Implant Bed Preparation Research Articles

The Influence of Various Preparation Parameters on the Histological Image of Bone Tissue during Implant Bed Preparation—An In Vitro Study

The purpose of this study was to present the level of bone tissue deformation after drilling under variable conditions in three different dental implant systems in a microscopic analysis. Straumann, Osstem, and S-Wide systems were used to drill boreholes in 27 porcine ribs at three different rotation speeds and under three different cooling conditions. The material was analyzed using a Nikon 80i microscope. The analysis concerned the morphological quality of the obtained boreholes. The statistical analysis revealed that satisfactory results in all drilling systems were obtained when the rotational speed did not exceed 800 revolutions per minute (rpm) regardless of the cooling temperature. However, increased rotational speed and cooling at 4 °C produced better results than without cooling in all the tested systems. Different implant systems have unique drill geometry and therefore generate differences in tissue damage under various conditions. In the experiment, a sufficient required structure was obtained in all systems, but the Straumann system yielded the best results under all the examined conditions.

An In Vitro Evaluation of Primary Stability Values for Two Differently Designed Implants to Suit Immediate Loading in Very Soft Bone.

The achievement of sufficient implant stability in poor quality bone seems to be a challenge. Most manufacturers develop special dental implants, which are claimed to show higher stability even in very soft bone. The aim of this experimental study was to compare two recently introduced dental implants with differing thread designs. A total of 11 implants of each group were inserted in the part of the fresh bovine ribs, corresponding to very soft bone. The primary stability was measured with resonance frequency analysis (RFA) and Periotest; the average of two measurements for each method and for each implant was taken and statistical analysis was applied. The highest stability values were obtained with the ICX Active Master implants, followed by the Conelog® Progressive-Line implants placed with the very soft bone protocol. The primary stability values of the Conelog® Progressive-Line implants inserted by the very soft bone protocol and the ICX Active Master implants placed with the standard protocol showed sufficient stability for immediate loading in low-density bone. Within the limitations of this study, the thread design of the implants and underdimensioned implant bed preparation seem to be effective for better primary stability in cancellous bone.

A Comparative Analysis Regarding the Osseointegration of Immediate Loaded Implants Using Two Different Implant Site Preparations: Erbium:Yttrium-Aluminum-Garnet Laser Versus Surgical Conventional Way-An In Vivo and Histological Animal Study.

Objective: The aim of the study is to evaluate the possibility of preparing the implant site using the erbium:yttrium-aluminum-garnet (Er:YAG) laser scanner prototype and to reduce and/or eliminate time between primary (mechanical) stability and secondary (biological) stability, looking to the immediate occlusal loading in a single implant. Background: A prerequisite for successful osseointegration is the establishment of direct bone-to-implant contact without interposition of nonbone or connective tissue. In recent years, the use of laser radiation was presented as an alternative/adjunctive treatment for bone tissue ablation due to vaporization of the tissues in the absence of a smear layer. Methods: The experimental protocol included six minipigs, which underwent tooth extraction, followed (after 2 months) by implant bed preparation in two methods: using a conventional bur kit and using an Er:YAG laser scanner (X runner) protocol. Four implants were placed in positions 34, 37, 44, and 47 on each animal. The animals underwent the second surgical procedure for bone sample collection (including the implant) before their sacrifice at 45-60-90-120 days. The newly formed bone was evaluated on the bone samples using histological examination and quantitative evaluations of different histological parameters based on microscopical analysis. Results: The results that we obtained allow some interesting comparison in terms of different bone composition, depending on the method of implant site preparation and on healing periods. Moreover, it was possible to compare the bone composition, at different time stages, of implant sites prepared in the same way. Conclusions: Our research allowed us to demonstrate that the use of Er:YAG laser compared with traditional drill leads to the presence of a greater share of lamellar bone and a lower necrotic share in the implant site. We also showed the possibility of applying immediate occlusal loading on an in vivo animal model.

