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Purpose: To evaluate the correspondence between output from a new artificial intelligence tool (AIT) and clinician evaluation regarding the immediate loading suitability of dental implants based on insertion torque curves recorded during implant placement in an in vitro test. The secondary aim was to analyze peak insertion torque (PIT) and variable torque work (VTW) values of the implants. Materials and Methods: The study was performed with four different densities of artificial bone blocks of solid rigid polyurethane without a cortical layer. Five types of implants with different macrogeometries were used. A total of 140 implants (7 implants of each type in the four polyurethane blocks) were inserted. Immediately after implant placement, the insertion torque curves were classified by the operator as suitable (S) or nonsuitable (NS) for immediate loading. The same curves were then analyzed by the new AIT, which classified them as belonging to the "YES" or "NO" class. For each implant, PIT and VTW values were also recorded. Results: The correspondence between clinician and AIT evaluation was 99.3%, with only one false negative reported by the algorithm analysis. The AIT was found to have a sensitivity of 98.95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 97.8%. Mean PIT of the whole sample was 34.19 ± 19.43 Ncm, while mean VTW was 2,266.89 ± 1,993.73 Ncm. Statistically significant differences were found between implant systems in the whole sample and according to density of the polyurethane block. Conclusions: The AIT showed a high level of accuracy in the prediction of immediate loading suitability of dental implants based on the provided insertion torque curves. All the implants used in the in vitro test achieved good levels of primary stability, except when inserted in the least-dense polyurethane block. Clinical studies conducted with larger samples and more clinicians are necessary to confirm these results. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether a recently introduced implant placement micromotor that provides site-specific, operatorindependent cancellous bone density measurements can detect the presence of a cortical bone layer and measure its thickness and density. Materials and Methods: An in vitro experiment was performed on six double-layer polyurethane foam blocks mimicking the jawbone with different cortical thickness/cancellous density combinations. The densities were measured using the micromotor after either removing the cortical layer or leaving it intact, both with and without irrigation. Results: The results were compared by means of nonparametric statistical tests. Independent of irrigation, the micromotor detected the cortical layer when it was left intact and accurately estimated its thickness. The micromotor did not discriminate between blocks when they were considered separately, but it did when they were grouped into four or three classes. Conclusions: The present study suggests that the micromotor may represent a valid device to quantitatively assess bone quality and density. If the micromotor can quantitatively distinguish different cortical/cancellous bone combinations in humans, it may be a helpful tool for performing finely tuned, patient-tailored preparations of the implant seat, making tooth rehabilitation in challenging clinical conditions more predictable. [ABSTRACT FROM AUTHOR]

Purpose: To assess the handling properties and clinical function of a new class of material, a so-called mineral-organic bone adhesive (Tetranite; TN), which as yet has no precedent in orthopedic or oral and maxillofacial surgery, for clinically unstable implants placed in immediate extraction sockets and immediately temporized in the anterior maxilla. Materials and Methods: A cohort of up to 15 patients requiring between one and four immediate dental implants placed into maxillary extraction sockets from canine to canine were eligible for inclusion. Implants had to be unstable with an insertion torque of < 15 Ncm. Implants were then stabilized using TN, which was allowed to set before reassessing stability using both torque and resonance frequency measurements. Implant stability quotients (ISQs) taken after TN setting were compared to ISQs taken prior to its application, and the implants had to demonstrate resistance to a forward torque of 20 Ncm to be considered stable. ISQs were monitored at 1 week and 1, 3, 7, and 12 months postplacement. In addition, peri-implant tissue health was monitored, adverse events were recorded, and implant success was determined at 1 year postplacement. Results: Eleven patients received a total of 14 implants. Three out of the first six implants failed within 1 month (50%), and thus a protocol amendment was made to remove steps considered potentially destructive to the bonding process. As a result of these amendments, only one further failure was experienced for the next eight implants placed (12.5%). Mean ISQ data averaged for buccolingual and mesiodistal measurements demonstrated a baseline value before TN application of 59.1 Ncm (SD: ± 9.7; range: 40.5 to 73.0). After final setting of the TN, mean ISQ measured 71.9 Ncm (± 6.5; 56.0 to 80.0). At 3 months, just prior to restoration placement, mean ISQ measured 71.0 Ncm (± 6.6; 57.0 to 78.0). Thereafter, the mean ISQ continued to increase at both the 7- and 12-month follow-ups with scores of 78.9 (± 4.6; 72.0 to 84.5) and 80.3 (± 3.8; 74.5 to 85.0), respectively. The surviving 10 implants went on to be fully restored and remained in function beyond the end of the study period to yield a final success rate of 71.4%. Conclusions: The purpose of a first-in-human study is to demonstrate an extrapolation of preclinical data into the controlled human clinical arena. It is an opportunity to learn what does and does not translate well from experimental data. In that regard, the current pilot study can be deemed a complete success. The implant survival rate of 71.4%, while disappointing, should be considered in light of the protocol amendments identified, the user handling experience learned, and the opportunity to modify the material to better perform in the human patient, as all represent important lessons learned. The notable increase in ISQ sheds light on the nature by which the glue was substituted for bone to yield a stable implant by the end of the study period. [ABSTRACT FROM AUTHOR]

Objectives: To examine and compare the stability of buccal shelf mini-screws using self-drilling and pre-drilling implant placement techniques. Methodology: It was a split-mouth, randomized controlled trial comprising of 7 patients, each receiving two buccal shelf bone screws. The screws were placed using a self-drilling protocol in one quadrant and a pre-drilling protocol in the opposing quadrant decided via coin toss randomization. Stability was examined at the time of placement and 1,2, 3 and 4 months thereafter, using the Resonance Frequency Analysis method with the Osstell Beacon TM device. The Implant Stability Quotient (ISQ) obtained was then compared and assessed between both quadrants. Friedman’s Two-Way Analysis of Variance and the Wilcoxon signed rank test were utilized for the intergroup comparison. A statistically significant result was defined as one with a p-value of less than 0.05. Results: A statistically significant difference between the mean ISQ reading in the pre-drilling and self-drilling group was observed, indicating higher stability of bone screws placed with the pre-drilling protocol. The primary stability of the buccal shelf screws decreased after placement, but the secondary stability remained stable. Conclusion: Buccal shelf bone screws placed with a pre-drilling protocol depicted greater primary and secondary stability as compared to the self-drilling protocol, as depicted by the ISQ readings obtained. Resonance Frequency Analysis can be used as a valuable tool to assess the stability of buccal shelf bone screws. Clinical relevance: The use of buccal shelf screws has increased tremendously over the past few years due to their myriad applications and have now become an essential part of an orthodontist’s armamentarium. It is therefore essential for clinicians to be well-informed about all aspects of their use including insertion techniques. The results of this trial indicate that the pre-drilling protocol provides better stability and therefore treatment outcomes. [ABSTRACT FROM AUTHOR]

