SmartPeg Reference Guide

Yes, it can be sterilised with a Prion cycle at 134 °C for 18 minutes.

Whether you are using a single-use or a reusable SmartPeg, it should always be installed using the SmartPeg Mount and tightened to approximately 4–6 Ncm – typically described as finger tight. This ensures proper seating and accurate ISQ measurements without risking damage to the implant or the SmartPeg.

Yes. You can mix single-use and reusable SmartPegs during the same treatment session. The only requirement is that you use the correct SmartPeg Type number for the specific implant or abutment you are measuring.

Whether the SmartPeg is single-use or reusable does not affect the measurement.

Yes, as long as its integrity and performance are maintained.

Osstell is also the only company offering both a sterile single-use and a reusable SmartPeg made of aluminium, supported by more than 1,500 published studies on the ISQ method.

With the Osstell original ISQ scale and SmartPegs, no conversion tables or correction factors are needed. The measured ISQ value is the true value, regardless of whether you use a single use or a reusable SmartPeg.

SmartPegs are supplied in different packaging formats depending on whether they are single-use or reusable:

Single-use SmartPegs

• Delivered sterile.
• Supplied in boxes of 5 pieces, in a single sterile barrier system with protective outer packaging.
• Intended for one treatment session only and must not be reused.

Reusable SmartPegs

• Delivered nonsterile in individual packaging.
• Must be cleaned, disinfected and sterilized before the first clinical use and after every subsequent use. (See quickguide at osstell/ifu).

SmartPeg Mount

• Delivered nonsterile with the instrument.
• Can be purchased separately, in package of 5.
• Must also be cleaned, disinfected and sterilized before use and between patients. (See quickguide at osstell/ifu).

Yes. The reusable and single use SmartPegs are designed so they can be easily distinguished visually:

• The single-use SmartPeg is supplied sterile, has an aluminium coloured (non coloured) magnet, and does not include any laser marked identifiers on the body.
• The reusable SmartPeg has a black magnet on top and carries laser marked Type and LOT numbers on the body for identification and traceability.

The reusable SmartPeg can be used for up to 20 reprocessing cycles, as long as its integrity and performance are maintained.

If inspection reveals wear, deformation, corrosion, damaged threads, or any loss of functional compatibility, the SmartPeg must be discarded, even if it has been processed fewer than 20 times.

The single-use SmartPeg is intended for one treatment session only and must not be reprocessed.

The reusable SmartPeg is engineered with special protective surface coating – one on the SmartPeg body and another black protective coating on the magnet. These coatings provide resistance to moisture, cleaning chemicals, wear, and corrosion, ensuring that the SmartPeg maintains its performance throughout the validated number of reprocessing cycles.

The reusable SmartPeg can easily be distinguished from the single use version: it has a black magnet, and its LOT and Type number are laser marked on the body for clear identification.

Prior to the first clinical use, and after each use the reusable products must be cleaned, disinfected and sterilized according to the instructions in the quickguide that is found here: Osstell/ifu

You can record ISQ at abutment level in OsstellConnect, but it is important to follow the correct clinical measurement procedure to obtain accurate values.

How to measure ISQ at abutment level

1. Perform an implant level measurement first, before placing the abutment.
2. Measure again at abutment level during the same session, using a SmartPeg made for abutment level measuring.
3. Determine the offset by noting the difference between implant level and abutment level ISQ. This offset remains stable throughout healing and should be used when interpreting follow-up measurements.
4. For all subsequent visits, measure on the abutment and apply the same offset to understand the true implant ISQ.

How to record the measurement in OsstellConnect:

1.  Go to the patient’s record, select the patient and the implant in the tooth chart. Click ‘Add abutment’, choose the abutment, and save.
2. Select ‘Measure stability’ and choose ‘Abutment’ under Measurement level. Measure on the abutment as you would at implant level and save.
3. To review the stability trend, open the Stability tab and toggle ‘Show abutment’. You can also enable ‘Show details’ to view buccal–lingual and mesial–distal ISQ values.

For a more detailed explanation and clinical guidance, see our blog post here.

