Novel Implant Site preparation using Densah Burs Osseodensification: A Clinical study

Need for the study

Endosseous dental implants arenow considered to be the treatment of choice for replacement of all forms oftooth loss. An essential condition for successful implant therapy is thepresence of an adequate quantity and quality of bone.  If a tooth or teeth have been missing for aconsiderable period of time, or if there has been traumatic loss of tooth andbone, placement of implants may prove challenging and often requires elaboratebone-grafting procedures. Unfortunately, bone-grafting techniques require alonger treatment time, a need for a second surgical appointment, and anadditional surgical site if autogenous bone is used1.Thisis more important in recent days due to popular immediate loading protocolsbeing implemented into treatment by many clinicians.

Standarddrill designs used in dental implantology are made to excavate bone to createroom for implant placement. They cut away bone effectively but typically do notproduce a precise circumferential osteotomy. Osteotomies may become elongatedand elliptical due to chatter of the drills. In these circumstances, theimplant insertion torque is reduced leading to poor primary stability andpotential lack of integration. Osteotomies drilled into narrow bone locationsmay produce dehiscence, buccally or lingually, which also reduces primarystability and will require an additional bone grafting. For more than a decade,clinicians have been asking for improvement in bone drilling and preparation. 2Improvementsin surgical technique will present better prospects for improving clinicalresults.3Unlike standard surgical technique, bone condensingtechnique aims to maintain most of the existing bone and to compress itapicolaterally. Thicker trabeculae and reduced intertrabecular spaces mean enhancedmicrostructure of local bone that improves primary implant stability allowingearlier new bone formation.4

Dr.Salah Huwais came up with the concept of osseodensification, a novelbiomechanical implant site preparation technique. It produces low plasticdeformation of bone due to its non-excavation osteotomy preparation methodleading to expansion of pilot hole. Preservation of bone bulk takes placeduring drilling, so bone tissue is simultaneously compacted. and autografted inan outwardly expanding direction to form the osteotomy. It is accomplished byusing multifluted proprietary densifying burs- Densah Burs. 5

To the best of our knowledge veryfew studies have been conducted to know about the efficacy of Densah burs inachieving Osseodensification. Our study will be an effort in this direction.

**1.**Research hypothesis (H1) :

Densah Bur results in increasedbone ridge width while maintaining Implant stability.

**2.**Null hypothesis (H0) :

Densah Bur does not resultin increased bone ridge width while maintaining Implant stability.

Objectives of the study

1)     To evaluate Boneridge width before and immediately after preparation of the implant site whenusing the Densah Bur .

2)     To evaluateinsertion torque value (ITV) of implant.

3)     To evaluate implantstability quotient (ISQ).

CLINICAL PARAMETERS :

At the baselinevisit the study outcome data will be collected; including:

1. Measuring the bone ridge width, priorand post implant site preparation (drilling) at two levels- crestal & aposition 10 mm apical to the crest using bone gauge.

2. Intraoral photographs of the preparedopening

3. Dental implant torque readings will beobtained post implant placement (ITV) (in Ncm).

4. ISQ as measure of both initial and thedynamic development of osseointegration