Changes in implant stability using different site preparation techniques: Osseodensification drills versus piezoelectric surgery. A multi-center prospective randomized controlled clinical trial

Abstract

Introduction: Implant stability is influenced by bone density, implant design, and site preparation characteristics. Piezoelectric implant site preparation (PISP) has been demonstrated to improve secondary stability compared with conventional drilling techniques. Osseodensification drills (OD) have been recently introduced to enhance both bone density and implant secondary stability. The objective of the present multi-center prospective randomized controlled trial was to monitor implant stability changes over the first 90 days of healing after implant bed preparation with OD or PISP.

Methods: Each patient received two identical, adjacent or contralateral implants in the posterior maxilla. Following randomization, test sites were prepared with OD and control sites with PISP. Resonance frequency analysis was performed immediately after implant placement and after 7, 14, 21, 28, 60, and 90 days. Implants were then restored with single screw-retained metal-ceramic crowns and followed for 12 months after loading.

Results: Twenty-seven patients (15 males and 12 females; mean age 63.0 ± 11.8 years) were included in final analysis. Each patient received two identical implants in the posterior maxilla (total = 54 implants). After 1 year of loading, 53 implants were satisfactorily in function (one failure in test group 28 days after placement). Mean peak insertion torque (40.7 ± 12.3 Ncm and 39.5 ± 10.2 Ncm in test and control group, respectively) and mean implant stability quotient (ISQ) value at baseline (71.3 ± 6.9 and 69.3 ± 7.6 in test and control group, respectively) showed no significant differences between the two groups. After an initial slight stability decrease, a shift to increasing ISQ values occurred after 14 days in control group and after 21 days in test group, but with no significant differences in ISQ values between the two groups during the first 90 days of healing.

Conclusion: No significant differences in either primary or secondary stability or implant survival rate after 1 year of loading were demonstrated between implants inserted into sites prepared with OD and PISP.

Keywords: implant site preparation; implant stability; osseodensification; piezosurgery; resonance frequency analysis.

FIGURE 1

Osseodensification drills (Densah, Versah) were used at 1200 rpm in the following sequence: from left to right (I) pilot (clockwise); (II) WT1828 (counterclockwise), and (III) WT2838 (counterclockwise).

FIGURE 2

Piezoelectric tips (Piezomed, W&H) were used in the following sequence: from left to right (I) I1; (II) I2P; (III) Z25P; (IV) I3P, and (V) Z35P.

FIGURE 3

Two‐sample Wilcoxon rank‐sum test showed no significant differences in mean peak insertion torque between the two groups. Insertion torque is expressed in Ncm. OD: osseodensification drills (test); Piezo: piezoelectric tips (control)

FIGURE 4

Changes in mean implant stability quotient values of both groups during the first 90 days after implant insertion. The lowest peak was registered at 14 days for the control group and at 21 days for the test group. OD: osseodensification drills (test); Piezo: piezoelectric tips (control)