The Effectiveness of Osseodensification Drilling Protocol for Implant Site Osteotomy: A Systematic Review of the Literature and Meta-Analysis

Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Ioana Roxana Bordea, Edit Xhajanka, Donato Mario Romeo, Mario Romeo, Carlo Maria Felice Zappone, Giuseppina Malcangi, Antonio Scarano, Felice Lorusso, Ciro Gargiulo Isacco, Grazia Marinelli, Maria Contaldo, Andrea Ballini, Francesco Inchingolo, Gianna Dipalma, Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Ioana Roxana Bordea, Edit Xhajanka, Donato Mario Romeo, Mario Romeo, Carlo Maria Felice Zappone, Giuseppina Malcangi, Antonio Scarano, Felice Lorusso, Ciro Gargiulo Isacco, Grazia Marinelli, Maria Contaldo, Andrea Ballini, Francesco Inchingolo, Gianna Dipalma

Abstract

Many different osteotomy procedures has been proposed in the literature for dental implant site preparation. The osseodensification is a drilling technique that has been proposed to improve the local bone quality and implant stability in poor density alveolar ridges. This technique determines an expansion of the implant site by increasing the density of the adjacent bone. The aim of the present investigation was to evaluate the effectiveness of the osseodensification technique for implant site preparation through a literature review and meta-analysis. The database electronic research was performed on PubMed (Medline) database for the screening of the scientific papers. A total of 16 articles have been identified suitable for the review and qualitative analysis-11 clinical studies (eight on animals, three on human subjects), four literature reviews, and one case report. The meta-analysis was performed to compare the bone-to-implant contact % (BIC), bone area fraction occupied % (BAFO), and insertion torque of clockwise and counter-clockwise osseodensification procedure in animal studies. The included articles reported a significant increase in the insertion torque of the implants positioned through the osseodensification protocol compared to the conventional drilling technique. Advantages of this new technique are important above all when the patient has a strong missing and/or low quantity of bone tissue. The data collected until the drafting of this paper detect an improvement when the osseodensification has been adopted if compared to the conventional technique. A significant difference in BIC and insertion torque between the clockwise and counter-clockwise osseodensification procedure was reported, with no difference in BAFO measurements between the two approaches. The effectiveness of the present study demonstrated that the osseodensification drilling protocol is a useful technique to obtain increased implant insertion torque and bone to implant contact (BIC) in vivo. Further randomized clinical studies are required to confirm these pieces of evidence in human studies.

Keywords: bone to implant contact; endo-osseous dental implant; osseodensification bone osteotomy; primary stability.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Studies screening and inclusion for qualitative analysis and meta-data evaluation processes [63].
Figure 2
Figure 2
Comparison of the statistic value p. between the conventional technique of implant site preparation and technique with the use of drills for osseodensification. Parameters used BAFO (considered in 4 studies of 11) and BIC (considered in 6 studies of 11). For p < 0.05 we considered statistically valid the favorable results obtained by the osseodensification technique compared to the conventional technique.
Figure 3
Figure 3
Main characteristics of the osseodensification drilling technique: details of clockwise and counterclockwise implant site preparation modalities.
Figure 4
Figure 4
Details of the osseodensification drills system. (A) description of the cutters with an indication of the depth of the bone from 3.00 mm to 20 mm of the method “implant drilling with bone compaction instrumentation technique.” (B) Complete osseodensification Kit 13. “implant drilling with bone compaction instrumentation technique.” (C) Complete kit of all the cutters Versah® (includes all the 13 cutters) with the method “implant drilling with bone compaction instrumentation technique.” Autoclavable kit at 137°. (D) Cutters in progressive order of the method “implant drilling with bone compaction instrumentation technique.”
Figure 5
Figure 5
Initial drilling pilot cutter of the method “implant drilling with bone compaction instrumentation technique.”
Figure 6
Figure 6
Second cutter with a diameter of 2.0 mm in the method “implant drilling with bone compaction instrumentation technique.”
Figure 7
Figure 7
Third cutter with a diameter of 2.3 mm in the method “implant drilling with bone compaction instrumentation technique.”
Figure 8
Figure 8
Fourth cutter with a diameter of 2.5 mm in the method “implant drilling with bone compaction instrumentation technique.”
Figure 9
Figure 9
Fifth cutter with a diameter of 3.0 mm in the method “implant drilling with bone compaction instrumentation technique.”
Figure 10
Figure 10
Tenth cutter with a diameter of 4.5 mm in the method “implant drilling with bone compaction instrumentation technique.”
Figure 11
Figure 11
The 13th and last cutter with a diameter of 5.5 mm, method “implant drilling with bone compaction instrumentation technique.”
Figure 12
Figure 12
Forest plot of comparison of BIC percentage, of the clockwise procedure (right) and counter-clockwise procedure (left).
Figure 13
Figure 13
Forest plot of comparison of insertion torque, of the clockwise procedure (right) and counter-clockwise procedure (left).
Figure 14
Figure 14
Forest plot of comparison of insertion torque, of the BAFO (right) and counter-clockwise procedure (left).
Figure 15
Figure 15
Risk of bias measurement: (A) summary of risk of bias for each included study (left) and (B) summary of each risk of bias item presented as percentages across all included studies (right).

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Source: PubMed

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