Several factors may cause unexpected ISQ values or failure to obtain a reading:

1.  Incorrect use or condition of the SmartPeg
   • Single-use SmartPeg: These are intended for one treatment session and one patient only. Reusing a single-use SmartPeg may lead to worn threads and unreliable measurements.
   • Reusable SmartPeg: Ensure it has been correctly cleaned, inspected, and is not damaged. Wear, deformation or contamination can affect performance.
2.  Wrong SmartPeg type selected
   Make sure you have selected the correct SmartPeg Type for the specific implant system and connection. Refer to the SmartPeg Reference Guide.
3.  Tissue or debris in the implant connection
   Bone fragments, soft tissue or fluid between the implant interface and the SmartPeg can prevent proper seating. Clean the implant prosthetic connection thoroughly before attaching the SmartPeg.
4. Electromagnetic interference
   Nearby sources of electromagnetic disturbance may disrupt the measurement. Remove or switch off the source where possible.
5. Incorrect measuring instrument positioning
   Hold the instrument tip 2–4 mm from the SmartPeg and aim it correctly towards the top of the peg at an angle of approximately 45°. Do not touch the magnet.

ISQ should always be measured in two directions, because implant stability can vary depending on the amount of surrounding bone in different directions. Measuring from two angles ensures that both the most and the least stable directions are captured.
To do this, take one measurement in the buccal-lingual direction and one in the mesial-distal direction. These two ISQ values represent the different stability directions. Sometimes the values are identical; sometimes they differ.
If the two measurements differ, always rely on the lowest ISQ value, as it reflects the weakest direction and therefore provides the most clinically relevant information about implant stability.

Osstell measures implant stability using Resonance Frequency Analysis (RFA). The small SmartPeg that you attach to the implant has a tiny magnet on top. When the probe sends magnetic pulses, the SmartPeg starts to vibrate – similar to a very small tuning fork.
How it works:

1.  The probe sends magnetic pulses
   These pulses make the SmartPeg vibrate without touching it.
2. The vibration changes depending on how stable the implant is
   – A stable implant (good bone support) makes the SmartPeg vibrate faster.
   – A less stable implant makes it vibrate slower.
3. The device converts this vibration into an ISQ value
   – Higher stability → higher frequency → higher ISQ
   – Lower stability → lower frequency → lower ISQ

It takes less than a second, and the ISQ value is shown immediately.

Yes. The ISQ value can be affected if the SmartPeg is not mounted correctly.

For accurate measurements, the SmartPeg should be attached finger tight using the SmartPeg Mount, which corresponds to about 4–6 Ncm.

At this level, the SmartPeg has firm, stable contact with the implant, and the resulting ISQ value is consistent – typically within ±2 ISQ units.

• If the SmartPeg is not fully seated:
  The contact becomes unstable, and the ISQ value can appear artificially low, or you don’t receive any value.
• If too much force is applied:
  Overtightening does not improve accuracy. It may damage the SmartPeg threads.
  – A reusable SmartPeg may be damaged so it cannot be used again.
  – A single use or reusable SmartPeg may have its threads deformed, which can lead to inaccurate measurements during that session or, in worst case a broken SmartPeg.

In short: finger tight (4–5 Ncm) is enough to ensure stable contact and reliable ISQ readings.

If no ISQ value appears, it usually means the SmartPeg’s vibration is not being detected clearly by the instrument. Several factors can cause this, and most are easy to resolve:

1. Distance to instrument is too great
   The instrument should normally be held 2–4 mm from the magnet on top of the SmartPeg. Do not touch the magnet. If no value appears, move the instrument closer until the signal is detected.
2.  Angle needs adjustment
   The magnetic field is directional, so the orientation of the instrument matters. Measurements should be taken at approximately a 45° angle relative to the top of the SmartPeg.
3.  Ensure you have the correct SmartPeg Type for the specific implant
   Use this link to find the correct SmartPeg Type: Find my SmartPeg
4.  Soft tissue damping
   Surrounding tissue can sometimes dampen the vibration more than expected. Holding the instrument a bit closer usually compensates for this.
5. The implant platform is not clean
   Ensure the implant platform is clean and free of debris, so the SmartPeg seats properly and transmits its vibration.
6. The SmartPeg is worn or damaged
   • If you are using a reusable SmartPeg, make sure it has been inspected before use and that it is within 20 reprocessing cycles. A reusable SmartPeg that is worn out, bent, or has damaged threads will not vibrate correctly — and the instrument may not be able to pick up a reading.
   • A single‑use SmartPeg is intended for one treatment session only.
   • Ensure the SmartPeg is properly seated on the implant and that it is not in contact with surrounding tissue, as this can prevent accurate signal detection and may result in no ISQ value or an incorrect one.
7. Electromagnetic interference
   Strong electromagnetic noise sources nearby may disturb the measurement. (See the FAQ on “Electromagnetic noise” for details.)

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

• SmartPeg Mount
• Reusable SmartPeg
• Probe (IDx)

Please note that single-use SmartPegs are disposable and cannot be autoclaved!