Functionality testing of an innovative biomechanically optimized and surface-modified orthodontic mini-screw-a comparative study.

The aim of this biomechanical study was to assess the interrelated effect of both surface roughness and surgical technique on the primary stability of dental implants. For the experiment, 160 screw-designed implants (Biocomp), with either a machined or an etched surface topography, were inserted into polyurethane foam blocks (Sawbones). As an equivalent of trabecular bone, a density of 0.48 g/cm(3) was chosen. To mimic the cortical layer, on top of these blocks short-fibre-filled epoxy sheets were attached with a thickness varying from 0 to 2.5 mm. The implant sites were prepared using either a press-fit or an undersized technique. To measure the primary stability of the implant, both the insertion and the removal torques were scored. Independent of the surgical technique used, both implant types showed an increased insertion and removal torque values with increasing cortical thickness, although >2 mm cortical layer no further increase in insertion torque was observed. In the models with only trabecular bone (without cortical layer) and with a 1 mm cortical layer, both implant types showed a statistically higher insertion and removal torque values for undersized compared with the press-fit technique. In addition, etched implants showed a statistically higher insertion and removal torque mean values compared with machined implants. In the models with 2 and 2.5 mm cortical layers, with respect to the insertion torque values, no effect of either implantation technique or implant surface topography could be observed. The placement of etched implants in synthetic bone models using an undersized preparation technique resulted in enhanced primary implant stability. A correlation was found between the primary stability and the cortical thickness. However, at or above a cortical thickness of 2 mm, the effect of both an undersized surgical approach, as also the presence of a roughened (etched) implant surface, had no extra effect. Besides the mechanical aspects, the biological effect of undersized drilling, i.e. the bone response on the extra insertion torque forces should also be elucidated. Therefore, additional in vivo studies are needed.

In-vitro comparison of different palatal sites for orthodontic miniscrew insertion: Effect of bone quality and quantity on primary stability.

This clinical trial was conducted to evaluate the stability and failure rate of surface-treated orthodontic mini-implants and determine whether they differ from those of non-surface-treated orthodontic mini-implants. Randomized clinical trial with a split-mouth study design. Department of Orthodontics, SRM Dental College, Chennai. Patients who required orthodontic mini-implants for anterior retraction in both arches. Self-drilling, tapered, titanium orthodontic mini-implants with and without surface treatment were placed in each patient following a split-mouth design. The maximum insertion and removal torques were measured for each implant using a digital torque driver. The failure rates were calculated for each type of mini-implant. The mean maximum insertion torque was 17.9 ± 5.6 Ncm for surface-treated mini-implants and 16.4 ± 9.0 Ncm for non-surface-treated mini-implants. The mean maximum removal torque was 8.1 ± 2.9 Ncm for surface-treated mini-implants and 3.3 ± 1.9 Ncm for non-surface-treated mini-implants. Among the failed implants, 71.4% were non-surface-treated mini-implants and 28.6% were surface-treated mini-implants. The insertion torque and failure rate did not differ significantly between the groups, whereas the removal torque was significantly higher in the surface-treated group. Thus, surface treatment using sandblasting and acid etching may improve the secondary stability of self-drilling orthodontic mini-implants. The trial was registered in the Clinical Trials Registry, India (ICMR NIMS). Registration number: CTRI/2019/10/021718.

Orthodontic miniscrews have gained popularity; however, they have some drawbacks, including screw loosening due to bone resorption caused by excess microdamage�during screw insertion. Pilot hole preparation through the cortical bone is considered beneficial to avoid such microdamage, while an overly large pilot hole impairs primary stability. Hence, we used a human bone analogue to evaluate the microdamage and primary stability to estimate the optimal pilot hole size that would minimize the screw loosening risk. Ti6Al4V�miniscrews and 1.0-mm-thick synthetic cortical bone pieces were prepared. Various compressive loads were applied in indentation tests to bone surfaces, and the microdamaged areas were confirmed as stress-whitening zones. Screw insertion tests were performed in which a miniscrew was inserted into the test pieces' pilot hole with a diameter of 0.7–1.2 mm in 0.1-mm intervals, and the stress-whitening area was measured. The insertion and removal torque were also measured to evaluate primary stability. The stress-whitening areas of the 1.0–1.2 mm pilot hole size�groups were significantly smaller than those of the other groups (p < 0.05), whereas the 0.9- and 1.0-mm pilot hole diameter groups showed higher primary stability than other groups. In conclusion, the bone analogue could be utilized to evaluate microdamage in cortical bones and the primary stability of miniscrews.

