Osteogenic parameters surrounding trabecular tantalum metal implants in osteotomies prepared via osseodensification drilling

Abstract

Background Surgical fixation of implants into bone for the correction of bone deformities or defects is a traditional approach for skeletal stabilization. Important measures of efficacy of implants include implant stability and osseointegration—the direct interaction between living bone and an implant. Osseointegration depends on successful implant placement and subsequent bone remodeling. This study utilized osseodensification drilling (OD) in a low bone density model using trabecular metal (TM) implants. Material and Methods Three osteotomy sites, Regular, OD-CW (clockwise), and OD-CCW (counterclockwise), were prepared in each ilium of three female sheep. Drilling was performed at 1100rpm with saline irrigation. Trabecular metal (TM) (Zimmer®, Parsippany, NJ, USA) implants measuring 3.7mm in diameter x 10mm length were placed into respective osteotomies. A three-week period post-surgery was given to allow for healing to take place after which all three sheep were euthanized and the ilia were collected. Samples were prepared, qualitatively and quantitatively analyzed using histology micrographs and image analysis software (ImageJ, NIH, Bethesda, MD). Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were quantified to evaluate the osseointegration parameters. Results All implants exhibit successful bone formation in the peri-implant environment as well as within the open spaces of the trabecular network. Osseointegration within the TM (quantified by %BIC) as a function of drilling technique was more pronounced in OD samples(p>0.05). The %BAFO however shows a significant difference (p=0.036) between the CCW and R samples. Greater bone volume and frequency of bone chips are observed in OD samples. Conclusions The utilization of OD as a design for improved fixation of hardware was supported by increased levels of stability, both primary and secondary. Histological data with OD provided notably different results from those of the regular drilling method. Key words:Osseodensification drilling, trabecular tantalum metal, osteotomies, implants, subtractive drilling.

Can Bone Compaction Improve Primary Implant Stability? An In Vitro Comparative Study with Osseodensification Technique

“…In fact, high interfacial pressures and mechanical preparation seem to produce a pro-resorptive environment as indicated by the lack of alkaline phosphatase activity and collagen I. Although several authors assessed whether the osseodensification technique produces bone chips usable as autografts during implant site preparation [41], the mechanical movement and heat generation on the bone walls could negatively influence the osseointegration phenomenon [33].…”

The Effectiveness of Osseodensification Drilling Protocol for Implant Site Osteotomy: A Systematic Review of the Literature and Meta-Analysis

“…As resulting from the table previously described, the alveolar preparation performed with drills for osseodensification allows us to increase the surface of contact between the surface of the implant and the autologous bone of the patient [ 66 , 70 , 71 , 73 , 74 , 75 ]. Moreover, we may consider how the use of drills for osseodensification with anticlockwise movement (REVERSE) allows us to preserve and compact the residue bone in the immediate proximity of the implant in a more effective way than the use of clockwise movement [ 64 , 68 , 69 , 71 , 72 , 73 ]. We analyzed another comparison about the quantity and quality of the autologous bone maintained by the preparation with osseodensification than the Summers osteotomes, which has reported a BIC higher than 19.4% with the use of the technique with drills Versah (Densah, MI, USA) [ 32 ].…”

“…The values used to compare the several techniques are BIC [ 62 , 66 , 70 , 73 , 75 ], BAFO [ 66 , 71 , 72 , 73 ] ( Figure 2 ), insertion torque [ 67 , 69 , 70 , 72 , 74 ], biomechanical analysis [ 69 ], histological analysis [ 71 , 73 , 75 ], ISQ [ 67 ], and histomorphometry analysis [ 60 ]. Moreover, it is important to underline the difference in the execution of the compared techniques ( Figure 3 ), i.e., preparation for osseodensification: pilot drill 1.5 mm, followed by the osseodensification drills Versah ® used with anticlockwise movement at 900–1200 rpm with irrigation [ 67 ]; conventional preparation: pilot drill 1.7 mm, followed by the drills recommended by the producers until the desired diameter (4.7 mm), technique with Summers osteotomes: pilot drill 1.7 mm, followed by the osteotomes until the compaction of the desired area, I, II, III; technique of osseodensification: pilot drill 1.7 mm, subsequent drills of diameter 2.5 mm, 3.5 mm, and 4.5 mm, with irrigation [ 32 ]; conventional preparation: pilot drill at 800–1000 rpm, followed by the drills recommended by the producer until the desired diameter, preparation for osseodensification: pilot drill with clockwise movement at 800–1500 rpm with abundant irrigation, then drills for osseodensification until the desired diameter [ 42 ]; conventional preparation: pilot drill 2 mm, drills 3.2 mm, and 3.8 mm, preparation for osseodensification with clockwise movement: pilot drill 2 mm, pilot drills 2.8 mm and 3.8 mm, preparation for osseodensification with anticlockwise movement: pilot drill 2 mm, drills 2.8 mm and 3.8 mm, and the three preparations have been performed at 1100 rpm with salt irrigation [ 68 ]; conventional preparation: pilot drill 2 mm, conventional drills 3.2 mm and 3.8 mm, preparation for osseodensification with clockwise movement: pilot drill 2 mm, drills, 2.8 mm and 3.8 mm, and the three preparations have been performed at 1100 rpm with salt irrigation [ 39 ]; conventional preparation: pilot drill 2 mm, conventional drills 2.8 mm and 3.4 mm, following the protocol Zimmer Biomet until the desired diameter, preparation for osseodensification with clockwise and anticlockwise movement: pilot drill 1.7 mm and drills 2.8 mm and 3.8 mm, the three preparations have...…”

“…A total of five studies were included according to histomorphometry BAFO for a comparative evaluation between clockwise and counter-clockwise procedures [ 66 , 68 , 70 , 74 , 75 ].…”

“…The risk of bias measurement was conducted on all studies included for the meta-analysis and summarized in Figure 15 A,B, where a total of five studies on animals showed a low risk of bias [ 66 , 68 , 70 , 74 , 75 ].…”