title: Stability and Crestal Bone Behavior Following Simultaneous Placement of Multiple Dental Implants (Two or More) with the Bone Splitting Technique: A Clinical and Radiographic Evaluation.
abstract: OBJECTIVE
  The present study aimed to measure the implant stability quotient (ISQ) values at three different time points after surgical procedures and crestal bone behavior in multiple implants (two or more) installed simultaneously with the bone splitting technique.
  
  
  METHODS
  For this study, 45 patients with different edentulous areas in the maxilla were selected, and a total of 114 dental implants were installed. Implant stability was measured by resonance frequency analysis immediately following implant placement to assess immediate stability (time 1) and stability at 90 days (time 2), and 150 days (time 3). Crestal bone height was measured in peri-apical radiographs at 90 and 150 days after implantation in relation to each implant shoulder, given that the implants were installed at the level of the crestal bone.
  
  
  RESULTS
  Six implants were not osseointegrated. Overall, the means and standard deviations of the ISQ values were 60.3 ± 4.94 (95% confidence interval [CI], 44-69) at baseline, 66.6 ± 5.28 (95% CI, 49-75) at 90 days, and 72.1 ± 4.28 (95% CI, 59-79) at 150 days (p < 0.0001). The mean marginal bone loss of the implants was 1.11 ± 0.61 mm on the mesial side and 1.17 ± 0.61 mm on the distal side at time 2, and 1.73 ± 0.68 mm on the mesial side and 1.79 ± 0.70 mm on the distal side at time 3. A strong positive correlation between implant stability and bone loss was detected (p < 0.0001).
  
  
  CONCLUSIONS
  Within the limits of this study, the bone splitting technique with simultaneous implant installation exhibited a good success rate with respect to the osseointegration index but requires attention with respect to crestal bone behavior.
authors.affiliation: Department of Research, Biotecnos Research Center, Santa Maria, Brazil.|Department of Research, International Research Cathedra. UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain.
authors.forename: Sergio Alexandre
authors.initials: SA
authors.lastname: Gehrke
authors.affiliation: Department of Research, International Research Cathedra. UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Maté Sánchez de Val
authors.affiliation: Department of Research, International Research Cathedra. UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain.
authors.forename: Maria Piedad
authors.initials: MP
authors.lastname: Ramírez Fernández
authors.affiliation: Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, Guarulhos, São Paulo, Brazil.
authors.forename: Jamil Awad
authors.initials: JA
authors.lastname: Shibli
authors.affiliation: Private Practice, Bauru, São Paulo, Brazil.
authors.forename: Paulo Henrique Orlato
authors.identifier: http://orcid.org/0000-0002-0868-6022
authors.initials: PH
authors.lastname: Rossetti
authors.affiliation: Department of Research, International Research Cathedra. UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Calvo Guirado
mesh_terms: D000328:Adult; D059605:Dental Implant-Abutment Design; D003758:Dental Implantation, Endosseous / Q000379:methods*; D017267:Dental Prosthesis Design; D017268:Dental Prosthesis Retention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D063166:Maxillary Osteotomy / Q000379:methods*; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000000981:diagnostic imaging / Q000601:surgery; D016348:Osseointegration / Q000502:physiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D000074269:Resonance Frequency Analysis
keywords: bone splitting technique; crestal bone behavior; dental implant; implant stability; resonance frequency analysis