CONTEMPORARY METHODS TO

MEASURE PRIMARY STABILITY OF

IMMEDIATELY LOADED DENTAL
IMPLANTS :A REVIEW
 

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 CONTENTS
 INTRODUCTION
 IMPLANT LOADING
 METHODS
Invasive/Destructive Methods
Noninvasive/Nondestructive
 CONCLUSION
 REFERENCES

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 INTRODUCTION

 Dental implants represent one of the most successful treatment

modalities in dentistry.

 The use of dental implants in the rehabilitation of partially and

completely edentulous patients has been significantly increased in
dentistry since 1980.

 Although high survival rates of implants supporting prosthesis have

been reported.

 Failure still happens due to bone loss as a results of primary and

secondary implant stability.

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 IMPLANT LOADING
 Conventional loading of dental implants is defined as
being greater than 2 months subsequent to implant
placement.

 Early
loading of dental implants is defined as being
between 1 week and 2 months subsequent to implant
placement.

 Immediate loading of dental implants is defined as

being earlier than 1 week subsequent to implant 4
placement.
 METHODS

Invasive/Destructive
Methods

Noninvasive/Nondestructive

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 INVASIVE/DESTRUCTIVE
METHODS
Following methods were included:

• Histologic / histomorphologic analysis


• Tensional test

• Push-out/pull-out test and

• Removal torque analysis

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HISTOMORPHOMETRIC ANALYSIS

 Obtained by calculating the peri-implant bone quantity and bone-

implant contact (BIC) from a dyed specimen of the implant and
periimplant bone.

 Assessed at pre, intra, and postsurgical time points.

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 TENSIONAL TEST
 Earlier measured by detaching the implant plate from the supporting
bone (Kitsugi, et al. 1996).

 Later modified by Branemark – by applying the lateral load to the

implant fixture (Branemark et al. 1998).


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 PUSH-OUT/PULL-OUT TEST
 Investigates the healing capabilities at the bone implant interface
(Brunski, et al. 2000).
 It measures interfacial shear strength by applying load parallel to
implant-bone interface.
 It is assessed during the healing period of implant.
 Applicable to only non-threaded implants.

 Technique sensitive.

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 REMOVAL TORQUE ANALYSIS
 Implant is considered stable if the reverse or unscrewing torque
was greater than 20Ncm (Sullivan et al. 1996)

 Implant surface in the process of osseointegration may fracture

under the applied torque stress (Ivanoff, et al. 1997)


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NONINVASIVE/NONDESTRUCTIVE

 The surgeon’s perception

 Radiographical analysis/imaging techniques
 Cutting torque resistance (for primary stability)
 Insertion torque measurement
 Reverse torque
 Seating torque test
 Modal analysis and Implatest
 Percussion test
 Pulsed oscillation waveform (POWF)
 Periotest
 Resonance frequency analysis (RFA):
 Electronictechnology 11
 Magnetic technology.
 THE SURGEON’S PERCEPTION
 One method of trying to evaluate primary stability is quite
simply the perception of the surgeon.

 This is often based on the cutting resistance and seating

torque of the implant during insertion. A perception of
“good” stability may be heightened by the sensation of an
abrupt stop when the implant is seated.

 One’s personal perception is difficult to communicate to

others. However, most importantly, this type of
measurement can only be made when the implant is
inserted, it cannot be used later, for example, before
loading the implant.
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 RADIOGRAPHIC ANALYSIS
 Non invasive method-bitewing view is used to measure crestal bone
level.

 It has been reported that 1.5mm of radiographic bone loss can be

expected in the first year of loading in a stable implant with 0.1mm of
annual bone loss. (Albrektsson et al)

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CUTTING TORQUE RESISTANCE ANALYSIS
 Developed by Johansson and Strid, improved by Friberg.

 The amount of unit volume of bone removed by current fed electric

motor is measured by controlling the hand pressure during drilling at
low speed.

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INSERTION TORQUE MEASUREMENT
 An increase in insertion torque greater than 30Ncm may signify an
increase in primary stability.

 But maximum insertion torque is produced by the pressure of implant

neck on the dense cortical bone of the alveolus.

 Higher insertion torque in cortical and cancellous bone- more than

50Ncm can lead to increase concentration of compressive stress-
periimplant failure.

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 REVERSE TORQUE TEST
Reverse torque test was proposed by Roberts et al. and developed by
Johansson and Alberktsson.

It is used to assess the secondary stability of the implant.

