Osseointegrated implants for prosthetic rehabilitation of the edentulous patient show high success rates if certain preconditions are fulfilled. Implant stability plays a critical role for a successful critical outcome since short implants and implants placed in soft bone are more prone to failure (13, 49). In the original protocols for implant placement, primary implant stability was ensured by new bone formation and remodelling, termed osseointegration, which was accomplished during an initial healing period in which implants remained nonloaded to secure undisturbed bone formation onto the implant surface. The process of osseointegration increases the stiffness of the bone around the implant, and the bony interlock with the implant surface prevents micro-movement and the formation of fibrous scar tissue at the time of implant loading. However, the development of new implant surfaces and clinical techniques has enabled a marked reduction of the initial healing period, even to the point of an immediate ⁄ early loading of implants that show high primary stability (7, 37). Thus, the success of immediate ⁄ early loading implant techniques is dependent on the ability of the clinician to determine the degree of primary implant stability and changes in stability along with new bone formation and remodelling. The clinical perception of primary implant stability is frequently based on the cutting resistance of the implant during its insertion. The feeling of good stability may be accentuated if there is the sense of an abrupt stop at the seating of the implant. Root forms of tapered implants often have a geometry that will provide a firm stop and perhaps a false perception of high stability. A percussion test has also been used to assess implant stability. The percussion test may involve the tapping of a mirror handle against the implant carrier and is designed to elicit a ringing sound from the implant as an indication of good stability or osseointegration. Percussion tests probably provide more information about the tapping instrument, and will at best only yield poor qualitative information. Insertion torque measurements are sometimes used to determine primary implant stability (6). Application of a reverse or unscrewing torque has also been proposed for the assessment of implant stability at the time of abutment connection (53). Implants that rotate under the applied torque are considered failures and are then removed. However, an implant surface in the process of osseointegrating, albeit slowly, may fracture under the applied torque stress. Moreover, as animal experiments have demonstrated the re-integration of loosened and rotationally mobile implants (26), the reverse torque testing has fallen into disrepute. Other techniques, such as the Periotest and resonance frequency analysis, aim to provide an objective measure of implant stability and osseointegration that is noninvasive and does not damage the implant–tissue interface (6, 28). The resonance frequency analysis technique has been extensively used in experimental and clinical research for the last 10 years. The purpose of this

http://implocerk.com/images/Sennerby%20Perio%202000,%202008.pdf

Implant stability measurements using resonance frequency analysis: biological and biomechanical aspects and clinical implications.

Critical factors for the success of orthodontic mini-implants : A systematic review

OBJECTIVES The aim of this study was to demonstrate a possible correlation between bone microarchitecture and primary implant stability. MATERIAL AND METHODS Twenty-two implants (Ankylos((R)) and Straumann((R))) were inserted into the maxillae and mandibles of human cadavers. Bone structure was determined by computed tomography in three specimens (male, age 53; female, 67; female, 80). A strict clinical protocol was used for implantation. Primary implant stability was measured by resonance frequency analysis (Osstell Mentor). The bone structure was analyzed by micro-computed tomography (CT). Bone histomorphometrical parameters were calculated and correlated to primary implant stability. RESULTS Implant stability quotients (ISQ) ranged from 50 to 70% depending on the specimens and sites. Histomorphometry indicated differences in the bone microstructures of the specimens. However, ISQ values were not related to trabecular bone histomorphometrical parameters. The sole correlation was found between ISQ values and cortical bone thickness. CONCLUSION This study confirms the relevance for primary stability of cortical thickness around implants. The thickness of cortical bone can be assessed using a standard clinical CT.

Correlating implant stability to bone structure.

Background: Resonance frequency analysis (RFA) provides a non-invasive assessment of implant stability. The established RFA device uses electronic technology, whereas a recently developed device uses magnetic technology. The goal of this clinical trial was to evaluate the ability of the magnetic RFA device to detect changes in stability during early healing following implant placement and to determine whether the implant stability quatient (ISQ) values obtained correlated with those made with the electronic device.Methods: RFA assessments were performed using electronic- and magnetic-based devices on 34 non-submerged titanium dental implants in 17 patients. Each patient received two implants in the posterior maxilla or mandible. Implant stability was measured at placement and weekly until week 6, when implants received provisional crowns, and at 12 weeks, when definitive crowns were cemented. During each visit, measurements were taken three times and averaged to obtain a single representative ISQ for each...

