Implant Bed Preparation Research Articles

Heat Generation during Dental Implant Bed Preparation Using Surgical Guides with and without Internal Irrigation Channels Evaluated on Standardized Models of the Alveolar Bone

Dental implant bed preparation involves surgical drilling. Heat generated in this process can cause a temperature elevation beyond the bone damage limit (10 °C), affecting the osseointegration of the implant. Surgical templates ensure accurate implant placement, but they limit the access of the irrigation fluid. This study evaluated the hypothesis that surgical guides with internal cooling prevent bone heating more effectively than classical guides. To eliminate biological variability, this study was conducted on artificial bone pieces that mimic the bone density of the human mandible. We created a surgical template that incorporated four pairs of guides—one classical (CLA) and one with internal cooling (INT) in each pair. For each specimen, we randomly selected the type of surgical guide to start with and performed four osteotomies with a 2.7 mm-diameter drill; then, we widened each hole with a 3.3 mm drill and finalized it with a 3.7 mm drill. The temperature was recorded by thermocouples placed at 0.8 mm from the prospective edge of the final osteotomy. In 168 measurements (12 osteotomies on 14 specimens) conducted for each type of surgical guide, the mean temperature rise was 7.2 ± 4.9 °C (mean ± standard deviation) for CLA and 5.0 ± 3.8 °C for INT. The mean differences between temperature elevations were 1.5 °C, 2.1 °C, and 3.0 °C for the first, second, and third drill, and they were statistically significant: the p-values of Student’s t-test were 0.004, 0.01, and 0.001, respectively. Although the mean temperatures remained safe, temperature rises exceeded 10 °C in 23.8% (9.5%) of the osteotomies performed in the presence of CLA (INT). Taken together, our results suggest that surgical guides with internal cooling ensure a significant drop in the temperature rise caused by implant site drilling.

The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study.

The present study clinically analyzes implant survival of immediate implant placement cases using the drilling through roots (DTR) technique for anatomically-guided implant site preparation, as an aid to placing immediate dental implants in multi-radicular teeth. This clinical analysis utilized patients' electronic dental records who underwent immediate implant surgery using the DTR technique. All immediately placed implants were followed up regularly every year, after restoration. Implant survival was assessed with the Albrektsson et al. criteria. Inferential statistics was performed using SPSS v 21(IBM Corp., Armonk, NY) software. The Kaplan-Meier survival analysis was done to assess the implant survival probability. A total of 250 records of dental implants placed in 227 subjects using the DTR technique were considered. Results showed that the mean survival duration of implants was found 63.29 months and the median survival duration to be 55 months. A 100% success rate was seen in implant fixed bridge cases, and about 97.6% success was seen in single crown cases. No significant difference was seen in the survival rates during the follow-up period when compared according to the quadrants/site of implant placement. The findings concluded that tooth-guided rapid implant placement is a unique strategy for convenient and safe insertion, providing accurate three-dimensional positioning. The DTR method is a novel approach that facilitates accurate positioning and angulation of the implant bed preparation by stabilizing and guiding the osteotomy drills using the retained root. As a result, it enables optimal implant positioning at multirooted extraction sites. How to cite this article: Mahesh L, Miselli A, Bhasin MT, et al. The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study. J Contemp Dent Pract 2024;25(5):432-439.

Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study.

