RU2850970C1 - Method for preoperative diagnosis of bone tissue and method for installing dental implant - Google Patents

Abstract

FIELD: medicine; surgical dentistry.

SUBSTANCE: inventions are intended for use in dental implantation. Before installing a dental implant, preoperative diagnosis of the patient's bone tissue is performed to assess the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. The type of bone tissue is determined, where type the first type is high-density bone tissue with a layer of compact bone of 4 mm or more, the tooth was removed more than 6 months ago, type 2 - high-density bone tissue with a compact bone layer of 2 to 3 mm, or an implant is planned to be placed in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, Type 3 - bone tissue of normal density with compact bone from 1 to 2 mm, or implant placement is planned in the area of bone augmentation performed 4 to 6 months ago, or the tooth was extracted no more than 4 months ago. Type 4 - low-density bone tissue with compact bone up to 1 mm, or implant placement in the socket of a single-root tooth simultaneously with its removal, or planned implant placement in the area of bone augmentation performed 2 to 4 months ago, or tooth extracted no more than 2 months ago. Type 5 - soft bone tissue with no compact bone, or implant placement in the socket of a multi-rooted tooth simultaneously with its removal, or planned implant placement in the area of bone augmentation performed 0 (simultaneously with implantation) to 2 months ago. After preoperative diagnosis, a preliminary hole is formed in compact bone, socket or interradicular septum e, then a trial osteotomy is performed with a pilot drill, after which the type of bone tissue at the site of future implantation is finally determined , where: in the case of soft bone of unsatisfactory quality of the fifth type, no further osteotomy is performed, and the implant is inserted along the formed channel, compacting the bone tissue as it is inserted ; in the case of low bone density of the fourth type, further osteotomy is performed with a pilot drill in the mode of bone tissue osteocondensation ; with normal bone density of the third type, further osteotomy is performed with a pilot drill in the mode of osteotomy; with increased bone density of the second type, following the pilot drill , a main drill of a larger diameter is used in the mode of bone tissue osteocondensation ; for high bone density of the first type, after the pilot drill in the bone osteotomy mode , use the main drill in the bone osteotomy mode , after forming the bed, insert the implant, wherein the pilot drill and the main drill have concave conical profiles, and a radial recess is made in the upper part of each drill edge, made with the possibility of performing additional osteotomy.

EFFECT: increased stability of the dental implant after its installation and reduced trauma during the installation procedure.

4 cl, 8 ex

Description

The invention relates to dental and surgical operations, in particular to methods for implanting dental implants and methods for preparing for it.

A METHOD OF BONE EXPANSION AND COMPRESSION FOR INSTALLATION OF A DENTAL IMPLANT USING THREADED EXPANDERS is known, comprising the following steps: creating a small initial osteotomy site on the upper or lower jaw to a desired depth using a pilot drill at a predetermined location of the implant; screwing a first threaded expander into said osteotomy site, thereby expanding said osteotomy site laterally by moving bone tissue radially from the longitudinal axis of said osteotomy site; allowing said first expander to remain in said osteotomy site for a sufficient amount of time to form the inner wall of said osteotomy site; removing said first expander by unscrewing said first expander in the opposite direction; repeating steps (b)-(d) using a second thread expander that has an increasing outer diameter and substantially the same thread structure as said dental implant, starting from following the thread pattern created in steps (b)-(d) to further expand said osteotomy site laterally to a final diameter that is additional to, but narrower than, the outer diameter of said dental implant, such that the expanded osteotomy site allows said implant to sufficiently bite into and uniformly interact with the surrounding bone tissues [US 2005026114 A1, published 03.02.2005].

A disadvantage of this alternative is the lack of stability of the implanted implant. This method uses sequential expansion with threaded expanders, which only expand the bone tissue rather than remove it. This results in a loose internal structure of the implant bed, consisting of compressed, unremoved bone tissue. This can lead to a decrease in primary stability, especially in low-density bone.

