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Primary and secondary stability: What is important and what we do not know

Osstell, the developer of ISQ (Implant Stability Quotient) technology, will be introducing the Osstell Beacon at EuroPerio9. (Images: Osstell)

Wed. 20. June 2018

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AMSTERDAM, Netherlands: Osstell, the developer of ISQ (Implant Stability Quotient) technology, will be introducing the Osstell Beacon at EuroPerio9, to be held in Amsterdam in the Netherlands from 20 to 23 June. An intuitive tool designed to facilitate the evolution of implant diagnostics, the Osstell Beacon guides implant treatments for more predictable results, according to the company.

Primary and secondary stability

Physiological healing after implant placement varies from patient to patient and site to site. Surgeons must find a balance between mechanical stability and avoiding excessive trauma to the alveolar bone, especially the cortical bone at the alveolar crest. The two measures of quantifying primary stability are insertion torque value (ITV) and resonance frequency analysis (RFA). Both parameters are accurate measures of rotational and axial stability, respectively, but only one (RFA) is repeatable.

The comfort of achieving a high insertion torque may be unfounded. High insertion torque can lead clinicians to believe implants can be loaded immediately. When cortical bone at the crest is over-compressed, it resorbs, leading to bone loss, deep probing depths and susceptibility to peri-implantitis. Using RFA to assess stability is accurate and may not be correlated to ITV.1 It may also be repeated at future treatment times to evaluate increased or decreased stability. ISQ is a value used to determine stability via RFA.

Recommendations by some that arbitrary ITVs are necessary to temporise or load immediately placed implants is largely unsupported in the literature. Norton found that implants placed at ITVs well below some of these recommended values can receive temporary crowns out of occlusal contact at the time of surgery.2 Other studies have also found that ITVs around 20 N cm are not correlated to ISQ values, and many patients receiving immediate provisionals would not be afforded this option, resulting in removable or adhesive temporary restorations.

Using ISQ as a primary measure of stability is not only useful but also repeatable. Implants temporised at time of placement can be evaluated at various postoperative times to determine when secondary stability or osseointegration has occurred and final crowns can be placed. ISQ is a safe and reliable means to evaluate implant stability.

Osstell at EuroPerio9

At Osstell’s booth (Booth 11.08B), visitors will be able to see the Osstell Beacon first-hand and address any questions they may have to company representatives.

“The Osstell Beacon is a natural step for us as part of the Osstell approach,” said CEO Jonas Ehinger. “It is a way for us to cater to a different segment of the market and a different use of our technology—although it is also designed to work in combination with our other products and services, such as Osstell Connect and the Osstell IDx.”

Editorial note: A list of references can be obtained from Osstell.

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