Assessment of Osstell™ and Periotest® systems in measuring dental implant stability (in vitro study)

Osseodensification: An Alternative to Conventional Osteotomy in Implant Site Preparation: A Systematic Review

Osseodensification is an innovative method of preparing the implant osteotomy using drills that promote bone self-compaction. The main objective of this technique is to promote peri-implant bone densification and compaction of autologous bone and to increase the primary stability of the implant due to the viscoelastic characteristics of the alveolar bone using Densah® burs in a counterclockwise direction at a speed of 800 to 1500 rpm. The objective of this review is the analysis of the scientific literature regarding the applicability of the osseodensification technique in oral implantology. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used and registered at PROSPERO. The search strategy included electronic databases from 2016 to 2023 and was performed by two independent reviewers. The results demonstrate the advantage of the osseodensification technique in relation to conventional drilling, allowing an increase in the bone density and primary stability of the implant, bone density, and bone-implant contact. The osseodensification technique can be applied in different clinical situations: sub-antral bone grafts, narrow alveolar bone crests, low-density bone areas, and immediate implant placement in post-extraction sockets.

Clinical Validation of Dental Implant Stability by Newly Designed Damping Capacity Assessment Device during the Healing Period

Background and Objectives: To evaluate the stability of a dental implant and the effectiveness of a newly designed damping capacity assessment device by improving the number of blows and strength evaluated by a prospective clinical study. Materials and Method: The stability of dental implants was measured in 50 implants in a total of 38 patients. Measurements were performed using Anycheck and Periotest M devices, twice in total, divided into buccal and lingual directions. In addition, measurements were performed on the day of surgery, two weeks, one month, two months, and three months after surgery for a total of five times. After the standardization of the measured values, the differences and changes over time for each device were observed. Result: No difference in standardized values between the two devices was observed at any time point. In both devices, stability decreased at two weeks postoperatively but gradually increased thereafter. No differences were observed in the values according to the measurement direction. Conclusions: The damping capacity of Anycheck was similar to that of Periotest M. After a slight decrease in stability two weeks after implant placement, implant stability increased over time.

Fractal Dimension as a Tool for Assessment of Dental Implant Stability—A Scoping Review

A lot of modalities for assessing implant stability are available for clinicians, but they fail to assess trabecular changes as they are solely dependent on the operator’s skills. The use of Fractal Dimension (FD) has evolved to be used as a measure for trabecular changes depicting implant stability before and after implant placement. The objective of this systematic review was to qualitatively analyse the available scientific literature describing the use of FD as a tool to measure implant stability on the basis of trabecular changes. An electronic search in PubMed, Web of Science and Scopus was carried out using relevant keywords, such as: fractal dimension; fractal analysis; dental implants; implant stability; osseointegration, etc. Studies reporting the use of FD as a tool to measure implant stability were included and subjected to qualitative analysis using ROBINS-I and Cochrane risk of bias assessment criteria. Fourteen studies were included in this review. Results showed that FD was found to be used solely as a measure of implant stability in seven studies, out of which six studies showed an increment in FD values. The majority of studies concluded with a statistical correlation between FD and respective other assessment methods used. FD may not serve as a sole indicator of implant stability; however, it can be used as an adjunct to conventional methods along with additional fractal factors.

Intra- and inter-operator concordance of the resonance frequency analysis. A cross-sectional and prospective clinical study

OBJECTIVE

Resonance frequency analysis (RFA) provides an evaluation of implant stability over time. This analysis is a non-invasive, precise, and objective method. Several studies compare the RFA system with other devices. However, few investigations analyze repeatability and reproducibility between different operators. The aim of this study was to evaluate the intra- and inter-operator concordance of the Osstell® ISQ.

MATERIAL AND METHODS

RFA measurements were performed with Osstell® ISQ in a total of 37 implants placed in 21 patients. At the time of implant placement, 6 measurements per implant were taken by three different experienced operators. Three measurements were carried out consecutively and three by removing and placing the SmartPeg-Osstell® to assess intra-operator and inter-operator agreement.

RESULTS

Intra-operator concordance according to the intraclass correlation coefficient (ICC) showed high concordance. The ICC values were higher than 0.9 (p < 0.0001) for consecutive measures and alternative measures, being almost perfect of Landis & Koch classification. For inter-operator concordance The ICC was 0.709 (p < 0.0001) and 0.670 (p < 0.0001) for consecutive and alternative measures, respectively, both estimates being in the substantial category. In torque and ISQ values, no statistically significant differences were observed when operators and measurements were compared.

CONCLUSIONS

Osstell® ISQ system was stable both in intra-operator and inter-operator measurements. This device has excellent repeatability and reproducibility, demonstrating reliability to measure the stability of dental implants.

