Drilling Protocol Research Articles

Evaluation of Bone Density for Primary Implant Stability Using a Newly Designed Drill: An In Vitro Study on Polyurethane Bone Blocks.

Bone density is an important factor for long-term implant success. Peri-implant bone density evaluation before implant placement can be useful for treatment planning, such as the selection of proper implant size or drilling protocol in each case. In this study, we aimed to establish an objective intraoperative bone density evaluation method by measuring the drilling torque value using a newly designed density measurement drill. Drilling torque value measurement was performed intraoperatively using three types of drills; two previously reported drills and a newly designed drill as a density measurement drill. Polyurethane bone blocks of different densities (D1-D4) were used in this experiment. After the measurement, implants were inserted based on the scheduled plan, and insertion torque (IT) and implant stability quotient (ISQ) were measured to assess primary implant stability. The drilling torque value increased with the bone blocks' density, and there were significant differences among different densities in all groups (p < 0.05). The drilling torque value showed a positive correlation with IT in all groups (p < 0.05). In addition, the drilling torque value increased with the increase in ISQ in all groups. Within the limitations of this study, a newly designed density measurement drill was able to classify D1-D4 in polyurethane bone blocks despite its narrow diameter, and an objective intraoperative bone evaluation can be achieved. An intraoperative assessment of the drilling torque value can predict primary implant stability and provide valuable information for intraoperative treatment planning, such as undersized drilling protocol and implant size change.

A Comparison of Deep Learning vs. Dental Implantologists in Cone-Beam Computed Tomography-Based Bone Quality Classification.

Bone quality assessment is crucial for pre-surgical implant planning, influencing both implant design and drilling protocol selection. The Lekholm and Zarb (L&Z) classification, which categorizes bone quality into four types based on cortical bone width and trabecular bone density using cone-beam computed tomography (CBCT) data, lacks quantitative guidelines, leading to subjective interpretations. This study aimed to compare the performance of deep learning (DL)-based approaches against human examiners in assessing bone quality, according to the L&Z classification, using CBCT images. A dataset of 1100 CBCT cross-sectional slices was classified into four bone types by two oral and maxillofacial radiologists. Five pre-trained DL models were trained on 1000 images using MATLAB®, with 100 images reserved for testing. Inception-ResNet-v2 achieved the highest accuracy (86.00%) with a learning rate of 0.001. The performance of Inception-ResNet-v2 was then compared to that of 23 residency students and two experienced implantologists. The DL model outperformed human assessors across all parameters, demonstrating excellent precision and recall, with F1-scores exceeding 75%. Notably, residency students and one implantologist struggled to distinguish bone type 2, with low recall rates (48.15% and 40.74%, respectively). In conclusion, the Inception-ResNet-v2 DL model demonstrated superior performance compared to novice implantologists, suggesting its potential as an supplementary tool for cross-sectional bone quality assessment.

Heat Generation and Pain Assessment in Piezosurgery Versus Conventional Drilling for Implant Placement: A Systematic Review.

The development of new technologies in implant dentistry has led to the introduction of piezosurgery, which utilizes ultrasonic vibrations for micrometric and selective bone cutting. It is hypothesized to reduce trauma to bone tissue, thereby potentially improving the healing process compared to traditional drilling methods. This systematic review examines the differences in heat generation and pain perception between piezosurgery and conventional drilling techniques for dental implant placement. An extensive review of literature was performed using various databases, includingPubMed via MEDLINE, EBSCO, and Google Scholar. Out of an initial pool of 2,279 articles, nine studies met the predefined inclusion criteria and were included in the final analysis following title and abstract screening and subsequent full-text evaluation. The quality of the selected studies was rigorously assessed using the Risk of Bias (RoB 2.0), Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I), and Quality Assessment Tool for In Vitro Studies (QUIN) tools. Data pertaining to thermal effects and postoperative pain associated with piezosurgery relative to conventional drilling protocols were collected. The results indicated a significant reduction in postoperative pain with piezosurgery; however, the technique was associated with higher intraoperative temperatures during osteotomy. These findings provide valuable insights into the potential benefits and limitations of piezosurgery in dental implant procedures.

