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      Influence of cortical bone and implant design in the primary stability of dental implants measured by two different devices of resonance frequency analysis: An in vitro study


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          This study aimed to evaluate the effect of the implant design and the presence of cortical bone in the primary stability, as well as analyze the differences between the stability measurements obtained by two different resonance frequency analysis (RFA) devices.

          Material and Methods

          A total of 80 Klockner implants of two different models [40 Essential Cone implants (group A) and 40 Vega implants (group B)] were used. The implants were placed in two polyurethane blocks that simulated the mechanical properties of the maxillary bone. One block featured a layer of cortical bone that was absent from the other block. The primary stability of all implants was measured by insertion torque and RFA using two different devices: Penguin RFA and Osstell IDX.


          Primary stability was superior in the cortical bone in both torque and RFA. In the block containing cortical bone, group A implants obtained a greater insertion torque than did group B. The insertion torque was lesser in the bone lacking cortex. Regarding the ISQ of the implants, group A presented higher values in the block with cortical bone, but the values were lower in the block without cortical bone. There were no significant differences between the values obtained from the Osstell IDX and Penguin RFA.


          The presence of cortical bone positively influences the primary stability of dental implants. The design of the implant also has a statistically significant influence on implant primary stability, although the impact depends on whether there is coronal cerclage or not. There were no statistically significant differences in the implant stability measurements obtained by two different devices.

          Key words:Implant stability, resonance frequency analysis, torque, osstell, penguin, cortical.

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          Most cited references40

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          Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period.

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            Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man.

            A total of 2895 threaded, cylindrical titanium implants have been inserted into the mandible or the maxilla and 124 similar implants have been installed in the tibial, temporal or iliac bones in man for various bone restorative procedures. The titanium screws were implanted without the use of cement, using a meticulous technique aiming at osseointegration--a direct contact between living bone and implant. Thirty-eight stable and integrated screws were removed for various reasons from 18 patients. The interface zone between bone and implant was investigated using X-rays, SEM, TEM and histology. The SEM study showed a very close spatial relationship between titanium and bone. The pattern of the anchorage of collagen filaments to titanium appeared to be similar to that of Sharpey's fibres to bone. No wear products were seen in the bone or soft tissues in spite of implant loading times up to 90 months. The soft tissues were also closely adhered to the titanium implant, thereby forming a biological seal, preventing microorganism infiltration along the implant. The implants in many cases had been allowed to permanently penetrate the gingiva and skin. This caused no adverse tissue effects. An intact bone-implant interface was analyzed by TEM, revealing a direct bone-to-implant interface contact also at the electron microscopic level, thereby suggesting the possibility of a direct chemical bonding between bone and titanium. It is concluded that the technique of osseointegration is a reliable type of cement-free bone anchorage for permanent prosthetic tissue substitutes. At present, this technique is being tried in clinical joint reconstruction. In order to achieve and to maintain such a direct contact between living bone and implant, threaded, unalloyed titanium screws of defined finish and geometry were inserted using a delicate surgical technique and were allowed to heal in situ, without loading, for a period of at least 3--4 months.
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              Understanding peri-implant endosseous healing.

              If dental implantology is an increasingly successful treatment modality, why should we still need to understand the mechanisms of peri-implant bone healing? Are there differences in cortical and trabecular healing? What does "poor quality" bone mean? What stages of healing are most important? How do calcium phosphate-coated implants accelerate healing? What is the mechanism of bone bonding? While there are still many aspects of peri-implant healing that need to be elucidated, it is now possible to deconvolute this biological reaction cascade, both phenomenologically and experimentally, into three distinct phases that mirror the evolution of bone into an exquisite tissue capable of regeneration. The first and most important healing phase, osteoconduction, relies on the recruitment and migration of osteogenic cells to the implant surface, through the residue of the peri-implant blood clot. Among the most important aspects of osteoconduction are the knock-on effects generated at the implant surface, by the initiation of platelet activation, which result in directed osteogenic cell migration. The second healing phase, de novo bone formation, results in a mineralized interfacial matrix equivalent to that seen in the cement line in natural bone tissue. These two healing phases, osteoconduction and de novo bone formation, result in contact osteogenesis and, given an appropriate implant surface, bone bonding. The third healing phase, bone remodeling, relies on slower processes and is not considered here. This discussion paper argues that it is the very success of dental implants that is driving their increased use in ever more challenging clinical situations and that many of the most important steps in the peri-implant healing cascade are profoundly influenced by implant surface microtopography. By understanding what is important in peri-implant bone healing, we are now able to answer all the questions listed above.

                Author and article information

                J Clin Exp Dent
                J Clin Exp Dent
                Medicina Oral S.L.
                Journal of Clinical and Experimental Dentistry
                Medicina Oral S.L.
                1 March 2020
                March 2020
                : 12
                : 3
                : e242-e248
                [1 ]Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Oviedo, Oviedo, Spain
                [2 ]Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
                [3 ]Department of Surgery, Gynecology and Obstetrics. Faculty of Sport and Health Sciences, University of Zaragoza, Huesca, Spain
                Author notes
                Department of Surgery and Medical-Surgical Specialties Faculty of Medicine and Dentistry, University of Oviedo Catedrático Jose María Serrano 8, Oviedo, Asturias, Spain , E-mail: davidchavarri@ 123456hotmail.com
                Copyright: © 2020 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 8 January 2020
                : 23 June 2019
                Oral Surgery


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