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Gottlow J, Sennerby L. Influence of diameter and length on primary stability in various implant site densities-An in vitro study in polyurethane blocks. Clin Implant Dent Relat Res 2024; 26:327-332. [PMID: 37926940 DOI: 10.1111/cid.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The influence of dental implant length and diameter on primary stability in various bone densities is not well understood. AIM To in vitro study the effect of length and diameter on resonance frequency analysis (RFA), insertion torque (IT) and displacement (DP) measurements of dental implants in different implant site densities. MATERIALS AND METHODS Dental implants of four different diameters (Ø 3.5, 4.0, 4.5 and 5.0 mm) and three different lengths (7, 11 and 15 mm) (Neoss Ltd, Harrogate, UK) were placed in polyurethane blocks of three different densities (Sawbones Europe AB, Malmö, Sweden). The primary stability was assessed by RFA (ISQ) (Osstell, Osstell AB, Gothenburg, Sweden) and insertion torque measurements (ITmax in N cm) (iChiropo™, Bien-Air Dental SA, Bienne, Switzerland). In addition, the blocks were mounted in a rig and a lateral force of 25 N cm was applied to the implants and the DP was measured in μm with a micrometer gauge placed on the opposite side of the load transducer. Statistical analyses using linear and quadratic models were applied. RESULTS Implant length, diameter and block density were found to be significant independent predictors of RFA, ITmax, and DP measurements. Implant length had a strong effect, while the effect of diameter in general was subtle, particularly in the softest block. CONCLUSIONS Implant length affects primary stability more than implant diameter in polyurethane blocks of uniform density along the whole length of the tested implants.
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Affiliation(s)
- Johan Gottlow
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Sennerby
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lee SH, Yun PY, Yi YJ, Kim YK, Lee HJ, Jo DW. Low Bone Density Predictability of CBCT and Its Relation to Primary Stability of Tapered Implant Design: A Pilot Study. J ORAL IMPLANTOL 2023; 49:556-563. [PMID: 35881816 DOI: 10.1563/aaid-joi-d-21-00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Pil-Young Yun
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yang-Jin Yi
- Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Deuk-Won Jo
- Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Sapoznikov L, Haim D, Zavan B, Scortecci G, Humphrey MF. A novel porcine dentin-derived bone graft material provides effective site stability for implant placement after tooth extraction: a randomized controlled clinical trial. Clin Oral Investig 2023; 27:2899-2911. [PMID: 36826514 PMCID: PMC10264522 DOI: 10.1007/s00784-023-04888-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Assessment of the clinical performance of a porcine dentin-derived particulate bone graft material for bone regeneration after tooth extraction with implant placement at 4 months, in comparison to a commercially available porcine bone-derived graft. MATERIAL AND METHODS This study was a randomized, parallel-group, semi-double-blinded clinical trial evaluating the clinical safety, tolerability, and performance of Ivory Dentin Graft™ in comparison with a commercial bone-derived material in alveolar ridge preservation following tooth extraction (registered at ClinicalTrials.gov, May 12th, 2017, Identifier NCT03150472). Extraction sites were grafted with test or comparator material and a titanium implant placed at 4 months after taking a graft site biopsy. Primary endpoints were the extent of new bone growth and bone-graft integration at 4 months. RESULTS The dentin graft material had statistically significantly more new bone formation (60.75% vs 42.81%, p = 0.0084, N = 20 vs 16), better bone-graft integration scores (good integration in 85% vs 40%, p = 0.0066), and higher mean radiodensity of the bone (981.5HU vs 727.7HU, p = 0.0011) at the graft site compared to the bone-derived material. The mean implant insertion torque force was similar for the dentin and bone materials (34.75 Ncm vs 34.06 Ncm). Titanium implant placement was successful in 95% of patients with the dentin graft material compared to 81.25% for the bone graft. Both materials had similar clinical safety and tolerability as determined by adverse events and local site reactions. Physician-assessed ease of grafting and ease of implant placement on a 10-point scale showed no statistical differences (8.78 vs 8.27, p = 0.2355; 8.05 vs 8.75, p = 0.1118, respectively). CONCLUSIONS A porcine dentin-derived bone graft material has clinical safety, tolerability, and performance for implant placement at 4 months after tooth extraction at least as good as a commercial bone-derived material. CLINICAL RELEVANCE The availability of porcine dentin-derived bone graft material allows wider use of dentin-derived material which has so far only been available in the form of autologous dentin from the patient's own teeth.
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Affiliation(s)
| | - Doron Haim
- Shamir Medical Center, 70300, Zerifin, Israel
| | - Barbara Zavan
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Gérard Scortecci
- Basal Implantology Program, Department of Maxillo-Facial Surgery, School of Medicine, University Côte d'Azur, 06000, Nice, France
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Mehta S, Rohinikumar S, Rajendra Prabhu A, Nesappan T, Veeraraghavan VP, Eswaramoorthy R. Correlation between CT - derived bone density and optimal bone densities acquired from CBCT scans. Bioinformation 2023; 19:495-498. [PMID: 37822826 PMCID: PMC10563580 DOI: 10.6026/97320630019495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/30/2023] [Accepted: 04/30/2023] [Indexed: 10/13/2023] Open
Abstract
It is of interest to explore the correlation between preoperative bone density, assessed via CBCTT, and primary stability of dental implants, assessed by torque ratchet. A total of 100 patients who had implant placed were taken a sample for this retrospective study. The Hounsfield units (HU) derived preoperative bone densities at implant sites that were acquired with the help of the CBCT and the primary stability was achieved during the day of surgery. Both were compared to optimum bone densities. Statistical correlation was done between the HU and Bone density. Data suggests that evaluating HU values, along with other parameters, before performing implant surgery could lead to better primary implant stability.
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Affiliation(s)
- Saumya Mehta
- Department of Implantology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India
| | - Subhashree Rohinikumar
- Department of Implantology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India
| | - Abhinav Rajendra Prabhu
- Department of Implantology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India
| | - Thiyaneswaran Nesappan
- Department of Implantology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India
| | - Vishnu Priya Veeraraghavan
- Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India
| | - Rajalakshmanan Eswaramoorthy
- Department of Biomaterials, Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Medical and Technical Sciences, Saveetha University, Chennai 600077, India
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Heitzer M, Kniha K, Katz MS, Winnand P, Peters F, Möhlhenrich SC, Hölzle F, Modabber A. The primary stability of two dental implant systems in low-density bone. Int J Oral Maxillofac Surg 2022; 51:1093-1100. [PMID: 35339332 DOI: 10.1016/j.ijom.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
Primary stability in low-density bone is crucial for the long-term success of implants. Tapered implants have shown particularly favourable properties under such conditions. The aim of this study was to compare the primary stability of tapered titanium and novel cylindrical zirconia dental implant systems in low-density bone. Fifty implants (25 tapered, 25 cylindrical) were placed in the anterior maxillary bone of cadavers meeting the criteria of low-density bone. The maximum insertion (ITV) and removal (RTV) torque values were recorded, and the implant stability quotients (ISQ) determined. To establish the isolated influence of cancellous bone on primary stability, the implantation procedure was performed in standardized low-density polyurethane foam bone blocks (cancellous bone model) using the same procedure. The primary stability parameters of both implant types showed significant positive correlations with bone density (Hounsfield units) and cortical thickness. In the cadaver, the cylindrical zirconia implants showed a significantly higher mean ISQ when compared to the tapered titanium implants (50.58 vs 37.26; P < 0.001). Pearson analysis showed significant positive correlations between ITV and ISQ (P = 0.016) and between RTV and ISQ (P = 0.035) for the cylindrical zirconia implants; no such correlations were observed for the tapered titanium implants. Within the limitations of this study, the results indicate that cylindrical zirconia implants represent a comparable viable treatment option to tapered titanium implants in terms of primary implant stability in low-density human bone.