CLINICAL RELEVANCE

Resonance frequency analysis (RFA) is a non-invasive, objective, and reliable diagnostic method to determine the ideal moment to load the implant, as well as to predict possible failures.

Stability of Dental Implants and Thickness of Cortical Bone: Clinical Research and Future Perspectives. A Systematic Review

Dental surgery implantation has become increasingly important among procedures that aim to rehabilitate edentulous patients to restore esthetics and the mastication ability. The optimal stability of dental implants is correlated primarily to the quality and quantity of bone. This systematic literature review describes clinical research focusing on the correlation between cortical bone thickness and primary/secondary stability of dental fixtures. To predict successful outcome of prosthetic treatment, quantification of bone density at the osteotomy site is, in general, taken into account, with little attention being paid to assessment of the thickness of cortical bone. Nevertheless, local variations in bone structure (including cortical thickness) could explain differences in clinical practice with regard to implantation success, marginal bone resorption or anchorage loss. Current knowledge is preliminarily detailed, while tentatively identifying which inconclusive or unexplored aspects merit further investigation.

Implant primary stability with an osteocondensation drilling protocol in different density polyurethane blocks

The implant primary stability is a fundamental condition for avoiding implant micro-motions that might result in fibrous encapsulation; its achievement is facilitated by macro- and micro-geometry of the implant, and by the bone density and architecture at the intended implant site. The aim was to evaluate an osteocondensing drilling protocol for dental implant positioning compared to standard protocol on polyurethane block. A total of 40 implants, 20 for each osteocondensing group (Test) and 20 for standard drilling group (Control), were positioned. Insertion torque (IT), removal torque (RT), and Periotest were measured. A IT, RT, and Periotest significant difference was present in favor of the implant osteocondensing protocol. The results suggested that osteocondensing protocol represents a useful technique for implant placement in poor density bone.

The behavior of polyetheretherketone healing abutments when measuring implant stability with electronic percussive testing

BACKGROUND

It is unknown whether it is possible to measure implant stability with polyetheretherketone (PEEK) healing abutments using electronic percussive testing (EPT).

PURPOSE

To investigate the reliability of the percussive test values (PTVs) measured with PEEK healing abutments and to compare them with the PTVs measured with titanium healing abutments.

MATERIAL AND METHODS

Thirty dental implants were inserted into the fresh pelvis belonging to a cow. Titanium healing abutments (2 and 5 mm), PEEK healing abutments (5 mm), and prepable standard titanium abutments (5 mm) were screwed to the implants, respectively, and PTVs were measured by two examiners using a wireless EPT device. Differences in PTVs between different dental implant components were evaluated using Friedman's test with post hoc Wilcoxon signed-rank test and Bonferroni correction. Inter and intra-observer reliabilities were detected using interclass correlation coefficients (ICCs) RESULTS: The mean PTVs obtained using the PEEK healing abutments were significantly higher than the mean PTVs obtained using the other abutments for both examiners (P < .01). The ICCs for intra-observer reliability were detected as poor for PEEK healing abutments; and excellent for the other abutment types for both examiners. The ICCs for the inter-observer reliability between the two examiners were poor (0.25) for PEEK healing abutments, and excellent for the 2 and 5 mm titanium healing abutments and for standard abutments (0.82, 0.84 and 0.93, respectively).

CONCLUSION

Within the limitations of this in vitro study, it may be concluded that EPT measurements should be avoided using PEEK healing abutments because of the poor reliability.

A novel technique for measurement of orthodontic mini-implant stability using the Osstell ISQ device

OBJECTIVES

To develop and validate a method for application of the Osstell ISQ device in the assessment of mini-implant stability.

MATERIALS AND METHODS

An adaptor was developed for attachment of Osstell's SmartPeg onto a variety of orthodontic mini-implants. For validation of the adaptor, Benefit mini-implants were inserted into bone blocks that mimicked different stability conditions. The Osstell device was used to assess mini-implant stability with the adaptor (test measurement) and conventional SmartPeg attachment (gold-standard measurement). Implant stability quotient (ISQ) values were assessed for agreement, repeatability, and reproducibility.

RESULTS

Strong positive correlations were found between ISQ values obtained using the novel adaptor and the conventional attachment. Repeatability and reproducibility of ISQ values with the adaptor were similar to those obtained with the conventional attachment.

CONCLUSIONS

A method was developed and validated to assess the stability of orthodontic mini-implants using the Osstell system. The novel mini-implant adaptor provided repeatable and reproducible measurements of mini-implant stability, which agreed with those obtained using a conventional SmartPeg attachment. This adaptor permits noninvasive stability assessment of various designs of mini-implants, most of which are incompatible with the conventional SmartPeg attachment.