To assess the implant stability and amount of marginal bone loss in immediate implant placement (IIP) in mandibular molars by using pre-extractive interradicular implant bed preparation vs conventional post-extractive interradicular implant bed preparation. This randomized clinical trial was conducted on fourteen patients who had an immediate dental implant at the mandibular molar area by two different techniques. All patients were divided randomly into two equal groups: Group I (control) was treated with conventional post-extractive interradicular implant bed preparation, and group II (test) was treated by pre-extractive interradicular implant bed preparation All surgeries were performed by the same surgeon. All patients were followed up clinically at immediate post-surgery (T0), 7 days (T1), 3 weeks (T2), 90 days (T3), and 3 months after loading (T6) for healing and to evaluate the marginal bone loss radiographically at T0, T3 and T6. Descriptive and bivariate statistics were computed using the SPSS version (SPSS, IBM Inc., Chicago, IL), and p ≤ 0.05 was considered an indicator of statistical significance. A total of 7 female and 7 male patients with a mean age of 32.07 ± 5.87 years. Radiographically, there is no significant statistical difference in comparing between two groups for the marginal bone loss. However, there was a highly significant statistical difference (p < 0.001) in each group between different interval periods (T0, T3, T6) with mean start 5.27 ± 0.53, and 5.19 ± 0.72 at (T0) reaching 7.60 ± 0.89 and 7.09 ± 0.96 at (T3) and slightly decrease of 7.52 ± 0.79 and 7.02 ± 0.79 in (T6) with radiographic evaluation, and it represented clinically in each group with mean 3.57 ± 0.313 and 4.0 ± 0.58 at (T0) increase to 6.55 ± 0.395 and 6.52 ± 0.45 at (T6) for both group respectively. There is no statistically significant difference in soft tissue healing with an average mean of 4.57 ± 0.24 and 3.57 ± 0.509 (p = 0.001) when comparing between both groups respectively. Both techniques seem useful for dental implant placement in badly decayed mandibular molars. However, pre-extracted interradicular implant bed preparation for IIP might offer advantages in terms of primary implant stability and bone preservation. However, further studies are needed to confirm these findings. Both techniques are alternative methods for the treatment of badly decayed mandibular molars by immediate dental implant except for minor complications that do not interfere with dental implant placement. How to cite this article: Alzaibak LMA, Abdel-Monem TM, Elgohary NM, et al. Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(4):303-312.

Effects of intentional early dense‐polytetrafluoroethylene membrane removal on vertical ridge augmentation

AbstractBackgroundVertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium‐reinforced dense polytetrafluoroethylene (TR‐dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality.MethodsA TR‐dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4‐month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum.ResultsThe histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw‐retained crowns were delivered 2 months after implant insertion and the 3.5‐year follow‐up showed perfectly maintained hard and soft tissues.ConclusionsIntentional early removal of TR‐dPTFE membrane after a 4‐month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants.Key points Titanium‐reinforced dense polytetrafluoroethylene (TR‐dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long‐term crestal bone maintenance. Early removal of TR‐dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.

Autologous bone harvested during implant bed preparation: A randomized clinical trial comparing high-speed drilling with irrigation versus low-speed drilling without irrigation.

To compare collected bone weight and the frequency of autologous bone harvesting from the flutes of surgical drills used for implant bed preparation using two different drilling techniques. A comparative evaluation of radiographic bone density and bone quality was also made. A randomized clinical trial was made of 66 dental implants in patients with a single posterior edentulous site. The compared drilling techniques were high-speed drilling with irrigation (control group) and low-speed drilling without irrigation (test group). The bone collected in both groups was dried and weighed with a precise electronic balance. The frequency of harvesting was calculated. The median radiographic bone density of each implant site was measured using cone-beam computed tomography (CBCT) pixel values. Patient sex, age, implant position and dimensions, as well as the last drill diameter were analyzed as independent variables. The level of significance was 5%. The harvesting of bone chips from drill flutes proved possible in 51.5% of the procedures in the control group and in 100% in the test group (p < 0.001). There were also statistically significant differences in bone weight between the control group (6.7 ± 10.6 mg) and the test group (41.9 ± 30.3 mg) (p < 0.001). The CBCT pixel values were directly correlated with the collected bone weight in both groups. The median radiographic bone density, arch and last drill diameter were significantly associated with harvesting bone frequency and collected bone weight (p < 0.05). Our findings suggest that the frequency and weight of autologous bone harvested from drills are greater with low-speed drilling without irrigation than with high-speed drilling with irrigation. Radiographic bone density, arch and last drill diameter also significantly influenced the harvesting outcomes.

A Finite Element Analysis of a Tooth-Supported 3D-Printed Surgical Guide without Metallic Sleeves for Dental Implant Insertion

Static guided surgery for dental implant insertion is a well-documented procedure requiring the manufacturing of a custom-made surgical guide, either teeth-supported, mucosal-supported, bone-supported, or mixed (teeth-mucosal-supported), depending on the clinical situation. The guidance of the surgical drills during implant bed preparation could be undertaken using a sequence of different diameters of metal drill sleeves or, with the sleeves incorporated in the surgical guide, shank-modified drills, both clinically accepted and used with good results. Despite the great number of advantages associated with the use of guided surgery, one of the major risks is guide fracture during drilling for implant bed preparation. Therefore, the aim of the present study was to evaluate the surgical guides without metal sleeves and to simulate, with the aid of Finite Element Analysis (FEA), the use of such dentally supported guides for implant insertion. The FEA is performed in CATIA v5 software after defining the surgical guide mesh material and bone properties. A maximum stress of 6.92 MPa appeared on the guide at the special built-in window meant to allow cooling during drilling, and the maximum value of the guide displacement during drilling simulation was 0.002 mm. Taking into consideration the limits of the current research, the designed tooth-supported surgical guide can withstand the forces occurring during the surgery, even in denser bone, without the risk of fracture.

