Osseointegration Of Dental Implants Research Articles

Evaluation of Subantimicrobial Dose Doxycycline Effects on Dental Implant Osseointegration in Type II Diabetic Patients

Objective : The present study was carried out to compare radiographic outcomes of dental implant in type II diabetic patients with or without adjunctive administration of subantimicrobial dose doxycycline. Subjects and Methods : This study included 20 patients with controlled type II diabetes mellitus of both genders, their age ranged from 40-48years.The study groups were designed in two groups, test group treated with dental implant with systemic administration of subantimicrobial dose doxycycline(SDD) for twice per day for 3 months and control group received dental implant alone. Results: Regarding radiographic marginal bone levels measurements; in both groups the mean marginal bone loss increased by time, with significant difference between both groups where the test group (SDD received group) showed the lower marginal bone loss values. In both groups, bone density measurements increased by time, with significant percentage change recorded for test group (SDD received group) 55.22% while control group recorded 17.40% from base line values. Conclusions: The use of sub-antimicrobial dose doxycycline with dental implants in type II diabetic patients was effective as an adjunctive host modulatory drug. Systemic administration of subantimicrobial dose doxycycline with dental implants in type II diabetic patients resulted in greater increase in bone density and less marginal bone loss thus subantimicrobial dose doxycycline can enhance the osseointegration of dental implants.

Effect of ultraviolet photofunctionalization of dental titanium implants on osseointegration.

The aim of the current study was to evaluate the effect of ultraviolet (UV) photofunctionalization of dental titanium implants with exposure to the oral cavity on osseointegration in an animal model. Forty-eight titanium implants (Camlog® Conelog® 4.3 mmx9.0 mm) were placed epicrestally into the edentulous jaws of three minipigs and implant stability was assessed by measuring the implant stability quotient (ISQ). Prior to implantation half of the implants were photofunctionalized with intense UV-light. After three months, the implants were exposed and ISQ was measured again. After six months of implant exposure, the minipigs were sacrificed and the harvested specimens were analyzed using histomorphometric, light, and fluorescence microscopy. Forty-two of 48 implants osseointegrated. The overall mean bone-implant contact area (BIC) was (64±22)%. No significant differences were found in BIC or ISQ value (multivariate analysis of variance (MANOVA), P>0.05) between implants with and without exposure to UV photofunctionalization. No significant effects were observed on osseointegration of dental titanium implants nine months after exposure of UV photofunctionalization.

Surface Modification of Titanium Dental Implants: A Review

Osseointegration of titanium dental implants is the most important clinical parameter for an implant to be successful. One of most biocompatible material, titanium can be made to affix fast on to host bone via various modification of its surface. Machined and smooth titanium implant osseointegrate into living bone tissue but with a roughened surface, this is much more predictable as well as promising clinically. Surface modification allows for an increase in the surface area on to which the osteoblasts easily start laying bone. So, there have been various methods to roughen the surface of titanium implants. The article describes various methods used for modifying the surfaces of dental implants, giving a note on their clinical efficacy as well as advantages and disadvantages of these methods.

Influence of the Thermal Treatment to Address a Better Osseointegration of Ti6Al4V Dental Implants: Histological and Histomorphometrical Study in a Rabbit Model.

Background Pure titanium continues to be the first choice for dental implants and represents the gold standard for their biocompatibility and physical and mechanical characteristics, while the titanium alloy (Ti6Al4V) has good mechanical properties. The surface structure of the titanium oxide layer formation on the surface influences and improves the bone response around dental implants. Purpose The purpose of this study is to evaluate the influence of a thermal treatment of Ti6Al4V implant surfaces and the bone healing response in a rabbit model. Methods Altogether sixteen implants with same design were inserted into the distal femoral metaphysis. A screw (13 mm long, 4 mm in diameter) was inserted in an implant bed. Each rabbit received two implants, one in the left femur and one in the right femur. The samples were histologically and histomorphometrically evaluated at 8 weeks. Results A statistically significant difference (p = 0.000034) was present histologically in the percentages of bone-implant contact (BIC) between the test group (BIC = 69.25±4.49%.) and control group (BIC = 56.25 ± 4.8%) by one-way analysis of variance (ANOVA). Significance was set at p ≤ 0.05. Conclusions The outcome of the present study indicates a novel approach to improving bone healing around titanium implants.

