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Table of Contents
REVIEW ARTICLE
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 103-109

Primary stability: The password of implant integration


Department of Prosthodontics, Army College of Dental Sciences, Chennapur, Secunderabad, Andhra Pradesh, India

Date of Web Publication10-Oct-2012

Correspondence Address:
Amreena Gill
Senior Lecturer , Army College of Dental Sciences, C/o Maj Gen Amarjit Singh, Deputy Commandant and CI, MCEME, Trimulgherry, Secunderabad - 500015, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.102223

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   Abstract 

The dental implant therapy has a phenomenal rise and has occupied the summit in today's dentistry. The scientific societies and researchers are in constant effort toward improvement, excellence, and simplification of implant therapy. Today, the practitioners are enthusiastic to imbibe the simplified implant procedures and techniques and would like to carry out the same in their private practice. Implant design, bone biology, primary stability, osseointegration, prosthetic options etc., are the several issues taken into account for successful implant therapy. The factors which influence integration are design of implant, material composition of implant, variance in the bone quality (soft or hard), and type of surgical procedure employed (simple or complex). The primary stability is the initial engagement between the bone and implant and one has to ensure that it should be strong and paramount. Implantologists completely monitor the primary stability by synchronizing the above factors. The primary stability is unique and having singular expression is considered as the "password of Implant Integration Account." If the primary stability is good, implant can be loaded quickly and to the maximum.

Keywords: Factors, implant, primary stability


How to cite this article:
Rao PL, Gill A. Primary stability: The password of implant integration. J Dent Implant 2012;2:103-9

How to cite this URL:
Rao PL, Gill A. Primary stability: The password of implant integration. J Dent Implant [serial online] 2012 [cited 2019 Aug 18];2:103-9. Available from: http://www.jdionline.org/text.asp?2012/2/2/103/102223


   Introduction Top


Osseointegration is a prerequisite for successful implant treatment. The term was defined by Brånemark (1985) as "a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant." Primary implant stability has been acknowledged as an essential criterion for later achievement of such osseointegration. Dental implant stability is a measure of the anchorage quality of an implant in the alveolar bone and is considered to be the consequential parameter in implant dentistry. Implant stability can occur at two different stages: primary and secondary. [1] It has been established to affect the process of osseointegration, the pattern of implant loading, and, finally, the success of an implant. [2] Primary stability of an implant mostly comes from mechanical engagement with cortical bone. It thus prevents the formation of a connective tissue layer between implant and bone, consequently ensuring bone healing. Therefore, primary stability of an implant is a prerequisite to undisturbed peri-implant bone healing. Secondary stability, on the other hand, offers biological stability through bone regeneration and remodeling. Secondary stability, which is seen after the healing period, is primary stability with a further gain in stability because of bone formation around the implant [3] [Figure 1]. Degree of implant stability may also depend on the condition of the surrounding tissues. It is, therefore, of an utmost importance to be able to quantify implant stability at various time points and to project a long-term prognosis based upon measured implant stability. [1] A secure primary stability leads to a predictable secondary stability. [1] Secondary stability has been shown to begin to increase at 4 weeks after implant placement. At this time point, the lowest implant stability is expected. Therefore, the original Brånemark protocol suggested a 3- to 6-month non-loaded healing period to achieve adequate stability before functional loading. [4]
Figure 1: Comparison of natural socket periphery and implant periphery

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   Background Top


Mihoko Atsumi et al. [1] proposed the following factors that affect the primary stability:

  1. Bone quantity and quality
  2. Surgical technique, including the skill of the surgeon
  3. Implant (eg, geometry, length, diameter, surface characteristics).
Ilser Turkyilmaz et al. [5] in a study mentioned that the factors affecting the primary implant stability can be divided into:
  1. patient-related (ie, bone volume and quality)
  2. procedure-dependent parameters
    1. type of implant (drill size-implant size, pre-tapped or self-tapped implant)
    2. type of surgical procedure


An insufficient primary stability causes poor healing related to the early loss of the implant. [6] The main two factors affecting implant stability are the location and the stiffness of the implant in the surrounding tissue. The stiffness can be considered in three ways: (1) the stiffness of the implant components themselves associated with the geometry and material composition; (2) the stiffness of the implant-bone interface; and (3) the stiffness of the bone itself associated with the trabecular/cortical bone ratio and bone density. Maintenance of low implant micromovement, especially in early healing periods, presents importance in promotion of direct bone ingrowth to implant surface. [7] Thus, when the implant is stable in the bony bed during placement and during healing, new bone will predictably fill the bone-to implant interface and most of the implant surface will become in direct contact with living bone. [8]

Primary stability at implant installation is achieved by the physical congruence between the surgically created bone bed and the implant, which is dependent from the macroscopic implant design, the surgical technique and the bone density.