A Novel Irrigation System to Reduce Heat Generation during Guided Implantology: An In Vitro Study.

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

The impact of surgical guide design and bone quality on heat generation during pilot implant site preparation: an in vitro study

BackgroundSurgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting ‘conventional’ and limiting ‘guided’ surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels.MethodsForty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer’s instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene’s test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05.ResultsThe mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036).ConclusionLimiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range.

Effect of Bovine Milk on Implant Osseointegration: an in vivo Study.

The safety and success of an implant after surgery depend on many factors, some related to the implant's biocompatibility, properties, surface modification, design, and other factors related to surgical procedures, implant bed preparation, and drilling techniques. It is recognized that the success of implant dentistry depends on several factors that may be related to biochemical properties and modification in mechanical properties. The present study aimed to assess the effect of using bovine milk as an irrigant solution on implant osseointegration. The implant socket was prepared by drilling bone holes in 20 femurs of the rabbits at steady rotation speeds with different irrigate solutions (normal saline / commercial pasteurized bovine milk). Mechanical tests and histological investigation were performed to estimate the removal torque record and implant contact area, BIC. Findings illustrate that implant contact area (BIC) and removal torque mean values are higher in experimental compared to control with more bone apposition and maturation at 4&8 week measured periods. Osseointegration is accelerated by using bovine milk in irrigation and rinsing of implant socket.

COMPARATIVE EVALUATION OF CRESTAL BONE LEVEL IN RELATION TO IMPLANTS PLACED USING CONVENTIONAL OSTEOTOMES AND BONE EXPANSION SCREWS

BACKGROUND AND OBJECTIVES: The comparison of crestal bone loss in relation to implants placed using conventional drilling osteotomy method and using bone expansion screws in maxillary region. METHODS: The crestal bone loss was measured after implant placement and after a period of six months, and the results analyzed. Equal number of male and female patients of comparable age group who opted implant treatment were selected.RESULTS AND DISCUSSION: After a period of six months of implant placement, a mean value of 1.37 mm of crestal bone loss was noticed for implants placed using conventional osteotomy method while a mean of 0.73 was noticed in relation to implants placed using expansion screws.CONCLUSION: The implants placed using bone expansion screws show less crestal bone loss compared to implants placed using conventional osteotomy method in maxillary edentulous ridge having less than ideal bone width. It infers that the bone expansion method using expansion screws is more reliable and relatively noninvasive way of implant bed preparation.

Effect on implant drills and postoperative reactions for pre-extraction interradicular implant bed preparation during the COVID-19 pandemic and beyond.

The aim of the present study was to observe the abrasion of implant drills and postoperative reactions for the preparation of the interradicular immediate implant bed during the COVID-19 pandemic and beyond.Thirty-two implant drills were included in four groups: blank, improved surgery, traditional surgery, and control. In the improved surgery group, a dental handpiece with a surgical bur was used to decoronate the first molar and create a hole in the middle of the retained root complex, followed by the pilot drilling protocol through the hole. The remaining root complex was separated using a surgical bur and then extracted. Subsequently, the implant bed was prepared. Implant drills were used in the traditional surgery group to complete the decoronation, hole creation, and implant-drilling processes. The tooth remained intact until the implant bed was prepared. The surface roughness of the pilot drill was observed and measured. Surgery time, postoperative reactions (swelling, pain, and trismus), and fear of coronavirus disease 2019 scale (FCV-19S) were measured and recorded, respectively.Statistical analysis revealed significant difference with surface roughness among blank group (0.41 ± 0.05 μm), improved surgery group (0.37 ± 0.06 μm), traditional surgery group (0.16 ± 0.06 μm), and control group (0.26 ± 0.04 μm) (P < .001). Significant differences were revealed with surgery time between improved surgery group (5.63 ± 1.77 min) and traditional surgery group (33.63 ± 2.13 min) (P < .001). Swelling, pain, and trismus (improved group: r ≥ 0.864, P ≤ .006; traditional group: r ≥ 0.741, P ≤ .035) were positively correlated with the FCV-19S.This study proved that a new pilot drill could only be used once in traditional surgery but could be used regularly in improved surgery. Improved surgery was more effective, efficient, and economical than the traditional surgery. The higher FCV-19S, the more severe swelling, pain, and trismus.

