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Influence of Cortical Layer and Surgical Techniques on the Primary Implant Stability in Low-density Bone: An In Vitro
RahmathShameem Shafiullah1, Ramasubramanian Hariharan2, Chitra S Krishnan2
1Department of Prosthodontics, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 9840362006,
Aim:
This study aimed at evaluating the influence of cortical layer and surgical techniques on the primary stability of implants in low-density bone.
Materials And Methods:
Two solid rigid polyurethane blocks with a density equivalent to 0.32 g/cm3 simulating cancellous bone were used. A short fiber-filled epoxy resin sheet of 2 mm was layered to one block to simulate cortico cancellous bone. A total of 40 implants were used in this study (n = 40). Twenty implants each (n = 20) were inserted in cancellous (Group 1) and cortico-cancellous bone (Group 2), of which 10 implants each (n = 10) were placed using undersized preparation technique with surgical drills-A and osteotomes-B, in both the groups. Insertion torque (IT) and implant stability quotient (ISQ) for each implant placed were assessed to determine the primary stability of each implant using a digital torque meter and resonance frequency analyzer, respectively. The values were statistically analyzed using an independent t-test (p < 0.05). Pearson's correlation analysis was performed to correlate between IT and ISQ.
Results:
Technique B resulted in significantly higher IT and ISQ values in Group 1 (27.69 ± 1.2 N cm; 52.5 ± 1.05 ISQ) and Group 2 (38.8 ± 0.87 N cm; 70.1 ± 1.04 ISQ) compared to those with technique A (22.40 ± 1.62 N cm; 41.75 ± 1.20 ISQ and 33.24 ± 0.67 N cm; 63.72 ± 1.33 ISQ), respectively. Group 2 exhibited significantly higher IT and ISQ values as compared to Group 1 irrespective of the surgical technique employed (p < 0.05).
Conclusion:
The presence of the cortical layer significantly influenced the primary stability and preparing low-density bone with an undersized preparation technique using osteotomes that significantly increased the IT and ISQ.
Clinical Significance:
Undersizing the preparation site considerably will help achieve a significant increase in primary stability in the poor quality bone as in the posterior maxilla, thereby contributing to the success of the implant.
