Comparative Analysis of Stability of Dental Implants
I.Yu. Popovych, T.O. Petrushanko, G.A. Yeroshenko, D.V. Steblovskiy
COMPARATIVE ANALYSIS OF STABILITY OF DENTAL IMPLANTS
Ukrainian Medical Stomatological Academy, Poltava
The paper is written within the research scientific work, entitled “The mechanisms of the effect of morbigenous factors on the dental status of individuals with somatic pathology and the ways of its correction and blocking” (State registration number 0115U001138).
Dental implants are increasingly used in oral surgery. Notwithstanding the advancement of the methods for treatment of caries and its complications, the need of population in implant treatment is increasing annually. 65% of the population aged 35-45 years has dentition defects . In replacement of single defects of the dentition, the manufacturing of structures based on dental implants is the method of choice . The use of dental implants in provision of prosthetic dental care opens up new opportunities and prospects for rehabilitation of patients with partial or complete absence of teeth . Every year, dental implantation is becoming more accessible and acceptable for many patients when choosing the methods for replacement of both the bounded and free-end edentulous spaces.
The formation of the high dental culture in the population determines the motivation and desire of contemporary person to preserve teeth and, if necessary, restore the missing teeth in the rehabilitation of dentitions, as well as the most sparing management of remaining teeth.
Currently, permanent impact of various pathogenic factors (cosmic-planetary, social, physical, chemical and biological) on humans contributes to the occurrence of numerous somatic and dental diseases, including inflammatory-dystrophic periodontal diseases. The rate of the prevalence and severity of generalized periodontitis along with various somatic diseases, especially among young population, is increasing annually [4, 5]. Correlations between the inflammatory-dystrophic periodontal lesions and cardiovascular, endocrine pathology, gastritis, peptic ulcer has been experimentally and clinically proven [6, 7]. The most frequent complication of the clinical course of periodontitis is tooth loss caused by the destructive processes in the osseous tissue of the alveolar ridge. The dentition defects in patients with generalized periodontitis require special management to eliminate them, especially during dental implantation.
The achievement of the optimal primary and secondary stabilization of the dental implant in the osseous tissue of the jaws, especially in periodontitis, is one of the priorities for both dental implant manufacturers and dental surgeons. Different approaches can be used to solve such problems. One of the solutions is the creation of the special surface of the implant and its design, as well as the advancement of the surgical and prosthetic stages of implantation.
The paper was aimed at the comparison of the primary and secondary stability of two dental implants, different in design, during the experiment on the porcine jaws with D3-D4 bone density.
Materials and Methods
MegaGen AnyOne and Alpha Dent Active Bio dental implants have been studied and compared. MegaGen AnyOne dental implant has been used as the control. It is indicated for use in patients with D3-D4 bone density, which is often diagnosed in the presence of inflammatory and dystrophic diseases of the periodontal tissues, as well as in patients of risk group who have poor bone density, in particular, of the alveolar ridge of the maxilla and mandible. In such cases, the primary and secondary stabilization of the dental implant is critical in its further predicted functioning.
Alpha Dent Active Bio dental implant has been used for comparative analysis. It has a triangular design in the cervical third (the site for osseointegration of the newly formed osseous tissue), providing with anti-rotational effect.
The study was conducted at the laboratories of the Institute of Pig Husbandry and Agricultural Production of the National Academy of Agrarian Sciences of Ukraine (Poltava), involving 3 Ukrainian large breed pigs (castrated males aged 6 +/- 1 month old) weighing 70.0 ± 4.5 kg, kept on a standard diet and fed twice a day with dry mash and water available ad libitum (standard feeding system). The housing of pigs was individual. Based on the previous studies it was established that type III bone quality (D3) prevails in the studied animals, both in the upper and lower jaws .
At the stages of the experiment, the animals were sedated with sodium thiopental (5 mg / kg intravenously). Four dental implants were placed into the alveolar ridge of jaw bones of each pig according to the protocol of manufacturers for the type III bone quality by the two-step technique, namely, 2 Alpha Dent Active Bio dental implants of 3.75*8mm and 2 MegaGen AnyOne dental implants of 3.50*8.5 mm (one on the upper and lower jaw, respectively). Primary stability of the implant was determined using a torque wrench at the time of insertion of the dental implant.
All experimental studies were carried out in accordance with the principles of the European Convention for the Protection of Vertebrate Animals (Strasbourg, 1986), the “General Principles of Experiments on Animals”, which were approved by the I National Congress on Bioethics (Kiev, 2001) and the requirements of the “Procedure for conducting scientific studies, experiments on animals ”(2012).