Mechanical Properties of the Periodontal System and of Dental Constructs Deduced from the Free Response of the Tooth

The biomechanical behaviour of the periodontal ligament (PDL) is still not well understood although this topic has been studied for almost 100 years. This study reports on clinical and mathematical studies to determine the constitutive law of the PDL. A set of mechanical parameters of the tooth-PDL system is obtained, and a new method for the evaluation of these parameters from the free response of the tooth is introduced. This response is produced by repeated impacts applied to the gingival tissue in the apical part of the tooth investigated—with the aid of a Periotest exciter. A Doppler ultrasound probe is utilized to determine the response of the tooth-PDL system. The parameters evaluated from these measurements can be considered as the elastometric properties of the dental system investigated. A modal analysis/system identification method is utilized to estimate these parameters. The investigations are carried out for different teeth abutments, both with and without a dental bridge/fixed partial prosthesis (FPP). The differences between the responses of the systems in these two cases are determined with the new method proposed. They are discussed with regard to the specific purposes of the FPP. The study demonstrates that this method can provide the dentist with the necessary objective evaluations regarding the properties and health of the tooth-PDL system, as well as of the construct that is obtained after installing a dental bridge.

Clinical Assessment of Dental Implant Stability During Follow-Up: What Is Actually Measured, and Perspectives

The optimization of loading protocols following dental implant insertion requires setting up patient-specific protocols, customized according to the actual implant osseointegration, measured through quantitative, objective methods. Various devices for the assessment of implant stability as an indirect measure of implant osseointegration have been developed. They are analyzed here, introducing the respective physical models, outlining major advantages and critical aspects, and reporting their clinical performance. A careful discussion of underlying hypotheses is finally reported, as is a suggestion for further development of instrumentation and signal analysis.

In vitro comparison of primary stability of two implant designs in D3 bone

Background

Primary stability (PS) is a key factor for implant survival rate and depends on implant design or bone quality. The aim of this study was to compare different thread designs implants, evaluating PS with periotest values (PV) and implant stability quotient (ISQ) values through resonance frequency analysis (RFA).

Material and Methods

A total of 60 implants (Radhex®, Inmet-Garnick S.A., Guadalajara, Spain) were placed in freshly bovine ribs in vitro. Two designs were used: 30 tapered body with single thread design (PHI) and 30 tapered body with double thread design implants (PHIA). Both designs were 4mm wide and 12mm long. Implants were placed according to manufacturer’s guidelines. Osstell™ and Periotest® devices were used to evaluate PS by a blinded independent observer. Computed tomographies (CTs) of the ribs were made (BrightSpeed Series CT systems, GE Healthcare, Milwaukee, WI, USA) and bone quality surrounding each implant was evaluated in Hounsfield Units (HU) using Ez3D Plus software (Vatech Co., Korea). Bone quality was classified according to Misch and Kircos in D1, D2, D3 or D4.

Results

All implants were mechanically stable. Only implants placed in D3 bone (350-850 HU) were selected for the study: 28 PHI and 26 PHIA. The one way ANOVA showed significant difference (p<0.005) among two implants designs in ISQ values (61,55 ± 6,67 in PHI and 68,94 ± 5,82 in PHIA). No significant difference (p = 0,171) was shown in PV between two designs (-4,47 ± 1,39 in PHI and -4,77 ± 0,87 in PHIA).

Conclusions

Higher PS was found using Osstell™ device in implants with double thread design (PHIA) in comparison to implants with single thread design (PHI) in D3 bone.

Key words:Dental implant, primary stability, Osstell, Periotest, bone quality, implant design.

A Comparison of the Mechanical Measures Used for Assessing Orthodontic Mini-Implant Stability

PURPOSE

Mechanical loosening remains a common complication associated with mini-implant failure. The purpose of this study was to compare common mechanical measures of mini-implant stability to determine their association and reliability.

MATERIALS AND METHODS

Ninety self-drilling orthodontic mini-implants from 6 manufacturers were inserted into artificial bone blocks. Insertion torques (ITs) and Periotest values (PVs) were measured. Subsequently, mini-implants underwent pull-out testing for measures of pull-out load (POL) and screw displacement (ScrD). Stability measurements were compared using one-way ANOVA, associations among them were assessed using correlation analyses, and reliability was evaluated using coefficients of variation (COVs).

RESULTS

Variations in stability of mini-implants were found, specific to the mechanical measure used for assessment (P < 0.05). The strongest correlations were found between IT and PV (r = -0.68) and between IT and POL (r = 0.66). Overall, PV showed the greatest variability (COV: 11%-100%) compared with IT (≤11%), POL (≤4%), and ScrD (≤19%).

CONCLUSIONS

IT, PV, and POLs only agreed moderately in their assessment of mini-implant stability, and Periotest showed the least reliability in predicting mini-implant stability. As such, independent and interchangeable use of these stability measures should be avoided.

Mathematical evaluation of the influence of multiple factors on implant stability quotient values in clinical practice: a retrospective study

Objectives

The objective of this study is to mathematically evaluate the influence of multiple factors on implant stability quotient values in clinical practice.

