Reliability of the Osstell Implant Stability Quotient and Penguin Resonance Frequency Analysis to Evaluate Implant Stability

The effect of photobiomodulation therapy on implant stability: A systematic review and meta-analysis

This study was designed to determine the effect of photobiomodulation therapy on dental implant stability. A complete systematic search was performed in PUBMED/MEDLINE, COCHRANE library databases, EMBASE, SCOPUS, and Google Scholar databases on articles published until June 2024. All the RCTs and CCTs reported the solo impact of photobiomodulation on dental implant stability in humans were included. The means and standard deviation for implant stability and sample size were extracted for the meta-analysis. The statistical analysis was conducted using Stata 17 software, and random effect models were applied to assess the source of heterogeneity. The I2 statistic was used to estimate the significance of any discrepancies in the therapy result. After a full-text inspection, 17 articles were qualified for systematic review, and 14 were included in the meta-analysis. Statically significant differences in implant stability were observed between the laser and the control groups on weeks 2 in ISQ reporting groups (p = 0.01, CI 95%) and weeks 4 and 8 in PTV reporting groups (p < 0.001, CI 95%). Despite limitations, the study suggests that PBM therapy benefits patients with dental implants at different periods, particularly during the early phases of healing.

Correlation of two different devices for the evaluation of primary implant stability depending on dental implant length and bone density: An in vitro study

Non-invasive objective implant stability measurements are needed to determine the appropriate timing of prosthetic fitting after implant placement. We compared the early implant stability results obtained using resonance frequency analysis (RFA) and damping capacity analysis (DCA) depending on the implant length and bone density. Total 60, 4.0 mm diameter implants of various lengths (7.3 mm, 10 mm, and 13 mm) were used. In Group I, low-density bone was described using 15 PCF (0.24 g/cm3) polyurethane bone blocks, and in Group II, 30 PCF (0.48 g/cm3) polyurethane bone blocks were used to describe medium density bone. RFA was performed using an Osstell® Beacon+; DCA was performed using Anycheck®. Measurements were repeated five times for each implant. Statistical significance was set at P <0.05. In Group I, bone density and primary implant stability were positively correlated, while implant length and primary implant stability were positively correlated. In Group II, the implant stability quotient (ISQ) and implant stability test (IST) values in did not change significantly above a certain length. Primary implant stability was positively correlated with bone density and improved with increasing implant length at low bone densities. Compared with the Osstell® Beacon+, the simplicity of Anycheck® was easy to use and accessible.

Radiographic Study of Transcrestal Sinus Floor Elevation Using Osseodensification Technique with Graft Material: A Pilot Study

This pilot study aimed to evaluate the level of implant success after transcrestal sinus floor elevation (tSFE) using the osseodensification technique (OD) combined with beta-tricalcium phosphate (β-TCP) by analyzing clinical and radiographic results. Moreover, the increase in bone height was analyzed immediately after surgery, 3 months after, and before loading by taking standardized radiographic measurements. Thirteen patients, four males and nine females, with a mean age of 54.69 ± 5.86 years, requiring the placement of one implant in the upper posterior maxilla, with a residual bone height of <8 mm and a minimum bone width of 5 mm, participated in the study. The bone gain data was obtained using cone-beam computed tomography (CBCT) immediately after surgery and twelve months after the placement. The correlation between initial and final bone height with implant stability was also assessed. The results were analyzed using SPSS 23 software (p < 0.05). The results of the study indicated a 100% implant success rate after a follow-up period of twelve months. Preoperative main bone height was 5.70 ± 0.95 mm. The osseodensification technique allowed a significant increase of 6.65 ± 1.06 mm immediately after surgery. After a twelve-month follow-up, a graft material contraction of 0.90 ± 0.49 mm was observed. No correlation was observed between the bone height at the different times of the study and the primary stability of the implant. Considering the limitations of the size sample of this study, the osseodensification technique used for transcrestal sinus lift with the additional bone graft material (β-TCP) may provide a predictable elevation of the maxillary sinus floor, allowing simultaneous implant insertion with adequate stability irrespective of bone height limitations.