Temporary anchorage devices (TADs) address challenges in traditional orthodontic anchorage like patient compliance and precision, showing significantly improved clinical outcomes, particularly for cases requiring maximum anchorage. A systematic electronic search was performed in five research databases, focusing on studies published between 2015 and 2023. The ROBINS-I tool from the Cochrane Bias Methods Group assessed the risk of bias. Data analysis included categorical and numerical variables, with categorical variables analyzed using Cohen's method in a random effects model to account for variability. Sensitivity and heterogeneity were evaluated using a 'leave-one-out' approach and the I 2 statistic, respectively. At the same time, publication bias was checked using Egger's test, with findings presented through Forest and Funnel plots. Numerical variables were subjected to weighted regression analysis. Examination of 15 studies involving 1981 patients and 3272 orthodontic mini-implants identified key factors affecting implant stability. Failure rates varied significantly, influenced by factors such as the characteristics and insertion site of the orthodontic mini-implants (OMIs), patient-specific variables, and operator experience. Notably, the insertion site and implant characteristics like size did not significantly affect failure rates, but there was a negative correlation between the magnitude of force applied and failure rates. The success of orthodontic mini-implants is broadly consistent across patient demographics and is not significantly impacted by gender or age, though failure rates were higher in males and when implants were placed in the maxilla. These findings suggest that higher applied forces might reduce failure rates. This review underlines mini-implant efficacy across varied patient demographics, emphasizing the importance of site selection, jaw location, and force application in enhancing success rates and guiding tailored treatment strategies. PROSPERO ID CRD42023411955. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to clinically evaluate the primary and secondary stability of dental implants with different macrodesigns using resonance frequency analysis and to determine whether implant design and length influence implant stability. Materials and methods: This study included 48 healthy patients receiving dental implants, and a pre-implant planning protocol was used, which involved detailed bone analysis, clinical examinations, and Cone beam computed tomography (CBCT) analysis. The implants were of various types and dimensions (Alpha-Bio Tec (Israel), DFI, SPI, and NEO), and the surgical procedures were performed using standard methods. Implant stability was measured using resonance frequency analysis (RFA) immediately after placement and after 3, 6, and 12 months. The total number of implants placed in all patients was 96. Results: The average primary stability value for 10 mm SPI implants placed in the maxilla was 68.2 ± 1.7 Implant Stability Quotient (ISQ) units, while for 10 mm NEO implants, it was 74.0 ± 0.9. The average primary stability value for a 10 mm DFI implant placed in the mandible was 72.8 ± 1.2 ISQ, while for a 10 mm NEO implant placed in the mandible, it was 76.3 ± 0.8 ISQ. Based on the Friedman ANOVA test, the differences in the stability measurements for the 10 mm and 11.5 mm SPI implants and for the 10 mm and 11.5 mm NEO implants in the maxilla on day 0 and after 3, 6, and 12 months were significant at p < 0.05. Similarly, based on the Friedman ANOVA test, the differences in the stability measurements for the 10 mm and 11.5 mm DFI implants and for the 10 mm and 11.5 mm NEO implants in the mandible on day 0 and after 3, 6, and 12 months were significant at p < 0.05 (p = 0.00000). Conclusions: Universal tapered implants of the NEO type stood out as the optimal choice, as they provided statistically significantly higher primary stability in both soft and hard bone types compared to other implants. The implant length did not significantly affect this stability. [ABSTRACT FROM AUTHOR]

Purpose: To determine the biologic and biomechanical effects of two implant drilling protocols on the cortical bone around implants subjected to immediate loading. Materials and Methods: A total of 48 implants were inserted into the mandibles of six sheep following one of two drilling protocols: undersized preparation (US; n = 24) and nonundersized preparation (NUS; n = 24). Immediately after implant insertion, an abutment was placed on each implant and 36 implants were subjected to 10 sessions of dynamic vertical loads (1,500 cycles, 1 Hz) of 25 N or 50 N. Insertion torque value (ITV) was recorded at implant installation. Resonance frequency analysis (RFA) was measured at implant insertion and at each loading session. Fluorochrome was administered at day 17, and the animals were euthanized after 5 weeks. The removal torque values (RTVs) were measured, and samples underwent histomorphometric, μCT (microcomputed tomography), and fluorescence image acquisition analyses. The bone volume density (BV/TV), bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), and fluorochrome stained bone surface (MS) were calculated. A linear mixed model analysis was performed, and Pearson paired correlation was calculated. Results: Five implants from the NUS group failed, with a mean ITV of 8.8 Ncm and an RFA value of 57. The mean ITVs for US group and NUS group were 80.5 (± 14) Ncm and 45.9 (± 25) Ncm, respectively (P < .001). No differences were noted in the RFA values from the time of implant insertion until the end of the study. No differences in RTV, BV/TV, BAFO, or MS were observed between the groups. Intense new bone formation took place in the NUS group implants that were subjected to load. Conclusions: Undersized preparation of cortical bone ensured a greater BIC compared to a nonundersized preparation. Moreover, this study demonstrated that immediate loading did not interfere with the osseointegration process, but loading induced intense new bone formation in the NUS group. It is not recommended to immediately load the implants when the clinically perceived primary stability is lower than an ITV of 10 Ncm and an RFA value of 60. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate primary stability of a new dental implant design in low-density bone sites, compare it with another implant design previously studied in the same bone density, and explore possible correlations between primary stability parameters. Materials and Methods: The study was carried out on fresh humid bovine bone classified as type III. The test group consisted of 30 DS Prime Taper implants (PT), and the control group consisted of 30 Astra Tech EV implants (EV). All the implants were inserted according to the protocol provided by the manufacturer. After placement, variable torque work (VTW), peak insertion torque (pIT), and resonance frequency analysis (RFA) were recorded. Results: Mann-Whitney test showed that the mean VTW and pIT were significantly higher in the test group PT compared to the control group EV; furthermore, statistical analysis showed that the mean RFA was slightly higher in the control group EV but without reaching statistical significance. Pearson correlation analysis showed a very strong positive correlation between pIT and VTW values in both groups; furthermore, it showed a positive correlation between pIT and RFA values and between VTW and RFA values again in both groups. Conclusion: The results showed that the novel tapered implants were able to reach good primary stability in low-density bone sites and that this was superior to parallel-walled implants when measured with VTW and pIT. Moreover, a statistically significant correlation was found between the three methods used to measure implant primary stability. [ABSTRACT FROM AUTHOR]

After tooth loss, particularly in the posterior maxilla, the alveolar ridges undergo bone resorption. Therefore, ensuring the appropriate quantity and quality of alveolar bone is crucial for accurate implant positioning and achieving optimal esthetic and functional results. This study aimed to evaluate biomechanical parameters (insertion torque: IT, removal torque: RT, and implant stability quotient: ISQ) of distinct truncated cone implant designs (Sinus-plant and SLC) on polyurethane blocks simulating type D3 and D4 bone. SLC implants exhibited significantly higher IT, RT, and ISQ values compared to Sinus-plant implants, except in the 10 pounds per cubic foot (PCF) density block with a cortical layer for the IT (24.01 ± 0.91 vs. 23.89 ± 1.66 Ncm). The IT values for SLC implants ranged from 13.95 ± 0.19 Ncm in the lowest density block to 37.94 ± 0.45 Ncm in the highest density block, consistently providing significantly higher primary stability with an ISQ of approximately 70 in the highest density block. Despite lower ISQ in the lowest density block (48.60 ± 0.52 and 48.80 ± 0.42 in buccolingual and mesiodistal directions), it was deemed acceptable considering the inadequate bone densities in the maxillary region. These findings on SLC suggest potential clinical advantages, including reduced procedure duration and costs, improved stability, and the possibility of immediate implant placement following sinus augmentation, thereby streamlining the rehabilitation process.

