Primary Stability Of Implants Research Articles

Comparative Evaluation of Osseodensification Versus Conventional Osteotomy Technique on Dental Implant Primary Stability: An Ex Vivo Study.

Purpose One of the commonest treatment options for replacing missing teeth is a root-form implant. Clinically, the key mechanical factor in achieving success is primary stability. This ex vivo study aims to evaluate whether osseodensification method will achieve good primary stability or the conventional drilling protocol. Methods Fresh iliac bone of the sheep was selected similar to D3 and D4 bone densities. A total of 22 osteotomy sites were prepared in the bone sample, of which 11 were prepared by osseodensification method (test group) and other 11 by conventional undersized drilling (control group). Primary stability was measured using insertion torque (IT), resonance frequency analysis (RFA), and reverse torque values (RTVs) by measuring implant stability quotient (ISQ). The recorded data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) Version 22.0. The differences between groups were compared using the Mann-Whitney U test and independent t-test. The Pearson correlation coefficient test was performed to measure the linear relationship between two variables. The statistical significance level was established at p<0.05. Results When the correlation among IT, RTV, and ISQ was measured, a statistically significant correlation between IT and RTV (p=0.001) and between IT and ISQ (p=0.0001) was observed. A statistically significant (p=0.014) correlation between RTV and ISQ was also found. Conclusion Osteotomy prepared by osseodensification method showed higher IT, RTV, and ISQ values than the conventional undersized group.

Understanding the thrust force evolution and primary stability for dental implantation - An in-vitro experimental investigation.

The dental implant is challenging due to the unstable quality of the surrounding bone. This study aimed to explore the feasibility of using thrust force characteristics to identify different bone types and the influencing mechanisms of spindle speed and feed rate on primary stability of dental implants through in-vitro experiments. 13 groups of osteotomy experiments were performed on mandibles and maxillae of pigs with different bone types (I, II, and III) under different spindle speeds (600 and 800 rpm) and feed rates (20 and 60 mm/min). The thrust force evolution under different conditions was extracted and analysed to elaborate the distribution and thickness of the cortical and trabecular bone layers on different bone types. Dental implant placements were performed, and corresponding primary stabilities were obtained. Furthermore, histologic observation was conducted to reveal the bone/implant contact morphology. From the results, the amplitude and trend of thrust force show a regular variation during drilling different bone types. The highly dynamic information of thrust force can be analysed to characterise the distribution and thickness of the cortical and trabecular bone layers, hence effectively detecting different bone types. Since a lower feed rate and resulting bone temperature elevation lead to more thermal damages, primary stability decreases with the decrease of feed rate. Spindle speed has no significant effect. This study establishes a more in-depth understanding into the thrust force evolution and also provide a clinical option for reducing the complexity of bone type and drilling parameters determination in osteotomy.

Primary Stability of Trabecular Metal Implant in Comparison to Fully Threaded Implants: In Vitro Study Simulating Immediate Implant Placement.

The aim of this study was to evaluate primary stability of 3.7-mm diameter porous tantalum Trabecular Metal (TM) implant, and compare it to fully threaded implants, in the in vitro model of immediate implant placement in the anterior maxilla. A total of 60 implants were placed into bovine ribs using surgical guides. Implants were divided in 3 groups of 20 according to the design: TM, Tapered Screw-Vent (TSV), and NobelReplace. To simulate immediate placement in anterior maxilla, implants were placed under a sharp angle toward the ribs, not fully submerged. Placement angle of 20.7° was calculated after analysis of 148 virtually planned implants on cone beam computerized tomography scans of 40 patients. No statistically significant difference in implant stability quotient (ISQ) was found between TM (65.8 ± 2.6), TSV (64.7 ± 2.7), and NobelReplace (64.6 ± 2.7). TSV implants achieved higher insertion torque (37.0 ± 4.8 Ncm) than TM (32.9 ± 5.2 Ncm) and NobelReplace (23.2 ± 3.3 Ncm). TSV had the shortest insertion time of 13.5 ± 1.0 seconds, compared to 15.2 ± 1.2 seconds for TM, and 19.7 ± 1.7 seconds for NobelReplace. Pearson correlation analysis showed significantly correlated insertion torque and ISQ values for TM group (P = .011, r = .56), a nonsignificant correlation was found for TSV and NobelReplace. The results of the present study indicate that TM implant can achieve good primary implant stability in insertion torque and resonance frequency analysis.