Influence of Multiple Sterilization on Performance of Titanium Pegs When Measuring Implant Stability With Resonance Frequency Analyses

This in vitro study was conducted to investigate the repeatability of the implant stability quotients (ISQ) measured with multipegs after numerous sterilizations and to detect the exact time when the readings start to deviate. Multipegs were sterilized with 3 different methods (autoclaved, autoclaved + ultrasonic cleaner, chemical disinfection + autoclaved) and grouped according to the method applied. All specimens were put into the autoclave with sealed packages every time they were sterilized. Each specimen was sterilized 50 times according to the technique described in its group after an ISQ measurement was performed. Results of the 2-way analysis of variance showed that neither the sterilization method nor the cycles, nor their interaction, were statistically significant. A multipeg may be reused multiple times after sterilization procedures and may be more cost-effective than a disposable smartpeg for checking implant stability after confirming these results in further investigations.

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.

Resonance frequency analysis with two different devices after conventional implant placement with ridge preservation: A prospective pilot cohort study

BACKGROUND

Primary and secondary implant stability is of high importance for survival and success of dental implants in the short and long term. Measurements of implant stability during healing provide the opportunity to monitor the course of the osseointegration process.

PURPOSE

To compare implant stability quotient (ISQ) by resonance frequency analysis (RFA), recorded with two different devices after implant placement.

MATERIALS AND METHODS

Patients with the need of single tooth extraction in posterior sites of the maxilla and the mandible were treated in a surgical center. All patients received additional augmentation with a bovine bone substitute and platelet-rich fibrin (PRF) after atraumatic tooth extraction. After a healing period of 10 weeks, 28 self-tapping titanium-implants were placed. Implant stability was recorded with two different devices (Osstell and Penguin) at the time of implant insertion (T0), 10 days later (T1), and after 7 (T2), or 17 weeks (T3).

RESULTS

No implant was lost, and no postoperative complication occurred during follow-up. Patient cohort comprised 9 female (32.1%) and 19 male patients (67.9%), with a mean age of 52.8 years, 64.3 years, respectively. Mean overall insertion torque was 43.6 Ncm at implant placement with no significant difference between implant location, age, or gender. No patient dropped out. During observation period, a significant increase in mean ISQ was recorded with both devices. Significant positive correlations between insertion torque and ISQ were recorded with both devices at T0, T2, and T3. No significant differences were observed in ISQ-values between both devices, and measuring directions at any point of measurement.

CONCLUSIONS

Within the limitations of this cohort study, both devices were suitable for RFA-measurement and revealed comparable results. Due to the cordless design, handling of the Penquin device was more comfortable. Reusability of the Penguin MultiPeg-transducers may offer an additional benefit with regard on ecological aspects.

Comparison of reliability of three resonance frequency analysis devices: An in vitro study

The purpose of the present study was to investigate the intra-observer and inter-observer reliability of three resonance frequency analysis (RFA) devices and to compare the implant stability quotient (ISQ) values according to implant macro design and diameter in two different bone densities. A total of 64 implants (Neoss Proactive) of varying diameters (3.5 and 4.0 mm) and implant macro design (tapered and straight) were placed in two artificial bone blocks (the density of type 2 and 3). The implant primary stability was measured using Osstell IDx, Osstell Beacon and Penguin RFA. The ISQ value of each implant was measured by two observers and recorded five times in two directions. The intra-observer and inter-observer reliability of RFA devices were evaluated. In addition to that, mean ISQ values were calculated for each RFA device to evaluate the effect of implant diameter, implant macro design, and bone density on ISQ values. ISQ values were significantly higher for implants placed within the type 2 bone than for the type 3 bone. The 4.0 mm diameter implants presented higher ISQ values than 3.5 mm diameter implants. The intra-class correlation coefficient (ICC) values for intra-observer reliability were above 0.85 for each observer and the ICC values for inter-observer reliability were 0.94, 0.93, 0.98 for Osstell IDx, Osstell Beacon and Penguin RFA, respectively. Although there was excellent inter-observer reliability with three RFA devices, the intra-observer reliability of Osstell Beacon and Penguin RFA were slightly better than Osstell IDx. Bone density and implant diameter were parameters affecting the primary stability of implants.

