Histomorphometric and Immunohistochemical Evaluation of Bone Healing Around Implants Placed Using Piezosurgery vs Conventional Drills: A Split-Mouth Pilot Study.

This pilot study evaluated and compared histomorphometric and immunohistochemical characteristics of peri-implant bone tissue after implant site preparation using piezoelectric tips versus conventional drills. Six patients with bilateral partial edentulism underwent a split-mouth protocol. Twelve alveolar ridges were randomized into 6 control implant sites prepared using conventional drills (drill group) and 6 test implant sites prepared using piezoelectric implant inserts (piezo group). At 28 days after surgery (T1), single-stage "study fixtures" with 0.5 mm of peri-implant bone tissue were explanted and processed for histological, histomorphometric, and immunohistochemical analysis in both groups. For each sample inflammatory infiltrates, necrotic bone (zone 1), woven and newly formed bone (zone 2), native bone (zone 3), a vascular endothelium differentiation and neo-osteogenesis marker (cluster of differentiation 31 [CD31]), and an osteoblastic cell differentiation and osteogenesis marker (special AT-rich sequence-binding protein 2 [SATB2]) were evaluated. According to their histological bone features, the 3 histologically distinct areas were evident in both groups: zones 1, 2, and 3 according to their histological bone features. Zone 1 showed lower extension in the piezo group than in the drill group (p = .028). Regarding the immunohistochemical markers, in all areas of the piezo group, SATB2 and CD31 were statistically higher than in the drill group. Implant site preparation using piezo surgery results in less bone necrosis, greater osteoblastic activity, and greater vessel proliferation compared with the conventional surgical approach.