Have you ever placed an implant in an augmented bone site and added another few months of healing time just to be on the safe side?
It has long been recognized in the dental implant literature that implant stability is a critical factor in predictable treatment outcomes. Both primary stability (mechanical stability) and stability prior to provisionalization or restoration of the implant should be considered in the individual treatment plan. The secondary (aka biological stability) will indicate the level of osseointegration when compared to the initial primary stability (mechanical stability) at placement of the implant. There are other factors, of course, to be considered but there is little disagreement in the literature that implant stability is key.
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.
Primary and secondary stability is a much discussed topic. Which one should a clinician aim for to achieve successful implant treatments? We met with Dr. Stephen Jacobs after his lecture at the AO Annual Meeting about primary and secondary implant stability to clarify things.
Could you explain the difference between primary and secondary stability?
During the twenty-two years of my clinical and scientific work with dental implants I have been a witness to huge development in the implant dentistry. Changes to implants' macro and micro design, surfaces, and surgical and prosthetic procedures that expand today's treatment with dental implants. But for me, the most impressive improvement was an implementation of resonance frequency analysis (RFA) from scientific to clinical work in implant dentistry.
Measuring ISQ has become a critical component in my implant treatment, as it provides objective information about the stability of the implants I place. Based upon the initial implant stability or ISQ value, I determine the loading protocol and timing of restoration (immediate, early, delayed).
I have been placing dental implants since 1998 and as most of you, I have seen many advances in the field of dentistry that make implant dentistry safer and more predictable. The biggest boon to treatment absolutely has to be the advent of CBCT technology. This has made the surgical phase of treatment more predictable and safer for the patient.