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Affiliation(s)
- M Heitzer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - K Kniha
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - M S Katz
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - P Winnand
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Peters
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S C Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
| | - F Hölzle
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Modabber
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Tripathi T, Singh N, Bhutiani N, Rai P. Rehabilitation using dental implants following closure of large alveolar cleft defect by HYDIS-TB appliance: One-year follow-up. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Effect of Bone Density Measured by Cone Beam Computed Tomography and Implant Dimensions on the Stability of Dental Implants. J Craniofac Surg 2021; 33:e553-e557. [PMID: 34930876 DOI: 10.1097/scs.0000000000008429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT The aim of this study was to evaluate the effect of bone density value in Hounsfield unit derived from cone beam computed tomography (CBCT), and implant dimensions in relation to implant stability parameters namely the resonance frequency analysis and the insertion torque (IT) value. It included 24 patients who received 42 dental implants (DI). The bone density of the planned implant site was preoperatively measured using cone beam computed tomography. The implant stability was measured using Osstell implant stability quotient (ISQ). The ISQ values were recorded immediately postoperatively and after 16 weeks. The IT value was categorized as 35 N/cm or > 35 N/cm. The mean (standard deviation) primary stability was 79.58 (5.27) ISQ, which was significantly higher than the secondary stability 74.31 (6.34) ISQ (P < 0.0001). There was a significant moderate positive correlation of bone density with primary stability (r = 0.4, P = 0.0099) and no correlation with secondary stability (r = 0.003, P = 0.9867). The bone density of DI with 35 N/cm IT was significantly lower than with > 35 N/cm IT (P = 0.0390). Better stability was recorded with wider implants. Whereas the length of the DI showed a nonsignificant correlation with primary and secondary stability (P = 0.7633 and 0.4670, respectively). The DI dimensions showed a nonsignificant correlation with the IT. Cone beam computed tomography may be considered as a reliable method to assess bone density and predict the implant stability. The diameter of DI affected the implant stability favorably, whereas DI length showed no effect.
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8
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Gehrke SA, Scarano A, de Lima JHC, Bianchini MA, Dedavid BA, De Aza PN. Effects of the Healing Chambers in Implant Macrogeometry Design in a Low-Density Bone Using Conventional and Undersized Drilling. J Int Soc Prev Community Dent 2021; 11:437-447. [PMID: 34430506 PMCID: PMC8352059 DOI: 10.4103/jispcd.jispcd_96_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
Background: The ideal installation technique or implant macrogeometry for obtaining an adequate osseointegration in low-density bone tissue follows a challenge in the implantology. Aims and Objective: The aim of the present study was to evaluate the behavior of three osteotomy techniques and two implant macrogeometries in two low-density polyurethane blocks. The insertion torque (IT), initial stability, pullout resistance, and weight of the residual bone material deposited on the implants were assessed. Materials and Methods: A total of 120 implants with two different macrogeometries were used. They were divided into six groups according to the implant macrogeometry and the drilling technique performed (n = 20 implants per group). The implants were installed in polyurethane blocks with pounds per cubic foot (PCF) 10 and PCF 20 densities. The IT, initial stability, pullout resistance, and weight residual bone were measured. Results: Differences were found in the values referring to the macrogeometry of the implants and the type of osteotomy performed. In all groups, the initial stability of the PCF 10 blocks was quite low. The undersized osteotomies significantly increased the values measured in all tests in the PCF 20 density blocks. Conclusions: In conclusion, even when a modified (undersized) osteotomy technique is used, implants inserted in low-quality bone (type IV) can present problems for osseointegration due their low initial stability and bone resistance. However, the modification in the implant macrogeometry (with healing chambers) presented more quantity of bone on the surface after the pullout test.
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Affiliation(s)
- Sergio A Gehrke
- Department of Research, Biotecnos, Montevideo, Uruguay.,Department of Biotechnology, Universidad Católica de Murcia, Murcia, Spain.,Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
| | - Antônio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - José H C de Lima
- Department of Rehabilitation, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Marco A Bianchini
- Post-Graduate Program in Implant Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Berenice A Dedavid
- Department of Materials Engineering, Pontificia Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Piedad N De Aza
- Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
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Can the Bone Density Estimated by CBCT Predict the Primary Stability of Dental Implants? A New Measurement Protocol. J Craniofac Surg 2021; 32:e171-e174. [PMID: 33705063 DOI: 10.1097/scs.0000000000006991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of dental implants to restore edentulous parts of the jaws is a common and well-documented treatment method. Effective dental implant treatment is known to be affected by both the quality and the quantity of bone required for implant placement, bone quality is a critical factor to consider when predicting stability of implants. Thus, stability of the initial implant and the possibility of early loading could be predicated using cone-beam computed tomography (CBCT) scans and primary stability parameters before implant placement. OBJECTIVES The aim of this study was to objectively assess bone density obtained by CBCT and the correlations with primary stability of dental implants using implant stability meter IST device. METHODS A total of 40 implants were placed in 16 patients (9 males and 7 females with a range of 22 to 61 years (mean age 40.44 ± 12.3 years). The bone densities of implant recipient sites were preoperatively recorded using CBCT. The maximum insertion torque value of each implant was measured by engine during implant placement and compared to the primary stability for every implant using implant stability meter device (IST). RESULTS A statistically significant correlation was found between bone density value from CBCT with the primary implant stability and insertion torque. CONCLUSION Although the small samples size, the study shown bone density assessment using CBCT is an efficient method and significantly correlated with primary stability using implant stability meter device IST and insertion torque.
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Costa ALF, de Souza Carreira B, Fardim KAC, Nussi AD, da Silva Lima VC, Miguel MMV, Jardini MAN, Santamaria MP, de Castro Lopes SLP. Texture analysis of cone beam computed tomography images reveals dental implant stability. Int J Oral Maxillofac Surg 2021; 50:1609-1616. [PMID: 33962826 DOI: 10.1016/j.ijom.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/10/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
The aim of this study was to characterize the alveolar bone of edentulous maxillary sites using texture analysis (TA) of cone beam computed tomography (CBCT) images and to correlate the results to the insertion torque, thus verifying whether TA is a predictive tool of final implant treatment. This study was conducted on patients who had received single implants in the maxilla (46 implants) 1year earlier and whose torque values were properly recorded. Three cross-sections of the sites were selected on CBCT scans. Two regions of interest (ROIs) corresponding to the implant bone site and peri-implant bone were also outlined, according to virtual planning. The CBCT scans were exported to MaZda software, where the two ROIs were delimited following the previously demarcated contours. Values for the co-occurrence matrix were calculated for TA. With regard to the insertion torque value, there was a direct correlation with the contrast of the peri-implant bone (P<0.001) and an inverse correlation with the entropy of the implant bone site (P=0.006). A greater contrast indicates a greater torque value for insertion of the implants, and there is a possible association with a lower entropy value of the implant-bone interface.
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Affiliation(s)
- A L F Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, Brazil.
| | - B de Souza Carreira
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - K A C Fardim
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - A D Nussi
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, Brazil
| | - V C da Silva Lima
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - M M V Miguel
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - M A N Jardini
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - M P Santamaria
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - S L P de Castro Lopes
- Department of Diagnosis and Surgery, São José dos Campos School of Dentistry, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
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Morphological Evaluation of Bone by CT to Determine Primary Stability-Clinical Study. MATERIALS 2020; 13:ma13112605. [PMID: 32521622 PMCID: PMC7321591 DOI: 10.3390/ma13112605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022]
Abstract
Background: Primary stability is an important prognostic factor for dental implant therapy. In the present study, we evaluate the relationship between implant stability evaluation findings by the use of an implant stability quotient (ISQ), an index for primary stability, and a morphological evaluation of bone by preoperative computed tomography (CT). Subjects and methods: We analyzed 98 patients who underwent implant placement surgery in this retrospective study. For all 247 implants, the correlations of the ISQ value with cortical bone thickness, cortical bone CT value, cancellous bone CT value, insertion torque value, implant diameter, and implant length were examined. Results: 1. Factors affecting ISQ values in all cases: It was revealed that there were significant associations between the cortical bone thickness and cancellous bone CT values with ISQ by multiple regression analysis. 2. It was revealed that there was a significant correlation between cortical bone thickness and cancellous bone CT values with ISQ by multiple regression analysis in the upper jaw. 3. It was indicated that there was a significant association between cortical bone thickness and implant diameter with ISQ by multiple regression analysis in the lower jaw. Conclusion: We concluded that analysis of the correlation of the ISQ value with cortical bone thickness and values obtained in preoperative CT imaging were useful preoperative evaluations for obtaining implant stability.