Aims: Periprosthetic fracture and implant loosening are two of the major reasons for revision surgery of cementless implants. Optimal implant fixation with minimal bone damage is challenging in this procedure. This pilot study investigates whether vibratory implant insertion is gentler compared to consecutive single blows for acetabular component implantation in a surrogate polyurethane (PU) model. Methods: Acetabular components (cups) were implanted into 1 mm nominal under-sized cavities in PU foams (15 and 30 per cubic foot (PCF)) using a vibratory implant insertion device and an automated impaction device for single blows. The impaction force, remaining polar gap, and lever-out moment were measured and compared between the impaction methods. Results: Impaction force was reduced by 89% and 53% for vibratory insertion in 15 and 30 PCF foams, respectively. Both methods positioned the component with polar gaps under 2 mm in 15 PCF foam. However, in 30 PCF foam, the vibratory insertion resulted in a clinically undesirable polar gap of over 2 mm. A higher lever-out moment was achieved with the consecutive single blow insertion by 42% in 15 PCF and 2.7 times higher in 30 PCF foam. Conclusion: Vibratory implant insertion may lower periprosthetic fracture risk by reducing impaction forces, particularly in low-quality bone. Achieving implant seating using vibratory insertion requires adjustment of the nominal press-fit, especially in denser bone. Further preclinical testing on real bone tissue is necessary to assess whether its viscoelasticity in combination with an adjusted press-fit can compensate for the reduced primary stability after vibratory insertion observed in this study. Cite this article: Bone Joint Res 2024;13(6):272–278.

Background: Acute total hip arthroplasty has gained increasing popularity in the treatment of complex acetabular fractures in elderly patients, but the biomechanical evidence is lacking. Therefore, we measured the primary stability to evaluate whether acute total hip arthroplasty using a multi-hole acetabular cup and posterior column plating through a single K-L approach can safely be used for treating complexed acetabular fractures in the elderly. Methods: In 18 composite osteoporotic hemipelves, T-type acetabular fractures were treated in three ways: CSP (Cup with acetabular screws augmentation combined with posterior plate) group, CP (Cup without acetabular screw combined with posterior plate) group and CSPA (Cup with acetabular screws combined with posterior plate and anterior plate) group. Each specimen was dynamically loaded (300 to 1700 N, 1 Hz). Primary stability of the acetabular cup and fracture gap was evaluated by 3-dimensional (3D) micromotions. Results: No significant differences in the 3D-micromotions were observed among the CSP, CP and CSPA groups except the test point on the anterior column of the acetabulum in the CP scenario (CSP 49.33 ± 21.08 μm vs. CP 224.83 ± 52.29 μm, p < 0.001; CSPA 45.50 ± 12.16 μm vs. CP 224.83 ± 52.29 μm, p < 0.001). No significant differences in the fracture gap displacement on the posterior column of acetabulum were observed among the CSP, CP and CSPA groups. Conclusion: Our results show, that acute total hip arthroplasty using a multi-hole cup with acetabular screws and posterior column plating through single a K-L approach offers good primary stability to allow good osseous integration for treating complex acetabular fractures in the elderly. Furthermore, it also provides good fracture gap displacement on the posterior column. [ABSTRACT FROM AUTHOR]

Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11–L3). First, acquisition of the native multisegmental kinematics in our robot-based spine tester with three-dimensional motion analysis was set as a baseline for each sample. Then, an incomplete burst fracture was generated in the vertebral body L1 with renewed kinematic testing. After subsequent kyphoplasty was performed on the fractured vertebral body, primary stability was examined again. Results: Initially, a significant increase in the range of motion after incomplete burst fracture generation in all three directions of motion (extension–flexion, lateral tilt, axial rotation) was detected as proof of post-traumatic instability. There were no significant changes to the native state in the adjacent segments. Radiologically, a significant loss of height in the fractured vertebral body was also shown. Traumatic instability was significantly reduced by kyphoplasty. However, native kinematics were not restored. Conclusions: Although post-traumatic segmental instability was significantly reduced by kyphoplasty in our in vitro model, native kinematics could not be reconstructed, and significant instability remained. [ABSTRACT FROM AUTHOR]

After tooth loss, particularly in the posterior maxilla, the alveolar ridges undergo bone resorption. Therefore, ensuring the appropriate quantity and quality of alveolar bone is crucial for accurate implant positioning and achieving optimal esthetic and functional results. This study aimed to evaluate biomechanical parameters (insertion torque: IT, removal torque: RT, and implant stability quotient: ISQ) of distinct truncated cone implant designs (Sinus-plant and SLC) on polyurethane blocks simulating type D3 and D4 bone. SLC implants exhibited significantly higher IT, RT, and ISQ values compared to Sinus-plant implants, except in the 10 pounds per cubic foot (PCF) density block with a cortical layer for the IT (24.01 ± 0.91 vs. 23.89 ± 1.66 Ncm). The IT values for SLC implants ranged from 13.95 ± 0.19 Ncm in the lowest density block to 37.94 ± 0.45 Ncm in the highest density block, consistently providing significantly higher primary stability with an ISQ of approximately 70 in the highest density block. Despite lower ISQ in the lowest density block (48.60 ± 0.52 and 48.80 ± 0.42 in buccolingual and mesiodistal directions), it was deemed acceptable considering the inadequate bone densities in the maxillary region. These findings on SLC suggest potential clinical advantages, including reduced procedure duration and costs, improved stability, and the possibility of immediate implant placement following sinus augmentation, thereby streamlining the rehabilitation process. [ABSTRACT FROM AUTHOR]

In past decades, the success rates of the first dental implant treatments were low (75%). Nowadays, oral rehabilitation with titanium dental implants has a high success rate (95%–98%). The success rate significantly increases due to increased scientific knowledge about osseointegration, changes in surgical techniques, and the development of implant surface treatments. Despite the high success rate of implants, there are no protocols to define the time for the prosthesis to be installed, the insertion torque, and the prosthesis loaded after surgery. This work compares a new dental implant's primary (mechanical) and secondary (osseointegration) stability. Dental implants with micro- and nano-roughness surfaces were placed in 24 patients with a minimum of 35 N·cm and a maximum of 60 N·cm. Primary stability was quantified with a torque wrench and an Ostell Mentor Device. The secondary stability 45 and 60 days after surgery was measured with Ostell. The results showed no statistical difference in secondary stability at 45 and 60 days postoperatively among implants. The success rate of dental implants can be associated with the surface morphology with micro- and nano-roughness, the insertion torque value, and the shape of the implant threads. When the manufacturer's guidelines are followed, it is possible to prosthetically rehabilitate the patient with an implant 45 days after surgery. [ABSTRACT FROM AUTHOR]

Objectives: To determine the correlation between the primary implant stability quotient and the implant percussion sound frequency. Materials and Methods: A total of 14 pigs' ribs were scanned using a dental cone beam computed tomography (CBCT) scanner to classify the bone specimens into three distinct bone density Hounsfield units (HU) value categories: D1 bone: >1250 HU; D2: 850–1250 HU; D3: <850 HU. Then, 96 implants were inserted: 32 implants in D1 bone, 32 implants in D2 bone, and 32 implants in D3 bone. The primary implant stability quotient (ISQ) was analyzed, and percussion sound was recorded using a wireless microphone connected and analyzed with frequency analysis software. Results: Statistically significant positive correlations were found between the primary ISQ and the bone density HU value (r = 0.719; p < 0.001), and statistically significant positive correlations between the primary ISQ and the percussion sound frequency (r = 0.606; p < 0.001). Furthermore, significant differences in primary ISQ values and percussion sound frequency were found between D1 and D2 bone, as well as between D1 and D3 bone. However, no significant differences were found in primary ISQ values and percussion sound frequency between D2 and D3 bone. Conclusion: The primary ISQ value and the percussion sound frequency are positively correlated. [ABSTRACT FROM AUTHOR]

