In Vitro Handling Characteristics of a Particulate Bone Substitute for Ridge Preservation Procedures.

While particulate bone substitute materials are applied in a variety of augmentation procedures, standardized defects are being used for preclinical testing. This in vitro study evaluated the density and homogeneity of a particulate bone substitute in ridge preservation procedures. Premolars and molars were extracted in ten semimandibles of minipig cadavers. Light body impression material was used for determining the volume of the extraction sites followed by augmentation with particulate material, thereby weighing the graft material needed. Microradiographs and histologic sections were obtained for evaluating the homogeneity and density of the augmentation material. Statistical analyses were based on Shapiro-Wilk tests, Spearman's rho and one sample Wilcoxon test followed by Bonferroni-Holm correction for multiple testing (α = 0.05). Based on 103 single alveoli evaluated, the mean volume determined was 0.120 cm3 requiring a mean amount of graft material of 0.155 g. With only three exceptions, all parameters (volume, mass of augmentation material, density and homogeneity) correlated significantly (p < 0.020). The apical parts of the alveoli showed reduced density as compared to the middle parts (p < 0.001) and the homogeneity of the augmentation material was also lower as compared to the middle (p < 0.001) and cervical parts (p

'One River, Two Systems': Hong Kong's River Management.

Hong Kong (HK), one of the world's most densely populated metropolises, is home to over 200 rivers and streams extending about 2500 km in length. During the 1970s-1990s, most of these rivers were converted into artificial canals, to which the local society pays little attention. Since the 2010s, the HK government has initiated river revitalization to enhance the social-environmental roles of rivers. This study employed a mixed research method, including literature and policy analysis, expert interviews, field visits, and a public survey, to identify key challenges in HK's Integrated River Basin Management (IRBM). The findings highlighted the lack of IRBM's institutional arrangements in HK, characterized by a fragmented 'one river, two systems' approach without both coordination and collaboration. The Water Supplies Department (WSD) impounds upland streams as reservoirs for securing the local water supply, while the Drainage Service Department (DSD) manages heavily channelized, culverted downstream serving as storm drains with diminished ecological functionality. One significant barrier to the implementation of IRBM in HK was the limited public participation, although our survey revealed a high level of public willingness to participate in river management. Presently, river revitalization efforts have achieved limited success, with ecological measures appearing mostly "cosmetic" and the conservation of freshwater biodiversity neglected. This further underscored the pressing need for the embracement of IRBM in HK to safeguard basin-wide freshwater ecosystems. Our survey also indicated low public awareness of river revitalization initiatives and widespread dissatisfaction with their outcomes. In conclusion, we proposed the development of IRBM in HK by instituting river basin coordination, prioritizing river ecosystem restoration in revitalization projects, and involving the public through tailored strategies.

Measurement and Modeling of Ship-Related Ultrafine Particles and Secondary Organic Aerosols in a Mediterranean Port City.

Maritime transport emerges as a major source of ultrafine particle (UFP) pollution in coastal regions with consequences for the health of people living in port cities. Inhalation of UFPs can cause inflammation and oxidative stress, which are starting points for further diseases. In addition to primary particles, secondary organic aerosol (SOA) may form through the photo-oxidation of volatile organic compounds emitted in ship exhaust. The characterization of size-segregated and chemical properties of particles is essential for assessing the health implications related to shipping. We applied a coupled regional-local chemistry transport modeling system to study the effects of ship emissions on atmospheric concentrations of UFP and SOA in the Mediterranean port city Marseille (France), which is characterized by the combination of high port activity, industrialized emissions, and active photochemistry in summer. Our results show that the average potential impact from local shipping in the port area was 6-9% for SOA and 27-51% for total particle number concentration in July 2020. The estimated oxidative potential of daily mean particulate organic matter related to shipping was lower than the oxidative potential reported for heavy fuel oil (HFO). The lower oxidative potential in this study is very likely due to the low share of ships using HFO during stopover.