   Bone Quantity and Quality Affecting the Primary Stability Top


Typically, implant stability is anticipated to decrease during the early weeks of healing; this is followed by an increase in stability. [9] This is related to the biologic reaction of the bone to surgical trauma. During the initial bone remodeling phase, bone and necrotic material are resorbed by osteoclastic activity, which is reflected by a reduction in the ISQ (implant stability quotient) value. This process is followed by new bone apposition initiated by osteoblastic activity, ie, adaptive bone remodeling around the implant. [10] An accelerated formation of bone-to-implant contact contributes to a faster increase in secondary stability. This biologic process eliminates the decrease in primary stability and ensures consistency of stability over time (without the drop during the healing period). [11] The long-term success of dental implants in various clinical situations depends to a large extent on the quality of the implant and bone bond (Adell et al. 1981; Albrektsson et al. 1981; Zarb and Schmitt 1990). Because of a higher ratio of compact to trabecular bone in the mandible, implants inserted into the anterior mandible have higher survival rates than implants placed in the posterior maxilla (Adell et al. 1981; Lazzara et al. 1996; Alsaadi et al. 2007). Initial implant stability is mainly determined by the bone quantity and quality (trabecular/cancellous to cortical bone ratio). A positive correlation was found between primary stability and cortical thickness of the artificial bone. In case of a poor supportive capacity of bone (reduced bone density), compared with the implant diameter, a smaller drill diameter should be chosen, as from the findings of the present study it can be assumed that the undersized drilling technique locally optimizes the bone density and consequently improves the primary stability. [12] However, the thicker the cortical layer, the less the effect of both an undersized surgical approach, as also the presence of a roughened (etched) implant surface. [12] Clinical studies have revealed a higher survival rate for dental implants in the mandible. However, a lower survival rate of the implants placed in the maxilla, particularly in the posterior region, has been reported in the literature, which can be explained by the bone around the implant having poorer volume and quality in maxilla. [5] The results suggested that using thinner drills for implant placement in the maxillary posterior region where bone density is relatively low may be a viable option to increase primary implant stability, which may result in better implant survival rates. [5] K. Wang et al. in their study demonstrated that axial NF (natural frequency) value which is a parameter to evaluate implant stability in the vertical direction increased with the buccal bi-cortical anchorages. In the study, regardless of bone quality and implant diameter, buccal bi-cortical anchorages resulted in higher NF values than the uni-cortical anchorage. Bi-cortical anchorage was put forth from a clinical aspect, that is, the buccal (lingual) modality, in which a wide-diameter implant is suggested to be placed in a slightly buccal (lingual) position to engage buccal (lingual) compact bone. It is speculated that this pattern of anchorage has beneficial effects on stabilizing the immediately loaded implants against deteriorative micro-motion at bone-implant interface in the initial phase of bone adaptation. [13] In another study by Nabeel H. M. Alsabeeha et al. [14] it was observed that for the midline area of the edentulous mandible, host-site variables such as age, gender, bone volume, and quality appear not to influence the primary stability of single implants placed to support overdentures. [14] Huang HL and coworkers in their study concluded that the initial stability at the time of implant placement is influenced by both the cortical bone thickness and the elastic modulus of trabecular bone; however, these parameters are not totally linearly correlated with ITV (insertion torque value), PTV (periotest value), and ISQ (implant stability quotient). The placement of an immediately loaded implant in cases with thin cortical bone and/or weak trabecular bone can induce extreme bone strains and may increase the risk of implant failure. [15] In a study by Julie Roze et al. [16] it was observed that the ISQ values were significantly higher for the implants placed in mandibular than in maxillary sites. Boronat-Lopez et al. (2006) observed that ISQ values were higher in anterior than in posterior regions, but recordings in the mandible were systematically higher than in the maxilla. The results showed showed thicker cortical bone in mandibular than in maxillar sites in accordance with the literature data (Miyamoto et al. 2005), thus explaining the greater ISQ values observed in these sites. Cortical bone thickness is thus of considerable importance for primary implant stability. Trabecular bone structure seems to play a minimal role in primary fixation but is certainly of considerable importance for peri-implant bone healing. [16]


