Achieve stability to achieve success – Kate Scheer

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  Posted by: Dental Design      7th February 2018

The role of stability in achieving successful osseointegration has been well documented in recent years. Only with this biological process can professionals ensure predictable and reliable implant loading and long-term success of dental implants for long-lasting, quality results.

There are two different stages of stability: primary and secondary. Primary stability refers to the mechanical engagement of an implant with the surrounding bone, while bone regeneration and remodelling determine the secondary – or biological – stability of the implant. There are a number of factors that are known to affect primary stability, including bone quantity and quality, surgical technique and implant geometry such as length, diameter and surface characteristics. Any negative outcomes at this stage may have a knock-on effect, as the secondary stability is ultimately determined by the results of the primary stability. For this reason, continuous monitoring and regular assessment of the primary stability are absolutely essential, whatever the circumstances of the case.

With that being said, there are some situations in which measuring the implant stability at different time-points is more pertinent to the overall outcome than others. For immediate loading, for instance, there has to be consistently high implant stability measurements in order for the treatment to be successful. Where there isn’t sufficient stability, any attempt to carry out immediate implant placement will be compromised.

Only with objective measurements can clinicians accurately determine the optimal time to load an implant and ensure the right decision is made with each and every case. This not only helps to improve the likelihood of long-term success for the patient, but also demonstrates to the patient that all possible treatment pathways have been evaluated using measurable values as opposed to subjective judgements. What’s more, should any problems occur later on down the line or if the implant subsequently fails, the evidence is there to support any action taken and could prove useful in locating the source of the issue. Likewise, being able to show patients implant stability measurements can be a great educational tool in helping them to understand the decision process behind their treatment. This is especially true in situations where a patient may be keen to undergo immediate placement before sufficient primary stability has been achieved.

There are a number of different methods in which clinicians can assess primary implant stability, some of which are considered by experts to be more destructive than others. One of the more invasive techniques is histomorphometric analysis, which is where calculations of peri-implant bone quantity and bone-implant contact is obtained through a dyed specimen of the implant and peri-implant bone. Tensional testing, push-out/pull-out testing and removal torque analysis are also defined as destructive, and as such their clinical usage is limited.[i]

Instead, methods that are regarded as non-invasive are preferred – though some more than others. Indeed, as has already been established relying on nothing more than perception is not always the most effective technique, as it’s difficult to provide evidence should a problem arise. What’s more, these calculations can only be made once the implant is inserted, not before loading the implant.i Still, an experienced clinician’s opinion and skill should always be taken into consideration.

Imaging techniques are widely used to assess quantity and quality of the jawbone, but research shows that there are limitations in making an accurate assessment of implant stability and assessing facial bone level. The same goes for cutting torque resistance analysis, which can be useful in determining an optimal healing period, but is sometimes unsuitable for providing information on bone quality until the osteotomy site is prepared. Other methods include modal analysis, reverse torque test and percussion test, though the two procedures that are typically employed in practice are periotest and resonance frequency analysis.i Periotest uses an electro-magnetically driven and electronically controlled tapping metallic rod in a handpiece to measure the reaction of the peri-implant tissues to a defined impact load. Some research indicates, however, that the reliability of this method is debatable due to poor sensitivity, lack of resolution and susceptibility to operator variables.[ii]

Out of all the methods available, resonance frequency analysis is perhaps one of the most widely used, and has been shown to be a reliable tool for identifying implant stability.[iii] It uses vibration and a principle of structural analysis to measure the resonance frequency of a transductor attached to the implant body, and has a display panel to show the implant stability quotient (a measurement of the firmness at the implant-tissue interface).

The Implantmed Sl-1023 with Osstell ISQ module by leading manufacturer, W&H, is now available to clinicians looking to enhance their implant workflow and improve primary stability outcomes. Having recently earned the prestigious Red Dot Design Award 2017, W&H’s Implantmed is an ideal solution for any practitioner looking to offer quality implant outcomes to patients.

Implant primary stability is integral to the overall result of any dental implant. To maximise your chances of success and to achieve safer, more reliable results, be sure to equip yourself with the best possible tools.


To find out more visit, call 01727 874990 or email






[i] Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc. 2016; 16 (2): 124-130. Accessed online November 2017 at

[ii] Salvi GE, Lang NP. Diagnostic parameters for monitoring peri-implant conditions. Int J Oral Maxillofac Implants. 2004; 19(SUPPL):116-27. Accessed online November 2017 at file:///Users/officeone/Downloads/Group4-article01.pdf

[iii] Sul YT, Johansson CB, Jeong Y, Wennerberg A, Albrektsson T. Resonance frequency and removal torque analysis of implants with turned and anodized surface oxides. Clin Oral Implants Res. 2002 Jun;13(3):252–259. Accessed online November 2017 at


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