La scala ISQ consente di definire uno standard clinico da 1 a 100. Sono stati svolti più di 500 studi utilizzando i valori misurati RFA e la scala ISQ. Sul sito è www.osstell.com/scientific-forum disponibile una banca dati con funzioni di ricerca.
Stabilità dell’impianto nel tempo
Nel risultato di un’integrazione ossea, la stabilità meccanica originaria viene integrata e/o sostituita dalla stabilità biologica. La stabilità finale di un impianto corrisponde alla somma di questi due valori.
Normalmente, la stabilità non rimane costante dopo l’impianto. Ad esempio: è possibile che la stabilità diminuisca ma venga seguita da un aumento della stabilità biologica.
Evoluzione della stabilità.
Il valore medio della durata totale di tutti gli impianti è di 70 ISQ. Se il valore ISQ è alto all’inizio, è normalmente possibile bilanciare un leggero recesso della stabilità nel corso del tempo. Un recesso ingente, oppure addirittura un recesso costante deve invece essere considerato un segnale di allarme. Dopo il processo di guarigione, valori inferiori, sono normali. In caso contrario, può essere che l’impianto sia stato inserito non correttamente e in questo caso occorre reagire immediatamente.
Qualità dell’osso
Il valore medio della durata totale di tutti gli impianti è di 70 ISQ. Se il valore ISQ è alto all’inizio, è normalmente possibile bilanciare un leggero recesso della stabilità nel corso del tempo. Un recesso ingente, oppure addirittura un recesso costante deve invece essere considerato un segnale di allarme. Dopo il processo di guarigione, valori inferiori sono normali. In caso contrario, può essere che l’impianto sia stato inserito non correttamente e occorra reagire immediatamente
As a result of osseoinegration, initial mechanical stability is supplemented and/or replaced
by biological stability, and the final stability level for an implant is the sum of the two.
Stability does not generally remain constant after implant placement. For example, there
is likely to be an initial descrease in stability, followed by an increase as the implant becomes biologically stable.
Stability development
The overall average value of all implants over time is approcimately 70 ISQ.
If the initial ISQ value is hight, a small drop in stability normally levels out with time.
A big drop in stability or a continuing decrease should be taken as a warning sign.
Lower values are expected to be higher after the healing period. The opposite could
be a sign of an unsuccessful implant and actions should be considered.
Bone quality
High initial stability (ISQ values 70 and above) tends to not increase with time, even if the
high mechanical stability will decrease to be replaced by a developed biological stability.
Lower initial stability will normally with time due to the lower mechanical stability
being enforced by the bone remodeling process (osseointegration).
Values such as ISQ 55 or lower should be taken as a warning sign and actions to improve
the stability might be considered (larger implant diameter, longer healing time etc.)*
*Implant stability measurements using Resonance Frequency Analysis. Biological ans biomechanical aspects and clinical implications.
Periodontology 2000, 2008. Sennerby & Meredith
Die ISQ-Skala ermöglicht das Festlegen eines klinischen Standardbereichs von 1-100. Es wurden über 500 Studien anhand der RFA-Messwerte und der ISQ-Skala durchgeführt. Eine Datenbank mit Suchfunktion finden Sie auf www.osstell.com/scientific-forum
Implantatstabilität in der Zeit
Als ein Ergebnis der Osseointegration wird die ursprünglich mechanische Stabilität ergänzt und/oder ersetzt durch die biologische Stabilität. Die endgültige Stabilität eines Implantates entspricht der Summe dieser Beiden.
Die Stabilität bleibt gewöhnlich nicht konstant nach der Implantation. Als Beispiel: Es ist zwar wahrscheinlich, dass die Stabilität nachlässt, was jedoch anschließend folgt ist eine Steigerung der biologischen Stabilität.
Stabilitätsentwicklung
Der Durchschnittswert aller Implantate während der gesamten Zeit beträgt 70 ISQ.
Wenn der ISQ Wert anfänglich hoch ist, kann ein kleiner Rückgang der Stabilität normalerweise im Laufe der Zeit ausgeglichen werden. Ein großer Abfall jedoch, oder gar ein kontinuierlicher Rückgang sollte als ein Warnsignal betrachtet werden.