Evaluation of different debridement strategies for implant-abutment connections: An in vitro study.

STATEMENT OF PROBLEM: Technical complications, including abutment fracture, are a clinical reality. After retrieving failed components, re-establishing a reliable implant-abutment connection is essential, but recommendations on how to clean the interface are lacking. PURPOSE: The purpose of this in vitro study was to evaluate different clinical debridement strategies for removing titanium powder from an implant-abutment interface with regard to their efficacy and associated risk of damaging the interface. MATERIAL AND METHODS: Specimens (n=5) were assembled from previously cut implant halves, which were then contaminated by placing titanium powder inside the implant-abutment connection. Activated rinsing, airflow, and an ultrasound scaler, as well as combinations thereof, were then used to clean the implant-abutment connections. Both parts of each specimen were rated under a light microscope with respect to contamination and damage. In addition, abutments were placed in intact implants (n=10), which had previously been contaminated and cleaned, to record torque curves and abutment stability. Statistical analysis of ratings was based on Kruskal-Wallis tests and the Nemenyi All Pairs test with single-step P value correction, while abutment stability and torque were analyzed using analysis of variance and Tukey HSD tests (α=.05). RESULTS: Erythritol as an abrasive medium led to significantly greater contamination than the scaler (P=.002), activated rinsing (P=.021), and airflow with sodium bicarbonate combined with either conventional (P=.002) or activated rinsing (P=.007). Greater damage was also observed with erythritol because of accumulations of the abrasive media, while scratches were seen after scaler application. Airflow using sodium bicarbonate in combination with activated rinsing showed the lowest level of damage (versus scaler P=.030). Using conventional (P=.010) or activated (P=.029) rinsing, airflow treatment led to a significant reduction in contamination. The scaler led to a significant decrease in abutment stability (P=.048), while activated rinsing and the combination of airflow and activated rinsing did not significantly affect abutment stability. Abutments placed in implants previously contaminated and cleaned required greater torque as compared with original implants (versus activated rinsing, P=.009). CONCLUSIONS: Activated rinsing constituted the best technique for cleaning implant-abutment connections. Cleaning efficiency can be enhanced with airflow using sodium bicarbonate as an abrasive medium.

Implant-Supported Overdentures: Current Status and Preclinical Testing of a Novel Attachment System.

Numerous attachment systems exist for implant-supported overdentures, with each having specific limitations in terms of retention, cost, wear, maintenance and cleanability. A retrospective analysis of patients restored with implant-supported overdentures using bars, telescopic crowns and Locator-type attachments was performed and the patients were interviewed. An in vitro strain gauge study compared telescopic crowns, Locator-type attachments and a novel flexible attachment system employing a shape memory alloy (NiTi) with respect to peri-implant strain development during insertion, loading and removal of an overdenture. A significantly lower number of attachment-related complications was observed in bars as compared to telescopic crowns (p = 0.00007) and Locator-type attachments (p = 0.00000), respectively. Greater overall patient satisfaction was noted in bar-retained restorations while Locator-type attachments led to lower levels of satisfaction regarding prosthesis retention. In vitro, telescopic crowns caused maximum strain development during prosthesis insertion and loading, while during removal this was observed in Locators with white retentive inserts. NiTi attachments caused significantly lower strain development during insertion as compared to telescopic crowns (p = 0.027). During loading, NiTi attachments caused significantly lower strain development than Locators with blue retentive inserts (p = 0.039). During removal, NiTi attachments caused significantly less strain development as compared to Locators with white retentive inserts (p = 0.027). Positional discrepancies between male and female attachment parts affected the retention and reaction force between both components, which may be minimized by using the novel NiTi attachment system. This may be beneficial in terms of component wear and implant loading.

Pilot study on the applicability of boron-doped diamond electrodes for tooth whitening.

