New Osseodensification Implant Site Preparation Method to Increase Bone Density in Low-Density Bone: In Vivo Evaluation in Sheep

Paolo Trisi, Marco Berardini, Antonello Falco, Michele Podaliri Vulpiani, Paolo Trisi, Marco Berardini, Antonello Falco, Michele Podaliri Vulpiani

Abstract

Purpose: The aim of this study was to evaluate a new surgical technique for implant site preparation that could allow to enhance bone density, ridge width, and implant secondary stability.

Materials and methods: The edges of the iliac crests of 2 sheep were exposed and ten 3.8 × 10-mm Dynamix implants (Cortex) were inserted in the left sides using the conventional drilling method (control group). Ten 5 × 10-mm Dynamix implants (Cortex) were inserted in the right sides (test group) using the osseodensification procedure (Versah). After 2 months of healing, the sheep were killed, and biomechanical and histological examinations were performed.

Results: No implant failures were observed after 2 months of healing. A significant increase of ridge width and bone volume percentage (%BV) (approximately 30% higher) was detected in the test group. Significantly better removal torque values and micromotion under lateral forces (value of actual micromotion) were recorded for the test group in respect with the control group.

Conclusion: Osseodensification technique used in the present in vivo study was demonstrated to be able to increase the %BV around dental implants inserted in low-density bone in respect to conventional implant drilling techniques, which may play a role in enhancing implant stability and reduce micromotion.

Figures

Fig. 1
Fig. 1
Left side: Clinical photograph of osteotomic site preparation in test group. The bone ridge width was 4 to 6 mm but no dehiscence or fenestration occurred after the 5-mm diameter site preparation. The blue arrows indicate the areas in which the bone ridge expansion is more evident. Right side: A particular osteotomic site in test group. This typical bone hole margins testified that OD burs did not cut the bone but expand it.
Fig. 2
Fig. 2
Left side: Clinical photograph of OD burs in action under profuse saline solution irrigation. No bone dehiscence occurred despite the great bur diameter. Right side: Implant positioning in test group. The blue arrows indicate the areas in which bone ridge expansion is more evident.
Fig. 3
Fig. 3
Sample after animal sacrifice in test group. Implants appear osteointegrated and showed no bone resorption.
Fig. 4
Fig. 4
Implants in the control group. It is evident that bone ridge width did not allow inserting the wider diameter implant without creating bone defects. Newly formed bone connected bone trabeculae to titanium implant surface. Bone resorption of approximately 0.3 to 0.5 mm in implant neck area is visible in both samples (toluidine blue, ×10 magnification).
Fig. 5
Fig. 5
Left side: Test group. The most peculiar feature of the healing pattern was the unusual granular aspect. The granules observed in the trabeculae, seemed like mineralization nuclei (highlighted by blue arrows). These granules were surrounded by active osteoblasts, osteoid tissue, and osteons (toluidine blue, ×30 magnification) Right side: Implant coronal area in test group. No bone resorption was observed. Many mineralization nuclei were present in the most coronal implant area (toluidine blue, ×25 magnification).
Fig. 6
Fig. 6
Implants in the test group. The granular aspect was more visible in the coronal portion of the implants. The bone density increase is also evident in this area. The cortical wall changed its direction denoting a bone ridge expansion (red arrows) (toluidine blue, ×10 magnification).

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