Clinical Outcomes of Full Arch Immediate Fixed Prostheses Supported By a Novel Implant System with Low Speed Site Preparation A 5 Years Retrospective Case Series

Background: The aim of this case series was to evaluate the 5-years clinical and radiographic outcomes of immediate full-arch fixed prosthesis supported by a novel implant system characterized by a low-speed site preparation protocol. Methods: Six medically compromised patients (3 females and 3 males) were consecutively enrolled and treated. Each patient received a fixed full-arch rehabilitations supported by two axial and two tilted implants. A total of 24 implants (N1 System, Nobel Biocare AB, Göteborg, Sweden) were placed in three mandibles and three maxillae using a low-speed drilling protocol with no irrigation. Prosthetic loading was applied within 2 hours of surgery, while then definitive restorations were placed 4 months later. Patients were scheduled for follow-up every 6 months up to 2 years and then annually. Radiographic evaluation of marginal bone level change was performed on regular intervals. Results: Between February 2019 and July 2019, six patients received a full-arch fixed prosthesis on four implants. All implants reached a minimum insertion torque of 30 Newton for immediate loading. After 5 years of observation (range 62-67 months), no implants failed and all definitive prostheses were stable and functional, resulting in a cumulative survival rate of 100%. After 5 years, the marginal bone loss was 1.46 ± 0.16 mm for the mandible and 1.85 ± 0.18 mm for the maxilla. Two implants (one axial and 1 tilted) in 1 patient treated in the maxillary arch reported more then 2 mm of marginal bone loss after 5 years. Conclusions: Within the limitations of this study, the successful medium-term results seem to confirm that immediate fixed full-arch rehabilitation, supported by two anterior axial and two posterior tilted implants, could be an effective and biologically beneficial treatment for complete arch edentulism. The reduced bone remodeling evidenced after 5 years of function confirm the biologically friendly concept behind this novel implant system.

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial

BackgroundTo verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries.MethodsIn total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days.ResultsThe mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05).ConclusionFurthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants.Trial registrationThis study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

Influence of Trabecular Bone Presence on Osseodensification Instrumentation: An In Vivo Study in Sheep.

Osseodensification enhances the stability of endosteal implants. However, pre-clinical studies utilizing osseodensification instrumentation do not account for the limited presence of trabeculae seen clinically. This study aimed to evaluate the effect of osseodensification instrumentation on osteotomy healing in scenarios with and without the presence of trabecular bone. A ~10 cm incision was made over the hip of twelve sheep. Trabecular bone was surgically removed from twelve sites (one site/animal; negative control (Neg. Ctrl)) and left intact at twelve sites (one site/animal; experimental group (Exp.)). All osteotomies were created using the osseodensification drilling protocol. Each osteotomy received an endosteal implant and was evaluated after 3 or 12 weeks of healing (n = 6 animals/time). Histology revealed increased woven and lamellar bone surrounding the implants in the Exp. group relative to the Neg. Ctrl group. The Exp. group demonstrated the presence of bone fragments, which acted as nucleating sites, thereby enhancing the bone formation and remodeling processes. Bone-to-implant contact (%BIC) and bone area fractional occupancy (%BAFO) were significantly higher in the Exp. group relative to the Neg. Ctrl group both at 3 weeks (p = 0.009 and p = 0.043) and 12 weeks (p = 0.010 and p = 0.008). Osseodensification instrumentation in the presence of trabecular bone significantly improved osseointegration. However, no negative influences such as necrosis, inflammation, microfractures, or dehiscence were observed in the absence/limited presence of trabeculae.

Evaluation of Postoperative Effects of Using Ozonated Water as an Irrigant on Soft and Hard Tissues Surrounding Dental Implants: A Randomized Controlled Clinical Trial.

