Immediate versus early loading of immediately placed bone-level tapered dental implants with hydrophilic surface in full arch maxillary rehabilitation: A pilot randomized clinical trial with 2-year follow-up.

This study aimed to compare implant stabilities between the immediate and early loaded, immediately placed bone-level tapered dental implants in the maxilla and to evaluate marginal bone loss (MBL), oral health-related quality of life (OHRQoL), and patient satisfaction at a 2-year follow-up. A pilot, prospective, randomized, controlled clinical trial was conducted on 24 maxillary failing dentition patients. The bone-level tapered implants of 12 patients were immediately loaded with temporary restorations, while the other 12 patients did not receive any kind of temporization. Implant-supported screw-retained complete porcelain-fused-to-metal prostheses were delivered to all patients in the seventh postoperative week. The insertion torque values of implants assigned to the immediate and early loading groups were 33.0 ± 4.87 and 29.26 ± 8.31 Ncm, respectively. The dynamics of implant stability changes from implant placement up to a 2-year follow-up were similar for both groups (Penguin®, p = 0.268; Ostell®, p = 0.552), while the MBL was at submillimeter level. The cumulative implant survival rate was 91.80% for immediately loaded implants and 97.22% for early loaded implants, without significant difference (p = 0.162). The total score on the Oral Health Impact Profile questionnaire significantly decreased over time in both groups, indicating improvement in OHRQoL (p < 0.001), and the high level of patient satisfaction remained after 2 years of function regardless of a loading protocol. Both loading protocols, immediate and early, of six immediately placed bone-level tapered dental implants are an adequate treatment choice for fixed rehabilitation of the maxillary failing dentition.

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes.

OBJECTIVES: To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. MATERIALS AND METHODS: A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. RESULTS: In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). CONCLUSIONS: Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. CLINICAL RELEVANCE: Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Reconstructive Peri-Implantitis Therapy by Using Bovine Bone Substitute with or without Hyaluronic Acid: A Randomized Clinical Controlled Pilot Study.

BACKGROUND: The present pilot study aimed to assess clinical and radiographic efficiencies of bovine bone substitute (BBS) merged with hyaluronic acid (HA) in peri-implantits reconstructive surgery. METHODS: Peri-implantitis (diagnosed 6.03 ± 1.61 years of implant loading) bone defects were randomly treated either with BBS plus HA (test group) or BBS alone (control group). Clinical parameters including peri-implant probing depth (PPD), bleeding on probing (BOP), implant stability (ISQ), and radiographic changes in vertical and horizontal marginal bone (MB) levels were assessed at six months postoperatively. New temporary and permanent screw-retained crowns were made at two weeks and three months postoperatively. Data were analyzed using parametric and non-parametric tests. RESULTS: In both groups, 75% of patients and 83% of implants achieved treatment success after six months (no BOP, PPD <5 mm, and no further MB loss). Clinical outcomes improved over time within groups; however, without significant difference between them. ISQ value obtained significant increases in the test compared to the control group at six months postoperatively (p < 0.05). The vertical MB gain was significantly greater in the test group compared to the control (p < 0.05). CONCLUSIONS: Short-term outcomes suggested that BBS merged with HA could improve clinical and radiographic outcomes in peri-implantitis reconstructive therapy.

Immediate Vs Early Loading of Bone Level Tapered Dental Implants With Hydrophilic Surface in Rehabilitation of Fully Edentulous Maxilla: Clinical and Patient Centered Outcomes.

The aim was to: (1) compare changes among primary and secondary implant stability between immediate and early loaded implants in edentulous maxilla, (2) evaluate oral health-related quality of life (OHRQoL), and (3) determine patient satisfaction with 6 implant supported fixed full-arch dentures. A prospective, randomized controlled clinical trial was conducted on 24 edentulous maxilla patients. The BLT SLActive implants in 12 patients were immediately loaded with temporary restorations while 12 patients did not receive temporary restorations. Definitive (final) dentures were delivered to all patients after 6 weeks. Stability of the implants were assessed by insertion torque (IT) and resonance frequency analysis (RFA). Oral Health Impact Profile-19 (OHIP-19) questionnaire was used to evaluate OHRQoL and a visual analogue scale (VAS) was used for patient satisfaction. The IT value of implants assigned for immediate and early loading group was 27.17 ± 9.55 Ncm and 25.01 ± 11.06 Ncm, respectively. Changes in implant stability from baseline to week 6 were similar in both groups when measured by Penguin (P = .881) and Ostell (P = .828). Patients in the immediate loading group reported significantly lower OHIP physical pain scores (P = .016) and OHIP psychological disability score (P = .046), and the patients reported significantly higher VAS function score (P = .009) and VAS esthetics score (P = .009). Implant loading protocols do not have a significant effect on the change in implant stability 6 weeks after implantation; however, immediate loading significantly improves OHRQoL as well as satisfaction of patients with maxillary edentulism treated by fixed full-arch dentures. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in the edentulous maxilla.

