Clinical Considerations of Adapted Drilling Protocol by Bone Quality Perception

Area of Science:

• Dental Implantology
• Biomaterials Science
• Surgical Techniques

Background:

• Dental implant success relies on achieving stable primary fixation and minimizing complications.
• Insertion torque value (ITV) and marginal bone loss (MBL) are critical indicators of implant stability and long-term osseointegration.
• Osteotomy preparation, particularly drilling protocols adapted to bone quality, significantly influences surgical outcomes.

Purpose of the Study:

• To evaluate the relationship between insertion torque value (ITV) and marginal bone loss (MBL) in a dental implant system.
• To assess the impact of a bone quality-adapted drilling technique on ITV and MBL.
• To determine the influence of surgical factors on implant stability and bone response.

Main Methods:

• A multicenter retrospective study involving 188 implants in 87 patients.
• Osteotomy preparation was customized based on radiographic assessment and perceived bone quality.
• Insertion torque value (ITV), bone quality, drilling protocol, and marginal bone loss (MBL) were recorded and analyzed.
• Statistical analysis included ANOVA, Kruskal-Wallis tests, and multiple regression models.

Main Results:

• Mean ITV was 30.8 ± 15.1 Ncm, significantly influenced by arch, bone quality, implant diameter, and drilling protocol.
• Median MBL was 0.05 mm, with significant differences between arches and drilling protocols.
• The undersized drilling protocol was associated with significantly higher MBL.
• Multiple regression revealed that bone quality and implant diameter influenced ITV, while MBL was affected by bone quality, implant diameter, ITV, and their interaction.

Conclusions:

• Excessive insertion torque in dense bone is linked to adverse marginal bone responses.
• A thorough presurgical assessment of bone quality is essential for selecting an appropriate drilling protocol.
• Optimizing drilling protocols based on bone quality perception can minimize surgical trauma and improve implant outcomes.