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      Evaluation of the correlation between insertion torque and primary stability of dental implants using a block bone test

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          Abstract

          Purpose

          Implant stability at the time of surgery is crucial for the long-term success of dental implants. Primary stability is considered of paramount importance to achieve osseointegration. The purpose of the present study was to investigate the correlation between the insertion torque and primary stability of dental implants using artificial bone blocks with different bone densities and compositions to mimic different circumstances that are encountered in routine daily clinical settings.

          Methods

          In order to validate the objectives, various sized holes were made in bone blocks with different bone densities (#10, #20, #30, #40, and #50) using a surgical drill and insertion torque together with implant stability quotient (ISQ) values that were measured using the Osstell Mentor. The experimental groups under evaluation were subdivided into 5 subgroups according to the circumstances.

          Results

          In group 1, the mean insertion torque and ISQ values increased as the density of the bone blocks increased. For group 2, the mean insertion torque values decreased as the final drill size expanded, but this was not the case for the ISQ values. The mean insertion torque values in group 3 increased with the thickness of the cortical bone, and the same was true for the ISQ values. For group 4, the mean insertion torque values increased as the cancellous bone density increased, but the correlation with the ISQ values was weak. Finally, in group 5, the mean insertion torque decreased as the final drill size increased, but the correlation with the ISQ value was weak.

          Conclusions

          Within the limitations of the study, it was concluded that primary stability does not simply depend on the insertion torque, but also on the bone quality.

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          Most cited references32

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          Implant stability measurement of delayed and immediately loaded implants during healing.

          The purpose of the present study was (1) to measure the primary stability of ITI implants placed in both jaws and determine the factors that affect the implant stability quotient (ISQ) determined by the resonance frequency method and (2) to monitor implant stability during the first 3 months of healing and evaluate any difference between immediately loaded (IL) implants and standard delayed loaded (DL) implants. The IL and DL groups consisted of 18 patients/63 implants and 18 patients/43 implants. IL implants were loaded after 2 days; DL implants were left to heal according to the one-stage procedure. The ISQ was recorded with an Osstell apparatus (Integration Diagnostics AB, Gothenburg, Sweden) at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. Primary stability was affected by the jaw and the bone type. The ISQ was higher in the mandible (59.8+/-6.7) than the maxilla (55.0+/-6.8). The ISQ was significantly higher in type I bone (62.8+/-7.2) than in type III bone (56.0+/-7.8). The implant position, implant length, implant diameter and implant deepening (esthetic plus implants) did not affect primary stability. After 3 months, the gain in stability was higher in the mandible than in the maxilla. The influence of bone type was leveled off and bone quality did not affect implant stability. The resonance-frequency analysis method did not reveal any difference in implant stability between the IL and DL implants over the healing period. Implant stability remained constant or increased slightly during the first 4-6 weeks and then increased more markedly. One DL and IL implant failed; both were 8 mm long placed in type III bone. At the 1-year control, the survival rate of the IL and the DL implants was 98.4% and 97.7%, respectively. This study showed no difference in implant stability between the IL and DL procedures over the first 3 months. IL short-span bridges placed in the posterior region and full arch rehabilitation of the maxilla with ITI sandblasted-and-etched implants were highly predictable.
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            Predicting osseointegration by means of implant primary stability.

            The purpose of the present clinical study was (1) to evaluate the Osstell as a diagnostic tool capable of differentiating between stable and mobile ITI implants, (2) to evaluate a cut-off threshold implant stability quotient (ISQ) value obtained at implant placement (ISQitv) that might be predictive of osseointegration, (3) to compare the predictive ISQitv of immediately loaded (IL) implants and implants loaded after 3 months (DL). Two patient groups were enrolled, 18 patients received 63 IL implants and 18 patients were treated with 43 DL implants. The ISQ was recorded at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. All implants passed the 1-year loading control. Two implants failed, one DL implant with ISQ at placement (ISQi) of 48 and one IL implant with ISQi of 53. The resonance-frequency analysis (RFA) method was not a reliable diagnostic tool to identify mobile implants. However, implant stability could be reliably determined for implants displaying an ISQ> or =47. After 1 year of loading, all DL implants with an ISQi> or =49 and all IL implants with an ISQi> or =54 achieved and maintained osseointegration. By the end of 3 months, implants with ISQi 69 had their stability decrease during the first 4 weeks before remaining stable. Although preliminary, these data might orient the practitioner to choose among various loading protocols and to selectively monitor implants during the healing phase.
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              Optimal implant stabilization in low density bone.

              Initial stability of the implant is one of the fundamental criteria for obtaining osseointegration. An adequate primary anchorage is often difficult to achieve in low density bone (type IV). Various surgical suggestions were advanced in the 1980s which were aimed at achieving optimal osseous integration in poor quality bone. They offered satisfactory short-term results. Recently, as a result of surgical and technological innovations, new therapeutic proposals have shown very interesting results in their initial studies.
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                Author and article information

                Journal
                J Periodontal Implant Sci
                J Periodontal Implant Sci
                JPIS
                Journal of Periodontal & Implant Science
                Korean Academy of Periodontology
                2093-2278
                2093-2286
                February 2013
                28 February 2013
                : 43
                : 1
                : 30-36
                Affiliations
                [1 ]Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea.
                [2 ]Implant R&D Center, Osstem Implant Co., Busan, Korea.
                [3 ]Dental Clinic, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
                Author notes
                Correspondence: Ki-Tae Koo. Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. periokoo@ 123456snu.ac.kr , Tel: +82-2-2072-0108, Fax: +82-2-744-0051
                Article
                10.5051/jpis.2013.43.1.30
                3596632
                23508040
                bde9086a-a3fa-4fe1-9698-ca54eee97473
                Copyright © 2013 Korean Academy of Periodontology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/).

                History
                : 17 December 2012
                : 18 January 2013
                Categories
                Research Article

                Dentistry
                bone density,dental implants,torque
                Dentistry
                bone density, dental implants, torque

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