The closest technical solution is described in METHOD AND KIT FOR DRILLING DENTAL IMPLANTS. A method of drilling a dental implant socket for a dental implant screw in the mouth of a patient after extraction of a tooth from the jawbone of said patient, thereby forming an extraction socket in said jawbone with at least one tooth root socket in said jawbone corresponding to the position of at least one root of said tooth, said method includes: while said extraction socket remains open and unhealed, placing a pin device in said at least one tooth root socket; wherein said pin device is configured to determine the depth and angle of said tooth root socket relative to said jawbone; said pin device is further configured to also be used as a template for guiding a drill for drilling said dental implant socket at an optimal angle and depth for a dental implant screw; wherein said optimal angle and depth for said dental implant screw need not be the same as the angle and depth of said tooth root recess; using a position fixing device to maintain the position and orientation of said post device relative to said jaw bone; removing said post device from the mouth of said patient; and using said position fixing device to subsequently guide said drill to the optimal angle and depth for the dental implant screw [WO 2013138308 A1, published 19.09.2013].

A drawback of the closest technical solution is the insufficient stability of the implant being installed. The device and method are based on the root socket, which does not always align with the optimal implant trajectory. The socket may not be parallel to the cortical plate, have an unfavorable slope, be asymmetrical, etc. As a result, the implant may be placed at an incorrect angle, extending beyond the cortical plate or into anatomical risk zones. This reduces primary stability and may impact the quality of osseointegration.

The technical problem solved by the invention is to eliminate the shortcomings of analogues.

The objective of the claimed invention is to increase the stability of the implant and reduce the trauma of the operation.

The technical result consists in increasing the stability of the implant after its installation and reducing the trauma of the dental implant installation surgery.

Said technical result is achieved by the fact that in the method of preoperative diagnostics of bone tissue before installing a dental implant using a pilot drill and a main drill made with the possibility of performing osteotomy of bone tissue and osteocondensation of bone tissue, according to which the presence and thickness of compact bone, the location of the roots of the teeth and the residual volume of bone after removal are assessed, after which, based on the data obtained, the type of bone tissue is preliminarily determined, where the first type is high-density bone tissue with the presence of a compact bone layer of 4 mm or more, the tooth was removed more than 6 months ago, the second type is high-density bone tissue with the presence of compact bone from 2 to 3 mm, or it is planned to install an implant in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, the third type is normal-density bone tissue with the presence of compact bone from 1 to 2 mm, or it is planned to install an implant in the area of bone augmentation performed from 4 to 6 months ago, or the tooth was removed no more than 4 months ago, the fourth type is low-density bone tissue with the presence of compact bone up to 1 mm, or installation of an implant in the socket of a single-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed 2 to 4 months ago, or the tooth was removed no more than 2 months ago; type five - soft bone tissue in the absence of compact bone, or installation of an implant in the socket of a multi-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 0 (simultaneously with implantation) to 2 months ago.

In particular, preoperative diagnostics includes a clinical examination of the patient, anamnesis collection and radiographic examination.

The said technical result is achieved in that in the method of installing a dental implant, which includes a method of preoperative diagnostics of bone tissue and installation of a dental implant after tooth extraction using a pilot drill and a main drill made with the possibility of performing osteotomy of bone tissue and osteocondensation of bone tissue, according to which the presence and thickness of compact bone, the location of the roots of the teeth and the residual volume of bone after extraction are assessed, after which, based on the data obtained, the type of bone tissue is preliminarily determined, where the first type is high-density bone tissue with the presence of a compact bone layer of 4 mm or more, the tooth was removed more than 6 months ago, the second type is high-density bone tissue with the presence of compact bone from 2 to 3 mm, or it is planned to install an implant in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, the third type is normal-density bone tissue with the presence of compact bone from 1 to 2 mm, or it is planned to install an implant in the area of bone augmentation performed from 4 to 6 months ago, or the tooth was removed no more than 4 months ago, type four - low-density bone tissue with the presence of compact bone up to 1 mm, or installation of an implant in the socket of a single-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 2 to 4 months ago, or the tooth was removed no more than 2 months ago, type five - soft bone tissue in the absence of compact bone, or installation of an implant in the socket of a multi-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 0 (simultaneously with implantation) to 2 months ago, after performing preoperative diagnostics, an approximate hole is formed in the compact bone, socket or interroot septum, then a trial osteotomy is performed with a pilot drill, after which the type of bone tissue at the site of future implantation is finally determined, where: in case of soft bone of unsatisfactory quality of the fifth type, further osteotomy is not performed, and the implant is inserted along the formed channel, compacting as the bone tissue is immersed; in case of low bone density of type IV, further osteotomy is performed with a pilot drill in the bone tissue osteocondensation mode; in case of normal bone density of type III, further osteotomy is performed with a pilot drill in the osteotomy mode; in case of increased bone density of type II, a larger diameter main drill is used after the pilot drill in the bone tissue osteocondensation mode; in case of high bone density of type I, a main drill in the bone tissue osteotomy mode is used after the pilot drill in the bone tissue osteotomy mode, after the bed is formed, an implant is inserted, wherein the pilot drill and the main drill contain concave conical profiles, and a radial recess is made in the upper part of each face of the drills, made with the possibility of performing an additional osteotomy.

