Cytokines and growth factors involved in the osseointegration of oral titanium implants positioned using piezoelectric bone surgery versus a drill technique: A pilot study in minipigs

Background: Most dental implants are positioned using a drilling surgery technique. However, dentistry recently experienced the implementation of piezoelectric surgery. This technique was introduced to overcome some of the limitations involving rotating instruments in bone surgery. This study used biomolecular and histologic analyses to compare the osseointegration of porous implants positioned using traditional drills versus the piezoelectric bone surgery technique. Methods: porous titanium implants were installed into mini-pig tibias. Histomorphology and levels of bone morphogentic protein (BMP)-4, transforming growth factor (TGF)-beta 2, tumor necrosis factor-alpha, and interleukin -1 beta and -10 were evaluated in the peri-implants osseous samples. Results: Histomorphological analysis demonstrated that more inflammatory cells were present in samples from drilled sites. Also, neo-osteogensis was consistently more active in bone samples from the implant sites that were prepared using piezoelectric bone surgery. Moreover, bone around the implants treated with the piezoelectric bone surgery technique showed an earlier increase in BMP-4 and TGF-beta 2 proteins as well as a reduction in proinflammatory cytokines. Conclusions: Piezoelectric bone surgery appears to be more efficient in the first phases of bone healing; in induced an earlier increase in BMPs, controlled the inflammatory process better, and stimulated bone remodeling as early as 56 days post-treatment.