Objective: Recent years have seen a rise in the usage of dental implants to restore lost teeth. The stability of a dental implant is the main factor in determining its success. Implant stability is influenced by various factors. Several approaches have been employed clinically to evaluate stability at different time intervals. One non-invasive way to assess implant stability is by resonance frequency analysis. Utilizing the resonance frequency analysis method, this study seeks to understand how implant length and diameter affect primary and secondary stability. Methods: The current prospective study was conducted in the Prosthodontics Department of Institute of Dentistry, CMH Lahore Medical College. The duration of the study was six months. A total of 90 implants of sizes 4.5 x 8.5 mm and 4 x 10mm were placed. Resonance frequency measurements were recorded using OsstellTM AB device for primary stability at implant insertion and at 12 weeks for secondary stability. All the measurements were carried out by only one of the researchers to minimize inter-observer bias. Results: The average primary stability was 70.33±6.60, and the average secondary stability was 71.43±5.44. The data was stratified for age, gender, and implant site, and the mean primary and secondary stability of both sizes didn't show any statistically significant differences. Conclusion: Without forfeiting implant stability, both implant sizes (4 x 10mm and 4.5 x 8.5mm) can be used interchangeably, depending on available space and anatomical constraints. [ABSTRACT FROM AUTHOR]

Introduction: Aseptic loosening and periprosthetic fractures are main reasons for revision after THA. Quite different from most other stem systems, Corail cementless hip stems show better survival rates than their cemented counterpart, which can possibly be explained by the use of a collar. The study aimed to investigate primary stability with standard and undersized hip stems both collared and collarless. Materials and methods: Primary stability of cementless, collared and collarless, femoral stems was measured in artificial bones using both undersized and standard size. After preconditioning, 3D micromotion was measured under cyclic loading at the bone-implant interface. Results: The use of a collar resulted in higher micromotion within the same stem size but showed no statistically significant difference for both standard and undersized hip stems. The collared and collarless undersized stems showed no significant differences in 3D micromotion at the upper measuring positions compared to the standard stem size. Micromotion was significantly higher in the distal measuring positions, with and without collar, for the undersized stems (vs. standard collarless stem size). Conclusion: The key finding is that the collarless and collared Corail hip stems, within one stem size, showed no significant differences in primary stability. Undersized stems showed significantly higher micromotion in the distal area both with and without collar. [ABSTRACT FROM AUTHOR]

Background: The primary stability of the dental implant is a crucial factor determining the ability to initiate temporary implant-supported prosthesis and for subsequent successful osseointegration, especially in the maxillary non-molar sites. This study assessed the reliability of the insertion torque of dental implants by relating it to the implant stability quotient values measured by the Osstell device. Material and methods: This study included healthy, non-smoker patients with no history of diabetes or other metabolic, or debilitating diseases that may affect bone healing, having non-restorable fractured teeth and retained roots in the maxillary non-molar sites. Primary dental implant stability was evaluated using a torque ratchet from the dental implant kit and ISQ values generated from the Osstell device. Results: Twenty patients (13 female and 7 male) with an age range of 25-65 years received twenty immediate dental implants. The insertion torque value ranged from 15 to 50 N/cm with a mean of 28 N/cm. At the same time, the ISQ values ranged between 50 and 80 ISQ values, with a mean of 63 ISQ values. The results showed a statistically significant positive correlation between the insertion torque of the dental implant measured by torque rachet and ISQ values checked with Osstell. Conclusion: The insertion torque can be used as a reliable method to estimate the primary stability of the immediately inserted dental implants in the maxillary non-molar sites comparable to the Osstell device ISQ values. In addition, torque ratchet is readily available in the dental implant kit at no additional cost, making it a valuable choice over the Osstell device.

Purpose: To evaluate the effect of insertion depth, bone type, and implant diameter on the primary stability of short implants. Materials and Methods: Commercial dental implants with different lengths (6 and 8 mm; BLX, Straumann) were inserted into artificial bone specimens of good and poor quality at three different depth positions: equicrestal, 1-mm subcrestal, and 2-mm subcrestal. Insertion torque values were recorded spontaneously during the implant procedure. Both maximum insertion torque values (MITVs) and final insertion torque values (FITVs) were recorded. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. Results: The mean MITVs of all groups ranged from 31.8 to 46.2 Ncm. However, the mean FITVs of all groups ranged from 8.8 to 29 Ncm. Torque values decreased significantly when the implants were inserted into their final positions. When insertion depth was increased, the PTV and ISQ decreased. Long implants and implants inserted into good-quality bone yielded greater primary stability, and bone quality appeared to have a greater effect on primary stability. Conclusion: When 6-mm short implants are inserted in a subcrestal position, low primary stability may be yielded, particularly in poor-quality bone. [ABSTRACT FROM AUTHOR]

Aim of the study The purpose of this study is to demonstrate the effectiveness of two primary stability measurement tools: insertion torque value and the stability coefficient using resonance frequency analysis with the ISQ (Implant Stability Quotient) in the therapeutic decision for the immediate loading of dental implants anchored in the golden quadrilateral of the maxillary bone. Material and methods 22 patients presenting with total edentation or advanced periodontal disease were consulted and operated in a private oral surgery clinic. A total of 110 conical- shaped implants were inserted. Results The average ISQ scale value for implant 1.1 was higher in the control group but it did not reach statistical significance between the two statistically analyzed groups. The average ISQ scale value for implant 1.4 was higher in the test group, compared to the control group, showing statistically significant significance. Patients in the control group associated a higher average value for the ISQ scale in the case of implant 2.4 , being a statistically significant parameter in our study group. The average insertion torque value for the implant was higher in the test group of patients at implant 1.1, implant 1.4 and implant 2.4 . Conclusions The insertion torque, along with the resonance frequency analysis, serve as tools for measuring primary stability. In our study, both groups exhibited adequate primary stability for immediate prosthetic loading, but the distal implants anchored in the golden quadrilateral of the maxilla showed a significant value.

Purpose: To evaluate an alternative cutting, progressive thread design to increase primary stability in low-density bone. Materials and Methods: Four different implants with different macrogeometries (Nobel Biocare Active [NA] Internal RP implants [4.3 × 11.5 mm], Straumann BLX Roxolid RB implants [4.5 × 10 mm], Astra Tech Implant EV implants [4.2 × 11 mm], and PrimeTaper [PT 4.2 × 11 mm]) were placed in simulated osteotomies and extraction sockets in synthetic bone (Sawbones) according to the manufacturers' protocol. Insertion torque and ISQ values were measured using Implantmed Plus motor and Ostell IDX, respectively. Insertion time was recorded. Average values were calculated and compared using ANOVA and Tukey test. Results: Insertion torque (range: 5 to 44 Ncm) increased with increasing synthetic bone density for all implants. Different ISQ values in synthetic low-density bone were not observed in higher-density synthetic bone. Insertion torque of all implants was reduced when implants were placed in simulated sockets compared to simulated osteotomies. In both low-density and higher-density synthetic bone, the primary stability of PrimeTaper implants with cutting and progressive thread design was equivalent to that of the Nobel Biocare NobelActive implant with compressive thread design and greater than the BLX implant with compressive thread design. Conclusion: Different implant macrogeometries obtain relatively high primary stability in low-density bone when measured by ISQ. Doublethread implant designs reduce insertion times in higher-density bone. A cutting and progressive compressing thread design provides density-sensing performance compared to aggressive condensing thread designs. This macrogeometry can achieve high primary stability associated with modest insertion torque compared to aggressive threaded implant designs known to attain the highest insertion torque. The presence of multiple cutting threads may offer advantages in obtaining primary stability in low-density bone. [ABSTRACT FROM AUTHOR]