Unravelling the effect of macro and microscopic design of dental implants on osseointegration: a randomised clinical study in minipigs

Several dental implants are commercially available and new prototype design are constantly being fabricated. Nevertheless, it is still unclear what parameters of the design affect most the osseointegration of dental implants. The purpose of this study is to assess the effects of the microscopic and macroscopic design of dental implants in the osseointegration by comparing three macroscopic designs (Straumann tissue level (STD), essential cone (ECD) and prototype design (PD)) and six surface treatments. A total of 96 implants were placed in 12 minipigs. The implant stability quotient (ISQ), was assessed at the time of implantation, as well as at 2, 4 and 8 weeks. Histomorphometric and statistical analyses were conducted at the different sacrifice times, being 2, 4 and 8 weeks, to analyse the bone to implant contact (BIC), the bone area density (BAT) and the density of bone outside the thread region (ROI). The macroscopic design results showed higher ISQ values for the ECD, whereas the histomorphometric analysis showed higher ossoeintegration values for the STD. Regarding the microscopic design, both Sandblasted plus acid etching (hydrochloric/sulphuric acid) in a nitrogen atmosphere (SLActive) and Shot-blasted or bombarded with alumina particles and posterior alkaline immersion and thermal treatment (ContacTi) showed superior results in terms of osseointegration and reduced the osseointegration times from 8 weeks to 4 weeks compared to the other analysed surfaces. In conclusion, each of the macroscopic and microscopic designs need to be taken into account when designing novel dental implants to enhance the osseointegration process.

Osseointegration in osteoporotic-like condition: A systematic review of preclinical studies.

Osteoporosis is one of the most common skeletal disorders affecting a significant percentage of people worldwide. Research data suggested that systemic diseases such as osteoporosis could act as risk factors for osseointegration, jeopardizing the healing process and thus the predictability of dental implant success on compromised patients. It is well accepted that preclinical studies in animal models reproducing the osteoporotic condition are one of the most important stages in the research of new biomaterials and therapeutic modalities. The aim of this systematic review was to investigate whether osteoporosis compromises dental implant osseointegration in experimental osteoporotic-like conditions. A 3-stage systematic literature research was conducted in MEDLINE via OVID and EMBASE up to and including March 2017. Experimental studies reporting on dental implant osseointegration on different osteoporotic animal models were assessed. The studies had to report on the percentage of bone-to-implant contact (%BIC) as the primary outcome. ARRIVE guidelines for reporting on animal research were applied to evaluate the methodological quality and risk of bias of the studies. Fifty-seven studies met the inclusion criteria and were assessed qualitatively. The most adopted animal model was the rat. A variability of %BIC values was observed, ranging from 30% to 99% and from 26% to 94% for the healthy and osteoporotic group, respectively. The great majority (47) of the included studies concluded that estrogen deficiency significantly affects BIC values, 9 studies stated that it was not possible to observe statistical differences in BIC between ovariectomized and healthy groups and 1 study did not provide a comparison between the healthy and osteoporotic group. Owing to the great heterogeneity in implant surface, study design, observation time-points, site of implant placement and reported outcomes, a meta-analysis could not be performed. An overall high risk of bias was observed, owing to the limited information on animal housing and husbandry, baseline characteristics and health status, ethical statement and allocation to the experimental groups provided. Although the available studies seem to suggest a lower osseointegration in osteoporotic-like conditions, no robust conclusions can be drawn due to the great heterogeneity and overall low quality of the available studies. Future studies with emphasis on minimizing the possible sources of bias and evaluating osseointegration of dental implants placed into jawbones instead of long bones are warranted.

Injectable cartilaginous template transformed BMSCs into vascularized bone

Regeneration of alveolar bone for dental implant remains a major issue, partifcularly for patients suffering from severe bone adsorption and irregular socket trauma. Recapitulating embryological development is becoming an attractive approach for engineer organ or three-dimensional tissues from stem cells. In this study, we aimed to develop an injectable “cartilaginous” graft with adequate mechanical resistance and ideal bone remodelling potential. The cartilaginous graft was composed of a particulate decellularised cartilage matrix (PDCM), chondrogenically primed bone mesenchymal stem cell (BMSC) bricks (CB), and enriched platelet-rich plasma (P) gel. In immunodeficient mice, we found that angiogenesis occurred quickly inside PDCM-CB-P constructs after implantation, thereby improving tissue survival and bone formation. In rabbit tibia bone defects around implants, we confirmed that CBs not only transformed into bone tissue rapidly, but also significantly promoted bone remodelling and replacement of PDCM, thus realising osseointegration of dental implants within 3 months. In conclusion, CBs exhibited the potential for endochondral ossification in vivo, and application of a cartilaginous template composed of PDCM, CB, and P provided a minimally-invasive, “free material residual” approach to regenerate alveolar bone tissues in vivo. This method could have applications in peri-implant bone regeneration.