Aim To evaluate the short-term and long-term postoperative effects of ozonated water when used as an irrigant in terms of postoperative pain, healing, and implant stability when compared to normal saline irrigation during implant surgery, both carried out using conventional drilling protocol. Methods A total of 34 implants were placed in 17 patients, two implants in each patient, one implant using normal saline as an irrigant and another one using ozonated water as an irrigant during the surgical procedure of implant site osteotomy. Postoperative pain was assessed after 48 hours of the surgical procedure using the visual analog scale (VAS). Soft tissue healing was assessed after eight days using the tissue healing index. Osseointegration was checked by measuring the primary stability at the moment of implant placement and comparing it to the secondary stability measured three months after the implant placement. These stability values (ISQ) were obtained using resonance frequency analysis (RFA). Results The VAS scores for the control group (Group A) after 48 hours were 71.76±5.57 and for the experimental group (Group B) after 48 hours were 47.64±5.33 so mean values in the experimentalgroup were significantly lower as compared to that in the control group (p<0.001). The mean healing index score for the control group (Group A) was 3.35±0.49 and the mean healing index score for the experimental group (Group B) was 4.64±0.49 so the mean values of tissue healing index in the experimental group were significantly higher as compared to that in the control group (p<0.001). The increase in stability value over the period of three months is 5.83 ISQ in the control group while the increase in stability value over the period of three months is 7.06 ISQ in the experimental group. The difference although not statistically significantshows a slight increase in stability in the experimental group as compared to that of the control group. Conclusion Ozone water irrigation at implant site osteotomy reduced postoperative pain and accelerated the tissue wound healing but the significant effect on osseointegration could not be determined.

Ceramic Implant Rehabilitation: Consensus Statements from Joint Congress for Ceramic Implantology: Consensus Statements on Ceramic Implant.

The objectives of the study group focused on the following main topics related to the performance of 1- and 2-piece ceramic implants: defining bone-implant-contact percentages and its measurement methods, evaluating the pink esthetic score as an esthetic outcome parameter after immediate implantation, recognizing the different results of ceramic implant designs as redefined by the German Association of Oral Implantology, incorporating the patient report outcome measure to include satisfaction and improvement in oral health-related quality of life, and conducting preclinical studies to address existing gaps in ceramic implants. During the Joint Congress for Ceramic Implantology (2022), the study group evaluated 17 clinical trials published between 2015 and 2021. After extensive discussions and multiple closed sessions, consensus statements and recommendations were developed, incorporating all approved modifications. A 1-piece implant design features a coronal part that is fused to the implant body or interfaces with the postabutment restoration platform, undergoing transmucosal healing. Long-term evaluations of this implant design are supported by established favorable clinical evidence. Inaccuracies in the pink esthetic score and bone-implant-contact percentages were managed by establishing control groups for preclinical studies and randomizing clinical trials. The patient-reported outcome measures were adjusted to include an individual visual analog scale, collected from each clinical study, that quantified improved oral health and quality of life. Preclinical investigations should focus on examining the spread of ceramic debris and the impact of heat generation on tissue and cellular levels during drilling. Further technical advancements should prioritize wound management and developing safe drilling protocols.

Oversized Surgical Preparation of the Implant Site: Systematic Review and Meta-analysis of Preclinical Studies.

To answer the following focus question: In preclinical in vivo experimental models, do oral implants placed in overdimensioned (OD) sites present greater biomechanical properties and histomorphometric parameters of osseointegration compared to implants placed in standard or undersized implant sockets? Online databases were searched for controlled animal studies reporting on OD sites up to February 2023. The relative implant- final drill discrepancy (IDD) was used to categorize the control and test groups according to surgical drilling protocol: (1) control: undersized (IDD > 0.5 mm) or standard (IDD = 0.2 to 0.5 mm); and (2) test OD: stress-free oversized (IDD = 0.0 to -0.1 mm); test GAP: friction-free oversized (IDD ≤ -0.1 mm). Random-effects meta-analyses were performed for the outcomes of insertion and removal torque values (ITV and RTV, respectively), bone-to-implant contact (%BIC), and bone density (%BD) for short- (0 to 2 weeks), intermediate- (3 to 4 weeks), and long-term (≥ 5 weeks) healing periods. Of the 527 records identified, 13 studies met the eligibility criteria. Histologically, the OD and GAP groups prevented ischemic necrosis and extensive bone resorption at the bone-implant interface in both the marginal cortical layer and the trabeculae. Faster and increased rates of bone formation, characterized by primary osteons and highly vascularized tissue, took place in OD sites between 1 and 5 weeks of healing. Meta-analyses indicated statistically significant benefits in favor of (1) control vs OD for short-term healing in extraoral sites, with pooled estimates (weighted mean difference) of ITV = 25.35 Ncm, %BIC = 2.10%, and %BD = 26.19%; (2) control vs OD for long-term healing in intraoral sites, with %BD = 11.69%; (3) control vs GAP for intermediate-term healing in extraoral sites, with %BD = 3.03%; and (4) control vs GAP for long-term healing in extraoral sites, with RTV = 5.57 Ncm. Oversized surgical preparation of the implant site does not seem to provide any additional benefit compared to standard or undersized sites regarding quantitative parameters of osseointegration. However, it does minimize marginal bone resorption and yields better-quality bone healing, despite the comparable results among different experimental animal models in the late postoperative period.