The aim of the presented retrospective study was to evaluate the early crestal bone changes around an implant type designed for high primary stability. A total number of 111 implants placed clinically were evaluated regarding insertion torque, bone density, implant stability quotient (ISQ) and early crestal bone loss from standardized digital radiographs. The implants were allocated in two groups: the „regular torque " group contained all implants that achieved less than 50 Ncm as final insertion torque (n = 63) and the „high torque" group contained the implants that achieved 50–80 Ncm (n = 48). To avoid possible damage either to the implant´s inner connection or to the bone by application of excessive force, a limit of 80 Ncm was set for all surgeries. All implants underwent submerged healing for three months. ISQ measurements and standardized digital radiographs were taken at day of insertion and at day of second stage surgery. The bone loss was measured on the mesial and distal aspect of the implant. The data evaluation showed the following results: Mean bone loss was 0.27 ± 0.30 mm for the high torque group and 0.24 ± 0.27 mm for the regular torque group. The difference was not statistically significant (p = 0.552). In the two groups, no complications nor implant loss occurred. For the evaluated implant type, there was no significant difference in crestal bone changes and complication rate between high and regular insertion torque in the early healing period. [ABSTRACT FROM AUTHOR]

The ideal stem size and stem position is important for the success of total hip arthroplasty, since it can affect early implant loosening and periprosthetic fractures (PPF). This study aimed to investigate how small deviations from the ideal stem size and position influences the PPF risk and primary stability. Six experienced surgeons performed preoperative templating based on which the benchmark size for each femur was determined. Consecutive implantations were performed in six cadaveric femur pairs—one side was implanted with an undersized stem followed by the benchmark size and the contralateral side with a benchmark size followed by an oversized stem (Corail, Depuy Synthes). Moreover, three different alignments (six varus, six neutral, six valgus‐undersized) were compared using 18 femurs. Cortical strains during broaching and implantation were measured, and laser scans were used to determine final stem position. All specimens underwent dynamic loading. Primary stability was estimated from stem subsidence and pull‐out forces. Templated stem size varied between surgeons (±1 size; p = 0.005). Undersizing increased stem subsidence by 320% (p < 0.001). Oversized stems exhibited 52% higher pull‐out forces (p = 0.001) and 240% higher cortical strains (p = 0.056). Cortex strains increased with varus alignment (R2 = 0.356, p = 0.011) while primary stability decreased with valgus stem alignment (p = 0.043). Surgeons should be aware that small deviations from the ideal stem size and malalignments of the stem can significantly alter the mechanical situation and affect the success of their surgery. [ABSTRACT FROM AUTHOR]

The approach employed for the site preparation of the dental implant is a variable factor that affects the implant's primary stability and its ability to integrate with the surrounding bone. The main objective of this in vitro study is to evaluate the influence of different techniques used to prepare the implant site on the primary stability of the implant in two different densities of artificial bone. Materials and Methods: A total of 150 implant sites were prepared in rigid polyurethane blocks to simulate two distinct bone densities of 15 pounds per cubic foot (PCF) and 30 PCF, with a 1-mm-thick simulated cortex. The implant sites were equally distributed among piezoelectric surgery (PES), traditional drills (TD), and black ruby magnetic mallet inserts (MM). Two methods have been employed to evaluate the implant's primary stability, Osstell and micro-tomography. Results: In the present study, we observed significant variations in the implant stability quotient (ISQ) values. More precisely, our findings indicate that the ISQ values were generally higher for 30 PCF compared to 15 PCF. In terms of the preparation technique, PES exhibited the greatest ISQ values, followed by MM, and finally TD. These findings corresponded for both bone densities of 30 PCF (PES 75.6 ± 1.73, MM 69.8 ± 1.91, and TD 65.8 ± 1.91) and 15 PCF (PES 72.3 ± 1.63, MM 62.4 ± 1.77, and TD 60.6 ± 1.81). By utilizing Micro-CT scans, we were able to determine the ratio of the implant occupation to the preparation site. Furthermore, we could calculate the maximum distance between the implant and the wall of the preparation site. The findings demonstrated that PES had a higher ratio of implant to preparation site occupation, followed by TD, and then the MM, at a bone density of 30 PCF (PES 96 ± 1.95, TD 94 ± 1.88, and MM 90.3 ± 2.11). Nevertheless, there were no statistically significant differences in the occupation ratio among these three approaches in the bone density of 15 PCF (PES 89.6 ± 1.22, TD 90 ± 1.31, and MM 88.4 ± 1.17). Regarding the maximum gap between the implant and the site preparation, the smallest gaps were seen when TD were used, followed by MM, and finally by PES, either in a bone density 15 PCF (PES 318 ± 21, TD 238 ± 17, and MM 301 ± 20 μm) or in a bone density 30 PCF (PES 299 ± 20, TD 221 ± 16, and MM 281 ± 19 μm). A statistical analysis using ANOVA revealed these differences to be significant, with p-values of < 0.05. Conclusion: The outcomes of this study indicate that employing the PES technique and osteo-densification with MM during implant insertion may enhance the primary stability and increase the possibility of early implant loading. [ABSTRACT FROM AUTHOR]

Narrow-diameter implants (NDI) serve as a solution for treating limited bone volume in the anterior mandible. This study aimed to evaluate the one-year clinical outcomes of various NDIs in the mandibular incisor area after immediate loading in partially edentulous patients. This single-center, prospective, single-blinded, randomized controlled trial study included 21 patients, with 7 patients in each of the following groups: control (BLT NC SLActive®; Straumann), experimental group 1 (CMI IS-III Active® S-Narrow; Neobiotech), and experimental group 2 (CMI IS-III Active® Narrow; Neobiotech). Using full digital flow, two fixtures were placed in each patient and immediately provisionalized on the day of surgery. Evaluations encompassed periapical radiographs, implant stability quotient (ISQ), implant stability test (IST) readings, per-implant soft tissue health, patient satisfaction surveys, and esthetic score assessments. Definitive prostheses were delivered twelve weeks post-surgery (CRiS, number: KCT0007300). Following exclusions due to low stability values (n = 2), fixture failure (n = 5), and voluntary withdrawal (n = 1), the implant success rate for patients completing all clinical protocols stood at 100%. The resulting patient failure rates in the control, experimental group 1, and experimental group 2 were 50.0%, 42.9%, and 14.3%, respectively. There were no significant differences between the groups in terms of marginal bone loss, soft tissue health, patient satisfaction, and esthetic scores. Narrow implants showed superior clinical outcomes, followed by S-Narrow and Straumann implants. Calculated one-year survival rates at the implant level were 66.7% for the control group, 85.7% for experimental group 1, and 100% for experimental group 2. All three types of NDIs showed acceptable clinical and radiographic results during the year-long observation period. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to determine whether differences in the macro-geometry of titanium implants promote changes in osseointegration. Material and method: SCOPUS, PubMed/Medline, Web of Science, and EMBASE databases were searched in June 2021. In addition, it was performed a manual search of the reference lists of the included articles. Eligibility criteria were in vivo studies that addressed the effect of titanium implant macro-geometry on osseointegration, studies that evaluated periodontally healthy models, and papers indexed in Journal Citation Reports. Results: The database search resulted in 1037 articles. Of the 19 articles selected for full reading, 16 remained in this systematic review. These had a high heterogeneity making it hard to perform statistical analysis of the data, so a descriptive analysis was performed. Conclusions: Based on the studies included in this systematic review, implant macro-geometry provides influences on osseointegration. In this sense, the various isolated characteristics (thread type, thread pitch, thread depth, face angle) should be studied so that the implant geometry can balance the compressive stress and tensile stress and produce a minimum shear force. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the effects of two drill designs on insertion torque (IT) and implant stability quotient (ISQ) during osteotomy. Methodology: This in vivo animal study involved eight female New Zealand white rabbits divided into two groups: Group A underwent osteotomy using standard drills from the Zimmer surgical kit, and Group B used Densah drills. IT values and ISQ were taken during and after implant placement. Rabbits received premedication, and postoperative care was provided. Results: Significant differences in peak IT were observed between the two groups, with Group B demonstrating a statistically significant advantage. However, no significant differences were found in ISQ between the groups. Conclusion: This study highlights the potential benefits of osseodensification in enhancing primary stability during osteotomy.