Comparison of Resonance Frequency Analysis and of Quantitative Ultrasound to Assess Dental Implant Osseointegration

Dental implants are widely used in the clinic. However, there remain risks of failure, which depend on the implant stability. The aim of this paper is to compare two methods based on resonance frequency analysis (RFA) and on quantitative ultrasound (QUS) and that aim at assessing implant stability. Eighty-one identical dental implants were inserted in the iliac crests of 11 sheep. The QUS and RFA measurements were realized after different healing times (0, 5, 7, and 15 weeks). The results obtained with the QUS (respectively RFA) method were significantly different when comparing two consecutive healing time for 97% (respectively, 18%) of the implants. The error made on the estimation of the healing time when analyzing the results obtained with the QUS technique was around 10 times lower than that made when using the RFA technique. The results corresponding to the dependence of the ISQ versus healing time were significantly different when comparing two directions of RFA measurement. The results show that the QUS method allows a more accurate determination of the evolution of dental implant stability when compared to the RFA method. This study paves the way towards the development of a medical device, thus providing a decision support system to dental surgeons.

Impact of particulate deproteinized bovine bone mineral and porous titanium granules on early stability and osseointegration of dental implants in narrow marginal circumferential bone defects

The use of two particulate bone graft substitute materials in experimental narrow marginal peri-implant bone defects was investigated with respect to early bone healing and implant stability. Porous titanium granules, oxidized white porous titanium granules (WPTG), and demineralized bovine bone mineral (DBBM) were characterized in vitro, after which the two latter materials were tested in experimental peri-implant bone defects in six minipigs, with empty defects as control. After mandibular premolar extraction, the top 5mm of the alveoli were widened to 6mm in diameter, followed by the placement of six implants, three on each side, in each pig. Six weeks of healing was allowed. The WPTG showed better mechanical properties. No significant differences in resonance frequency analysis were found directly after compacting or healing, and similar quantities of defect bone formation were observed on micro-computed tomography for all groups. Histomorphometric analysis demonstrated a more coronal bone-to-implant contact in the DBBM group, which also displayed more defect bone fill as compared to the WPTG group. The better mechanical properties observed for WPTG appear of negligible relevance for the early stability and osseointegration of implants.

Does the Intake of Selective Serotonin Reuptake Inhibitors Negatively Affect Dental Implant Osseointegration? A Retrospective Study.

The success of osseointegration is influenced by several factors that affect bone metabolism and by certain systemic medications. Selective serotonin reuptake inhibitors (SSRIs) have been previously suggested to be among these medications. This study aims to investigate the association between systemic intake of SSRIs and failure of osseointegration in patients rehabilitated with dental implants. A retrospective cohort study was conducted, including a total of 2055 osseointegrated dental implants in 631 patients (109 implants in 36 SSRI \users and 1946 in 595 nonusers). Predictor and outcome variables were SSRI intake and osseointegration failure, respectively. The data were analyzed with Mann-Whitney test or Fisher exact test accordingly. Both patient-level and implant-level models were implemented to evaluate the effect of SSRI exposure on the success of osseointegration of dental implants. Median duration of follow-up was 21.5 months (range = 4-56 months) for SSRI users and 23 months (range -60 months) for nonusers ( P = .158). Two of 36 SSRI users had 1 failed implant each; thus, the failure rate was 5.6%. Eleven nonusers also had 1 failed implant each; thus, the failure rate was 1.85%. The difference between the 2 groups failed to reach statistical significance at patient and implant levels ( P = .166, P = .149, respectively). The odds of implant failure were 3.123 times greater for SSRI users compared with nonusers. Patients using SSRIs were found to be 3.005 times more likely to experience early implant failure than nonusers. The results of this study suggest that SSRIs may lead to increase in the rate of osseointegration failure, although not reaching statistical significance.

Micromotion Phenomena at the Implant Bone Interface: A Biomechanical and Histomorphometric Study

Purpose: Excessive micromotion at the implant-bone interface may result in fibrous encapsulation instead of osseointegration of dental implants. This study quantified micromotion of implants placed in polyurethane foam and sheep tibia and tried to establish correlations with histologic parameters. Method: Dental implants (n=5) were placed in the tibiae of two sheep and allowed to heal for five and twenty weeks respectively (totalof 10 implants). Identical implants were placed in polyurethane foam with densities of 10 pcf and 20 pcf and a 3 mm thick cortical layer with a density of 40 pcf (n=5 per bone type; total of 10 implants). For determining micromotion at the implant bone interface, specimens were loaded in a universal testing machine and extensometers were used for recording implant displacement during loading. Implant stability, bone mineral density (BMD) and bone to implant contact (BIC) were determined additionally. Statistical analysis was based on Wilcoxon rank sum tests and Spearman rank correlation tests with the level of significance set at p<=0.05. Results: An increase in trabecular bone density and healing time caused a basic trend towards greater implant stability (p<0.05 for polyurethane foam; p>0.05 for sheep) and less implant displacement as a consequence of loading. The histologic parameters BIC and BMD also increased with healing time, however, this effect was only significant for BMD in the cervical (p=0.02) and apical (p=0.05) part. No difference in micromotion was found between implants placed in sheep and those placed in polyurethane foam with trabecular density of 10 pcf. Only few and inconsistent correlations were found between the parameters evaluated. Conclusions: Bone quality seems to affect implant micromotion although the exact determinants remain unclear. Implants placed in cellular polyurethane foam with density 10 pcf combined with a 3 mm layer of solid foam with density 40 pcf showed biomechanical behavior comparable to implants placed in sheep tibia.

Diverse effect of BMP-2 homodimer on mesenchymal progenitors of different origin

Bone morphogenetic protein-2 (BMP-2), is a potential factor to enhance osseointegration of dental implants. However, the appropriate cellular system to investigate the osteogenic effect of BMP-2 in vitro in a standardized manner still needs to be defined. The aim of this study was to examine the effect of BMP-2 on the cell proliferation and osteogenic differentiation of human osteogenic progenitors of various origins: dental pulp stem cells (DPSC), human osteosarcoma cell line (Saos-2) and human embryonic palatal mesenchymal cell line (HEPM). For induction of osteogenic differentiation, cell culture medium was supplemented with BMP-2 homodimer alone or in combination with conventionally used differentiation inducing agents. Differentiation was monitored for 6–18 days. To assess differentiation, proliferation rate, alkaline phosphatase activity, calcium deposition and the expression level of osteogenic differentiation marker genes (Runx2, BMP-2) were measured. BMP-2 inhibited cell proliferation in a concentration and time-dependent manner. In a concentration which caused maximal cell proliferation, BMP-2 did not induce osteogenic differentiation in any of the tested systems. However, it had a synergistic effect with the osteoinductive medium in both DPSC and Saos-2, but not in HEPM cells. We also found that the differentiation process was faster in Saos-2 than in DPSCs. Osteogenic differentiation could not be induced in the osteoblast progenitor HEPM cells. Our data suggest that in a concentration that inhibits proliferation the differentiation inducing effect of BMP-2 is evident only in the presence of permissive osteoinductive components. β-glycerophosphate, was identified interacting with BMP-2 in a synergistic manner.

Impact of Chronic Kidney Disease Mineral and Bone Disorder on Jaw and Alveolar Bone Metabolism: A Narrative Review.

Chronic kidney disease (CKD) has become a worldwide public health problem. It is estimated that nearly 90% of patients with chronic renal failure manifest some symptoms of oral disease. With advances in medical treatment, CKD patients are living longer and require oral care. Chronic kidney disease is often accompanied by disturbances in mineral metabolism which are classified as their own clinical entity known as CKD-mineral and bone disorder (CKD-MBD). CKD-MBD affects all aspects of bone physiology: bone volume, bone turnover and bone mineralization. Jaw bones affected with CKD-MBD can have important clinical implications for the survival and osseointegration of dental implants, success of bone regeneration therapy, and increased risk of bone loss in patients with periodontitis or risk of bone fracture. Assessment of bone turnover is the most important diagnostic tool to monitor progression of CKD-MBD. Bone biomarkers and radiographical examination of bone density may be particularly useful to both, diagnosis and monitoring of bone turnover. Cone beam computed tomography (CBCT) as a reliable method with many advantages over other radiographic methods can be used for analysis of jaw bone micro-architectural changes and may be of a great help in bone quality determination in CKD-MBD.