Oblique Cutting Based Mechanical Model for Insertion Torque of Dental Implant

The insertion torque of a dental implant is an important indicator for the primary stability of dental implants. Thus, the preoperative prediction for the insertion torque is crucial to improve the success rate of implantation surgery. In this present research, an alternative method for prediction of implant torque was proposed. First, the mechanical model for the insertion torque was established based on an oblique cutting process. In the proposed mechanical model, three factors, including bone quality, implant geometry and surgical methods were considered in terms of bone-quality coefficients, chip load and insertion speeds, respectively. Then, the defined bone-quality coefficients for cancellous bone with the computed tomography (CT) value of 235–245, 345–355 and 415–425 Hu were obtained by a series of insertion experiments of IS and ITI implants. Finally, the insertion experiments of DIO implants were carried out to verify the accuracy of developed model. The predicted insertion torques calculated by the mechanical model were compared with those acquired by insertion experiments, with good agreement, the relative error being less than 15%. This method allows the insertion torque for different implant types to be quickly established and enhances prediction accuracy by considering the effects of implants’ geometries and surgical methods.

Densification of cancellous bone with autologous particles can enhance the primary stability of uncemented implants by increasing the interface friction coefficient

Sufficient primary stability is one of the most important prerequisites for successful osseointegration of cementless implants. Bone grafts, densification and compaction methods have proven clinically successful, but the related effects and causes have not been systematically investigated. Postoperatively, the frictional properties of the bone-implant interface determine the amount of tolerable shear stress. Frictional properties of different implant surfaces have been widely studied. Less attention has been paid to the influence of host bone modifications. The purpose of this study was to investigate the influence of densification of cancellous bone with bone particles on the interface friction coefficient.Cancellous bone samples from femoral heads were densified with bone particles obtained during sample preparation. The densification was quantified using micro-Ct. Friction coefficients of the densified and paired native samples were determined.Densification increased the BV/TV in the first two millimeters of the bone samples by 10.5 ± 2.7% to 30.5 ± 2.7% (p < 0.001). The static friction coefficient was increased by 10.5 ± 6.1% to 0.43 ± 0.03. The static friction coefficient increased with higher BV/TV of the bone interface, which is represented by the top 2 mm of the bone.The increase in contact area, intertrabecular anchorage and particle bracing could be responsible for the increase in friction. Optimization of particle shape and size based on the patient’s individual bone microstructure could further increase frictional resistance. Bone densification has the potential to improve the primary stability of uncemented implants.

The Importance of Correlation between CBCT Analysis of Bone Density and Primary Stability When Choosing the Design of Dental Implants-Ex Vivo Study.

This study aims to determine the correlation between the mean value of bone density measured on the CBCT device and the primary stability of dental implants determined by resonant frequency analysis. An experimental study was conducted on a material of animal origin: bovine femur and pig ribs. Two types of implants were used in this study: self-tapping and non-self-tapping of the same dimensions. Results of the experimental study showed a statistically significant correlation between bone density expressed in HU units and the primary stability of self-tapping and non-self- tapping dental implants expressed in ISQ units in bovine femur bones and self-tapping implants and pig rib bones. There was no statistically significant correlation between non-self-tapping dental implants in pig rib bones. Self-tapping and non-self-tapping implants did not show statistical significance in the primary stability in bones of different qualities. The analysis of bone density from CBCT images in the software of the apparatus expressed in HU units can be used to predict the degree of primary stability of self-tapping and non-self-tapping dental implants in bones of densities D1 and D2, and self-tapping dental implants in bones of the lower quality D4.

