W&H (UK) Ltd’s Kate Scheer asks: “Do you have the right tools to measure dental implant primary stability?”
The role of stability in achieving successful osseointegration has been well documented in recent years. There are two different stages: primary and secondary. Primary stability refers to the mechanical engagement of an implant with the surrounding bone, while bone regeneration and remodelling determine the secondary – or biological – stability of the implant.
There are a number of factors that are known to affect primary stability, including bone quantity and quality, surgical technique and implant geometry such as length, diameter and surface characteristics. Any negative outcomes at this stage may have a knock-on effect, as the secondary stability is ultimately determined by the results of the primary stability. For this reason, continuous monitoring and regular assessment of the primary stability are absolutely essential, whatever the circumstances of the case.
Only with objective measurements can clinicians accurately determine the optimal time to load an implant and ensure the right decision is made with each and every case. This not only helps to improve the likelihood of long-term success for the patient, but also demonstrates to the patient that all possible treatment pathways have been evaluated using measurable values as opposed to subjective judgements. What’s more, should any problems occur later on down the line or if the implant subsequently fails, the evidence is there to support any action taken and could prove useful in locating the source of the issue. Likewise, being able to show patients implant stability measurements can be a great educational tool in helping them to understand the decision process behind their treatment. This is especially true in situations where a patient may be keen to undergo immediate placement before sufficient primary stability has been achieved.
There are a number of different methods in which clinicians can assess primary implant stability, some of which are more effective than others. These include radiographic analysis/imaging techniques, cutting torque resistance, modal analysis, reverse torque test and percussion test . Two of the most common procedures, however, are periotest and resonance frequency analysis.
Periotest uses an electro-magnetically driven and electronically controlled tapping metallic rod in a handpiece to measure the reaction of the peri-implant tissues to a defined impact load. Some research indicates, however, that the reliability of this method is debatable due to poor sensitivity, lack of resolution and susceptibility to operator variables .
Out of all the methods available, resonance frequency analysis is perhaps one of the most widely used, and has been shown to be a reliable tool for identifying implant stability . It uses vibration and a principle of structural analysis to measure the resonance frequency of a transductor attached to the implant body, and has a display panel to show the implant stability quotient (a measurement of the firmness at the implant-tissue interface).
The Implantmed Sl-1023 with Osstell ISQ module by leading manufacturer, W&H, is now available for clinicians looking to enhance their implant workflow and improve primary stability outcomes using non-invasive diagnostic techniques. Having recently earned the prestigious Red Dot Design Award 2017, W&H’s Implantmed is an ideal solution for any practitioner looking to offer quality implant outcomes to patients.
To maximise the chances of successful osseointegration in your implant patients, be sure to equip yourself with the best possible tools for the task at hand.
1] Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc. 2016; 16 (2): 124-130. Accessed online November 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837777/
2] Salvi GE, Lang NP. Diagnostic parameters for monitoring peri-implant conditions. Int J Oral Maxillofac Implants. 2004; 19(SUPPL):116-27. Accessed online November 2017 at file:///Users/officeone/Downloads/Group4-article01.pdf
3] Sul YT, Johansson CB, Jeong Y, Wennerberg A, Albrektsson T. Resonance frequency and removal torque analysis of implants with turned and anodized surface oxides. Clin Oral Implants Res. 2002 Jun;13(3):252–259. Accessed online November 2017 at https://www.ncbi.nlm.nih.gov/pubmed/12010155