Methods to Improve Osseointegration of Dental Implants in Low Quality (Type-IV) Bone: An Overview.

Nowadays, dental implants have become more common treatment for replacing missing teeth and aim to improve chewing efficiency, physical health, and esthetics. The favorable clinical performance of dental implants has been attributed to their firm osseointegration, as introduced by Brånemark in 1965. Although the survival rate of dental implants over a 10-year observation has been reported to be higher than 90% in totally edentulous jaws, the clinical outcome of implant treatment is challenged in compromised (bone) conditions, as are frequently present in elderly people. The biomechanical characteristics of bone in aged patients do not offer proper stability to implants, being similar to type-IV bone (Lekholm & Zarb classification), in which a decreased clinical fixation of implants has been clearly demonstrated. However, the search for improved osseointegration has continued forward for the new evolution of modern dental implants. This represents a continuum of developments spanning more than 20 years of research on implant related-factors including surgical techniques, implant design, and surface properties. The methods to enhance osseointegration of dental implants in low quality (type-IV) bone are described in a general manner in this review.

Oral and masticatory rehabilitation using osseointegrated dental implants after resective treatment of multicystic ameloblastoma in the lower jaw with a fibula graft

Ameloblastoma is an aggressive odontogenic tumor which typically occurs between third and fourth decade of life that often needs resective approach. Immediate reconstruction may show better results. The treatment of multicystic ameloblastoma in the mandible being a rare case that occurred in the late second decade of life, which was surgically removed along with the affected teeth with safety margins, and the region was immediately reconstructed using a vascularized graft, removed from the fibula. Its integration, in combination with osseointegrated dental implants and fixed implant-supported prostheses, restored chewing function and esthetics. After 6 years from fibular graft and 24 months of dental implants, an excellent outcome was observed, with oral health and normal functions properly restored, and the immediate reconstruction of the mandible in resective cases, associated with oral rehabilitation with dental implants, may be considered a suitable treatment option.

The effect of surface immobilized NBD peptide on osteoclastogenesis of rough titanium plates in vitro and osseointegration of rough titanium implants in ovariectomized rats in vivo.

Successful osseointegration in dental implants depends on balanced activation of osteoclasts and osteoblasts. Osteoporosis up-regulates osteoclast activity, so it is desirable to find effective interventions to inhibit osteoclastogenesis and enhance the osseointegration of implants under these conditions. It has been reported that the NF-κB essential modulator (NEMO)-binding domain (NBD) peptide can prevent osteoclast formation and bone resorption. In this study, we conjugated NBD peptide onto the surface of rough pure titanium (Ti) using the layer by layer technique. We analyzed the surface characteristics and determined the successful NBD integration by the presence of trivial granular structures, increased S elements and hydrophilia. Importantly, we first reported that Ti surface-conjugated NBD peptide retained its inhibitory effects on osteoclastogenesis by reducing osteoclast sealing zone formation and function. These effects were mediated by a reduction in NFATc1 expression, which in turn regulated integrin ανβ3 and MMP9 by targeting the P65 signaling pathway. In vivo TRAP staining suggested NBD-coating decreased osteoclast formation with less pseudopodia. Micro-CT and histomorphometric analysis demonstrated that NBD-coating enhanced pronounced osseointegration in vivo in ovariectomized rats. This study holds great promise for in vivo use of immobilized NBD peptide and offers an effective therapeutic approach to select more suitable Ti-implant surface modifications for improving implant osseointegration in osteoporotic patients.

GBR and porous titanium before dental implantation

Presents the results of clinical case with porous titanium for guided bone regeneration on alveolar bone. Established that the porous titanium bioinert and can be successfully used to accelerate osseointegration in dental implants.

