Abstract
ObjectivesConventional dental implants inserted in the molar region of the maxilla will reach into the sinus maxillaris when alveolar ridge height is limited. When surgery is performed without prior augmentation of the sinus floor, primary stability of the implant is important for successful osseointegration. This study aimed at identifying the impact of bone quality and quantity at the implantation site on primary implant stability of a simulated bicortical placement.Materials and methodsIn our in vitro measurements, bone mineral density, total bone thickness and overall cortical bone thickness were assessed by micro-computed tomography (μCT) of pig scapulae, which resembled well the bicortical situation found in human patients. Dental implants were inserted, and micromotion between bone and implant was measured while loading the implant with an axial torque.ResultsThe main findings were that primary implant stability did not depend on total bone thickness but tended to increase with either increasing bone mineral density or overall cortical bone thickness.Clinical relevanceLimited bone height in the maxilla is a major problem when planning dental implants. To overcome this problem, several approaches, e.g. external or internal sinus floor elevation, have been established. When planning the insertion of a dental implant an important aspect is the primary stability which can be expected. With other factors, the dimensions of the cortical bone might be relevant in this context. It would, therefore, be helpful to define the minimum thickness of cortical bone required to achieve sufficient primary stability, thus avoiding additional surgical intervention.
Highlights
In recent decades, implant-supported dentures have become increasingly common in dental practice
Three cycles each of ± 15 Ncm (43% of the ideal insertion torque) were applied with a rotating speed of 2°/min and with the starting direction rotating counter-clockwise
This topic is of major interest, as the impact of these variables on successful osseointegration of dental implants is important for the clinician [20]
Summary
Implant-supported dentures have become increasingly common in dental practice. As a result of improvement of the implant surface, excellent osseointegration rates have been achieved. In addition to the structure of the implant surface, the complex osseointegration process [1] is affected by other factors, e.g. primary implant. A maximum segment size of 40 mm × 60 mm and a minimum segment thickness of 4 mm were chosen as the basis for further preparations. A 10 mm × 10 mm region of interest (ROI) was marked with one side located at a cut edge (cf Fig. 2, left). The position of each ROI was chosen, if possible, such that bone thickness did not exceed approximately 8 mm. To enable location of the ROI during micro-computed tomography (μCT), edges were marked with small (1-mm) drilled holes
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