Effect of the Implant Macro-Design on Primary Stability: A Randomized Clinical Trial

Aim of the study: Comparing the impact of two different implant macro-designs on the primary stability. Material and methods: Patients received implants in the lower posterior jaw (bone type II and III). Two different macro-design implants were inserted randomly in accordance with a conventional drilling protocol, the first one is the hybrid self-tapping implant: Straumann® bone level BL and the second one is tapered self-tapping implant: Straumann® bone level tapered BLT.16 implants (3.3 and 4.1 mm diameter, length between 8 and 10 mm) of each of the two above-mentioned implants were used. The assessment of the primary stability of each implant design was carried out by using two methods, recording the maximum insertion torque IT (DTA device) and recording the implant stability quotient ISQ using the resonance frequency analysis RFA (with the Osstell device). Results: Within the limitation of the present study, in all bone types, BLT implants showed significantly higher mean insertion torque IT when compared to BL with respectively 46.67±6.85 Ncm for BLT implants and 35.77±6.72 Ncm for BL implants (p=0.01 as per the Anova test), and higher mean ISQ with respectively 77.15±5.16 and 70.74±4.83. (p=0.01 as per the Anova test). Conclusion: In type II and III bone, the tapered self-tapping implant (Straumann® BLT) statistically showed better primary stability when compared to hybrid self-tapping implant: Straumann® bone level BL. Within the limitations of the present study, it can be concluded that the implant Macro-Design might be considered as a reliable parameter to achieve acceptable primary stability of dental implants in areas with low bone density. In the present study, the two methods used to assess the primary stability of the different macro-designs, torque assessment and the resonance frequency analysis RFA, showed a weak correlation. The macro-geometry is basically made to satisfy the needs in some critical bone situations and in immediate loading protocol.

Is Resonance Frequency Analysis a Reliable Evaluation for Primary Stability of Implants Without Apical Contact?

The primary stability of dental implants is one of the most crucial factors for providing long-term success of osseointegration. Vertical deficiencies, such as those due to maxillary sinus pneumatization, may cause a severe vertical limitation to residual bone height. This study aimed to examine the primary stabilization of implants without apical contacts. Eighty bone-level implants (4.1-mm diameter/10-mm length) were placed into polyurethane test blocks without apical contacts. According to coronal bone-to-implant contact, groups were set as 4, 6, 8, and 10 mm, respectively. Resonance frequency analysis (RFA) using a SmartPeg was performed separately toward the transversal and horizontal axes by two independent researchers. Data were statistically compared for interobserver and among groups. Interobserver reliability varied from moderate to excellent (intraclass correlation coefficient [ICC]: 0.629 to 0.985). There were no significant differences among the 6 mm, 8 mm, and 10 mm groups, although the 4 mm group showed the significantly lowest stability (P < .001). Transversal and longitudinal measurements of the same groups did not show a parallel correlation statistically. RFA values may be affected by the finger torque in tightening of the SmartPeg among different researchers. Fully placed implants did not significantly show the highest stability among various apically contactless groups. Consequently, RFA should not be used alone to evaluate primary stability for implants without an apical contact.

Evaluation of the Osseodensification Technique in Implant Primary Stability: Study on Cadavers.

The objective of this study was to compare the osseodensification drilling technique used with Densah implant drills (Versah) to standard drilling by evaluating their contribution to primary implant stability. A total of 21 mandibles dissected from cadavers were selected. Axiom drills (Anthogyr) were used for 29 standard drilling (SD) protocols in the control group. In the test group, the Densah profile drills were used to perform 29 osteotomies (OD). Implant placement was performed for 58 of these procedures. The insertion torque (IT) and implant stability quotient (ISQ) were recorded. High-resolution CBCT allowed for a postoperative analysis of the peri-drilling bone tissue. For 16 osteotomies without implant placement, Mann-Whitney U test was used for comparison of IT and ISQ values between groups. Spearman rank correlation coefficient was used between IT and ISQ values. The significance level was α = .05. The IT values for OD and SD were, respectively, 34.9 Ncm ± 19.1 and 23.6 Ncm ± 9.8. The IT was significantly higher in the OD group compared to the SD group (P = .036). A moderate positive correlation (ρ = 0.527) between IT and ISQ was observed, as well as a significant increase (P = .026) in bone density. There was a significant increase in IT and bone density following an osseodensification procedure compared to standard drilling.

