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The need for improved diagnostics

The need for improved diagnostics. Patients want good looking teeth , sooner rather than later, and risk patients ask for the treatment too . The changed treatment scenario puts greater requirements on more capable diagnostic tools . Clinical benefits of

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The need for improved diagnostics

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  1. The need for improveddiagnostics • Patients wantgoodlookingteeth, soonerratherthan later, and risk patients ask for the treatmenttoo. • The changedtreatment scenario puts greaterrequirements on morecapablediagnostictools. Osstell ISQ Monitor osseointegration

  2. Clinical benefitsof Osstell in dailypractice • Speaker: Ola Olsson, VP Global Marketing • Place: Gothenburg, Sweden Osstell ISQ Monitor osseointegration

  3. Osstell AB • 1991: First human trials • 1999: Osstell AB wasformed • 2001: First generation Osstell instrument introduced • 2004: Osstell Mentor introduced • 2009: Osstell ISQ introduced • 2010: OsstellScientific Forum established • 2013: >600 Scientificpublications Osstell ISQMonitor osseointegration

  4. Increasedneed for implantdiagnostics • Increaseddemand for reducedtreatment timeOne stage, early- or immediateloading • More risk patients in dailypracticeCompromisedbone, smokers, bruxism, diabeticpatients, osteoporosis, grafted sites, sinus elevation, membranes, extraction socketsetc Osstell ISQ Monitor osseointegration

  5. ”Left corner” – Higher Risk Bone quality & quantity High • *Failure rate %: - Surgeonsexperience <5 year 5 timesfailure - Bruxism 29,3 - Diabetes 28,6 - Immplacement 22,5 • Iliaccrestblock+GBR+ • Sinus graft 50 Low risk Medium Low High risk* Time Immediate-/ earlyloading * Loma Linda, Immediateloading, JOrI, Vol. XXXVIII /Special Issue No. One/2012 Osstell ISQ Monitor osseointegration

  6. Avoidingexcessivemicro motion, a key parameter for implantsuccess ”The achievement and maintenance of implant stability”* * Albrektsson T, Zarb GA. Current interpretations of the osseointegratedresponse: Clinical significance. Int J Prosthodont 1993: 6: 95-105 Osstell ISQ Monitor osseointegration

  7. The techniquebehindOsstell • ResonanceFrequencyAnalysis (RFA)How it works, correlation to micromobility • BenefitscomparedwithothertechniquesTorque, tactile feeling, percussion test Osstell ISQ Monitor osseointegration

  8. ResonanceFrequencyAnalysis (RFA) and ISQ RFA uses the principle of a tuningfork. The stiffer the interface between the bone and the implant, the higher the frequency. ISQ has a non-linearcorrelation to micromobility. The scale is from 1-100 ISQ Increaseddistance from the bonelevel to the topof the magnet willlower the ISQ-value. Osstell ISQ Monitor osseointegration

  9. How it works Magneticpulsesvibratesthe SmartPegattached to the implant. The vibration frequency of the SmartPeg is measured. The morestable the implant, the higher the frequency (ISQ). By measuring on two different occasions, you canverify not only the initial mechanicalstability, butalsodetermine the degree of osseointegration. Osstell ISQ Monitor osseointegration

  10. ISQ has a strong correlation to micromobility Excessivemicro motion couldjeopardize the treatmentoutcome RFA measuresresistanceto lateral micromobility Torquemeasuresresistanceto shearforces Osstell ISQ Monitor osseointegration

  11. ISQ and micromobilityFEA 2013-02-11, Semcon Micro mobilitydecreases app. 50 % between 60 to 70 ISQ x10-1 m/N Osstell ISQ Monitor osseointegration

  12. Stabilitydevelopment over time As a result of osseointegration, initial mechanical stability is supplementedand/or replaced by biological stability, and the final stability level for an implant is the sum of the two. Stability does not generallyremainconstant after implant placement. For example, there is likely to be an initial decrease in stability, followed by an increase as the implant becomesbiologicallystable. Osstell ISQ Monitor osseointegration

  13. Cons and pros with different techniques ResonanceFrequencyAnalysis (RFA) Torque and tactilefeeling Percussion test • Onlyat placement. • Does not measurelateral stability • Torquetest at second stagecouldbe invasive • Not optimal for implants • Operator dependent • Lowsensitivity • Repeatable, objective and non invasive • Measuresstability in all directions • Could be used at placement and before final restoration to monitor the degree of osseointegration Osstell ISQ Monitor osseointegration

  14. How and when to measure • HandlingAim for the magnet on top • When to measureTwomeasurements, at placementand before final restoration Osstell ISQ Monitor osseointegration

  15. Measurementprocedure 1. Attachthe SmartPeg (4-6 Ncm) 2. Aimfor the magnet on top of the SmartPegto get the ISQ value. Repeatthe measurement at a different angle (90°) Osstell ISQ Monitor osseointegration

  16. The highest and the loweststabilityvalue Normally, the implantstability is the same in all directions. However, sometimes the bonevariesaround the implantcausing the implantstability to be different in different directions. Osstell is designed to provide the highest and the lowest ISQ values in such situations. When the stability is high, this difference is less important, but if implant stability is very low in one direction it might require a more conservative approach. The graphaboveillustrates different stability in different directions, ISQ 81 and 53 Osstell ISQ Monitor osseointegration

  17. When to measure At implantplacement Before loading/finalprosthetis Time Initial mechanicalstability Baseline ISQ Surgicalprotocol: 1-stage, 2-stage? Immediate-, early-, traditional-, delayedloading? To determine the degree of osseointegration Compare with baselineISQ Temporization? Modifiedprosthesis? Add time and take a new measurement? Tactile feeling or torquewill not serve as a baseline for futurecomparisons and couldpotentiallydestroyongoingosseointegration at second stage. Osstell ISQ Monitor osseointegration