Evaluation of two different resonance frequency devices to detect implant stability: A clinical trial

Aim: The study was set to evaluate the validity of subjective jaw bone quality assessment.

Materials and Methods: A total of 298 patients (198 females, mean age 56.4) were treated with oral implants at the Periodontology Department at the University Hospital of KUL. A total of 761 TiUnite™ implants have been installed. Subjective bone quality assessment was performed on radiographs and by the surgeon's tactile sensation and was compared with torque measurements. In a subset of patients, implant stability was also assessed by implant stability quotient and/or periotest values.

Results: Subjective assessment of bone quality was related to the PTV, ISQ and placement torque [in the crestal, the second and the apical third (N cm)], respectively; in grade 1: −5.3, 73.3 (4.2, 9.6, 15.2), and grade 3 or 4: −1.6, 55 (3.3, 5.5, 8.4). For the surgeon's tactile sensation, a good correlation was noted for the presence of a thick cortex: −4.6, 70.3 (4.2, 9.7, 15.1), or a thin one: −0.3, 65.9 (3.6, 6.9, 10.1). For dense trabecular bone, the values were −2.8, 69.4 (4.4, 9.7,14.8), while for poor trabecular bone, the values were−1.7, 66.4 (3.6, 6.4, 9.8).

Conclusions: Subjective assessment of bone quality is related to PTV, ISQ and placement torque measurements at implant insertion.

A biomechanical assessment of the relation between the oral implant stability at insertion and subjective bone quality assessment.

The aim of the present study was to determine the correlation between the primary stability of dental implants placed in edentulous maxillae and mandibles, the bone mineral density and different histomorphometric parameters. After assessing the bone mineral density of the implant sites by computed tomography, 48 stepped cylinder screw implants were installed in four unfixed human maxillae and mandibles of recently deceased people who had bequeathed their bodies to the Anatomic Institute I of the University of Erlangen-Nuremberg for medical–scientific research. Peak insertion torque, Periotest values and resonance frequency analysis were assessed. Subsequently, histologic specimens were prepared, and bone-to-implant contact, the trabecular bone pattern factor (TBPf), the density of trabecular bone (BV/TV) and the height of the cortical passage of the implants were determined. The correlation between the different parameters was calculated statistically. The mean resonance frequency analysis values (maxilla 6130.4±363.2 Hz, mandible 6424.5±236.2 Hz) did not correlate with the Periotest measurements (maxilla 13.1±7.2, mandible –7.9±2.1) and peak insertion torque values (maxilla 23.8±2.2 N cm, mandible 45.0±7.9 N cm) (P=0.280 and 0.193, respectively). Again, no correlations could be found between the resonance frequency analysis, the bone mineral density (maxilla 259.2±124.8 mg/cm3, mandible 349.8±113.3 mg/cm3), BV/TV (maxilla 19.7±8.8%, mandible 34.3±6.0%) and the TBPf (maxilla 2.39±1.46 mm−1, mandible –0.84±3.27 mm−1) (P=0.140 and 0.602, respectively). However, the resonance frequency analysis values did correlate with bone-to-implant contact of the oral aspect of the specimens (maxilla 12.6±6.0%, mandible 35.1±5.1%) and with the height of the crestal cortical bone penetrated by the implants in the oral aspect of the implant sites (maxilla 2.1±0.7 mm, mandible 5.1±3.7 mm) (P=0.024 and 0.002, respectively). The Periotest values showed a correlation with the height of the crestal cortical bone penetrated by the implants in the buccal aspect of the implant sites (maxilla 2.5±1.2 mm, mandible 5.4±1.2 mm) (P=0.015). The resonance frequency analysis revealed more correlations to the histomorphometric parameters than the Periotest measurements. However, it seems that the noninvasive determination of implant stability has to be improved in order to give a more comprehensive prediction of the bone characteristics of the implant site.

Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants

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Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants