Dental Implant Monitoring Using Resonance Frequency Analysis (RFA) and Cone Beam Computed Tomography (CBCT) Measurement

Dental implants commonly practiced replacing edentulous teeth. However, it is still challenging to evaluate the progress of osseointegration during the healing process after implant placement. This study aims to measure the implant stability of pre- and post-crown placement to monitor osseointegration during the healing process and correlate it with the bone quality and quantity and other parameters. Resonance Frequency Analysis (RFA) method as a standard method has been used to monitor implant stability. Ten patients from Hospital Universiti Sains Malaysia have been involved with and treated by immediate implant placement procedures on their mandibular jaw system. Monitoring was also conducted by measuring the density of bone estimated based on Cone Beam Computed Tomography data. On the basis of the study, RFA and density monitoring show that there are at least three classes of patients: Class 1 are the patients who have a significant increment of implant stability; Class 2 are the patients with constant implant stability; and Class 3 are the patients who have negative implant stability progress, or their implant stability was decreasing. On the basis of the result, monitoring of implant stability by measuring the density is still challenging, the correlation between secondary implant stability and density is not significant statistically. It is recommended in future research to evaluate the implant stability by involving more patients from different races and also correlating the implant stability with the dynamic properties such as stress distribution.

CBCT; Density; Dental implant; Osseointegration; RFA

In the last decade, dental implant treatment has become more popular and it practiced protecting the remaining teeth, improving mastication, and also the appearance of the patient. The primary purposes of dental implant placement are to replace the edentulous tooth (Supriadi et al., 2015). However, a dental implant was planted not only to improve appearance, but also to improve the masticatory function and to prevent the changes of the dental arch dimension or to restore facial skeletal structure (Turkyilmaz and Mcglumphy, 2008).

Staden et al. (2006) showed that the success rate of dental implants is over 95%, and the survival rate at 15 years is about 90% (2006). However, the compatibility of the dental implant might generate some problems for a specific patient, such as in conveying the force during mastication. As the dental implant is not a natural tooth, some patients need adaptation until the jawbone system accepts the implanted biomaterial to experience more convenience. The integration of the implanted biomaterial into the jawbone system is called as osseointegration. 

During the healing process, where osseointegration is still not achieved, some problems might appear to particular patients, such as infection or mechanical problem due to an inadequate load protocol. For example, in the case where the implant is not placed correctly, or the shape of the implant is not suitable, it would not appropriately couple into the jawbone. In such a case, a space will be generated between the surface of the implant and the bone, which can be potentially used by bacteria to grow. The problem might become more severe if the daily mastication also promotes the immobility of the implant and holes. Daily mastication will also generate stress in the implant body and bone. If the generated stress is too low, the stimulus of osteoblast activity required for bone growth might also be delayed. Again, if the generated stress is too high, then the stability of the implant might be disturbed, thus affecting the osseointegration process (Chang et al., 2010). Hence, the monitoring of osseointegration becomes the most critical task, especially during the healing period, to ensure the success of implant treatment.

Implant stability as an indicator of the immobility of an implant is measured directly through clinical measurement (Rabel et al., 2007). On the basis of the occurrence, implant stability is categorized into primary implant stability, which is the stability achieved during implant placement, and secondary implant stability, which is reached after implant placement. Many factors affect the implant stability, including the material of implant used, size, length, and diameter of the implant, and internal factors such as bone conditions and health. The most critical internal factor determining implant stability is the quality and quantity of the bone and osseointegration process (Rabel et al., 2007).

Implant stabilities have been evaluated using different methods such as pull in, push out, cutting torque resistance, reverse torque test, and percussion test. However, all these methods are categorized as destructive methods which are only available for preclinical usage (Swami et al., 2016). In clinical usage, non-destructive methods such as radiographic (Computed Tomography (CT), CBCT) and RFA methods are used.

The monitoring of a dental implant system of a patient after surgery is needed to evaluate the progress of osseointegration. On the basis of the monitoring of implant stability on three different stages, the success of implant treatment is achieved. The increment of implant stability indicated those achievement of implant treatment. In general, implant stability increased from Stages 1 to 2 with an increment from 68.85 to 77.80 ISQ, and from Stage 2 to 3 with an increment from 77.80 to 82.17 in ISQ scale. The implant stability, either the primary or secondary, is not statistically correlated to bone density. However, the available space for the implant site, that is the bone height of mandible and cortical thickness, is associated strongly with the implant stability of the patient. The patient who has a thicker cortex or higher bone can have high primary implant stability.

Density of bone during healing stage will change due to the modeling and remodeling processes; however the measurement of density to indicate implant stability is still challenging. To improve the correlation between density and implant stability measurements, in future work, more patients with different races should be involved. Besides that, the implant stability can also be correlated with other dynamic parameters such as stress distribution and displacement of site implant to better understand the integrated biomechanical evaluation of jaw system.

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