• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.8.1-8.6
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• 2018

Background: This study was to evaluate the effect of bone graft procedure on the primary stability of implants installed in fresh sockets and assess the vertical alteration of peri-implant bone radiographically. Methods: Twenty-three implants were inserted in 18 patients immediately after tooth extraction. The horizontal gap between the implant and bony walls of the extraction socket was grafted with xenografts. The implant stability before and after graft procedure was measured by Osstell Mentor as implant stability quotient before bone graft (ISQ bbg) and implant stability quotient after bone graft (ISQ abg). Peri-apical radiographs were taken to measure peri-implant bone change immediately after implant surgery and 12 months after implant placement. Data were analyzed by independent t test; the relationships between stability parameters (insertion torque value (ITV), ISQ abg, and ISQ bbg) and peri-implant bone changes were analyzed according to Pearson correlation coefficients. Results: The increase of ISQ in low primary stability group (LPSG) was 6.87 ± 3.62, which was significantly higher than the increase in high primary stability group (HPSG). A significant correlation between ITV and ISQ bbg (R = 0.606, P = 0.002) was found; however, age and peri-implant bone change were not found significantly related to implant stability parameters. It was presented that there were no significant peri-implant bone changes at 1 year after bone graft surgery. Conclusions: Bone graft procedure is beneficial for increasing the primary stability of immediately placed implants, especially when the ISQ of implants is below 65 and that bone grafts have some effects on peri-implant bone maintenance.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.1
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• pp.29-33
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• 2019

Objectives: Bone density seems to be an important factor affecting implant stability. The relationship between bone density and primary and secondary stability remains under debate. The aim of this study was to compare primary and secondary stability measured by resonance frequency analysis (RFA) between different bone types and to compare implant stability at different time points during 3 months of follow-up. Materials and Methods: Our study included 65 implants (BioHorizons Implant Systems) with 3.8 or 4.6 mm diameter and 9 or 10.5 mm length in 59 patients. Bone quality was assessed by Lekholm-Zarb classification. After implant insertion, stability was measured by an Osstell device using RFA at three follow-up visits (immediately, 1 month, and 3 months after implant insertion). ANOVA test was used to compare primary and secondary stability between different bone types and between the three time points for each density type. Results: There were 9 patients in type I, 18 patients in type II, 20 patients in type III, and 12 patients in type IV. Three implants failed, 1 in type I and 2 in type IV. Stability values decreased in the first month but increased during the following two months in all bone types. Statistical analysis showed no significant difference between RFA values of different bone types at each follow-up or between stability values of each bone type at different time points. Conclusion: According to our results, implant stability was not affected by bone density. It is difficult to reach a certain conclusion about the effect of bone density on implant stability as stability is affected by numerous factors.

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.4
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• pp.292-298
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• 2012

Purpose: The purpose of this study is to ascertain the stability of the implant by comparing the effects of the change of implant diameter, length and design on implant stability quotient. Materials and methods: To remove the variable due to the difference of bone quality, the uniform density (0.48 g/$cm^3$) Polyuretane foam blocks (Sawbones$^{(R)}$, Pacific Research Laboratories Inc, Vashon, Washington) were used. Implants (Implantium$^{(R)}$, Dentium, Seoul, Korea) were placed with varying diameters (${\phi}3.8$, ${\phi}4.3$ and ${\phi}4.8$) and length (8 mm, 10 mm and 12 mm), to assess the effect on implant stability index (ISQ). Also the influence of the design of the submerged and the non-submerged (SimplelineII$^{(R)}$, Dentium, Seoul, Korea) on ISQ was evaluated. To exclude the influence of insertion torque, a total of 60 implants (n = 10) were placed with same torque to 35 N. Using Osstell$^{TM}$ mentor (Integration Diagnostic AB, Sweden) ISQ values were recorded after measuring the resonant frequency, one-way ANOVA and Tukey HSD test results were analyzed. (${\alpha}$=0.05). Results: 1. The change of the diameter of the implant did not affect the ISQ (P>.05), but the increase of implant length increased the ISQ(P<.001). 2. The change in implant design were correlated with the ISQ, and the ISQ of submerged design was significantly higher than that of the non-submerged design(P<.05). Conclusion: In order to increase implant stability, the longer implant is better to be selected, and on the same length of implant, submerged design is thought to be able to get a higher ISQ than the non-submerged.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.285-292
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• 2008