OBJECTIVES: While various approaches are available for tooth whitening, the basic concept employs the use of peroxides in the form of gels, which are applied to tooth surfaces. Previous studies have shown that reactive oxygen species acting as potent disinfectants can be produced using boron-doped diamond (BDD) electrodes for the electrolysis of water. With these electrodes being applicable, for example, for endodontic treatment, it was the goal of this pilot study to use such electrodes for tooth whitening. MATERIAL AND METHODS: Two groups (n = 10) of intact clinical crowns were obtained by horizontally cutting off roots of extracted human teeth. The crowns were either bleached by applying a commercially available agent based on 40% hydrogen peroxide or were immersed in saline undergoing electrolysis with BDD electrodes. Whitening of specimens was judged on standardized photographs by examiners with three different levels of experience. Statistical analysis was based on Gwet's AC2 coefficient with quadratic weights, Shapiro-Wilk tests, and two-way analysis of variance of aligned rank transformed data (level of significance set at α = .05). RESULTS: Levels of reliability ranging from fair to substantial were recorded for single persons while the level of reliability ranged between fair and moderate for groups of raters. The level of experience had no significant effect on the ratings (p = .2500). The bleaching method had a significant effect on ratings (p = .0005) with BDD electrodes showing less effect. CONCLUSIONS: Bleaching by applying BDD electrodes was possible, but was not as effective as the use of commercially available in-office whitening gel. A potential explanation may be seen in different concentrations of reactive oxygen species.

Preclinical Testing of Boron-Doped Diamond Electrodes for Root Canal Disinfection-A Series of Preliminary Studies.

While numerous approaches have meanwhile been described, sufficient disinfection of root canals is still challenging, mostly due to limited access and the porous structure of dentin. Instead of using different rinsing solutions and activated irrigation, the electrolysis of saline using boron-doped diamond (BDD) electrodes thereby producing reactive oxygen species may be an alternative approach. In a first step, experiments using extracted human teeth incubated with multispecies bacterial biofilm were conducted. The charge quantities required for electrochemical disinfection of root canals were determined, which were subsequently applied in an animal trial using an intraoral canine model. It could be shown that also under realistic clinical conditions, predictable disinfection of root canals could be achieved using BDD electrodes. The parameters required are in the range of 5.5 to 7.0 V and 9 to 38 mA, applied for 2.5 to 6.0 min with approximately 5 to 8 mL of saline. The direct generation of disinfective agents inside the root canal seems to be advantageous especially in situations with compromised access and limited canal sizes. The biologic effect with respect to the host reaction on BDD-mediated disinfection is yet to be examined.

Wedge Shaped vs Round Implants: Bone Strain During the Insertion Process.

A novel implant system resembling the shape of a wedge and employing piezosurgery for implant bed preparation has been introduced with the aim of solving the problem of horizontal bone deficiency. This in vitro study compared emerging bone strain during insertion of a conventionally round implant vs the wedge implant. Adhering to the manufacturers' protocols, implant surgery was performed in polyurethane foam blocks equipped with strain gauges attached to the buccal and occlusal surfaces. Five implants per group were placed while strain development during insertion was recorded. Primary implant stability was determined using resonance frequency analysis. Statistical analysis was based on Welch's 2-sample tests (α = 0.05). In general, greater strain development was found on the buccal aspect of bone compared to the occlusal aspect with an overall range between -724 µm/m and 9132 µm/m. A stepwise increase in strain development was seen in the wedge implants while, in the round implants, a continuous increase in strain development was recorded. Absolute strain development on the buccal aspect of bone was significantly greater in wedge implants (P = .0137) while, on the occlusal aspect, significantly lower strain development was seen for wedge implants (P = .0012). Primary stability of wedge implants was significantly lower compared to round implants (P = .0005). Wedge implants differ from round implants with respect to the insertion process characterized by a stepwise increase in bone deformation. High strain development in buccal bone may constitute a risk factor for bone resorption and should be avoided by reducing the degree of underpreparation of the implant site.

Rationale for a novel attachment system for implant-supported overdentures.