Effect of osseodensification on the increase in ridge thickness and the prevention of buccal peri-implant defects: an in vitro randomized split mouth pilot study

BackgroundImplant installation with conventional drilling can create buccal bone defects in areas of limited ridge thickness. Implant installation with osseodensification may aid in preventing buccal bone defects in these situations. This in vitro pilot study evaluated the impact of osseodensification on the increase in alveolar ridge thickness and the prevention of buccal peri-implant defects.MethodsTen fresh pig mandibles with limited bone thickness were selected for use in an experimental randomized split mouth pilot study. Two site-preparation protocols were used: conventional drilling with cutting burs (CTL, n = 10) and osseodensification with Densah® burs (OD, n = 10). After implant bed preparation, 20 implants (4.5 × 10 mm) were placed in the prepared sites and the insertion torque was recorded. Clinical and photographic analysis evaluated ridge thickness and the extent (height, width, and area) of bone defects in the buccal and lingual bone walls following implant placement. Three-dimensional measurements were performed using STL files to analyze the increase in buccal ridge thickness following site preparation and implant placement. The height of the buccal bone defect was considered as the primary outcome of this study. Defect width, area, implant insertion torque, and linear buccal ridge increase after implant site preparation and installation were also assessed. Non-parametric evaluations were carried out with the Mann–Whitney test to verify intergroup differences.ResultsThere was no statistically significant difference between groups in the baseline ridge thickness. OD presented a significantly higher insertion torque, associated with reduced buccal and lingual bone defect width, in comparison to CTL.ConclusionsThe increase in buccal ridge thickness after site preparation and implant placement was significantly higher in OD compared to CTL. Osseodensification increased the ridge thickness through expansion and reduced buccal bone defects after implant installation.

Case Report: Combining Molar Interradicular Osteotomy With Immediate Implant Placement: A Three-Year Case-Series Study

Background: Immediate implant placement in the area of multirooted molars includes many anatomical challenges, particularly with osteotomy preparation in the interradicular bone.Methods: In this article, we are reporting ten cases in which implant beds were prepared before root extraction. After coronectomy, pre-extractive interradicular implant bed preparations were performed through the retained root complexes. A dimple in the roof of the furcation was created using a no. 8 round surgical bur. The osteotomies were then completed through the tooth’s initially retained root complex in the regular sequence of drilling. Before implant placement, the remaining root segments were removed. The retained root parts guided the osteotomy drills and allowed for precise positioning and angulation of the implant bed preparation with respect to the emergence profile of the tooth.Results: Data from a 3-year follow-up of the crestal bone showed good bone levels in relation to the implant platform.Conclusion: The technique described permitted accurate implant placement in the prepared osteotomy, thus enabling immediate implant positioning in multirooted extraction sites.

Peculiarities of acetabulum morphology determining the technology of pelvic prosthesis component implantation

Introduction. The most effective method of treatment of patients with severe forms of coxarthrosis is endoprosthetics, the success of which directly depends on the correctness of preoperative planning based on knowledge of the morphology of the acetabulum in normal and pathological conditions. The aim of the investigation was to reveal the morphological features of the acetabulum in osteoarthritis of the hip joint, determining the technology of implant bed preparation for the prosthesis cup. Materials and methods. The study was conducted on 19 macerated pelvic preparations and 72 direct projection pelvic radiographs in 72 patients with stage III osteoarthritis of different etiology aged from 41 to 70 years (61.5 ± 1.4). Hyperplastic coxarthrosis was observed in 21 (29.2%), protrusion in 23 (31.9%), and dysplastic in 28 (38.9%) cases. Clinical, radiological, morphometric, and statistical methods of investigation were used. Methods of descriptive statistics were used. Results. The following data were obtained during morphometric studies: In hyperplastic coxarthrosis, the bottom thickness was 11.9±1.83 mm with an acetabular index (IVI) of 0.51±0.019; in protrusion coxarthrosis, the bottom thickness was significantly reduced and was 5.7 ± 0.93 mm, IVI of 0.66 ± 0.039; in dysplastic coxarthrosis, the bottom thickness was 14.5 ± 1.18 mm, IVI 0.42 ± 0.024 respectively. Discussion. Studies on acetabulum morphometry are being conducted worldwide; among residents of different countries, data on the depth of the acetabulum differ, the morphometric data obtained by us are relevant in terms of the variational anatomy of the population of the Ural region. The morphological features of acetabulum affect the technology of preparing the implant bed for the prosthesis cup, so the preoperative design of implantation is relevant. The proposed method of finding the center of rotation of the deformed acetabulum makes it possible to determine the required thickness of augments to compensate for bone defects in the area of the acetabulum floor and arch. Conclusions. The morphological features of the acetabulum in hyperplastic, dysplastic, and protrusion coxarthrosis determine the technology of implant bed preparation for a prosthetic cup.

