Professional Documents
Culture Documents
Preparo e Estabilidade Implantar
Preparo e Estabilidade Implantar
Purpose. The purpose of this study was to examine the primary stability of dental implants placed by using different
methods of preparation for in vitro monocortical and bicortical models of the posterior maxilla.
Material and methods. Sixty screw-shaped implants (4.0 × 10 mm) were inserted into solid rigid polyurethane blocks.
The implants were divided into 6 groups (n=10) to test 2 variables: 1) location (monocortical or bicortical block) and
2) preparation method (standard preparation, underpreparation, or the osteotome technique). The insertion and
removal torques were measured and resonance frequency analysis (RFA) was performed to determine the primary
stability of each implant. Insertion and removal torque data were analyzed by 2-way ANOVA, followed by the post hoc
Tukey HSD multiple comparison test. RFA data were analyzed by 2-way and 1-way ANOVAs and the Tukey HSD mul-
tiple comparison test (α=.05). The Pearson correlation analysis was also performed to examine correlations among
the values.
Results. The preparation method had a significant effect on insertion torque, RFA value, and removal torque; how-
ever location had a significant effect only on the removal torque (P<.001). There was a significant interaction be-
tween location and preparation method for RFA values (P=.045) and a significant difference in standard preparation
method according to the location (P=.039); however, there was no significant difference in underpreparation (P=1.00)
and osteotome technique (P=1.00). Statistically significant correlations were found between insertion torque and RFA
values (r=0.529, P< .001), insertion torque and removal torque values (r=0.517, P< .001), and removal torque and
RFA values (r=0.481, P<.001).
Conclusions. Underpreparation and bicortical fixation significantly increased implant stability and the osteotome
technique decreased implant stability in synthetic bone models that mimicked the posterior maxillary region. The pri-
mary stability values had statistically significant correlations to each other. (J Prosthet Dent 2012;107:366-372)
Clinical Implications
Based on the results of this in vitro study, standard preparation and
the bicortical fixation method produce greater primary stability than
the various other surgical methods evaluated.
Supported by grant No. KHU-20091453 from the Kyung Hee University, Seoul, Korea.
a
Clinical Assistant Professor, Department of Biomaterials & Prosthodontics, Kyung Hee University Dental Hospital at Gangdong.
b
Professor & Chairman, Department of Biomaterials & Prosthodontics, Kyung Hee University Dental Hospital at Gangdong.
c
Assistant Professor, Department of Biomaterials & Prosthodontics, Kyung Hee University Dental Hospital at Gangdong.
d
Adjunct Assistant Clinical professor, Center for Implantology, Boston University School of Dental Medicine.
e
Assistant Professor, Department of Periodontics, Kyung Hee University Dental Hospital at Gangdong.
The Journal of Prosthetic Dentistry Ahn et al
June 2012 367
Several critical factors are neces- implants, the increase in bone density lution and high variability of these in-
sary for successful osseointegration is actually limited to the periapical struments during examination.25 Cur-
of dental implants, including the area of the entire periimplant area, rently, there is no gold standard for
primary stability and surface charac- and in the pericylinder area there was the accurate measurement of implant
teristics of the implant, anatomical no increase in bone density with the stability, and studies have cast doubt
conditions, bone metabolism, design osteotome technique. In addition, upon the correlation between the val-
of the interim prosthesis, and the oc- many studies have suggested that the ues of insertion and removal torques
clusion pattern during the healing use of the osteotome decreases or and RFA.21,26-29
phase.1 The primary stability of the does not affect primary stability.18-20 This study had 2 objectives: to
implant, which results from the initial According to Nkenke et al,21 use of compare the primary implant stabil-
interlocking between alveolar bone the osteotome to condense the bone ity associated with different prepara-
and the body of the implant, affects results in longitudinal cracks and gaps tion methods in both monocortical
the secondary stability of the implant in the region of the bone collar, in- and bicortical models of the posterior
because the latter results from subse- creasing the rate of implant failure. To maxilla and to examine the correla-
quent contact osteogenesis and bone date there is insufficient scientific and tion between biomechanical testing
remodeling.2,3 As a consequence, a clinical evidence to support immedi- (insertion and removal torque) and
high degree of primary implant stabil- ate loading in the posterior maxillary RFA. The null hypotheses were that
ity is a key prerequisite for immediate region.22 location (monocortical block or bicor-
or early loading.4,5 The primary de- Several methods can be used to tical block) and preparation method
terminants of the primary stability of measure primary implant stability; (standard preparation, underprepara-
an implant are the surgical technique these include biomechanical tests, tion, or osteotome technique) would
used, the design of the implant, and which are represented by measure- not affect the primary stability of im-
the mechanical properties of the bone ment of the insertion and removal plants and that there would be no cor-
tissue.6 torque and nondestructive measure- relation between the values of inser-
The posterior region of the maxilla ments such as resonance frequency tion and removal torques and RFA.