Purpose: The present study was performed to evaluate the effect of surface treatment of the cervical area of implant on bone regeneration in fresh extraction socket following implant installation. Materials and methods: The four minipigs, 18 months old and 30 kg weighted, were used. Four premolars of the left side of both the mandible and maxilla were extracted. ${\phi}$3.3 mm and 11.5 mm long US II plus implants (Osstem Implant co., Korea) with resorbable blasting media (RBM) treated surface and US II implants (Osstem Implant co., Korea) with machined surface at the top and RBM surface at lower portion were installed in the socket. Stability of the implant was measured with $Osstell^{TM}$ (Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden). After 2 months of healing, the procedures and measurement of implant stability were repeated in the right side by same method of left side. At four months after first experiment, the animals were sacrificed after measurement of stability of all implants, and biopsies were obtained. Results: Well healed soft tissue and no mobility of the implants were observed in both groups. Histologically satisfactory osseointegration of implants was observed with RBM surface, and no foreign body reaction as well as inflammatory infiltration around implant were found. Furthermore, substantial bone formation and high degree of osseointegration were exhibited at the marginal defects around the cervical area of US II plus implants. However, healing of US II implants was characterized by the incomplete bone substitution and the presence of the connective tissue zone between the implant and newly formed bone. The distance between the implant platform (P) and the most coronal level of bone-to-implant contact (B) after 2 months of healing was $2.66{\pm}0.11$ mm at US II implants group and $1.80{\pm}0.13$mm at US II plus implant group. The P-B distance after 4 months of healing was $2.29{\pm}0.13$mm at US II implants group and $1.25{\pm}0.10$mm at US II plus implants group. The difference between both groups regarding the length of P-B distance was statistically significant(p<0.05). Concerning the resonance frequency analysis (RFA) value, the stability of US II plus implants group showed relatively higher RFA value than US II implants group. Conclusion: The current results suggest that implants with rough surface at the cervical area have an advantage in process of bone regeneration on defect around implant placed in a fresh extraction socket.

• Journal of Korean Dental Science
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• v.2 no.2
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• pp.12-17
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• 2009

Purpose : To determine whether peri-implant crestal bone loss could be affected by systemic disease, primary ISQ value, implantation method (submerged vs. non-submerged), surface treatment, and bone density Materials and methods : Patients who underwent fixture installation from June 24, 2005 to October 23, 2008 at Seoul National University Bundang Hospital were evaluated. A total of 157 patients (male: 52, female: 85) had 346 fixtures installed. Among them, 49 patients had periapical radiographs taken 1 year after prostheses were first set. A total of 97 fixtures were implanted. In particular, 30 fixtures were installed in patients with systemic diseases such as diabetes mellitus, cardiovascular disease, hypertension, and liver disease. The immediate stability of implants was measured with $Osstell^{tm}$. Implant surface treatment was classified into two groups (RBM, Cellnest (Anodized)), and bone density, into four groups (D1~D4). The bone resorption on the mesial and distal areas of fixtures was measured with periapical radiographs using the paralleling technique, and the mean value was calculated. The length determination program in IMPAX (AGFA, Belgium) was used. Results : At least 332 out of 346 (96%) installed GS II implants were successfully osseointegrated 1 year after prostheses were first set. The mean value of the bone resorption of the installed GS II implants was 0.44mm. The minimum value was 0mm, and the maximum value, 2.85mm. There was a statistically significant difference between the implantation methods (submerged, non-submerged) with regard to the amount of alveolar bone loss 1 year after prostheses were first set (p<0.05). Non-submerged implants showed less crestal bone loss. Note, however, that other variables had no correlation with crestal bone loss (p>0.05). Conclusion : There was a statistically significant difference between the 1-stage method and 2-stage method with regard to the amount of alveolar bone loss 1 year after prostheses were first set. Systemic disease, primary ISQ value, surface treatment, and bone density were not associated with alveolar bone loss. Other variables were assumed to have a correlation with alveolar bone loss.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.2
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• pp.250-262
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• 2007

