Frequently asked questions

Learn more about our products, the ISQ scale and how to use it, the Osstell technology and much more.

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Questions about Osstell and the ISQ scale

  • Why should I use Osstell?

  • Osstell helps you ensure that the implant is stable enough to load before initiating the prosthetic rehabilitation. This is especially important if you are trying to reduce treatment times or if you are treating risk patients.

  • What does Osstell measure?

  • Osstell measures the lateral stability of the implant and thereby indirectly the degree of osseointegration. The results are presented as an ISQ, ranging from 1-100 ISQ, which correlates to micro mobility.

  • How does the Osstell technique work?

  • The SmartPeg, with its magnet on top, works like a small tuning fork. The magnet is emitted with magnetic pulses from the probe which makes the SmartPeg vibrate. Due to the stiffness in the interface between the implant surface and the bone the SmartPeg will vibrate accordingly. The more dense bone the higher stability, the higher frequency and the higher ISQ value. The ISQ value will be displayed on the screen within a second after the measurement is done.
    If you start with low mechanical stability at placement the value will increase due to the increased stability caused by osseointegration. If the initial value is in the high range, e.g. 75 ISQ it will stay about the same even after osseointegration, since the initial mechanical stability was already so high. If the implant does not osseointegrate the ISQ value will decrease significantly and should be taken as a warning.

  • What is the difference between Osstell and periotests?

  • Periotests are designed for natural teeth that are attached to the bone with a periodontium. An implant is attached directly to the bone without periodontium.
    Osstell uses a more sensitive scale with a non-contact, non-invasive technique which is totally objective and repeatable.

  • What is the difference between ISQ and torque?

  • Torque is a one time, static measurement at placement of the implant and cannot be repeated later on in a non-invasive way. It measures the rotational friction between the implant surface and the bone and not the lateral stability of the implant.
    Osstell measures the lateral stability of the implant and the measurements could be repeated in a non-invasive, dynamic way to monitor the development of osseointegration.

  • What is the difference between ISQ and BIC?

  • You can have high percentage of bone contact in soft bone but low implant stability compared with a situation with dense bone, less contact percentage but still higher stability. This is explained by the stiffness in the bone itself (Young’s Modulus). In soft bone you will get a low ISQ at placement and you will see an increased stability value due to osseointegration. If you have high initial mechanical stability already at placement, osseointegration will not add stability in a significant way since the implant was already stable. If the implant does not osseointegrate the ISQ value will continue to decrease.

  • When should I measure?

  • Measure at implant placement and again before the final restoration to monitor the development of osseointegration. If the ISQ value is not high enough it is advised to add time and remeasure before proceeding with the prosthetic rehabilitation of the implant.

  • Why do I need to take two measurements at the same occasion?

  • The SmartPeg measures the stability in all directions and singles out the most stable and the least stable direction. Sometimes, there is no difference between them. To make sure to measure both values, the probe should be held perpendicular to the jaw line for one measurement, and in line with the jaw line for the other measurement. The two ISQ’s represent these values. If the instrument finds them both at the same time, and they differ more than 3 ISQ units, they are presented on the display together.

  • How does Osstell measure osseointegration?

  • If you see an increased ISQ value, compared to the baseline value taken at placement, it is the effect of osseointegration. The same is true for high values that should stay high over time. If there is a significant drop in ISQ value, it is probably due to a failing implant.

  • Are there any studies that prove the Osstell method?

  • There are currently more than 670 articles where Osstell was used in the study, published in scientific papers. These abstracts could be found in our searchable database under "Knowledge Base".

  • What does ISQ stand for?

  • ISQ means Implant Stability Quotient and derives from Herz since the technique we use is Resonance Frequency Analysis (RFA). The scale in Herz is non-intuitive and hard to communicate so it was translated to a scale from 1-100 ISQ more than 20 years ago. Today we know that the scale correlates to micro mobility and that high stability means > 70 ISQ, between 60-69 is medium stability and < 60 ISQ is considered as low stability.

  • What is an ISQ value?

  • ISQ, or Implant Stability Quotient, is a scale from 1 to 100 and is a measure of the stability of an implant. The ISQ is a close to linear mapping of the resonance frequency of the SmartPeg that is attached to the implant.

  • What ISQ value should I have before loading?

  • Most users agree, which is in line with the scientific studies, that a preferable second ISQ value for non-splinted implants should be 70 ISQ or more to initiate the prosthetic rehabilitation. For splinted implants which will stabilize each other, lower ISQ values could be used. More information about how to use the ISQ scale can be found under "Knowledge Base".