In particular, the reference hole is formed with a spherical bur.

In this application, increasing the stability of an implant after its installation means ensuring primary stability, i.e., immediate fixation of the implant after installation, ensuring secondary stability, i.e., accelerated and dense bone grafting after implant installation, as well as long-term functional stability due to resistance to fatigue loads, which are achieved through the geometry of the implant, the prevention of implant fractures, and the elimination of stress concentrators.

In this application, reduced trauma refers to a reduction in anatomical trauma by reducing the likelihood of microcracks and macrofractures in bone due to excessive pressure or vibration, as well as thermal damage, where overheating can lead to bone necrosis at temperatures above 47°C. Reduced trauma also refers to a reduction in surgical trauma, due, for example, to a reduction in the number of instruments used, as well as a reduction in biological trauma and clinical consequences due to a reduction in healing time and the risk of peri-implantitis.

According to the invention, a preoperative bone diagnosis is performed before dental implant placement. This assessment evaluates the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. Preoperative diagnosis may include procedures such as a clinical examination, medical history, and radiographic examination, such as cone beam computed tomography (CBCT) or multislice computed tomography (MSCT). A clinical examination and medical history allow for the identification of individual patient characteristics, such as health status, contraindications, or risk factors, which helps prevent complications during and after surgery. Radiographic methods such as CBCT or MSCCT provide accurate visualization of the anatomical structures of the jaw, including bone density, volume, and the location of important anatomical structures (e.g., the mandibular nerve or maxillary sinus). This allows the surgeon to select the optimal size and type of implant and determine the correct placement while avoiding damage to adjacent structures. Furthermore, bone tissue assessment helps plan bone grafting or sinus lift procedures in advance, if necessary, to ensure adequate support for the implant. This combined approach minimizes intraoperative risks, reduces tissue trauma, improves the primary stability of the implant, and promotes successful osseointegration in the long term.

After collecting the analytical data, on their basis they preliminarily determine the type of bone tissue, where the first type is high-density bone tissue with the presence of a compact bone layer of 4 mm or more, the tooth was removed more than 6 months ago, the second type is increased density bone tissue with the presence of compact bone from 2 to 3 mm, or it is planned to install an implant in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, the third type is normal density bone tissue with the presence of compact bone from 1 to 2 mm, or it is planned to install an implant in the area of bone augmentation performed 4 to 6 months ago, or the tooth was removed no more than 4 months ago, the fourth type is low-density bone tissue with the presence of compact bone up to 1 mm, or installation of an implant in the socket of a single-rooted tooth simultaneously with its removal, or it is planned to install an implant in the area of bone augmentation performed 2 to 4 months ago, or the tooth was removed no more than 2 months ago, the fifth type is bone tissue soft in the absence of compact bone, or installation of an implant in the socket of a multi-rooted tooth simultaneously with its removal, or it is planned to install an implant in the area of bone augmentation performed from 0 (simultaneously with implantation) to 2 months ago.

The proposed classification of bone implant sites represents a significant improvement in the quality of dental implantology, as it takes into account not only bone density but also additional clinically significant parameters, such as compact bone thickness, time since tooth extraction or augmentation, and the possibility of immediate implant placement. This allows for a more accurate assessment of bone condition and the selection of optimal treatment strategies, which directly impacts implant stability and reduces surgical morbidity. A key advantage of the classification is its emphasis on compact bone thickness, which provides a more objective assessment of its quality compared to traditional systems that assess density in a generalized manner. Furthermore, the inclusion of recommendations for immediate implant placement and loading expands the scope of clinical application, allowing for shorter treatment times without compromising the outcome. Taking into account the time elapsed since tooth extraction or augmentation helps predict the maturity of bone tissue and its readiness for implant placement, minimizing the risk of implant failure. Another important aspect is the principle of selecting the bone type with the worst characteristics when data is ambiguous, which increases planning reliability and reduces the risk of complications. Overall, the use of this classification facilitates more accurate implant selection, their correct positioning, reduced intraoperative risks (such as bone perforation or damage to anatomical structures), and improved osseointegration. All of this, taken together, leads to increased primary and long-term implant stability, reduced surgical trauma, and improved clinical outcomes in dental implantology.

