title: Influence of surgical technique and surface roughness on the primary stability of an implant in artificial bone with different cortical thickness: a laboratory study.
abstract: OBJECTIVE
  The aim of this biomechanical study was to assess the interrelated effect of both surface roughness and surgical technique on the primary stability of dental implants.
  
  
  METHODS
  For the experiment, 160 screw-designed implants (Biocomp), with either a machined or an etched surface topography, were inserted into polyurethane foam blocks (Sawbones). As an equivalent of trabecular bone, a density of 0.48 g/cm(3) was chosen. To mimic the cortical layer, on top of these blocks short-fibre-filled epoxy sheets were attached with a thickness varying from 0 to 2.5 mm. The implant sites were prepared using either a press-fit or an undersized technique. To measure the primary stability of the implant, both the insertion and the removal torques were scored.
  
  
  RESULTS
  Independent of the surgical technique used, both implant types showed an increased insertion and removal torque values with increasing cortical thickness, although >2 mm cortical layer no further increase in insertion torque was observed. In the models with only trabecular bone (without cortical layer) and with a 1 mm cortical layer, both implant types showed a statistically higher insertion and removal torque values for undersized compared with the press-fit technique. In addition, etched implants showed a statistically higher insertion and removal torque mean values compared with machined implants. In the models with 2 and 2.5 mm cortical layers, with respect to the insertion torque values, no effect of either implantation technique or implant surface topography could be observed.
  
  
  CONCLUSIONS
  The placement of etched implants in synthetic bone models using an undersized preparation technique resulted in enhanced primary implant stability. A correlation was found between the primary stability and the cortical thickness. However, at or above a cortical thickness of 2 mm, the effect of both an undersized surgical approach, as also the presence of a roughened (etched) implant surface, had no extra effect. Besides the mechanical aspects, the biological effect of undersized drilling, i.e. the bone response on the extra insertion torque forces should also be elucidated. Therefore, additional in vivo studies are needed.
authors.affiliation: Department of Periodontology and Biomaterials, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Afsheen
authors.initials: A
authors.lastname: Tabassum
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Meijer
authors.forename: Johannes G C
authors.initials: JG
authors.lastname: Wolke
authors.forename: John A
authors.initials: JA
authors.lastname: Jansen
mesh_terms: D000134:Acid Etching, Dental; D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D001842:Bone and Bones; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D017268:Dental Prosthesis Retention; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D020878:Device Removal; D006801:Humans; D016014:Linear Models; D008855:Microscopy, Electron, Scanning; D011140:Polyurethanes; D013314:Stress, Mechanical; D013499:Surface Properties; D019415:Torque
chemical_list: D001672:Biocompatible Materials; D015921:Dental Implants; D011140:Polyurethanes