Resonance Frequency Analysis Tool for Implant Stability

Resonance Frequency Analysis Tool for embed StabilityDr. Vishwanath Pattar Dr. Anjana Bagewadi MDS Resonance frequency analysis (RFA) A diagnostic tool for institute constancy Dental embeds have become a probatory aspect of tooth replacement in prosthodontic intervention. High enter success rates of the order of 78-100 % have been published, with more than 15 years of observation age. Treatment success of dental implant mainly depends on the constancy of the implant b whizz support. Implant stableness is a mechanical phenomenon which is related to the local bone quality and quantity, type of implant, and placement technique used. The application of a simple, clinically applicable, non-invasive test to assess implant stability and osseointegration is considered highly desirable. Resonance frequency analysis (RFA) is one of such techniques which is most frequently used nowadays. mother of this paper is to review the technique of Radio frequency analysis and use of it to che ck the implant stability.Key words Resonance frequency analysis, Implant stability, Implant stability quotient(ISQ)Introduction Dental implants have reported success rates of over 90 % over long periods of time. However failures still occur and depend to be unpredictable. One factor that is being increasingly considered in failure of dental implants is occlusal loading . It has been clinically demonstrated that implant stability plays a significant role in determining treatment outcome (Sennerby Meredith 1998, Esposito et al. 1998). Implant stability can be seen as a combination of 1). Mechanical stability, which is the result of slopped bone holding the implant tightly in place.2). Biological stability, which is the result of new bone cells forming at the site of the implant and osseointegration. Initially implant stability was accountd by Surgeons perception piece placing the implant (Insertion and seating torque), percussion testing, reverse torque test and radiographs etc. But none of them proven to be effective in measuring the implant stability. Resonance Frequency Analysis (RFA) is a non-invasive diagnostic tool for detecting the implant stability of dental implants during the healing stages and in subsequent routine follow-up care after treatment.Advantages of Rasonance frequency analysis1) Optimal loading decisions It makes it easier for dentists to decide when is the optimal time to load implants. At placement, stability can be unwieldy to quantify objectively by merely relying on tactile perception. Torque measurements are difficult to repeat once the implant has started to integrate and can therefore not provide a baseline for subsequent comparisons. The invasive torque method may plane damage the healing if used for monitoring osseointegration2)Early warnings preventing failure Dentists sometimes encounter patients whose initial stability score is low. The reason could be that they have had to permit a bone graft. In such higher-risk si tuations, most surgeons would avoid an early-loading protocol. Similarly, a significant decrease in stability indicates a potential problem and should be considered an early warning. The surgeon may prefer to unload the implant or perhaps place additional implants and then wait until stability increases. RFA system makes the treatment of high-risk patients easier and more predictable allowing more of these patients to be treated and more of their treatments to be successful.3)Quality assurance Because RFA system helps the dentist decide when to load and avoid failure in high-risk situations, it becomes a quality-assurance system for the clinic. Most patients intuitively understand the stability measures and how they govern when to load an implant and when to wait. This increases their sense of confidence, security and quality.4) information can be transferable All the stability records measured from start of the treatment and the follow up records can be transefered from one clinician to other. It makes easy to the one clinician to communicate with other about the treatment modalities.Implant stability quotient (ISQ)ISQ (Implant Stability Quotient) is a measurement scale for use with the RFA (Resonance Frequency Analysis) method of determining implant stability. Its a mapping of resonance frequencies (kHz), presented as a clinically useful scale of 1-100 ISQ. 1 is the least ISQ value and 100 is the highest ISQ value. ISQ is used RFA to measure stability becauseSupports making dear(p) decision about when to loadAllows advantageous protocol choice on a patient-to-patient basis.Indicates situations in which it is best to unloadSupports good communication and increased trustProvides better case documentationInstrument kitFig.1 Hand held probe Fig.2 MonitorFig.3 Main plugFig.4 Data cable Fig.5 testing device Fig.6 Smart-pegTechnique Resonance frequency analysis (RFA) uses a sophisticated technology with computer-based measurement of resonance frequency (RF ), which is determined by two parameters the stagecoach of bone density on implant-bone interface area and the level of marginal alveolar bone approximately the transducer Osstell is representative of RFA-technique and was tested first in 1997The machine consists of an Osstell transducer and Osstell analyzer connected to a PC or independent. The transducer is L-shaped or bolts-like (smartpeg) and firmly screwed in order to be positioned on the implant and its superstructure (45 N/cm) and consists of 2 small voltage controlled transducers. High-energy pulse-type oscillations of a continuous sinusoidal pulse excite implant, in order to register the mechanical vibration among the implant interconnection zone and the bone. As soon as the apparatus is activated the first electric transducer applies excitation signal of increasing frequency from 5 to 15 kHz to implant. Other voltage-controlled element registers ultrasonic vibrations response, ie resonant frequency of the implant-bone interface area and transmits a created signal to the amplifier, which amplifies it and to the analyzer which reads, evaluates and compares it with the frequency of the accredited signal. The measured amplitude of resonance frequency is displayed numerically and graphically on the Osstell analyzer, and the maximum amplitude represents the stability of the implant, quantified through the ISQ units. The ISQ value reflects the rigidity of the system transducer- implant-bone and transducer normalization parameters. Measured on a scale from 0 ISQ (3500 Hz) to 100 ISQ units (8500 Hz), a higher ISQ value indicates a greater stability of the implant. After a while ISQ values rise because of osseointegration where implantbone the connection becomes stronger.Fig. 7 Fig.8 Fig.9ISQ values60 70 Immediate loading can be doneThis graph illustrates the progress of implant stability over time, expressed in ISQ terms. The converging green curves show the two most likely scenarios implant stability eventually sets at around 70 ISQ. A high initial ISQ value tends to decrease, as mechanical stability is supplanted by osseointegration. And a low initial value tends to increase, as osseointegration sets in. The scenario to make out for is illustrated by the red curve. Here, osseointegration is not progressing as planned, and loading such an implant may result in a failed treatment High initial stability (ISQ values of 70 and above) tends not to increase over time despitethe fact that the initial high mechanical stability decreases and is replaced by increased biologic stability. Lower initial stability normally increases with time because the lowermechanical stability is increased by the bone remodeling process (osseointegration). Values of ISQ 55 or lower should be taken as a warning sign and actions to improve the stability should be considered (larger implant diameter, longer healing time, etc.)* *(Implant stability measurements employ Resonance Frequency Analysis. Biologica l and biomechanical aspects and clinical implications. Periodontology 2000, 2008. Sennerby Meredith)ReferencesChang WA et al. A newly designed resonance frequency analysis device for dental implant stability detection Dent Mater J. 2007 Sep26(5)665-71Rajiv KG et al . Resonance frequency analysis Indian Journal of Dental Research, 22(4), 2011