According to the invention, after preoperative diagnostics, a pilot hole is created in the compact bone, socket, or interradicular septum. This improves the stability of the implant through more precise positioning and minimizes the risk of damage to surrounding tissue. This hole serves as a guide, ensuring the correct trajectory for implant placement, reducing the risk of implant displacement and improving primary fixation. Furthermore, this approach reduces surgical trauma by eliminating the need for excessive bone drilling and lowering the risk of damage to adjacent roots, blood vessels, and nerves. This reduces surgical time, postoperative swelling and patient discomfort, and accelerates the healing process. Thus, the use of a pilot hole optimizes the dental implant placement process, increasing its long-term stability and reducing the invasiveness of the procedure.

If necessary, a pilot hole can be created with a round bur, allowing for additional control over the precise direction of subsequent drilling, further minimizing the risk of implant misalignment. This method can further ensure gentle bone preparation, reducing thermal tissue damage. If necessary, the hole diameter can be adjusted to suit specific anatomical conditions, increasing the accuracy of implant placement. Additionally, using a round bur can reduce vibration and bone trauma, improving the primary stability of the implant. If necessary, the procedure can be supplemented with a surgical template for even greater positioning accuracy.

After forming a pilot hole in compact bone, a socket or interradicular septum, a trial osteotomy is performed with a pilot drill, which is necessary to determine the type of bone tissue at the site of future implantation, where: in case of soft bone of unsatisfactory quality of type 5, further osteotomy is not performed, and the implant is inserted along the formed channel, compacting the bone tissue as it goes deeper; in case of low bone density of type 4, further osteotomy is performed with a pilot drill in the bone tissue osteocondensation mode, after which the implant is inserted into the prepared bone bed; in case of normal bone density of type 3, further osteotomy is performed with the first profile drill in the bone cutting mode, after which the implant is inserted; in case of increased bone density of type 2, the pilot drill is followed by the main drill of a larger diameter in the bone tissue osteocondensation mode, after which the implant is inserted into the bone bed; in case of high bone density of the first type, after a pilot drill in the osteotomy mode of bone tissue, a main drill is used in the osteotomy mode of bone tissue

The use of this bone density classification allows for the most precise adaptation of the surgical protocol to the individual patient's characteristics, which fundamentally impacts the quality of dental implantation. The key advantage of this approach is that it enables differentiated bone bed preparation, taking into account the specific biomechanical properties of the bone in each clinical situation. For type I bone, with a compact layer thickness of over 4 mm and a long healing period after extraction, the most comprehensive osteotomy protocol is used: after creating a guide hole with a round bur, a pilot and main drill are sequentially used in a classic osteotomy. This multi-stage approach prevents bone overheating during the treatment of high-density tissue, ensures smooth expansion of the bed, and creates ideal conditions for stable implant fixation without the risk of overload. For type II bone density, with a compact layer of 2-3 mm, or when implanting in an area of long-standing augmentation, the use of osteocondensation with a main drill becomes essential. This technique allows not only for bone removal but also for compacting it around the newly formed bed, significantly increasing the primary stability of the implant. For type III bone density, with a compact layer of 1-2 mm or recent augmentation, a gentle bone cutting regimen with a first profile drill is used. This method minimizes trauma to the less dense bone structure, preserving its biological potential for osseointegration. Particular attention should be paid to working with types IV and V bone density, where standard osteotomy protocols can be not only ineffective but also harmful. In these cases, either conventional drilling is completely abandoned (for type V), using a compression device technique, or a special osteocondensation regimen with a pilot drill is used (for type IV), which allows for sufficient implant stability even in conditions of severe bone insufficiency. This differentiated approach minimizes iatrogenic bone damage, prevents overheating, and preserves tissue biological activity, ultimately accelerating healing and osseointegration. This significantly reduces the risk of intraoperative complications, such as bone fractures, perforations, and excessive bleeding, as well as postoperative problems, such as peri-implantitis, bone resorption around the implant, and implant loosening. An additional advantage is the reduction in surgical time due to the elimination of unnecessary processing steps in soft bone and the optimization of the protocol for dense tissue, which reduces the overall invasiveness of the procedure. Therefore, the use of this classification and the corresponding surgical protocols not only improves implant stability at all stages—from insertion to complete osseointegration—but also makes the implantation procedure itself safer, more predictable, and more physiologically comfortable for the patient, which ultimately determines the long-term success of the treatment.

