Absence of Healing Impairment in Osteotomies Prepared via Osseodensification Drilling

Witek, Lukasz; Neiva, Rodrigo; Alifarag, Adham M.; Shahraki, Farnaz; Sayah, Ghazaleh; Tovar, Nick; Lopez, Christopher D.; Gil, Luiz Fernando; Coelho, Paulo G.

doi:10.11607/prd.3504

Cited by 31 publications

(32 citation statements)

References 3 publications

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“…The maximized biomechanical behavior of the OD technique has been possible due to the creation of novel osteotomy burs which take advantage of bone elastic and plastic properties while applying a time‐dependent stress (force) to create a time‐dependent strain (deformation), compacting bone particles into the trabecular space instead of removing them 13,14 . Moreover, such a technique has shown a simultaneous sealing/bridging into the intrathread spaces as a result of the reversed compression exerted by the bone spring‐back effect created by the residual elastic strain generated during the osteotomy, without the excessive strain that would lead to an extensive remodeling and stability dip of conventional press‐fit undersized preparations 14,17–21,33 …”

Section: Discussionmentioning

confidence: 99%

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

Bergamo

Zahoui

Barrera

et al. 2021

Clin Implant Dent Rel Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Bergamo

Zahoui

Barrera

et al. 2021

Clin Implant Dent Rel Res

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“…Finally, the osseodensification drill, rotating in a clockwise or counterclockwise direction, also produces bone fractures and not just bone compaction, evidenced by histological findings of bone chips adjacent to the implant's body inserted in sheep's ilium [53]. These bone chips can contribute to increased primary stability through an increase in the frictional contacts.…”

Section: Discussionmentioning

confidence: 99%

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

et al. 2020

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The goal of this study was to evaluate the effects of two implant bed preparation techniques on the implant primary stability (IPS) and the bone density of the implant site. We completed 40 implant bed osteotomies in pig ribs using two techniques: osseodensification (OD) plus under-drilling (UD) with universal osseodensification drills (Test A), and under-drilling alone with drills of the same implant system (Test B). Implants with a 4.1 mm diameter and 10 mm length were inserted, and the IPS was evaluated with three methods: (insertion torque (IT), periotest (PTV), and resonance frequency analysis (RFA). The bone density was evaluated using micro-computed tomography. ANOVA and Tukey’s post-hoc test were used for comparison of the IPS values, and Kruskal–Wallis was used to evaluate the bone density. Statistical significance was set at p < 0.05. The tested B technique (UD) achieved a higher IPS compared to the Test A technique (OD + UD) for all the evaluation methods (p < 0.05). Bone density was higher at the apical and middle region in Test A compared to Test B and control sites (p < 0.05). We concluded that although the bone density increased with the hybrid OD technique with universal drills, implant beds prepared with UD using drills with geometry similar to that of the implant are more efficient at increasing IPS values.

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“…The process relies on the peculiar macrogeometry of the shaping drills that, rotating in counterclockwise direction, exercise simultaneous actions of bone cutting and compacting action of the bone particulate, the compaction and autografting process being more prominent when the drilling is performed in counterclockwise direction at medium‐high speed (800‐1100 rpm) through a bouncing‐pumping motion under copious irrigation. Animal and clinical studies proved that the osseodensification drilling process was particularly effective on improving the stability and overall success of implants placed on low density bone (type 4), such as the atrophic maxillary bone or iliac crest cancellous bone, by increasing primary biomechanical stability and promoting faster and more robust osteointegration due to the autografting of bone particles between the implant threads 7,14,22‐27 …”

Section: Discussionmentioning

confidence: 99%

Osseodensification drilling vs conventional manual instrumentation technique for posterior lumbar fixation: Ex‐vivo mechanical and histomorphological analysis in an ovine model

Torroni

Parente

Witek

et al. 2020

Journal Orthopaedic Research

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Lumbar fusion is a procedure associated with several indications, but screw failure remains a major complication, with an incidence ranging 10% to 50%. Several solutions have been proposed, ranging from more efficient screw geometry to enhance bone quality, conversely, drilling instrumentation have not been thoroughly explored. The conventional instrumentation (regular [R]) techniques render the bony spicules excavated impractical, while additive techniques (osseodensification [OD]) compact them against the osteotomy walls and predispose them as nucleating surfaces/sites for new bone. This work presents a case‐controlled split model for in vivo/ex vivo comparison of R vs OD osteotomy instrumentation in posterior lumbar fixation in an ovine model to determine feasibility and potential advantages of the OD drilling technique in terms of mechanical and histomorphology outcomes. Eight pedicle screws measuring 4.5 mm × 45 mm were installed in each lumbar spine of eight adult sheep (four per side). The left side underwent R instrumentation, while the right underwent OD drilling. The animals were killed at 6‐ and 12‐week and the vertebrae removed. Pullout strength and non‐decalcified histologic analysis were performed. Significant mechanical stability differences were observed between OD and R groups at 6‐ (387 N vs 292 N) and 12‐week (312 N vs 212 N) time points. Morphometric analysis did not detect significant differences in bone area fraction occupancy between R and OD groups, while it is to note that OD showed increased presence of bone spiculae. Mechanical pullout testing demonstrated that OD drilling provided higher degrees of implant anchoring as a function of time, whereas a significant reduction was observed for the R group.

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Absence of Healing Impairment in Osteotomies Prepared via Osseodensification Drilling

Cited by 31 publications

References 3 publications

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

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

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

Osseodensification drilling vs conventional manual instrumentation technique for posterior lumbar fixation: Ex‐vivo mechanical and histomorphological analysis in an ovine model

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