ABSTRACT Objectives To determine the correlation between the primary implant stability quotient and the implant percussion sound frequency. Materials and Methods A total of 14 pigs' ribs were scanned using a dental cone beam computed tomography (CBCT) scanner to classify the bone specimens into three distinct bone density Hounsfield units (HU) value categories: D1 bone: >1250 HU; D2: 850–1250 HU; D3:

This present study has the purpose of determining how surface topography of implants affects the initial stability of miniscrew implants (MSIs). Electronic databases like PubMed Central, Scopus, Web of Science, Embase, and Cochrane Library, as well as reference lists, were thoroughly searched up until September 2022. Clinical trials involving individuals who got anchorage through mini-implants, along with information on categories of mini-implants dimension, shape, thread design, and insertion site, were required as part of the eligibility criteria. Primary and secondary stability were also assessed. We carried out selection process for the study, extraction of data, quality assessment, and a meta-analysis. The qualitative synthesis included 10 papers: three randomized, four prospective, and four retrospective clinical investigations. The results of this meta-analysis demonstrate that the clinical state of MIs is controlled by their geometrical surface qualities, which are also influenced by their shape and thread design. According to the evidence this meta-analysis produced, this circumstance exists. The duration of the follow-up period and MI success rates did not correlate with one another.

Abstract Objectives To evaluate the histological parameters and bone mechanical properties around implants with low primary stability (PS) in grafted bone substitutes within an oversized osteotomy. Materials and methods An oversized osteotomy penetrating the double cortical bone layers was made on both femora of 24 New Zealand white rabbits. Bilaterally in the femur of all animals, 48 implants were installed, subdivided into four groups, corresponding to four prepared tissue-engineering bone complexes (TEBCs), which were placed between the implant surface and native bone wall: A: tricalcium phosphate β (TCP-β); B: autologous adipose derived-stem cells with TCP-β (ASCs/TCP-β); C: ASCs transfected with the enhanced-GFP gene with TCP-β (EGFP-ASCs/TCP-β); D: ASCs transfected with the BMP-2 gene with TCP-β (BMP2-ASCs/TCP-β). Trichrome fluorescent labeling was conducted. Animals were sacrificed after eight weeks. The trichromatic fluorescent labeling (%TFL), area of new bone (%NB), residual material (%RM), bone-implant contact (%BIC), and the removal torque force (RTF, N/cm) were assessed. Results ASCs were successfully isolated from adipose tissue, and the primary ASCs were induced into osteogenic, chondrogenic, and adipogenic differentiation. The BMP-2 overexpression of ASCs sustained for ten days and greatly enhanced the expression of osteopontin (OPN). At eight weeks post-implantation, increased %NB and RTF were found in all groups. The most significant value of %TFL, %BIC and lowest %RM was detected in group D. Conclusion The low PS implants osseointegrate with considerable new bone in grafted TEBCs within an oversized osteotomy. Applying BMP-2 overexpressing ASCs-based TEBC promoted earlier osseointegration and more solid bone mechanical properties on low PS implants. Bone graft offers a wedging effect for the implant with low PS at placement and promotes osteogenesis on their surface in the healing period.

Background and Objectives: The aim of this study was to clinically evaluate the primary and secondary stability of dental implants with different macrodesigns using resonance frequency analysis and to determine whether implant design and length influence implant stability. Materials and methods: This study included 48 healthy patients receiving dental implants, and a pre-implant planning protocol was used, which involved detailed bone analysis, clinical examinations, and Cone beam computed tomography (CBCT) analysis. The implants were of various types and dimensions (Alpha-Bio Tec (Israel), DFI, SPI, and NEO), and the surgical procedures were performed using standard methods. Implant stability was measured using resonance frequency analysis (RFA) immediately after placement and after 3, 6, and 12 months. The total number of implants placed in all patients was 96. Results: The average primary stability value for 10 mm SPI implants placed in the maxilla was 68.2 ± 1.7 Implant Stability Quotient (ISQ) units, while for 10 mm NEO implants, it was 74.0 ± 0.9. The average primary stability value for a 10 mm DFI implant placed in the mandible was 72.8 ± 1.2 ISQ, while for a 10 mm NEO implant placed in the mandible, it was 76.3 ± 0.8 ISQ. Based on the Friedman ANOVA test, the differences in the stability measurements for the 10 mm and 11.5 mm SPI implants and for the 10 mm and 11.5 mm NEO implants in the maxilla on day 0 and after 3, 6, and 12 months were significant at p < 0.05. Similarly, based on the Friedman ANOVA test, the differences in the stability measurements for the 10 mm and 11.5 mm DFI implants and for the 10 mm and 11.5 mm NEO implants in the mandible on day 0 and after 3, 6, and 12 months were significant at p < 0.05 (p = 0.00000). Conclusions: Universal tapered implants of the NEO type stood out as the optimal choice, as they provided statistically significantly higher primary stability in both soft and hard bone types compared to other implants. The implant length did not significantly affect this stability.

Purpose: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

While finite element (FE) models have been used extensively in orthopedic studies, validation of their outcome metrics has been limited to comparison against ex vivo testing. The aim of this study was to validate FE model predictions of the initial cup mechanical environment against patient‐matched in vivo measurements of acetabular cup migration using radiostereometric analysis (RSA). Tailored musculoskeletal and FE models were developed using a combination of three‐dimensional (3D) motion capture data and clinical computerized tomography (CT) scans for a cohort of eight individuals who underwent primary total hip replacement and were prospectively enrolled in an RSA study. FE models were developed to calculate the mean modulus of cancellous bone, composite peak micromotion (CPM), composite peak strain (CPS) and percentage area of bone ingrowth. The RSA cup migration at 3 months was used to corroborate the FE output metrics. Qualitatively, all FE‐predicted metrics followed a similar rank order as the in vivo RSA 3D migration data. The two cases with the lowest predicted CPM (<20 µm), lowest CPS (<0.0041), and high bone modulus (>917 MPa) were confirmed to have the lowest in vivo RSA 3D migration (<0.14 mm). The two cases with the largest predicted CPM (>80 µm), larger CPS (>0.0119) and lowest bone modulus (<472 MPa) were confirmed to have the largest in vivo RSA 3D migration (>0.78 mm). This study enabled the first corroboration between tailored musculoskeletal and FE model predictions with in vivo RSA cup migration. Investigation of additional patient‐matched CT, gait, and RSA examinations may allow further development and validation of FE models. [ABSTRACT FROM AUTHOR]

This present study has the purpose of determining how surface topography of implants affects the initial stability of miniscrew implants (MSIs). Electronic databases like PubMed Central, Scopus, Web of Science, Embase, and Cochrane Library, as well as reference lists, were thoroughly searched up until September 2022. Clinical trials involving individuals who got anchorage through mini-implants, along with information on categories of mini-implants dimension, shape, thread design, and insertion site, were required as part of the eligibility criteria. Primary and secondary stability were also assessed. We carried out selection process for the study, extraction of data, quality assessment, and a meta-analysis. The qualitative synthesis included 10 papers: three randomized, four prospective, and four retrospective clinical investigations. The results of this meta-analysis demonstrate that the clinical state of MIs is controlled by their geometrical surface qualities, which are also influenced by their shape and thread design. According to the evidence this meta-analysis produced, this circumstance exists. The duration of the follow-up period and MI success rates did not correlate with one another. [ABSTRACT FROM AUTHOR]

