Osseodensification Effective for Immediate Molar Replacement.

A fairly common treatment modality for anterior and posterior single-rooted teeth, immediate implant placement in molar areas is less prevalent. Technical challenges can arise when creating an implant osteotomy in a fresh extraction socket of a multi-rooted tooth. Also, the proximity to important anatomic structures and the difficulty in achieving adequate implant stability in wide sockets can also be hindrances. The principles of osseodensification may be utilized as part of a novel, predictable technique for immediate molar replacement with an implant. This article discusses the osseodensification technique, including such key factors as site assessment, radiographic evaluation, minimally traumatic tooth removal, implant positioning, and instrumentation.

Molar Septum Expansion with Osseodensification for Immediate Implant Placement, Retrospective Multicenter Study with Up-to-5-Year Follow-Up, Introducing a New Molar Socket Classification.

The ideal positioning of immediate implants in molar extraction sockets often requires the osteotomy to be in the interradicular septum, which can be challenging in some cases, with traditional site preparation techniques. Patients who had undergone molar tooth extraction and immediate implant placement at five different centers, and followed up between August 2015 and September 2020, were evaluated. Inclusion criteria were use of the osseodensification technique for implant site preparation. The primary outcome was septum width measurement pre-instrumentation and osteotomy diameter post expansion. Clinical outcomes, such as implant insertion torque (ISQ) and implant survival rate, were also collected. A total of 131 patients, who received 145 immediate implants, were included. The mean overall septum width at baseline was 3.3 mm and the mean osteotomy diameter post instrumentation was 4.65 mm. A total of ten implants failed: seven within the healing period and three after loading; resulting in a cumulative implant survival rate of 93.1%. This retrospective study showed that osseodensification is a predictable method for immediate implant placement with interradicular septum expansion in molar extraction sockets. Furthermore, it allowed the introduction of a new molar socket classification. In the future, well-designed controlled clinical studies are needed to confirm these results and further explore the potential advantages of this technique.

Osseodensification effect on implants primary and secondary stability: Multicenter controlled clinical trial.

BACKGROUND: Osseodensification (OD) has shown to improve implant stability; however, the influences of implant design, dimensions, and surgical site characteristics are unknown. PURPOSE: To compare the insertion torque (IT) and temporal implant stability quotients (ISQ) of implants placed via OD or subtractive drilling (SD). MATERIALS AND METHODS: This multicenter controlled clinical trial enrolled 56 patients, whom were in need of at least 2 implants (n = 150 implants). Patients were treated with narrow, regular, or wide implants and short, regular, or long implants in the anterior or posterior region of the maxilla or in the posterior region of the mandible. Osteotomies were performed following manufacturers recommendation. IT was recorded with a torque indicator. ISQ was recorded with resonance frequency analysis immediately after surgery, 3 and 6 weeks. RESULTS: Data complied as a function of osteotomy indicated significantly higher IT for OD relative to SD. OD outperformed conventional SD for all pairwise comparisons of arches (maxilla and mandible) and areas operated (anterior and posterior), diameters and lengths of the implants, except for short implants. Overall, ISQ data also demonstrated significantly higher values for OD compared to SD regardless of the healing period. Relative to immediate readings, ISQ values significantly decreased at 3 weeks, returning to immediate levels at 6 weeks; however, ISQ values strictly remained above 68 throughout healing time for OD. Data as a function of arch operated and osteotomy, area operated and osteotomy, implant dimensions and osteotomy, also exhibited higher ISQ values for OD relative to SD on pairwise comparisons, except for short implants. CONCLUSIONS: OD demonstrated higher IT and temporal ISQ values relative to SD, irrespective of arch and area operated as well as implant design and dimension, with an exception for short implants. Future studies should focus on biomechanical parameters and bone level change evaluation after loading.

Alveolar Ridge Expansion by Osseodensification-Mediated Plastic Deformation and Compaction Autografting: A Multicenter Retrospective Study.

INTRODUCTION: Osseodensification preserves bone bulk, facilitates compaction autografting, and deforms trabecular bone in an outward strain, which result in alveolar ridge plastic expansion. The aim of this retrospective study was to evaluate ridge expansion after osseodensification. MATERIALS AND METHODS: Patients treated with implant placement through osseodensification were evaluated. The alveolar ridge width was measured at the level of the crest and 10 mm apical to the crest before and after osseodensification. Insertion torque and implant stability quotient (ISQ) values were recorded at implant placements. Expansion values were grouped into the following 3 groups according to the initial alveolar ridge width: group 1: 3 to 4 mm (n = 9), group 2: 5 to 6 mm (n = 12), and group 3: 7 to 8 mm (n = 7). RESULTS: Twenty-one patients who received 28 implants were included. Twenty-six implants were integrated, resulting in a survival rate of 92.8%. There was a significant difference in the mean expansion value at the coronal aspect of the ridge between group 1, group 2, and group 3 (2.83 ± 0.66 mm, 1.5 ± 0.97 mm, 1.14 ± 0.89 mm, P < 0.05). The mean torque and ISQ values were 61.2 ± 13.9 Ncm and 77 ± 3.74. CONCLUSION: Osseodensification can alter ridge dimensions and allow for ridge expansion. Greater expansion can be expected at the crest in narrow ridges with adequate trabecular bone volume.

Use of the Immediate Dentoalveolar Restoration Technique Combined with Osseodensification in Periodontally Compromised Extraction Sites.