Wedge Shaped vs Round Implants: Bone Strain During the Insertion Process.

A novel implant system resembling the shape of a wedge and employing piezosurgery for implant bed preparation has been introduced with the aim of solving the problem of horizontal bone deficiency. This in vitro study compared emerging bone strain during insertion of a conventionally round implant vs the wedge implant. Adhering to the manufacturers' protocols, implant surgery was performed in polyurethane foam blocks equipped with strain gauges attached to the buccal and occlusal surfaces. Five implants per group were placed while strain development during insertion was recorded. Primary implant stability was determined using resonance frequency analysis. Statistical analysis was based on Welch's 2-sample tests (α = 0.05). In general, greater strain development was found on the buccal aspect of bone compared to the occlusal aspect with an overall range between -724 μm/m and 9132 μm/m. A stepwise increase in strain development was seen in the wedge implants while, in the round implants, a continuous increase in strain development was recorded. Absolute strain development on the buccal aspect of bone was significantly greater in wedge implants (P = .0137) while, on the occlusal aspect, significantly lower strain development was seen for wedge implants (P = .0012). Primary stability of wedge implants was significantly lower compared to round implants (P = .0005). Wedge implants differ from round implants with respect to the insertion process characterized by a stepwise increase in bone deformation. High strain development in buccal bone may constitute a risk factor for bone resorption and should be avoided by reducing the degree of underpreparation of the implant site.

The Assessment of the Maximum Heat Production and Cooling Effectiveness of Three Different Drill Types (Conical vs. Cylindrical vs. Horizontal) during Implant Bed Preparation—An In Vitro Study

The aim of this experimental study was to verify thermal diffusion differences, by measuring the maximum temperature achieved with different drill shapes. Synthetic bone blocks of type I density made from solid rigid polyurethane (PUR) foam were used to perform the drilling procedures. The experiment was conducted at three different rotation speeds: 800, 3000 and 5000 rpm. Conical drills (with and without an internal cooling hole) were compared with horizontal drills and disc drills. The temperature during drilling for implant bed preparation was estimated with the use of thermocouples and an infrared (IR) camera. The temperature during drilling with disc cutters for lateral basal implants did not exceed 33 ∘C and the temperature decreased in proportion to higher drill speed. The results indicate that the tested design is safe and will not cause bone overheating.

An immediate implant placement technique to rehabilitate multi-rooted teeth by pre-extraction interradicular implant bed preparation using remaining roots as a guide: A case presentation

The introduction of osseointegrated implants have revolutionized the art and science of modern dentistry giving a new lease of life to the restorative aspects in day-to-day practice. Immediate loading (IL) of dental implants can significantly decrease treatment time and thus increase patient acceptance. IL of dental implants has recently gained popularity due to several factors including reduced trauma as well as aesthetic and psychological benefits to the patient. The present case report describes the immediate replacement of partially edentulous maxilla using Nobel Active™ implant. It describes about the diagnosis, treatment planning and procedures involving the placement of single tooth immediate implant followed by uneventful healing.

Osseodensification enables bone healing chambers with improved low-density bone site primary stability: an in vivo study

Primary implant stability is a prerequisite for successful implant osseointegration. The osseodensification technique (OD) is a non-subtractive drilling technique that preserves the bone tissue, increases osteotomy wall density, and improves the primary stability. This study aimed to investigate the hypothesis that OD, through a wider osteotomy, produces healing chambers (HCs) at the implant-bone interface without impacting low-density bone primary stability. Twenty implants (3.5 × 10 mm) with a nanohydroxyapatite (nHA) surface were inserted in the ilium of ten sheep. Implant beds were prepared as follows: (i) 2.7-mm-wide using subtractive conventional drilling (SCD) technique (n = 10); (ii) 3.8-mm-wide using an OD bur system (n = 10). The sheep were randomized to two groups, with samples collected at either 14-(n = 5) or 28-days (n = 5) post-surgery and processed for histological and histomorphometric evaluation of bone-implant contact (BIC) and bone area fraction occupancy (BAFO). No significant group differences were found with respect to final insertion torque and implant stability quotient (p > 0.050). BIC values were higher for SCD after 14 and 28 days (p < 0.050); however, BAFO values were similar (p > 0.050). It was possible to conclude that the OD technique allowed a wider implant bed preparation without prejudice on primary stability and bone remodeling.