Primary Stability and Fracture Resistance of Zirconia and Titanium Implants: A Paired Comparative In Vitro Study.

Compare Neodent Zi® zirconia implants' insertion torque (IT) and removal torque (RT) with Neodent Alvim® titanium. Measure the maximum torque supported by the zirconia implant until its fracture (MT) and the maximum torque sustained by the assembler of this implant (MTA) until its fracture. In this in-vitro study twenty four implants were used. Two groups of implants with the same macrogeometry and from the same manufacturer were compared, Zirconia (n=12) and Titanium (n=12). Implant bed preparations were completed in bovine ribs following a standardized drilling protocol. Then, the insertion torque (IT), removal torque (RT), maximum torque to fracture (MT) and maximum torque to fracture of the assembler (MTA) were completed using a calibrated torque meter. Data was presented using descriptive statistics including means, standard deviations (SD), medians, and quartiles. The Shapiro-Wilk test was used to verify data normality and the Wilcoxon test was used to evaluate differences between groups. Statistical significance was established as p < 0.05. Zirconia implants showed: IT 89.33 ± 31.18 Ncm and RT 84.89 ± 32.92 Ncm. Titanium implants showed: IT 77.58 ± 28.96 Ncm and RT 76.75 ± 31.29 Ncm without significant differences (p>0.05). In relation to fracture under rotational force, the zirconia implants fractured at 106.17 ± 22.54 Ncm, and the implant assembly fractured at 84.00 ±13.14 Ncm. Neodent Zi® implants showed stability but lower fracture torque than Alvim® titanium. As the fracture values of the assembler were significantly lower than the fracture values of the zirconia implants, it can be stated that, as recommended by the manufacturer, they act as a safety measure during installation.

Trephination-based autonomous robotic surgery for dental implant placement: A proof of concept

ObjectivesTo present a novel drilling protocol of trephine osteotomy technique for autologous bone grafting with simultaneous implant placement using an autonomous robotic system. MethodsThe novel protocol consists of 1) preoperative procedures: marker fabrication and fixation, data acquisition, and preoperative planning; 2) intraoperative procedures: registration and calibration, and osteotomy and implant placement performed by an autonomous dental implant robot; 3) postoperative procedures: CBCT acquisition and accuracy assessment. ResultThe protocol was an effective method for implant osteotomy, with no reported intraoperative complications. The implant surgery was successfully completed, and autogenous bone was obtained. Meanwhile, the accuracy of implant placement was clinically acceptable, with minor deviations. ConclusionsTrephination-based robotic surgery can be successfully implemented in implant osteotomy, which might replace freehand implant surgery and conventional drilling protocol. However, further clinical studies are necessary. Clinical significanceThe main finding of this case is a potential alternative for preserving autogenous bone during implant surgery.

The Effectiveness of Osseodensification Drilling versus the Conventional Surgical Technique on Implant Stability: A Clinical Trial.

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

A New Approach to Implant Stability Using a Flexible Synthetic Silicate-Additive Beta-Tricalcium Phosphate-Poly(D,L-lactide-co-caprolactone) Bone Graft: An In Vitro Study.

The aim of this study was to evaluate the use of a flexible synthetic polymer bone graft to provide implant stability during implant placement in a dense cortical bone model. In the control group (Group 1), sockets were prepared on polyurethane blocks according to the standard implant socket drilling protocol; both oversizing and deepening were applied in Group 2; and only oversizing was applied in Group 3. In Groups 2 and 3, flexible synthetic polymer bone grafts were placed in the sockets prior to implant placement. The implants were placed at the bone level in all groups. The highest torque value obtained was recorded as the insertion torque. In this study, 75 implant sites were included across three groups. The torque values of the implants in the control group were significantly higher than those of the implants with the oversized and deepened sockets and the oversized-only sockets (p < 0.05; p < 0.01). The torque values of the implants with the oversized and deepened sockets were significantly higher than those of the implants with the oversized-only sockets (p < 0.01). In this study, a flexible synthetic polymer bone graft was shown to be effective in achieving implant stability in the management of implants where there has been a loss of primary stability.

