Effects of Condensation on Peri-implant Bone Density and Remodeling

Abstract

Bone condensation is thought to densify interfacial bone and thus improve implant primary stability, but scant data substantiate either claim. We developed a murine oral implant model to test these hypotheses. Osteotomies were created in healed maxillary extraction sites 1) by drilling or 2) by drilling followed by stepwise condensation with tapered osteotomes. Condensation increased interfacial bone density, as measured by a significant change in bone volume/total volume and trabecular spacing, but it simultaneously damaged the bone. On postimplant day 1, the condensed bone interface exhibited microfractures and osteoclast activity. Finite element modeling, mechanical testing, and immunohistochemical analyses at multiple time points throughout the osseointegration period demonstrated that condensation caused very high interfacial strains, marginal bone resorption, and no improvement in implant stability. Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability.

TGF‐β activity in acid bone lysate adsorbs to titanium surface

“…Osseointegration of dental implants is a sequential process that is initiated by drilling the implant bed. The translation of primary mechanical stability into a secondary one is a sequential process initiated by the catabolic action of osteoclasts resorbing the injured necrotic bone . Approximately 1 week after implant placement, the anabolic action of osteoblasts takes over forming new woven bone on the surface of the previously resorbed pristine bone and also on the surface of the titanium implant .…”

Increasing the stability of dental implants: The concept of osseodensification

“…However, if the implant is scheduled to be immediately loaded then an insertion torque of at least 32 Ncm is to be considered 60 , which should be increased to 45Ncm in sites of low quality bone 61 .…”

Biophysical regulation of osteotomy healing: An animal study

“…Rather than drilling, an initial osteotomy can be enlarged using specialized cutting tools or by forcibly advancing an osteotome into a pilot hole . These types of condensation procedures may increase interfacial bone volume/total volume (BV/TV), but a common error is to assume that interfacial bone with a higher BV/TV will provide better initial support greater to an implant . “Densifying” interfacial bone by condensation can damage the connectivity of bony trabeculae, and an extensive literature demonstrates that damaged bone is significantly weaker than intact bone .…”

“…These types of condensation procedures may increase interfacial bone volume/total volume (BV/TV), but a common error is to assume that interfacial bone with a higher BV/TV will provide better initial support greater to an implant . “Densifying” interfacial bone by condensation can damage the connectivity of bony trabeculae, and an extensive literature demonstrates that damaged bone is significantly weaker than intact bone . Consequently, implants placed in such osteotomies do not exhibit better primary‐ or secondary‐stability …”

“…“Densifying” interfacial bone by condensation can damage the connectivity of bony trabeculae, and an extensive literature demonstrates that damaged bone is significantly weaker than intact bone . Consequently, implants placed in such osteotomies do not exhibit better primary‐ or secondary‐stability …”