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Chmielewski K, Ryncarz W, Yüksel O, Goncalves P, Baek KW, Cok S, Dard M. Image analysis of immediate full-arch prosthetic rehabilitations guided by a digital workflow: assessment of the discrepancy between planning and execution. Int J Implant Dent 2019; 5:26. [PMID: 31304566 PMCID: PMC6626765 DOI: 10.1186/s40729-019-0179-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/17/2019] [Indexed: 11/18/2022] Open
Abstract
Background A dentition with adequate function and esthetics is essential for the well-being and quality of life. A full implant-retained fixed prosthetics is an ideal solution for fully edentulous arch, however requires complex planning, surgical, and prosthetic procedure. With the help of digital workflow, it becomes a predictable and fast solution for the dentists and the patients. This retrospective study analyzed the most advanced surgical approach in full-arch rehabilitation with dental implants and immediate loading using digital workflow. Methods Patient records of fully edentulous jaws treated in four clinical centers in Warsaw, Poland, were evaluated. Computer-assisted planning and surgical template fabrication were done using the planning software coDiagnostiX™, based on a pre-op cone beam computed tomography (CBCT) and scanned data of a plaster model. A post-op CBCT was acquired after the placement of four to six implants by the guided system. The influence of different surgical variables on the discrepancy between planning and execution was analyzed, together with the biomechanical indices. Results A total of nine patient records were selected of 12 edentulous jaws treated with 62 implants. The overall mean three-dimensional (3D) offset at the implant base was 1.60 mm, at the tip 1.86 mm. The mean angle of deviation was 4.89°, the mean implant stability quotient (ISQ) 70.42, and the insertion torque 35.58 Ncm. The 3D offsets were influenced by the gender of the patient, treated jaw, the diameter, and length of the implant. The angle of deviation was affected only by the treated jaw. Insertion torque was influenced by the treated jaw, the age of the patient, the length of the implant, tooth type, and the side of the jaw. Discussion Bone quality of the patient and implant preparation procedure influenced the discrepancy between the planning and the execution of the digitally guided implant placement. Dense bone—mandible, posterior area, young age, and man—and multiple preparations of the implant bed—wider and longer implant—could be suggested as risk factors. Conclusion Digital workflow successfully enabled the immediate full-arch rehabilitation with a predictable outcome by different surgeons in multiple centers.
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Affiliation(s)
- Krzysztof Chmielewski
- SmileClinic Advanced Implant Center - Klinika Stomatologii Estetycznej i Implantologii, ul. Karola Szymanowskiego 2, 80-280, Gdańsk, Poland
| | - Wojciech Ryncarz
- Stomatologia estetyczna implantologia - Klinika Proimplant, ul. Cecylii Śniegockiej 8, 00-430, Warszawa, Poland
| | - Orcan Yüksel
- YÜKSEL
- GIESENHAGEN Dentale Implantologie, Bockenheimer Landstr. 92, 60323, Frankfurt, Germany
| | - Pedro Goncalves
- Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland
| | - Kyung-Won Baek
- Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland.
| | - Susy Cok
- Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland
| | - Michel Dard
- Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland.,Oral, Diagnosis and Rehabilitation Sciences, College of Dental Medicine, Columbia University, 622 W. 168th St., New York, NY, 10032, USA
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Sargolzaie N, Samizade S, Arab H, Ghanbari H, Khodadadifard L, Khajavi A. The evaluation of implant stability measured by resonance frequency analysis in different bone types. J Korean Assoc Oral Maxillofac Surg 2019; 45:29-33. [PMID: 30847294 PMCID: PMC6400699 DOI: 10.5125/jkaoms.2019.45.1.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives Bone density seems to be an important factor affecting implant stability. The relationship between bone density and primary and secondary stability remains under debate. The aim of this study was to compare primary and secondary stability measured by resonance frequency analysis (RFA) between different bone types and to compare implant stability at different time points during 3 months of follow-up. Materials and Methods Our study included 65 implants (BioHorizons Implant Systems) with 3.8 or 4.6 mm diameter and 9 or 10.5 mm length in 59 patients. Bone quality was assessed by Lekholm-Zarb classification. After implant insertion, stability was measured by an Osstell device using RFA at three follow-up visits (immediately, 1 month, and 3 months after implant insertion). ANOVA test was used to compare primary and secondary stability between different bone types and between the three time points for each density type. Results There were 9 patients in type I, 18 patients in type II, 20 patients in type III, and 12 patients in type IV. Three implants failed, 1 in type I and 2 in type IV. Stability values decreased in the first month but increased during the following two months in all bone types. Statistical analysis showed no significant difference between RFA values of different bone types at each follow-up or between stability values of each bone type at different time points. Conclusion According to our results, implant stability was not affected by bone density. It is difficult to reach a certain conclusion about the effect of bone density on implant stability as stability is affected by numerous factors.
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Affiliation(s)
- Naser Sargolzaie
- Department of Periodontics, College of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Sarah Samizade
- Department of Periodontics, College of Dentistry, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Hamidreza Arab
- Department of Periodontics, College of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Habibollah Ghanbari
- Department of Periodontics, College of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Leila Khodadadifard
- Department of Periodontics, College of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Amin Khajavi
- Department of Periodontics, College of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
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Andersson P, Pagliani L, Verrocchi D, Volpe S, Sahlin H, Sennerby L. Factors Influencing Resonance Frequency Analysis (RFA) Measurements and 5-Year Survival of Neoss Dental Implants. Int J Dent 2019; 2019:3209872. [PMID: 31065267 PMCID: PMC6466959 DOI: 10.1155/2019/3209872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diagnostic instruments based on resonance frequency analysis (RFA) can be utilised to assess dental implant stability during treatment and follow-up. AIM The aim of the present study was to investigate the influence of patient- and implant-related factors on implant stability and the 5-year implant survival. In addition, the influence of stability (ISQ value) at placement and abutment connection on implant survival was evaluated. MATERIALS AND METHODS RFA measurements from a total of 334 consecutive patients with 745 dental implants (Neoss Ltd., Harrogate, UK) were retrospectively analysed after at least 5 years in function. Statistics were used to evaluate the influence of the different variables on implant stability and implant survival. Odds ratio calculations were performed to compare the risk for implant failure using 60, 65, 70, and 75 ISQ as threshold levels at placement and loading. RESULTS A total of 20 implant failures in 14 patients were noted during the 5 years of follow-up, giving an overall cumulative survival rate (CSR) of 97.3% at the implant level and 95.8% at the patient level. Gender, jaw, position, bone quality, and implant diameter had an influence on implant stability at placement. Jaw, bone quality, and implant diameter had an influence on stability after 3-4 months of healing. More failures were observed in full than in partial rehabilitations. Age, gender, jaw, position, bone quantity, bone quality, implant diameter, and implant length had no influence on implant survival. Implants with ISQ values below the threshold levels showed lower survival rates compared to implants with values above these levels. CONCLUSIONS The present study showed a significantly higher risk for implant failure, showing an ISQ value below 70 and 75 at placement or after 3-4 months of healing. The results indicate that RFA measurements can be used to identify implants with increased risk for failure.
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Affiliation(s)
- Peter Andersson
- 1Private Practice, Clinica Feltre, Viale 14 Agosto 1866, No. 31, 32032 Feltre, Italy
| | - Luca Pagliani
- 2Private Practice, Via Giuseppe Mercalli 11, Milano, Italy
| | - Damiano Verrocchi
- 3Private Practice, Via Angelo Guadagnini 21, 38054 Fiera Di Primiero, Italy
| | - Stefano Volpe
- 4Private Practice, Piazza del Fante 10, 00195 Rome, Italy
| | - Herman Sahlin
- 5Neoss AB, Arvid Wallgrens Backe 20, 413 46 Gothenburg, Sweden
| | - Lars Sennerby
- 6Department of Oral & Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 405 30 Gothenburg, Sweden
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de Oliveira Nicolau Mantovani AK, de Mattias Sartori IA, Azevedo-Alanis LR, Tiossi R, Fontão FNGK. Influence of cortical bone anchorage on the primary stability of dental implants. Oral Maxillofac Surg 2018; 22:297-301. [PMID: 29876688 DOI: 10.1007/s10006-018-0705-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Rodrigo Tiossi
- Department of Restorative Dentistry, School of Dentistry, State University of Londrina (UEL), Rua Pernambuco, 540, Centro, Londrina, PR, 86020-120, Brazil.