After determining the bone type and shaping the implant bed, the implant is inserted. The procedure begins with thoroughly rinsing the formed bone bed with sterile saline to remove bone chips and any microparticles, which prevents inflammation and promotes better osseointegration. Then, using a special implant carrier or implant driver, the sterile implant is carefully removed from its packaging, observing all aseptic precautions, and placed onto the tip of an implant physiodispenser or surgical key. When working with dense bone types I and II, a tap can be used to cut the threads before insertion, which is especially important when using screw implants with aggressive threads – this avoids excessive pressure on the bone and prevents microcracks. The implant is inserted strictly along the axis of the formed socket with controlled force and speed (usually 15-30 rpm). This is critical when working with soft bone types IV and especially V, where a compression insertion technique without pre-drilling is used. The implant is inserted using a self-tapping method, gradually compacting the surrounding bone tissue. During insertion, the torque is constantly monitored using a torque wrench or a physiodispenser: to achieve primary stability, values of 30-50 N/cm for dense bone and 15-25 N/cm for soft bone are considered optimal. When inserting into augmentation sites or fresh sockets, extreme caution is exercised, avoiding excessive pressure to avoid compromising the integrity of the bone block or damaging the socket walls. After reaching the planned implantation depth (usually at the level of the cortical plate or 0.5-1 mm lower for subcrestal placement), a final check of the implant position is performed using X-ray control or a surgical template, assessing its compliance with the planned position relative to adjacent teeth and anatomical structures. Then, depending on the treatment protocol, either a healing abutment is placed (for a one-stage procedure) or the implant is covered with a cap and the mucosa is sutured (for a two-stage protocol). The final step is repeated antiseptic treatment of the surgical site and application of a sterile dressing. The entire installation process is performed under constant cooling with sterile saline and monitoring of the implant position, ensuring minimal tissue trauma and creating optimal conditions for subsequent osseointegration.

According to the invention, the pilot drill and main drill each contain concave conical profiles, and a radial recess is formed in the upper portion of each drill facet, allowing for additional osteotomy. The concave conical shape of the drills ensures smooth tool entry into bone tissue with a gradual increase in the diameter of the treated channel, preventing sudden surges in bone load and reducing the risk of microcracks, which is particularly critical when working with dense bone types I and II. The radial recesses on the faces create the effect of additional cutting edges, which perform a delicate additional osteotomy as the drill advances. This allows for even distribution of cutting force across the entire contact surface of the tool with the bone, preventing localized overload and tissue overheating. This design feature is particularly important when processing bone types III and IV, where the combination of areas of varying density requires particularly precise force distribution.

Optimized removal of bone chips through radial grooves significantly reduces compressive forces on the walls of the implant bed, preserving the natural bone structure and its biological activity—a direct impact on the quality of subsequent osseointegration. When working with soft type V bones, this drill geometry minimizes trauma by gently inserting the instrument without jerking or applying excessive pressure, which is critical for preserving the already meager bone volume. An additional advantage is the ability to control the bone bed expansion without changing instruments. By combining the main cutting profile with additional edges in the grooves, the surgeon can precisely control the degree of bone preparation depending on the bone type, reducing the number of osteotomy stages and the overall surgical time.

The result is a perfectly smooth bone bed with an optimal fit for the future implant, completely eliminating areas of overheating or excessive bone compaction, which are the main causes of peri-implantitis and bone resorption during the healing phase. When the implant is placed in such a prepared bed, uniform load distribution is achieved across the entire contact surface, significantly increasing primary stability (especially important during immediate loading) and creating ideal conditions for subsequent osseointegration. At the same time, the trauma of the entire procedure is reduced by reducing vibration during drilling, eliminating instrument "jamming" in dense bone, and minimizing thermal tissue damage, which collectively accelerates postoperative healing and reduces the risk of complications. Thus, the proposed drill geometry provides a fundamentally new level of osteotomy quality control for all types of bone tissue, which ultimately determines the success of the entire implantation.

