Considerations Regarding Dental Implant Site Preparation using Osseo densification Osteotomy. A Critical Review

Abstract

Abstract: Conventional osteotomies for implant placement are typically prepared with implant drills originally designed for non-dental procedures. Such drill designs have proven efficacy for implant placement, resulting in good implant success rates over many years. Conventional drill designs used in oral implantology remove bone to create space for implant insertion. While these osteotomy drills effectively remove bone, they may not always create circumferential osteotomy sites. Therefore, implant insertion torques may be lower than ideal, possibly compromising primary implant stability (PIS). This in turn may adversely affect implant osseointegration (OI). Osteotomies performed in areas with narrow bone anatomy may also cause a dehiscence, which potentially further reduces PIS. Furthermore, additional bone grafting procedures may be required thereby prolonging healing time before implant restorations can be completed. More recently, a novel biomechanical bone preparation technique called “osseodensification” (OD) has been proposed. Unlike traditional dental implant drilling procedures, osseodensification does not remove bone tissue. Conversely, bone tissue is retained and compacted in outwardly expanding directions within the osteotomy preparation site. This is similar to the effect of a traditional hammer osteotome but with less adverse effects. When the OD bur is rotated at high speed in a counterclockwise direction, a dense bone tissue layer is created along the walls and base of the osteotomy site. The formation of this dense compacted bone layer may contribute towards faster OI by enhancing PIS. This review discusses the potential advantages of OD and critically evaluates the currently available literature investigating this interesting implant bed preparation technique.