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Clinical Relevance of Bone Density Values from CT Related to Dental Implant Stability: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6758245. [PMID: 29955608 PMCID: PMC6000841 DOI: 10.1155/2018/6758245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
Abstract
Purpose The majority of the techniques used to assess the primary implant stability are subjective and empirical and can be used during or after the surgery. The aim of this study is to evaluate the bone density prior to surgery, in order to give recommendations to the clinician about the best surgical technique and the type of implant which is needed. Materials and Methods A surgeon operated on 75 patients for 269 implants over the period 2010–2014. He required a CT to plan the surgery and he documented the type, the diameters, and the lengths of the implants, the insertion torque, and the ISQ values. At a later stage another clinician measured bone density and cortical thickness. We endeavoured to get the most accurate superimposition between the implants placed by the surgeon and those placed by the clinician. Results In maxilla ISQ showed a significant positive correlation with HU values detected for coronal-buccal (r = 0.302; p = 0.020) and middle-lingual (r = 0.295; p = 0.023). Torque showed a positive correlation with cortical bone thickness at the middle of the ridge (ρ = 0.196; p = 0.032). Conclusion It is important to take into consideration the Hounsfield Units and the cortical thickness as predictive parameters during the preoperative assessment, with regard to the choice of the implant type as well as the surgical technique.
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Klintström E, Klintström B, Pahr D, Brismar TB, Smedby Ö, Moreno R. Direct estimation of human trabecular bone stiffness using cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:72-82. [PMID: 29735401 DOI: 10.1016/j.oooo.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/04/2018] [Accepted: 03/16/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the possibility of estimating the biomechanical properties of trabecular bone through finite element simulations by using dental cone beam computed tomography data. STUDY DESIGN Fourteen human radius specimens were scanned in 3 cone beam computed tomography devices: 3-D Accuitomo 80 (J. Morita MFG., Kyoto, Japan), NewTom 5 G (QR Verona, Verona, Italy), and Verity (Planmed, Helsinki, Finland). The imaging data were segmented by using 2 different methods. Stiffness (Young modulus), shear moduli, and the size and shape of the stiffness tensor were studied. Corresponding evaluations by using micro-CT were regarded as the reference standard. RESULTS The 3-D Accuitomo 80 (J. Morita MFG., Kyoto, Japan) showed good performance in estimating stiffness and shear moduli but was sensitive to the choice of segmentation method. NewTom 5 G (QR Verona, Verona, Italy) and Verity (Planmed, Helsinki, Finland) yielded good correlations, but they were not as strong as Accuitomo 80 (J. Morita MFG., Kyoto, Japan). The cone beam computed tomography devices overestimated both stiffness and shear compared with the micro-CT estimations. CONCLUSIONS Finite element-based calculations of biomechanics from cone beam computed tomography data are feasible, with strong correlations for the Accuitomo 80 scanner (J. Morita MFG., Kyoto, Japan) combined with an appropriate segmentation method. Such measurements might be useful for predicting implant survival by in vivo estimations of bone properties.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Benjamin Klintström
- School of Technology and Health, KTH Royal Institute of Technology, Hälsovägen, Stockholm, Sweden
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Technical University Vienna, Vienna, Austria
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institute and Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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Rokn AR, Labibzadeh A, Ghohroudi AAR, Shamshiri AR, Solhjoo S. Histomorphometric Analysis of Bone Density in Relation to Tactile Sense of the Surgeon During Dental Implant Placement. Open Dent J 2018; 12:46-52. [PMID: 29492168 PMCID: PMC5814951 DOI: 10.2174/1874210601812010046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/25/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: A correct diagnosis and optimal treatment planning is essential for success in implant dentistry. Proper diagnosis of bone quality is an important part of the diagnostic procedure. Objective: The purpose of this study was to correlate the tactile sense of the surgeon in the assessment of bone density to the histomorphometric analysis of bone quality. Methods: In this study, 56 bone samples from 33 patients were harvested from implant sites with trephine drills. The samples were analyzed with Image J software. In the samples following parameters were measured: BV/TV, superficial cortical plate thickness, the number and thickness of haversian canals in cortical bone and the number, thickness and distance of trabecules in cancellous bone. The clinical hardness of bone during drilling was evaluated by surgeon according to Misch. GEE analysis with exchangeable correlation structure and linear model was used to evaluate the relationship between the tactile sense of the surgeon and histomorphometric parameters and all analysis was adjusted for two confounding variables: gender and location. Results: There were 51.79% implants in D2 samples and 48.21% in D3. Bone classification according to Misch was significantly correlated to distance of trabecules in cancellous bone (P-value=0.05), and shown marginally significant correlation with mean superficial cortical bone thickness (P-value =0.07) and number of haversian canals (P-value =0.005) in cortical bone. Discussion: There were differences between our results and others. The authors believed that these differences mainly are because of confounding factors, that in this study were eliminated. The clinical finding during surgery can approximately explain the histologic properties of bone. Conclusion: It is concluded that tactile sense of the surgeon can exhibit the histologic properties of the bone, and we are able to estimate the healing prognosis of the bone in implant placement.
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Affiliation(s)
- Amir Reza Rokn
- Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Labibzadeh
- Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Reza Shamshiri
- Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Somaye Solhjoo
- Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Merheb J, Vercruyssen M, Coucke W, Quirynen M. Relationship of implant stability and bone density derived from computerized tomography images. Clin Implant Dent Relat Res 2017; 20:50-57. [DOI: 10.1111/cid.12579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Joe Merheb
- Unit of Periodontology, Department of Oral Health Sciences; University of Leuven; Leuven Belgium
| | - Marjolein Vercruyssen
- Unit of Periodontology, Department of Oral Health Sciences; University of Leuven; Leuven Belgium
| | - Wim Coucke
- Scientific Institute of Public Health; Brussels Belgium
| | - Marc Quirynen
- Unit of Periodontology, Department of Oral Health Sciences; University of Leuven; Leuven Belgium
- Research Group Periodontology & Oral microbiology, Department of Oral Health Sciences; University of Leuven; Leuven Belgium
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Tettamanti L, Andrisani C, Bassi MA, Vinci R, Silvestre-Rangil J, Tagliabue A. Immediate loading implants: review of the critical aspects. ACTA ACUST UNITED AC 2017; 10:129-139. [PMID: 29876038 DOI: 10.11138/orl/2017.10.2.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Modern dentistry have witnessed, a rapid and continuing evolution. Concerning the implant-rehabilitation protocols, they have been redefined in order to satisfy patient's increasing expectations in terms of comfort, aesthetic and shorter treatment period. The purpose of this review is to explore the concept of implant immediate loading and the indications for clinical practice. All the critical aspects that could influence the outcomes of this treatment will also be considered. Materials and methods Three protocols for implant load timing have been classified: immediate loading implants (ILI); early loading implants (ELI); and conventional loading implants (CLI). Two subclassifications point out the different loading modality: 1) Occlusal loading or Non-Occlusal loading, 2) Direct loading or Progressive loading. Micromovements have been considered, since the start of implant dentistry, one of the main risk for the success of osseointegration. The determinant and most accessible parameter to assess the primary stability is the implant insertion torque value. To achieve the necessary torque value to perform immediate loading, it is therefore important to evaluate the bone density at the implant site. Computerized tomography (CT) has been regarded as the best radiographic method to evaluate the residual bone. Results The clinical success of this technique is highly dependent on many factors: patient selection, bone quality and quantity, implant number and design, implant primary stability, occlusal loading and clinician's surgical ability. Among these, implant primary stability is undoubtedly the most important. Conclusion Studies on ILI show that successful outcome can be expected, if the previous criteria are fulfilled. It seems that ILI demonstrate a greater risk for implant failure when compared to CLI, although the survival rates were high for both the procedures. The use of different surgical procedures, type of prostheses, loading times and have very different study designs. This lack of homogeneity limits the relevance of the conclusions that can be drawn.
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Affiliation(s)
- L Tettamanti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - R Vinci
- Oral Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - A Tagliabue
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Radiographic Fractal and Clinical Resonance Frequency Analyses of Posterior Mandibular Dental Implants: Their Possible Association With Mandibular Cortical Index With 12-Month Follow-up. IMPLANT DENT 2017; 25:789-795. [PMID: 27824719 DOI: 10.1097/id.0000000000000496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the present study was to investigate whether the mandibular cortical index (MCI) has a relationship with fractal dimension of bone and/or implant stability, and to justify the possible association between MCI, fractal dimension, and stability. MATERIALS AND METHODS Eighty-two subjects who received dental implants to replace missing mandibular premolar/molar sites were selected. Three months after surgical placement, implants were restored with fixed ceramic fused metal crowns. MCI was evaluated at baseline; fractal dimensions were measured with fractal analysis (FA) and implant stability quotient (ISQ) with resonance frequency analysis immediately after surgery and 12-month follow-up. RESULTS FA at mesial and distal regions for Class 1, Class 2, and Class 3 MCI resulted with significant increases at 12-month follow-up compared to baseline. The ISQ in patients with Class 2 and Class 3 MCI resulted with a significant decrease compared to Class 1 MCI at baseline and at 12 months. All MCI classes evaluated with ISQ and FA at baseline values resulted with significant increases at 12 months. Significant correlations were considered for all mandibular posterior implants between baseline and 12-month measurements for ISQ and FA evaluations. CONCLUSIONS Fractal analysis may be a useful method for understanding the healing process around implants and implant stability quotient values. Mandibular cortical index evaluations should be considered before implant procedures, which may provide a presurgical treatment plan and may provide information about the mandibular bone quality.
