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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 111-116

Evaluation of dental implant osseointegration with resonance frequency analysis method: A retrospective study


1 Department of Periodontology, Faculty of Dentistry, Harran University, Sanliurfa, Turkey
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, Sanliurfa, Turkey

Date of Submission19-Mar-2019
Date of Acceptance04-Jun-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. Mehmet Gul
Department of Periodontology, Faculty of Dentistry, Harran University, 63000, Sanliurfa
Turkey
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DOI: 10.4103/srmjrds.srmjrds_23_20

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  Abstract 

Background/Aim: Dental implant stabilities are essential to prevent implant loss. The purpose of the study is to appraise the physical properties, bone density, and bone thickness of dental implants and the effects of the implant locations on stability. Materials and Methods: Thirty-six patients participated in the study at the Harran University Periodontology Department (between 2019 and 2020). Of these patients, 19 patients were female, 17 patients were male, and the average age of patients was 48.21 years. Patients who underwent dental implant surgery were contained in the study. A total of 127 dental implants were placed using standard surgical protocols. The specific transducer compatible with implant system was fixed to the implant body by means of an abutment using a screw. The implant stability quotient (ISQ, Osstell™) values were determined for each implant 4, 8, and 12 weeks after surgery. Results: As a result of the statistical analysis, the values of the ISQ taken in the mandible region were higher in the 4, 8, and 12 weeks compared to the values of the ISQ values obtained from the maxilla region. Statistically significant differences were also found between these values (P < 0.05). Conclusion: We found that implants with a long and wide width represented higher ISQ values and stability compared to shorter and narrower implants. Higher values were found in the mesiodistal direction compared to the buccolingual and buccopalatal directions, and in the mandible compared to the maxilla. This situation increases the stability in places where bone density and bone thickness are higher.

Keywords: Bone density, bone thickness, dental implant stability, Osstell™


How to cite this article:
Gul M, Durmus HI. Evaluation of dental implant osseointegration with resonance frequency analysis method: A retrospective study. SRM J Res Dent Sci 2020;11:111-6

How to cite this URL:
Gul M, Durmus HI. Evaluation of dental implant osseointegration with resonance frequency analysis method: A retrospective study. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Nov 28];11:111-6. Available from: https://www.srmjrds.in/text.asp?2020/11/3/111/298258


  Introduction Top


Various factors, such as morphology of the bone bed, primary stability of the implant, adequate healing time after loading, and infection control, are crucial for the long-term success of dental implants. Deficient primary stability of implant and mechanical and physical stress associated with osseointegrated implants can result in loss of osseointegration and implant failures.[1]

Osseointegration is defined as direct connection between the bone and the implant surface and is crucial for implant stability. The implant–bone interface is a highly dynamic area of interaction. This sophisticated interaction entails not only the modification of the mechanical environment but also biomaterial and biocompatibility issues. Osseointegration processes involve early interlocking between the implant body and the alveolar bone. Biological fixation involves continuous bonding of the implant to the bone. The process is complex and many factors can affect the maintenance of the bone and its formation on the implant surface.[2]

Today, there are approximately 1300 implant systems, which differ in size, shape, wettability, bulk and surface material, surface topography, implant-abutment connection, and surface chemistry.[3]

Various methods have been proposed for measuring the degree of osseointegration and the quality of bone quality, including histology and histomorphometry, removal torque analysis, pull-and push-through tests, and X-ray examination. A new device based on resonance frequency analysis (RFA; Osstell™) has been developed to measure the in vivo conditions of the implant-bone interface in a noninvasive and nondestructive way. RFA values have been correlated with changes in dental implant stability, failure of dental implants, the supracrestal dimensions of the dental implant, and osseous healing.[4],[5],[6]

The idea of using RFA to measure implant stability was first suggested by Meredith et al.[7] This method is based on measuring the vibration within the bone in response to sound waves produced and transmitted by a transmitter attached to the dental implant.[8],[9]

A clinical device has been developed to analyze resonance frequency using the implant stability quotient (ISQ), which can have a value of between 1 and 100. An ISQ of 100 indicates the highest degree of stability. Various transducers have been designed for different implant types and are calibrated by the producer. The ISQ values that have been reported for successfully integrated implants range from 57 to 82, and the average ISQ value after 1 year of loading is 69.[10],[11]

The aim of this study is to evaluate the clinical stability of comparable surgically inserted implants of different widths at different points during the routine healing period. To determine the loading time in the early recovery stage, the resonance frequency method is used to investigate osseointegration of the same surface and morphological implants of different widths and lengths.