   Implant Characteristics Influencing Primary Implant Stability Top


Joe Merheb et al. [17] in their study performed resonance frequency analysis (RFA) test at implant placement, and RFA and PTV were scored at loading. Bone density [Hounsfield (HU) scores] and coronal cortical thickness at osteotomy sites were measured from pre-operative computerized tomography scans. They concluded that the implant length or diameter did not seem to influence primary stability when considered as single parameters. However, in a stepwise multiple regression analysis, both parameters became significant probably due to the elimination of the confounding influence of the cortical thickness and/or the impact of bi-cortical anchorage. The implant diameter, however, was shown to affect the RFA scores significantly at loading and confirms therefore the tendency to use wider implants in zones of poor bone quality or poor anchorage to improve success by increasing the possible bone to implant contact (Winkler et al. 2000). In the literature, the correlation between primary stability and implant design was subject to controversy. Comparisons have been carried out using implants with different diameters, lengths or designs. Some authors (Balleri et al. 2002; Miyamoto et al. 2005; Boronat-Lopez et al. 2006) have determined a negative correlation between implant length and primary stability measured by RFA (resonance frequency analysis). However, other authors have not established any significant correlation between ISQ value and length, diameter or position of the implant (Bischof et al. 2004; Akkocaoglu et al. 2005; Akca et al. 2006). In a study by Julie Roze et al. a significant increase in ISQ values between custom-made plain, and threaded dental, implants inserted into the same sites was observed. It is clear that ISQ values are affected by the primary stability provided by the threads of the dental implants. [16] Primary stability can also be improved by adapting the surgical technique and by implant selection. For instance, the use of thinner drills and wider and tapered implant designs will result in a high primary stability. This improvement is due to lateral compression of the bone trabeculae and an increase of the interfacial bone stiffness. [18] Surface texturing of implants does directly contribute to initial implant stability. It may reduce the risk of stability loss and consequently facilitate wound healing (secondary osseointegration). [18] Greater implant length and diameter increase the contact surface area at the bone-implant interface and have been found to result in better (more negative) PTVs (periotest values) (Cranin et al. 1998; Engel et al. 2001; Morris et al. 2003). Francisco Mesa et al. [19] in a study concluded that primary DIS (dental implant stability) failure is more likely in females than males, at sites other than the anterior mandible because of the differences in bone masses. The texture of an implant's surface can influence the rate and extent of bone-implant fixation, which is expressed by the amount of bone-to-implant contact (BIC). For example, in poor bone quality sites, implants with an acid-etched surface can achieve a significantly higher BIC as compared with implants with a machined surface (Weng et al. 2003; Veis et al. 2007). Surface-roughened implants have a failure rate (3.2%) five times lower than machined surface implants (15.2%) (Khang et al. 2001). Rough surfaces have to be considered as "osteophilic," because the rate and degree of osseointegeration was found to be superior for the rough surface as compared with the machined-surface implants (Abrahamsson et al. 2004). A comparison of different implant designs has been examined in the past. O'Sullivan et al. compared the primary stability characteristics of five different implant designs. The study demonstrated higher RF (resonance frequency) analysis and insertion torque values for tapered implants than for nontapered implants, suggesting increased stability in tapered implants. [20] A study by Linus Chong et al. concluded that fully inserted implants without self-tapping blades have higher initial stability than implants with self-tapping blades. The non-self-tapping implant has a higher number of threads than the self-tapping implant, thus increasing the surface area in contact with adjacent block/bone walls. In the self-tapping implant design, the self-tapping blades present in the apical third of the implant minimize the contact surface area of the implant thus leading to decreased primary stability. Lateral compression of material/bone associated with self-tapping thread design did not enhance the primary stability of the self-tapping design used in the study. [21] A study by O'Sullivan and colleagues [22] was conducted to analyze the mechanical performance and the primary and secondary stability characteristics of dental implants with 1° and 2° of taper when compared with the standard Brånemark design. Their results showed that an implant designed with 1° of taper results in a better primary stability compared with the standard Brånemark design.