Comparison of different surgical procedures on the stability of dental implants in posterior maxilla: A randomized clinical study

BackgroundStability of a dental implant is very important when planning immediate loading and design of a final restoration. The aim of this study was to compare the primary and the secondary stability of dental implants inserted by three different surgical techniques: conventional (standard) technique using a sequence of drills for implant bed preparation, osteotome technique using tapered hand instruments for creating implant sites by condensing the bone and guided flapless implant surgery with surgical templates. Material and methodsThe study included 150 patients (80 males and 70 females), 46–71 years old, who required implant supported fixed partial dentures in the posterior maxilla of D3 or D4 bone density. Patients were randomly assigned into one of the three surgical insertion technique groups. All patients received tapered implants of the same manufacturer of the same length and two different widths (3.3 × 11.5 mm or 4.2 × 11.5 mm). Primary and secondary implant stability were measured by means of resonance frequency analysis (RFA) at the time of implant placement and 5 months after surgery using the Ostell ISQ device (Osstell AB, Sampgatan, Goteborg, Sweden). Statistical analysis included one-sample Kolmogorov Smirnov test, descriptive statistics, multivariate analysis (Bonferoni post-hoc tests) and paired t-tests. ResultsPatients in the osteotome group exhibited higher primary stability (P < 0.01) than in the conventional and surgically guided flapless groups. There were no significant differences in the secondary stability (p > 0.05). Wider implants presented higher ISQ values (P<0.01). ConclusionThe osteotome technique led to the highest implant primary stability, therefore it can be recommended when immediate loading is planned or for one-piece implant insertion.

The effect of platelet-rich fibrin on the acceleration of osteoblast proliferation after endosseous dental implant insertion

The osseointegration process of dental implants begins with osteoblast differentiation and proliferation, which is an important aspect of the bone regeneration process. Platelet-rich fibrin (PRF) is a platelet that contains a large amount of fibrin and growth factor, which is widely used to accelerate bone regeneration. This study aims to determine the effect of PRF on the acceleration of osteoblast proliferation after endosseous dental implant insertion. Twelve male Wistar rats weighing 250 to 300 gr of 8 to 15 weeks as an animal model were divided into two groups, the control group and treatment group, based on days and PRF treatment. Three ml of Wistar rat blood was obtained and centrifuged for 12 minutes at a speed of 2700 rpm to make PRF. Afterward, platelet-rich fibrin was applied to implant bed, and the dental implant was inserted at the lateral epicondyle of the right femur in 3 mm depth and 1.8 mm diameter dimension. Incontrol groups, dental implants were immediately inserted after implant bed preparation without PRF administration. Observation of the Wistar rats was carried out on days 14 and 28 for each group. The rats were terminated accordingto the timeline of group design. The epicondylus lateralis femoris dextra bone of the rats was taken and fixed with 10% buffered formalin solution. Then, histological samples were made with hematoxylin-eosin staining. Sample observation was done under a light microscope to calculate the number of osteoblasts. The data were analyzed using the two-way ANOVA test, followed by LSD post hoc test. Based on the two-way ANOVA test, there was a significant difference between control groups and treatment groups (p&lt;0.05), and there were significant differences between the observation result of days 14 and 28 (p&lt;0.05). The application of PRF increased osteoblast proliferation for the first 14 days, but the rate decreased after that. Based on the LSD post hoc test, there were differences in osteoblast proliferation between the treatment and control group (p&lt;0.05). Thus, it is concluded that platelet-rich fibrin increased the acceleration ofosteoblast proliferation after endosseous dental implant insertion.

In Vitro Evaluation of the Primary Stability of Short Implants in Different Surgical Techniques.

This study was designed to evaluate the effects of four different surgical techniques on the primary stability of short implants in two sizes (4-mm and 6-mm length) through resonance frequency analysis and insertion torque measurement in vitro. Forty implant site preparations and implant insertions were performed in pig ribs. Guided surgery, bone condensing, conventional drilling, and undersized preparation surgical techniques were used five times in each bone block to prepare 4-mm/6-mm-length implant beds. The maximum insertion torque and implant stability quotient (ISQ) values were recorded for each implant. Both the ISQ and torque differed significantly for various surgical techniques (P = .009 and P < .001). The conventional technique had higher ISQ (79.00), whereas the condenser technique had higher torque (48.00 Ncm) than did the other techniques. The mean torque was significantly higher in all surgical techniques other than the guided surgery group regardless of implant length (P < .01 for all). Implant lengths were not significantly different in terms of ISQ and torque in all surgical techniques. There are significant correlations between the implant bed preparation technique and primary implant stability when using short implants. Conventional surgery and the bone condensing technique are favorable alternatives with higher primary stability and torque values in short implants.