Implementation examples

First example of implementation:

A preoperative bone examination was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. Based on the data obtained, the bone tissue at the implant site was tentatively determined to be type I, defined as high-density bone with a compact bone layer of 4 mm or more, and the tooth having been extracted more than 6 months previously. A pilot hole was then created in the compact bone and a trial osteotomy was performed with a pilot drill. The bone tissue type I at the future implantation site was then definitively determined, and the implant site was finalized using the main drill in bone osteotomy mode. After the site was formed, the implant was inserted. The pilot and main drills contained concave conical profiles, and a radial recess was made in the upper part of each drill facet to allow for additional osteotomy.

Second implementation example:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on these data, the bone tissue at the implant site was tentatively classified as Type II, which is defined as high-density bone with 2 to 3 mm of compact bone, or the planned implant placement in an area of bone augmentation performed more than 6 months ago, or a tooth extracted more than 6 months ago. A pilot hole was then created in the compact bone using a round bur and a trial osteotomy was performed using a pilot drill. The Type II bone tissue at the future implant site was then definitively determined, and a socket was formed using a larger-diameter main drill in osteocondensation mode. After the bed was formed, the implant was inserted using a pilot drill and a main drill that contained concave conical profiles, and a radial recess was made in the upper part of each face of the drills, designed to allow for additional osteotomy.

Third example of implementation:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on these data, the bone tissue at the implant site was tentatively classified as Type III, which is defined as normal bone density with 1 to 2 mm of compact bone. The implant was either planned for placement in an area of bone augmentation performed 4 to 6 months previously, or the tooth was extracted within 4 months. A pilot drill was used to create a pilot hole in the compact bone and perform a trial osteotomy. The final bone type III determination was then made at the future implant site, and the implant site was formed using a pilot drill in osteotomy mode. After the bed was formed, the implant was inserted using a pilot drill containing concave conical profiles, and a radial recess was made in the upper part of each face of the drill, designed to allow for additional osteotomy.

Fourth implementation example:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of the tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on the data obtained, the bone tissue at the implant site was tentatively classified as Type IV, which is defined as low-density bone with up to 1 mm of compact bone. The implant was either placed in the socket of a single-rooted tooth simultaneously with its extraction, or planned for placement in the area of bone augmentation performed 2 to 4 months previously, or the tooth was extracted no more than 2 months previously. Following this, the single-rooted tooth was extracted, a pilot hole was created in the socket using a round bur, and a trial osteotomy was performed using a pilot drill. The final bone type IV determination was made at the future implant site, and the implant site was formed using a pilot drill in osteocondensation mode. After the bed was formed, the implant was inserted using a pilot drill containing concave conical profiles, and a radial recess was made in the upper part of each face of the drill, designed to allow for additional osteotomy.

Fifth implementation example:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of the tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on the data obtained, the bone tissue at the implant site was tentatively classified as type 5, which is defined as soft bone tissue with no compact bone. The implant was either placed into the socket of a multi-rooted tooth simultaneously with its extraction, or was planned for placement in the area of bone augmentation performed between 0 (simultaneous with implantation) and 2 months previously. Following this, the multi-rooted tooth was extracted, a pilot hole was created in the compact bone of the interradicular septum using a round bur, and a trial osteotomy was performed with a pilot drill. After this, the fifth bone type was finally determined at the future implantation site, bed formation ceased, and the implant was inserted along the formed channel, compacting the bone tissue as it went deeper. A pilot drill with concave conical profiles was used, and a radial recess was made in the upper part of each drill facet to allow for additional osteotomy.

Sixth implementation example:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. Based on the data obtained, the bone tissue at the implant site was preliminarily determined to be type I, defined as high-density bone with a compact bone layer of 4 mm or more, and the tooth having been extracted more than 6 months previously. A pilot hole was then created in the compact bone and a trial osteotomy was performed with a pilot drill. The bone tissue at the future implantation site was then determined to be type II, and a site was created using a larger-diameter main drill in osteocondensation mode. After the site was formed, the implant was inserted using the pilot drill and main drill, which contained concave conical profiles. A radial recess was made in the upper part of each drill facet to allow for an additional osteotomy.

