(15) A Novel Method to Reduce Marginal Bone Remodeling in a Two-stage, Fully Guided Implant Placement Protocol: A Pilot Study

Abstract Statement of the problem:

Marginal bone remodeling is a physiologic bone resorption process at the alveolar crest that follows dental implant placement. Early marginal bone loss/remodeling has been proven to progress to levels that risk compromising long-term outcomes. More specifically, a retrospective human study by Galindo-Moreno et.al, found that not only is marginal bone remodeling a key factor in the development of peri-implantitis, but the vast majority of implants with greater than 0.5 mm of marginal bone remodeling at 6 months after placement were not found to have radiographic success when reassessed 12 months after placement.1,2 Thus, the preservation of crestal bone height in the healing and/or early loading phases (within 6 months of placement), has become a significant priority in the placement of 2-stage dental implants.

The Torque, Reverse Torque, Placement (TRTP) technique is a novel method that involves placing the implant and then partially reverse torquing it before finally placing it to the planned osteotomy length. This technique promotes blood-pooling around the implant surface to increase blood supply and potentially decrease marginal bone remodeling in the early stages of implant osseointegration using a fully guided 2-stage implant surgery protocol.

Materials and

Methods:

A case series was performed at Touro College of Dental Medicine from May 2022 to December 2023 and included 10 patients with the objective to demonstrate the TRTP technique's efficacy in a 2-stage surgical approach. In each case, at least one implant was placed using the TRTP technique in an experimental site and compared against an implant placed using standard protocols in a control site. Only one implant system was used, and all implants were placed using a comprehensively planned, fully guided surgical protocol in a 2-stage approach. Clinical and radiographic evaluations were completed at the time of implant placement and second-stage surgery. Marginal bone remodeling was calculated by measuring the difference in the height of crestal bone associated with the implant between immediate postoperative and 4-month second-stage radiographs.

Results

In the experimental sites, where implants were placed exclusively using the TRTP technique, minimal to no detectable marginal bone remodeling ( < .5mm) was observed at the second-stage surgery. In contrast, control sites following standard protocols exhibited varying degrees of marginal bone remodeling (0.5 mm-3.0 mm). These outcomes remained consistent when comparing protocols on contralateral sides of the same arch, on ipsilateral sides of the same arch, and on opposing arches. Notably, when comparing sites that had been previously grafted, experimental sites displayed minimal to no marginal bone remodeling, while control sites exhibited appreciable marginal bone remodeling.

Conclusion:

In sites where standard protocols were followed, marginal bone remodeling was observed, whereas minimal to no marginal bone remodeling was found in sites where the TRTP technique was used. This case series indicates that the novel TRTP technique could be a supplementary method to reduce marginal bone remodeling before second-stage surgery. However, additional testing is required to confirm its effectiveness. The authors will use this report to further test the technique's efficacy with future case-control studies.

References
1. Galindo-Moreno, P., Catena, A., Pérez-Sayáns, M., Fernández-Barbero, J. E., O'Valle, F., & Padial-Molina, M. (2022). Early marginal bone remodeling around dental implants to define success in implant dentistry: A retrospective study. Clinical implant dentistry and related research, 24(5), 630–642. https://doi.org/10.1111/cid.13122

2. Galindo-Moreno, P., León-Cano, A., Ortega-Oller, I., Monje, A., O Valle, F., & Catena, A. (2015). Marginal bone loss as success criterion in implant dentistry: beyond 2 mm. Clinical oral implants research, 26(4), e28–e34. https://doi.org/10.1111/clr.12324