Need for the study 

              Endosseous dental implants are now considered to be the treatment of choice for replacement of all forms of tooth loss. An essential condition for successful implant therapy is the presence of an adequate quantity and quality of bone.  If a tooth or teeth have been missing for a considerable period of time, or if there has been traumatic loss of tooth and bone, placement of implants may prove challenging and often requires elaborate bone-grafting procedures. Unfortunately, bone-grafting techniques require a longer treatment time, a need for a second surgical appointment, and an additional surgical site if autogenous bone is used¹. This is more important in recent days due to popular immediate loading protocols being implemented into treatment by many clinicians.

Standard drill designs used in dental implantology are made to excavate bone to create room for implant placement. They cut away bone effectively but typically do not produce a precise circumferential osteotomy. Osteotomies may become elongated and elliptical due to chatter of the drills. In these circumstances, the implant insertion torque is reduced leading to poor primary stability and potential lack of integration. Osteotomies drilled into narrow bone locations may produce dehiscence, buccally or lingually, which also reduces primary stability and will require an additional bone grafting. For more than a decade, clinicians have been asking for improvement in bone drilling and preparation. ²Improvements in surgical technique will present better prospects for improving clinical results.³Unlike standard surgical technique, bone condensing technique aims to maintain most of the existing bone and to compress it apicolaterally. Thicker trabeculae and reduced intertrabecular spaces mean enhanced microstructure of local bone that improves primary implant stability allowing earlier new bone formation.⁴ 

Dr. Salah Huwais came up with the concept of osseodensification, a novel biomechanical implant site preparation technique. It produces low plastic deformation of bone due to its non-excavation osteotomy preparation method leading to expansion of pilot hole. Preservation of bone bulk takes place during drilling, so bone tissue is simultaneously compacted. and autografted in an outwardly expanding direction to form the osteotomy. It is accomplished by using multifluted proprietary densifying burs- Densah Burs. ⁵

             To the best of our knowledge very few studies have been conducted to know about the efficacy of Densah burs in achieving Osseodensification. Our study will be an effort in this direction.

1.      Research hypothesis (H₁) :

Densah Bur results in increased bone ridge width while maintaining Implant stability.

2.        Null hypothesis (H0) :

Densah Bur does not result in increased bone ridge width while maintaining Implant stability.

Objectives of the study

1)      To evaluate Bone ridge width before and immediately after preparation of the implant site when using the Densah Bur .

2)      To evaluate insertion torque value (ITV) of implant.

3)      To evaluate implant stability quotient (ISQ).

CLINICAL PARAMETERS :

At the baseline visit the study outcome data will be collected; including:

1) Measuring the bone ridge width, prior and post implant site preparation (drilling) at two levels- crestal & a position 10 mm apical to the crest using bone gauge.

2) Intraoral photographs of the prepared opening

3) Dental implant torque readings will be obtained post implant placement (ITV) (in Ncm).

4) ISQ as measure of both initial and the dynamic development of osseointegration