Immediate implant placement (IIP) in mandibular molars is challenged by wide extraction sockets and limited septal bone support. This pilot feasibility randomized clinical trial evaluated primary and secondary implant stability following septal expansion using piezoelectric surgery (PISP) compared with osseodensification (OD) using Densah® burs. Twenty patients were randomly allocated (1:1) to either PISP group or OD group for immediate mandibular molar implant placement. The primary outcome was implant stability quotient (ISQ), measured immediately and at 3 months. Secondary outcomes included insertion torque, osteotomy preparation time, and postoperative pain assessed using a visual analogue scale (VAS) during the first postoperative week. Normality was evaluated using Shapiro–Wilk tests and Q–Q plots. Between-group comparisons were performed using independent t-tests, while VAS scores were analyzed using Mann–Whitney U and Friedman tests (α = 0.05). No statistically significant differences were observed between groups in primary or secondary ISQ (p > 0.05). Both groups demonstrated a significant increase in ISQ at 3 months compared with baseline (p < 0.001). The mean insertion torque was significantly higher in the PISP group (40.33 ± 3.24 Ncm; p = 0.004) compared to the OD group (35.00 ± 3.53 Ncm). Osteotomy preparation time was significantly longer in the PISP group (9.00 ± 0.94 min) than in the OD group (6.00 ± 0.82 min) (p < 0.001). Postoperative VAS pain scores were significantly lower in the PISP group throughout the first week (p < 0.05). All implants achieved clinical stability with no intra- or postoperative complications. The preliminary findings of this pilot feasibility trial demonstrated that PISP achieves comparable biomechanical stability to OD, establishing its clinical feasibility for immediate molar implant placement in anatomically complex posterior regions. NCT06957860 ; registered May 5, 2025.
Hussien El H Hassan, Abdelaziz F Khlalil, Dina M N Metawie· BMC Oral Health· 1 citation
Insufficient bone width is a common obstacle when placing dental implants. Numerous methods have been devised to enhance bone thickness. Autogenous bone is considered the benchmark material owing to its superior properties. The split bone block technique showed favorable results in bone gain, although donor site morbidity and the need for a second surgical site were major concerns. The study aimed to assess bone augmentation in the anterior mandible, using the symphysis as both the donor and recipient site, while the original technique required two surgeries. This prospective, single-center, formal consecutive case series study focused on outcomes and involved 11 patients, each having a bone width of less than 4 mm in the anterior mandibular area. Patients underwent a procedure for horizontal ridge augmentation, with implants being placed after a four-month interval. The study assessed the healing of the surgical site, reported complications, and measured pain levels using a visual analogue scale. It evaluated bone gain in width, primary stability, secondary stability of implants, short-term implant success, and augmented bone stability. The current study revealed postoperative swelling occurred in 45.5% of patients, while hematoma and flap dehiscence were each observed twice. Visual Analog Scale pain scores decreased over two weeks (P < 0.001). Mean radiographic bone width increased from (3.27 ± 0.80 mm) preoperatively to (5.88 ± 0.82 mm) at 4 months (P < 0.001). Furthermore, mean implant stability quotient scores improved from 72.80 (3.94) to 88.90 (2.10) (P < 0.001). The short-term implant success was 90.9%, and the mean linear augmented bone stability was 88.41% ± 6.24% (median: 90.57%), with individual values ranging from a minimum of 74.39% to a maximum of 94.57%. The findings of this preliminary case series suggest that the auto-augmentation technique from the mandibular symphysis is a technically feasible protocol for horizontal ridge augmentation. By confining the surgery to a single localized window, it achieves adequate bone gain while minimizing donor-site trauma and optimizing patient recovery profiles. The trial was registered on 12/09/2024 at clinicaltrials.gov (ID: NCT06727591).
Hossam Saleh, R. Eldibany, Dina M N Metawie· BMC Oral Health· 0 citations