Biomechanical and histologic basis of osseodensification drilling for endosteal implant placement in low density bone. An experimental study in sheep

Lahens, Bradley; Neiva, Rodrigo; Tovar, Nick; Alifarag, Adham M.; Jimbo, Ryo; Bonfante, Estevam A.; Bowers, Michelle; Cuppini, Marla; Freitas, Helora; Witek, Lukasz; Coelho, Paulo G.

doi:10.1016/j.jmbbm.2016.06.007

Cited by 102 publications

(136 citation statements)

References 22 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…In a recent study, osseodensification did prove effective at conserving bone in a low bone-density sheep hip model (Lahens et al, 2016), but to our knowledge, this is the first time osseodensification has been assessed in a spine model where hardware fixation is of utmost importance for the stability of rigid fixation constructs.…”

Section: Discussionmentioning

confidence: 83%

“…This new technique, osseodensification, is performed via gradual compaction of bone tissue, forming the walls of the osteotomy through densification, essentially acting as an auto-graft to supplement implant fixation (Huwais and Meyer, 2016). In a hip model where low bone density is present, osseodensification drilling was determined to have superior primary stability as measured by insertion torque, and demonstrated no impairment to osseointegration when compared to regular drilling, irrespective of implant macrogeometry (Lahens et al, 2016). The present study investigated if osseodensification would positively affect fixture stability and osseointegration degrees in the higher density bone found in vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…Osseodensification is performed in an attempt to develop a condensed autograft surrounding the implant, making it valuable in clinical settings where there is an anatomic paucity of bone (Lahens et al, 2016). Unlike traditional drilling protocols (which we refer to as subtractive drilling), osseodensification increases primary stability due to densification of the drilled osteotomy site walls centrifugally by means of non-subtractive drilling (Huwais and Meyer, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Unlike traditional drilling protocols (which we refer to as subtractive drilling), osseodensification increases primary stability due to densification of the drilled osteotomy site walls centrifugally by means of non-subtractive drilling (Huwais and Meyer, 2016). The rationale is that compacted, autologous bone immediately in contact with an endosteal device will not only have higher degrees of primary stability due to physical interlocking between the bone and the device, but also facilitate osseointegration due to osteoblasts nucleating on instrumented bone in close proximity to the implant (Lahens et al, 2016). The objective of this study was to assess the biomechanical and histologic effects of osseodensification surgical instrumentation on a large animal, highly translational cervical spine model.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Osseodensification for enhancement of spinal surgical hardware fixation

Lopez

Alifarag

Torroni

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

Self Cite

View full text Add to dashboard Cite

Integration between implant and bone is an essential concept for osseous healing requiring hardware placement. A novel approach to hardware implantation, termed osseodensification, is described here as an effective alternative. 12 sheep averaging 65 kg had fixation devices installed in their C2, C3, and C4 vertebral bodies; each device measured 4 mm diameter×10 mm length. The left-sided vertebral body devices were implanted using regular surgical drilling (R) while the right-sided devices were implanted using osseodensification drilling (OD). The C2 and C4 vertebra provided the t=0 in vivo time point, while the C3 vertebra provided the t=3 and t=6 week time points, in vivo. Structural competence of hardware was measured using biomechanical testing of pullout strength, while the quality and degree of new bone formation and remodeling was assessed via histomorphometry. Pullout strength demonstrated osseodensification drilling to provide superior anchoring when compared to the control group collapsed over time with statistical significance (p < 0.01). On Wilcoxon rank signed test, C2 and C4 specimens demonstrated significance when comparing device pullout (p=0.031) for both, and C3 pullout tests at 3 and 6 weeks collapsed over time had significance as well (p=0.027). Percent bone-to-implant contact (%BIC) analysis as a function of drilling technique demonstrated an OD group with significantly higher values relative to the R group (p < 0.01). Similarly, percent bone-area-fraction-occupancy (BAFO) analysis presented with significantly higher values for the OD group compared to the R group (p=0.024). As a function of time, between 0 and 3 weeks, a decrease in BAFO was observed, a trend that reversed between 3 and 6 weeks, resulting in a BAFO value roughly equivalent to the t=0 percentage, which was attributed to an initial loss of bone fraction due to remodeling, followed by regaining of bone fraction via production of woven bone. Histomorphological data demonstrated autologous bone chips in the OD group with greater frequency relative to the control, which acted as nucleating surfaces promoting new bone formation around the implants, providing superior stability and greater bone density. This alternative approach to a critical component of hardware implantation encourages assessment of current surgical approaches to hardware implantation.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Osseodensification for enhancement of spinal surgical hardware fixation

Lopez

Alifarag

Torroni

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

Self Cite

View full text Add to dashboard Cite

show abstract

“…Originally it was suggested that the stage of bone tapping should be omitted, especially in cases of low density bone 76 .…”

Section: Increasing the Primary Stability Of An Implantmentioning

confidence: 99%

Increasing the stability of dental implants: The concept of osseodensification

Podaropoulos¹

2017

Balkan J Dent Med

View full text Add to dashboard Cite

show abstract

Basis of bone metabolism around dental implants during osseointegration and peri‐implant bone loss

Ínsua

Monje

Wang

et al. 2017

J Biomedical Materials Res

178

158

View full text Add to dashboard Cite

Despite the growing number of publications in the field of implant dentistry, there are limited studies to date investigating the biology and metabolism of bone healing around dental implants and their implications in peri-implant marginal bone loss. The aim of this review article is to provide a thorough understanding of the biological events taking place during osseointegration and the subsequent early and late phases of bone remodeling around dental implants. An update on the coupling mechanism occurring during bone resorption-bone remodeling is provided, focused on the relevance of the osteocytes, bone lining cells and immune cells during bone maintenance. An electronic and manual literature search was conducted by three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles up to September 2016 with no language restriction. Local bone metabolism is subject to signals from systemic calcium-phosphate homeostasis and bone remodeling. Three areas of interest were reviewed due to recent reported compromises in bone healing including the putative effects of (1) cholesterol, (2) hyperlipidemia, and (3) low vitamin D intake. Moreover, the prominent influence of osteocytes and immune cells is discussed as being key regulators during dental implant osseointegration and maintenance. These cells are of crucial importance in the presence of biofilm accumulation and their associated byproducts that leads to hard and soft tissue breakdown; the so called peri-implantitis. Factors that could negatively impact osteoclastogenesis or osteal macrophage activation should be monitored in future research including implant placement/torque protocols, bone characteristics, as well as meticulous maintenance programs to favor osseointegration and future long-term stability and success of dental implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2075-2089, 2017.

show abstract

Biomechanical and histologic basis of osseodensification drilling for endosteal implant placement in low density bone. An experimental study in sheep

Cited by 102 publications

References 22 publications

Osseodensification for enhancement of spinal surgical hardware fixation

Osseodensification for enhancement of spinal surgical hardware fixation

Increasing the stability of dental implants: The concept of osseodensification

Basis of bone metabolism around dental implants during osseointegration and peri‐implant bone loss

Contact Info

Product

Resources

About