Ready to load?

The only objective guide when to load

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Evolving implant treatment scenarios

The importance of implant stability

What used to be a select treatment for the fewis rapidly becoming common day practice,available to more patients. Thanks to the de-velopment of methods and components, pa-tients who used to be turned away can now betreated. New protocols for treatment coincidewith the increasing demand for early function.

Clinicians, as providers of implant treatment,are faced with the question whether thesechanges represent a risk or an opportunity.

Some issues have become more obvious to-day than before:

• When to load your implants?

• How to predict and avoid potential failures?

Clinicians need to avoid the risk of failure byearly loading in inappropriate cases. It is ofequal importance that patients are providedwith the most effective, efficient and least in-vasive treatment in the minimum time. Recentdata on immediate and early loading chal-lenges traditional protocols. The trend is defi-nitely away from a static protocol to a moreindividualised treatment!

Long-term experience in using osseointegratedimplants for rehabilitation of edentulous pa-tients shows that high success rates can beachieved (Esposito et al 2000). The most im-portant prerequisite is achievement and main-tenance of implant stability. Recently it hasbeen demonstrated that implants having highprimary stability can be subjected to imme-diate/early loading, with predictable results(Brånemark et al 1999, Ericsson et al 2000).

The use of Osstell™ provides a way to clini-cally measure implant stability and osseo-integration (Meredith 1997). Recent findingswith Osstell™ shows that it can be used as adiagnostic method to optimise implant treat-ment with regard to healing periods, type ofprosthetic construction and surgical protocol(1 vs. 2 stage). Moreover, since measurementscan be repeated over time, changes in implantstability during loading can be monitored. Im-plants exhibiting a decrease in stability, possi-bly due to overloading, can be detected andrescued prior to failure.

How to use the Osstell™ mentor ISQ-value

Implant stability is measured by using the in-strument together with the wireless Smartpeg™

attached to an implant or abutment. The tech-nique is contactless, totally non-invasive andpatients experience no sensation from themeasurement, which takes 1-2 seconds. Sta-bility is displayed as an ISQ-value by the in-strument. This value (Implant Stability Quo-tient) is derived from the resonance frequencyof the peg, which in turn depends on the sta-bility of the implant. ISQ is scaled from 1 to100; the higher the ISQ, the more stable theimplant.

Stability can be measured at placement andalso at any time during healing to determine ifbone formation and remodelling is progress-ing as expected. The ISQ value can be usedto support treatment decisions during implantcare.

At placementKnowledge about the initial stability is impor-tant when making decisions regarding;

• Whether or not to restore the implant?

• Treatment protocol; immediate, early ordelayed loading?

In addition the initial ISQ value will serve as abaseline enabling assessment of osseointe-gration and bone formation over time. If thereis a change in bone height or stiffness therewill be a corresponding change in the ISQ.

Before loadingIf a 2-stage procedure is chosen, the ISQ valuecan be measured at placement and again be-fore loading, facilitating decisions regarding:

• Temporisation?

• Modified prosthetic construction?

• Wait and remeasure?

After loadingIf a screw retained prosthesis is used it ispossible to re-measure at any time after load-ing. The technique is very sensitive to long-term changes in marginal bone height or sta-bility.

Osstell™ mentor– a guide to:

• When to load

• Early warning

• Quality assurance

Integration Diagnostics AB, Gamlestadsvägen 3B, SE-415 02 Göteborg, SwedenTel +46 31 340 82 50. Fax +46 31 41 31 15.

www.osstell.com

2501

5 G

B-2

200

5.12

Osstell™ mentor, version 2

Instrument KitThe instrument is compact, hand held and easyto use. Measurement results are displayed,stored in memory and can also be transferredto a computer via the optional Docking Stationand the Data Manager. It operates from a re-chargeable battery, and is delivered with ameasurement probe, mains plug, test blockand manuals.(Order no 100300)

Docking Station KitThe Docking Station is the communication unitfor your PC when using the Data Manager forstoring measurements in your computer or toupgrade the software in the instrument. It alsoserves as a charging station and a holder forthe instrument when the measurement probeis detached from the instrument. Using theprobe separated from the instrument, togetherwith the cable, allows for sterile operation sincethe probe and the probe cable are auto-clavable.

The kit includes the Docking Station, Probecable and the USB cable.(Order no 100303)

Smartpeg™

The Smartpeg is attached to the implantor abutment when a measurement ismade. It is easy to mount and due tothe small size the space required is mini-mal. Smartpegs are available for majorimplant systems. They are single use,and delivered sterile.(Order no, see separate Smartpeg™ list)

ReferencesResonance Frequency Measurement of Implant Stability In Vivo on Implants with a Sandblasted and Acid-Etched Surface, Journal ofOral & Maxillofacial Implants, 2003, vol 18, 641-651, Barewal R M, Oates T, Meredith N, Cochran D L.Analisi della Frequenza di Risonanza (RFA), Osteointegrazione e carico immediato 2002;19-32. Sennerby L, Meredith N.The application of resonance frequency measurements to study the stability of titanium implants during healing in the rabbit tibia.Clin Oral Implants Res. 1977 Jun;8(3): 234-43. Meredith N, Shagaldi F, Alleyne D, Sennerby L, Cawley P.Evaluation of implant stability by resonance frequency analysis. STARGET 1.2003. Schubert H, Schubert T.Primary Implant Stability Diagnostics with Resonance Frequency Analysis. Poster EAO Vienna 2003. Keen D S, Jovanovic S, Bernard W.Teeth now – A concept for immediate prosthetic rehabilitation. Poster San Diego 2003. Östman P O, Hellman M, Sennerby L.

For additional information about Osstell™ mentor, supported implant systems, references and more, see our web site: www.osstell.com

• Four times faster • More resistant to electromagnetic noise

• No pulsing beeps (optional) • Data Manager compatible*

Data Manager*The Data Manager is a PC-based software,which allows measure-ments to be transferred toa computer (DockingStation required).(Order no 100304)