Histological Studies

Histology, histomorphometirc, oral and maxillofacial, osseodensification, periodontology, surgery, surgical procedure

H 1. Osseodensification Versus Subtractive Drilling Techniques in Bone Healing and Implant Osseointegration: Ex Vivo Histomorphologic/Histomorphometric Analysis in a Low-Density Bone Ovine Model

Mullings O, Tovar N, Abreu de Bortoli JP, Parra M, Torroni A, Coelho PG, Witek L. Osseodensification Versus Subtractive Drilling Techniques in Bone Healing and Implant Osseointegration: Ex Vivo Histomorphologic/Histomorphometric Analysis in a Low-Density Bone Ovine Model. Int J Oral Maxillofac Implants. 2021 Sep-Oct;36(5)

$Primary implant stability is a prerequisite for successful implant osseointegration. The osseodensification technique (OD) is a non-subtractive drilling technique that preserves the bone tissue, increases osteotomy wall density, and improves the primary stability. This study aimed to investigate the hypothesis that OD, through a wider osteotomy, produces healing chambers (HCs) at the implant-bone interface without impacting low-density bone primary stability. Twenty implants (3.5 10 mm) with a nanohydroxyapatite (nHA) surface were inserted in the ilium of ten sheep. Implant beds were prepared as follows: (i) 2.7-mm-wide using subtractive conventional drilling (SCD) technique (n = 10); (ii) 3.8-mm-wide using an OD bur system (n = 10). The sheep were randomized to two groups, with samples collected at either 14-(n = 5) or 28-days (n = 5) post-surgery and processed for histological and histomorphometric evaluation of bone-implant contact (BIC) and bone area fraction occupancy (BAFO). No significant group differences were found with respect to final insertion torque and implant stability quotient (p > 0.050). BIC values were higher for SCD after 14 and 28 days (p < 0.050); however, BAFO values were similar (p > 0.050). It was possible to conclude that the OD technique allowed a wider implant bed preparation without prejudice on primary stability and bone remodeling.$

H 2. Osseodensification enables bone healing chambers with improved low‑density bone site primary stability: an in vivo study

Mello-Machado, R.C., Sartoretto, S.C., Granjeiro, J.M. et al. Osseodensification enables bone healing chambers with improved low-density bone site primary stability: an in vivo study. Sci Rep 11, 15436 (2021).

biomechanical stability, lumbar spine fixation, manual instrumentation, ovine model

H 3. Osseodensification drilling vs conventional manual instrumentation technique for posterior lumbar fixation: Ex‐vivo mechanical and histomorphological analysis in an ovine mode

Torroni, A, Lima Parente, PE, Witek, L, Hacquebord, JH, Coelho, PG. Osseodensification drilling vs conventional manual instrumentation technique for posterior lumbar fixation: Ex‐vivo mechanical and histomorphological analysis in an ovine model. J Orthop Res. 2020; 1– 7.

This study sought to qualitatively and quantitatively evaluate the effect of osteotomy preparation by conventional (control group) or OD (OD group) instrumentation on osteotomy healing. An incision of 10 cm was made in the anteroposterior direction over the hip in five sheep, and 15 osteotomies were prepared in the left ilium of the sheep (n = 3/sheep). Three different instrumentation techniques were utilized: (1) conventional/regular drilling (R [recommended by manufacturer]) in a 3-step series of a 2-mm pilot, 3.2-mm, and 3.8-mm twist drills; (2) OD clockwise (OD-CW) drilling with Densah Bur (Versah) 2.0-mm pilot, 2.8-mm, and 3.8-mm multi-fluted tapered burs; and (3) OD counterclockwise (OD-CCW) drilling with Densah Bur 2.0-mm pilot, 2.8-mm, and 3.8-mm multifluted tapered burs. Drilling was performed at 1,100 rpm with saline irrigation. Qualitative histomorphometric analysis of the osteotomies after 6 weeks did not show any healing impairment due to the instrumentation. Histologic analysis shows bone remodeling and growth in all samples, irrespective of osteotomy preparation technique, with the presence of bone chips observed along the length of the osteotomy wall in sites subjected to osseodensification drilling.