Introduction: The radiographic examination of alveolar bone using 3D radiographic examination is essential in dental implant treatment planning. Our study aimed to systematically review and quantitatively analyze the correlation between alveolar bone parameters, specifically bone density and cortical bone thickness, assessed using cone beam computed tomography (CBCT) and/or multidetector computed tomography (MDCT); and primary implant stability (PIS) determined using implant stability quotient (ISQ), Periotest® value (PTV), and insertion torque value (ITV). Methods: This review was registered in the PROSPERO database (registration number CRD42022307245). An electronic literature search was conducted on the PubMed, SCOPUS, and Web of Science databases for papers published until February 2022. The Quality Assessment in Prognostic Studies (QUIPS) tool was used to assess risk of bias. Meta‐analyses were conducted to calculate the estimated average correlation coefficient based on a multilevel random‐effects model, followed by subgroup analysis. Results: Twenty‐six studies were included in this review, consisting of 17 prospective cohort studies, eight retrospective cohort studies, and one nonrandomized controlled trial. A total of 3109 implants placed in 1171 subjects were analyzed. Twenty‐three studies were evaluated using meta‐analysis. The alveolar bone condition was significantly correlated with ISQ (r = 0.60; p <.001), IT (r = 0.52; p <.001), and PTV (r = −0.42; p <.05). Conclusion: Alveolar bone condition is significantly associated with PIS. Low bone density and thin cortical bone can lead to low PIS; therefore, modification of treatment planning and surgical procedures might be needed to avoid poor osseointegration. [ABSTRACT FROM AUTHOR]

Dental implants are a mainstream solution for missing teeth. For the improvement of dental implant surface treatment and design, short dental implants have become an alternative to various complex bone augmentation procedures, especially those performed at the posterior region of both the maxilla and mandible. The objective of this study was to evaluate the effect of various insertion methods on the primary stability of short dental implants. Commercial dental implants were inserted into artificial mandibular bone specimens using various insertion methods (equicrestal position, subcrestal position 1.5 mm, and lateral cortical anchorage) in accordance with an implant surgical guide. Insertion torque value (ITV) curves were recorded while implant procedures were performed. Both maximum ITVs (MITVs) and final ITVs (FITVs) were evaluated. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. A Kruskal–Wallis test was conducted to analyze the results for four primary stability parameters, and the Dunn test was used for a post hoc pairwise comparison when a difference was identified. For all groups, their mean MITVs ranged from 33.6 to 59.4 N cm, whereas their mean FITVs ranged from 17.5 to 43.5 N cm. Insertion torque value, ISQ, and PTV decreased significantly when implants were inserted into subcrestal positions. When implants were inserted in the lateral bicortical position, the four aforementioned parameters yielded greater values. When 6-mm short implants were inserted in a lateral cortical anchorage position, high primary stability was yielded. [ABSTRACT FROM AUTHOR]

This article discusses a study that examines the effectiveness of two primary stability measurement tools for dental implants: insertion torque value and resonance frequency analysis with the ISQ scale. The study focuses on immediate loading of dental implants in the golden quadrilateral of the maxillary bone. The results show that both measurement tools are useful for ensuring adequate primary stability and long-term survival of dental implants. The study also emphasizes the importance of anchoring implants in areas of maximum resistance, such as the golden quadrilateral, for optimal results. [Extracted from the article]

The objective was to evaluate the influence of residual bone height (RBH) and implant macro-design on the primary stability (PS) of implants using a simultaneous sinus floor elevation (SFE) and implant insertion model. Fresh bovine rib samples that resembled type-IV density that were confirmed by computerized tomography were prepared to represent 4 groups of varying RBHs (3, 6, 9, 15 mm). To simulate simultaneous implant insertion with SFE, 120 implants in different macro-designs (group R: NobelReplace; group P: NobelParallel; group A: NobelActive, Nobel Biocare, Gothenburg, Sweden) were randomly inserted at RBHs of 3, 6, 9, and 15 mm in each rib. The implant stability quotient (ISQ) was measured immediately after implant insertion. RBH and implant macro-design have an impact on ISQ values (P <.001). ISQ values were the highest with RBH of 15 mm, followed by RBHs of 9, 6, and 3 mm. (P <.001). There was no statistically significant difference between different implant macro-designs at RBHs of 3 and 15 mm regarding ISQ values (P =.111, P =.551). ISQ values of group P were higher than those of group R and group A at an RBH of 6 mm (P =.049, P =.029). ISQ values were also higher in group P compared to group A at an RBH of 9 mm (P =.006). A higher PS may be expected in sites with higher RBH, regardless of the macro-design. In addition, cylindric implant design may enhance the PS at RBHs of 6 and 9 mm in simultaneous implant insertion with SFE. [ABSTRACT FROM AUTHOR]

Osseointegrated transfemoral prostheses experience aseptic complications with an incidence between 3% and 30%. The main aseptic risks are implant loosening, adverse bone remodeling, and post-operative periprosthetic fractures. Implant loosening can either be due to a lack of initial (primary) stability of the implant, which hinders bone ingrowth and therefore prevents secondary stability, or, in the long-term, to the progressive resorption of the periprosthetic bone. Post-operative periprosthetic fractures are most often caused by stress concentrations. A method to simultaneously evaluate the primary stability and the load transfer is currently missing. Furthermore, the measurement errors are seldom reported in the literature. In this study a method to reliably quantify the bone implant interaction of osseointegrated transfemoral prostheses in terms of primary stability and load transfer was developed, and its precision was quantified. Micromotions between the prosthesis and the host bone and the strains on the cortical bone were measured on five human cadaveric femurs with a typical commercial osseointegrated implant. To detect the primary stability of the implant and the load transfer, cyclic loads were applied, simulating the peak load during gait. Digital Image Correlation was used to measure displacements and bone strains simultaneously throughout the test. Permanent migrations and inducible micromotions were measured (three translations and three rotations), while, on the same specimen, the full-field strain distribution on the bone surface was measured. The repeatability tests showed that the devised method had an intra-specimen variability smaller than 6 μm for the translation, 0.02 degrees for the rotations, and smaller than 60 microstrain for the strain distribution. The inter-specimen variability was larger than the intra-specimen variability due to the natural differences between femurs. Altogether, the measurement uncertainties (intrinsic measurement errors, intra-specimen repeatability and inter-specimen variability) were smaller than critical levels of biomarkers for adverse remodelling and aseptic loosening, thus allowing to discriminate between stable and unstable implants, and to detect critical strain magnitudes in the host bone. In conclusion, this work showed that it is possible to measure the primary stability and the load transfer of an osseointegrated transfemoral prosthesis in a reliable way using a combination of mechanical testing and DIC.

