EM - Teses de Doutoramento - Ciências Biomédicas
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- Comparison between osseodensification and conventional osteotomy protocol for implant site preparationPublication . Gaspar, João Rui Carvalho; Mendes, José João; Neiva, RodrigoOral rehabilitation with endosseous implants is a safe and effective treatment option which is associated with high success rates. Implant stability is a critical factor for the clinical success of rehabilitation and includes primary stability (mechanical engagement obtained upon insertion into the bone, holding the implant in place), and secondary stability (biological fixation that occurs due to the new bone formation during healing, resulting in osseointegration). It has been shown in the literature that implant micromotion exceeding 50 to 150 μm during healing period can lead to fibrous tissue interposition at the boneimplant interface and consequent failure in the osseointegration process. Therefore, according to several authors, high degrees of primary stability are associated in the literature with superior and higher probability of osseointegration. Furthermore, there are several parameters that must be considered during the implant site preparation, which should be as atraumatic as possible to maintain cell viability. The preservation of the bone structure and collagen matrix, together with the increase in primary stability, also demonstrated the potential to accelerate the post-surgery healing process. In 2015, a novel surgical technique for implant site preparation termed osseodensification (OD) has been introduced. It is a non-subtractive drilling technique that preserves bone by using specially designed burs in counterclockwise (CCW; noncutting motion) with copious irrigation. Contrary to conventional drilling techniques, OD promotes bone compaction along the osteotomy walls and into the trabecular spaces, increasing the bone density at the site. Several authors reported that this technique can help to obtain higher values of primary stability and implant insertion torque, especially in less dense bone. However, these drills have a dual-mode action since they may also be used in clockwise direction (CW) in which they have cutting capacity like any other system. Since it pushes the bone instead of removing it, OD has enormous potential in the field of oral implantology in different indications, namely in ridge expansion, post-extraction implant placement or maxillary sinus floor elevation (SFE) by crestal approach with high predictability and reduced morbidity, compared to alternative techniques.The main objective of this doctoral project was to contribute to advance knowledge regarding the OD technique and to validate its versatility and application in different clinical situations. In this sense, we decided to perform a systematic review and meta-analysis, with the aim of comparing implant stability between site preparation with OD compared to the conventional osteotomy protocol. This review was the first to exclusively analyze human data and demonstrated that OD consistently achieved higher values of primary and secondary stability (4-6 months after implant placement) compared with conventional drilling (Chapter 3). In addition, we had the opportunity to participate in an international multicenter retrospective clinical study, with colleagues from five nationalities, which confirmed the ability of OD to expand the interradicular septum for the post-extraction implant placement in molars. Furthermore, this study also allowed the introduction of a new molar socket classification, which can be used by the scientific community and facilitate communication between peers (Chapter 4). Finally, according to the current evidence, OD appears to have, in fact, enormous potential for SFE. However, there is still a lack of scientific studies with adequate methodology that effectively allow the OD technique to be considered as a valid alternative to the classic lateral window technique (LW), especially in highly resorbed posterior maxilla in which it continues to be considered the gold standard. Therefore, we decided to conduct a randomized clinical trial with the aim of comparing the effectiveness and impact on patients' quality of life of SFE with OD versus LW, both with simultaneous implant placement when residual bone height (RBH) < 4 mm. The results showed that, although both techniques were similarly effective, OD significantly outperformed LW in pain experience, impact on self-perceived quality of life, surgery duration, postoperative edema and analgesics intake (Chapter 5). In conclusion, OD represents a paradigm shift in implantology in terms of implant site preparation. This thesis confirms its clinical potential and versatility in different situations, from optimizing the implant site alone to bone expansion or SFE by crestal approach. Furthermore, our results position OD as a real and valid alternative to the LW technique in extreme cases with reduced RBH, with a significant improvement in patient experience.