To compare insertion temperatures and torques of Hydroxyapatite (HA) coated and uncoated 5.5 mm AO cortical screws in equine third metatarsal bones (MTIII) in vitro, and to compare insertion and extraction torques of HA coated and uncoated screws after 4, 8, 12 and 16 weeks of healing in equine third metacarpal bones (MCIII) in vivo. No significant temperature differences were recorded in cadaveric bones for AO and HA coated screws. Insertion torques were significantly higher for HA coated implants compared to uncoated screws. In vivo, the AO screws lost 50% of their initial stability within 4 weeks of healing and failed to gain stability over the next 12 weeks. The HA screws maintained stability (at 4 weeks), and roughly doubled (at 8 weeks) and tripled (at 12 weeks) their insertional torques over time. HA coated screws can safely be inserted in equine cortical bone. AO cortical stainless steel screws fail to maintain stability in equine cortical bone. The addition of HA coating to the screws enables active osseointegration over 3 months of healing, as indicated by significantly higher extractional torques after 8, 12 and 16 weeks respectively. Screw failure can occur under acute load and cyclic fatigue indicating the need for improved stability in the equine patient. HA coating, leading to active osseointegration, is commonly used in human implants for this purpose. Varying results in equine models led to guarded acceptance of implant coatings amongst equine surgeons. Our results support the osseointegrative properties of HA coated screws in horses.

Concerns have been expressed about the possibility of high insertion torque (IT) causing necrosis, impaired osseointegration, and crestal bone loss over time. The present study investigated the relationship between primary stability and implant success, including early and late maintenance of crestal bone levels. Implants were placed in patients at three study centers. Every effort was made to achieve the highest possible primary stability, which was measured with IT and implant stability quotient (ISQ). The IT and ISQ at insertion and reopening (3 to 4 months), as well as bone levels at several points in time, were recorded. The correlations between IT, ISQ, and immediate and 3-year crestal bone loss were investigated through linear regression analyses. Average IT was 76.1 ± 20.8 Ncm, while the average ISQ score was 80.4 ± 8.4. The implant success rate at 36 months was 98.6%. The crestal bone loss around most implants (41.0%) ranged from 0.05 to 0.5 mm. None of the osseointegrated implants had crestal bone loss greater than 2.5 mm. The linear regression analysis showed no correlation among early or 3-year crestal bone loss and IT, ISQ at surgery, and ISQ at reopening. The implants studied avoided any negative effects deriving from the high IT values (≥ 50 Ncm) applied during 3 years of follow-up.

Resonance Frequency Analysis, Insertion Torque, and Bone to Implant Contact of 4 Implant Surfaces

Objective: Mini-screws have widely been used as a temporary anchorage device. We previously reported the importance of insertion torque for primary implant stability. However, it remains unclear whether or not the destruction of cortical bone surrounding the mini-screw depends on the magnitude of the insertion torque, and whether or not the destroyed bone can be repaired around titanium alloy miniscrews. Materials and Methods: Self-drilling type titanium alloy mini-screws were placed into the rat maxillary bone. Insertion torque and screw diameter were varied and their effect on primary stability of miniscrew was evaluated. Bone remodeling around the mini-screw and the ratio of osteoid and calcified bones was examined using Villanueva bone staining on each section. Moreover, during the experimental period, the tensile strength of the implanted screw was measured. Results: Irrespective of the diameter of micro-implants which were implanted with 5-10 N.cm insertion torque were in close contact with the cortical bone, whereas the cortical bone was broken when implants were inserted with 15-20 N.cm insertion torque. While using the 15-20 N.cm insertion torque, the screw surface did not exhibit close contact with the cortical bone and osteoid was increased at 56 d after implantation. Furthermore, tensile strength of the bone in the 15-20 N.cm insertion torque group remained lower than in the 5-10 N.cm group through an experiment period. Conclusions: Our findings emphasized that we should use an optimal insertion torque at 5-10 N.cm for mini-screw implantation to establish primary stability.

It may be difficult to achieve primary stability in the posterior maxilla because of poor quality and quantity of bone. Studies have shown that the osteotome technique immediately increases bone density thereby increasing primary stability. An in vitro study was conducted to compare the stability achieved by the osteotome and conventional drilling techniques in low density bone. Forty endosseous implant fixtures (n = 40) were inserted in a solid rigid polyurethane block simulating low density (D3) bone. The implants were divided into 4 groups to test 2 variables: (1) implant length (10 mm or 13 mm) and (2) preparation of osteotomy (conventional drilling or osteotome technique). Insertion torque (IT) and resonance frequency analysis (RFA) were measured for each implant. Statistical analysis using one-way ANOVA and Tukey post hoc test was done to study IT and RFA data of the 4 groups. Pearson Correlation test was used to determine the correlation between IT and RFA values of the implants. The IT and RFA values were statistically significant higher using the osteotome technique as compared to conventional drilling (P < 0.0001). Statistically significant higher values were also found for IT and RFA of 13 mm implants as compared to 10 mm implants. A significant correlation was found between insertion torque and RFA values in all 4 groups (r = 0.86, P < 0.0001). The conclusion was that the osteotome technique significantly increased primary stability.

