Sergio Alexandre Gehrke

Clinical analysis of the stability of dental implants after preparation of the site by conventional drilling or piezosurgery

We used resonance frequency analysis to evaluate the implant stability quotient (ISQ) of dental implants that were installed in sites prepared by either conventional drilling or piezoelectric tips. We studied 30 patients with bilateral edentulous areas in the maxillary premolar region who were randomised to have the implant inserted with conventional drilling, or with piezoelectric surgery. The stability of each implant was measured by resonance frequency analysis immediately after placement to assess the immediate stability (time 1) and again at 90 days (time 2) and 150 days (time 3). In the conventional group the mean (SD) ISQ for time 1 was 69.1 (6.1) (95% CI 52.4-77.3); for time 2, 70.7 (5.7) (95% CI 60.4-82.8); and for time 3, 71.7 (4.5) (95% CI 64.2-79.2). In the piezosurgery group the corresponding values were: 77.5 (4.6) (95% CI 71.1-84.3) for time 1, 77.0 (4.2) (95% CI, 69.7-85.2) for time 2, and 79.1 (3.1) (95% CI 74.5-87.3) for time 3. The results showed significant increases in the ISQ values for the piezosurgery group at each time point (p=0.04). The stability of implants placed using the piezoelectric method was greater than that of implants placed using the conventional technique.

Investigation of the effect of movement and irrigation systems on temperature in the conventional drilling of cortical bone

We have compared the results of the external irrigation technique with those of a double irrigation technique with continuous intermittent movement. Maximum thermal measurements were made in the cortical part of 10 samples of bovine ribs during osteotomy to simulate the preparation of a surgical bed for the installation of dental implants at a depth of 10 mm. Twenty specimens were drilled for each group: external irrigation and continuous movement (control group 1, CG1); external irrigation and intermittent movement (control group 2, CG2); double irrigation and continuous movement (test group 1, TG1); and double irrigation and intermittent movement (test group 2, TG2). The double irrigation technique gave significantly better results regardless of the drilling movement used. Thermal increases between samples was 19.2% in group CG1, 10.4% in CG2, 5.4% in TG1, and 3.4% in TG2. The double irrigation technique produced a significantly smaller increase in temperature in the cortical bone during both types of drilling (p=0.001), which illustrated its greater efficiency compared with that of the external irrigation technique.

Temperature Changes in Cortical Bone after Implant Site Preparation Using a Single Bur versus Multiple Drilling Steps: An In Vitro Investigation

OBJECTIVES The study aims to test the hypothesis of no differences in temperature variation by using a single bur for implant site preparation as compared with conventional drilling sequence using multiple burs with incremental diameter. MATERIALS AND METHODS Synthetic blocks of bone (type I density) were used for drilling procedures. THREE GROUPS WERE EVALUATED Group 1 and Group 2 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively; Group 3 - drilling with a single bur for a 4.2 mm conical implant. For each group, 20 drilling procedures were performed without irrigation and 20 with external irrigation. The temperature in the cortical bone during osteotomy for implant site preparation was measured through a thermocouple. RESULTS The mean temperatures and standard deviations for the drilling without irrigation were: 25.5 ± 1.24°C for Group 1; 28.1 ± 1.76°C for Group 2; 26.5 ± 1.79°C for Group 3. Considering the drilling with irrigation, the mean values and standard deviations were: 20.4 ± 1.17°C for Group 1; 22.2 ± 1.38°C for Group 2; 20.2 ± 0.83°C for Group 3. Groups 1 and 3 yielded similar results, while Group 2 displayed significantly higher temperature increase than the other two groups. CONCLUSIONS The single bur drilling protocol did not produce greater bone heating than the conventional protocol and may be considered a safe procedure.