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Primary Stability of Cylindrical and Conical Dental Implants in Relation to Insertion Torque—A Comparative Ex Vivo Evaluation. IMPLANT DENT 2017; 26:250-255. [DOI: 10.1097/id.0000000000000531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Implant stability is a principal precondition for the success of implant therapy. Extraoral implants (EO) are mainly used for anchoring of maxillofacial epithesis. However, assessment of implant stability is mostly based on principles derived from oral implants. The aim of this study was to investigate clinical stability of EO craniofacial disk implants (single, double, and triple) by resonance frequency analysis at different stages of the bone's healing. Twenty patients with orbital (11), nasal (5), and auricular (4) defects with 50 EO implants placed for epithesis anchorage were included. Implant stability was measured 3 times; after implant placement, at 3 months and at least after 6 months. A significant increase in implant stability values was noted between all of the measurements, except for triple-disk implants between third and sixth months, and screw implants between 0 and third months. Disk implants showed lower implant stability quotient (ISQ) values compared with screw implants. Triple-disk implants showed better stability compared with single and double-disk implants. Based on resonance frequency analysis values, disk implants could be safely loaded when their ISQ values are 38 (single disks), 47 (double disks), and 48 (triple disks). According to resonance frequency analysis, disk implant stability increased over time, which showed good osseointegration and increasing mineralization. Although EO screw implants showed higher ISQ values than disk implants, disk-type implants can be safely loaded even if lower values of stability are measured.
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Reliability of Resonance Frequency Analysis as an Indicator of Implant Micromotion. IMPLANT DENT 2016; 25:783-788. [DOI: 10.1097/id.0000000000000498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To evaluate the bone density using the surgeon's tactile sense and compare it to the Lekholm and Zarb classification and computed tomography (CT) scan to see if correlations exist. MATERIALS AND METHODS Fifty-two implants were inserted in 22 patients. The bone densities of recipient site were preoperatively determined by density value as Hounsfield Units (HU) using CT scans. According to the Lekholm and Zarb classification, the bone quality scored 1 to 4 on cross-sectional CT. The clinical hardness of recipient sites were assessed on drilling by the surgeon's tactile sense and recorded as D1-D4 based on Misch criteria. Linear regression analysis was used to evaluate the relationship between density values of implant sites. RESULTS The mean bone density was 536.94 ± 220.39 HU. There were 7.7% implants in bone type D1, 46.2% in D2, 32.7% in D3, and 13.5% in D4. Bone classification according to Lekholm and Zarb was significantly correlated to the surgeon's tactile sense (Spearman's rho = 0.36; P = 0.01) and with HU on CT images (Spearman's rho = -0.61; P < 0.001). The surgeon's tactile sense had a significant correlation with bone density in preoperative CT scans (Spearman's rho = -0.67; P < 0.001). A significant correlation was found between the bone density in HU with age (Spearman's rho = 0.34; P = 0.01). CONCLUSION A high-quality cross-sectional CT may suffice as a site-specific preoperative diagnostic predictor that can confirm and complement the tactile sense of the surgeon to help differentiate good, moderate, and poor bone density.
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Vayron R, Nguyen VH, Bosc R, Naili S, Haïat G. Assessment of the biomechanical stability of a dental implant with quantitative ultrasound: A three-dimensional finite element study. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2016; 139:773-780. [PMID: 26936559 DOI: 10.1121/1.4941452] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dental implant stability is an important determinant of the surgical success. Quantitative ultrasound (QUS) techniques can be used to assess such properties using the implant acting as a waveguide. However, the interaction between an ultrasonic wave and the implant remains poorly understood. The aim of this study is to investigate the sensitivity of the ultrasonic response to the quality and quantity of bone tissue in contact with the implant surface. The 10 MHz ultrasonic response of an implant used in clinical practice was simulated using an axisymmetric three-dimensional finite element model, which was validated experimentally. The amplitude of the echographic response of the implant increases when the depth of a liquid layer located at the implant interface increases. The results show the sensitivity of the QUS technique to the amount of bone in contact with the implant. The quality of bone tissue around the implant is varied by modifying the bone biomechanical properties by 20%. The amplitude of the implant echographic response decreases when bone quality increases, which corresponds to bone healing. In all cases, the amplitude of the implant response decreased when the dental implant stability increased, which is consistent with the experimental results.
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Affiliation(s)
- Romain Vayron
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR, 8208 CNRS, 61 avenue du Général de Gaulle, 94010 Créteil Cedex, France
| | - Vu-Hieu Nguyen
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR, 8208 CNRS, 61 avenue du Général de Gaulle, 94010 Créteil Cedex, France
| | - Romain Bosc
- Université Paris-Est, INSERM U955, Equipe 10, 8 rue du Général Sarrail, 94010 Créteil Cedex, France
| | - Salah Naili
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR, 8208 CNRS, 61 avenue du Général de Gaulle, 94010 Créteil Cedex, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi-Échelle, MSME UMR 8208 CNRS, 61 avenue du Général de Gaulle, 94010 Créteil Cedex, France
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Support Immersion Endoscopy in Post-Extraction Alveolar Bone Chambers: A New Window for Microscopic Bone Imaging In Vivo. PLoS One 2015; 10:e0145767. [PMID: 26713617 PMCID: PMC4695096 DOI: 10.1371/journal.pone.0145767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/08/2015] [Indexed: 12/15/2022] Open
Abstract
Using an endoscopic approach, small intraoral bone chambers, which are routinely obtained during tooth extraction and implantation, provide visual in vivo access to internal bone structures. The aim of the present paper is to present a new method to quantify bone microstructure and vascularisation in vivo. Ten extraction sockets and 6 implant sites in 14 patients (6 men / 8 women) were examined by support immersion endoscopy (SIE). After tooth extraction or implant site preparation, microscopic bone analysis (MBA) was performed using short distance SIE video sequences of representative bone areas for off-line analysis with ImageJ. Quantitative assessment of the microstructure and vascularisation of the bone in dental extraction and implant sites in vivo was performed using ImageJ. MBA revealed bone morphology details such as unmineralised and mineralised areas, vascular canals and the presence of bleeding through vascular canals. Morphometric examination revealed that there was more unmineralised bone and less vascular canal area in the implant sites than in the extraction sockets.
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Linck GKSB, Ferreira GM, De Oliveira RCG, Lindh C, Leles CR, Ribeiro-Rotta RF. The Influence of Tactile Perception on Classification of Bone Tissue at Dental Implant Insertion. Clin Implant Dent Relat Res 2015; 18:601-8. [PMID: 25850635 DOI: 10.1111/cid.12341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various ways of using the Lekholm and Zarb (L&Z) classification have added to the lack of scientific evidence of the effectiveness of this clinical method in the evaluation of implant treatment. PURPOSE The study aims to assess subjective jawbone classifications in patients referred for implant treatment, using L&Z classification with and without surgeon's hand perception at implant insertion. The association between bone type classifications and quantitative parameters of primary implant stability was also assessed. MATERIALS AND METHODS One hundred thirty-five implants were inserted using conventional loading protocol. Three surgeons classified bone quality at implant sites using two methods: one based on periapical and panoramic images (modified L&Z) and one based on the same images associated with the surgeon's tactile perception during drilling (original L&Z). Peak insertion torque and implant stability quotient (ISQ) were recorded. RESULTS The modified and original L&Z were strongly correlated (rho = 0.79; p < .001); Wilcoxon signed-rank test showed no significant difference in the distribution of bone type classification between pairs using the two methods (p = .538). Spearman correlation tested the association between primary stability parameters and bone type classifications (-0.34 to -0.57 [p < .001]). CONCLUSIONS Tactile surgical perception has a minor influence on rating of subjective bone type for dental implant treatment using the L&Z classification.