  Materials and Methods Top


Thirty-six patients participated in the study, which was conducted at the Harran University Periodontology Department (between 2019 and 2020). Of these patients, 19 were female, 17 were male, and the average age was 48.21 years. The study was conducted at the Health Institution Research Centre, Harran University, Sanliurfa, Turkey (ethics committee approval no: 2020/02). Healthy patients older than 20 years were included in the study. Patients under 20 years, patients with bruxism, patients with any known systemic disease that may have affected the healing process (e.g., uncontrolled diabetes, osteoporosis) were excluded. Patients with a primary stability score of <40 were also excluded from the study. Before the operation, each patient was informed about the study and the measuring instruments. A total of 127 dental implants were placed in accordance with standard surgical protocols [Type I: width 3.5 mm, length 12 mm; Type II: width 3.5 mm, length 10 mm; Type III: width 4.1 mm, length 10 mm; Type IV: width 4.5 mm, length 8 mm, Nucleoss, İzmir, Turkey]. Recipient areas included past and new extraction sites (83 past and 44 new extractions areas). Dental implants were fixed using manual torque ratchets, and initial stability was clinically assessed.

The flap was repositioned and sutured around the dental implants. The specific transducer for the implant system was connected to the implant body by means of a mucosal abutment using a screw. For each implant, ISQ readings were taken 4, 8, and 12 weeks after surgery. The ISQ measurements were taken separately by two dentists. Two ISQ measurements were taken of the maxilla, one in the mesiodistal (M-D) direction and one in the buccopalatal (BP) direction, two measurements were taken of the mandible, one in the M-D direction and one in the buccolingual (BL) direction [Figure 1]. No implants were loaded immediately or early. The data were analyzed for implant type, anatomical location, and implant length and width.
Figure 1: (a) ISQ measurements in the maxilla in the mesio-distal(M-D) direction. (b) ISQ measurements in the maxilla buccopalatal(B-P) direction

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Statistical analysis

The strength of the study was calculated as 80% in dental implant osseointegration RFA method. The effect size was 0.5 and the α value was taken as 0.05. Sample size estimation was performed by using G*Power (Franz Faul, University of Kiel, Kiel, Germany) version 3.1.9.2. The total number of samples was determined as 106. Every implant type was analyzed individually using nonparametric methods. The differences between the implants (maxilla vs. mandible) were evaluated using the Mann–Whitney U statistical test. The differences between the implant types were evaluated using the Kruskal–Wallis-H test. All P values were adjusted using the Holm-Bonferroni step-down method.


  Results Top


Surgical procedures were completed without complications, and ISQ readings were taken without causing patient discomfort [Figure 1]. Of the 127 implants, 124 were clinically stable at the end the healing time. Three badly integrated implants were identified in three different patients. These three implants had ISQ values of <40 and were considered unsuccessful. The ISQ values of the clinically stable implants were analyzed separately for different anatomical locations at different healing times.

Of the 36 patients, 19 were female, 17 were male, and the average age was calculated as 48.21 years. In the 4th week, the average ISQ value was 72.37, and the standard deviation was 4.634 in the M-D direction. In the 8th week, the average ISQ value was 76.23, and the standard deviation was 3.006 in the M-D direction. In the 12th week, the average ISQ value was 78.44, and the standard deviation was 1.763 in the M-D direction [Table 1].
Table 1: Age and the implant stability quotient values (4 weeks, 8 weeks, and 12 weeks)

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In the 4th week, the average ISQ value was 69.20, and the standard deviation was 6.387 in the B-LP direction. In the 8th week, the average ISQ value was 74.20, and the standard deviation was 3.183 in the B-LP direction in the 12th week, the average ISQ value was 77.05, and the standard deviation was 2.044 in the B-LP direction [Table 1].

Of the 124 implants, 33.1% were applied to the maxilla and 66.9% were to the mandible. 29.8% Type I, 39.5% Type II, 14.5% Type III, and 16.2% Type IV implants were identified.

Statistical analysis showed that the ISQ values taken from the mandible region were higher than those obtained from the maxilla region at 4, 8, and 12 weeks. These values were also found to be statistically significant (Mann–Whitney statistical test, P < 0.05) [Table 2].
Table 2: The implant stability quotient values by location (maxilla, mandible)

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Statistical analysis of the ISQ values for the M-D direction in the 4th week showed a statistically significant difference between Type I implants and Type IV implants (Kruskal–Wallis-H test, P < 0.001). Statistically significant differences were also found between Types II and IV (P < 0.001) and Types III and IV (P = 0.07). Statistical analysis of the ISQ values for the B-LP direction in the fourth week showed a statistically significant difference between Types I and III (Kruskal–Wallis-H test, P = 0.005). Types I and IV (P = 0.002), Types II and III (P = 0.04), and Types II and IV (P < 0.001) [Table 3].
Table 3: Implant stability quotient values and P values according to the implant type

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Statistical analysis of the ISQ values for the M-D direction in the 8th week showed a statistically significant difference between Types II and IV (Kruskal–Wallis-H test, P < 0.001) and Types III and IV (P < 0.05). The analysis of the ISQ values for the B-LP direction in the 8th week showed no statistically significant difference between any of the implant types (Kruskal–Wallis-H test, P = 0.106) [Table 3].

