Initial stability and bone strain evaluation of the immediately loaded dental implant: an in vitro model study

The aim of this study was to evaluate the effects of cortical bone thickness and trabecular bone elastic modulus on the strain in the bone surrounding an immediately loaded implant. We also examined the correlations between bone structure and the following indices of primary implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ).

The ITV, PTV, and ISQ were measured in 24 artificial jaw bone models representing cortical bone with four thicknesses (0, 1, 2, and 3 mm) and trabecular bone with four elastic moduli (137, 47.5, 23, and 12.4 MPa). Two loading conditions were applied (force of 130 N applied vertically and at 45° laterally), and the strains in the crestal region were measured by rosette strain gauges with a data acquisition system.

When the cortical bone thickness and the elastic modulus of trabecular bone decreased, the bone strains increased by 10.3-52.1% and 39-73.1%, respectively, for vertical loading and by 35-62% and 42.4-56.2% for lateral loading. The cortical bone thickness has a stronger correlation (R(2) =0.95-0.71) with ITV, PTV, and ISQ than the elastic modulus of trabecular bone (R(2) =0.89-0.59).

The initial stability at the time of implant placement is influenced by both the cortical bone thickness and the elastic modulus of trabecular bone; however, these parameters are not totally linearly correlated with ITV, PTV, and ISQ. The placement of an immediately loaded implant in cases with thin cortical bone and/or weak trabecular bone can induce extreme bone strains and may increase the risk of implant failure.