Introduction
The field of dental implants has seen significant advancements in recent years, and one technique that has garnered attention is "Osseodensification." This innovative approach revolutionizes the traditional dental implant placement process by enhancing bone density and implant stability. Osseodensification involves a unique drilling technique that condenses and densifies the bone while preparing the implant site, promoting improved osseointegration and long-term implant success. Instead of normal implant placement preparation, a more refined biomechanical approach is undertaken. This innovative preparation is done with a help of a specially designed densifying and fluted bur (bone-cutting instrument). This bur slides over the bone surface creating plastic bone deformations.
What Is A Dental Implant?
A dental implant is a small, screw-like post made of biocompatible materials, typically titanium, that is surgically placed into the jawbone to serve as a replacement for a missing tooth root. It provides a stable foundation for artificial teeth, such as crowns, bridges, or dentures, to be securely attached.
The dental implant fuses with the jawbone over time through a process called osseointegration, where bone cells grow and attach to the implant's surface. This integration ensures that the implant becomes a permanent and stable part of the jawbone, mimicking the function of a natural tooth root. Once the dental implant has fully integrated with the jawbone, a dental crown or other prosthetic can be attached to the implant, restoring the appearance, function, and feel of a natural tooth. Dental implants are a popular and effective solution for individuals who have lost a tooth or multiple teeth, as they offer long-term benefits, improved oral health, and enhanced aesthetics.
What Is Primary Implant Stability?
The primary implant stability plays a dynamic and pivotal role in the long-term success rates of dental implants. Several techniques and advances have been made in the field of implant dentistry for which the major term we come across for implant success remains "primary stability” of the dental implant.
According to traditional dental implant literature for every 9.8N/cm increase in the implant torque insertion when single dental implantation is done by the implant dentist, the failure rates tend to decrease almost by a wide margin of 20 percent ensuring long-term primary and secondary dental implant stability. This is affected when the implant dentist uses a particular insertion torque that ranges between 15 to 40 N/cm after the surgical drilling and correct positioning of the implant without any major angular deviations.
For the primary stability of the dental implant, the dentist needs to assess the bone condition and density accurately by preoperative assessment. The bone quantity and quality in a patient is what is important for maintaining the essence of primary stability and in turn bone-implant contact (BIC) preservation in the long run. If the bone-implant contact is affected after a few months or years as it occurs in the cases of failed dental implants, then that is indirectly or directly linked to loss or lack of primary stability of the implant.
What Are the Advantages of Osseodensification Technique Over Other Traditional Techniques?
Osseodensification is one of the recently advanced implant dentistry techniques introduced in the year 2014. This is based upon the osseodensification drilling concepts that primarily use a specially designable reverse cutting bur for the alveolar bone during dental implantation. Though this technique shows promising results to improve the primary stability of the dental implant, more research is underway to establish these concepts further into daily clinical practice and are adopted by the implant dentist to enhance the primary implant stability based on their individual understanding of the subject.
Osseodensification is a concept that has advantages over the primitive or previously tried and tested concepts like:
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Under preparation of the osteotomy hole.
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Osteotome instrument usage to widen or significantly improvise upon the buccolingual width of the bone.
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Osteocompression or osteocompaction methods.
These techniques incorporate specially designed dental implants and bone drilling surgical burs for dental implantation. In 2000, this technique was first introduced using implant threads that were composed of sinusoidal designs or round thread designs. However, in spite of the use of these techniques to enhance the bone quality or quantity and selectively attempt to increase the primary stability of the implant, research finds less influence with the use of such methods on the lateral margins of the implant or upon the stability of the dental implant itself. In fact, osteotome instruments are used more with caution by the implant dentist for the purpose of bone condensation, especially because, they can have the capacity to not only trigger microfractures in the bone and cause its resorption but also result in extensive damage to the bone cells or osteocytes.
When compared to these traditional methods recorded in dental literature, modern-day implant dentists in the study of osseodensification techniques have shown that the bone trabeculae tend to be more preserved because of the principle of non-subtractive drilling that is primarily adopted in this method of surgical technique.
What Is the Procedure of Osseodensification Technique in Dental Implants?
In osseodensification, the specialized burs or reverse-cutting bone burs also called Densah burs are used with the intention to minimize bone loss that occurs due to conventional implant drilling. With copious irrigation and the use of these specialized burs, the bony trabeculae are guided without much compression into the creation of the implant osteotomy hole. This causes the periphery and the apex of the implant bed to get compressed over the fabricated bone grafts used for maintaining bone shape and volume prior to implantation (bone graft augmentation) and aid in better osseointegration or bone implant fusion. Research also shows that the insertion torque of the operators for such dental implants placed through this procedure is nearly doubled and the bone width can be increased by nearly two to three folds.
However, due to the limited clinical use of such burs and experimentation in clinical practice, exact evidence of the improvement of primary dental implant stability by this technique remains elusive and needs further clinical research currently before adopting this technique completely into implant practice. However, theoretically and practically, researchers claim the use of this technique to demonstrate effective preservation of the peri-implant bone because of the principles of non-subtractive drilling and bone preservation or compaction technique used.
Why Is Research Favorable to Osseodensification Technique in Dental Implants?
In comparison to the traditional osteotomy technique of implant drilling, the implant bed preparation if not used with copious irrigation and operator tactility can result in higher temperatures of drill leading to potential bone tissue necrosis. However in this subtractive drilling method, irrigation is an added advantage, and as much as the trabecular bone is cut conservatively with the bone debris being guided into the implant bed with much less chatter, the science of implant drilling shows more favor for such a conservative approach. This is because by avoiding unnecessary temperatures or with the aid of copious irrigation and subtractive drilling, the specialized Densah burs and the implant thread designs of sinusoidal or rounded shapes are capable of stimulating the right flow of electric current in between the bone cells. This streaming potential or the correct electric current between bone cells needed for osseointegration can probably create a highly stimulative environment for new osteoblasts (bone-forming cells) that eventually aid in proper bone-implant contact and bone implant fusion between the implant threads and the alveolar bone resulting in the success of not only osseointegration but also long term primary and secondary implant stability.
Conclusion
To conclude, the technique of osseodensification is and remains a further advancing surgical technique that utilizes conservative principles of peri-implant bone preservation and in comparison to the traditional or conventional implant drilling procedures, these newer techniques through osseodensification are considered by researchers and clinicians alike as a subtractive approach that guides bone chips as well as the bone debris towards the implant bed created through osteotomy preparation with less chatter and hence increased primary stability of the dental implant and long-term success.
