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    Ask the expert! Dr. Barry Levin answers your questions.

    [fa icon="calendar"] Oct 24, 2019 9:18:05 AM / by Osstell

    Barry Levin

    Over 400 clinicians from all over the world participated to Osstell Scientific Symposium at EAO Congress 2019 in Lisbon, on September 26th 2019. Dr. Barry Levin was one of four renowned speakers. He answered numerous questions from the audience about his use of Osstell in his daily practice after his lecture entitled "Post-extraction implants, Insertion Torque Value (ITV) & ISQ. How to value each measurement and when to restore implants in immediate and grafted sites" featuring clinical cases from his private practice, supported by clinical studies performed by him.

    Would you also like to ask questions to Dr. Barry Levin? Comment at the bottom of the page, he will answer you!

     

    What protocol do you use for patients using biphosphonates?  When to place implant and when not?

    Dr. Barry Levin: No set protocol.  I factor the patient’s entire health history. This includes duration taking a bisphosphonate, other meds. Overall health. With high risk patients, I usually incorporate growth factors and more staged approaches to implant treatment. In patients on IV bisphosphonates, particularly long-term, I may not perform any surgical procedures and recommend endodontic therapy and non-surgical periodontal treatments to allow these high risk patients to maintain their natural dentition if possible.

     

    How was the original tooth fixed to the abutment when used as a provisional?

    Dr. Barry Levin: I always use screw-retention for provisional restorations. NEVER cement. I do not use the original teeth because as a periodontist, it is more practical to fabricate a temporary crown with a temporary abutment and bis-acryl and flowable composite resin. For immediate-temporization cases, cement can complicate early healing either biologically as an irritant or mechanically if multiple manipulations to re-cement crowns during the osseointegration period is required. With sub-crestal, angle correction implants, palatal screw-retention is predictable, esthetic and less time-consuming than masking a facial screw-access channel.

    This case was presented by Dr. Barry Levin during his lecture at the Osstell Scientific Symposium at the EAO Congress. Watch it here.

     

    Do you combine the ISQ measure with other measures such as insertion torque when deciding on whether to do a provisional or not?

    Dr. Barry Levin: I combine both ISQ and ITV.  My threshold for ITV is normally at 20 Ncm. This is based on the 2016 study published in IJPRD.  Multiple factors, such as ISQ, ITV, occlusion, compliance, etc are all crucial.

    You can read the full article on The International Journal of Periodontics & Restorative Dentistry.

     

    Bone lost in the case with 50 N, do you make a flap or not? Do you consider it to be important with the flap in the  preservation of crestal bone?

    Dr. Barry Levin: I think this can be of consequence. Normally a flap is elevated and I factor about 0.5mm of crestal bone loss into that situation, placing the implant slightly subcrestal. With guided or navigational surgery, this can be avoided, but I still believe the crestal bone is vulnerable to necrosis due to excessive pressure when seating an implant requires higher ITV in healed sites.

    This case was presented by Dr. Barry Levin during his lecture at the Osstell Scientific Symposium at the EAO Congress. Watch it here.

     

    Why in your opinion is it that there is no relation between the ISQ and the insertion torque?

    Dr. Barry Levin: This is based on the 2016 study, where in immediate, non-molar sites, there was no statistically significant correlation determined. In grafted sites, we were still unable to demonstrate a strong significant correlation.  In healed sites, the literature is inconclusive regarding this question.  Most consensus papers fail to substantiate a strong correlation.

    Read more about The Correlation Between Immediate Implant Insertion Torque and Implant Stability Quotient, by Dr. Barry Levin.

     

    What is your opinion on zirconia implants? Is only aesthethic value the winning factor or does the ISQ values differ?

    Dr. Barry Levin: I have no experience with zirconia implants. I am not sure what the long-term rewards will be compared to the long-term complications we are yet to see reported. If adequate facial bone and soft tissue thickness exists with proper surgical and prosthetic technique, ceramic abutments traverse the supracrestal, submucosal space, which in my opinion, circumvent the need for these implants until more long term research supports their routine applications.

     

    Is it mandatory to remove the implant if the ISQ decreases at 3 months?

    Dr. Barry Levin: I would treat these cases on an individual basis. If a 3 month “dip” is significant and the implant appears mobile, I would probably remove the implant. If the “dip” is small &/or there is no perceived mobility or bone loss, I probably will exercise patience before removing the implant.

     

    What's your opinion about using Osstell in Basal one piece implants?

    Dr. Barry Levin: I don’t see a disadvantage of incorporating ISQ into this protocol.  Stability is still a requirement for successful osseointegration, regardless of position in the jaws. Having a baseline measurement can allow clinicians to make more informed decisions pertaining to loading and progress of integration. I would recommend this.

     

    What difference  should I expect when measuring on implant level compared to multi unit level?

    Dr. Barry Levin: I think the values may differ from implant level to abutment level. However, acquiring the baseline value serves the purpose of facilitating comparisons between different time points in treatment &/or maintenance. 

     

    Watch Dr. Barry Levin's lecture

     

    Barry Levin

     

    Thank you everyone joining us at the Osstell Scientific Symposium. See you next year in Berlin!

     

     

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    Topics: loading protocol, isq, implant loading, primary stability, EAO, immediate loading, secondary stability, implant stability, risk patient, implant complication, healing time, implant placement

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