  18. Stabilitydevelopment in different bonequality High initial stability (ISQ values 70 and above) tends to not increase with time, evenif the high mechanicalstabilitywilldecrease to be replaced by a developedbiologicalstability. Lower initial stabilitywillnormallyincrease with time due to the lowermechanicalstabilitybeingenforced by the boneremodeling process (osseointegration). Valuessuch as ISQ 55 or lowershould be taken as a warningsign and actions to improve the stabilitymight be considered (largerimplant diameter, prolonged healing time etc.)* * Implant stability measurementsusingResonanceFrequencyAnalysis. Biological and biomechanicalaspectsand clinicalimplications. Periodontology 2000, 2008. Sennerby & Meredith Osstell ISQ Monitor osseointegration

  19. Earlywarning! The overall averagevalue of all implants over time is approximately 70 ISQ. If the initial ISQ value is very high, a small drop in stability normallylevelsout with time. A bigdrop in stability or a continuingdecreaseshould be taken as a warning sign. Lowervalues are expected to be higher after the healing period. The oppositecould be a sign of an unsuccessful implant and actionsshould be considered. Osstell ISQ Monitor osseointegration

  20. Why video The clinicaluse of the ISQ-scale • Twovalues to see the trendTwomeasurements, at placementand beforefinal restoration • Different indicationsSingle, partial or full arch with a metal framework Osstell ISQ Monitor osseointegration

  21. Osstell ISQ Monitor osseointegration

  22. Osstell ISQ Monitor osseointegration

  23. > 600 Scientificreferences Morethan600 articles has beenpublished, validating the concept. A searchable data basecould be found at: www.osstell.com Osstell ISQ Monitor osseointegration

  24. Osstell ISQMonitor osseointegration • ReducetreatmenttimeMeet the demand from patient and referrals Increased patient turnover • Manage risk patientsTreatmore patients in a predictableway Improvedrevenues Other Qualityassurance/legal aspectsCommunication with patients and colleagues Osstell ISQ Monitor osseointegration

  25. Thankyou! Osstell ISQ Monitor osseointegration

  26. Why video Supplement • ISQs’ correlation to torque and BIC (Boneto Implant Contact)Aim for the magnet in different directions • OsstellScientific ForumAnnual symposium, support, scientificadvisors Osstell ISQ Monitor osseointegration

  27. ISQ and torque (Ncm) Insertion torque measures the rotational friction together with the force required to cut the bone. The diameter of the implant will influence the torque. Peak torque can give high values due to the “collar effect” when the implant collar is seated in cortical bone. Reverse torque could be invasive as a test of osseointegration Same torque in different bonequalitiescangivebigdifferences in micro motion. Different implant designs with the same torque and in the same bonequalitygave different micro motion (Trisi, Athens 2010) Seating torque is sometimes a poor measurement of implant stability (Degidi et al 2010) A very good correlation between ISQ and micro mobility is shown by Trisi et al (2010) and Pagliani et al (2012) Torque is a static measurement at placement and we need to monitor the biological dynamic process called osseointegration, Norton (2013) Osstell ISQ Monitor osseointegration

  28. Young’smodulus for different material 20 ISQ Generally, ifYoung’smodulusincreases from a high level, the stabilitywill not increase in a significantway. As a consequence, if the initial implantstability is alreay high osseointegrationwill not addstability in a significantway. 50 ISQ 65 ISQ 80ISQ *FEA 2013-02-11, Semcon Osstell ISQ Monitor osseointegration

  29. ISQ and Bone to Implant Contact (BIC) Increased BIC (osseointegration) willincrease the stabilityif the initial stability is low to medium. Low BIC High BIC Low, medium bonedensity 66 ISQ 55 ISQ Increased BIC (osseointegration) will not affect the stability in a significantwayif the initial stability is alreadyvery high. Lack of osseointegrationwill be shown as a decreased ISQ value High BIC Low BIC High bonedensity 74 ISQ 76 ISQ The aboveimplies that it is possible to haverealtively High BIC/Low ISQ in soft bonecompared with Low BIC/High ISQ in densebone. Osstell ISQ Monitor osseointegration

  30. OsstellScientific Forum To better serve the increased interest for Resonance Frequency Analysis (RFA) the “Osstell Scientific Forum” has been formed, sponsored by Osstell AB. Key elements • www.osstell.com/Scientific ForumA basis to share knowledge and scienceabout RFA (databasewith > 500 abstracts of scientific publications, video presentations etc.) • Annual Symposium Monaco 2009, Glasgow 2010, Athens 2011, Copenhagen 2012 and next meeting will be in Dublin at EAO october, 2013. 3. Research support Donation of ISQ instruments and SmartPegs to researchers doing studies that include implant stability measures in the protocols. 4. Scientific Advisors The Scientific Forum will be governed by a group of Scientific Advisors who will review and structure scientific documentation of RFA. Osstell ISQ Monitor osseointegration

  31. ScientificAdvisors “As scientific advisors to the Osstell Scientific Forum, we would like to welcome you to make use of it. We have all been using RFA technology and the ISQ scale for many years – in our daily practice as well as in our research. We want to encourage you to explore this useful technology and scale, and to share your data and clinical experience with the ISQ Forum. Together, we can develop a substantial scientific and clinical database that will help all of us optimize the clinical outcome for our patients.” Osstell ISQ Monitor osseointegration

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