Take-home messages

  • When IDI Evolution bone density and primary stability measurement systems, incorporated in TMM3, are used in the clinical setting, they allow for developing rational implant positioning protocols. If the implant system is fully characterized, as all IDI Evolution systems are, the operator can – based on objective bone density measurements – quantitatively define the degree of undersizing to be applied during implant site preparation to achieve sufficient primary stability, or the desired stability in relation to the rehabilitation project.
  • Surgeons, thus, do not rely only on their subjective perceptions anymore, and design their surgical procedures objectively, to the benefit of patient health.

First meaningful evidence of the significant impact that TMM3 and the IDI Evolution bone density and primary stability measurement systems can have on everyday clinical practice came with the publication, in 2018, of the results of a retrospective study, where the system was used in a rather challenging condition: implant placement performed concurrently with maxillary sinus lift, even in quite thin ridges (≤ 2mm).

The study involved 160 patients receiving 253 IDI Evolution implants; these implants had previously undergone a fully biomechanical characterization: that is, precise curves had been constructed that, depending on bone density, allow to calculate the primary stability that can be achieved in relation to their dimensions (diameter, length), and the degree of undersizing.

This allowed Dr. Arosio and colleagues to use a rational approach to implant positioning in the posterior sector undergoing bone regeneration, systematically undersizing the bone crest by 12.5% as they found its density to be consistently ≤ 0.45 g/cm3.

Patients were rehabilitated and followed for at least 5 years. By adopting a rational protocol for implant positioning researchers found not only an implant success rate entirely in line with the literature – on average 98% - but, most importantly, they observed no significant difference in success or MBL in considering different bone ridge heights (< 4 mm or ≥ 4 mm).

The study is of fundamental importance because it shows that the rational choice of an implant site undersizing protocol, in an objectively challenging condition, leads to predictable results, by eliminating the potentially negative effect of one of the variables at play, the crestal thickness. This result, based on objective numerical data obtained thanks to the use of the IDI Evolution systems could not have been obtained in a repeatable and predictable manner with other non-characterized systems, which would have forced operators to follow the traditional path of subjective perception and the use of only, albeit important and indispensable, personal clinical sensitivity.

References

Arosio P, Greco GB, Zaniol T, Iezzi G, Perrotti V, Di Stefano DA. Sinus augmentation and concomitant implant placement in low bone-density sites. A retrospective study on an undersized drilling protocol and primary stability. Clin Implant Dent Relat Res. 2018 Apr;20(2):151-159. doi: 10.1111/cid.12558.
Link to the article
IF: 3,900 (2025)

After five years, the difference in MBL between implants placed in ridges  more than 4 mm high and those inserted in thinner ones was not statistically significant (N=253) – just as the implant success rates (97.8 and 98.2%, not shown), demonstrating that the application of a rational implant positioning protocol eliminated the potential negative effect of different bone thickness.

What is the importance for clinical research?

  • The importance of this result for clinical research is fundamental: having an objective system for measuring both bone density and primary stability, the latter obtained through a dynamic parameter, more sensitive and informative than static ones (ISQ and IT), allows - once the implant system to be used has been biomechanically characterized - to develop rational implant positioning protocols for any morpho-anatomical condition that can be diagnosed.
  • Given a specific anatomic condition, one can objectively measure its density obtaining a numerical value that can be compared with the primary stability curves that, for that particular implant system, can be obtained in relation to the applicable undersizing. One can then rationally decide to which extent undersizing the ridge, with the certainty of achieving the desired primary stability. In addition, at the end of the placement, one can immediately verify whether the primary stability obtained is consistent with that expected, thus having an equally immediate confirmation of the adequacy of the preparation performed.  

What is the impact on everyday practice?

  • Over time, IDI Evolution databases are enriched with new data that, analyzed retrospectively, allow refining implant positioning protocols dedicated to the various morpho-anatomical and clinical conditions that can be encountered every day.
  • These protocols are then made available to the community of the IDI Evolution system users. Positioning protocols are also made available following precise prospective research that IDI Evolution and users of its systems intend to implement in the future.

In support of IDI Evolution devices

IDI Evolution devices, namely the TMM3 implant insertion motor, the IDI Evolution implants, and the IDI Evolution data collection software, represent a system aimed at defining objective implant insertion protocols and making them available to different users, thus increasingly realizing a reproducible and predictable implantology. Thanks to the complete biomechanical characterization of the IDI Evolution implant systems, the possibility of objectively measuring bone density, the adoption of a dynamic primary stability measurement parameter, more sensitive to bone density variations than IT and ISQ, the surgeon can develop rational implant positioning protocols, increasing the repeatability of surgery and the reproducibility of its outcome, to greater guarantee of achieving clinical success for the patient.

Other Publications

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We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

The relationship between the extent of cortical undersizing, the primary stability it allows to achieve, the early and late marginal bone resorption it may induce has still not been clarified: studies on this matter are contradictory and inconclusive.
However, IDI Evolution systems are the only ones capable of site-specific discrimination and operator-independent assessment of different combinations of cortical thickness and cancellous density, providing a measure of implant primary stability, the Torque-Depth Integral, which also evaluates the mechanical stress exerted on the cortical thickness.

Read moreabout We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

The research carried out by IDI Evolution shows that TMM3 measures even bone quality, that is the combination of a given cortical layer thickness and a given trabecular density.

Read moreabout We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used

The Integral of the torque-depth curve, measured by TMM3 during implant insertions, varies predictably in relation to how underprepared the implant tunnel is.
The variation of the Integral is also predictable when altering the implant geometry, both in terms of shape (conical, cylindrical, etc.) and dimensions (diameter/length).
The mathematical algorithms describing these variations are also influenced by bone density.

Read moreabout We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used