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Dr. Jörg-Martin Ruppin answers your questions

Dec 18, 2022

Dr. Jörg-Martin Ruppin
April 2021: Foundation of Implant Center Dr. Ruppin & Kollegen, Penzberg, Germany
2018: Appointed to the mentor program of the German Society for Implantology (DGI)
2015: Recognition as a certified specialist in implantology by the European Dental Association
2009 to March 2021: Head of the Masur Implant Center, Penzberg
2007 to 2009: Worked as oral surgeon in practice clinic for implantology, oral and maxillofacial surgery and plastic surgery, Munich
2001 to 2007: Training as a specialist in oral surgery with treatment focus on implantology and prosthodontics, private outpatient clinic of Prof. Dr. Dr. Riediger; teaching and research work with focus on 3D diagnostics and computer-navigated implantology, University Clinic of RWTH Aachen University
1999 to 2001: Assistant dentist, Freiburg
1998: State examination and doctorate at the Albert Ludwigs University in Freiburg im Breisgau, Germany

Questions and answers from the live Q&A

Do you use Osstell ISQ only for immediate loading cases?

Dr. Jörg-Martin Ruppin: No, i also use it to check osseointegration after submerged healing.

Are ISQ measurements easy to obtain, do they add a lot of time to the procedure?

Dr. Jörg-Martin Ruppin: It is actually quite quick and easy: mounting the smart peg takes about 30 seconds and the measuring itself another 30 seconds; i think the whole procedure will add no more than 1-2 minutes to the procedure.

Has OsstellConnect aided you in the tracking of your treatments and communicating to your patients? Do you believe this provides more confidence from your patients in the outcome of the treatment?

Dr. Jörg-Martin Ruppin: Yes, I do think so. I usually explain and show the ISQ readings to the patients and usually they are grateful and feel reassured.

How long have you been using ISQ in your Clinical practice?

Dr. Jörg-Martin Ruppin: Since 3 years.

Where does the treatment data chart over time come from? What software?

Dr. Jörg-Martin Ruppin: It is provided in the OsstellConnect software.

Amazing to see the reaction to progressive loading.

Dr. Jörg-Martin Ruppin: Yes, and we have seen reactions like this several times now!

What type of implants have been placed?

Dr. Jörg-Martin Ruppin: Included in the presented study have been Camlog and Conelog Progressive Line implants (BioHorizons Camlog) ranging from 9-13 mm and from 3.3 to 5.0mm diameter.

Do you explain to the patient about the measurement? Why and so on.

Dr. Jörg-Martin Ruppin: Yes, and the patients usually appreciate this.

Dr. Ruppin, do you have any insight about the mechanism of ISQ reading for tissue level abutment and not directly to implant like right now so far?

Dr. Jörg-Martin Ruppin: The measurement works the same way on abutment level as on implant level. The values on abutment level may differ a little bit compared to implant level (tendency to slightly lower values), but there is not a significant difference. More important than the absolute value is the difference in the different measurements, for example at day of placement and after 2-3 months of healing to understand what is happening to the healing bone.

Why you need to use high torque in immediate implant or it was used for the clinical study?

Dr. Jörg-Martin Ruppin: A certain torque is mandatory for immediate implants to make sure you have enough primary stability and the implant will still be stable at the weakest point of healing (around week 3-6). But as said it is not the torque alone, but should always be the combination of torque AND ISQ.

What ISQ & torque values do you feel comfortable with immediate loading the implant(s)?

Dr. Jörg-Martin Ruppin: I stick to the loading scale as provided by Osstell: for a single unit, i want to have >30 Ncm and > 70 ISQ, for a splinted restoration, values of > 60 are still acceptable.

How do you decide whether or not to use progressive loading if the ISQ is not high enough? How soon you may see the ISQ increase if the progressive loading is working?

Dr. Jörg-Martin Ruppin: At least some mechanical stability is mandatory, e.g. the implant must clinical be hand-tight and not moveable. If there is a possibility to have a splinted restoration (2 or more implants), go always splinted! The ISQ starts to increase normally after 6-8 weeks; normally I wait for 12 weeks before I go into re-measurements.

Some implant systems are using drills for condensation of the bone, does it better for the healing when I rise the torque, but pressure to the vascularisation and stress the spogiosa? Is condensation of the bone around the implant advantage?

Dr. Jörg-Martin Ruppin: From what I’ve read in the literature, I think (excessive) pressure to the bone is definitely harmful. So here’s a conflict: we need enough primary (mechanical) stability and therefore sometimes need to condensate and compress bone to have enough mechanical stability for immediate loading. But from the bony healing point of view, this may mean we are slowing down healing due to excessive resorption and remodeling… So condensation of bone is not an advantage, but sometimes it can be necessary to achieve enough primary stability.

Thank you everyone joining us at the Osstell ISQ Symposium. See you again next year!
You can watch the webinar on-demand here.
More information about the symposium can be found on

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