title: Evaluation of primary and secondary stability of titanium implants using different surgical techniques.
abstract: OBJECTIVE
  To investigate the influence of different surgical techniques on the primary and secondary implant stability using trabecular bone of goats as an implantation model.
  
  
  METHODS
  In the iliac crest of eight goats, 48 cylindrical-screw-type implants with a diameter of 4.2 mm (Dyna(®) ; Bergen op Zoom, the Netherlands) were installed, using three different surgical techniques: (i) 5% undersized, using a final drill diameter of 4 mm; (ii) 15% undersized, using a final drill diameter of 3.6 mm; and (iii) 25% undersized, using a final drill diameter of 3.2 mm. Peak insertion torque values were measured by a Digital(®) (MARK-10 Corporation, New York, NY, USA) torque gauge instrument during placement. At 3 weeks after implantation, removal torque was measured. Histomorphometrically, the peri-implant bone volume was measured in three zones; the inner zone (0-500 μm), the middle zone (500-1000 μm) and the outer zone (1000-1500 μm).
  
  
  RESULTS
  Evaluation of the obtained data demonstrated no statistically significant difference between different surgical techniques regarding removal torque values. With respect to the percentage peri-implant bone volume (%BV), also no significant difference could be observed between all three applied surgical techniques for both the inner, middle and outer zone. However, irrespective of the surgical technique, it was noticed that the %BV was significantly higher for the inner zone as compared to middle and outer zone (P < 0.05) around the implant.
  
  
  CONCLUSIONS
  At 3 weeks after implant installation, independent of the used undersized surgical technique, the %BV in the inner zone (0-500 μm) peri-implant area was improved due to both condensation of the surrounding bone as also the translocation of host bone particles along the implant surface. Surprisingly, no mechanical beneficial effect of the 25% undersized surgical technique could be observed as compared to the 5% or 15% undersized surgical technique to improve primary or secondary implant stability.
authors: Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Afsheen
authors: A
authors: Tabassum
authors: Gert J
authors: GJ
authors: Meijer
authors: X Frank
authors: XF
authors: Walboomers
authors: John A
authors: JA
authors: Jansen
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D017268:Dental Prosthesis Retention; D003799:Dental Stress Analysis; D020878:Device Removal; D005260:Female; D006041:Goats; D007085:Ilium / Q000601:surgery; D020007:Implants, Experimental; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D013314:Stress, Mechanical; D013499:Surface Properties; D014025:Titanium; D019415:Torque; D055114:X-Ray Microtomography
chemical_list: D015921:Dental Implants; D014025:Titanium
keywords: bone healing; insertion torque; primary stability; removal torque; secondary stability; titanium implants; undersized surgical technique