Evaluation of different osteotomy techniques on primary stability of implants using RFA

Primary stability of implant is based on its mechanical engagement to the surrounding bone at the time of installation. It can be affected by patient- related factors like the bone quality and quantity and underlying systemic diseases and the surgical technique. Among various methods available for measuring primary implant stability, the most recommended method is the use of Resonance Frequency Analysis (RFA) due to its versatility. The aim of this study was to evaluate the influence of 4 different osteotomy techniques on the primary stability of implants using RFA. Forty implants of same size and system were installed on goat's mandible under four osteotomy approaches 1) undersized (two-step down) 2) subcrestal 3) osteotome technique 4) bicortical anchorage. Primary stability of all the implants placed was measured using RFA test. The results were statistically analyzed and highest mean ISQ value was observed when implants were placed under bicortical anchorage. Implants when placed under bicortical anchorage achieved better primary stability and hence this osteotomy approach can be followed in areas where primary stability is expected to be compromised.

Primary Implant Stability Analysis of Different Dental Implant Connections and Designs-An In Vitro Comparative Study.

Primary implant stability can be evaluated at the time of placement by measuring the insertion torque (IT). However, another method to monitor implant stability over time is resonance frequency analysis (RFA). Our aim was to examine the effect of bone type, implant design, and implant length on implant primary stability as measured by IT and two RFA devices (Osstell and Penguin) in an in vitro model. Ninety-six implants were inserted by a surgical motor in an artificial bone material, resembling soft and dense bone. Two different implant designs—conical connection (CC) and internal hex (IH), with lengths of 13 and 8 mm, were compared. The results indicate that the primary stability as measured by RFA and IT is significantly increased by the quality of bone (dense bone), and implant length and design, where the influence of dense bone is similar to that of CC design. Both the Osstell and Penguin devices recorded higher primary implant stability for long implants in dense bone, favoring the CC over the IH implant design. The CC implant design may compensate for the low stability expected in soft bone, and dense bone may compensate for short implant length if required by the anatomical bone conditions.

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.

Orthodontic mini implant and their primary stability: A comparative study

Background: Mini implants has been widely used now a days as anchorage for achieving best orthodontic outcome. Good primary stability of mini implants is key for their success. Two type of mini implant (one single threaded and other double threaded) were used for this study, insertion torque and removal torque was evaluated.Material and Method: 40 patients were selected and two equal (n=20) groups were formed. In first group (group1) single threaded mini implants were used, in second group (group 2) double threaded mini implants were used. Maximum insertion torque (m.i.t) and removal torque (m.r.t) were recorded for two groups. Statistical analysis was done.Results: Torque was compared in both group. Max. Insertion torque (mit) was found higher than max. Removal torque (mrt) for both the groups and between the groups. Higher values for m.i.t than m.r.t was found in intergroup comparison.Conclusion: Mini screws are effective for temporary anchorage device. Double threaded mini implants has more insertion and removal torque, so they have better primary stability.

EFFECTIVENESS OF DENTAL IMPLANTATION WITH IMMEDIATE LOADING WHEN REPLACING FRONTAL DENTITION DEFECTS

Dental implantation, viewed as an independent research-based method used to treat patients with partial and complete adentia, has a special place among the major dental specialties. There are surgical algorithms and established methods for using dental implants available. The classical two-stage implantation protocol with delayed loading is considered the most reliable and predictable, featuring the lowest complication rate. The increased interest in direct dental implantation with immediate loading can be accounted for by psycho-emotional factors, accelerated implant osseointegration, better functional and aesthetic results, prevention of alveolar process bone atrophy, as well as reduced volume of surgical and orthopedic interventions. The stability of dental implants after direct implantation and immediate loading has been found to match the stability of implants after employing a two-stage technique. The primary stability of dental implants installed directly into the hole of the removed tooth on the anterior mandible is due to a small volume of spongy substance at a significantly thick cortical layer, possible installation of an implant with a length exceeding the length of the tooth root, the availability of a proper keratinized gum zone, as well as the removal from occlusion temporary structures on implants.