Statistical analysis of the ISQ values for the M-D direction in the 12th week showed a statistically significant difference between Types II and IV (Kruskal-Wallis-H test, P < 0.001), whereas analysis of the ISQ values for the B-LP direction in the 12th week showed no statistically significant differences between any of the implants types (Kruskal–Wallis-H test, P = 0.162) [Table 3].


  Discussion Top


An atraumatic technique is needed to measure early and late stability changes in the dental implants.[12] Therefore, we used RFA the most important feature of which is that it is atraumatic. This means that measurements could be taken at different times to obtain information about implant stability without damaging the bone–implant connection, which would have affected the stability of the implant.[12] Gupta et al. reported that implant stability quotient (ISQ) is a noninvasive and effective method.[13] Kästel et al. they have worked to ensure that the ISQ values are determined objectively and reliably and have measured in both mesial and buccal directions.[14]

In our study, we examined bone-dental implant stability methods and used the RFA method. Since it was atraumatic, we were able to evaluate the stability of dental implants at different times without affecting the stability of the implant.

This high precision clinical diagnostic tool enables the detection of early healing changes and dental implants stability, and is being used more frequently due to increases in emergency and early loading situations. The development of such a clinical tool based on measurements of the resonance frequency of a small transducer connected to an implant armature allows us to compare the implant–bone interface at different stages of wound healing.[15],[16],[17],[18]

For our study, we divided the implants into four types according to their lengths and widths and used RFA to evaluate the differences between ISQ values in the 4th, 8th, and 12th weeks for both the B-LP and M-D direction.

A dental implant successfully undergoes osseointegration, when there is direct contact between the alveolar bone and the titanium surface of the implant without the presence of fibrous tissue.[19] Some studies have shown a correlation between bone trabecular structural parameters and dental implant stability.[20] However, the effect of high mechanical quality on implant stability is subject to debate as the former does not indicate a high potential for biological integration and can also be a stress factor.[21] On this issue, there is a general consensus among researchers that certain risk factors predispose individuals to more complications and implant failures, which can result in lower implant survival rates. Various local, systemic, and environmental conditions might account for this, including bone site healing status, periodontal disease, smoking, diabetes, bruxism, and surgical and prosthetic variables.[22],[23]

Several periodontal parameters were analyzed to confirm whether the implant geometry and surface structure had any effect the periodontal condition of the area surrounding the implant. The alveolar bone level of each group was measured, and the levels were compared.[24] The relationship between long implants and successful osseointegration is not only related to the crestal bone interface, initial stability and the total area of the bone-implant interface are also important. Long implants can better tolerate the forces they may be subject to after loading.[25] The results of clinical studies should be carefully evaluated because as several factors can affect the resonance frequency of dental implants, including the true height of the alveolar bone surrounding the implant and the width and density of the bone.[4] Guljé et al. found a 97% survival rate for short implants after 1-year, while the survival rate of longer implants was 99%.[26] Esposito et al. studied block implants and short implants placed in maxillary sinus augmentation areas and reported a 92% survival rate for longer implants.[27] Rossi et al. conducted a 5-year study and found that shorter implants had a lower survival rates (86.7%) than longer implants (96.7%).[28]

A comparison of the ISQ values of implant types I and II, which were the same width, showed that the ISQ values of implant Type I, which was 12 mm in length were higher than the ISQ values of implant Type II, which was 10 mm in length at 4, 8, and 12 weeks. However, the difference was not statistically significant (P > 0.05). A comparison of the ISQ values of Types II and III, which were the same implant length, at 4 weeks showed that, the B-LP ISQ values were higher than the Type II implants with a width of 4.1 mm and a the Type III implants with 3.5 mm width. This difference was statistically significant (P < 0.05). Therefore, we propose that the widths and lengths of implants play an important role in ISQ values.

The structural features of the bone are associated with mechanical loading stimulations caused by chewing forces. The lower jaw typically has more compact trabeculae than the upper jaw.[19] The results of this study were compatible with several histological studies in which the ISQ readings obtained in the early stages of osseointegration showed higher implant stability in the mandible than in the maxilla.[29],[30],[31] These data also support the results of clinical trials on high mandibular implant survival.[32],[33],[34]

In our study, implants were compared according to the region in which they were installed. Consistent with other studies, we found that implants installed in the mandible had higher ISQ values than those installed in the maxilla at 4, 8, and 12 weeks. This difference was statistically significant (P < 0.05). The ISQ values were higher in the mandible than the maxilla because the maxilla is more trabecular than the mandible and the bone density of the mandible is higher than the maxilla. Thus, we propose that bone density around the implant positively affects implant stability and ISQ values.


  Conclusion Top


Our results show that long and wide implants have higher ISQ values and stability compared to shorter and narrower implants. We also found higher values in the M-D direction compared to the BL or BP directions, and in the mandible compared to the maxilla. We propose that stability is better in places where bone density and bone thickness are higher. When we compared the effects of implant length and width on stability, we found that width had a greater effect on implant stability. In this study, it was determined that it was effective on bone thickness as well as bone density on implant stability. However, further research is needed for more precise results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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