A New Site Preparation Protocol That Supports Bone Quality Evaluation and Provides Predictable Implant Insertion Torque

Abstract

When preparing an implant site, clinicians often base their assessment of the bone on subjective tactile and visual cues. This assessment is used to plan the surgical procedure for site preparation, including how many drilling steps will be used. The subjective nature of bone evaluation, consequently, results in poor reproducibility and may lead to under or over preparation of the site. Recently, an unconventional site preparation protocol was developed in which the decision of which instruments to use is dictated by insertion torque of the novel site preparation instrument (OsseoShaper ™ , Nobel Biocare AB, Gothenburg, Sweden). The aim of this study was to quantify the correlation of the site preparation torques of the new instrument with bone density and maximum implant insertion torques. In vitro and in vivo data showed strong linear correlation between site preparation torque and density and resulted in reliable implant insertion torques, respectively. From our analysis, we conclude that this new instrument and protocol has the potential to eliminate the need for additional intraoperative bone evaluation and may reduce the risk of inadequate preparation of the site due to the ability to serve as a predictor of the final implant insertion torque.profile combined with a cutting flute and unconventional site preparation protocol. Following the pilot drill, the osteotomy is shaped with an implant-specific single use instrument, OsseoShaper1 (OS1), without irrigation at low speed (25-100 rpm) using a motorized drill unit with a maximum torque setting of 40 Ncm (Figure 1). The OS1 torque, measured by a drill unit with real-time torque display, determines the workflow for implant placement. If the OS1 achieves the desired depth and position with less than 40 Ncm, the implant can be placed. If the OS1 torque reaches 40 Ncm before it reaches the planned position, the next instrument should be used to further shape the implant site.

Transmucosal abutments in the esthetic zone: Surgical and prosthetic considerations

“…The system was developed based on new concepts and tools for the osteotomy to preserve bone viability. 27,28 It features a trioval conical connection with an 8 and 2. F I G U R E 2 0 Bonding of the zirconia crown on the titanium base with opaque composite resin cement following "APC" technique": Airparticle abrasion with alumina, primer application, and composite resin cement on both materials.…”

“…For this specific case, a novel implant system (N1, Nobel Biocare, Zurich, Switzerland), which was optimized for immediate implant placement, was selected. The system was developed based on new concepts and tools for the osteotomy to preserve bone viability 27,28 . It features a trioval conical connection with an 8° and 2.5 mm high contact surface, creating a very strong connection and tight seal with a reduced insertion torque of 20 Ncm, 29 allowing for slim prosthetic components.…”

A Retrospective Observational Study Assessing the Clinical Outcomes of a Novel Implant System with Low-Speed Site Preparation Protocol and Tri-Oval Implant Geometry

“…These osseoshaping instruments are designed to create larger bone chips than conventional drills and rotate in the reverse direction when being removed from the osteotomy, which deposits the bone chips into the hole [ 10 ]. The low speed produces a temperature below that associated with osteocyte necrosis, requiring no irrigation [ 17 , 18 , 19 ], and the resultant bone coagulum contributes to bone formation, improving implant integration and stability [ 10 ].…”

“…Another advantage of the low-speed osseoshaping tools is the ability to use these tools to evaluate the quality of the implant site based on the torque required for site preparation. A recent study [ 18 ] examining the use of the osseoshaping tools in bone surrogate materials, mini pigs, and human patients found strong, linear correlations between the torque required for site preparation using the osseoshaping instruments and both bone density and implantation torque, allowing clinicians to evaluate the implant site during site preparation, without additional assessments. A recently published clinical case series examining the use of osseoshaping instruments to place fifteen implants in seven patients found that, in most cases, the entire procedure could be completed in only three steps: pilot drilling, osseoshaping tool use, and implant insertion [ 20 ].…”

Science, Innovation and Education as Pillars of High-Quality Implant Dentistry: Overcoming Challenges through Innovation Dictates Trends

“…Innovation in implant dentistry includes methods, comprising both surgical [14] and prosthetic preparation techniques [15,16], post-operative interventions to increase implant stability [17], or new methods of measuring peri-implant bone [18], aiming to increase the probability of success in the long term. Innovation in implant dentistry also includes new materials and surface treatments.…”