|Maya Genisa||- Yarsi University
|Zainul Ahmad Rajion||IIUM|
|Erry Mochamad Arief||USM|
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
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
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.
Barewal, R.M., Oates, T.W., Meredith, N., Cochran, D.L., 2003. Resonance Frequency Measurement of Implant Stability In Vivo on Implants with a Sandblasted and Acid-Etched Surface. The International Journal of Oral & Maxillofacial Implants, Volume 18(5), pp. 641–651
Bischof, M., Nedir, R., Szmukler-Moncler, S., Bernard, J.-P., Samson, J., 2004. Implant Stability Measurement of Delayed and Immediately Loaded Implants during Healing. Clinical Oral Implants Research, Volume 15(5), pp. 529–539
Chang, P.-C., Lang, N.P., Giannobile, W.V., 2010. Evaluation of Functional Dynamics during Osseointegration and Regeneration Associated with Oral Implants: A Review. Clinical Oral Implants Research., Volume 21(1), pp. 1–12
Farre-Pages, N., Auge-Castro, M., Alaejos-algarra, F., Mareque-Bueno, J., Ferres-Padro, E., Hernandez-Alfaro, F., 2011. Relation between Bone Density and Primary Implant Stability. Medicina Oral Patología Oral y Cirugia Bucal, Volume 16(1), pp. e62–e67
Guler, A.U., Sumer, M., Duran, I., Sandikci, E.O., Telcioglu, N.T., 2013. Resonance Frequency Analysis of 208 Straumann Dental Implants during the Healing Period. The Journal of Oral Implantology, Volume 39(2), pp. 161–167
Hériveaux, Y., Audoin, B., Biateau, C., Nguyen, V.H., Haïat, G., 2020. Ultrasonic Propagation in a Dental Implant. Ultrasound in Medicine and Biology, Volume 46(6), pp. 1464–1473
Iridiastadi, H., Vani, T., Yamin, P.A.R., 2020. Biomechanical Evaluation of a Patient-Handling Technology Prototype. International Journal of Technology, Volume 11(1), pp. 180–189
Javed, F., Ahmed, H.B., Crespi, R., Romanos, G.E., 2013. Role of Primary Stability for Successful Osseointegration of Dentqualityal Implants: Factors of Influence and Evaluation. Interventional Medicine & Applied Science, Volume 5, pp. 162–167
Juboori, M.J.AL, Attas, M.A.AL, Gomes, R.Z., Alanbari, B.F., 2018. Using Resonance Frequency Analysis to Compare Delayed and Immediate Progressive Loading for Implants Placed in the Posterior Maxilla: A Pilot Study. The Open Dentistry Journal, Volume 12(1), pp. 801–810
Konstantinovi?, V.S., Ivanjac, F., Lazi?, V., Djordjevi?, I., 2015. Assessment of Implant Stability by Resonant Frequency Analysis. Vojnosanitetski Pregled, Volume 72(2), pp. 169–174
López, A.B., Martínez, J.B., Pelayo, J.L., García, C.C., Peñarrocha, M., 2008. Resonance Frequency Analysis of Dental Implant Stability during the Healing Period. Medicina Oral, Volume 13(4), pp. 2–5
Meredith, N., Science, D., Maudlin, L., 1997. Resonance Frequency Measurements of Implant Stability in Viva. A Cross-Sectional and Longitudinal Study of Resonance Frequency Measurements on Implants in the Edentulous and Partially Dentate Maxilla., Clinical Oral Implants Research, Volume 8(3), pp. 226–233
Rabel, A., Kohler, S.G., Westhausen, A.M.S., 2007. Clinical Study on the Primary Stability of Two Dental Implant Systems with Resonance Frequency Analysis. Clinical Oral Investigations, Volume 11(3), pp. 257–265
Sahib, A.M., Al-Adili, S.S., 2019. Evaluation of Healing Process of Periapical Defect Filled by Platelet Rich Fibrin using Cone Beam Computed Tomography-Comparative Clinical Study. Indian Journal of Public Health Research and Development, Volume 10(6), pp. 448–453
Sennerby, L., Meredith, N., 2008. Implant Stability Measurements using Resonance Frequency Analysis?: Biological and Biomechanical Aspects and Clinical Implications. Periodontology 2000, Volume 47(1), pp. 51–66
Seo, T., Song, B., Seo, K., Cho, J., Yoon, G., 2011. A Study of Optimization of Machining Conditions in Micro End-Milling by using Response Surface Design. International Journal of Technology, Volume 2(3), pp. 248–256
Staden, V., Guan, H., Loo, Y.C., 2006. Application of Finite Element Method in Dental Implant Research. Computer Methods in Biomechanics and Biomedical Engineering, Volume 9(4), pp. 257–270
Supriadi, S., Sitanggang, T.W., Irawan S,B., Suharno, B., Kiswanto, G., Prasetyadi, T., 2015. Orthodontic Bracket Fabrication using the Investment Casting Process. International Journal of Technology, Volume 6(4), pp. 613–621
Swami, V., Vijayaraghavan, V., Swami, V., 2016. Current Trends to Measure Implant Stability. Journal of Indian Prosthodontic Society, Volume 16(2), pp. 124–130
Turkyilmaz, I., Mcglumphy, E.A., 2008. Influence of Bone Density on Implant Stability Parameters and Implant Success: A Retrospective Clinical Study. BMC Oral Health, Volume 8(32), pp. 1–9
Wada, M., Tsuiki, Y., Suganami, T., Ikebe, K., Sogo, M., Okuno, I., 2015. The Relationship between the Bone Characters Obtained by CBCT and Primary Stability of the Implants. International Journal of Implant Dentistry, Volume 1(2), pp. 1–7