Effect of surgical drill guide and irrigans temperature on thermal bone changes during drilling implant sites - thermographic analysis on bovine ribs.

Background/Aim: During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. Methods: A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 x 2 factorial design: drill guide (with or without) and saline (at 25°C or 5°C). Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. Results: The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p < 0.001). No significant interaction was found (p > 0.05). Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p < 0.001). Conclusion: Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide.

Two-Center Prospective, Randomized, Clinical, and Radiographic Study Comparing Osteotome Sinus Floor Elevation with or without Bone Graft and Simultaneous Implant Placement.

PURPOSE: To evaluate stability and success rate of hydrophilic nanostructured implants placed via osteotome sinus floor elevation (OSFE) without grafting material or using ß-tricalcium phosphate (ß-TCP), deproteinized bovine bone (DBB), or their combination, and also to assess three-dimensional volumetric stability of endo-sinus bone gained in the aforementioned conditions. MATERIALS AND METHODS: OSFE with simultaneous implant placement (10-mm long SLActive-BL® , Straumann, Basel, Switzerland) was performed. Grafting materials were randomly allocated to implant sites, whereas one site was left without graft. Implant stability was measured by resonance frequency analysis over 6 months. Implant success was evaluated after 2 years of loading. Volume of new endo-sinus bone was calculated from CBCT images using 3D Slicer® software. RESULTS: A total of 180 implants were inserted into posterior maxilla of 45 patients with 6.59 ± 0.45 mm of residual bone height, and all remained successful after 2 years. Implant stability steadily increased during healing, without significant difference between groups (p = .658). After 2 years, endo-sinus bone significantly shrank (p < .001) in all groups (DBB:66.34%; ß-TCP:61.44%; new bone formed from coagulum: 53.02%; ß-TCP + DBB:33.47%). CONCLUSIONS: Endo-sinus bone gained after OSFE inevitably and significantly shrinks regardless of whether grafting material is applied or not. Grafting material offers no significant advantage to stability nor clinical success of hydrophilic and nanostructured implants placed simultaneously with OSFE.

Immediately loaded mini dental implants as overdenture retainers: 1-Year cohort study of implant stability and peri-implant marginal bone level.

AIM: This 1-year cohort study investigated stability and peri-implant marginal bone level of immediately loaded mini dental implants used to retain overdentures. MATERIALS AND METHODS: Each of 30 edentulous patients received 4 mini dental implants (1.8 mm × 13 mm) in the interforaminal mandibular region. The implants were immediately loaded with pre-made overdentures. Outcome measures included implant stability and bone resorption. Implant stability was measured using the Periotest Classic(®) device immediately after placement and on the 3rd and 6th weeks and the 4th, 6th and 12th months postoperatively. The peri-implant marginal bone level (PIBL) was evaluated at the implant's mesial and distal sides from the polished platform to the marginal crest. Radiographs were taken using a tailored film holder to reproducibly position the X-ray tube at the 6th week, 4th and 12th months postoperatively. RESULTS: The primary stability (Periotest value, PTV) measured -0.27 ± 3.41 on a scale of -8 to + 50 (lower PTV reflects higher stability). The secondary stability decreased significantly until week 6 (mean PTV = 7.61 ± 7.05) then increased significantly reaching (PTV = 6.17 ± 6.15) at 12 months. The mean PIBL measured -0.40 mm after 1 year of functional loading, with no statistically significant differences at the various follow-ups (p = 0.218). CONCLUSIONS: Mini dental implants placed into the interforaminal region could achieve a favorable primary stability for immediate loading. The follow-up Periotest values fluctuated, apparently reflecting the dynamics of bone remodeling, with the implants remaining clinically stable (98.3%) after 1 year of function. The 1-year bone resorption around immediately loaded MDIs is within the clinically acceptable range for standard implants.