Nach dem Heilungsprozess sind niedrigere Werte der Normalfall. Sollte das nicht der Fall sein, so kann ein Grund sein, dass das Implantat falsch gesetzt wurde. Hier sollte man sofort reagieren.
Knochenqualität
Der Durchschnittswert aller Implantate während der gesamten Zeit beträgt 70 ISQ.
Wenn der ISQ Wert anfänglich hoch ist, kann ein kleiner Rückgang der Stabilität normalerweise im Laufe der Zeit ausgeglichen werden. Ein großer Abfall jedoch, oder gar ein kontinuierlicher Rückgang sollte als ein Warnsignal betrachtet werden.
Nach dem Heilungsprozess sind niedrigere Werte der Normalfall. Sollte das nicht der Fall sein, so kann ein Grund sein, dass das Implantat falsch gesetzt wurde. Hier sollte man sofort reagieren.
one abutment – the 1st time EN
Today, the surfaces of implant systems improved particularly in speed and quality of osseointegration. Also, a rethinking is necessary for implantologists considering the actual scientific and clinical perceptions.
An open, transgingival healing with physiological overload might bring a significant effect in bone stability by adjusted trabeculaes which can better absorb the forces directed on the implant. This approach would outclass a closed healing by far in terms of bone morphology and soft tissue stability. Be careful as overloading the implant unphysiologically can cause an implant loosening.
Statements about primary stability can easily be made when the handler measures and records the insertion torque of the implant.
Is the insertion torque higher than 30 Ncm, the final abutment can be fitted during the same session. Provided a hybrid-abutment is on-hand, as for example the LTS-BASE® connected with the appropriate adhesive body. Abutment and implant can already be chosen during the planning phase at the digital volume tomography.
LTS-Hybride-Abutment at the time of implantation
LTS-Hybride-Abutment after healing
After osseointegration the abutment may be ground intra-orally like a natural tooth and can be moulded in a conventional way (closed). We call this technique “One Abutment – the first time”. In this procedure the final abutment will be inserted as early as possible. So, the soft tissue can grow together with the NCW-surface of the abutment and has a maximum long-term stability.
Also look at: clinical pictures
If the bone quality is reduced and the insertion torque is between 20 – 30 Ncm, the tongue and cheek pressure could be too strong for the final abutment, and thus osseointegration is prevented. In this case the use of a healing cap (gingiva former) is indicated. It almost covers flush with the gingiva and protrudes only slightly above the soft tissue. Tongue and cheek pressure stay low, so the stress at the implant is kept in the physiological range.
LTS-healingcap at the time of implantationLTS-healingcap after healing
After osseointegration of the implant the healing cap is removed and replaced by a LTS hybrid abutment in the same session. The healed soft tissue complex remains stable and unchanged through its congruency in shape. Finishing may be done immediately, and the preparation margin may be fixed epigingivally. The risk of cement leftovers in the sulcus is almost excluded. Previous implant moulding can be dropped completely. By moulding at abutment level all fitting inaccuracies between abutment and implant are balanced.
LTS-healingcap after healingLTS-Hybride-Abutment after healing
In all situations where bones were augmented and no sufficient primary stability could be maintained, insertion torque will then be significantly below 20Ncm, we recommend conventional closed healing of the implant.
„One Abutment – one time“ conception by Zimmer DentalTM
This is only for your information. We want to give a short introduction into the “One Abutment – one time” conception that was developed by Zimmer Dental company. At the time of the exposure a final, rotary-symmetric abutment is applied which should not be removed, and will be moulded by means of a transfer cap, having subgingival preparation margins.
Individualization is not possible in this case. External link One Abutment – one timeTM (PDF)
Current scientific studies on the topic
Post-extraction socket implants: Part 1 – The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change: A retrospective cohort study; Tarnow DP, Chu SJ, Salama MA, Stappert CFJ, Salama H, Garber DA, Sarnachiaro GO, Sarnachiaro E, Gotta SL, Saito H: Int J Periodontics Restorative Dent 2014 (in press – IJPRD May 2014)
Conclusions:
1. Flapless tooth extraction
2. Screw-retained PR
3. Place BG to FGM the ‘prosthetic socket seal’ seal
Italian (italiano) 