Seventh example of implementation:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on these findings, the bone tissue at the implant site was tentatively classified as Type II, which is defined as high-density bone with 2 to 3 mm of compact bone, or the planned implant placement in an area of bone augmentation performed more than 6 months ago, or a tooth extracted more than 6 months ago. A pilot drill was used to create a pilot hole in the compact bone and perform a trial osteotomy. It was finally determined that the bone tissue belonged to Type III, not Type II, and a site was created using a pilot drill in osteotomy mode. After the bed was formed, the implant was inserted using a pilot drill containing concave conical profiles, and a radial recess was made in the upper part of each face of the drill, designed to allow for additional osteotomy.

Eighth implementation example:

A preoperative bone assessment was performed, assessing the presence and thickness of compact bone, the location of tooth roots, and the residual bone volume after extraction. This preoperative assessment included a clinical examination, medical history, and radiographic examination. Based on the data obtained, the bone tissue at the implant site was tentatively classified as type 5, which is defined as soft bone tissue with no compact bone. The implant was either placed in the socket of a multi-rooted tooth simultaneously with its extraction, or was planned for placement in the area of bone augmentation performed between 0 (simultaneous with implantation) and 2 months previously. A pilot drill was used to create a pilot hole in the compact bone and perform a trial osteotomy. The final determination was made that the bone tissue at the future implant site was type 4, replacing type 5, and a pilot drill was used to create a site for osteocondensation. After the bed was formed, the implant was inserted using a pilot drill containing concave conical profiles, and a radial recess was made in the upper part of each face of the drill, designed to allow for additional osteotomy.

To confirm the effect of the claimed method on increasing the stability of the implant after its installation and reducing the trauma of the dental implant installation surgery, a number of studies were conducted.

During the experimental study, a comparative test of ten different methods of preoperative diagnostics and installation of dental implants was conducted in order to determine their effectiveness in achieving the technical result - increasing the stability of the implant after its installation and reducing the trauma of the operation.

Method No. 1 - corresponded to the method according to the first example of implementation;

Method No. 2 - corresponded to the method according to the second example of implementation;

Method No. 3 - corresponded to the method according to the third example of implementation;

Method No. 4 - corresponded to the method according to the fourth example of implementation;

Method No. 5 - corresponded to the method according to the fifth example of implementation;

Method No. 6 - corresponded to the method according to the sixth example of implementation;

Method No. 7 - corresponded to the method according to the seventh example of implementation;

Method No. 8 - corresponded to the method according to the eighth example of implementation;

Method No. 9 - corresponded to the method according to patent US 2005026114 A1, published 03.02.2005;

Method No. 10 - corresponded to the method according to patent WO 2013138308 A1, published 09.19.2013;

The effectiveness was assessed according to the following criteria:

1. The level of trauma was determined using microscopy and optical scanning of the bone bed after its formation before implant installation.

2. Primary implant stability was measured using resonance frequency analysis (RFA) and the Osstell ISQ (Implant Stability Index, 1 to 100). An ISQ value ≥ 70 indicates high stability.

3. The time spent on forming the bed and installing the implant (in minutes) as an indirect indicator of the technical complexity and level of invasiveness of the procedure.

The results of the experiment showed the following:

- Methods 1-5 (based on precise differentiation of bone tissue type using pilot and main drills with a concave conical profile and radial recesses for additional osteotomy) demonstrated a minimal number of microcracks and macrodestruction of the bone bed, high primary stability: the average ISQ value was 75.2 with a minimal spread from 72 to 78.

Methods 6-8, illustrating intraoperative adjustments to the specified bone tissue type, created a smooth bone bed with minimal microcracks and macrodamage and demonstrated similarly high stability scores—ISQ 74.8, with an average operative time of 20.1 minutes. Despite the need to adapt the technique during the procedure, the use of universal drills ensured minimal trauma and good implant stability.

Method 9, using threaded expanders, resulted in compact bone fractures in 2 out of 10 cases and microcracks in all cases. It yielded an average ISQ of 68.4, below the threshold for high stability. The average surgical time was 27.3 minutes, indicating greater technical complexity.

Method 10, based on the placement of a guide pin into an unhealed root socket, demonstrated a moderate number of microcracks and macrodamage and provided an average stability score of 66.7. The operating time was 29.1 minutes. The main problem with this approach was the misalignment of the pin in unstable bone support, especially when the socket orientation was misaligned with the implant axis or a thin vestibular plate.