Abstract Background Glenoid bone loss is among the most important risk factors for recurrent anterior shoulder instability, and a bony reconstruction is recommended in cases of critical bone loss (> 15%). The commonly used surgical techniques, including coracoid transfer, are associated with considerable complications. The aim of this study was to assess the motion at the glenoid-bone-block interface after coracoid and spina-scapula bone-block reconstruction of the anterior glenoid. Methods Twelve cadaveric shoulders were tested. A 20% bone defect of the anterior glenoid was created, and the specimens were randomly assigned for glenoid augmentation using a coracoid bone block (n = 6) or a scapular spine bone block (n = 6). The glenoid-bone interface was cyclically loaded for 5000 cycles with a force of 170 N. The micromotion was tracked using an optical measurement system (GOM ARMIS) and was evaluated with the GOM Correlate Pro software. Results The most dominant motion component was medial irreversible displacement for the spina-scapula (1.87 mm; SD: 1.11 mm) and coracoid bone blocks (0.91 mm; SD: 0.29 mm) (n.s.). The most medial irreversible displacement took place during the first nine cycles. The inferior reversible displacement was significantly greater for spina-scapula bone blocks (0.28 mm, SD: 0.16 mm) compared to coracoid bone blocks (0.06 mm, SD: 0.10 mm) (p = 0.02). Conclusions The medial irreversible displacement is the dominant motion component in a bone-block reconstruction after a critical bone loss of the anterior glenoid. The spina-scapula and coracoid bone blocks are comparable in terms of primary stability and extent of motion. Thus, spina-scapula bone blocks may serve as alternatives in bony glenoid reconstruction from a biomechanical point of view.

A variety of implant placement and loading protocols are identified, ranging from immediate implant placement on the day of extraction to delayed placement for at least 6 months after complete healing. The method of assessment of implant placement and loading plays an important role in the implantation. The expected clinical outcomes depend largely on multiple factors, such as the macroscopic design of the implant, surgical technique, and the quality and quantity of local bone in contact with the implant, which would be described in detail. The purpose of this literature review was to explore the relationship between the factors influencing the implant placement stability and implant design. By understanding the original appearance of implant design and the stability requirements of implant placement, it is hoped that more research in the future can meet the needs of dentists and patients.

This study was designed as proof of principle and safety test of the novel technique, the Immediate Stabilization System (ISS). The technique is designed to immediately stabilize polymer-augmented pedicle screws (PAS) in deficient bone and avoid complications of loosening pedicle screws at the bone-screw interface, especially in osteoporotic patients. A polymer sleeve was designed as augmentation to improve screw anchorage after drilling the screw hole. By applying ultrasonic energy, the polymeric tube was molded into the pores of the host bone forming a strong and uniform bond with the adjacent bone. The original screw was then implanted into the denser bony environment leading to an enhanced immediate stability. The ISS-treated implants were compared to conventionally placed pedicle screws in ex-vivo cadaver bones (2 sheep spines, n = 6 implants per spine, total 12 screws) and in-vivo in a spinal sheep model (Swiss alpine sheep, n = 5, 4 implants per animal, total 20 screws). The primary stability of ISS-treated pedicle screws was increased in ex-vivo bone (+24% insertion torque (IT)) and in-vivo (+32.9% IT) in sheep spine. Removal torque (RT) was lower in the in PAS tested for 8 weeks in-vivo. The ISS technology demonstrated improved anchorage of pedicle screws in ex-vivo cadaver bones as well as in-vivo studies in sheep spine.

Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11–L3). First, acquisition of the native multisegmental kinematics in our robot-based spine tester with three-dimensional motion analysis was set as a baseline for each sample. Then, an incomplete burst fracture was generated in the vertebral body L1 with renewed kinematic testing. After subsequent kyphoplasty was performed on the fractured vertebral body, primary stability was examined again. Results: Initially, a significant increase in the range of motion after incomplete burst fracture generation in all three directions of motion (extension–flexion, lateral tilt, axial rotation) was detected as proof of post-traumatic instability. There were no significant changes to the native state in the adjacent segments. Radiologically, a significant loss of height in the fractured vertebral body was also shown. Traumatic instability was significantly reduced by kyphoplasty. However, native kinematics were not restored. Conclusions: Although post-traumatic segmental instability was significantly reduced by kyphoplasty in our in vitro model, native kinematics could not be reconstructed, and significant instability remained.

Orthodontic Mini-Implants have a high success rate, but it is crucial to assess the load that they bear in order to maintain their primary stability. Increasing the diameter can improve this stability, but there are limitations due to the proximity of the tooth roots. To avoid damage, smaller diameters are used, which can decrease resistance and cause permanent deformations. Objective: The objective of this study is to evaluate the influence of the diameter of Mini-Implants through bending force tests, taking into account primary stability after one and two insertions. Methods: Here, 40 Ti6AI4V alloy Mini-Implants of two different brands and diameters were divided into eight groups, half of which received one insertion in the artificial bone, and the rest received two. All were subjected to a constant bending force using an INSTRON-Electropuls E10000LT (Norwood, MA, USA) until fracture. Results: The smaller-diameter Mini-Implants were less resistant to fracture, but both were able to withstand the necessary loads produced by orthodontic movements. As for the inserts, there were no statistically significant differences. Conclusions: There is an advantage to using 1.6 mm Mini-Implants over 2.0 mm ones, as a smaller diameter does not lead to fracture due to the forces used in orthodontic treatment. Having one or two inserts did not have a statistically significant effect.

Purpose: The aim of this study was to investigate the influence of different clinical parameters on the primary stability of a variable thread tapered implant system with a focus on surgical undersizing protocols. Materials and Methods: This retrospective study evaluated patients who received NobelActive implants in a single institution. The relationship between the independent variables, bone quality, implant diameter, implant length, implantation time, region of the jaw, and surgical undersizing protocol, and the dependent variable, maximum insertion torque, was investigated. Statistical analysis was conducted using analysis of variance (ANOVA) and multiple linear regression. Results: A total of 1,292 implants placed in 574 fully or partially edentulous patients were evaluated. For the total sample size, without further differentiation between bone qualities, statistically significantly higher primary stability values were shown for an 8% to 9% undersized group (50.33 ± 17.16 Ncm), compared with a 16% undersized group (41.88 ± 17.63 Ncm), a 20% undersized group (33.65 ± 15.78 Ncm), a 26% to 28% undersized group (34.53 ± 15.49 Ncm), and a 35% to 44% undersized group (32.78 ± 18.80 Ncm). No statistical differences were found for undersizing protocols in bone quality 4. Bone quality had the highest influence on primary stability (Welch-Test F(3, 65.57) = 119.48, P < .001, X² = .20). Contrary to the other investigated independent variables, no statistically significant differences in primary stability were found for the different implantation times. Conclusion: Undersizing protocols exceeding 8% to 9% do not seem to enhance primary stability values. Further studies are needed to investigate the biologic consequences of undersizing, including the impact of implant design characteristics. [ABSTRACT FROM AUTHOR]

Abstract Purpose The macrogeometry of a dental implant plays a decisive role in its primary stability. A larger diameter, a conical shape, and a roughened surface increase the contact area of the implant with the surrounding bone and thus improve primary stability. This is considered the basis for successful implant osseointegration that different factors, such as implant design, can influence. This narrative review aims to critically review macro-geometric features affecting the primary stability of dental implants. Methods For this review, a comprehensive literature search and review of relevant studies was conducted based on formulating a research question, searching the literature using keywords and electronic databases such as PubMed, Embase, and Cochrane Library to search for relevant studies. These studies were screened and selected, the study quality was assessed, data were extracted, the results were summarized, and conclusions were drawn. Results The macrogeometry of a dental implant includes its surface characteristics, size, and shape, all of which play a critical role in its primary stability. At the time of placement, the initial stability of an implant is determined by its contact area with the surrounding bone. Larger diameter and a conical shape of an implant result in a larger contact area and better primary stability. But the linear relationship between implant length and primary stability ends at 12 mm. Conclusions Several factors must be considered when choosing the ideal implant geometry, including local factors such as the condition of the bone and soft tissues at the implant site and systemic and patient-specific factors such as osteoporosis, diabetes, or autoimmune diseases. These factors can affect the success of the implant procedure and the long-term stability of an implant. By considering these factors, the surgeon can ensure the greatest possible therapeutic success and minimize the risk of implant failure. Graphical Abstract