PURPOSE: To quantify the effect of support stiffness on the retention forces of telescopic crowns and to evaluate a prototype attachment system incorporating a nickel-titanium element. MATERIALS AND METHODS: In the first part of the study, telescopic crowns were fabricated employing standard laboratory procedures. For six combinations of telescopic crowns, the separation force was determined while varying the stiffness of their supporting implants. In the second study part, an in vitro mandibular model with three interforaminal implants was equipped with strain gauges and extensometers. Two prostheses either employing cylindrical telescopic crowns or prototype attachments were fabricated and statically loaded on the model using either the midline or the left canine or both canine implants for support while strain in the peri-implant area and prosthesis displacement were recorded. Statistical analysis of both study parts was based on pairwise comparisons with the level of significance set at α = .05. RESULTS: With one exception (P = .161), for each assembly of two telescopic crowns, the separating force was always dependent on the stiffness of the supporting implants. With 3 exceptions out of a total of 14 comparisons for peri-implant strain and prosthesis displacement, the use of the prototype attachments always led to significantly lower mean values compared to the use of cylindrical telescopes (P < .00). CONCLUSION: The individual retention force of telescopic crowns on implants should be set at a lower level compared to telescopic crowns on natural abutments. Incorporating a nickel-titanium element into attachment systems for implant-supported removable prostheses reduces peri-implant strain and may facilitate the use of telescopic crowns.

Adhesive removable partial denture attachments made from zirconia ceramic: A finite element analysis and in vitro study.

STATEMENT OF PROBLEM: Whether adhesive zirconia ceramic removable partial denture attachments are feasible with current technology is unclear. PURPOSE: The purpose of this finite element analysis and in vitro study was to evaluate the effect of the lever arm, tooth preparation, and aging on the loading of the tooth-zirconia attachment interface. MATERIAL AND METHODS: Three different finite element analysis (FEA) models allowing for the loading of an adhesive attachment either directly or through a removable partial denture were used. Two models represented a human tooth with 2 different types of attachments, while the third model also included a removable partial denture. For the evaluation of bond strength, a combination of shear and hydrostatic stress was used. In addition, composite resin teeth were fabricated, and zirconia bars were bonded to them with varying tooth preparations and lever arm lengths. In 1 group the influence of aging was analyzed. Fracture load was determined by using a universal testing machine. Statistical analysis was based on the Shapiro-Wilk normality test, ANOVA, and Games-Howell test (α=.05). RESULTS: The maximum stress of 65 MPa occurring in the bonding area was reduced to 37 MPa by adding a retainer to the attachment. Loading of the denture resulted in a maximum stress of 9 MPa. Mean fracture loads ranged from 33.6 N to 209.1 N. Preparing a flat bonding surface showed a nonsignificant increase (P=.197), whereas aging led to a nonsignificant decrease in fracture load (P=.075). A lever arm extended by 2 mm significantly reduced fracture load (P=.002). The addition of an occlusal-distal (OD) cavity led to a nonsignificant increase (P=.186), which became significant when a mesial-occlusal-distal (MOD) preparation was applied (P=.001). CONCLUSIONS: Adhesive zirconia attachments should use a MOD cavity and have a cross section of at least 2.5×2.5 mm. The attachment should not extend more than 3 mm.

Use of a dentin bonding agent for the fixation of strain gauges on bone.

Capturing deformation of bone using strain gauges is still a common approach in biomechanics. So far, the bone surfaces had to be sanded and cleaned using various solvents prior to attaching the sensors using cyanoacrylate. This work proposes a novel approach employing common bonding procedures to enamel and dentin as used in restorative dentistry. Bovine ribs were obtained and osteotomies were created following clinical protocols for dental implant insertion. A unidirectional strain gauge was attached to the outer surface of the bone specimens using the steps of acid etching with phosphoric acid, application of a three-bottle dentin adhesive and light curing. Emerging strains were then captured during implant insertion as well as during static loading of the implants in a universal testing machine. The method described here allowed for the reliable fixation of strain gauges on unaltered bone surfaces. Both, compressive and tensile strains emerging in the surrounding of the dental implants could be captured.

