|Year : 2016 | Volume
| Issue : 2 | Page : 120-123
A study on the resistance at bone-implant interface during implant insertion in a cadaver goat jaw model
Goutam Das, Sohini Banerjee, Abhijit Chakraborty, TK Pal
Department of Periodontics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
|Date of Web Publication||15-Jul-2016|
Dr. Sohini Banerjee
Department of Periodontics, Guru Nanak Institute of Dental Sciences and Research, Kolkata - 700 114, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The aim of the study is to determine the resistance at bone-implant interface during insertion of dental implant. Materials and Methods: Freshly procured cadaver goat mandibles were collected from slaughterhouses. Four dental implants of two different diameters were inserted into osteotomized sites of the goat mandibles. The gradual changes in resonance frequency (RF) were recorded in RF analyzer for the five consecutive turns of implant insertion. Results and Observations: RF was found to be positively correlated with diameter of dental implants. Conclusion: RF analysis can be used to determine the type of resistance the implant faces during insertion and the kind of bone density through which it passes. It gives a forecast of expected initial stability.
Keywords: Dental implant, resistance, resonance frequency
|How to cite this article:|
Das G, Banerjee S, Chakraborty A, Pal T K. A study on the resistance at bone-implant interface during implant insertion in a cadaver goat jaw model. J Int Clin Dent Res Organ 2016;8:120-3
|How to cite this URL:|
Das G, Banerjee S, Chakraborty A, Pal T K. A study on the resistance at bone-implant interface during implant insertion in a cadaver goat jaw model. J Int Clin Dent Res Organ [serial online] 2016 [cited 2019 Apr 18];8:120-3. Available from: http://www.jicdro.org/text.asp?2016/8/2/120/186419
| Introduction|| |
Successful rehabilitation with dental implant system to rehabilitate the missing or lost tooth due to various reasons is a great challenge. Success depends on various factors such as macro- and micro-design of implant, the quality (density), and quantity of bone. The bone can be assessed both qualitatively and quantitatively preoperatively by clinical observation and various radiological imaging systems. Several investigators proposed various types of bone depending upon their densities. In 1988, Misch proposed four densities of bone (D1–D4) depending on macroscopic cortical and trabecular bone characteristics. Bone densities can also vary from the most crestal region to apical region of the ridge., One of the determinants of implant success is the initial stability which is established by optimum bone-implant contact (BIC) at the end of insertion procedures by completing all necessary turns. This initial stability of the implant can be perceived at each turn quantitatively during implant insertion. During insertion, the resistance offered by bone will be reflected at bone-implant interface and can also be indicative of the nature of bone (ratio of trabecular bone and marrow space) through which it passes. This experience of turning the implants during insertions gives an idea of final BIC and expects initial implant stability; this is especially helpful in immediate loading of the implant. Therefore, it will not be irrelevant if a study would have been carried out to determine the resistance at each turn of the implant in a suitable area of the jaw on a cadaver model.
| Materials and Methods|| |
The study has been carried out in the Department of Periodontics at Guru Nanak Institute of Dental Sciences and Research, Kolkata. It was done in a prospective manner after obtaining ethical clearance from the Institutional Ethics Committee. Two dental implants (Cortex Dynamix Premium; Cortex Dental Implants Industries Limited) of 8 mm length × 3.8 mm diameter and other two of 8 mm length × 4.2 mm diameter were taken [Figure 1]. The implant surface was made rough by the manufacturer by sand blasting with alumina followed by acid etching.
Two freshly procured adult goat jaw bones were collected from slaughterhouses. The edentulous retromolar area [Figure 2] of the goat mandible was selected for this study., Since it is an experimental work in an in vitro model, no randomization was made. Each mandible had given two surgical sites at its retromolar areas. Therefore, two mandibles had given four sites where all four implants were inserted.
Each implant was fitted in vice and the osteotomy was made in the cadaver jaw [Figure 3] using the pilot drill bit (2 mm), followed by larger diameter drill bit up to desired diameters. For implant of 3.8 mm diameter, the final osteotomy was made using drill of 3.2 mm diameter. For implant of 4.2 mm diameter, the final osteotomy was made using drill of 3.7 mm diameter. Each implant was inserted first manually (using fingers only) into the osteotomy site, and then, resonance frequency (RF) sensor was connected to it. The first value of resistance was recorded as control in RF analyzer (RFA) without giving torque [Figure 4]. Such procedures were observed five times at five turns and recorded as experimental. The RFA showed these five values in graphics for each implant. The peak of the graphical plot denotes the RF value of respective turn of that implant [Figure 5]. Five RF values were observed for each implant, which are summarized in [Table 1] along with controls.
|Figure 5: a frequency-impedance plot of a resonance depicting resonance frequency as a peak in the diagram|
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|Table 1: Statistical analysis of resonance frequency values of different implants used in the study|
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The data were then subjected to statistical analysis. Chi-square test was performed to find the significance between the parameters [Table 1]. The degree of freedom was found to be 4. The RFA values of 4.2 mm diameter implant were found to be statistically significant (P ≤ 0.05) [Table 1].