Patients and methods

Resonance frequency analysis was performed at T1 (measured immediately at the time of implant placement) and at T2 (measured before dental restoration) in 177 patients (329 implants). Using a multivariate linear regression model, we analyzed the influence of the following eleven candidate factors: sex, age, maxillary/mandibular location, bone type, immediate/delayed implantation, bone grafting (presence or absence), insertion torque, I-/II-stage healing pattern, implant diameter, implant length, and T1–T2 time interval.

Results

The following factors were identified to significantly influence the implant stability quotient (ISQ) values at T1: insertion torque, bone grafting, I-/II-stage healing pattern, immediate/delayed implantation, maxillary/mandibular location, implant diameter, and sex. In contrast, the ISQ values at T2 were significantly influenced only by three factors: implant diameter, T1–T2 time interval, and insertion torque.

Conclusion

Among the eleven candidate factors, seven key factors were found to influence the T1-ISQ values, while only three key factors influenced the T2-ISQ values. Both T1 and T2-ISQ values were found to be influenced by implant diameter and insertion torque. T1 was influenced specifically by the sex of the patient, the location (maxillary or mandibular), the implantation mode (immediate/delayed implantation), the healing stage, and the absence or presence of bone graft materials.

Evaluation of primary stability of innovated orthodontic miniscrew system (STS): An ex-vivo study

BACKGROUND

Stability is determined as one of the requirements in use of Temporary Anchorage Devices (TAD) in orthodontics. Miniscrew has been a widely used Bone Anchor. Compared with mini-implant that necessitates osseointegration; mechanical retention is a determining factor for primary stability of miniscrew. Studies investigated various ways to increase primary stability. The aim of this study is to introduce a new configuration of miniscrew system which is believed to obtain more primary stability.

MATERIAL AND METHODS

Freshly ovine mandibles were cut in blocks. Twenty-seven miniscrews (diameter 1.6 × 8 mm; G2, Dual Top Anchor System, Jeil Medical, Seoul, Korea) were inserted in the blocks and divided in 2 experimental groups: single miniscrew and the innovated design "Seifi Twin Screw (STS)". Primary stability was evaluated by Periotest "M"® device.

RESULTS

Independent t-test showed a significant difference between 2 experimental groups in periotest evaluation (p< 0.05). STS demonstrated higher primary stability due to its mechanical configuration and design.

CONCLUSIONS

The STS provides higher primary stability and was found to be effective in increased success rate of miniscrew systems from the standpoint of primary stability.

KEY WORDS

Anchorage procedures, anchorage techniques, orthodontic anchorage procedures, miniscrews, temporary anchorage device.

A noncontact resonance frequency detection technique for the assessment of the interfacial bone defect around a dental implant

This study employed a noncontact resonance frequency (RF) detection technique that was developed by our group to evaluate the interfacial bone in in vitro implant-bone models. Based on our method, the implant-bone structure was excited by the acoustic energy of a loudspeaker, and its vibration response was acquired with a capacitance sensor. The spectral analysis was used to characterize the first RF value. Two types of in vitro defect models, Buccal-Lingual (BL) and Mesial-Distal (MD), were constructed for the verification. The measurements of the RF for a defect model clamped at four different heights (9, 10, 11, and 12 mm) were performed in two sensing directions (BL and MD). Moreover, each model was also analyzed using an Osstell Mentor. The obtained two parameters, RF and ISQ (Implant Stability Quotient), were statistically analyzed through one-way analysis of variance (ANOVA) and linear regression analysis for comparisons. The RF and the ISQ values obtained for all of the defect models at the four clamp heights decreased significantly (p < 0.05) with an increase in the severity of the defect. The two parameters for each imperfection increase significantly (p < 0.05) with an increase in the clamp height. Additionally, the RFs of all of the defect models are linearly correlated with their corresponding ISQs for the four clamp heights and the two measuring orientations. Therefore, our developed technique is feasible for the assessment of the postoperative healing around a dental implant.

Development of a dental implant mobility measurement system using an inductive sensor

Estimation of dental implant stability is an important factor for diagnosis of implant treatment. In this study, we have developed a new system for measuring dental implant mobility. Movement of the implant was measured by an inductive sensor and an amplification adaptor was developed to multiply movement of the implant. Impulse response signal of the implant was acquired and power spectrum analysis was applied for the signal. Various implant-tissue interfacial conditions were simulated in an in vitro experiment and average peak frequency of the power spectrum was calculated for each condition. Artificial implantation model of acryl was fabricated and holes of different levels of depth and diameter were drilled. Two types of impression materials were used to fix the dental implant into the hole. The peak frequency showed linear relationship (P-value<0.01) with the depth and the diameter of the hole. Differentiability of the system was evaluated by ANOVA test.