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Ask the experts!

Nov 22, 2018

Clinicians from all over the world participated to Osstell Scientific Symposium at EAO Congress 2018 in Vienna, on October 11th.

How do you use Osstell to communicate with the patient or referring doctors? How to use Osstell Connect? How do surgical skills affect the overall treatment? Dr. Paul S. Rosen, DMD, MS (USA), Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria), Dr. Francisco Teixeira Barbosa, DDS (Spain) answered these and many other questions from the audience, led by moderator Dr. Marcus Dagnelid, DDS (Sweden).

You can read their answers below about how they use Osstell in daily practice. Ask questions in the comments at the bottom of the page!

EAO Osstell Symposium

How does peri-implantitis affect ISQ value?

Dr. Paul S. Rosen, DMD, MS (USA): I do not know as most of the time when I see this problem there is a cemented crown on the dental implant. My speculation would be that ISQ would diminish.

How do I go about repeating ISQ values after implantation? Isn’t the soft tissue disturbed?

Dr. Paul S. Rosen, DMD, MS (USA): I don’t worry about disturbing the soft tissues to do this after implantation. I do try to keep the repeated disconnection of the abutment to a minimum. It is far better to disturb the soft tissues on 1-2 occasions than to proceed with restoring the implant when inadequate healing has occurred.

Did ISQ value increase after provisionalization?

Dr. Paul S. Rosen, DMD, MS (USA): Typically the answer is no. At best, the ISQ stays the same as prior to provisionalizing. I however see a slight decrease which is a small price to pay for this service.

Is primary stability of no importance?

Dr. Paul S. Rosen, DMD, MS (USA): No, it is of importance and a part of the overall equation to determine the course of healing. I think that what RFA does is to modify preconceived notions that insertion torque i.e. primary stability is the sine qua non and that all decisions are based upon it.

Dr Paul Rosen EAO 2018

When there is a big difference between two readings for a specific implant, how do I decide when to load?

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): I have seen this phenomena certain times- most of the time the value in the bucco- oral direction is affected. Important is to monitor the mesio- distal value- which most of the time is in a normal range. I highly recommend to repeat the measurement after a certain time (minimum 1 week). For my clinical decision the development of the implant stability is crucial. In my experience in most of the cases the difference disappears – if not the higher value is my personal benchmark.

Do you think that Osstell allows the indirect measure of the graft maturation. For instance : sinus lift

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): In the early stage only the residual bone height gives the implant stability which is also developing over time. At a later timepoint the graft contributes to the implant stability but I think it is impossible to distinguish between these two structures.

How do you use the Osstell device for patient communication?

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): Patients as well as colleagues like to see „inside“ the healing process- especially when you want to go into early prosthetic reconstruction being on the safe side. The communication of the ISQ values is simple for the dentist and easy to understand for the patient- the ISQ value shows us where we are in the „traffic light system“. „Green“ means „great“- let’s go. I like to compare it with the ultrasound check ups while pregnancy- it gives us certain security when you see what is going on.

Can you explain the surgical skills importance reference again?

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): Every implantologist is having a learning curve. In the early stage of our implant placement period we might adjust previous drilling directions and depth. This results sometimes in inprecise drillholes and results in less primary stable implants.

Does ISQ correlate to insertion torque for primary stability?

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): ISQ and IT show a positive correlation up to values around 50 N/cm. Higher torques unnecessary results in higher biological and mechanical stress without additional benefits in terms of implant stability.

Some researchers are concerned about VitK and HDLs and implant healing/stability. Should this be a routine part of pre- op checks?

Assoc. Prof. Priv. Doz.Ulrike Kuchler, DDr (Austria): The healing of dental implants follows a biological sequence with numerous factors influencing this sequence. We know from preclinical studies that vitamins and clinical chemistry play a role in osteoblastic and osteplastic function but the impact has not been fully elucidated yet.

Prof. Ulrike Kuchler

How can and should I use the Osstell Connect portal?

Dr. Francisco Teixeira Barbosa, DDS (Spain): We should use the Osstell portal to track our success rate, average time on loading, percentage cases of immediate loading and to compare them with the rest of the community. The Osstell portal also allows you to stay update with the last news about the scientific community.

Which value guides you to load?

Dr. Francisco Teixeira Barbosa, DDS (Spain): For immediate loading with splinted implants, implants should have at least 60 ISQ. In single restorations 70 ISQ. Also, for the definitive restoration I wait till the ISQ is above 70, in case it is not, I use a provisional and I track ISQ.

Can ISQ be used for detecting early stage of periimplantitis?

Dr. Francisco Teixeira Barbosa, DDS (Spain): There are some publications that stated that implants with Peri-implantitis show a decrease in the ISQ (Monje 2018), but it is not the proper way to guide use to diagnose Peri-implantitis. We should stick to the traditional protocols (probing, bleeding on probing and X-Ray).

In the Osstell Connect platform will we be able to put implant information, like surface, company, parallel or tapered?

Dr. Francisco Teixeira Barbosa, DDS (Spain): So far is not available, but is also that Osstell should consider implement, as the result of the data of all users could be insightful to guide the community towards more comprhensive understanding between the different features of implant brands.

Dr Francisco Barbosa

Thank you everyone joining us at the Osstell Scientific Symposium. See you next year in Lisbon!

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