Comparison of Osteotome and Conventional Drilling Techniques for Primary Implant Stability: An In Vitro Study.

It may be difficult to achieve primary stability in the posterior maxilla because of poor quality and quantity of bone. Studies have shown that the osteotome technique immediately increases bone density thereby increasing primary stability. An in vitro study was conducted to compare the stability achieved by the osteotome and conventional drilling techniques in low density bone. Forty endosseous implant fixtures (n = 40) were inserted in a solid rigid polyurethane block simulating low density (D3) bone. The implants were divided into 4 groups to test 2 variables: (1) implant length (10 mm or 13 mm) and (2) preparation of osteotomy (conventional drilling or osteotome technique). Insertion torque (IT) and resonance frequency analysis (RFA) were measured for each implant. Statistical analysis using one-way ANOVA and Tukey post hoc test was done to study IT and RFA data of the 4 groups. Pearson Correlation test was used to determine the correlation between IT and RFA values of the implants. The IT and RFA values were statistically significant higher using the osteotome technique as compared to conventional drilling (P < 0.0001). Statistically significant higher values were also found for IT and RFA of 13 mm implants as compared to 10 mm implants. A significant correlation was found between insertion torque and RFA values in all 4 groups (r = 0.86, P < 0.0001). The conclusion was that the osteotome technique significantly increased primary stability.

Resonance frequency analysis (RFA) and insertional torque (IT) stability comparisons of implants placed using osteotomes versus drilling techniques: A preliminary case study.

OBJECTIVE: Poor bone density in the posterior maxilla often presents challenges in achieving implant stability. Insertional torque (IT) and resonance frequency analysis (RFA) have been used to objectively monitor the process of osseointegration. This study was designed to quantitatively assess the primary and secondary stability of fixtures placed using the osteotome or conventional drilling technique, in soft bone. The study also assessed if there was a correlation between IT and RFA measurements. METHOD AND MATERIALS: Sixteen implants of a standardized dimension were randomly assigned to two groups: osteotome or conventional drilling. IT was taken at the time of placement. RFA was recorded at baseline and 30, 60, and 90 days. RESULTS: Average IT and RFA were 36 Ncm (range 25-45 Ncm) and 61.5 implant stability quotient (ISQ; range 44-72 ISQ), respectively. RFA in the osteotome group increased from day 0 to day 30 (63.5 to 68.0 ISQ) whereas it decreased in the conventional drilling group (65.9 to 56.6 ISQ). At 90 days, both groups showed similar results. No statistically significant difference between IT and RFA was found across all time intervals. CONCLUSION: IT and ISQ values were shown to fluctuate depending on various local anatomical factors such as density of the bone. Additional clinical and radiographic studies are needed in type 1 to 4 bone to determine the utilization of RFA and IT for routine implant surgery. Adequate stability measurements are critical for implant placement. Future guidelines and knowledge of stability and bone density values may help in establishing loading protocols and improving success rate.

Novel decision tree algorithms for the treatment planning of compromised teeth.

In clinical practice, dentists are faced with the dilemma of whether to treat, maintain, or extract a tooth. Of primary importance are the patient's desires and the restorability and periodontal condition of the tooth/teeth in question. Too often, clinicians extract teeth when endodontic therapy, crown-lengthening surgery, forced orthodontic eruption, or regenerative therapy can be used with predictable results. In addition, many clinicians do not consider the use of questionable teeth as provisional or transitional abutments. The aim of this article is to present a novel decision tree approach that will address the clinical deductive reasoning, based on the scientific literature and exemplified by selective case presentations, that may help clinicians make the right decision. Innovative decision tree algorithms will be proposed that consider endodontic, restorative, and periodontal assessments to improve and possibly eliminate erroneous decision making. Decision-based algorithms are dynamic and must be continually updated in accordance with new evidence-based studies.

Sequencing osteotomes to overcome challenges presented by deficient bone quantity and quality in potential implant sites.

The combination of inadequate bone volume, poor bone quality, and elevated occlusal forces contributes to the posterior maxilla being the least predictable site for implant survival. Osteotomes are surgical instruments that have been designed in an attempt to improve bone quantity and quality. Conflicting reports in the literature compare the percentages of bone-to-implant surface contact between the implants placed using osteotomes and conventional drills. However, some studies use different osteotomes that may be harmful to the bone. Innovative pilot intermediary osteotomes used in conjunction with divergent sequential osteotomes to ensure parallelism, expand narrow ridges predictably, safely and significantly internally elevate the sinus, aid in future site development, and assist in immediate implant placement are introduced. The hypothesis is that the quality of bone is simultaneously enhanced, but controlled clinical studies are needed to prove this theory.