This article describes the combined use of the immediate dentoalveolar restoration (IDR) technique and the osseodensification implant site preparation method to improve immediate implant primary stability in periodontally compromised extraction sites. Positioning of soft and hard tissues was evaluated in two clinical cases in which the IDR technique and the osseodensification implant site preparation method were used to replace teeth at sites with severe alveolar bone loss. The results were analyzed by clinical assessment, photography, radiography, and computed tomography scans. Based on this preliminary study, the use of osseodensification can enhance the results achieved using the IDR technique due to improved primary implant stability, as measured by higher insertion torque.

A Multicenter Retrospective Clinical Study with Up-to-5-Year Follow-up Utilizing a Method that Enhances Bone Density and Allows for Transcrestal Sinus Augmentation Through Compaction Grafting.

PURPOSE: To evaluate the effectiveness and predictability of a novel biomechanical, minimally invasive bone instrumentation technique that enhances bone density through compaction grafting, called osseous densification, and allows for transcrestal sinus membrane elevation and augmentation with simultaneous implant placement. MATERIALS AND METHODS: Patients who were consecutively treated with the bone densification and transcrestal sinus augmentation technique and were followed up in three treatment centers between May 2012 and September 2017 were included in this retrospective study. The summary statistics are presented as means for continuous variables and percentages for categorical variables. RESULTS: In total, 222 patients with 261 implants were included in the final clinical analysis. The included follow-up period ranged from 6 to 64 months with a mean of 35 months. The subsinus residual bone height at baseline was 5.4 mm (SD: 1.9). Following the sinus augmentation, a significant vertical increase of 7 mm (SD: 2.49) was observed. No sinus membrane perforations and no late implant failures were observed from 6 up to 64 months follow-up, yielding a cumulative implant survival rate of 97%. CONCLUSION: This osseous densification technique for maxillary implant site preparation with transcrestal sinus augmentation and simultaneous implant placement led to favorable clinical outcomes with up to 64 months of follow-up.

A Novel Osseous Densification Approach in Implant Osteotomy Preparation to Increase Biomechanical Primary Stability, Bone Mineral Density, and Bone-to-Implant Contact.

PURPOSE: It is essential to have sufficient bone bulk and density at the implant site in order to achieve good bone-to-implant contact and primary stability, which are crucial for osseointegration. A new osteotomy preparation technique was recently introduced that uses a bone preservation method that creates a layer of compacted bone along the surface of the osteotomy. The hypothesis of this study was that this novel technique would increase primary implant stability, bone mineral density, and the percentage of bone at the implant surface compared with drilling technique. MATERIALS AND METHODS: A total of 72 osteotomies were created in porcine tibial plateau bone samples using three preparation techniques: standard drilling; osseous extraction drilling with a new tapered, multi-fluted bur design; and osseous densification with the same multi-fluted bur rotating in a reversed direction that preserved and created a compacted layer of bone. The surgical process (temperature increase, drilling force, and torque), mechanical stability during the insertion and removal of 4.1-mm and 6.0- mm diameter implants (implant torque and stability quotient), and bone imaging (scanning electron microscopy, microcomputed tomography measurement of bone mineral density, and histomorphology) were compared among the three preparation techniques. RESULTS: Osseous densification significantly increased insertion and removal torques compared to standard drilling or extraction drilling. No significant differences in implant stability quotient readings or temperature increases were demonstrated among the three groups. Although the same bur was used for extraction drilling and osseous densification techniques, the osseous densification osteotomy diameters were smaller than both the extraction drilling and standard drilling osteotomies due to the spring-back effect of bone elastic strain created. Imaging methods documented a layer of increased bone mineral density around the periphery of osseous densification osteotomies. The percentage of bone at the implant surface was increased by approximately three times for implants prepared with osseous densification compared with standard drilling. CONCLUSION: This study confirmed the hypothesis that the osseous densification technique would increase primary stability, bone mineral density, and the percentage of bone at the implant surface compared with drilling. By preserving bulk bone, it is hypothesized that the healing process will be accelerated due to the bone matrix, cells, and biochemicals that are maintained in situ and autografted along the surface of the osteotomy site. The healing response requires further study in vivo.

Defect-determined regenerative options for treating periodontal intrabony defects in baboons.

BACKGROUND: In an effort to regenerate periodontal intrabony defects, the healing potential of the defect should determine what therapeutic modalities and materials are employed. The purpose of this study was to compare regenerative outcomes in baboon intrabony defects that were contained versus non-contained, using various regenerative therapies. METHODS: Nine adult baboons (Papio anubis) in good health were treated. Eighty-six interproximal, intrabony defects were surgically created: 43 contained by 3 walls of bone; 43 non-contained with a missing buccal wall. Chronicity and plaque accumulation were encouraged with wire ligature placement for 8 weeks. After ligature removal, scaling, and a 2- to 4-week healing period, the defects were treated with the following therapies: collagen membrane (GTR), human demineralized freeze-dried bone (DFDB) grafting (BG), combined therapy (GTR + BG) and a DFDB-glycoprotein sponge matrix (MAT). Clinical healing responses were evaluated in 58 sites by changes in soft tissue (recession, probing, clinical attachment) and hard tissue (resorption, defect fill) parameters 6 months post-treatment. Histologic evaluation (defect regeneration, connective tissue attachment, epithelial migration) was done on 26 sites. RESULTS: For contained defects, no real significant clinical (ANOVA) or histologic differences existed among treatments. However, for non-contained defects, combined therapy (GTR + BG) demonstrated clinically significant (P < or = 0.05, ANOVA) and histologically superior healing results over the other therapies tested. CONCLUSION: These results confirm a defect morphology directed rationale for periodontal intrabony therapy.