A 1-Year Prospective Clinical and Radiographic Study of Early-Loaded Bone Level Implants in the Posterior Maxilla.

PURPOSES: The primary aim of the study was to investigate a 1-year success rate of early-loaded bone level implants with a chemically modified sand-blasted, large grit, acid-etched surface (SLActive®, Institut Straumann AG, Basel, Switzerland) in the posterior maxilla. Secondary objectives included stability of these implants and peri-implant bone level. MATERIALS AND METHODS: Bone level® implants (Institut Straumann AG) inserted into premolar and/or molar maxillary sites were loaded after 6 weeks of healing. The implants were monitored for 1 year using the following outcome measures: implant success, primary and secondary stability, and peri-implant bone level. RESULTS: Out of 37 implants placed in 13 patients, 36 reached sufficient stability and were early loaded, whereas one underwent a delayed loading protocol. One-year success rate of early-loaded implants was 100%. Implant stability at baseline was 71.7 ± 5. 6 to be steadily increased thereafter up to 1 year (80.3 ± 3.3), except at 2 weeks when a nonsignificant decrease was noticed (71.9 ± 3.9). Continuous and significant bone loss was observed, reaching 0.4 ± 0.1 mm in the first postoperative year. CONCLUSION: Bone level implants with the SLActive surface placed into low-density bone and loaded after 6 weeks of healing can predictably achieve and maintain a successful tissue integration.

Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs.

AIM: The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis. METHOD: The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data. RESULTS: Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433). CONCLUSION: The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery.

Real-time thermographic analysis of low-density bone during implant placement: a randomized parallel-group clinical study comparing lateral condensation with bone drilling surgical technique.

OBJECTIVES: To compare the effect of two surgical techniques, lateral condensation and bone drilling, on changes in temperature of the adjacent low-density bone during implant placement into posterior maxilla and to investigate the influence of the host factors - age, gender, region of implantation, bone density, and thickness of the cortical bone at the recipient sites. MATERIAL AND METHODS: Local bone temperature was measured thermographically during implant placement into posterior maxilla following lateral bone condensing (test group) or bone drilling (controls). The main study outcomes were baseline bone temperature prior to implantation and maximum bone temperature recorded during implantation. Early implant success was evaluated after 6 months of healing. RESULTS: A total of 40 implants were randomly allocated to test and control groups and placed into maxillary premolar and/or molar region of 18 participants of both genders and average age of 51.74 years. All recorded bone temperatures were below the threshold for thermal necrosis. Although both groups showed significant increase in bone temperature during implant placement procedure (P ≤ 0.0005), it was significantly higher for bone condensing compared with drilling (P ≤ 0.0005; 3.79 ± 1.54°C; 1.91 ± 0.70°C respectively). No host factor was singled out as a significant predictor of bone temperature changes, although trend of higher increase was observed in young patients, regardless of gender, during implant placement procedure into maxillary first premolar region with bone density type 3 and cortical layer thicker than 1 mm. Early implant success rate after 6 months follow-up was 100%. CONCLUSION: Although both surgical techniques, bone condensing and bone drilling, can be considered safe regarding their thermal effect on the bone of posterior maxilla, bone drilling is associated with fewer local bone heating during implantation. Host factors do not affect the bone thermal changes significantly.

Implant stability and marginal bone level of microgrooved zirconia dental implants: A 3-month experimental study on dogs.

