Jan 2026· International Journal of Dentistry· Vol 2026· 0 citations· 27 references
Medicine
TL;DR
The use of sequential osseodensification protocols yielded superior mechanical stability parameters, specifically in IT and RT, in synthetic (polyurethane) bone models, but improvements in ISQ were predominantly noted in the denser type III model.
Abstract
Purpose Primary implant stability is a key factor for successful osseointegration and may be influenced by osteotomy preparation techniques, particularly in low‐density bone. Thus, this study compared undersized drilling (UD), UD combined with osseodensification, and sequential osseodensification protocols with varying degrees of undersizing in simulated bone types III and IV with respect to implant stability. Additionally, the relationships between insertion torque (IT), removal torque (RT), and implant stability quotient (ISQ) were analyzed. Materials and Methods Eighty implants (4.0 × 11 mm) were placed in polyurethane blocks simulating type III and IV bone with a cortical layer. Four osteotomy protocols were tested: UD, UD plus osseodensification (OD1), and sequential osseodensification with −0.5 mm (OD2) and −0.7 mm (OD3) undersizing. Primary stability was assessed using IT, RT, and ISQ measurements. Data were analyzed using two‐way ANOVA, Pearson correlation, and multiple regression analysis (α = 0.05). Results OD2 and OD3 produced higher IT values in both bone types compared with UD and OD1. In type III bone, OD3 showed the highest RT values, while in type IV bone, OD2 and OD3 were significantly higher than UD and OD1. ISQ values were higher for osseodensification protocols in type III bone, whereas no significant differences were observed in type IV bone. A strong correlation was found between IT and RT (r = 0.746), whereas ISQ showed weaker associations with torque. Conclusion The use of sequential osseodensification protocols yielded superior mechanical stability parameters, specifically in IT and RT, in synthetic (polyurethane) bone models. However, improvements in ISQ were predominantly noted in the denser type III model. Importantly, because the tested protocols involved different drill designs and underpreparation dimensions, these enhancements reflect the success of the overall surgical strategy rather than the isolated effect of osseous densification.
Neither the choice of drilling technique nor the implant macrogeometry significantly influences insertion torque or stability levels in regions of low bone density in this randomized controlled clinical study.
Worood A Akram, S. Bede· The Journal of craniofacial...· 0 citations
Background/Objectives: The primary aim of this study is to evaluate the impact of two different drilling methods on the primary stability of implants inserted into polyurethane blocks simulating different bone densities. The secondary aim is to analyse the indication provided by three different methods used to assess primary stability. Methods: The study was performed on two artificial bone blocks of solid rigid polyurethane without cortical layer and one laminated one. A total of 48 implants were placed following either a Regular Primary Stability (RPS) or an Enhanced Primary Stability (EPS) protocol based on site underpreparation. Immediately after implant placement, artificial intelligence tool (AIT) indication, peak insertion torque (pIT) and Resonance Frequency Analysis (RFA) values were recorded. The values were then categorised as suitable or not suitable for single-crown immediate loading by bone density and drilling protocol. Results: EPS drilling protocol produced significantly higher primary stability values than those in all bone densities, regardless of the primary stability measurement method used, except for the implants placed in D4 and evaluated by AIT. The grouping of values shows that implants placed in D3 and D4 never reached the immediate loading threshold for a single crown. In D2, EPS and RPS protocols both reach the threshold for all implants when evaluated with pIT or RFA; when AIT is used, RPS protocol was not able to reach the single-crown threshold in 50% of cases. Conclusions: Within the limitations of this in vitro study, underpreparation appears a viable technique to improve primary stability, nevertheless it might be insufficient to reach the threshold of immediate loading suitability in low density bone. All systems used are able to report the primary stability increase obtained by underpreparation, but AIT showed the potential to detect a loss of primary stability related to torque drop during insertion. These findings require further confirmation.
The available evidence indicates that this technique represents a promising alternative for optimizing implant site preparation and promoting greater primary stability, particularly in low-density bone, however, prospective long-term clinical studies are still required to establish its indications, limitations, and clinical outcomes.
Fagner Santos de Carvalho· Revista de Estudos Interdisc...· 0 citations
ABSTRACT Objectives Intraoperative bone assessment is critical for achieving primary implant stability, particularly at low‐density bone sites. Drilling torque value (DTV) has been proposed as an indicator of bone density and may help guide drilling preparation protocols to improve primary stability. However, the relationship between DTV and primary stability, especially histological bone parameters in biological bone, remains unclear. This study aimed to clarify the influence of different drilling protocols for primary stability at low‐density bone detected by DTVs in biological cancellous bones. Materials and Methods Cancellous bone blocks obtained from bovine ribs were used. A specially designed torque measurement drill was used to assess bone density intraoperatively. Based on the DTVs, low‐density bone sites corresponding to Misch D4 and D5 were selected. The dental Implants were placed using either a normal or undersized drilling protocol. The DTVs, insertion torque values (ITVs), and implant stability quotient (ISQ) were recorded. Histological evaluation was performed to assess the bone area fraction (BAF) around the implant. Results The ITVs were lower than the clinically recommended range for primary stability in both groups; however, they were significantly higher in the undersized group than in the normal‐sized group. The DTVs positively correlated with the ITVs in both groups. A positive correlation between DTV and ISQ was observed only in the normal‐sized group, whereas ITV was positively correlated with ISQ in both groups. Histological analysis revealed no significant difference in BAF between the two groups. BAF positively correlated with DTV, ITV, and ISQ. Conclusions DTV reflects the existing bone volume of low‐density tissue and is correlated with primary stability. Intraoperative assessment of drilling torque would facilitate the selection of appropriate drilling protocols to achieve primary stability. Bone density evaluation by measuring the DTV may provide a clinically useful method for the intraoperative evaluation at low‐density implant sites.
Yusuke Morimoto, Reiko Kobatake, K. Doi et al.· Clinical and Experimental De...· 0 citations
OBJECTIVE
To investigate the values of torque and implant stability quotient of implants with non-aggressive and «active» threads placed using standard spiral and stepped drills.
MATERIAL AND METHODS
As the experimental model was used pig's breastbone. Forty implants were divided in two groups which included 10 implants of each type according to thread design. In the first group bone site preparation was conducted with spiral drills, in the second one - using stepped drill. Peek torque values were measured with surgical motor and dynamometric key and to assess implant stability quotient was used Osstell device with Smartpeg and Multipeg pins.
RESULTS
In the first group, there was no significant difference using any type of implant. In the second group, there was a significant increase in the studied parameters during the use of implants with «active» threads with a stepped drill. Torque values increased in 1.7 times. The increase in stability quotient for both Smartpeg and Multipeg pins in average was 8% and 7% respectively. When comparing cylindrical implants with non-aggressive threads with standard drills and conical implants with «active» threads with a stepped drill, the increase of maximum torque and stability quotient was 80%, 8% and 7% respectively.
CONCLUSION
The use of cylindrical implants with non-aggressive threads when working in low density bone both when using spiral or stepped drills, is characterized by low values of torque and stability quotient. In low density bone the placement of conical implants with «active» threads using a stepped drill is effective.
B. A. Kudzaev, V. A. Badalyan, E. M. Chernovol· Stomatologiia· 0 citations
The dissociation between insertion torque and 90-day stability indicates that secondary stability is governed by factors beyond initial mechanical engagement, and suggests a potential long-term biomechanical difference warranting further study.
Ahmed Elkattan, Mónica Blázquez-Hinarejos, H. Assiri et al.· European Journal of Dentistr...· 0 citations