Kate Scheer considers how to ensure successful osseointegration.
The success of dental implant treatment can be affected by various elements – including both the patient’s oral and general health. The health of the bone and soft tissues can also impact the success of osseointegration, as well as the properties of the implant surface itself. This is of particular concern when patients are considered high risk. Should this be the case, it is important that the clinician is able to accurately monitor the progress of osseointegration, and assess implant stability to maximise treatment success. Because there are a number of factors which can impact the success of implant treatment, it is useful to have the right equipment available to do this, allowing the clinician to accurately judge when the implant is ready to be loaded.
How surface properties impact osseointegration
There are a number of factors which can have an effect on the success of osseointegration, one of these being the surface texture and material of the implant itself. The implant surface is in direct contact with the biological tissues, having an influence on the response and interaction they have. A textured surface, for example, increases the surface area of the implant. This helps to distribute stress more effectively, increasing the contact with the bone. Sometimes, surface properties can also stimulate bone growth. This can have a positive impact on osseointegration, going on to improve implant stability and result in more successful dental implant treatment.
Surface modifications may include blasting, acid etching, anodic oxidation, fluoride treatment, and calcium phosphate coatings. These aim to change the topography and chemistry of implant surfaces, to encourage stronger and faster osseointegration when compared to standard titanium surfaces. To ensure successful osseointegration, and therefore functional dental implants, it is important to achieve primary stability.
The challenges of measuring osseointegration
When an implant is stable, it is not clinically mobile. Primary stability is dependent on the implant used, the placement technique used, and the quality of the bone at the implant site. In the past, implant stability has been measured using various methods including push out/pull out test, cutting torque resistance analysis, reverse torque tests, and percussion tests. However, these methods present challenges as, not only do they fail to provide an accurate measurement of osseointegration progress, but they are also categorised as destructive methods, and should not be used to measure osseointegration in a clinical setting.
The tests aim to assess implant mobility and are used to determine if the procedure has been a success. While they will give the clinician an indication, the results of these more basic tests are not accurate and may lead to a false prognosis. Because of this, it is important to implement reliable, non-destructive analysis tools to produce an accurate result.
The right equipment for accurate measurement
The ability to correctly determine implant stability and osseointegration is fundamental for a successful treatment outcome. This cannot be accurately assessed using destructive methods including torque and percussion tests. Instead, non-invasive and non-destructive methods should be used, including CT and CBCT imaging, and resonance frequency analysis (RFA). RFA analyses the implant site, and produces a measurement of the level of implant stability known as its implant stability quotient (ISQ). The scale ranges from one to 100 with higher values indicating implant stability. Generally, implants which are clinically stable will produce ISQ values between 40 and 80.
To carry out resonance frequency analysis, it is important to use the appropriate equipment to evaluate with accuracy. The Osstell Beacon, from W&H, produces results within a matter of seconds, showing clinicians when an implant is successfully osseointegrated, and can therefore be loaded. The Osstell Beacon helps the clinician to determine implant stability objectively and to assess the progress of osseointegration, without jeopardising the healing process. It allows the avoidance of long treatment times, improving healing and ensuring the achievement of predictable results.
Additionally, because the Osstell Beacon operates wirelessly, it offers excellent freedom of movement. Data captured using the Osstell Beacon can be stored safely and compared on the Osstell Connect platform.
When it comes to high-risk patients, it is important to do everything possible to maximise the success of dental implant treatment. This means ensuring patients understand how best to maintain their oral health, and that the implants selected are appropriate for the individual case. By doing this, good primary stability is encouraged, as well as successful osseointegration and functional dental implants. Ensuring accuracy is crucial when measuring this, as implant stability will determine how and when clinicians choose to progress with treatment and loading, so it is important that implants are stable prior to this.