Implant removal using thermal necrosis\u2014an in vitro pilot study

ObjectivesThe purpose of this pilot porcine cadaver study was to evaluate the feasible temperature thresholds, which affect osteocyte viability and bone matrix in a preclinical setup, assessing the potential of thermal necrosis for implant removal for further in vivo investigations.Materials and methodsAfter implant bed preparation in the upper and lower jaw, temperature effects on the bone were determined, using two tempering pistons with integrated thermocouples. To evaluate threshold temperature and time intervals leading to bone necrosis, one piston generated warm temperatures at 49 to 56 °C for 10 s and the other generated cold temperatures at 5 to 1 °C for 30 s. Effects were assessed by a semi-quantitative, histomorphometrical scoring system, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and transmission electron microscopy (TEM).ResultsThe bone matrix was significantly degenerated starting at 51 °C for 10 s and 5 °C for 30 s. The osteocyte condition indicated significant bone damage beginning at cold temperatures of 2 °C. Temperature inputs starting at 53 °C led to decalcification and swollen mitochondria, which lost the structure of their inner cristae.ConclusionsThis study identified temperatures and durations, in both heat and cold, so that the number of samples may be kept low in further studies regarding temperature-induced bone necrosis. Levels of 51 °C for 10 s and 5 °C for 30 s have presented significant matrix degeneration.Clinical relevanceTemperature thresholds, potentially leading to thermo-explantation of dental implants and other osseointegrated devices, were identified.

Pre-Extractive Inter-Radicular Implant Bed Preparation versus Conventional Post-Extractive Inter-Radicular Implant Bed Preparation in Mandibular Molars

Aim: to assess the implant stability and amount of crestal bone loss in immediate implant placement in mandibular molars by using pre-extractive inter-radicular implant bed preparation versus conventional post-extractive inter-radicular implant bed preparation. Subjects and Methods: Twenty patients (5 males, 15 females), suffering from badly decayed vital or non-vital posterior mandibular molar teeth were selected and randomly divided into 2 groups, 10 per group; the first group received Pre-extractive interradicular implant bed preparation while the second group received Conventional post-extractive interradicular implant bed preparation. Results: immediateImplant stability results that assessed using Osstell device measuring ISQ values between groups were (58±0.81 ISQ units) for the test group and (54.6±1.07 ISQ units) for the control group at immediate implant placement which represent significant differences (p<0.001). marginal bone loss results of mesial and distal bones between one-year and six-months’ post-operative implant placement were (0.21 ±0.09 mm) in the test group and (0.37±0.17 mm) in the control group and marginal bone loss results of buccal and lingual bones between same periods were (0.21 ±0.04 mm) in the test group and (0.42±0.21 mm) of the control groups with significant differences of (p=0.022*) in mesial and distal bone loss and (p=0.006*) in buccal and lingual bone loss between groups. Conclusion: Implants that placed by pre-extractive inter-radicular implant bed preparation had a high primary stability and a less marginal bone loss in both bucco-lingual and mesio-distal dimensions from six-months to one-year than that placed by post-extractive inter-radicular implant bed preparation.

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls.

The goal of this study was to evaluate the effects of two implant bed preparation techniques on the implant primary stability (IPS) and the bone density of the implant site. We completed 40 implant bed osteotomies in pig ribs using two techniques: osseodensification (OD) plus under-drilling (UD) with universal osseodensification drills (Test A), and under-drilling alone with drills of the same implant system (Test B). Implants with a 4.1 mm diameter and 10 mm length were inserted, and the IPS was evaluated with three methods: (insertion torque (IT), periotest (PTV), and resonance frequency analysis (RFA). The bone density was evaluated using micro-computed tomography. ANOVA and Tukey’s post-hoc test were used for comparison of the IPS values, and Kruskal–Wallis was used to evaluate the bone density. Statistical significance was set at p < 0.05. The tested B technique (UD) achieved a higher IPS compared to the Test A technique (OD + UD) for all the evaluation methods (p < 0.05). Bone density was higher at the apical and middle region in Test A compared to Test B and control sites (p < 0.05). We concluded that although the bone density increased with the hybrid OD technique with universal drills, implant beds prepared with UD using drills with geometry similar to that of the implant are more efficient at increasing IPS values.