Cooling Efficiency of Sleeveless 3D-Printed Surgical Guides with Different Cylinder Designs.

Background and Objectives: Surgical guides might impede the flow of coolant to the implant drills during the preparation of the implant bed, potentially contributing to increased temperatures during bone drilling. The objective of this experimental study was to assess the cooling efficiency of various guiding cylinder designs for sleeveless surgical guides used in guided surgery. Materials and Methods: In this experimental study, surgical guides with three different guiding cylinder designs were printed. One group had solid cylinders (control) and two test groups (cylinders with pores and cylinders with windows). Forty customized polyurethane blocks with type III bone characteristics were fitted into the guide and fixed in a vise, and implant bed preparations were completed using a simplified drilling protocol with and without irrigation. An infrared thermographic camera was used to record the temperature changes during drilling at the coronal, middle, and apical areas. ANOVA test and Games-Howell post hoc test were used to determine significant thermal differences among groups. Results: A significant thermal increase was observed at the coronal area in the group without irrigation (39.69 ± 8.82) (p < 0.05). The lowest thermal increase was recorded at the surgical guides with windows (21.451 ± 0.703 °C) compared to solid (25.005 ± 0.586 °C) and porous surgical guides (25.630 ± 1.004) (p < 0.05). In the middle and apical areas, there were no differences between solid and porous cylinders (p > 0.05). Conclusions: 3D-printed sleeveless surgical guides with window openings at the guiding cylinders reduce the temperature elevation at the cortical bone in guided implant surgery.

Correlation between the size of released titanium particles and changes in the surface of dental implants during insertion into bone blocks: an in vitro study.

This study investigated the size and amount of titanium particles immediately released following dental implant insertion into bovine bone blocks and aimed to correlate them with the surface roughness of the implants. Twelve bone blocks were prepared from bovine mandibles. Six tapered (group A) and 6 cylindrical (group B) dental implants were inserted into the bone blocks under water irrigation, following the standard drilling protocol. After insertion, the implants were immediately removed from the bone. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and atomic force microscopy were performed to investigate the released titanium particles and implant surface roughness, respectively. The amount of titanium ions in the irrigation water was measured using inductively coupled plasma mass spectrometry. Dynamic light scattering (DLS) was used to determine the size range of the released titanium particles. The percentages of titanium content on the surface of implants decreased in both groups after implantation into bone blocks. SEM-EDX analysis confirmed the presence of titanium particles embedded in the implanted bone bed. Group B implants showed significantly higher concentrations of titanium ions in the collected water than group A implants (0.868 and 0.565 µg/L, respectively). Group A implants demonstrated high pre-implantation surface roughness, which led to a much greater decrease in post-implantation surface roughness than was observed for group B implants. DLS analysis showed that the titanium particles released from group A implants were within the nano-size range, whereas those released from group B implants were within the micro-size range. Dental implant placement leads to a decrease in implant surface roughness and the immediate release of titanium particles into the peri-implant bone. Variations in the size range and amount of released particles were correlated with implant surface roughness. This finding has clinical implications and warrants additional in vivo studies.

Influence of Implant Macro-Design, -Length, and -Diameter on Primary Implant Stability Depending on Different Bone Qualities Using Standard Drilling Protocols-An In Vitro Analysis.

