title: Comparison of conventional twist drill protocol and piezosurgery for implant insertion: an ex vivo study on different bone types.
abstract: OBJECTIVE
  The aim of this ex vivo study was to compare implant insertion procedures using piezosurgery and conventional drilling in different qualities of bone. Implant bed preparation time, generated heat, and primary implant stability were analyzed.
  
  
  METHODS
  Fresh ex vivo porcine bone block samples (cancellous, mixed, and cortical bone) were obtained. The bone quality was quantified by ultrasound transmission velocity (UTV). Each bone sample received three implants of the same diameter using each of the techniques of piezosurgery and conventional twist drills. Time for preparation was taken and the temperature while performing the osteotomy was measured using infrared spectroscopy. The primary implant stability after osteotomy was measured using resonance frequency analysis (RFA) and extrusion torque (ET). ANOVA with post hoc Tukey test was carried out to compare the values for the three different groups.
  
  
  RESULTS
  The UTV values strongly correlated with the density of the bone samples. There was a significant increase in time (threefold, P < 0.05 [302 s vs. 122 s in cortical bone]) but no difference in the temperature for the piezo group (~37°C in cortical bone). Regardless of the osteotomy technique, there was a statistically significant increase in RFA and ET values in implants inserted in cancellous bone (RFA: piezo 77, drill 76; ET: piezo 22, drill 21), mixed bone (RFA: piezo 85, drill 86; ET: piezo 105, drill 61), and cortical bone (RFA: piezo 90, drill 87; ET piezo 184, drill 79) samples, respectively (P < 0.05). In between the different osteotomy groups, there was no difference in the RFA values but significant higher ET values in mixed/cortical bone samples in favor for the piezosurgery group.
  
  
  CONCLUSIONS
  Piezosurgery and conventional implant bed drilling procedure do have similar mechanical outcomes regarding primary stability with high RFA values, but the preparation does need more time for piezosurgery group, so that piezosurgery might be a valuable tool in only very specific cases for implant bed preparation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Sagheb
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.|Department of Head and Neck Surgery, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India.
authors.forename: Vinay V
authors.identifier: http://orcid.org/0000-0002-2279-4281
authors.initials: VV
authors.lastname: Kumar
authors.affiliation: Department of Conservative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Adriano
authors.initials: A
authors.lastname: Azaripour
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Walter
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Nawas
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre of the University of Rostock, Rostock, Germany.
authors.forename: Peer W
authors.initials: PW
authors.lastname: Kämmerer
mesh_terms: D000818:Animals; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D003762:Dental Instruments; D066298:In Vitro Techniques; D010027:Osteotomy / Q000379:methods; D059745:Piezosurgery / Q000295:instrumentation / Q000379:methods*; D013055:Spectrophotometry, Infrared; D013552:Swine; D019415:Torque
chemical_list: D015921:Dental Implants
keywords: biomechanics; bone implant interactions; bone quality; piezosurgery; surgical techniques