Effect of low-level laser therapy on osseointegration of titanium dental implants in ovariectomized rabbits: biomechanics and micro-CT analysis

PURPOSE

The primary aim of this study is to assess, in an animal model, whether biostimulation of osteoporotic bone with low-level laser therapy improves the osseointegration of dental implants.

MATERIAL AND METHODS

Twenty-two female rabbits were randomly divided into two groups: sham-ovariectomy and bilateral-ovariectomy. Laser therapy was applied to the implants placed in the right tibial bones and was not applied to implants placed in the left tibial bones. The periotest device was used for the stability test. Periotest values were recorded after the implantation (T0) and when the animals were euthanized (T1). The removal torque test and micro-computed tomography examination were evaluated.

RESULTS

As a result of removal torque, the mean of ovariectomy-laser group (56.1 ± 5.1 Ncm) was higher than sham-ovariectomy group (55.4 ± 18.5 Ncm) (p = 0.9). In periotest analysis, a significant difference was found between the values of T1 and T0 in all groups, except sham-ovariectomy group (p < 0.05); and the highest difference was found in the ovariectomy-laser group. Micro-CT examination demonstrated that ovariectomy-laser group showed an increase of implant-bone contact when compared with ovariectomy (p < 0.05).

CONCLUSIONS

The values obtained from biomechanical tests and micro-CT in the ovariectomy-laser group were significantly higher than the ovariectomy group and achieved the values in the healthy bone.

Comparison of Measurements of Implant Stability by Two Different Radio Frequency Analysis Systems: An In Vitro Study

Aim:

To compare and evaluate the implant stability quotient (ISQ) measurements by two different radio frequency analysis (RFA) machines, Osstell Mentor and PenguinRFA.

Materials and Methods:

Twenty bone-level implants (3.7 × 10 mm2) were placed on a bovine bone in this in vitro study. The ISQ measurements were performed with the PenguinRFA and Osstell Mentor machines using the multipeg of the Penguin system. The measurements were repeated three times for each direction and an average ISQ value was calculated. The results were averaged (mean ± SD) and the intraclass correlation coefficient (ICC) was calculated to assess the relationship between the measurements.

Result:

The mean ISQ values for the Osstell and Penguin machines were 77.60 + 2.11 and 78.05 + 2.04, respectively. The ICC was 0.958. The ISQ values obtained from the Osstell and Penguin machines were significantly compatible ( P < .05).

Conclusion:

Both of the RFA devices provided similar and reliable ISQ measurements.

Is It Possible to Monitor Implant Stability on a Prosthetic Abutment? An In Vitro Resonance Frequency Analysis

In order to apply the “one-abutment–one-time” concept, we evaluated the possibility of measuring resonance frequency analysis (RFA) on the abutment. This trial aimed to compare the Implant Stability Quotient (ISQ) values obtained by the Penguin^RFA when screwing the transducer onto the implant or onto abutments with different heights and angulations. Eighty implants (VEGA^®, Klockner Implant System, SOADCO, Les Escaldes, Andorra) were inserted into fresh bovine ribs. The groups were composed of 20 implants, 12 mm in length, with two diameters (3.5 and 4 mm). Five different abutments for screwed retained restorations (Permanent^®) were placed as follows: straight with 1, 2, and 3 mm heights, and angulated at 18° with 2 and 3 mm heights. The mean value of the ISQ measured directly on the implant was 75.72 ± 4.37. The mean value of the ISQ registered over straight abutments was 79.5 ± 8.50, 76.12 ± 6.63, and 71.42 ± 6.86 for 1, 2, and 3 mm height abutments. The mean ISQ over angled abutments of 2 and 3 mm heights were 68.74 ± 4.68 and 64.51 ± 4.53 respectively. The present study demonstrates that, when the ISQ is registered over the straight abutments of 2 and 3 mm heights, the values decrease, and values are lower for angled, 3 mm height abutments.

Initial Stability Measurements of Implants Using a New Magnetic Resonance Frequency Analyzer With Titanium Transducers: An Ex Vivo Study

The establishment of dental implant stability is mandatory for successful osseointegration. Resonance frequency analysis (RFA) is the most frequently used method for the clinical measurement of implant stability. The purpose of the present study was to evaluate the reliability of the recently developed RF analyzer Penguin RFA and to compare it with the traditional RF analyzer Osstell ISQ. Sixty implants were inserted into fresh steer vertebrae and pelvis. Implant stability was measured using Penguin RFA by its transducers (multipegs) and Osstell ISQ by its transducers (smartpegs). Additionally, stability was measured by multipegs with Osstell ISQ and by smartpegs with Penguin RFA. The intraobserver and interobserver reliability of Penguin RFA were estimated by the intraclass coefficient (ICC). Mean implant stability quotients (ISQs) measured with Osstell ISQ were higher than the ISQs measured with Penguin RFA (P < .05). The intra- and interobserver reliability of Penguin RFA were considered as excellent (ICC > 0.7). For Osstell ISQ, no significance in ISQs was detected between the readings by smartpegs and multipegs (P > .05), while for Penguin RFA ISQs by smartpegs were significantly higher than the ISQs by multipegs (P <.05). The recently developed Penguin RFA is reliable and can be used in clinical practice for the measurement of dental implant stability regardless of the bone type. The multipegs originally manufactured for the Penguin RFA is also compatible with Osstell ISQ.

Influence of cortical bone and implant design in the primary stability of dental implants measured by two different devices of resonance frequency analysis: An in vitro study

Background

This study aimed to evaluate the effect of the implant design and the presence of cortical bone in the primary stability, as well as analyze the differences between the stability measurements obtained by two different resonance frequency analysis (RFA) devices.

Material and Methods

A total of 80 Klockner implants of two different models [40 Essential Cone implants (group A) and 40 Vega implants (group B)] were used. The implants were placed in two polyurethane blocks that simulated the mechanical properties of the maxillary bone. One block featured a layer of cortical bone that was absent from the other block. The primary stability of all implants was measured by insertion torque and RFA using two different devices: Penguin RFA and Osstell IDX.

Results

Primary stability was superior in the cortical bone in both torque and RFA. In the block containing cortical bone, group A implants obtained a greater insertion torque than did group B. The insertion torque was lesser in the bone lacking cortex. Regarding the ISQ of the implants, group A presented higher values in the block with cortical bone, but the values were lower in the block without cortical bone. There were no significant differences between the values obtained from the Osstell IDX and Penguin RFA.

Conclusions

The presence of cortical bone positively influences the primary stability of dental implants. The design of the implant also has a statistically significant influence on implant primary stability, although the impact depends on whether there is coronal cerclage or not. There were no statistically significant differences in the implant stability measurements obtained by two different devices.

Key words:Implant stability, resonance frequency analysis, torque, osstell, penguin, cortical.

Prospective, Clinical Pilot Study with Eleven 4-Mm Extra-Short Implants Splinted to Longer Implants for Posterior Maxilla Rehabilitation

In many clinical situations, rehabilitation with implants in the posterior maxillary region is complicated by limited bone availability. In this context, the use of 4 mm long implants (known as extra-short implants) may be used thanks to the concept of osseointegration enhancement. It has been demonstrated that short implants offer an alternative to the regeneration procedures involved in placing longer implants in areas where bone height is compromised. This prospective pilot study tested a treatment protocol in which 11 extra-short (4 mm) implants were splinted to 11 mesially placed longer (8 mm) implants in the posterior maxillary regions of partially edentulous patients, without using supplementary bone regeneration procedures. Eleven patients were included in this single cohort study. The clinical performance of the extra-short implants was assessed during a two-year follow-up period, obtaining a 100% survival rate and mean bone loss of 0.3 mm. Implant stability measured by resonance frequency analysis (RFA) at the time of placement was 54.9 ± 4.9, increasing to 77.0 ± 2.6 at 24 months. The study demonstrated the gradual consolidation of osseointegration in bone of less-than-ideal quality in the posterior maxillary region. The results obtained show that a partially edentulous maxilla with reduced bone height may be rehabilitated by using an extra-short implant splinted to a mesial implant of 8mm length or longer. Despite the small sample size, this pilot study observed that extra-short implants achieved adequate bone stability and clinical performance after a 24-month follow-up.