Background: The long-term success of dental implants largely depends on achieving primary stability, previously described as crucial to obtaining osseointegration and immediate loading protocol requirements. Implant thread depths seem to be one of the key factors influencing primary stability, particularly in low-density bone. Insertion torque (IT) and resonance frequency analysis (RFA) are considered the most reliable tests to assess primary stability. The aim of this work was to evaluate how different thread depths of commercially available dental implants affect primary stability in low-density D3 bone. Materials and Methods: An in vitro study was carried out between February 2024 and March 2024. Twenty-four dental implants were divided into four groups (six implants each) according to their thread depths (Group A: 4 mm, Group B: 4.5 mm, Group C: 5 mm, Group D: 5.5 mm) and were inserted in D3-type artificial bone blocks. The main outcome variables were the IT and the Implant Stability Quotient (ISQ) measured in four different areas of the implant (buccal, lingual, mesial, and distal) with an Osstel® ISQ reader. Descriptive and inferential analyses of the data were performed, and the significance value was set at 5%. Results: A total of 24 implants were analyzed. The highest IT values were obtained in Group D, with a mean of 54.03 Ncm (standard deviation (SD) = 8.99), while the lowest measurements were observed in Group A (mean = 25.12; SD: 2.96 N.cm). The mean ISQ values were consistently higher in Group D for each analyzed area, with a mean of 70.13 N.cm (SD = 1.12). Conclusions: Taking into consideration the limitations of this in vitro study, greater thread depths seem to increase the primary stability of dental implants placed in soft bone. Furthermore, a positive correlation was observed between all IT and ISQ values, regardless of the thread depth.

Prediction of primary stability via the force feedback of an autonomous dental implant robot

"Relationship between insertion torque and ISQ of 600 implants placed in soft bone with different surgical techniques." in vitro study.

Pedicle screw fixation strength: pullout versus insertional torque

A precise and scientifically established method for the evaluation of the bone quality/primary stability is the measure of the insertion torque (IT). The aim of this study was a comparison between the IT values and the bone-implant contact percentage (BIC) of human implants retrieved after a 4/8-week healing period. Seventeen implants, all with a sandblasted and acid-etched surface, were evaluated in the present study. The implants had been retrieved for different causes, after 4/8 weeks, with a 5 mm trephine bur, and immersed in 10% buffered formalin to be processed for histology. A not statistically significant correlation was found between IT and BIC (P<or=0.892). In the present study on human-retrieved implants, no statistically significant correlation was found between the IT values and BIC. These results could be due to a lack of relationship between bone structure and IT, or to the fact that primary stability may not only be influenced by bone volumetrical density and/or bone trabecular connectivity but also by the thickness and density of the cortical layer. Moreover, the present knowledge of the bone microstructure is not enough to explain the relationship of bone quality and primary implant stability.

Implant primary stability, which depends mainly on the amount and quality of bone, is important for implant survival. Socket preservation aims to reduce bone volumetric changes after tooth extraction. This animal study aims to examine whether preserving a ridge by using xenograft impairs the primary stability of the implant. Eighteen artificial bone defects were prepared in 4 sheep (5- and 8-mm length). Defects were randomly grafted with xenografts: Bio-Oss (BO), Bio-Active bone (BB), or left for natural healing (control). After 8 weeks, bone biopsy was harvested and dental implants installed. During installation, peak insertion torque (IT) was measured by hand ratchet, and primary stability by the Osstell method. Histomorphometric analysis showed a higher percentage of new bone formation in the naturally healed defects compared to sites with xenograft (control: 68.66 ± 4.5%, BB: 48.75 ± 4.34%, BO: 50.33 ± 4.0%). Connective tissue portion was higher in the BO and BB groups compared to control (44.25 ± 2.98%, 41 ± 6%, and 31.33 ± 4.5%, P < .05, respectively). Residual grafting material was similar in BO and BB (7 ± 2.44%, 8.66 ± 2.1%, respectively). Mean IT and implant stability quotient (ISQ) values were not statistically different among the groups. A positive correlation was found between IT and ISQ (r = 0.65, P = 0). In conclusion, previously grafted defects with xenograft did not influence primary stability and implant insertion torque in delayed implant placement. These results may be attributed to a relatively high bone fill of the defect (∼50%) 2 months after grafting.