Root Guided Immediate Implant Placement at Mandibular Molar Site: A Case Report

With the advancement in science and technology, Immediate implant placement has become a widely used and well accepted alternative to traditional treatment protocols. Post extraction implant placement in multicoated molar area is challenging. The primary stability in molar areas is achieved by engaging the interradicular bone but slipping of osteotomy drill to mesial or distal root socket during implant bed preparation is the main problem in post extraction immediate implant placement. Use of surgical guide, pre- extractive interradicular implant bed preparation and the combination of both these techniques has been used to overcome the problem related to immediate implant placement at molar sites. This paper presents an alternative approach in immediate Implant placement in multi rooted molar area that uses the anatomy and morphology of roots in guiding the osteotomy to provide an ideal3-dimensional implant positioning.

Bone expansion and bone condensation – Alternative techniques for maxillary implant bed preparation

Background Maxillary alveolar ridge resorption with a consequential width reduction and limitation of drilling into an atrophic ridge present a frequent problem in implantology. In such cases bone expansion and bone condensation, prior to dental implant placement, make additional surgical augmentation unnecessary especially in patients who refuse augmentation. D-shaped bone expanders, with an increasing diameter, push the alveolar cortical bone laterally by separating the labial and palatal lamellae. Aim/Hypothesis To show advantages and disadvantages of bone expansion and condensation in gaining the horizontal dimension of the maxillary alveolar ridge on four patients. The purpose was to show how the bone condensers, due to the rounded profile, after bone expansion, adjust the bed for implant placement. Material and Methods Dental implant bed was prepared in all patients using bone expanders and bone condensers. Case 1- a year after tooth 24 was extracted, alveolar width and height was 3 and 17 mm. Case 2- teeth 24 and 25 were extracted after several apicoectomies. The gap between implants and between implants and bone was filled with a particulated xenograft. Case 3- socket preservation was performed after the extraction of a fausse-routed tooth 22. During the healing period, a temporary Maryland bridge was provided. Case 4- the bilateral sinus-lift was performed and bone-grafts placed due to insufficient alveolar width. Six months later, bone showed low resistance during pilot drilling. During the implant bed preparation the graft had detached. Nevertheless, six implants were inserted and bone graft was fixed by screws. In all patients Ankylos implants (Dentsply Sirona, Germany) were inserted, and resorbable membranes and particulated xenograft were used (Bio-Gide® and Bio-Oss®, Geistlich, Switzerland Results In all patients a poorly structured bone showed low resistance during pilot drilling. All the implants were inserted six months after teeth extractions and implant beds were prepared using bone expanders and bone condensers. All implants were loaded six months after insertion. After a five-year follow-up period, satisfactory functionality and esthetics were observed in all four cases. Conclusion and Clinical Implications Bone expansion and condensation are valuable alternative techniques for implant insertion into maxillary alveolar ridge with compromised width. Poorly structured bone shows low resistance during pilot drilling. Thereby, instead of drilling, bone expanders can provide adequate bone width allowing that the implant bed is created by condensation. Both procedures can ensure bone dimensions to the adequate diameter of the planned implant. The healing phase should last up to six months (after these procedures).

Ultrasonic vs Drill Implant Site Preparation: Post-Operative Pain Measurement Through VAS, Swelling and Crestal Bone Remodeling: A Randomized Clinical Study.

Background: Piezosurgery is a surgical procedure that is able to perform osteotomies by a micrometric and selective cut of the bone tissue. The objective of this investigation was to evaluate two different techniques; an ultrasonic device, and a drill approach for implant site preparation. Methods: A total of fifty patients were recruited for the randomized clinical trial to receive dental implants for fixed prosthetic restoration in the posterior mandible and were allotted to two groups. In Group A the implant site was prepared following a drilling technique, while in Group B the implant site was prepared using an ultrasonic device; moreover, the operative duration was recorded. Postoperative pain and swelling were evaluated at 1, 2, 4, and 6 days. The crestal bone resorption was measured at 3 months from implant placement by a three-dimensional tomography evaluation. Results: The findings suggest that osteotomies performed by an ultrasonic device cause less pain and swelling. On the other hand, the piezoelectric preparation was characterized by a significative increase in the operative time. No statistical differences in crestal bone resorption were evident in the two different approaches. Conclusions: According to the outcome of the study, ultrasonic implant bed preparation can be used with success in implantology and could be considered a suitable alternative to traditional drilling techniques for dental fixture placement.

Potential Causes of Titanium Particle and Ion Release in Implant Dentistry: A Systematic Review.

Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.

PC440: Pre‐extractive interradicular implant bed preparation: a case report

PC440: Pre‐extractive interradicular implant bed preparation: a case report

The Bone Core Technique for the Augmentation of Limited Bony Defects: Five-Year Prospective Study with a New Minimally Invasive Technique.

The aim of this study was to evaluate a new minimally invasive surgical technique for the reconstruction of critical-size bony defect with local harvested bone core with simultaneous implant placement. In a prospective study, 186 consecutively treated patients were included and controlled clinically and radiologically for at least 5 years postoperative. Every patient presented a bony defect affecting the buccal, lingual, or palatal wall. In all cases, the alveolar crest was wide enough to allow implant placement inside the bony contours. During implant bed preparation, a trephine bur (3.5 mm external diameter and 2.5 mm internal diameter) was used to harvest a bone core from the socket. After implant insertion, the buccal/palatal/lingual bony defect was grafted with bone chips covered with the bone core stabilized through compression with microscrews. After 3 months of healing, the implants and the grafted bone were exposed and the width of the grafted area was measured. After prosthetic restoration, the patients were recalled regularly. A total of 223 grafted sites were documented. Minor primary healing complications were observed in 3 sites (1.4%), all in smoker patients, and were treated locally without any influence on the prognosis. All other sites healed uneventfully. In 19 cases (4.4%), exposure of the screw heads was detected 1 to 3 months postoperatively without any inflammation or consequences for the grafted bone. The average width of the reconstructed area at the end of the grafting procedure was 2.4 ± 0.8 mm, and at the reentry, 2.1 ± 0.6 mm. There was a difference of remodeling between bone cores grafted totally inside or partially outside the bony contours. Bone cores grafted completely inside the bony contours demonstrated no resorption at 3 months postoperative, while bone cores grafted partially outside the bony contours in most cases showed partial resorption of the bone outside the bony contours. After 3 months of healing, all 223 implants had achieved primary healing and osseointegration and were restored after an average time of 4 months. No implant failed during the control period. According to this study, the use of an autogenous bone core harvested during the implant bed preparation is a simple and safe method for the reconstruction of small bone defects.

Pose determination of a blade implant in threedimensions from a single two-dimensional radiograph.

The aim of the study was to introduce a mathematical method to estimate the correct pose of a blade by evaluating the radiographic features obtained from a single two-dimensional image.Blade-form implant bed preparation was performed using the piezosurgery device, and placement was attained with the use of magnetic mallet. The pose determination of the blade was described by means of three consecutive rotations defined by three angles of orientation (triplet φ, θ and ψ). Retrospective analysis on periapical radiographs was performed. This method was used to compare implant (axial length along the marker, i.e. the implant structure) vs angular correction factor (a trigonometric function of the triplet). The accuracy of the method was tested by generating two-dimensional radiographic simulations of the blades, which were then compared with the images of the implants as appearing on the real radiographs. Two patients had to be excluded from further evaluation because the values of the estimated pose angles showed a too-wide range to be effective for a good standardization of serial radiographs: intrapatient range from baseline to 1-year survey was > of a threshold determined by the clinicians (30°). The linear dependence between implant (CF°) and angular correction factor (CF^) was estimated by a robust linear regression, yielding the following coefficients: slope, 0.908; intercept, -0.092; and coefficient of determination, 0.924. The absolute error in accuracy was -0.29 ± 4.35, 0.23 ± 3.81 and 0.64 ± 1.18°, respectively, for the angles φ, θ and ψ. The present theoretical and experimental study established the possibility of determining, a posteriori, a unique triplet of angles (φ, θ and ψ) which described the pose of a blade upon a single two-dimensional radiograph, and of suggesting a method to detect cases in which the standardized geometric projection failed. The angular correction of the bone level yielded results very close to those obtained with an internal marker related to the implant length.

The effects of the Er:YAG laser on trabecular bone micro-architecture: Comparison with conventional dental drilling by micro-computed tomographic and histological techniques

Background: The use of lasers has become increasingly common in the field of medicine and dentistry, and there is a growing need for a deeper understanding of the procedure and its effects on tissue. The aim of this study was to compare the erbium-doped yttrium aluminium garnet (Er:YAG) laser and conventional drilling techniques, by observing the effects on trabecular bone microarchitecture and the extent of thermal and mechanical damage. Methods: Ovine femoral heads were employed to mimic maxillofacial trabecular bone, and cylindrical osteotomies were generated to mimic implant bed preparation. Various laser parameters were tested, as well as a conventional dental drilling technique. The specimens were then subjected to micro-computed tomographic (μCT) histomorphometic analysis and histology. Results: Herein, we demonstrate that mCT measurements of trabecular porosity provide quantitative evidence that laser-mediated cutting preserves the trabecular architecture and reduces thermal and mechanical damage at the margins of the cut. We confirmed these observations with histological studies. In contrast with laser-mediated cutting, conventional drilling resulted in trabecular collapse, reduction of porosity at the margin of the cut and histological signs of thermal damage. Conclusions: This study has demonstrated, for the first time, that mCT and quantification of porosity at the margin of the cut provides a quantitative insight into damage caused by bone cutting techniques. We further show that with laser-mediated cutting, the marrow remains exposed to the margins of the cut, facilitating cellular infiltration and likely accelerating healing. However, with drilling, trabecular collapse and thermal damage is likely to delay healing by restricting the passage of cells to the site of injury and causing localized cell death.

The effects of the Er:YAG laser on trabecular bone micro-architecture: Comparison with conventional dental drilling by micro-computed tomographic and histological techniques.

Background: The use of lasers has become increasingly common in the field of medicine and dentistry, and there is a growing need for a deeper understanding of the procedure and its effects on tissue. The aim of this study was to compare the erbium-doped yttrium aluminium garnet (Er:YAG) laser and conventional drilling techniques, by observing the effects on trabecular bone microarchitecture and the extent of thermal and mechanical damage. Methods: Ovine femoral heads were employed to mimic maxillofacial trabecular bone, and cylindrical osteotomies were generated to mimic implant bed preparation. Various laser parameters were tested, as well as a conventional dental drilling technique. The specimens were then subjected to micro-computed tomographic (μCT) histomorphometic analysis and histology. Results: Herein, we demonstrate that mCT measurements of trabecular porosity provide quantitative evidence that laser-mediated cutting preserves the trabecular architecture and reduces thermal and mechanical damage at the margins of the cut. We confirmed these observations with histological studies. In contrast with laser-mediated cutting, conventional drilling resulted in trabecular collapse, reduction of porosity at the margin of the cut and histological signs of thermal damage. Conclusions: This study has demonstrated, for the first time, that mCT and quantification of porosity at the margin of the cut provides a quantitative insight into damage caused by bone cutting techniques. We further show that with laser-mediated cutting, the marrow remains exposed to the margins of the cut, facilitating cellular infiltration and likely accelerating healing. However, with drilling, trabecular collapse and thermal damage is likely to delay healing by restricting the passage of cells to the site of injury and causing localized cell death.

Traditional Postextractive Implant Site Preparation Compared with Pre-extractive Interradicular Implant Bed Preparation in the Mandibular Molar Region, Using an Ultrasonic Device: A Randomized Pilot Study.

The immediate placement of single postextractive implants is increasing in the everyday clinical practice. Due to insufficient bone tissue volume, proper primary stability, essential for subsequent osseointegration, is sometimes not reached. The aim of this work was to compare two different approaches: implant bed preparation before and after root extraction. Twenty-two patients of both sexes were selected who needed an implant-prosthetic rehabilitation of the fractured first mandibular molar or presented an untreatable endodontic pathology. The sites were randomly assigned to the test group (treated with implant bed preparation before molar extractions) or control group (treated with implant bed preparation after molar extractions) by a computer-generated table. All implants were placed by the same operator, who was experienced in both traditional and ultrasonic techniques. The implant stability quotient (ISQ) and the position of the implant were evaluated. Statistical analysis was carried out. In the control group, three implants were placed in the central portion of the bone septum, while eight implants were placed with a tilted axis in relation to the septum; in the test group, all implants were placed in ideal positions within the root extraction sockets. The different position of the implants between the two procedures was statistically significant. This work presented an innovative approach for implant placement at the time of mandibular molar extraction. Preparing the implant bed with an ultrasonic device before root extraction is a simple technique and also allows greater stability to be reached in a selective case.

Implant Bed Preparation for Immediate Implantation in Molar Region: An Alternative Approach.

Implant Bed Preparation for Immediate Implantation in Molar Region: An Alternative Approach.