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Schnitman PA, Hayashi C, Han RK. Why guided when freehand is easier, quicker, and less costly? J ORAL IMPLANTOL 2015; 40:670-8. [PMID: 25233441 DOI: 10.1563/aaid-joi-d-14-00231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.
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Finite element simulation of ultrasonic wave propagation in a dental implant for biomechanical stability assessment. Biomech Model Mechanobiol 2015; 14:1021-32. [PMID: 25619479 DOI: 10.1007/s10237-015-0651-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/10/2015] [Indexed: 12/31/2022]
Abstract
Dental implant stability, which is an important parameter for the surgical outcome, can now be assessed using quantitative ultrasound. However, the acoustical propagation in dental implants remains poorly understood. The objective of this numerical study was to understand the propagation phenomena of ultrasonic waves in cylindrically shaped prototype dental implants and to investigate the sensitivity of the ultrasonic response to the surrounding bone quantity and quality. The 10-MHz ultrasonic response of the implant was calculated using an axisymetric 3D finite element model, which was validated by comparison with results obtained experimentally and using a 2D finite difference numerical model. The results show that the implant ultrasonic response changes significantly when a liquid layer is located at the implant interface compared to the case of an interface fully bounded with bone tissue. A dedicated model based on experimental measurements was developed in order to account for the evolution of the bone biomechanical properties at the implant interface. The effect of a gradient of material properties on the implant ultrasonic response is determined. Based on the reproducibility of the measurement, the results indicate that the device should be sensitive to the effects of a healing duration of less than one week. In all cases, the amplitude of the implant response is shown to decrease when the dental implant primary and secondary stability increase, which is consistent with the experimental results. This study paves the way for the development of a quantitative ultrasound method to evaluate dental implant stability.
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Veli I, Uysal T, Baysal A, Karadede I. Buccal cortical bone thickness at miniscrew placement sites in patients with different vertical skeletal patterns. J Orofac Orthop 2014; 75:417-29. [PMID: 25344123 DOI: 10.1007/s00056-014-0235-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cortical bone thickness plays an important role in the primary stability of miniscrews. The purpose of this study was to evaluate the buccal cortical bone thickness in adolescent subjects with different vertical skeletal patterns using cone-beam computed tomography (CBCT). MATERIALS AND METHODS We examined the CBCT images of 75 patients (30 males, 45 females; mean age 16.5 years; range 15.3-17.7 years) in the present study. High-, average- and low-angle subgroups were generated according to SN-GoMe angle. On volumetric images, we measured the buccal cortical bone thickness from canine to the second molar teeth at heights of 5, 7 and 9 mm from cemento-enamel junction (CEJ). For statistical evaluation, the Wilcoxon signed rank, Kruskal-Wallis and Tukey HSD tests were applied at the p < 0.05 level. RESULTS Buccal cortical bone was thickest in the low-angle group. We observed statistically significant differences in the maxilla between the high- and low-angle groups at all levels. In the mandible, we noted statistically significant differences between high-angle and low-angle groups in the canine-first premolar regions at heights of 5 and 7 mm, and in the second premolar-first molar region at 7 mm height from CEJ. Significant differences were also present between the first and second premolars at heights of 7 and 9 mm. Average cortical bone thickness ranged from 1.10-1.37 mm in the maxilla and 1.20-3.28 mm in the mandible for all groups. CONCLUSION Buccal cortical bone thickness in adolescents varied in different vertical skeletal patterns and was greater in the mandible than in the maxilla, with the distance increasing from the CEJ to the apex. As the buccal cortical bone is thinner in high-angle patients, patient-specific measures should be taken when performing miniscrew treatment.
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Affiliation(s)
- Ilknur Veli
- Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
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Howashi M, Tsukiyama Y, Ayukawa Y, Isoda-Akizuki K, Kihara M, Imai Y, Sogo M, Koyano K. Relationship between the CT Value and Cortical Bone Thickness at Implant Recipient Sites and Primary Implant Stability with Comparison of Different Implant Types. Clin Implant Dent Relat Res 2014; 18:107-16. [PMID: 25181581 DOI: 10.1111/cid.12261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have shown that bone quality at the implant recipient site can influence primary stability. PURPOSE The aims of this study were to explore the quantitative estimation of the primary stability of implants preoperatively using CT values and to examine the effect of different implant designs with recommended socket preparation on primary stability. MATERIALS AND METHODS Forty-four fresh porcine femoral heads were prepared. The bone surrounding implant sockets was preoperatively evaluated by helical CT. Forty-four implants (φ 4.3 × 10 mm), 22 straight and 22 tapered, were placed according to the manufacturer's instructions. The insertion torque value (ITV), implant stability quotient (ISQ), and removal torque value (RTV) were recorded as indicators of primary implant stability. RESULTS Significant correlations and linear relationships were found between the CT value and ITV, ISQ, and RTV for both straight and tapered implants (Spearman's correlation coefficient, p < .001; linear regression analysis, p < .01). Tapered implants had a significantly higher ITV than straight implants (analysis of covariance, p < .01). CONCLUSIONS Obtained results suggest that the primary stability of implants could be quantitatively estimated using the CT value preoperatively, indicating the CT value of bone surrounding an implant can contribute considerably to implant planning and design choice in clinical situations.
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Affiliation(s)
- Miori Howashi
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Tsukiyama
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yasunori Ayukawa
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kei Isoda-Akizuki
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Masafumi Kihara
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yu Imai
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Motofumi Sogo
- Division of Prosthodontics and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kiyoshi Koyano
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Troedhan A, Schlichting I, Kurrek A, Wainwright M. Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials. Sci Rep 2014; 4:5877. [PMID: 25073446 PMCID: PMC5376201 DOI: 10.1038/srep05877] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/01/2014] [Indexed: 02/07/2023] Open
Abstract
Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.
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Affiliation(s)
- Angelo Troedhan
- Head of Maxillofacial Surgery Dep., Center for Facial Esthetics Vienna, Brauhausgasse 12, 1050 Vienna, Austria
| | - Izabela Schlichting
- Head of Oral Surgery &Implantology Dep., Center for Facial Esthetics Vienna, Brauhausgasse 12, 1050 Vienna, Austria
| | - Andreas Kurrek
- Head of Oral Surgery &Implantology Dep., Implantology Clinic Oberkassel, Dominikanerstrasse 10, 40545 Dusseldorf
| | - Marcel Wainwright
- Head of Oral Surgery &Implantology Dep., Implantology Clinic Kaiserswerth, Kaiserswerther Markt 25, 40489 Dusseldorf
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Effect of Biodegradable Gelatin β-Tri Calcium Phosphate Sponges Containing Mesenchymal Stem Cells and Bone Morphogenetic Protein-2 on Equine Bone Defect. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2014.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hernández-Cortés P, Monje A, Galindo-Moreno P, Catena A, Ortega-Oller I, Salas-Pérez J, Mesa F, Gómez-Sánchez R, Aguilar M, Aguilar D, O'Valle F. An ex vivo model in human femoral heads for histopathological study and resonance frequency analysis of dental implant primary stability. BIOMED RESEARCH INTERNATIONAL 2014; 2014:535929. [PMID: 24995307 PMCID: PMC4065718 DOI: 10.1155/2014/535929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was designed to explore relationships of resonance frequency analysis (RFA)-assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. MATERIAL AND METHODS This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. RESULTS As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). CONCLUSION Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.
