Introduction
Osseointegration is the most important prerequisite and phase for the integration of dental implants into the underlying jaw bone through bone-implant contact or fusion. Osseointegration is a phenomenon that influences the long-term success rates, survival, and prognosis of dental implants. However, recent research in the last few decades in implant dentistry also pinpoints a crucial factor other than local osseointegration for dental implant success. This factor is called "primary implant stability." The primary stability of the implant is, in fact, a confluence or combination of several factors. It largely depends upon the bone quality, the fixture shape, and the drilling protocol of the dental implant by the dental implantologist or oral surgeon.
Bone quality is indeed the preliminary and important factor that needs to be locally and thoroughly assessed by the dental operator prior to implantation procedure by study and analysis through CBCT, ideally (computed beam tomography) at the region the dental implant needs to be placed. Implant placement, especially in low-density bone such as type IV bone found in the region of the posterior maxilla (upper jaw), is indeed clinically challenging for the implantologist to accomplish long-term survival rates and success because of the soft bone nature and higher chances of failure in this region due to the presence of Schneiderian membrane (found within the nasal chamber) or the maxillary sinus and the alveolar bone height as well. Other than this factor of bone density and type, surface modification of dental implants has also been of pivotal importance because of the macro engineering variables we associate with it.
Can Drilling Techniques Influence Dental Implant Success?
The drilling technique or the implant drilling and site preparation protocol adapted by the implant dentist or the oral surgeon is also a crucial factor for implant success. In this article, we will discuss the different techniques of implant drilling protocols and how they can affect the success rates of dental implants. The drilling technique should always improve upon the primary stability of the implant. Hence, the implant dentist should choose the technique considering patient factors, local variables, and bone density at the site of implantation. Your implant dentist can choose any of these techniques elaborated below to enhance especially the survival rates of implants fixed in the low-density bone.
What Are the Different Drilling Techniques in Implant Dentistry?
The implant dentist or oral surgeon can adapt different surgical techniques for drilling during dental implantation. These techniques include:
-
Optimization Technique or Undersized Drilling Technique - In this technique, the implant drilling protocol will follow the osteotomy site preparation with progressively larger drills. Still, the final drill diameter should be considerably smaller than the implant diameter to be inserted into the hole. According to recent research, this undersized technique has resulted in a higher torque insertion value. A higher value of torque is always indicative of improved primary implant stability, thus consequently influencing long-term successful outcomes. Histomorphometric (the measurement of the tissue shape or form) analysis of undersized osteotomy preparation shows case reports with higher bone-implant contact values at three weeks compared to conventionally drilled implants (in which the implant diameter and osteotomy hole are nearly the same size or diameter). However, research also indicates that at six weeks range, both conventionally drilled and undersized osteotomy implants showed nearly the same values of bone-implant contact (BIC). In terms of long-term survival rates, this technique is given importance by many implant dentists, especially in low bone density cases.
-
Osteotome Technique - This implant drilling technique involves gradual and lateral bone compression using a hand osteotome instrument. This instrument is applied to the bone after initial pilot hole preparation at the osteotomy site, which is small-sized, and eventually, the osteotome will cause bone compression apically. This osteotome instrument method ensures that additional bone is not removed, unlike conventional implant drilling with which this possibility of additional bone removal may exist. Thus, placing the dental implant into the prepared site ensures a higher degree of primary implant stability and improves final bone healing, according to implant dentists who practice the osteotome technique.
-
Osseodensification Technique - This technique follows protocols similar to the osteotome technique but uses specially designed burs known as osseodensification burs, unlike the osteotome hand instrument. The scope behind this technique is that these specialized burs or drill designs can be used for non-subtractive and counterclockwise drilling fashion that is adapted to increase bone contact with the dental implant. Also, the added advantage of this technique is that bone growth is hastened during osseointegration. The primary implant stability value is also shown to be in a higher range, so many implant dentists in recent decades have also practiced the osseodensification technique.
-
Piezoelectric Surgery - This is the most advanced form of implant drilling in modern-day implant dentistry and is now deemed a valuable alternative to traditional or conventional implant drilling procedures. The tissue response in regard to the use of the piezoelectric tool has been analyzed by implant dentists as rapid with safer, more precise, and good bone regeneration capacity that can be observed post-implant insertion. Because of the increased precision of this technique, adequate or good bone healing, as well as the added benefit of soft tissue preservation (that creates an adequate biologic seal or soft tissue depth around the dental implant), is achieved in this technique. Piezoelectric surgery is considered a less traumatic and less invasive technique for dental implantation.
Conclusion:
To conclude, the techniques of optimization or undersized drilling, osteotome, osseodensification, and piezoelectric surgery are all considered good alternative drilling technique protocols to the conventional implant drilling method. Especially in clinically challenging areas when the density of the bone in the patient is less for dental implantation, these alternative techniques can be practiced by the implant dentist to achieve successful long-term outcomes in the patient.