| Results and Observations|| |
RF data were obtained by RFA of four implants of two different diameters. The relationship of implant diameter with RF changes was presented through bar diagram [Figure 6], [Figure 7], [Figure 8]. The data thus observed in RFA were subjected to statistical analysis. With increase of diameter from 3.8 to 4.2 mm, a sharp change in RF value was observed. The statistical analysis showed correlation between diameter and RF [Table 1].
|Figure 6: graph depicting variation in RFA values (Hz) for 3.8 mm diameter implant along with mean values|
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|Figure 7: graph depicting variation in RFA values (Hz) for 4.2 mm diameter implant along with mean values|
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|Figure 8: graph depicting variation in average RFA values (Hz) for 3.8 and 4.2 mm diameter implant|
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| Discussion|| |
It was primarily hypothesized that as the implant proceeds further into osteotomy, the stability of the implant increases. The study shows the gradual increase of resistance measured through RF from turn 1 to turn 5. With increase of diameter from 3.8 to 4.2 mm, a sharp change in increased RF value was observed [Figure 8]. This also reflects the increasing order of BIC from initial to final stage of insertion. The easiness with which a mandible can be fitted into vice is not possible with the maxilla. The design of the study in this cadaver model is supposed to mimic in human since the pattern of alveolar bone and bone marrow are almost same.,, The question with which the study was designed satisfies the outcome of the result. The data collected through RF were the most dependable method being used worldwide and firmly based on scientific evidence. The relevant experimental work has not been found in the existing literature and novel in its own uniqueness. No systematic review, whatsoever, can be referred to this. Therefore, this study adds evidence, though done on cadaver, to the delivery of the patient's health-care system. Since this study is on a cadaver model, the same work is in progress on human to actually justify the clinical implication and to eliminate the controversies therein, if any. With these few number of samples, the study has its own inherent limitations in terms of clinical significance.
The initial stability occurs at the end of insertion procedure and is related to the level of primary bone to implant contact. It is influenced by various factors such as quality, quantity of bone, and implant macro- and micro-design. A thicker cortical layer braces the implant better than a thinner cortical layer. Similarly, denser bone offers greater resistance to movement. The success of immediate/early loading of implant is dependent on the degree of initial implant stability. Misch noted that the bone density positively influences the amount of BIC. More the BIC, more will be the implant stability. Initial stability is one of the determinants of osseointegration and secondary stability. There are various tests available for determination of implant stability.,, Useful tests require that implant initial stability is measurable closer to the time of placement. Depending on this concept RF is one of the most acceptable noninvasive techniques for determination of initial stability of dental implant. In this study, four dental implants of two different diameters from the same manufacturer were inserted into retromolar area of the goat mandible to determine the resistance at implant-bone interface with the help of RFA. Since the retromolar area of goat mandible was found to contain similar microanatomical features as that of human alveolar spongiosa,, the RFA for determination of implant stability would also be useful in human clinical situation.
| Conclusion|| |
The limitation of the study is the number of samples and fixed anatomical surgical site (cadaver mandible); the present study indicates that the quality of the bone through which the implant travels can be ascertained. This will help clinician as a guide for immediate implant loading. The value for optimum RF with gradual advancement of implant in osteotomized site clearly depicts the ultimate and final initial stability.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Misch CE. Density of bone: Effect on treatment plans, surgical approach, healing, and progressive bone loading. Int J Oral Implantol 1990;6:23-31.
Debnath S, Pal TK. Trabeculae and marrow space of human alveolar spongiosa: A dry skull study. West Bengal State Dent J 1996;13:19-22.
Pal TK, Chakraborty A, Banerjee S. A micro-anatomical comparison of goat jaw cancellous bone with human mandible: Histomorphometric study for implant dentistry. J Int Clin Dent Res Organ 2014;6:20-3.
Pal TK. Animal experimentations: Part I: General considerations. J Int Clin Dent Res Organ 2015;7:7-10.
Pal TK. Animal experimentations – Part II: In periodontal research. J Int Clin Dent Res Organ 2015;7:92-9.
Pal TK, Chakraborty A, Pal S. Biomechanics of fixation of screw type dental implants. J Indian Soc Periodontol 1999;2:7,23.
Tabassum A, Meijer GJ, Wolke JG, Jansen JA. Influence of surgical technique and surface roughness on the primary stability of an implant in artificial bone with different cortical thickness: A laboratory study. Clin Oral Implants Res 2010;21:213-20.
Ivanoff CJ, Sennerby L, Lekholm U. Reintegration of mobilized titanium implants. An experimental study in rabbit tibia. Int J Oral Maxillofac Surg 1997;26:310-5.
Ueda M, Matsuki M, Jacobsson M, Tjellström A. Relationship between insertion torque and removal torque analyzed in fresh temporal bone. Int J Oral Maxillofac Implants 1991;6:442-7.
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