Biomechanical evaluation of dental implants with three different designs: Removal torque and resonance frequency analysis in rabbits

The objective of this study was to investigate the effect of implant design on stability and resistance to reverse torque in the tibia of rabbits. Three test groups were prepared using the different characteristics of each implant model: square threads with progressive depth to the apex, a cervical portion without threads and a self-tapping system that is quite pronounced and aggressive (Group 1); triangular threads with flat tips with increasing thread depth from the cervical portion to the apex and a small self-tapping portion with a short thread pitch (Group 2); long thread pitch, progressive thread depth, an apical area with a small self-tapping portion (Group 3). For the two last groups, a final single-use drill was provided for each implant. Nine rabbits received 54 conical implants with a same surface treatment. The resonance frequency was analysed four times (0, 6, 8 and 12 weeks), and removal torque values were measured at three time intervals after the implantations (6, 8 and 12 weeks). In comparing the implant stability quotient at the four time points, highly significant statistic differences were found (p = 1.29(-10)). The reverse torque at the three time points was also significantly different among the groups (p = 0.00015). The implants of Group 2, with seemingly less aggressive design, more quickly reached high values of stability and removal torque. Under the limitations of this study, however, it is possible that in cases in which there may be low osseointegration response, the implant design should be evaluated.

Oral Streptococci Biofilm Formation on Different Implant Surface Topographies

The establishment of the subgingival microbiota is dependent on successive colonization of the implant surface by bacterial species. Different implant surface topographies could influence the bacterial adsorption and therefore jeopardize the implant survival. This study evaluated the biofilm formation capacity of five oral streptococci species on two titanium surface topographies. In vitro biofilm formation was induced on 30 titanium discs divided in two groups: sandblasted acid-etched (SAE- n = 15) and as-machined (M- n = 15) surface. The specimens were immersed in sterilized whole human unstimulated saliva and then in fresh bacterial culture with five oral streptococci species: Streptococcus sanguinis, Streptococcus salivarius, Streptococcus mutans, Streptococcus sobrinus, and Streptococcus cricetus. The specimens were fixed and stained and the adsorbed dye was measured. Surface characterization was performed by atomic force and scanning electron microscopy. Surface and microbiologic data were analyzed by Students t-test and two-way ANOVA, respectively (P < 0.05). S. cricetus, S. mutans, and S. sobrinus exhibited higher biofilm formation and no differences were observed between surfaces analyzed within each species (P > 0.05). S. sanguinis exhibited similar behavior to form biofilm on both implant surface topographies, while S. salivarius showed the lowest ability to form biofilm. It was concluded that biofilm formation on titanium surfaces depends on surface topography and species involved.

Different configuration of socket shield technique in peri-implant bone preservation: An experimental study in dog mandible

The aim of this study was to evaluate the influence of the residual root and peri implant bone dimensions on the clinical success of the socket shield technique. Thirty-six dental implants were installed in 6 dogs. The clinical crowns of teeth P3, P4 and M1 were beheaded. Afterwards, the roots were worn down 2-3mm in apical direction until they were located at crestal level. Posterior implant beds were prepared in the center of the roots passing by 3mm apically forming 6 groups in accordance to the remaining root thickness. Radiography of the crestal bone level was performed on day 0 and after 12 weeks. Histomorphometric analyses of the specimens were carried out to measure the crestal bone level, the bone to implant contact and the buccal and lingual bone thickness at the implant shoulder portion. Correlations between groups were analyzed through nonparametric Friedman test, statistical significance was set as p<0.05. All 36 implants were osseointegrated, but 3 samples showed a clinical inflammatory reaction and some radicular fragments presented a small resorption process. On the buccal and lingual side, the radicular fragment was attached to the buccal bone plate by a physiologic periodontal ligament. In the areas where there was space between the implant and the fragment, newly formed bone was demonstrated directly on the implant surface. Within the limitations of an animal pilot study, root-T belt technique may be beneficial in preserving and protecting the bundle bone and preservation of soft tissues. If the thickness of the buccal bone is 3mm, and the thickness of the remaining root fragment is 2mm, the socket shield technique is more predictable and the bone contours can be maintained.

Photoelastic stress analysis surrounding different implant designs under simulated static loading.

ObjectiveThe proposal of this study was to use a photoelasticity method to analyze the stress dissipation in the bone surrounding an implant under simulated loading. Materials and MethodsFour implant systems with different internal connection designs were studied: conical connection (group 1), triangular connection (group 2), Morse taper (group 3), and internal hexagon (group 4). After the models’ inclusion in a photoelastic resin, they were subjected to static loads of 100, 150, and 200 N. The lengths of fringes that were generated were measured at the bone crest parallel to the neck of the implant and along the implant body, as well as the dissipation of force across the entire area of extension. ResultsLower stress was observed at the crestal bone in groups 1 and 3 with no significant increase (P < 0.05) in different levels of load, whereas the stress levels in groups 2 and 4 were observed to be higher with loads of all intensities with significant differences from the other groups (P < 0.05). ConclusionsThe type of connection and the implant neck design influenced the dissipation of force. The conical-type connection exhibited better load dissipation in the neck area, regardless of the load applied on the implant.