Influence of Resonance Frequency Analysis (RFA) Measurements for Successful Osseointegration of Dental Implants During the Healing Period and Its Impact on Implant Assessed by Osstell Mentor Device

AIM

This study aimed to investigate and assess primary and secondary dental implant stability during the osseointegration period.

METHODS

A total of 77 implants were placed in 42 patients with 26 males and 16 females. The study was conducted by comparing the resonance frequency analysis (RFA) values of the implants inserted in the lower jaw. RFA was done immediately after implant insertion and after 12 weeks. Results were statistically evaluated using SPSS Statistics for Windows, Version 7.1. Level of significance was set at P < 0.05.

RESULTS

Significant differences were detected between the primary and secondary stability values, respectively. Maximum RFA value of 88 and the minimum value of 52 were observed. Stability values increased during the following three months, and all implants were successfully integrated without complication.

CONCLUSION

Our results indicate and suggest that there is a strong linear correlation between implant stability and ISQ values that can be directly estimated by the RFA, especially in the posterior edentulous mandible. Osstell implant device could represent a useful tool which can be used to identify the risk for implant failure.

The role of concentrated growth factor on implant stability: A preliminary study

PURPOSE

The purpose of this preliminary study was to evaluate the effect of concentrated growth factor (CGF) on dental implant stability in type 2 bone using the resonance frequency analysis (RFA) device Smartpeg®.

METHODS

The researchers carried out a prospective cohort study on a sample group composed of 12 patients (mean age=67) who required dental implants. Implant socket preparation (with and without CGF) was the primary predictor variable. In each patient, two dental implants were inserted in the anterior mandible. For the test group, one dental implant socket was covered with CGF membrane, while the other socket was prepared conventionally for the control group. Implant stability, as measured by RFA, was the outcome variable. Measurements were taken using the Ostell device at the time of implant placement and at the 1st, 2nd and 4th weeks.

RESULTS

Mean implant stability quotients (ISQs) were 67.00±4.573 for the study group and 64.75±5.065 for the control group. The difference between the two groups was not statistically significant.

CONCLUSION

It was found that CGF did not provide beneficial effect on dental implant stability in the early healing period in type 2 bone.

A review on the latest advancements in the non-invasive evaluation/monitoring of dental and trans-femoral implants

Dental implants and transcutaneous prostheses (trans-femoral implants) improve the quality of life of millions of people because they represent the optimal treatments to edentulism and amputation, respectively. The clinical procedures adopted by surgeons to insert these implants are well established. However, there is uncertainty on the outcomes of the post-operation recovery because of the uncertainty associated with the osseointegration process, which is defined as the direct, structural and functional contact between the living bone and the fixture. To guarantee the long-term survivability of dental or trans-femoral implants doctors sometimes implement non-invasive techniques to monitor and evaluate the progress of osseointegration. This may be done by measuring the stability of the fixture or by assessing the quality of the bone-fixture interface. In addition, care providers may need to quantify the structural integrity of the bone-implant system at various moments during the patients recovery. The accuracy of such non-invasive methods reduce recovery and rehabilitation time, and may increase the survival rate of the therapies with undisputable benefits for the patients. This paper provides a comprehensive review of clinically-approved and emerging non-invasive methods to evaluate/monitor the osseointegration of dental and orthopedic implants. A discussion about advantages and limitations of each method is provided based on the outcomes of the cases presented. The review on the emerging technologies covers the developments of the last decade, while the discussion about the clinically approved systems focuses mostly on the latest (2017-2018) findings. At last, the review also provides some suggestions for future researches and developments in the area of implant monitoring.