Analysis of the osseous/metal interface of drill free screws and self-tapping screws

Aim: A comparison of metal/osseous interface and bone remodelling after insertion of different types of titanium bone screws in vivo. Material: Samples of five of each of the following bone screw types were inserted into the anterior wall of the frontal sinus of five Göttingen minipigs: self-tapping micro- (1.5 mm) and miniscrews (2.0 mm) or drill free micro- (1.5 mm) and miniscrews (2.0 mm) (Martin Medizintechnik, Tuttlingen, Germany). Screw length was 7 mm. Methods: Sequential intraperitoneal injections of fluorochromes were performed between the second and ninth postoperative week. After 6 months the pigs were sacrificed, the screw-bone-blocks resected, and microradiographic, histological and fluorescence microscopical examinations were carried out. Results: Using drill free screws, mean screw/bone contact was 88.4% (miniscrews), or 93.8% (microscrews). With self-tapping miniscrews it was 54.9%, but in microscrews 81%; the differences were statistically significant (t -test: p<0.05). By fluorescence microscopy, the amount of bone remodelling (ratio of residual vs. newly formed bone) was measured. Significantly more of the residual bone was found in the region of the screw threads using drill free screws (miniscrews: mean 71.8%, microscrews: mean 67.9%) than in the region of screw threads with self-tapping screws (miniscrews: mean 33.1%, microscrews: mean 42.4%). Conclusion: The present data support the view that screw/bone contact with drill free screws was superior to that of self-tapping screws; the greater amount of original bone in the threads of drill free screws demonstrated that the insertion of drill free screws did not cause harm to the surrounding bone. Both results are important for osteosynthesis in regions where thin cortical bone is present, such as the central midface. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.