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.

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.