Comparison of extraction sites versus artificial defects with xenogenic bone substitute in minipigs.

OBJECTIVES: The preclinical evaluation of bone substitutes is frequently performed in artificially created defects. However, such defects do not reflect the predominant clinical application of bone substitutes for socket preservation. Hence, the goal of this animal study was to compare the performance of a xenogenic bone substitute in extraction sites versus artificial defects. MATERIAL AND METHODS: Four study sites each were created in the mandibles of four minipigs in the region of the third premolars and first molars, respectively. On one side, fresh extraction sockets were established while contralaterally trephine defects were created in healed alveolar bone. All sites were augmented using a particulate xenogenic bone substitute, covered by resorbable membranes and allowed to heal for 12 weeks. The amounts of new bone, non-bone tissue and remaining bone substitute granules were quantified through histological and micro-CT analysis. Comparative statistics were based on t-tests for two samples and ANOVA with the level of significance set at α = 0.05. RESULTS: Histomorphometric data from only two animals could be quantitatively analyzed due to difficulty with identifying the surgical sites. The percentage of newly formed bone ranged between 53.2% ± 5.6% for artificial defects and 54.9% ± 12.4% for extraction sites. With the exception of ANOVA indicating a greater amount of non-bone tissue in extraction sites as compared to artificial sites (p = 0.047), no statistically significant differences were observed. Micro-CT scans showed patterns similar to the ones observed in histomorphometry. As extraction sites could be identified only in two micro-CT reconstructions, quantitative assessment was not undertaken. CONCLUSIONS: Despite the comparable performance of bone substitute material in artificial defects and extraction sites found here, the data gathered with this experiment was insufficient for showing equivalence of both approaches.

Observational study on primary and secondary stability of two current bone level implant designs.

Objective: Achieving high levels of primary implant stability is considered to be desirable, despite some studies warning of the risk of bone damage. It was the goal of this observational clinical study to compare two current bone level implant systems with respect to primary and secondary stability. Method and materials: Data on bone quality, insertion torque, implant stability at insertion and after healing, as well as number of implants lost during healing were obtained from two centers either placing BLT (Bone Level Tapered, Straumann) or Nobel Parallel CC (Nobel Biocare) implants. Statistical analysis was based on Spearman rank correlation tests, analysis of variance, and t tests with the level of significance set at α = .05. Results: A total of 312 BLT and 92 Nobel Parallel CC implants were placed. Ten BLT and two Nobel Parallel CC implants failed resulting in survival rates of 96.79% and 97.83%, respectively. Mean insertion torque recorded in the different bone classes showed large standard deviations, and only torque values for BLT implants recorded in type 3 bone differed significantly from type 2 bone and type 1 bone (P = .024). For BLT implants, bone quality and insertion torque correlated (Spearman rho = -.3326; P = .0023) as did ISQ at insertion (Spearman rho = -.2241; P = .0429). Implant diameter significantly affected primary (P = .0013) and secondary (P = .0050) stability of Nobel Parallel CC implants while for BLT implants a significant effect was only seen for secondary stability (P = .0000). Bone quality had a significant effect on implant insertion torque for BLT implants (P = .0059). Bone quality had no general effect on ISQ changes during healing but 3.3-mm BLT implants showed significantly (P = .0005) lower stability after healing. Conclusion: Huge variation with respect to primary and secondary stability seems to exist among similar looking implant systems clinically used for identical indications.

City Scale Modeling of Ultrafine Particles in Urban Areas with Special Focus on Passenger Ferryboat Emission Impact.