BACKGROUND/AIM: The modification of implant surfaces could affect mechanical implant stability as well as dynamics and quality of peri-implant bone healing. The aim of this 3-month experimental study in dogs was to investigate implant stability, marginal bone levels and bone tissue response to zirconia dental implants with two laser-micro-grooved intraosseous surfaces in comparison with nongrooved sandblasted zirconia and sandblasted, high-temperature etched titanium implants. METHODS: Implant surface characterization was performed using optical interferometric profilometty and energy dispersive X-ray spectroscopy. A total of 96 implants (4 mm in diameter and 10 mm in length) were inserted randomly in both sides of the lower jaw of 12 Fox Hound dogs divided into groups of 24 each: the control (titanium), the group A (sandblasted zirconia), the group B (sandolasted zirconia plus microgrooved neck) and the group C (sandblasted zirconia plus all microgrooved). All the implants were immediately loaded. Insertion torque, periotest values, radiographic crestal bone level and removal torque were recorded during the 3-month follow-up. Qualitative scanning electon microscope (SEM) analysis of the bone-implant interfaces of each group was performed. RESULTS: Insertion torque values were higher in the group C and control implants (p < 0.05). Periotest values increased in all the periods in proportion to the extent of microgrooving as follows: the group C > the control > the group B > the group A (p < 0.05). Radiographic measurements showed minimal crestal bone loss at 3 months for microgrooved zirconia implants (groups C and B) and control implants compared with the group A implants (p < 0.05). The removal torque values increased with time for all the groups as follows: the group C > the control > the group B > the group A (p < 0.05). SEM showed that implant surfaces of the groups B and C had an extra bone growth inside the microgrooves that corresponded to the shape and direction of the microgrooves. CONCLUSION: The addition of microgrooves to the entire intraosseous surface of zirconia dental implants enhances primary and secondary implant stability, promotes bone tissue ingrowth and preserves crestal bone levels.

Heat generation during implant placement in low-density bone: effect of surgical technique, insertion torque and implant macro design.

OBJECTIVES: The study aimed to investigate the effect of surgical technique, implant macrodesign and insertion torque on bone temperature changes during implant placement. MATERIAL AND METHODS: In the in vitro study, 144 self-tapping (blueSKY(®) 4 × 10 mm; Bredent) and 144 non-self-tapping (Standard implant(®) 4.1 × 10 mm; Straumann) were placed in osteotomies prepared in pig ribs by lateral bone condensing or bone drilling techniques. The maximum insertion torque values of 30, 35 and 40 Ncm were used. Real-time bone temperature measurement during implant placement was performed by three thermocouples positioned vertically, in tripod configuration around every osteotomy, at a distance of 5 mm from it and at depths of 1, 5 and 10 mm. Data were analysed using Kruskal-Wallis, Mann-Whitney U-tests and Regression analysis. RESULTS: Significant predictor of bone temperature at the osteotomy depth of 1 mm was insertion torque (P = 0.003) and at the depth of 10-mm implant macrodesign (P = 0.029), while no significant predictor at depth of 5 mm was identified (P > 0.05). Higher insertion torque values as well as non-self-tapping implant macrodesign were related to higher temperatures. Implant placement in sites prepared by bone drilling induced significantly higher temperature increase (P = 0.021) compared with bone condensing sites at the depth of 5 mm, while no significant difference was recorded at other depths. Compared with 30 Ncm, insertion torque values of 35 and 40 Ncm produced significantly higher temperature increase (P = 0.005; P = 0.003, respectively) at the depth of 1 mm. There was no significant difference in temperature change induced by 35 and 40 Ncm, neither by implant macrodesign at all investigated depths (P > 0.05). CONCLUSIONS: Placement of self-tapping implants with low insertion torque into sites prepared by lateral bone condensing technique might be advantageous in terms of thermal effect on bone.

Evaluation of primary stability of self-tapping and non-self-tapping dental implants. A 12-week clinical study.

PURPOSE: The aim of this study was to investigate the relationship between surgical techniques and implant macro-design (self-tapping/non-self-tapping) for the optimization of implant stability in the low-density bone present in the posterior maxilla using resonance frequency analysis (RFA). MATERIALS AND METHODS: A total of 102 implants were studied. Fifty-six self-tapping BlueSkyBredent® (Bredent GmbH&Co.Kg®, Senden, Germany) and 56 non-self-tapping Standard Plus Straumann® (Institut Straumann AG®, Waldenburg, Switzerland) were placed in the posterior segment of the maxilla. Implants of both types were placed in sites prepared with either lateral bone-condensing or with bone-drilling techniques. Implant stability measurements were performed using RFA immediately after implant placement and weekly during a 12-week follow-up period. RESULTS: Both types of implants placed after bone condensing achieved significantly higher stability immediately after surgery, as well as during the entire 12-week observation period compared with those placed following bone drilling. After bone condensation, there were no significant differences in primary stability or in implant stability after the first week between both implant types. From 2 to 12 postoperative weeks, significantly higher stability was shown by self-tapping implants. After bone drilling, self-tapping implants achieved significantly higher stability than non-self-tapping implants during the entire follow-up period. CONCLUSIONS: The outcomes of the present study indicate that bone drilling is not an effective technique for improving implant stability and, following this technique, the use of self-tapping implants is highly recommended. Implant stability optimization in the soft bone can be achieved by lateral bone-condensing technique, regardless of implant macro-design.