Thus, methods 1-8, which utilize a step-by-step diagnosis of bone tissue type followed by adaptation of drilling tactics and the use of specialized drills, proved to be the most effective in achieving technical results: high primary stability (ISQ ≥ 70) was achieved in 96% of cases, with minimal trauma. In methods 9 and 10, stability was below the threshold, and trauma was higher than in methods 1-8. These data confirm the clinical feasibility of using the developed methods 1-8 for dental implant placement.

Claims (4)

1. A method for preoperative diagnostics of bone tissue before installing a dental implant using a pilot drill and a main drill made with the possibility of performing osteotomy of bone tissue and osteocondensation of bone tissue, according to which the presence and thickness of compact bone, the location of the roots of the teeth and the residual volume of bone after removal are assessed, after which, based on the data obtained, the type of bone tissue is preliminarily determined, where the first type is high-density bone tissue with the presence of a compact bone layer of 4 mm or more, the tooth was removed more than 6 months ago, the second type is high-density bone tissue with the presence of compact bone from 2 to 3 mm, or it is planned to install an implant in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, the third type is normal-density bone tissue with the presence of compact bone from 1 to 2 mm, or it is planned to install an implant in the area of bone augmentation performed 4 to 6 months ago, or the tooth was removed no more than 4 months ago, the fourth type is low-density bone tissue with the presence of compact bone up to 1 mm, or installation of an implant in the socket of a single-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed 2 to 4 months ago, or the tooth was removed no more than 2 months ago, type five - bone tissue is soft in the absence of compact bone, or installation of an implant in the socket of a multi-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 0, simultaneously with implantation, up to 2 months ago. 2. The method according to paragraph 1, characterized in that the preoperative diagnosis includes a clinical examination of the patient, collection of anamnesis and radiographic examination. 3. A method for installing a dental implant, including a method for preoperative diagnostics of bone tissue and installation of a dental implant after tooth extraction using a pilot drill and a main drill made with the possibility of performing osteotomy of bone tissue and osteocondensation of bone tissue, according to which the presence and thickness of compact bone, the location of the roots of the teeth and the residual volume of bone after extraction are assessed, after which, based on the data obtained, the type of bone tissue is preliminarily determined, where the first type is high-density bone tissue with the presence of a compact bone layer of 4 mm or more, the tooth was removed more than 6 months ago, the second type is high-density bone tissue with the presence of compact bone from 2 to 3 mm, or it is planned to install an implant in the area of bone augmentation performed more than 6 months ago, the tooth was removed more than 6 months ago, the third type is normal-density bone tissue with the presence of compact bone from 1 to 2 mm, or it is planned to install an implant in the area of bone augmentation performed 4 to 6 months ago, or the tooth was removed no more 4 months ago, type four - low-density bone tissue with the presence of compact bone up to 1 mm, or installation of an implant in the socket of a single-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 2 to 4 months ago, or the tooth was extracted no more than 2 months ago, type five - soft bone tissue in the absence of compact bone, or installation of an implant in the socket of a multi-rooted tooth simultaneously with its extraction, or it is planned to install an implant in the area of bone augmentation performed from 0, simultaneously with implantation, up to 2 months ago, after performing preoperative diagnostics, an approximate hole is formed in the compact bone, socket or interroot septum, then a trial osteotomy is performed with a pilot drill, after which the type of bone tissue at the site of future implantation is finally determined, where: in case of soft bone of unsatisfactory quality of the fifth type, further osteotomy is not performed, and the implant is inserted along the formed channel, compacting as it immersed bone tissue; in case of low bone density of type IV, further osteotomy is performed with a pilot drill in the bone tissue osteocondensation mode, after which the implant is inserted into the prepared bone bed; in case of normal bone density of type III, further osteotomy is performed with the first profile drill in the bone cutting mode, after which the implant is inserted; in case of increased bone density of type II, the pilot drill is followed by a main drill of a larger diameter in the bone tissue osteocondensation mode, after which the implant is inserted into the bone bed; in case of high bone density of type I, after the pilot drill in the bone tissue osteotomy mode, the main drill is used in the bone tissue osteotomy mode, after which the implant is inserted, wherein the pilot drill and the main drill contain concave conical profiles, and in the upper part of each face of the drills a radial recess is made, made with the possibility of performing an additional osteotomy. 4. The method according to paragraph 3, characterized in that the reference hole is formed with a spherical bur.