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Affiliation(s)
- Pedro Hernández-Cortés
- Department of Traumatology and Orthopedic Surgery, “San Cecilio” Clinical Hospital, University of Granada, Spain
| | - Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Pablo Galindo-Moreno
- Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Granada, Spain
| | - Andrés Catena
- Department of Experimental Psychology, School of Psychology, University of Granada, Granada, Spain
| | - Inmaculada Ortega-Oller
- Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Granada, Spain
| | - José Salas-Pérez
- Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Granada, Spain
| | - Francisco Mesa
- Department of Periodontics, School of Dentistry, University of Granada, Granada, Spain
| | - Rafael Gómez-Sánchez
- Department of Traumatology and Orthopedic Surgery, “San Cecilio” Clinical Hospital, University of Granada, Spain
| | - Mariano Aguilar
- Department of Pathology, School of Medicine and Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada, Spain
| | - David Aguilar
- Department of Pathology, School of Medicine and Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine and Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada, Spain
- Departamento de Anatomía Patológica, Facultad de Medicina, 18012 Granada, Spain
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Herekar M, Sethi M, Ahmad T, Fernandes AS, Patil V, Kulkarni H. A correlation between bone (B), insertion torque (IT), and implant stability (S): BITS score. J Prosthet Dent 2014; 112:805-10. [PMID: 24726588 DOI: 10.1016/j.prosdent.2014.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
STATEMENT OF PROBLEM Although criteria for assessing bone quality have been reported, an overall score that correlates bone quality with the primary stability and secondary stability of implants is not yet available. PURPOSE The purpose of this article was to propose a scoring index that will establish a correlation among the bone density values from computed tomography, maximum insertion torque values, and resonance frequency analysis in different phases of implant treatment. MATERIAL AND METHODS In this study, 60 implant sites were evaluated to assess bone density (Hounsfield units), insertion torque values (Ncm), and primary stability and secondary stability (implant stability quotient values obtained by using resonance frequency analysis). On the basis of computed tomography data, the bone was classified as D1 to D4. The insertion torque was noted and classified into 2 groups, A and B. The implant stability quotient values obtained from resonance frequency analysis depicting primary stability and secondary stability were classified into 5 groups. The primary score noted was a result of the values obtained for the 3 parameters at the time of implant placement. The secondary score was obtained by considering the values of the bone density and resonance frequency analysis recorded at different time intervals. RESULTS Bone densities of D2, D3, and D4 were noted, dividing the bone type into 3 groups. The maximum torque noted in the study was 40 Ncm. The difference between various insertion torque values and bone types was found to be statistically nonsignificant. Higher mean implant stability quotient values were obtained for primary and secondary stability for the D2 bone than for D3 and D4 bone. When analyzed according to the time of insertion, the mean values increased at second stage surgery in all bone types. The difference in mean values among all bone types was found to be statistically significant (P<.001). A comparison of primary and secondary implant stability quotient values in all bone types did not find any statistical significance (P=.780). A score was recorded at the time of implant placement and at the time of second stage surgery, and the prosthetic treatment was planned accordingly. CONCLUSIONS The score highlights the importance of considering the association of bone quality, insertion torque values, and stability as denoted by implant stability quotient throughout treatment. Based on the variation in the score noted at recall visits, alterations in the treatment plan can be made with respect to the healing period and prosthetic design.
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Affiliation(s)
- Manisha Herekar
- Professor and Department Head, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India.
| | - Megha Sethi
- Postgraduate student, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Tousif Ahmad
- Postgraduate student, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | | | - Viraj Patil
- Professor, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Harish Kulkarni
- Dean, Professor, and Head of Department, Department of Oral and Maxillofacial Surgery, Tatyasaheb Kore Dental College and Research Centre, Warnanagar, Maharashtra, India
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Sennerby L, Andersson P, Pagliani L, Giani C, Moretti G, Molinari M, Motroni A. Evaluation of a Novel Cone Beam Computed Tomography Scanner for Bone Density Examinations in Preoperative 3D Reconstructions and Correlation with Primary Implant Stability. Clin Implant Dent Relat Res 2013; 17:844-53. [DOI: 10.1111/cid.12193] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lars Sennerby
- Department of Oral and Maxillofacial Surgery; Institute of Odontology; University of Gothenburg; Gothenburg Sweden
- Clinica Feltre; Feltre Italy
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Javed F, Ahmed HB, Crespi R, Romanos GE. Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation. Interv Med Appl Sci 2013; 5:162-7. [PMID: 24381734 DOI: 10.1556/imas.5.2013.4.3] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022] Open
Abstract
A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants.
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Marquezan M, Lima I, Lopes RT, Sant'Anna EF, de Souza MMG. Is trabecular bone related to primary stability of miniscrews? Angle Orthod 2013; 84:500-7. [PMID: 24245816 DOI: 10.2319/052513-39.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the primary stability of miniscrews inserted into bone blocks of different bone mineral densities (BMDs) with and without cortical bone, and investigate whether some trabecular properties could influence primary stability. MATERIALS AND METHODS Fifty-two bone blocks were extracted from fresh bovine pelvic bone. Four groups were created based on bone type (iliac or pubic region) and presence or absence of cortical bone. Specimens were micro-computed tomography imaged to evaluate trabecular thickness, trabecular number, trabecular separation, bone volume density (BV/TV), BMD, and cortical thickness. Miniscrews 1.4 mm in diameter and 6 mm long were inserted into the bone blocks, and primary stability was evaluated by insertion torque (IT), mini-implant mobility (PTV), and pull-out strength (PS). RESULTS Intergroup comparison showed lower levels of primary stability when the BMD of trabecular bone was lower and in the absence of cortical bone (P≤.05). The Pearson correlation test showed correlation between trabecular number, trabecular thickness, BV/TV, trabecular BMD, total BMD, and IT, PTV, and PS. There was correlation between cortical thickness and IT and PS (P≤.05). CONCLUSION Cancellous bone plays an important role in primary stability of mini-implants in the presence or absence of cortical bone.
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Affiliation(s)
- Mariana Marquezan
- a PhD Student, Department of Pedodontics and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Snijders RS, van Wijk AJ, Lindeboom JA. A comparative study of the Osstell™ versus the Osstell Mentor™ to evaluate implant stability in human cadaver mandibles. J Oral Rehabil 2013; 40:774-9. [DOI: 10.1111/joor.12093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/25/2022]
Affiliation(s)
- R. S. Snijders
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam and Academic Center for Dentistry (ACTA); University of Amsterdam; Amsterdam The Netherlands
| | - A. J. van Wijk
- Department of Social Dentistry and Behavioural Sciences; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Free University (VU); Amsterdam The Netherlands
| | - J. A. Lindeboom
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam and Academic Center for Dentistry (ACTA); University of Amsterdam; Amsterdam The Netherlands
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Molteni R. Prospects and challenges of rendering tissue density in Hounsfield units for cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:105-19. [DOI: 10.1016/j.oooo.2013.04.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/11/2013] [Accepted: 04/19/2013] [Indexed: 11/30/2022]
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Salimov F, Tatli U, Kürkçü M, Akoğlan M, Oztunç H, Kurtoğlu C. Evaluation of relationship between preoperative bone density values derived from cone beam computed tomography and implant stability parameters: a clinical study. Clin Oral Implants Res 2013; 25:1016-21. [PMID: 23772811 DOI: 10.1111/clr.12219] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the efficacy of bone density value derived from cone beam computed tomography (CBCT) by evaluating its correlation with implant stability parameters including insertion torque value (ITV) and radiofrequency analysis in relation to different clinical variables including location, gender, age, bone quality, and implant diameter. MATERIAL AND METHODS A total of 65 implants were placed in 17 patients. The bone densities of implant recipient sites were preoperatively recorded using CBCT. Bone quality was subjectively assessed, which depends on the stiffness of the jawbone according to the Lekholm and Zarb index during drilling procedure. The maximum ITV of each implant was recorded using a digital torque meter during implant placement. Resonance frequency measurements were taken using an Osstell Mentor immediately after implant placement. Data were analyzed statistically. RESULTS The mean bone density, insertion torque, and implant stability quotient values of all implants were 556 ± 80, 37.4 ± 3.3 Ncm, and 73.8 ± 7.2, respectively. Statistically significant correlations were found between bone density values from CBCT and implant stability parameters in relation to all variables. CONCLUSION Bone density assessment using CBCT is an efficient method and significantly correlated with implant stability parameters and Lekholm and Zarb index. Thus, it is possible to predict initial implant stability and possibility of immediate or early loading using CBCT scans prior to implant placement.
