification in the literature. Materials and Methods: Three databases were searched: PubMed (MEDLINE), Cochrane Library, and Latin American and Caribbean center on health sciences information (LILACS). Studies were screened by title/abstract according to predetermined eligibility criteria. Full texts of 7 eligible articles were read among which 2 were excluded and 5 articles were included and underwent qualitative synthesis. Discussion: Studies advocating osseodensification are sparse and mainly animal studies of low evidence level. High risk of bias and low correlation between used animal models and human bone were detected in most of the studies. Conclusion: Although osseodensification seems to be a very promising technique, the findings are inconclusive and should be cautiously interpreted. Well-designed animal and human studies of longer follow-up periods are required before implementing such technique in regular daily practice. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective chart review study assessed patient records to determine implant insertion torque (IT) and implant stability quotient (ISQ) values during implant placement to evaluate the correlation with cortical bone anchorage (mono- or bicortical).Methods: Primary stability data (IT during implant placement surgery and ISQ values immediately after implant placement) and cone beam computed tomography of 33 patients (165 implants) were assessed. Patients were divided into the following groups: G1, implants with apical cortical bone contact; G2, implants with bicortical bone contact (apical and cervical regions); and G3, implants with cervical cortical bone contact.Results: Sixty-eight implants were excluded due to cortical bone contact on regions other than implant apical or cervical. Ninety-seven implants were therefore assessed for this study. No implant failure was found after a mean 70.42-month follow-up time. Implants with bicortical anchorage (G2) showed higher IT (64.1 Ncm) during implant placement and higher ISQ values (76) (p < 0.05). Monocortical implants (G1, apical, and G3, cervical) showed similar IT (G1 52.3 and G3 54.3) and ISQ values (G1 71.9 and G3 73) (p > 0.05). No correlation (Pearson correlation coefficient) was found between the two stability measurement devices for the different cortical bone anchorages that were analyzed (G1 0.190, G2 0.039, and G3 − 0.027) (p > 0.05).Conclusions: Insertion torque values and implant stability quotients were influenced by cortical bone contact. No significant correlation was found between IT and ISQ values—higher insertion torque values do not necessarily lead to higher implant stability quotients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Micro‐CT is a high‐resolution, non‐invasive, and non‐destructive imaging technique, currently acknowledged as a gold standard modality for assessing quantitatively and objectively dental morphology and bone microarchitecture parameters. Purpose: The aim of this study was to analyze critical dental and periodontal measurements characterizing the mandibular (MandFM) and maxillary (MaxFM) first molar architecture, as well as the corresponding bony socket, using micro‐CT. Materials and Methods: Thirty‐eight human dried skulls (22‐76 years) were scanned to enable the virtual analysis of 61 first molars. Depending on the type of measurement, the parameters were recorded on two‐dimensional sections or directly on three‐dimensional models. Tooth morphology was described by four aspects (e.g., tooth width, trunk length, root length, and root span), while the socket architecture was assessed by buccal plate thicknesses and bone density measurements. Results: Minimum, maximum, and mean distances as well as cortical and trabecular bone densities were recorded in MandFM and MaxFM. It is noteworthy that the buccal plate thickness was found to be less than 1 mm in more than 55% of cases in MaxFM, whereas only in 20.8% of cases in MandFM (and even 0% at two sites). A wide range of bone densities was observed and the comparison between MandFM and MaxFM did not show a significant difference. Furthermore, cortical densities were negatively correlated with aging, while trabecular densities were not influenced. Conclusions: Using micro‐CT, three‐dimensional aspects of the human first molar morphology and microstructural parameters of the surrounding bone were evaluated in the mandible and in the maxilla. These comprehensive measurements and their correlation with aging may be of great importance for the use of immediate implant placement in molar extraction sockets and thus the potential long‐term success of this treatment modality. [ABSTRACT FROM AUTHOR]

Previous results on synthetic blocks mimicking bone indicate that bone density can be measured by the friction encountered by a rotating probe while it descends into bone, and that primary implant stability may be measured through the integral (I) of the torque−depth curve at implant insertion. This study aims to repeat those tests on collagen-preserving equine bone blocks as they better reproduce the mechanical properties of natural bone. Fifteen cancellous equine blocks had their density measured using a measuring probe. This was compared to their known physical density through linear regression analysis. Implant placement was carried out into six cancellous equine blocks and primary stability was measured using (I), as well as the insertion torque (IT), the implant stability quotient (ISQ), and the reverse torque (RT). The relation between (I), (IT), (ISQ), and (RT) was investigated by correlation analysis. Bone density measured using the probe correlated significantly with actual density, both with (r = 0.764) and without irrigation (r = 0.977). (I) correlated significantly with IT and RT under all irrigation conditions, and with ISQ only without irrigation (r = 0.886). The results suggest that the probe provides actual bone density measurements. They also indicate that (I) measures primary implant stability and is more sensitive to density variations than IT, RT, and ISQ. Results are consistent with those obtained on synthetic blocks but suggest that equine bone blocks may better reproduce the mechanical properties of human cancellous alveolar bone. This should be the subject of additional studies.

Low-level laser therapy (LLLT) is a non-invasive modality to promote osteoblastic activity and tissue healing. The aim of this study was to evaluate the efficacy of LLLT for improvement of dental implant stability. This randomized controlled clinical trial was performed on 80 dental implants placed in 19 patients. Implants were randomly divided into two groups (n = 40). Seven sessions of LLLT (940 nm diode laser) were scheduled for the test group implants during 2 weeks. Laser was irradiated to the buccal and palatal sides. The same procedure was performed for the control group implants with laser hand piece in "off" mode. Implant stability was measured by Osstell Mentor device in implant stability quotient (ISQ) value immediately after surgery and 10 days and 3, 6, and 12 weeks later. Repeated measures ANOVA was used to compare the mean ISQ values (implant stability) in the test and control groups. Statistical test revealed no significant difference in the mean values of implant stability between the test and control groups over time (P = 0.557). Although the mean values of implant stability changed significantly in both groups over time (P < 0.05). Although the trend of reduction in stability was slower in the laser group in the first weeks and increased from the 6th to 12th week, LLLT had no significant effect on dental implant stability. [ABSTRACT FROM AUTHOR]

For achieving successful osseointegration, primary stability of implant is most important factor. Sufficient bone bulk and density at the implant site in order to achieve good bone-to-implant contact and primary stability are crucial for osseointegration. This novel technique would increase primary implant stability, bone mineral density, and the percentage of bone at the implant surface compared with drilling technique. It is primarily creating an autograft layer of condensed bone at the periphery of the implant bed by the aid of specially designed burs rotating in a clockwise and anti-clockwise direction. This procedure has also shown improvement in achieving better implant primary stability and better osteotomy than conventional implant drills. [ABSTRACT FROM AUTHOR]