Statement of problem: It was reported high success rate of implant-supported fixed prostheses using with $5{\sim}6$ implants on anterior mandible. Recently, immediate loading protocol was focused to overcome disadvantages of classic 2-stage delayed loading protocol. Purpose: This clinical study was to evaluate stability changes with time of immediately loaded and delayed loaded implants in edentulous mandible and to compare stability changes with time according to implantation sites. Materials and methods: Five or six implants were placed on anterior mandible depending on the arch shape. The immediately loading group was consisted of 8 patients received their prostheses within $24{\sim}48$ hours after implantation. The delayed loading group was consisted of 8 patients received their definitive prostheses following classical prosthetic procedures after a healing period of 3 months. All patients were recalled every 6 months for check-up. The evaluations of radiographic examination, ISQ value measurement and recording of complication were done. To evaluate marginal bone level, intraoral periapical radiographs were taken with long cone paralleling technique. At every evaluation recall, all prostheses were removed and ISQ values were measured with OsstellTM on individual implants. Results: 1. None of implants was failed. All implants showed stable marginal bone levels and ISQ values. 2. Marginal bone level changes with time showed statistically significant difference between immediately loading group and delayed loading group (P<0.001). 3. ISQ value changes with time did not show statistically significant difference between immediately loading group and delayed loading group (P=0.079). ISQ value decreased with time in both groups, however, all implants showed stable ISQ value at 30 months-recall evaluation. 4. Marginal bone level changes with time did not show statistically significant differences among implantation sites (P=0.604). 5. ISQ value changes with time showed statistically significant differences among implantation sites (P=0.047). ISQ values of most posterior implants decreased with time comparing to other implants. Conclusion: Although the marginal bone level of the terminal abutment didn't different with the other implants, ISQ value of the terminal abutment was lower than that of the other implants. Therefore, further clinical evaluation would be needed in this point of view.

• Journal of Periodontal and Implant Science
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• v.43 no.1
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• pp.30-36
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• 2013

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.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.5
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• pp.644-652
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• 2007

Statement of problem: Resonance frequency analysis is evaluated as the non-invasive and objective method for the evaluation of implant stability and has been increasingly used. It is necessary to evaluate the factors affect the ISQ measurement stability. Purpose: This study was performed to evaluate the effect of the autoclave sterilization and reuse of $Smartpeg^{TM}$ on ISQ measurement. Material and methods: $SmartPeg^{TM}$ (Integration Diagnostics Ltd., $G\ddot{o}teborg$, Sweden) of autoclave group (A) was autoclave sterilized 9 times and $Smartpeg^{TM}$ of reuse group (R) was reused 9 times. Ten $SmartPeg^{TM}s$ were allocated to each group and after each autoclave sterilization and reuse, implant stability quotient (ISQ) values were measured 3 times from the two directions a and b at a right angle. $Osstell^{TM}$ mentor (Integration Diagnostics Ltd. $G\ddot{o}teborg$, Sweden) was used and type 1 (article no. 100353) $Smartpeg^{TM}$ was selected according to $Smartpeg^{TM}$ reference list. Osstem Implant US II future (Osstem Co., Seoul, Korea) in $4.0mm{\times}11.5mm$ was embedded in the self-curing acrylic resin ($Orthojet^{(R)}$, Lang Dental, U.S.A.). Data was statistically analyzed by one-way ANOVA $({\alpha}=.05)$ and scheffe test was done where a significant difference exist. Correlation test was also done between ISQ value and the number of autoclave sterilization or reuse. Results: 1. In autoclave group, the means and sd. of ISQ value before autoclave sterilization were $84.97{\pm}0.41,\;84.93{\pm}0.74$ at direction a and b. There was significant differences between autoclave groups at direction a and b (P=.000). 2. In reuse group, the means and sd. of ISQ value before reuse were $85.40{\pm}0.62,\;85.50{\pm}0.57$ at direction a and b. There was no significant difference between reuse groups at direction a and b (P>.05). 3. There was a weak positive correlation between the number of reuse and ISQ value at direction a and b (${\gamma}=.207$ and .246, P<.01). Conclusion: Within the limitations of this study, the following conclusions were drawn. Till ninth reuse of $Smartpeg^{TM}$, the ISQ measurement stability did not be affected. After twice autoclave sterilization of $Smartpeg^{TM}$ the ISQ measurement stability was affected.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.3
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• pp.362-374
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• 2007