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Affiliation(s)
- Fariz Salimov
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Çukurova University, Adana, Turkey
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Dursun E, Tulunoglu I, Ozbek SM, Uysal S, Akalın FA, Kilinc K, Karabulut E, Tözüm TF. The Influence of Platform Switching on Clinical, Laboratory, and Image-Based Measures: A Prospective Clinical Study. Clin Implant Dent Relat Res 2013; 16:936-46. [DOI: 10.1111/cid.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erhan Dursun
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Ibrahim Tulunoglu
- Department of Prosthodontics; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - S. Murat Ozbek
- Department of Dento-Maxillofacial Radiology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Serdar Uysal
- Department of Dento-Maxillofacial Radiology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - F. Alev Akalın
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Kamer Kilinc
- Department of Biochemistry; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Erdem Karabulut
- Department of Biostatistics; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Tolga F. Tözüm
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
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Pauwels R, Nackaerts O, Bellaiche N, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, Bogaerts R, Jacobs R, Horner K. Variability of dental cone beam CT grey values for density estimations. Br J Radiol 2013; 86:20120135. [PMID: 23255537 DOI: 10.1259/bjr.20120135] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the use of dental cone beam CT (CBCT) grey values for density estimations by calculating the correlation with multislice CT (MSCT) values and the grey value error after recalibration. METHODS A polymethyl methacrylate (PMMA) phantom was developed containing inserts of different density: air, PMMA, hydroxyapatite (HA) 50 mg cm(-3), HA 100, HA 200 and aluminium. The phantom was scanned on 13 CBCT devices and 1 MSCT device. Correlation between CBCT grey values and CT numbers was calculated, and the average error of the CBCT values was estimated in the medium-density range after recalibration. RESULTS Pearson correlation coefficients ranged between 0.7014 and 0.9996 in the full-density range and between 0.5620 and 0.9991 in the medium-density range. The average error of CBCT voxel values in the medium-density range was between 35 and 1562. CONCLUSION Even though most CBCT devices showed a good overall correlation with CT numbers, large errors can be seen when using the grey values in a quantitative way. Although it could be possible to obtain pseudo-Hounsfield units from certain CBCTs, alternative methods of assessing bone tissue should be further investigated. ADVANCES IN KNOWLEDGE The suitability of dental CBCT for density estimations was assessed, involving a large number of devices and protocols. The possibility for grey value calibration was thoroughly investigated.
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Affiliation(s)
- R Pauwels
- Department of Oral Health Sciences, University of Leuven, Leuven, Belgium.
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Cassetta M, Stefanelli LV, Pacifici A, Pacifici L, Barbato E. How Accurate Is CBCT in Measuring Bone Density? A Comparative CBCT-CT In Vitro Study. Clin Implant Dent Relat Res 2013; 16:471-8. [DOI: 10.1111/cid.12027] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michele Cassetta
- Department of Oral and Maxillofacial Sciences; School of Dentistry; “Sapienza” University of Rome; Rome Italy
| | - Luigi Vito Stefanelli
- Department of Oral and Maxillofacial Sciences; School of Dentistry; “Sapienza” University of Rome; Rome Italy
| | - Andrea Pacifici
- Department of Oral and Maxillofacial Sciences; School of Dentistry; “Sapienza” University of Rome; Rome Italy
| | - Luciano Pacifici
- Department of Oral and Maxillofacial Sciences; School of Dentistry; “Sapienza” University of Rome; Rome Italy
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences; School of Dentistry; “Sapienza” University of Rome; Rome Italy
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Berhanu B, Rizzo P, Ochs M. Highly Nonlinear Solitary Waves for the Assessment of Dental Implant Mobility. JOURNAL OF APPLIED MECHANICS 2013; 80:0110281-110288. [PMID: 24891723 PMCID: PMC3994751 DOI: 10.1115/1.4006947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/17/2012] [Accepted: 06/07/2012] [Indexed: 06/03/2023]
Abstract
In this paper we present a noninvasive technique based on the propagation of highly nonlinear solitary waves (HNSWs) to monitor the stability of dental implants. HNSWs are nondispersive mechanical waves that can form and travel in highly nonlinear systems, such as one-dimensional chains of spherical particles. The technique is based on the hypothesis that the mobility of a dental implant affects certain characteristics of the HNSWs reflected at the interface between a crystal-based transducer and the implant. To validate the research hypothesis we performed two experiments: first we observed the hydration of commercial plaster to simulate at large the osseointegration process that occurs in the oral connective tissue once a dental-endosteal threaded implant is surgically inserted; then, we monitored the decalcification of treated bovine bones immersed in an acid bath to simulate the inverse of the osseointegration process. In both series, we found a good correlation between certain characteristics of the HNSWs and the stiffness of the material under testing.
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Affiliation(s)
- Bruk Berhanu
- Research Undergraduate Laboratory for NDE and SHM Studies Department of Civil and Environmental Engineering University of Pittsburgh Pittsburgh, PA, 15261 e-mail:
| | - Piervincenzo Rizzo
- Assistant Professor Laboratory for NDE and SHM Studies Department of Civil and Environmental Engineering University of Pittsburgh 942 Benedum Hall, 3700 O'Hara St. Pittsburgh, PA, 15261 e-mail:
| | - Mark Ochs
- Associate Dean and Chair Department of Oral and Maxillofacial Surgery at the School of Dental Medicine University of Pittsburgh Pittsburgh, PA 15261 e-mail:
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Pagliani L, Sennerby L, Petersson A, Verrocchi D, Volpe S, Andersson P. The relationship between resonance frequency analysis (RFA) and lateral displacement of dental implants: an in vitro
study. J Oral Rehabil 2012; 40:221-7. [DOI: 10.1111/joor.12024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/27/2022]
Affiliation(s)
- L. Pagliani
- Fiera Di Primiero/Feltre Implant Research Group; Feltre Italy
- Private Practice; Milan Legnano Italy
| | - L. Sennerby
- Fiera Di Primiero/Feltre Implant Research Group; Feltre Italy
- Clinica Feltre; Feltre Italy
- Department of Oral & Maxillofacial Surgery; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | | | - D. Verrocchi
- Fiera Di Primiero/Feltre Implant Research Group; Feltre Italy
- Private Practice; Fiera Di Primiero and San Dona Di Piave; Piave Italy
| | - S. Volpe
- Fiera Di Primiero/Feltre Implant Research Group; Feltre Italy
- Private Practice; Rome Italy
| | - P. Andersson
- Fiera Di Primiero/Feltre Implant Research Group; Feltre Italy
- Clinica Feltre; Feltre Italy
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Ribeiro-Rotta RF, de Oliveira RCG, Dias DR, Lindh C, Leles CR. Bone tissue microarchitectural characteristics at dental implant sites part 2: correlation with bone classification and primary stability. Clin Oral Implants Res 2012; 25:e47-53. [DOI: 10.1111/clr.12046] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Danilo Rocha Dias
- Department of Oral Medicine; School of Dentistry; Federal University of Goias; Goiania Goias Brazil
| | - Christina Lindh
- Department of Oral and Maxillofacial Radiology; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation; School of Dentistry; Federal University of Goias; Goiania Goias Brazil
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Parsa A, Ibrahim N, Hassan B, Motroni A, van der Stelt P, Wismeijer D. Influence of cone beam CT scanning parameters on grey value measurements at an implant site. Dentomaxillofac Radiol 2012; 42:79884780. [PMID: 22933535 DOI: 10.1259/dmfr/79884780] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the grey value variation at the implant site with different scan settings, including field of view (FOV), spatial resolution, number of projections, exposure time and dose selections in two cone beam CT (CBCT) systems and to compare the results with those obtained from a multislice CT system. METHODS A partially edentulous human mandibular cadaver was scanned by three CT modalities: multislice CT (MSCT) (Philips, Best, the Netherlands), and two CBCT systems: (Accuitomo 170(®), Morita, Japan) and (NewTom 5G(®), QR, Verona, Italy). Using different scan settings 36 and 24 scans were obtained from the Accuitomo and the NewTom, respectively. The scans were converted to digital imaging and communications in medicine 3 format. The analysis of the data was performed using 3Diagnosys(®) software (v. 3.1, 3diemme, Cantù, Italy) and Geomagic studio(®) 2012 (Morrisville, NC). On the MSCT scan, one probe designating the site for pre-operative implant placement was inserted. The inserted probe on MSCT was transformed to the same region on each CBCT scan using a volume-based three-dimensional registration algorithm. The mean voxel grey value of the region around the probe was derived separately for each CBCT. The influence of scanning parameters on the measured mean voxel grey values was assessed. RESULTS Grey values in both CBCT systems significantly deviated from Hounsfield unit values measured with MSCT (p = 0.0001). In both CBCT systems, scan FOV and spatial resolution selections had a statistically significant influence on grey value measurements (p = 0.0001). The number of projections selection had a statistically significant influence in the Accuitomo system (p = 0.0001) while exposure time and dose selections had no statistically significant influence on grey value measurements in the NewTom (p = 0.43 and p = 0.37, respectively). CONCLUSIONS Grey-level values from CBCT images are influenced by device and scanning settings.
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Affiliation(s)
- A Parsa
- Department of General and Specialized Dentistry, Section Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands.
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