  • Why do I sometimes get an electromagnetic noise warning when I approach the SmartPeg with the probe?

  • In general, Electromagnetic noise, or should be taken as an indication that the environment contains an alternating magnetic field of some magnitude. However there could be sudden bursts of electromagnetic noise from different electronic equipment, which could sometimes coincide with a measurement. TV-sets are among those devices that create a lot of noise.
    If the probe is close to the instrument (a few centimeters), the noise from the instrument itself will cause the warning. If the warning is only visible when the probe is held close to a SmartPeg, it can be due to:

    - If the implant is really rigid, it makes the signal from the SmartPeg very strong, which can cause the warning. Try to distance the probe from the SmartPeg a millimeter or two. Clinically this should happen very seldom, but on a plastic jaw model for instance, it can be necessary to hold the probe several millimeters from the SmartPeg, due to the lack of dampening soft tissue.

    - If the SmartPeg is not mounted properly, it can cause the warning. If this has happened the SmartPeg threads are probably damaged, and it has to be exchanged.

  • Can I re-use the SmartPegs?

  • The SmartPegs are single use items. To avoid damage to the implant, the SmartPeg material is quite soft, which limits the lifetime of the threads. So the SmartPeg cannot be reused for two reasons:
    First, the magnet cannot stand the heat of an autoclave, it will be affected and discolored. Second, the threads are made weak not to jeopardize the inner threads in the implant. Reusing the SmartPeg might wear out the threads and give misleading ISQ values.

  • Do I need a torque device to tighten the SmartPeg correctly?

  • No, it is enough with finger tightening and a firm contact between the components. The result is very repeatable even between different users for the same implant.

  • Do you affect the implant by using the Osstell?

  • Since we are only vibrating the SmartPeg we are basically not affecting the implant itself. The SmartPegs’ magnet is emitted by magnetic pulses with very low energy generated through the probe. This way the technique is totally objective, repeatable and non-invasive.

  • Which Osstell products can be autoclaved?

  • The following products may be autoclaved (over-pressurized steam up to 135 deg Celsius):

    - Probe
    - Probe extension cable
    - SmartPeg Mount

    Please note that SmartPegs are disposable and can not be autoclaved!

  • How do I know when the instrument is measuring?

  • The instrument measures constantly when switched on. To ensure that the instrument is working properly, use the SmartPeg test block (TestPeg) to take a measurement.

  • Why do I sometimes get two different ISQ values from the same implant?

  • The SmartPeg measures stability in all directions and singles out the most stable and the least stable directions. The two ISQ values represent these values. If they are both found at the same time, and they differ by more than 3 ISQ units, they are presented on the display together. The two values can also be found by measuring from two different directions.

  • Is the ISQ-value sensitive to how hard the SmartPeg is tightened?

  • The SmartPeg should be tightened with 4-5 Ncm, which means “finger tight”, using the SmartPeg Mount. It is enough with firm contact between the SmartPeg and the implant. The difference in ISQ value will then stay within 2 ISQ units. (If the SmartPeg is tightened too loosely, the ISQ-value will be lower.) If the SmartPeg is over-tightened, there is a risk that the SmartPeg threads will be damaged.

  • Sometimes I do not get an ISQ value at all?

  • The damping effect from the surrounding tissue can vary a great deal from implant to implant. If the damping is extreme, it may be necessary to hold the probe tip close to the magnet on top of the SmartPeg to get a reading. Normally, the probe is held 2-3 mm from the magnet, but if you do not get an ISQ value, try shortening the distance between the magnet and the probe tip. You can also try holding the probe at a slightly different rotational angle. Always make sure the implant platform is clean. See also the question about “Electromagnetic noise”.

  • What ISQ values can be expected in “normal” cases?

  • The average ISQ is approximately 70. The clinical range that can be seen is from 40-45 up to 85-90. Most implants have between 55 ISQ to 80 ISQ

  • What ISQ value should I have for immediate loading?

  • It is impossible to base the decision about immediate loading only on the ISQ-value. The literature shows that good primary stability is essential for a successful outcome, but there are of course also other parameters that have to be considered in such a decision. See also above about which ISQ values to expect. Many direct loading studies show good results with immediate loading if the primary stability is good. It seems as the implant stability will not change considerably from implantation to after osseointegration in many such cases.

  • Which SmartPeg to use for my implant?

  • You can check the SmartPeg Reference Guide by clicking Click here

  • What is the lowest ISQ value that you can get?