Air pollution by aerosol particles is mainly monitored as mass concentrations of particulate matter, such as PM10 and PM2.5. However, mass-based measurements are hardly representative for ultrafine particles (UFP), which can only be monitored adequately by particle number (PN) concentrations and are considered particularly harmful to human health. This study examines the dispersion of UFP in Hamburg city center and, in particular, the impact of passenger ferryboats by modeling PN concentrations and compares concentrations to measured values. To this end, emissions inventories and emission size spectra for different emission sectors influencing concentrations in the city center were created, explicitly considering passenger ferryboat traffic as an additional emission source. The city-scale chemical transport model EPISODE-CityChem is applied for the first time to simulate PN concentrations and additionally, observations of total particle number counts are taken at four different sampling sites in the city. Modeled UFP concentrations are in the range of 1.5-3 × 104 cm-3 at ferryboat piers and at the road traffic locations with particle sizes predominantly below 50 nm. Urban background concentrations are at 0.4-1.2 × 104 cm-3 with a predominant particle size in the range 50-100 nm. Ferryboat traffic is a significant source of emissions near the shore along the regular ferry routes. Modeled concentrations show slight differences to measured data, but the model is capable of reproducing the observed spatial variation of UFP concentrations. UFP show strong variations in both space and time, with day-to-day variations mainly controlled by differences in air temperature, wind speed and wind direction. Further model simulations should focus on longer periods of time to better understand the influence of meteorological conditions on UFP dynamics.

Students at Saarland University dental school-A survey on their background and curriculum perception.

INTRODUCTION: With the aim of optimising dental education without overburdening students, new legislation restructuring the undergraduate dental curriculum in German is under way. The goal of this study was to survey the current situation of dental students at one specific university with respect to their socio-economic background, admission to dental school, curriculum perception and work-life balance. MATERIALS AND METHODS: An online questionnaire was presented to all undergraduate students enrolled at Saarland University who had at least completed the first preclinical practical course in dentistry. RESULTS: A response rate of 85% was reached with two-thirds of the student body being females. The profession of 40% of students' parents either was physicians or dentist. Students reported a slight reduction in time spent for leisure activities during their studies, however, with sports activities hardly being affected. With respect to a proper work-life balance, almost 50% of respondents considered their clinical workload as being too high. Students did not express a clear opinion regarding curriculum structure, whilst the content mostly satisfied their expectations (59%). The majority (71%) of students considered their preclinical training as being demanding whilst less than 3% fully agreed that preclinical training provided an optimal background for patient treatment. The learning modules in the first clinical semester were considered as being adequate by 56% of students. Examinations during courses were seen as properly reflecting the students' knowledge by 79% of students. DISCUSSION: The status quo of German dental students is characterised by a high workload affecting the students' work-life balance and by a transition between preclinical and clinical education which only about half the student body perceives as being adequate. Patient-based examinations obviously are not considered as being problematic.

Influence of Aviation Emission on the Particle Number Concentration near Zurich Airport.

In addition to the much-publicized environmental impact of CO2 emission by air traffic, aviation particulate emission also deserves attention. The abundant ultrafine particles in the aviation exhaust with diameters less than 100 nm may penetrate deep into the human respiratory system and cause adverse health effects. Here, we quantified the detailed aviation particle number emission from Zurich Airport and evaluated its influences on the annual mean particle number concentrations in the surrounding communities. The actual flight trajectory data were utilized for the first time to develop an emission inventory with high spatial resolution. The estimated total particle number emission was in the magnitude of 1024 particles per year. The annual mean particle mass concentrations in the nearby communities were increased by about 0.1 µg m-3 due to the aviation emission, equivalent to about 1% of the background concentration. However, the particle number concentration could be increased by a factor of 2-10 of the background level (104 cm-3) for nearby communities. Further studies are required to investigate the health effects of the increased particle number concentration and to evaluate whether the regulation based on the mass concentration is still sufficient for the air quality near airports.

Evaluation of Insertion Energy as Novel Parameter for Dental Implant Stability.

