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    Primary and Secondary Stability: What is Important and What Don’t We Know

    [fa icon="calendar"] Jul 3, 2018 2:25:05 PM / by Barry P. Levin, DMD

    Physiologic healing after implant placement varies from patient to patient and site to site. Surgeons must find balance between mechanical stability and avoiding excessive trauma to alveolar bone, especially the cortical bone found at the alveolar crest. The two measures of quantifying primary stability are insertion torque volume (ITV) and resonance frequency analysis (RFA). Implant stability quotient or ISQ is a value used to determine stability via RFA.

    Both parameters are accurate measures of rotational and axial stability, respectively, though only one (RFA) is repeatable. The comfort of achieving high insertion torque may be unfounded. High insertion torque can lead clinicians to believe implants can be loaded immediately. When cortical bone at the crest is over-compressed, it resorbs, leading to bone loss, deep probing depths and susceptibility to peri-implantitis. RFA to assess stability is accurate, and may not be correlated to ITV (Levin) It may also be repeated at future treatment times to evaluate increased or decreased stability.


    Primary and Secondary Stability. What is Important and What Don’t We Know

    Recommendations by some, that arbitrary ITV’s are necessary to temporize or load immediately placed implants is largely unsupported in the literature. Norton found implants placed with insertion torque values well-below some of these recommended values can receive temporary crowns, out of occlusal contact, at time of surgery. Other studies have also found that ITVs around 20 Ncm are not correlated to ISQ values and many patients receiving immediate provisionals would not be afforded this option, resulting in removable or adhesive temporary restorations. Using Osstell ISQ as a primary measure of stability is not only useful but repeatable. Implants temporized at time of placement can be evaluated at various post-operative times to determine when “secondary stability” or osseointegration occurs, and final crowns can be placed.



    Norton MR Influence of insertion torque on the survival of immediately placed and restored single-tooth implants. Int J Oral Maxillofac Implants 2011;26:1333-1343.

    Levin, BP The Correlation Between Immediate Implant Insertion Torque and Implant Stability Quotient. Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):833-840. doi: 10.11607/prd.2865.


    More about primary and secondary stability on Osstell Blog: Why secondary stability is crucial for successful implant treatments, with Dr Stephen Jacobs.

    Download the implant stability ebook:

    Osstell ISQ Implant Stability Ebook 


    Topics: isq, primary stability, Immediate Implant Insertion Torque, insertion torque, secondary stability, osseointegration, implant stability, healing time

    Barry P. Levin, DMD

    Written by Barry P. Levin, DMD

    Barry P. Levin, D.M.D. is a Diplomate of The American Board of Periodontology. A graduate of Temple University School of Dental Medicine, he earned his certificate in Periodontics from the University of Maryland. Dr. Levin has been on staff at the University of Pennsylvania-Periodontal and Dental Implant Surgery Department since 1996. Dr. Levin publishes and lectures both nationally and internationally on topics pertaining to dental implantology and periodontics and has been involved in research pertaining to new and advanced dental implant designs and bone regenerative materials.

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