Significance of bone morphology and quality on the primary stability of orthodontic mini-implants: in vitro comparison between human bone substitute and artificial bone.

This study evaluated artificial bone models against ahuman bone substitute to assess the primary stability of orthodontic mini-implants (OMIs) at varying implant sites with different morphologies and qualities. Atotal of 1200 OMI placements of four types were inserted into four artificial bone models of different density (D1, D2, D3, D4) and into ahuman bone substitute (HB). The implants varied in diameter (2.0 and 2.3 mm) and length (9and 11 mm). Each specimen had four implant sites: no defect, one-wall defect, three-wall defect, and circular defect. The implant stability quotient (ISQ) values were measured using resonance frequency analysis (RFA) and insertion placement torque values (IPT) were assessed for primary stability. Correlation analysis was performed to evaluate the different models. The highest IPT value was registered for the 2.0 mm × 11 mm implant inserted into D1 with no defect (37.53 ± 3.02 Ncm). The lowest ISQ value was measured for the 2.3 mm × 9 mm OMI inserted into D3 with acircular defect (12.33 ± 5.88) and the highest for the 2.3 mm × 9 mm implant inserted into HB with no defect (63.23 ± 2.57). Astrong correlation (r = 0.64) for IPT values and avery strong correlation (r = 0.8) for ISQ values was found between D2 and HB. Bone defects and bone quality affected the primary stability of implants in terms of ISQ and IPT values. Results for bone model D2 correlated very well with the HB substitution material.

Fixture Length and Primary Stability: An In Vitro Study on Polyurethane Foam

(1) Background: Recently, novel dental implants that are characterized by different levels of surface roughness in the distinct parts of the fixture’s body have been introduced in the market. These surface characteristics could affect the primary stability of the implants. The aim of this in vitro study was to compare the primary stability of short and long implants, characterized by multiscale surface roughness, inserted on polyurethane blocks. The secondary aim was to understand if the implant length could be a crucial factor in the decision-making in immediate or rather than delayed loading protocol in the different bone densities. (2) Methods: A total of 20 cylindrical dental implants with a diameter of 5.0 mm were tested for the lengths 6.0 mm (short implants) versus 13.0 mm (long implants) on two different solid rigid polyurethane blocks (20 and 30 PCF). The primary stability was evaluated by measuring the insertion torque value (ITV), the removal torque (RTV), and the resonance frequency analysis RFA. (3) Results: The values of ITV, RTV, and RFA showed the same trend in all measurements. Long implants showed a significantly higher primary stability on 30 PCF blocks that present mechanical properties similar to high-density bone. On the contrary, no relevant differences were found on 20 PCF blocks, which mimic trabecular bone density. (4) Conclusions: The impact of fixture length on the primary stability of implants with multiscale surface roughness is significant in 30 PCF polyurethane corresponding to higher bone density, but not in lower ones.

Does Primary Stability Is Mandatory For Dental Implant Success? A Systematic Review Of Literature

Background: Implant primary stability is considered a prerequisite of implant osseointegration and ultimately, implant success. The prognosis of dental implants installed with low or without primary stability is still unclear. The aim of this systematic review was to assess the survival rate of implants placed with low/without primary stability and to diagnose risk factors that might affect outcomes of such implants. Material and methods: Electronic search in the National Library of Medicine (MEDLINE-PubMed) was performed on articles published in English up to September 2020. The terms (MeSH words) used in the search were ‘Dental’ OR ‘Oral’ AND ‘Implant’ AND ‘Survival’ OR ‘Success’ AND ‘Stability’ OR ‘Low stability’ AND ‘Insertion torque’. In addition to the online databases of selected journals. Randomized and controlled clinical trials, cohort studies, case-control studies, and prospective or retrospective case series were included. Results: Of the retrieved 386 publications, 24 studies met the inclusion criteria, with a total of 1632 implants, giving a survival rate of 96.32%. No statistically significant influence of the type and site of implantation on implant survival was recorded. A significant higher failure rate of immediately loaded implants that than those with delayed loading protocols. Conclusion: Poor primary stability might not negatively affect the survival rates of non-immediately loaded dental implants.