Following the three months after implant restoration, the animals were under constant surveillance. Within three months, the pigs were killed under 25 mg/kg thiopental anesthesia overdose; blocks with integrated implants and adjacent teeth were removed. Subsequently, the integrated implants were in the direct access, the plug was removed; the implants were disintegrated by turning counterclockwise with the help of an implant driver and a torque wrench. At the same time, the peak value of torque was recorded using a torque wrench.
Results and Discussion
Primary and secondary implant stability is one of the important factors in the evaluation of the prognosis of dental implantation. The stability of the implant is the absence of micromovements of the intraosseous portion of the dental implant after its insertion. It determines the possibility of functional load of dental implants, providing with assessment of the state of the intraosseous portion of implants along with X-ray methods.
The primary stability of the implant is determined at the time of its insertion and serves as a criterion for choosing an early or delayed load on the implant. It creates favorable conditions for its successful osseointegration in the bone tissue of the alveolar ridge of the jaw. The values of the optimal primary stability of the implant in a two-stage implantation protocol are within the range of 20-40 Ncm, especially when implanted into bone tissue with poor density. Insertion of dental implants with the specified TORQUE values provides the required stability of the implant in the bed without high compression of the bone tissue of the alveolar ridge.
The secondary stability of the implant, together with clinical and radiological methods, is one of the factors of osseointegration of the dental implant and the possibility of its load. It is determined within the time after integration of the dental implant in the alveolar ridge and serves as a landmark for its functional load. Secondary implant stability is determined when a new bone tissue is formed around the inserted intraosseous portion of a dental implant.
At the time of insertion of dental implants, all experimental animals showed no clinical signs of any infectious or somatic pathology and oral diseases. No complications of surgical interventions in the form of implant insertions and the follow up postoperative period were observed in pigs. None of the inserted dental implants failed after its integration.
The study of the state of the jaw fragments together with the implants showed that the mucous membrane of the animals’ alveolar ridge was clinically intact, pink in color, without visible pathological changes. Once the access to implants was provided, their osseointegration was visually determined. The plugs on all implants were preserved. No areas of bone resorption of the alveolar ridge around the implants were noted. Osseous tissue throughout the diameter of the implant evenly adhered to the area of its neck. This indicated the absence of compression at the time of insertion of dental implants, optimal primary stability of the implant and the implantation protocol. Resorption may also appear around the implant if the thickness of the external bone wall in the implant area is less than 2 mm. The resulting data are consistent with the findings of Ramazanov S.R. (2009).
The findings of the study have shown that the mean values of the primary stability of the integrated implants were 22.5 ± 1.12 Ncm (Alpha Dent Active Bio) and 21.67 ± 1.05 Ncm (MegaGen AnyOne) with no significant difference between them, which indicates the same stability of the implants. The findings of Trisi are consistent with findings of our studies. It has been experimentally proven that the optimal TORQUE parameters of primary stability of dental implants integrated in the jaw of live sheep is 24 N/cm. The increase in TORQUE value led to numerous microcracks in sheep.
Gary Greenstein and John Cavallaro suggest that torque in the range of 30-40 N/cm is the criterion for the implementation of the protocol for immediate implantation.
After the experiment the mean values of the dental implant stability were significantly different, accounting for 72.5±1.12 Ncm (Alpha Dent Active Bio) and 59.17±1.54 Ncm (MegaGen AnyOne).
The findings indicate that the design of the implant is important for the secondary stability of dental implants for unscrewing, namely the Alpha Dent Active Bio implant of Alpha Dent Bio Active Conus, unlike the MegaGen implant, is of triangular design on the top instead of a cylindrical one, which gives it additional possibilities for fixation and further osseointegration in the type III bone. The results of the secondary osseointegration of implants can suggest the earlier time for prosthetic stage of implant restoration with Alpha Dent Active Bio dental implants as compared to MegaGen AnyOne implants.
Based on the studies conducted, it has been proved that one of the main factors affecting the quality of stabilization and osseointegration is the design of the dental implant, which provides the anti-rotational effect, namely the triangular design of the portion of the Alpha Dent Active Bio implant. Dental implants used in the experimental study should be indicated for use in patients with poor bone density of the alveolar ridge of the jaws (D3-D4), which is most often diagnosed during in the development of periodontitis in humans.
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