(1) Background: Primary implant stability is vital for successful implant therapy. This study explores the influence of implant shape, length, and diameter on primary stability in different bone qualities. (2) Methods: Three implant systems (two parallel-walled and one tapered) with various lengths and diameters were inserted into polyurethane foam blocks of different densities (35, 25, 15, and 10 PCF) using standard drilling protocols. Primary stability was assessed through insertion torque (IT) and resonance frequency analysis (RFA). Optimal ranges were defined for IT (25 to 50 Ncm) and RFA (ISQ 60 to 80). A comparison of implant groups was conducted to determine adherence to the optimal ranges. (3) Results: Implant macro-design, -length, and -diameter and bone block density significantly influenced IT and RFA. Optimal IT was observed in 8/40 and 9/40 groups for the parallel-walled implants, while the tapered implant achieved optimal IT in 13/40 groups (within a 25-50 Ncm range). Implant diameter strongly impacted primary stability, with sufficient stability achieved in only one-third of cases despite the tapered implant's superiority. (4) Conclusions: The findings highlight the need to adapt the drilling protocol based on diverse bone qualities in clinical practice. Further investigations should explore the impact of these adapted protocols on implant outcomes.

Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report.

Coagulopathy is a well-recognized complication in dental surgery in patients who use oral anticoagulants or some dietary supplements. Proper pre-operative diagnosis, medical consultation, timely management, and conservative treatment can decrease the incidence of such complications. Management of bleeding during dental implant surgery commonly involves conventional methods such as discontinuation of anticoagulant use, compression, styptics, and local anesthetic administration containing vasoconstrictors. This clinical report describes the successful management of a patient with a history of coagulopathy who was rehabilitated with complete arch fixed implant-supported prostheses with immediate loading. A novel implant design with a significantly abbreviated single drill protocol for osteotomy preparation was used in an outpatient setting. The novel protocol successfully decreased the overall bleeding and significantly reduced the intraoperative time for the surgical procedure. Additional considerations related to the novel implant design and osteotomy protocol, supplementary applications, and advantages of the protocol are presented in this article.

Generated heat at implant site during gradual and single-drill protocols among Indian patients.

Excessive heat generation during bone drilling for dental implant placement is a known risk factor for bone necrosis and delayed healing. Therefore, it is of interest to evaluate the maximum change in temperature during and after preparation of the implant site for an implant diameter of 4.2 using gradual drilling and single drilling protocols. Hence, 26 artificial bone blocks with d1 density were divided into two groups where the group I had 13 sites prepared using a single drill and for group II bone blocks, 13 implant sites were prepared with the gradual drill protocol using 5 drills. The drill was done at room temperature with 1500 rpm using constant saline irrigation of 50ml/min. The maximum change in temperature was assessed using an intraoral camera. The data collected were statistically evaluated and results were formulated. Data shows that temperature change was significantly higher in group II where a gradual drill protocol was done compared to group I with a single drill protocol for placing the dental implant of diameter 4.2.Considering its limitations, the present in-vitro assessment concludes that a single drill protocol for preparing an osteotomy site for placing a dental implant of diameter 4.2 generates lesser heat than conventional gradual drilling protocols.

Determining primary stability for adhesively stabilized dental implants

ObjectivesTo examine factors influencing the primary stability of dental implants when stabilized in over-sized osteotomies using a calcium phosphate-based adhesive cement was the objective.MethodsUsing implant removal torque measurements as a surrogate for primary stability, we examined the influence of implant design features (diameter, surface area, and thread design), along with cement gap size and curing time, on the resulting primary implant stability.ResultsRemoval torque values scaled with implant surface area and increasing implant diameters. Cement gap size did not alter the median removal torque values; however, larger gaps were associated with an increased spread of the measured values. Among the removal torque values measured, all were found to be above 32 Ncm which is an insertion torque threshold value commonly recommended for immediate loading protocols.ConclusionThe adhesive cement show potential for offering primary implant stability for different dental implant designs. In this study, the primary parameters influencing the measured removal torque values were the implant surface area and diameter. As the liquid cement prevents the use of insertion torque, considering the relationship between insertion and removal torque, removal torque can be considered a reliable surrogate for primary implant stability for bench and pre-clinical settings.Clinical relevanceAt present, the primary stability of dental implants is linked to the quality of the host bone, the drill protocol, and the specific implant design. The adhesive cement might find applications in future clinical settings for enhancing primary stability of implants under circumstances where this cannot be achieved conventionally.

Assessment of Crestal Bone Loss and Implant Stability of Implant Drilling Protocol at Low Speed without Irrigation versus Conventional Drilling Protocol

Assessment of Crestal Bone Loss and Implant Stability of Implant Drilling Protocol at Low Speed without Irrigation versus Conventional Drilling Protocol