  • Clinically, the lowest number seen is approximately 40 ISQ. If the stability is less than 30, the implant is more or less “loose”. Values below 20 will not be seen, unless on a lab model with artificially low stability.

Questions about the Osstell IDx

  • How do I get started?

  • Simply register your IDx by following the instructions in the device or by going to osstellconnect.com

  • Do I need to be connected to WiFi to register?

  • No, you can also register your IDx at osstellconnect.com. All you need is the serial number.

  • Why do I need a backup code?

  • To enable automatic backup of your Osstell IDx, you will be asked to create a backup code made up of 8 characters. The purpose of the backup is to reset the unit if you for some reason remove patients by mistake or lose your instrument. The code is created during the registration process and you only have to enter it once. To make sure you can access your backup at a later date, it is VERY important that you write this code down and keep it in a safe place.

    Backup can also be done via USB without a code.

  • What are the requirements for Osstell Connect access?

  • Just connect the instrument via wifi and follow the instructions on the screen. A confirmation email with login details will be sent to your email address.

  • Why has the instrument been locked?

  • Have you registered your device? You can only use the Osstell IDx for a limited time without registration.

  • Is the IDx Portal both Windows and Mac compatible?

  • Yes, Osstell Connect is accessible via iPhone, iPad, Mac or PC.

  • Will Osstell Connect be connective with other systems, such as Dentrix?

  • No, for the moment is it not possible to connect to other patient data system.

  • What is the battery life of the Osstell IDx?

  • For normal use, the batteries last for at least one day but in most cases longer. It takes about 2 hrs to charge the IDx from a fully discharged state.

  • How do I perform a measurement?

  • Simply choose a tooth position on the touch screen and start measuring.

  • How do I add patient information?

  • Perform measurements, press End patient, and then save as Add new patient.

  • How do I edit patient information?

  • Simply select the pen symbol in the patient list to edit.

  • How can I save patient data?

  • The patient data can be saved either in the instrument or on Osstell Connect.

  • How can I delete ISQ values (e.g. in case I have accidentally measured twice from the same direction)?

  • Values can only be removed before saving clicking on the trash bin symbol. After saving the data cannot be modified.

  • Why do I need to set Date and Time again?

  • The IDx consumes power when it is turned off, so if the battery is totally drained and down at 0% the settings for date and time will be lost. If the battery is drained the IDx will ask you to set date and time again at start-up. If you connect the IDx to the internet, the date and time will be set automatically.

Questions about the Osstell ISQ

  • Where and how are the ISQ values stored and viewed?

  • Osstell ISQ use a “spreadsheet” to store the ISQ values (rows 1-20, columns A-T). To view the spreadsheet, press the center key to enter the menu, and then the same key again to enter spreadsheet viewing mode (Display data). Use the arrow keys to move around the spreadsheet.

  • What does “Display data” show?

  • Display data shows the data for each measurement. The memory cell position (e.g., A-2) is shown in the upper left. The ISQ value (e.g., ISQ 72-00) is shown in the upper right. The values are separated by a hyphen. If two values have been detected, select the lowest.

  • No reading from the Osstell ISQ?

  • If the Osstell ISQ does not provide a reading, please check the following:
    1. Always aim the probe tip at the very top of the SmartPeg magnet.
    2. The damping effect of the surrounding tissue can vary a great deal from implant to implant. If the damping is extreme,
    it can be necessary to hold the probe tip very close to the magnet on top of the SmartPeg to get a reading. Normally,
    the probe is held a couple of millimeters from the SmartPeg, but if you do not get an ISQ, try decreasing the distance
    between the magnet and the probe tip.
    3. The probe might be at a bad angle, with low signal strength. Try holding the probe at a slightly different angle.
    4. If the SmartPeg is not properly attached, or if material is trapped between the implant and the SmartPeg, this also
    cause problems. Unscrew the SmartPeg and retighten it.
    5. If the SmartPeg thread is worn, the SmartPeg needs to be replaced.

  • When should I reset the Osstell ISQ instrument?

  • A reset reverts the instrument to the default factory settings. This can be of value if any settings have caused the
    instrument to behave unusually, such as if the display contrast makes it difficult to read or the instrument is set to
    a language you do not understand.
    1. Turn off the instrument
    2. Push the following three buttons at the same time (as illustrated here): “Left arrow”, “Center button”,
    and “Right arrow”.
    3. If the instrument emits a small beep without starting up, the reset was successful.
    4. Start the instrument - and the first screen will be the “Set Date” screen followed by the “Set Time” screen.

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