RESUMEN

Anchorage, evaluated by the maximum insertion torque (IT), refers to mechanical engagement between dental implant and host bone at the time of insertion without external loads. Sufficient anchorage has been highly recommended in the clinic. In several studies, the effects of implant diameter and taper body design under external loading have been evaluated after insertion; however, there are few studies, in which their effects on stress distribution during insertion have been investigated to understand establishment of anchorage. Therefore, the objective of this study was to investigate the effects of dental implant diameter and tapered body design on anchorage combining experiments, analytical modeling, and finite element analysis (FEA). Two implant designs (parallel-walled and tapered) with two implant diameters were inserted into rigid polyurethane (PU) foam with corresponding straight drill protocols. The IT was fit to the analytical model (R2 = 0.88-1.0). The insertion process was modeled using explicit FEA. For parallel-walled implants, normalized IT and final FEA contact ratio were not related to the implant diameter while the implant diameter affected normalized IT (R2 = 0.90, p < 0.05, ß1 = 0.20 and ß2 = 0.93, standardized regression coefficients for implant diameter and taper body design) and final FEA contact ratio of tapered implants. The taper design distributed the PU foam stress further away from the thread compared to parallel-walled implants, which demonstrated compression in PU foam established by the tapered body during insertion.

Asunto(s)

Implantes Dentales , Estrés Mecánico , Poliuretanos , Análisis de Elementos Finitos , Tornillos Óseos

RESUMEN

Maximum insertion torque (IT) for threaded dental implants is a primary clinical measurement to assess implant anchorage, and strongly influences the clinical outcome. Insertion torque is influenced by surgical technique, implant designs, and patient factors such as bone density and quality. In this study, an analytical model was proposed for IT to estimate contributions from the thread and taper separately. The purpose of this study was to test if the analytical model could 1. differentiate the parallel-walled and tapered implant; and, 2. represent four factors: bone surrogate density, drill protocol, implant surface finish and cutting flute. The IT was modeled as the sum of the torques from the thread's inclined plane and interface shear stress from the tapered body integrated over the surface area, respectively, with two main parameters: effective force, F', F' and effective pressure, p'. The effective force, relates to the clamping force from the thread, while the effective pressure, p', associates with the contact pressure at the bone-implant interface. The model performed well (R2 = 0.88-1.0) and differentiated between the parallel-walled (p'= 0) and tapered implants (p'= 0.12). The model's parameters could individually represent the effects of the four factors. High bone surrogate density, two-step drill protocol, and rough surface increased both F' and p'. The cutting flute had opposing effects on F' and p' (ß4 = 0.35 and -0.24, respectively); and therefore, had the lowest net effect on IT. The proposed analytical model therefore improves the understanding of the principal contributors to dental implant IT by considering thread and taper mechanics independently.

Asunto(s)

Implantes Dentales , Densidad Ósea , Diseño de Prótesis Dental , Humanos , Fenómenos Mecánicos , Estrés Mecánico , Torque

RESUMEN

Anchorage of dental implants is quantified with a mechanical engagement to insertion, for example maximum insertion torque (MIT) and insertion energy (IE). Good anchorage of dental implants highly correlates to positive clinical outcomes. However, it is still unclear how bone density, drill protocol, surface finish and cutting flute affect anchorage. In this study, effects of the insertion factors on both MIT and IE were investigated using a full-factorial experiment at two levels: bone surrogate density (0.32 g/cm3 versus 0.48 g/cm3), drill protocol (Ø2.4/2.8 versus Ø2.8/3.2 mm), implant surface finish (machined versus anodized surface) and cutting flute (with versus without). Osteotomies were prepared on rigid polyurethane foam blocks with dimensions of 40 × 40 × 8 mm. Screw shaped dental implants with variable tapered body were consecutively inserted into and removed from the polyurethane foam blocks three times under constant axial displacement and rotational speed. Axial force and torque were recorded synchronously. Insertion energy was calculated from the area under the torque-displacement curve. In this study, we found the main insertion mechanics were thread forming for the first insertion. For the second and third insertions, the main mechanics shifted to thread tightening. Maximum insertion torque (MIT) responded differently to the four insertion factors in comparison to IE. Bone surrogate density, drill protocol and surface finish had the largest main effects for first MIT. For the first IE, drill protocol, surface finish and cutting flute were significant contributors. These results suggest that MIT and IE are influenced by different mechanics: the first MIT and the first IE were sensitive to thread tighten and forming, respectively. Together MIT and IE provide a complete assessment of dental implant anchorage.

Asunto(s)

Implantes Dentales , Densidad Ósea , Tornillos Óseos , Diseño de Prótesis Dental , Análisis del Estrés Dental , Fenómenos Mecánicos , Torque

RESUMEN

When preparing an implant site, clinicians often base their assessment of the bone on subjective tactile and visual cues. This assessment is used to plan the surgical procedure for site preparation, including how many drilling steps will be used. The subjective nature of bone evaluation, consequently, results in poor reproducibility and may lead to under or over preparation of the site. Recently, an unconventional site preparation protocol was developed in which the decision of which instruments to use is dictated by insertion torque of the novel site preparation instrument (OsseoShaper™, Nobel Biocare AB, Gothenburg, Sweden). The aim of this study was to quantify the correlation of the site preparation torques of the new instrument with bone density and maximum implant insertion torques. In vitro and in vivo data showed strong linear correlation between site preparation torque and density and resulted in reliable implant insertion torques, respectively. From our analysis, we conclude that this new instrument and protocol has the potential to eliminate the need for additional intraoperative bone evaluation and may reduce the risk of inadequate preparation of the site due to the ability to serve as a predictor of the final implant insertion torque.

RESUMEN

OBJECTIVES: Dental implants are widely used to restore function and appearance. It may be essential to choose the appropriate drilling protocol and implant design in order to optimise primary stability. This could be achieved based on an assessment of the implantation site with respect to bone quality and objective biomechanical descriptors such as stiffness and strength of the bone-implant system. The aim of this ex vivo study is to relate these descriptors with bone quality, with a pre-implantation indicator of implant stability: pilot-hole drilling force (Fdrilling), and with two post-implantation indicators: maximal implantation torque (Timplantation) and resonance frequency analysis (RFA). METHODS: Eighty trabecular bone specimens were cored from human vertebrae and bovine tibiae. Bone volume fraction (BV/TV), a representative for bone quality, was obtained through micro-computed tomography scans. Implants were kept in controlled laboratory conditions following standard surgical procedures. Forces and torques were recorded and RFA was assessed after implantation. Off-axis compression tests were conducted on the implants until failure. Implant stability was identified by stiffness and ultimate force (Fultimate). The relationships between BV/TV, Stiffness, Fultimate and Fdrilling, Timplantation, RFA were established. RESULTS: Fdrilling correlated well with BV/TV of the implantation site (r2 = 0.81), stiffness (r2 = 0.75) and Fultimate (r2 = 0.80). Timplantation correlated better with stiffness (r2 = 0.86) and Fultimate (r2 = 0.94) than RFA (r2 = 0.77 and r2 = 0.74, respectively). CONCLUSION: Our results indicate that BV/TV and bone-implant stability can be directly estimated by the force needed for the pilot drilling that occurs during the site preparation before implantation. Moreover, implantation torque outperforms RFA for evaluating the mechanical competence of the bone-implant system.

Asunto(s)

Hueso Esponjoso/cirugía , Implantes Dentales , Animales , Hueso Esponjoso/diagnóstico por imagen , Bovinos , Humanos , Microtomografía por Rayos X