Implant that rotate when reverse torque is applied indicates that bone-
implant contact is destroyed.

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 SEATING TORQUE TEST

 Like insertion torque, the final seating torque gives

some information about the primary stability of the
implant when the implant reaches its final apico-
occlusal position.

 It is done after implant placement.

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 MODAL ANALYSIS

A. Theoretical modal analysis: FEM(finite element analysis)-investigates

vibrational characteristics of objects
- to calculate stress and strain in various anticipated bone levels.
- Used in clinical studies and experiments.

B. Experimental Modal analysis:It is dynamic analysis-Measures natural

characterstic frequency,mode and attenuation-via vibration testing.
- Used in non-clinical studies-in-vitro approach
provides reliable measurement.
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 PERCUSSION TEST
 Clinical judgement about stability is carried out by percussing the
dental implant abutment with handle of dental instrument.

 A clear ringing crystal sound- successful osseointegration.

 This is advised during surgical phase after placing the implant.

 It is subjective, could give inaccurate measurements due to high

rigidity of implants Lacks precision

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 PULSED OSCILLATION WAVEFORM

 Described by Kaneko et al. POWF is based on estimation of frequency

and amplitude of the vibration of the implant induced by small pulsed
force of 1kHz by lightly touching with 2 fine needles connected with
piezoelectric elements.

 In vitro and experimental studies Sensitivity was low for assessment of

implant stability.

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 PERIOTEST
 Devised by Dr. Schulte Teerlinck et al.
 It is used to evaluate damping effect and stiffness of implant.
 An electronically driven and monitored rod is kept at
approximately 20 degrees and distance of 0.6-0.2mm (I to et al
2008, Schulte 1988).
 Periotest value range from -8 (low mobility) to +50 (high mobility)

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 RESONANCE FREQUENCY ANALYSIS
 Suggested by Meredith in 1998.
 A transducer with 2 piezoceramic elements is tightened to implant or
abutment screw.
 The transducer is screwed directly to the implant body and shakes the
implant at a constant input and amplitude,starting at a low frequency
and increasing in pitch until the implant resonates.
 High frequency resonance indicates stronger bone-implant interface.

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 ELECTRONIC TECHNOLOGY
RESONANCE FREQUENCY ANALYSIS
(OSSTELL™)
 First commercially available product The electronic technology
combines the transducer, computerized analysis and the excitation
source into one machine closely resembling the model used by
Meredith.
 Implant stability quotient (ISQ) is the measurement unit (ISQ of O to
100) used.

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 MAGNETIC TECHNOLOGY
RESONANCE FREQUENCY ANALYSIS
(OSSTELL™ MENTOR)

 The transducer has a magnetic peg on top and is fixed to implant or

abutment.

 On activation by magnetic resonance frequency probe the peg is

activated, which vibrates and induces electric volt sampled by
magnetic resonance frequency analyzer.

 Values are expressed as ISQ of O to 100.

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 CONCLUSION
 Till date no definite method has been establish to measure implant
stability accurately with fair amount of reliability.

 Though, clinical measurement of implant stability can be evaluated with

resonance frequency analysis with fair amount of predictability.

 The theoretical basis of resonance frequency analysis is based on sound

foundation; still there are uncertain issues.

 As critical value that can suggest success or failure of a particular

implant system.

 Hence, further research is needed to establish higher reliability of the

currently discussed methods.
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 REFERENCES
1. Current trends to measure implant stability Vasanthi Swami, Vasantha
Vijayaraghavan, Vinit Swami 2016.
2. The Reverse-Torque Test: A Clinical Report Daniel Y.
Sullivan,Richard L. Sherwood, Thomas A. Collins, Paul H. J. Krogh,
1996.
3. Implant Stability: Methods and Recent Advances Prof.Dr.Abu-Hussein
Muhamad, Dr.Chlorokostas Georges,Dr. Mahameed Mustafa ,
Dr.Azzaldeen Abdulgani, 2017.
4. Abu-Hussein M, Georges C, Watted N, Azzaldeen A ;A Clinical Study
Resonance Frequency Analysis of Stability during the Healing Period.
Int J Oral Craniofac Sci 2016,2(1): 065-071. DOI: 10.17352/2455
4634.000021
5. Meredith N. Assessment of implant stability as a prognostic
determinant. International Journal of Prosthodontics. 1998;11: 491-
501.
6. Atsumi M, Park SH, Wang HL. Methods used to assess implant
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stability: Current status. Int J Oral Maxillofac Implants. 2007;22:743-
54.
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