Prognostic Implication of Selective Serotonin Reuptake Inhibitors in Osseointegration of Dental Implants: A 5-year Retrospective Study

Dental implants are the preferred treatment modality in the present edentulous era. Selective serotonin reuptake inhibitors (SSRIs) have detrimental effect on bone density. The present study was conducted to determine the effect of SSRIs on the success rate of dental implants. The present study was conducted on 352 patients of both genders with 680 dental implants. History of depression and SSRI medication was retrieved. Patients were divided into two groups. Group I (110 patients, 230 dental implants) patients were on SSRI, while group II (242 patients, 450 dental implants) patients were non-SSRI. In all patients, the implant failure rate was recorded. In group I, 35 patients were >50 years, while 75 were <50 years of age. In group II, 60 patients were >50 years, while 182 were <50 years of age. The difference was significant (p < 0.05). Group I had 45 males and 65 females, while group II comprised of 105 males and 137 females. Group I showed 25 implant failures and group II had 21 implant failures. Age group >50 years showed 12 implant failures while <50 years had 13 in group I compared with 10 in patients >50 years and 11 in patients with <50 years of age; 56% smokers had implant in group I as compared with 60% failure in group II. In group I, 27% diabetic patients had failures as compared with 13.4% in group II. The difference was significant (p < 0.05). Group I showed maximum failures in terms of loosening of screw (8) followed by fracture of implant (7), peri-implantitis (6), and fracture of screw (4), whereas in group II, 7 cases were of loosening of screw, 6 cases were of fracture of screw, 5 cases of fracture of implant, and 3 cases of peri-implantitis. The difference was nonsignificant (p > 0.05). Selective serotonin reuptake inhibitors cause increased osteoclastic activity, leading to bone loss and implants placed in patients with history of depression are more prone to failures. Failure rates of dental implants are significantly increased in patients taking SSRIs due to depression. Careful case analysis and history of depression may minimize the failure rates.

Biology of teeth and implants: Host factors - pathology, regeneration, and the role of stem cells.

In chronic periodontitis and peri-implantitis, cells of the innate and adaptive immune systems are involved directly in the lesions within the tissues of the patient. Absence of a periodontal ligament around implants does not prevent a biologic process similar to that of periodontitis from affecting osseointegration. Our first focus is on factors in the biology of individuals that are responsible for the susceptibility of such individuals to chronic periodontitis and to peri-implantitis. Genetic factors are of significant importance in susceptibility to these diseases. Genetic factors of the host affect the composition of the oral microbiome in the same manner that they influence other microbiomes, such as those of the intestines and of the lungs. Our second focus is on the central role of stem cells in tissue regeneration, in the functioning of innate and adaptive immune systems, and in metabolism of bone. Epithelial cell rests of Malassez (ERM) are stem cells of epithelial origin that maintain the periodontal ligament as well as the cementum and alveolar bone associated with the ligament. The tissue niche within which ERM are found extends into the supracrestal areas of collagen fiber-containing tissues of the gingivae above the bony alveolar crest. Maintenance and regeneration of all periodontal tissues involves the activity of a variety of stem cells. The success of dental implants indicates that important groups of stem cells in the periodontium are active to enable that biologic success. Successful replantation of avulsed teeth and auto-transplantation of teeth is comparable to placing dental implants, and so must also involve periodontal stem cells. Biology of teeth and biology of implants represents the biology of the various stem cells that inhabit specialized niches within the periodontal tissues. Diverse biologic processes must function together successfully to maintain periodontal health. Osseointegration of dental implants does not involve formation of cementum or collagen fibers inserted into cementum - indicating that some stem cells are not active around dental implants or their niches are not available. Investigation of these similarities and differences between teeth and implants will help to develop a better understanding of the biology and physiologic functioning of the periodontium.

Comparative analysis and justification of the choice of experimental models used in the study of osseointegration of dental implants

We conducted a scientific study to compare the analysis of the experimental models used in the study of osseointegration of dental implants. Assess the possibility of participation of different animal species in the experimental part of the study of the process of osseointegration of dental implants. When planning an experiment related to the study of osseointegration of dental implants, the following criteria should be considered: the size, the possibility of surgical access, the possibility of installing the test sample, the localization for installation, the financial cost of the study, bioethical aspects. The experimental model using small cattle (sheep, sheep) best provides the necessary conditions for conducting osseointegration studies of various systems of dental implants, including TSIII SA and TSIII CA Osstem Implant systems. To select the optimal installation area for the test samples, X-ray studies, including CBCT and segmental crucibles, can be used.