A 1-year prospective cohort study on mandibular overdentures retained by mini dental implants.

AIM: The aim of this 1-year prospective cohort study was to evaluate the outcomes and complications of immediately loaded mini dental implants used for stabilizing mandibular overdentures in edentulous patients wearing conventional complete dentures. MATERIALS AND METHODS: Thirty patients received mandibular conventional complete dentures that were subsequently retained by 4 immediately loaded mini dental implants placed in the interforaminal region. Overdenture success, implant success and biological and prosthetic complications were evaluated after the first year of service. Quality of life using the Oral Heath Impact Profile (OHIP)- EDENT test, satisfaction with dental prosthesis and chewing efficiency using questionnaires and a Visual Analogue Scale (VAS) were evaluated twice: after they had received mandibular complete dentures, and again after they had received mandibular overdentures. RESULTS: After 1 year, no overdenture failed and 2 implants did not osseointegrate, resulting in a 98.3% success rate for loaded implants and 95.9% for total implants used (3 out of 123 were not loaded due to fracture). A flap surgical approach was performed in 7 patients, 3 implants fractured during insertion, 3 overdentures fractured, occlusion balancing was necessary for 11 dentures and relining for 8. Implant rehabilitation provided significant improvement in quality of life, stability, comfort, chewing and speaking ability while no significant differences were found in quality of maintenance of hygiene and for aesthetics. CONCLUSIONS: Mini dental implant retained overdentures can be a successful therapeutic procedure for treating mandibular edentulism that improves quality of life, patient satisfaction and chewing ability in patients wearing maxillary dentures. Longer follow-ups are needed to validate this therapy in the medium and long-term.

Implant stability in posterior maxilla: bone-condensing versus bone-drilling: a clinical study.

OBJECTIVE: The aim of this clinical trial was to compare primary and secondary stability of implants placed by bone condensing versus the standard drilling technique in the posterior edentulous maxilla. STUDY DESIGN: Forty-eight SLA Straumann implants 4.1 × 10 mm (Institut Straumann AG, Waldenburg, Switzerland) were placed into edentulous maxillary posterior region in the same positions bilaterally, using the bone condensation technique for one and the standard technique for the other side. Implant stability measurements were performed immediately after implant placement, as well as every week for the next 6 weeks by use of resonance frequency analysis (RFA). Data were analyzed using Mann-Whitney U and Wilcoxon tests. RESULTS: After bone condensing, significantly higher implant stability was recorded immediately after surgery as well as during the whole observation period of 6 weeks compared with bone-drilling technique (Mann-Whitney U test, P = .000). CONCLUSIONS: The bone-condensing technique can be recommended as an alternate surgical approach for implant site preparation in reduced bone density to achieve greater implant stability in the posterior maxilla.

An in vitro study of temperature changes in type 4 bone during implant placement: bone condensing versus bone drilling.

OBJECTIVE: The aim of this study was to compare changes in temperature of the surrounding bone at various osteotomy depths during implant site preparation by bone condensing and by bone drilling as well as the dynamics of their change. STUDY DESIGN: In the present "in vitro" study, pig ribs with uniform thickness of cortical bone of 2 mm were used. Lateral bone-condensing (experimental group) and bone-drilling techniques (control group) were performed. Temperature changes were recorded at a distance of 0.5 mm from the final test osteotomy by 3 thermocouples at the depths of 1, 5, and 10 mm in tripod configuration. Data were collected from 48 measurements, 24 for each group. RESULTS: Significantly higher mean temperature increase at the depth of 5 mm was observed during bone drilling compared with bone condensing, whereas for the depths of 1 and 10 mm differences were not significant between the 2 surgical techniques. During bone condensing, the mean temperature rise was continuously decreasing with increasing depth of osteotomies, whereas during bone drilling the mean temperature rise was first increased and reached a peak at the depth of 5 mm and then began to decrease with increasing depth of the osteotomies. CONCLUSIONS: The bone-condensing technique applied in the jaw bone class D4 offers an advantage over bone drilling because it generates a significantly smaller amount of heat.