Role of clinician's experience and implant design on implant stability. An ex vivo study in artificial soft bones

Georgios E Romanos; Abdulaziz Basha-Hijazi; Bhumija Gupta; Yan-Fang Ren; Hans Malmstrom

doi:10.1111/j.1708-8208.2012.00470.x

Role of clinician's experience and implant design on implant stability. An ex vivo study in artificial soft bones

Clin Implant Dent Relat Res. 2014 Apr;16(2):166-71. doi: 10.1111/j.1708-8208.2012.00470.x. Epub 2012 Jun 21.

Authors

Georgios E Romanos¹, Abdulaziz Basha-Hijazi, Bhumija Gupta, Yan-Fang Ren, Hans Malmstrom

Affiliation

¹ Professor of Clinical Dentistry, Division of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA; professor of Clinical Dentistry, Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA; resident, Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA; associate professor, Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA; professor and chair, Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.

PMID: 22726877
DOI: 10.1111/j.1708-8208.2012.00470.x

Abstract

Objectives: Clinical experience in implant placement is important in order to prevent implant failures. However, the implant design affects the primary implant stability (PS) especially in poor quality bones. Therefore, the aim of this study was to compare the effect of clinician surgical experience on PS, when placing different type of implant designs.

Methods: A total of 180 implants (90 parallel walled-P and 90 tapered-T) were placed in freshly slaughtered cow ribs. Bone quality was evaluated by two examiners during surgery and considered as 'type IV' bone. Implants (ø 5 mm, length: 15 mm, Osseotite, BIOMET 3i, Palm Beach Gardens, FL, USA) were placed by three different clinicians (master/I, good/II, non-experienced/III, under direct supervision of a manufacturer representative; 30 implants/group). An independent observer assessed the accuracy of placement by resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. Two-way analysis of variance (ANOVA) and Tukey's post hoc test were used to detect the surgical experience of the clinicians and their interaction and effects of implant design on the PS.

Results: All implants were mechanically stable. The mean ISQ values were: 49.57(± 18.49) for the P-implants and 67.07(± 8.79) for the T-implants. The two-way ANOVA showed significant effects of implant design (p < .0001), clinician (p < .0001), and their interaction (p < .0001). The Tukey's multiple comparison test showed significant differences in RFA for the clinician group I/II (p = .015) and highly significant (p < .0001) between I/III and II/III. The P-implants presented (for I, II, and III) mean ISQ values 31.25/49.18/68.17 and the T-implants showed higher ISQ values, 70.15/62.08/68.98, respectively. Clinicians I and II did not show extreme differences for T-implants (p = .016). In contrast, clinician III achieved high ISQ values using P- and T-implants following the exact surgical protocol based on the manufacturer guidelines. T-implants provided high stability for experienced clinicians compared with P-implants.

Conclusion: T-implants achieved greater PS than the P-implants. All clinicians consistently achieved PS; however, experienced clinicians achieved higher ISQ values with T-implants in poor quality bone.

Keywords: bone quality; clinician experience; implant stability.

MeSH terms

Animals
Bone and Bones / physiology*
Cattle
Dental Implants*
Dental Prosthesis Design*
In Vitro Techniques

Substances

Dental Implants