Insertion energy has been advocated as a novel measure for primary implant stability, but the effect of implant length, diameter, or surgical protocol remains unclear. Twenty implants from one specific bone level implant system were placed in layered polyurethane foam measuring maximum insertion torque, torque-time curves, and primary stability using resonance frequency analysis (RFA). Insertion energy was calculated as area under torque-time curve applying the trapezoidal formula. Statistical analysis was based on analysis of variance, Tukey honest differences tests and Pearson's product moment correlation tests (α = 0.05). Implant stability (p = 0.01) and insertion energy (p < 0.01) differed significantly among groups, while maximum insertion torque did not (p = 0.17). Short implants showed a significant decrease in implant stability (p = 0.01), while reducing implant diameter did not cause any significant effect. Applying the drilling protocol for dense bone resulted in significantly increased insertion energy (p = 0.02) but a significant decrease in implant stability (p = 0.04). Insertion energy was not found to be a more reliable parameter for evaluating primary implant stability when compared to maximum insertion torque and resonance frequency analysis.

Insertion torque/time integral as a measure of primary implant stability.

The goal of this in vitro study was to determine the insertion torque/time integral for three implant systems. Bone level implants (n = 10; BLT - Straumann Bone Level Tapered 4.1 mm × 12 mm, V3 - MIS V3 3.9 mm × 11.5 mm, ASTRA - Dentsply-Sirona ASTRA TX 4.0 mm × 13 mm) were placed in polyurethane foam material consisting of a trabecular and a cortical layer applying protocols for medium quality bone. Besides measuring maximum insertion torque and primary implant stability using resonance frequency analysis (RFA), torque time curves recorded during insertion were used for calculating insertion torque/time integrals. Statistical analysis was based on ANOVA, Tukey's honest differences test and Pearson product moment correlation (α = 0.05). Significantly greater mean maximum insertion torque (59.9 ± 4.94 Ncm) and mean maximum insertion torque/time integral (961.64 ± 54.07 Ncm∗s) were recorded for BLT implants (p < 0.01). V3 showed significantly higher mean maximum insertion torque as compared to ASTRA (p < 0.01), but significantly lower insertion torque/time integral (p < 0.01). Primary implant stability did not differ significantly among groups. Only a single weak (r = 0.61) but significant correlation could be established between maximum insertion torque and insertion torque/time integral (p < 0.01) when all data from all three implant groups were pooled. Implant design (length, thread pitch) seems to affect insertion torque/time integral more than maximum insertion torque.

Insertion and Loading Characteristics of Three Different Bone-Level Implants.

PURPOSE: While primary stability still constitutes an important factor for implant success, high levels of insertion torque resulting from bone compression are controversial and may constitute a co-factor in peri-implant bone loss. MATERIALS AND METHODS: Adhering to the manufacturers' protocols for medium-quality bone, implant surgery was performed in polyurethane foam blocks equipped with strain gauges attached to the buccal aspect. Following insertion and attachment of provisional abutments, oblique loading was performed. The following parameters were recorded for three different implant types (Straumann Bone Level Tapered [BLT], MIS V3 [V3], Dentsply Sirona ASTRA TX [ASTRA]): maximum insertion and removal torque, maximum strain during insertion and loading, and implant stability before and after loading (resonance frequency analysis [RFA]). Statistical analysis was based on analysis of variance (ANOVA), Tukey honest significant difference test, and Pearson's product moment correlation (α = .05). RESULTS: Maximum insertion torque (59.9 ± 4.94 Ncm) was recorded for BLT followed by V3 and ASTRA (P < .01 for all comparisons). Maximum removal torque (43.7 ± 9.69 Ncm) was also recorded for BLT, but the pairwise comparisons reached significance only for BLT vs ASTRA (P < .01) and V3 vs BLT (P = .03). Implant stability differed among groups only after loading, where the pairwise comparison between BLT and ASTRA reached significance (P = .02). Maximum strain during insertion was caused by BLT reaching 19,482.62