Comparing Osteotomy Quality Of Conventional Vs Single-bur Implant Bed Preparations
Objectives: The conventional protocol for implant bed preparation is comprised of multiple surgical drill bits of increasing diameters used in-series until the final osteotomy diameter is achieved. This process can lead to an imperfect osteotomy due to inconsistencies in the orientation of subsequent drill bits. The coronal aspect of the implant may acquire an elliptic or irregularly shaped osteotomy, leading to uneven stresses on the implant and decreased primary stability. It was hypothesized that if the number of drill bits was reduced to a single-bur protocol, both the regularity of the implant bed shape and mechanical stability of the osteotomy preparations will increase.
Methods: Four in-vitro test groups (shown below) are created to compare conventional implant bed preparations to single-bur preparations. For each group, 30 implant beds were prepared by the same operator to depths of 9mm (Groups A and C, Medentika Implant GmbH, Germany) or 10.5mm (Groups B and D, BioHorizons, USA) in bone similes made of a viable engineered bone matrix (BoneSim, USA). The quality of each osteotomy was evaluated using ImageJ to assess hole diameter, area, and roundness.
Results: Implant bed preparation completed using the single-bur protocol produced higher quality implant beds as shown by osteotomy circularity, diameter, and solidity compared to conventional protocols. While the Medentika single-bur protocol (Group C) created dimensions necessary for the osseous preparation, the BioHorizons one-step preparations (Group D) were not able to penetrate the bone analog successfully. The Medentika surgical drill bits utilizing the single-bur protocol had increased success rates with preparing dimensions for osteotomy prior to implant placement, as well as higher osteotomy quality.
Conclusions: The dimension results of the single-bur protocol resulted in an osteotomy preparation that could retain an implant after placement based on accurate diameter, circularity and solidity. The consolidated single-bur procedure provides for a more streamlined technique with possible clinical implications being easier on the patient by reducing procedure costs, time and discomfort. Accuracy of osseous preparations showed single-bur implant bed preparations to produced osteotomies of high quality.