Assessment of Bone Regeneration Using Tooth Ash and Injectable Platelet Rich Fibrin: A Microcomputed Tomographic (CT) Analysis

Introduction: One of the main challenge of bone graft or socket preservation in particular is to get good quality and quantity of bone in short time prior to implant bed preparation. The buccal bone at the crest of the ridge is a very thin bone and usually resorb faster than the rest of alveolar bone which may hinder an optimum dento-osseous implant insertion. The purpose of this study will be to assess the bone regeneration capabilities of Tooth Ash Particles (TAP) with injectable Plasma Rich Fibrin (i-PRF) and Tooth Ash Particles (TAP) alone at defects created in the goat mandible bone using micro-computed tomographic (micro-CT). Materials and Methods: A total, 54 bone defect (5 mm × 8 mm) were performed in the 18 goats. The created defect received different treatment (Tx): Tx.A: Unfilled defect (allow natural bone regeneration; Tx.B: Tooth Ash particle (TAP) alone; Tx.C: Tooth Ash + injectable PRF (TAP/i-PRF). Six goats, were sacrificed at different time points:Group 1: at 2nd week, Group2: at 5th week and Group3 at 8th week. The newly formed bone (NFB) was analyzed using micro-CT at different time points. Quantitative and qualitative assessment were carried out namely; the volume of new bone formation (NF-BV) within the defect and its mineral density (NF-BMD), Trabecular Thickness (Tb Th), Trabecular Number (Tb N) and Trabecular Separation (Tb Sp). Result: By 8th week, the mean NF-BV was 69.482 ± 6.554 mm3 (cubic millimeter), 65.872±6.804 mm3, 26.820±14.643 mm3, while the mean NF-BMD was 0.417±0.119g/mm3, 0.786±0.036 g/mm3, 0.805±0.033 g/mm3 for the defects which received Tx.C, Tx.B and Tx.A respectively. At 8th weekTb Th of NFB was 0.612±0.168, 0.913±0.112, and 0.701 ±0.126, Trabecular Number of NFB was 2.062±0.946, 1.002±0.155, and 1.816±2.042 and, Trabecular Separation of NFB was 0.330 ±0.131, 0.559 ±0.110, and 0.495 ±0.258 for the defects which received Tx.A, Tx.B and Tx.C respectively. Conclusion: Micro-CT study demonstrated that tooth ash particles mixed with injectable Platelet Rich Fibrin (i-PRF) on mandibular bone defect in goat’s model, resulting in new bone with significantly higher volume, mineral density and less remodeling rate when compared with normal bone regeneration of unfilled defects.

Intra-osseous heat generation during implant bed preparation with static navigation: Multi-factor in vitro study.

To compare the intra-osseous temperature reached during bone drilling for dental implant placement using open versus closed static surgical guides and evaluate the influence of bone density, osteotomy drilling depth, and irrigation fluid temperature. 960 osteotomies were performed with 2mm pilot drills in 16 solid rigid polyurethane foam blocks. Two main variables were considered: the guide type (open or closed guide) and bone density (hard (D1) or soft (D4). The blocks were divided into four groups according to the type of surgical template and bone density as follows: group one: closed guide and hard bone; group two: open guide and hard bone; group three: closed guide and soft bone; and group four: open guide and soft bone. A combination of different experimental conditions was used, including different bone osteotomy depths (6 or 13mm) and irrigation fluid temperatures (5°C or 21°C). The highest mean temperature was found in group one (28.29±4.02°C). In the soft bone groups (three and four), the mean maximum temperature decreased compared to groups one and two (dense bone) and was always higher with closed guides (23.38±1.92°C) compared to open guides (21.97±1.22°C) (p<.001). The osteotomy depth and irrigation fluid temperature also significantly influenced the bone temperature (p<.001), especially in hard bone. The greatest heat generation was observed in high-density bone. The final intra-bone temperature was about 1°C higher with a closed static surgical guide than with an open guide. The heat generation in osteotomy sites was substantially reduced by cooling the irrigation fluid to 5°C.