The Relation between Bone Density and Implant Stability, with Osseodensification One Stage Crestal Sinus Lift: A Prospective Clinical Study
Author(s): Jenna Z Alhayati and Auday M Al-Anee*
Background: One of the most important factors for successful osseointegration is primary stability. Many techniques have been tried in the past to improve implant primary stability in low bone density. The posterior maxilla is thought to have the lowest bone density. Furthermore, pneumatization of the maxillary sinus has a significant impact on bone height, which affects implant installation, in addition to poor density. Salah Huwais established the osseodensification technique in 2015, which employs a densifying bur to create a minimal plastic deformation. It is a unique biomechanical osteotomy preparation approach that uses a non-excavating drilling procedure to assist preserve bone. The nonexcavated compacted bone elevates and penetrates the sinus floor without perforating or breaching the membrane. Osseodensification has also improved implant stability by increasing peripheral and apical bone mineral density, bone-to-implant contact (BIC), and percentage of bone volume (BV) around it. Aim: The study is aimed to assess the relation between bone density and implant stability, with osseodensification one stage crestal sinus lift in a low-bone density atrophic posterior maxilla (residual bone height ≥ 2.0-<6.0 mm). Materials and methods: This study includes twenty crestal sinus floor elevations in seventeen individuals, with ten men and seven females meeting the qualifying criteria. A cone beam CT scan (CBCT) was performed for each participant (two weeks before surgery) to identify the exact alveolar bone height and width, as well as to record bone density at the planned implant site from the coronal view by ROI (region of interest) using On-demand software. Primary implant stability was assessed using an Osstell beacon at the time of implant placement, and secondary stability was assessed after six months of osseous healing. Results: The ages of the patients range from 29 to 70 years, with an average of 47.3 ± 11.5 years. The highest percentage of 70.6% was reported in ≥ 40 years old. Most implants were placed in D4 bone density 50%, with mean value of density 244.94 ± 70.95 HU. The highest value of primary implant stability appears in preoperative D4 bone density, and there is no statistically significant difference between primary and secondary implant stability in three groups of different bone density type. Conclusion: The current study found that a higher primary and secondary implant stability was detected in an atrophic posterior maxilla with a residual bone height of ≥ 2.0 mm and <6 mm and with a low bone density, based on the ISQ scale measured by Osstell Beacon. Furthermore, no statistically significant difference in primary and secondary implant stability exists across three different bone density types. This is due to and explains the effect of the osseodensification versah burs that increases and improves the bone density, to a proximately same range.