H 4. Absence of Healing Impairment in Osteotomies Prepared via Osseodensification Drilling

Witek, Lukasz, et al. “Absence of Healing Impairment in Osteotomies Prepared via Osseodensification Drilling.” The International Journal of Periodontics & Restorative Dentistry, vol. 39, no. 1, 1 Nov. 2019, pp. 65–71.,

implant, bone, insertion torque, osseodensifica- tion, histologic

H 5. The Effect of Osseodensification Drilling for Endosteal Implants with Different Surface Treatments: A Study in Sheep

Lahens B, Lopez CD, Neiva RF, Bowers MM, Jimbo R, Bonfante EA, Morcos J, Witek L, Tovar N, Coelho PG. The effect of Osseodensification drilling for endosteal implants with different surface treatments: A study in Sheep. J Biomed Mater Res B Appl Biomater. 2018 Aug 6.

Osseodensification Dental implants Primary stability Histomorphometric In vivo Bone

H 6. Osseodensification Outperforms Conventional Implant Subtractive Instrumentation: A Study in Sheep

Oliveira PGFP, Bergamo ETP, Neiva R, Bonfante EA, Witek L, Tovar N, Coelho PG. Osseodensification outperforms conventional implant subtractive instrumentation: A study in sheep. Mater Sci Eng C Mater Biol Appl. 2018 Sep 1;90:300-307.

biomaterials, hip, bone tissue engineering and repair, bone biology

H 7. Temporal Osseointegration: Early Biomechanical Stability through Osseodensification

Alifarag AM, Lopez CD, Neiva RF, Tovar N, Witek L, Coelho PG. Temporal Osseointegration: Early Biomechanical Stability through Osseodensification. J Orthop Res. 2018 Sep;36(9):2516-2523.

Alveolar expansion, animal model, atrophic ridges, dental implants

H 8. Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques

Tian J, Neiva R, Paulo G, Coelho P, et al. Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques. J. Craniofac Surg 2018;00:00-00.

osseodensification, BIC, BV%, primary stability

H 9. Histomorphometric Comparison of 3 Osteotomy Techniques

Slete FB, Olin P, Prasad H. Histomorphometric Comparison of 3 Osteotomy Techniques. Implant Dent. 2018 Aug;27(4):424-428.

Significant differences in insertion torque and RFA among the three drilling protocols were observed, with the Versah drills showing substantially higher values. No difference was observed between the two implant systems in regard to insertion torque and RFA. Minimal difference was shown between the R protocol and Versah protocol for the TX system in terms of BIC and BAFO. However, the EV system showed a large difference between the R protocol and Versah system in terms of BIC and BAFO with the Densah system being substantially higher in both categories. The EV system also had much higher BIC and BAFO in all drilling protocols compared to the TX system. Significantly more autogenous bone chip debris in direct contact with the implant surface were observed with Versah drilling protocols.

H 10. Effects of Osseodensification on Astra TX and EV Implant Systems

Neiva, R., Tanello, B., Duarte, W., Coelho, P., Witek, L. and Silva, F. (2018), Effects of osseodensification on Astra TX and EV implant systems. Clin Oral Impl Res, 29: 444-444.

$Integration between implant and bone is an essential concept for osseous healing requiring hardware placement. A novel approach to hardware implantation, termed osseodensification, is described here as an effective alternative. 12 sheep averaging 65 kg had fixation devices installed in their C2, C3, and C4 vertebral bodies; each device measured 4 mm diameter 10 mm length. The left-sided vertebral body devices were implanted using regular surgical drilling (R) while the right-sided devices were implanted using osseodensification drilling (OD). The C2 and C4 vertebra provided the t=0 in vivo time point, while the C3 vertebra provided the t=3 and t=6 week time points, in vivo. Structural competence of hardware was measured using biomechanical testing of pullout strength, while the quality and degree of new bone formation and remodeling was assessed via histomorphometry. Pullout strength demonstrated osseodensification drilling to provide superior anchoring when compared to the control group collapsed over time with statistical significance (p < 0.01). On Wilcoxon rank signed test, C2 and C4 specimens demonstrated significance when comparing device pullout (p=0.031) for both, and C3 pullout tests at 3 and 6 weeks collapsed over time had significance as well (p=0.027). Percent bone-to-implant contact (%BIC) analysis as a function of drilling technique demonstrated an OD group with significantly higher values relative to the R group (p < 0.01). Similarly, percent bone-areafraction- occupancy (BAFO) analysis presented with significantly higher values for the OD group compared to the R group (p=0.024). As a function of time, between 0 and 3 weeks, a decrease in BAFO was observed, a trend that reversed between 3 and 6 weeks, resulting in a BAFO value roughly equivalent to the t=0 percentage, which was attributed to an initial loss of bone fraction due to remodeling, followed by regaining of bone fraction via production of woven bone. Histomorphological data demonstrated autologous bone chips in the OD group with greater frequency relative to the control, which acted as nucleating surfaces promoting new bone formation around the implants, providing superior stability and greater bone density. This alternative approach to a critical component of hardware implantation encourages assessment of current surgical approaches to hardware implantation.$

