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      Biomechanical evaluation of oversized drilling technique on primary implant stability measured by insertion torque and resonance frequency analysis

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          Abstract

          Background

          This study evaluated the influence of implant site preparation depth on primary stability measured by insertion torque and resonance frequency analysis (RFA).

          Material and Methods

          Thirty-two implant sites were prepared in eight veal rib blocks. Sixteen sites were prepared using the conventional drilling sequence recommended by the manufacturer to a working depth of 10mm. The remaining 16 sites were prepared using an oversize drilling technique (overpreparation) to a working depth of 12mm. Bone density was determined using cone beam computerized tomography (CBCT). The implants were placed and primary stability was measured by two methods: insertion torque (Ncm), and RFA (implant stability quotient [ISQ]).

          Results

          The highest torque values were achieved by the conventional drilling technique (10mm). The ANOVA test confirmed that there was a significant correlation between torque and drilling depth ( p<0.05). However, no statistically significant differences were obtained between ISQ values at 10 or 12 mm drilling depths ( p>0.05) at either measurement direction (cortical and medullar). No statistical relation between torque and ISQ values was identified, or between bone density and primary stability ( p >0.05).

          Conclusions

          Vertical overpreparation of the implant bed will obtain lower insertion torque values, but does not produce statistically significant differences in ISQ values.

          Key words:Implant stability quotient, overdrilling, primary stability, resonance frequency analysis, torque.

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          Most cited references29

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          Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period.

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            Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man.

            A total of 2895 threaded, cylindrical titanium implants have been inserted into the mandible or the maxilla and 124 similar implants have been installed in the tibial, temporal or iliac bones in man for various bone restorative procedures. The titanium screws were implanted without the use of cement, using a meticulous technique aiming at osseointegration--a direct contact between living bone and implant. Thirty-eight stable and integrated screws were removed for various reasons from 18 patients. The interface zone between bone and implant was investigated using X-rays, SEM, TEM and histology. The SEM study showed a very close spatial relationship between titanium and bone. The pattern of the anchorage of collagen filaments to titanium appeared to be similar to that of Sharpey's fibres to bone. No wear products were seen in the bone or soft tissues in spite of implant loading times up to 90 months. The soft tissues were also closely adhered to the titanium implant, thereby forming a biological seal, preventing microorganism infiltration along the implant. The implants in many cases had been allowed to permanently penetrate the gingiva and skin. This caused no adverse tissue effects. An intact bone-implant interface was analyzed by TEM, revealing a direct bone-to-implant interface contact also at the electron microscopic level, thereby suggesting the possibility of a direct chemical bonding between bone and titanium. It is concluded that the technique of osseointegration is a reliable type of cement-free bone anchorage for permanent prosthetic tissue substitutes. At present, this technique is being tried in clinical joint reconstruction. In order to achieve and to maintain such a direct contact between living bone and implant, threaded, unalloyed titanium screws of defined finish and geometry were inserted using a delicate surgical technique and were allowed to heal in situ, without loading, for a period of at least 3--4 months.
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              Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis.

              Bone anchored implants are now being used in dentistry for supporting intraoral and craniofacial prostheses. Although high success rates have been reported, a small number of implants may fail during the early healing phase or lateral in function. Currently available clinical methods to determine implant stability and osseointegration are relatively crude and may entail percussing a fixture with a blunt instrument. Radiographs are of value, but a standardised technique is necessary to ensure repeatability. This investigation was designed to study the application of a non-invasive test method using resonance frequency analysis to make quantitative measurements of the stability of the implant tissue interface in-vitro and in-vivo. The resonance frequency of a small transducer was measured when attached to implants embedded at different heights in an aluminum block. A strong correlation (r = 0.94, p < 0.01) was observed between the observed frequency and the height of implantation fixture exposed. The change in stiffness observed in the bone surrounding an implant during healing was modelled by embedding implants in self-curing polymethylmethacrylate and measuring the resonance frequency at periods during polymerisation. A significant increase in resonance frequency was observed related to the increase in stiffness. Resonance frequency measurements were also made on implants in-vivo and the results correlated well with the in-vitro findings.
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                Author and article information

                Journal
                J Clin Exp Dent
                J Clin Exp Dent
                Medicina Oral S.L.
                Journal of Clinical and Experimental Dentistry
                Medicina Oral S.L.
                1989-5488
                1 July 2016
                July 2016
                : 8
                : 3
                : e307-e311
                Affiliations
                [1 ]Professor Department of Stomatology I, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
                [2 ]Professor Department of Surgery and medical-surgical specialties, University of Oviedo, Oviedo, Spain
                [3 ]Professor Department of Orthodontics and Dentofacial Orthopedics, University of Oviedo, Oviedo, Spain
                [4 ]Graduate student. Engineering Physics Department of Nuclear Engineering and Fluid Mechanics, Engineering School, University of the Basque Country, Bilbao, Spain
                [5 ]Researcher. Department of Graphic Design and Engineering Projects, University of the Basque Country UPV/EHU, Bilbao, Spain
                [6 ]Student of oral implantology degree in the University of the Basque Country, Leioa, Spain
                [7 ]Professor and full chair. Department of morphology and Cell Biology, University of Oviedo, Spain
                [8 ]Professor. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Chile
                Author notes
                C/Lucas de Tuy nº9 2D PC: 24001 León, Spain , E-mail: fjvazquezvega@ 123456gmail.com

                Conflict of interest statement:Nothing to declare.

                Article
                52873
                10.4317/jced.52873
                4930641
                27398182
                9bbad6b0-8b2c-428c-9c8a-e876ee13460e
                Copyright: © 2016 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 January 2016
                : 26 November 2015
                Categories
                Research
                Implantology

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