Statement of problem. The intial stability for osseointegration of implant has been an interesting factor. Especially, in the case of poor bone quality or immediately loaded implant, various strategies have been developed focusing on the surface of materials to improve implant fixation to bone. The microscopic properties of implant surfaces play a major role in the osseous healing of dental implants. Purpose. The aims of this study are to perform a histologic and histomorphometric comparison of the healing characteristics of three different surfaces and the comparison of resonance frequency analysis (RFA) values measured by $Osstell^{TM}$ and perio-test values (PTV) measured by Periotest. Material and methods. A total of 24 screw titanium implants (Dentium Co., Seoul, Korea) with 6mm in length and 3.4mm in diameter, were placed in the mandible of 4 beagle dogs. Implants were divided into three groups following the surface treatment methods: Group I is machined(control group). Group II is anodically oxidized. Group III is coated 500nm in thickness with hydroxyapatite(HA) by ion beam assisted deposition(IBAD) on the anodized oxidization. Bone blocks from 2 dogs were caught after 3 weeks of covered healing and another blocks from 2 dogs after 6 weeks. RFA values and PTV were measured right after insertion and at 3 and 6weeks. Histomorphometric analysis was made with Kappa Image Base System to calculate bone-to-implant contact (BIC) and bone area inside the threads. Pearson's correlation analyses were performed to evaluate the correlation between RFA and PTV, BIC and bone area ratio of three different surfaces at 3 and 6 weeks. Results. 1) In all surface treatment methods, the RFA values decreased and the PTV values increased until 6 weeks in comparison to initial values. 2) At 3 weeks, no significant difference was found from bone-to-implant contact ratio and bone area ratio of three different surface treatment methods(P>0.05). However, at 6 weeks, different surface treatment methods showed significantly different bone-toimplant contact ratio and bone area ratio(P<0.05). 3) In the implants with the IBAD on the anodic oxidization, significant difference was found between the 3 weeks and the 6 weeks bone area ratio(P<0.05). 4) Correlation was found between the RFA values and the bone area ratio at 3 and 6 weeks with significant difference(P<0.05). Conclusions. These results indicate that the implants with the IBAD on the anodic oxidization may have a high influence on the initial stability of implant.

• The Journal of Korean Academy of Prosthodontics
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• v.41 no.3
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• pp.271-287
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• 2003

Statement of problem: Resonance frequency analysis (RFA) has been increasingly served as a non-invasive and objective method for clinical monitoring of implant stability. Many clinical studies must be required for standardized baseline data using RFA. Purpose: This study was performed to evaluate RFA value changes in two stage surgery group and one stage surgery group in patients. Material and method: Forty-seven mandibles in consecutively implant installed patients were selected for this study and 141 fixtures were installed. Ninety-three fixtures were double threaded, machined surface design ($Br{\aa}anemark^{(R)}$ MK III, Nobel Biocare AB, Goteborg, Sweden) and 48 fixtures were root form, threaded, HA-coated surface one ($Replace^{TM}$, Steri-Oss/Nobel Biocare AB, USA). Among those, each 10 fixture was installed in one stage group patients. ISQ values were measured using $Osstell^{TM}$ (Integration Diagnostics Ltd. Sweden) during fixture installation, at healing abutment connection and in the loading period for two stage surgery group patients and during at each 4, 6, 8, 10, 12week and in the loading phase for one stage surgery group patients and evaluated the changes according to the time and fixture type. Results: In two stage surgery group, mean and SO of ISQ values of machined surface implants were $76.85{\pm}3.74,\;75.76{\pm}5.04,\;75.73{\pm}4.41$ and those of HA-coated surface implant were $75.05{\pm}6.23,\;77.58{\pm}5.23,\;78.32{\pm}4.29$ during fixtures installation, at healing abutment connection and in the loading period, respectively. In one-stage surgery group, the ISQ values of machined surface and HA-coated surface implants decreased until 4 or 6 week and maintained at plateau for 1-3 week and increased to the loading period. Conclusions: Machined and HA-coated surface implants showed minimal ISQ changes with time if they were installed at the sites showing at least intact cortical plate and good bone qualities. And HA-coated implants had a tendency to show somewhat increased ISQ values with time.