H 11. Osseodensification for Enhancement of Spinal Surgical Hardware Fixation

Lopez, Christopher D, Adham Alifarag, Andrea Torroni, Nick Tovar, Jesus Rodrigo Diaz-Siso, Lukasz Witek, Eduardo D Rodriguez and Paulo G. Coelho. Osseodensification for Enhancement of Spinal Surgical Hardware Fixation. Journal of the mechanical behavior of biomedical materials 69 (2017): 275-281.

bone volume, osseointegration, bone expansion, poor bone density

H 12. New Osseodensification Implant Site Preparation Method to Increase Bone Density in Low-Density Bone. In Vivo Evaluation in Sheep

Trisi P, Berardini M, Falco A, Vulpiani MP. New Osseodensification Implant Site Preparation Method to Increase Bone Density in Low-Density Bone: _In Vivo Evaluation in Sheep. Implant Dent 2016;25:24–31.

$A bonedrillingconcept,namelyosseodensification, hasbeenintroducedfortheplacement of endostealimplantstoincreaseprimarystabilitythroughdensification oftheosteotomy walls. Thisstudyinvestigatedtheeffectofosseodensification ontheinitialstabilityand early osseointegrationofconicalandparallelwalledendostealimplantsinlowdensity bone. Fivemalesheepwereused.Threeimplantswereinsertedintheilium,bilaterally, totaling 30implants(n 15 conical,and n 15 parallel).Eachanimalreceived3implantsof each type,insertedintobonesitespreparedasfollows:(i)regular-drilling(R:2mmpilot, 3.2 mm,and3.8mmtwistdrills),(ii)clockwiseosseodensification (CW),and(iii)counter- clockwise (CCW)osseodensification drillingwithDensahBur(Versah,Jackson,MI,USA): 2.0mmpilot,2.8mm,and3.8mmmulti-fluted burs.Insertiontorqueasafunctionof implant typeanddrillingtechnique,revealedhighervaluesforosseodensification relative to R-drilling,regardlessofimplantmacrogeometry.Asignificantly higherbone-to-implant contact (BIC)forbothosseodensification techniques(po0.05) wasobservedcomparedtoR- drilling. TherewasnostatisticaldifferenceinBICasafunctionofimplanttype(p 0.58), nor inbone-area-fractionoccupancy(BAFO)asafunctionofdrillingtechnique(p 0.22), but therewerehigherlevelsofBAFOforparallelthanconicimplants(p 0.001). Sixweeks after surgery,newboneformationalongwithremodelingsiteswasobservedforallgroups. Bone chipsinproximitywiththeimplantswereseldomobservedintheR-drillinggroup,$

H 13. Biomechanical and Histologic Basis of Osseodensification Drilling for Endosteal Implant Placement in Low Density Bone. An Experimental Study in Sheep

Lahens B, Neiva R, Tovar N, Alifarag AM, Jimbo R, Bonfante EA, Bowers MM, Cuppini M, Freitas H, Witek L, Coelho PG. Biomechanical and histologic basis of osseodensification drilling for endosteal implant placement in low density bone. An experimental study in sheep. J Mech Behav Biomed Mater. 2016 Oct; 63:56-65.

Mechanical pullout testing demonstrated that OD drilling provides better implant anchoring and stability compared with the R group. The trend that pullout strength was greater at 6 weeks than that at 12- weeks can be explained by the further development of secondary stability at the 12-week time point. Hence, it is evident that implant biomechanics are improved with OD both in primary and secondary stability

H 14. Mechanical Properties of Osseodensification Drilling as Compared to Regular Drilling

Gendy, Fady G., Gregory D Kurgansky, Leyla Y. Cavdar, Christopher D Lopez, Lukasz Witek, Paulo G. Coelho and Andrea Torroni. “Mechanical properties of Ossedensification drilling as compared to Regular drilling.” (2017).

10350 REV02 Last Updated: 07/19/2022

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