Experimental evaluation of the primary fixation stability of uncemented ceramic hip resurfacing implants.

Hip resurfacing arthroplasty is associated with increased frictional moments compared to standard heads owing to their large diameter. High frictional moments may harbor the risk of the implant loosening if the frictional moments exceed the fixation stability of the hip resurfacing arthroplasty. Therefore, the aim of this experimental study was to evaluate the fixation stability of ceramic hip resurfacing implants through a turn-off test. The test specimens, made of alumina toughened zirconia (ATZ) ceramics with an inner titanium-coated surface and square base bodies for better application to the test setup, were pushed on artificial bone materials until a predefined seating depth was achieved. Thereafter, the specimens were turned off from the artificial bone material by using a lever-arm and the turn-off moments were calculated. The density of the artificial bone material utilized (15 and 25 pcf), the press-fit (0.4 and 0.8 mm) and the size of the test specimens varied. The push-on forces ranged from 0.6 ± 0.1 kN to 5.6 ± 0.5 kN depending on the press-fit and artificial bone material. The turn-off moments relied on the respective press-fit, artificial bone material and size of the specimen. They belonged between the range of 8.5 ± 0.4 Nm and 105.4 ± 0.2 Nm. Most of the previously described frictional moments are lower compared to the turn-off moments determined in this study. However, in the worst-case scenario, the turn-off moments of the hip resurfacing implants may be reduced, especially when the adjacent bone stock has a low mineral density.

Preliminary Investigation on the Geometric Accuracy of 3D Printed Dental Implant Using a Monkey Maxilla Incisor Model

Additive manufacturing has proven to be a viable alternative to conventional manufacturing methodologies for metallic implants due to its capability to customize and fabricate novel and complex geometries. Specific to its use in dental applications, various groups have reported successful outcomes for customized root-analog dental implants in preclinical and clinical studies. However, geometrical accuracy of the fabricated samples has never been analyzed. In this article, we studied the geometric accuracy of a 3D printed titanium dental implant design against the tooth root of the monkey maxilla incisor. Monkey maxillas were scanned using cone-beam computed tomography, then segmentation of the incisor tooth roots was performed before the fabrication of titanium dental implants using a laser powder bed fusion (PBF) process. Our results showed 68.70% ± 5.63 accuracy of the 3D printed dental implant compared to the actual tooth (n = 8), where main regions of inaccuracies were found at the tooth apex. The laser PBF fabrication process of the dental implants showed a relatively high level of accuracy of 90.59% ± 4.75 accuracy (n = 8). Our eventual goal is to develop an accurate workflow methodology to support the fabrication of patient-specific 3D-printed titanium dental implants that mimic patients’ tooth anatomy and fit precisely within the socket upon tooth extraction. This is essential for promoting primary stability and osseointegration of dental implants in the longer term.

The Effect of Under-Drilling and Osseodensification Drilling on Low-Density Bone: A Comparative Ex Vivo Study

The aim of this study is to identify a method that can maximize implant primary stability (IPS) and bone density under the controlled drilling conditions of the same diameter and length in low-density bones through an ex vivo study. A total of 87 dental implants were placed with standard drilling, under-drilling, and osseodensification drilling in 13 fresh porcine sternums. The Periotest value and the implant stability quotient were measured to evaluate the primary stability. The difference in the Hounsfield unit (HU) between the hole and peripheral bone up to a distance of 1 mm was measured. Osseodensification and under-drilling technique increased the IPS, compared with conventional drilling technique with statistical significance under the drilling conditions of the same diameter and length. Osseodensification technique with the counter-clockwise direction had higher HU gaps than the standard drilling and osseodensification technique with clockwise direction. Due to the effect of bone densification, the gap of HU was increased by a minimum of 43 HU and a maximum of 180 HU. Within the limitations of this ex vivo study, it was found that the osseodensification technique with counter-clockwise direction is effective to increase IPS and bone mineral density in low-density bone.