is characterized by thin cortical bone analysis (RFA). Biomechanical test-
and trabecular bone of low density. In ing, such as measurement of the MATERIAL AND METHODS
addition, in many instances the height insertion and removal torque, is
of the bone in this region is insuffi- more accurate than nondestructive Polyurethane specimens
cient to achieve high primary stability measurements such as RFA and the
because of the presence of the maxil- Periotest.23 However since biome- Solid rigid polyurethane blocks
lary sinus. Therefore, dental implants chanical testing is destructive and can (Sawbones; Pacific Research Labora-
in this region show the highest rate be applied only once, its clinical util- tories Inc, Vashon, Washington) were
of failure, and surgical techniques ity is limited. Therefore, nondestruc- used to simulate monocortical and
have been proposed to increase their tive measurements such as RFA are bicortical conditions in the posterior
primary stability.7-10 The most widely commonly used in clinical practice.24 maxillary region (Fig. 1). To model
used methods include preparation The use of RFA and the Periotest is cancellous bone, a density of 0.32 g/
of the site with tools one size smaller also limited because of the low reso- cm3 was selected because the mean
than the diameter of the implant,11
bone condensation using an osteo-
tome,12-14 and the use of bicortical
fixation.15 Among these methods, the
osteotome technique was introduced
to increase the primary stability and
success rate of implants in areas of
poor bone density, such as the pos-
terior maxillary region.16 Theoretically,
the osteotome condenses the bone
to increase primary stability by lateral
osseocompression. However, accord-
ing to Blanco et al,17 who studied the
placement of implants using the osteo-
tome in the maxillary tuberosities of 1 Polyurethane synthetic bone blocks and implant specimens. Left: bone
human cadavers and performed histo- blocks with monocortical layer. Right: bone blocks with bicortical layer.
morphometric assessment around the
Ahn et al
368 Volume 107 Issue 6
drills were used in accordance with
the manufacturer’s instructions (Ne-
obiotech Co Ltd). The implants were
then placed in the block. For the UM
group, the 3.4 mm-diameter drill was
not used before the implants were
inserted. In the OM group, a round
bur and the 2 mm-diameter twist
drill were used, and the area was ex-
panded by using 2.2 mm, 2.8 mm,
and 3.5 mm-diameter osteotomes
(Straumann AG, Basel, Switzerland)
before placement of the implants in
the block. For the SB, UB, and OB
groups the implants were inserted in
bicortical blocks with the same surgi-
cal protocols as those described for
the SM, UM, and OM groups.
2 Schematic representation of different preparation methods for monocorti-
cal and bicortical blocks. Measurement of insertion torque
As a service to our subscribers, copies of back issues of The Journal of Prosthetic Dentistry for the preceding 5 years are
maintained and are available for purchase from Elsevier, Inc until inventory is depleted. Please write to Elsevier, Inc,
Subscription Customer Service, 6277 Sea Harbor Dr, Orlando, FL 32887, or call 800-654-2452 or 407-345-4000 for
information on availability of particular issues and prices.