A New Site Preparation Protocol That Supports Bone Quality Evaluation and Provides Predictable Implant Insertion Torque.

Stefan Velikov,Peter Heuberger,Cristiano Susin,Ainara Irastorza-Landa

doi:10.3390/jcm9020494

Stefan Velikov, Peter Heuberger + Show 2 more

Open Access

https://doi.org/10.3390/jcm9020494

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Abstract

When preparing an implant site, clinicians often base their assessment of the bone on subjective tactile and visual cues. This assessment is used to plan the surgical procedure for site preparation, including how many drilling steps will be used. The subjective nature of bone evaluation, consequently, results in poor reproducibility and may lead to under or over preparation of the site. Recently, an unconventional site preparation protocol was developed in which the decision of which instruments to use is dictated by insertion torque of the novel site preparation instrument (OsseoShaper™, Nobel Biocare AB, Gothenburg, Sweden). The aim of this study was to quantify the correlation of the site preparation torques of the new instrument with bone density and maximum implant insertion torques. In vitro and in vivo data showed strong linear correlation between site preparation torque and density and resulted in reliable implant insertion torques, respectively. From our analysis, we conclude that this new instrument and protocol has the potential to eliminate the need for additional intraoperative bone evaluation and may reduce the risk of inadequate preparation of the site due to the ability to serve as a predictor of the final implant insertion torque.

Highlights

Successful dental implant placement depends on the appropriate assessment of the alveolar bone quality, which should inform the appropriate selection of the surgical technique, site preparation tools, and implant characteristics
Within the limitations of this investigation, it was shown that the correlation between bone density and torque of the new site preparation instrument can assist in predicting bone quality and may serve as a predictor of the implant insertion torque
The novel site preparation protocol informs the procedural decisions and has the potential to reduce the risk of inadequate preparation of the site

Summary

Introduction

Successful dental implant placement depends on the appropriate assessment of the alveolar bone quality, which should inform the appropriate selection of the surgical technique, site preparation tools, and implant characteristics. Whereas the clinical and radiographic assessment of the implant site follow well-established parameters that can be promptly learned, the clinical judgment necessary to gauge bone characteristics has to be learned through experience [8,9]. In this regard, the clinical decision to under- or over-prepare the osteotomy has major consequences for primary implant stability and final implant position [10,11]. Novel concepts, such as drilling energy [12] or intraoperative compressive tests [13,14], have been proposed to correlate with bone density and estimate bone quality, their application in dental clinics is not yet common practice

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