Stability of implants placed in fresh sockets versus healed alveolar sites: Early findings

OBJECTIVES The present study measured implant stability quotient (ISQ) values at three different time points after surgical procedures to compare whether the stability values differed between implants placed in fresh extraction sockets versus healed alveolar sites. MATERIALS AND METHODS To measure implant stability, resonance frequency analysis (RFA) was performed in 77 patients (53 women, 24 men) with a total of 120 dental implants. These implants were divided into two groups: Group 1 included 60 implants in healed alveolar sites (22 in the maxilla, 38 in the mandible), and Group 2 included 60 implants in fresh sockets (41 in the maxilla, 19 in the mandible). Implant stability was measured immediately at implant placement (baseline), 90, and 150 days later. Statistical analysis was made using a multivariate regression linear model at implant level (α = 0.05). RESULTS Overall, the means and standard deviations of the ISQ values were 62.7 ± 7.14 (95% confidence interval [CI], 39-88) at baseline, 70.0 ± 6.22 (95% CI, 46-88) at 90 days, and 73.4 ± 5.84 (95% CI, 58-88) at 150 days. In Group 1, the ISQs ranged between 64.3 ± 6.20 and 75.0 ± 5.69, while in Group 2, presented lower values that ranged between 61.2 ± 8.09 and 71.9 ± 5.99 (P = 0.002). Anatomic location and times periods were the only identified variables with an influence on ISQ values at implant level (P < 0.0001). CONCLUSIONS The stabilities of the implants placed in the fresh sockets and in healed sites exhibited similar evolutions in ISQ values and thus osseointegration; however, the implants in the healed alveolar sites exhibited superior values at all time points.

Importance of Crown Height Ratios in Dental Implants on the Fracture Strength of Different Connection Designs: An In Vitro Study.

PURPOSE The aim of the present in vitro study was to assess the resistance to static fatigue of implants with different connections at various crown heights. MATERIALS AND METHODS Sixty conical implants and 60 abutments were used with the smallest diameters available for each model. Three groups (n = 20) were established based on the implant connections: Morse taper Ø3.50 mm (group 1), external hexagon Ø3.50 mm (group 2), and internal hexagon Ø3.50 mm (group 3). Four crown heights were tested: h1  = 8 mm, h2  = 10 mm, h3  = 12 mm, and h4  = 14 mm. All groups were subjected to quasi-static loading at a 30° angle to the implant axis in a universal testing machine. RESULTS The mean fracture strengths for group 1 were 1524 N (h1 ), 1469 N (h2 ), 750 N (h3 ), and 729 N (h4 ). Those for group 2 were 1504 N (h1 ), 814 N (h2 ), 491 N (h3 ), and 325 N (h4 ). Those for group 3 were 1543 N (h1 ), 672 N (h2 ), 403 N (h3 ), and 390 N (h4 ). CONCLUSIONS Resistance to loading decreases significantly with increasing crown height, and the connection design can affect the performance.

Effect of platelet-rich plasma in alveolar distraction osteogenesis: a controlled clinical trial

We have evaluated the effect of the use of platelet-rich plasma in alveolar distraction osteogenesis. Fourteen patients who were partly edentulous in the anterior premaxilla region were selected and randomised into two groups (n=7 in each group). Those in the experimental group were give platelet-rich plasma at the time of distraction, and the control group had only distraction. Selected cases had defects in the alveolar ridge of more than 3mm, and a minimal bone height of 7 mm from the alveolar ridge crest to important anatomical structures. The plaque index and gingival index were recorded on days 3, 7, 14, 21, 28, 45, 60, 75, 90, and 105 postoperatively. There was a strong negative correlation between the gingival index and augmentation of bone, and a strong positive correlation between the mean gingival index and loss of bone from the transported segment. The addition of platelet-rich plasma had a protective effect on the mucosa around the distractor, which decreased the potential for complications.