   Surgical Technique Affecting Primary Implant Stability Top


To achieve better primary stability and expand the range of indications with inferior bone quality, a procedure known as the osteotome technique for bone condensing was developed by Summer in 1994. The objective of this procedure is to retain the bone that would otherwise be removed by compressing it laterally and axially to create a precisely formed implant site. [23] The use of the osteotome technique for implant placement in normal ridge cases in a study by Padmanabhan and Gupta [23] revealed an average crestal bone loss of 1.19 mm compared to 0.99 mm bone loss with conventional procedure. It was concluded that the indications for the use of osteotome technique should be limited to those for which it was introduced, that is, knife-edge ridges and for bone with less density. It should not be considered a substitute or replacement for the conventional procedure of implant placement. [23] The drilling procedure used at the implant site, the implant's macrogeometry (tapered shape), and the bone quality at the implant site seem to influence the achievement of primary stability. Underpreparation of the implant bone bed makes it possible to increase the moment of force needed to screw the implant into position [Figure 2]. This moment of force is referred to as insertion torque. By increasing the insertion torque it is possible to improve an implant's primary stability. [24] A study by Paolo Trisi et al. showed that implants from the HT (high torque) group showed significantly higher bone apposition than implants from the LT (low torque) group at all examined healing times. [24] In recent years, titanium mini-implants have been used as stable orthodontic anchorages, allowing predictable tooth movement to be achieved successfully without patient cooperation. In their study, Mizuki Inaba and coworkers found that the inclination of the implant in the direction opposite to the tractional force was thought to facilitate anchorage. Slanting a mini-implant at an angle of 60° and 120° other than 90° increases the apparent cortical bone thickness, and might enhance stability. [25] A study by Ramakrishna et al. evaluated the effect of immediate loading on the primary stability of endosseous implants placed in the anterior incisor region by mapping the stability over a period of time, using resonance frequency analysis. It was concluded that immediate loading of implants placed in the maxillary and mandibular incisor region did not seem to affect the osseointegration of the implants which showed a high primary stability. [18]
Figure 2: Comparison of natural extraction socket and implant osteotome

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   Discussion Top


Primary implant stability is a prerequisite for implant survival, thereby preventing the formation of a connective tissue layer between implant and bone, thus ensuring bone healing (Branemark et al. 1977; Adell et al. 1981; Albrektsson et al. 1981; Meredith 1998; Lioubavina-Hack et al. 2006). Not only do the quantity and quality of bone dictate primary stability, but the surgical technique (relation between drill size and implant size) and the combination of the microscopic and macroscopic morphology of the implant itself are also decisive parameters (Adell et al. 1981; Zarb and Schmitt 1990; Sennerby and Roos 1998; Buchter et al. 2003; O'Sullivan et al. 2004; Saadoun et al. 2004; Sevimay et al. 2005). Optimal implant stability is especially essential in bone of low density (Listgarten 1997; Martinez et al. 2001). Several modifications of surgical technique have been described to increase the primary stability of implant in bone of low density. Some authors suggest the use of a final drill diameter that is smaller than the diameter of the implant (Friberg et al. 2001, 2002), others propose the technique of bone condensing, where, after using the pilot drill, the bone is pushed aside with awl-shaped instruments, called "condensers," thereby increasing the density of the surrounding bone (Summers 1994a-1994c). In case of insufficient bone density, it is advisable to seek anchorage of an implant in at least two cortices (Sennerby et al. 1992). Besides the surgical technique, implant surface parameters have a significant influence on primary implant stability. Many studies have already demonstrated that rough surfaces, by enlarging the implant area in contact with the host bone, favor primary stability (Vercaigne et al. 1998; Hansson 1999). It was determined that there were significant correlations between bone density and insertion torque values, bone density and ISQ values, and insertion torque and ISQ values. [6] The survival rate of self-tapping implants was found to be higher as compared to that of pre-tapped standard implants, which indicates that self-tapping leads to better implant stability. [26] A precise drilling technique to avoid overpreparation of implant sites has been cited as important, especially in soft-quality bone. [27] Venturelli [28] described a modified surgical protocol for soft-quality bone aimed at optimal primary stability by avoiding overpreparation and striving for bicortical support. Experimental studies have suggested that bicortical anchorage may be one way to improve implant stability. [26] Cylindric and grooved hydroxyapatite implants had lower failure rates than hydroxyapatite screws, titanium alloy screws, commercially pure titanium screws, and titanium alloy baskets. [26] From the literature on machined commercially pure titanium screws, it is clear that short implants fail more often than longer implants. [29],[30],[31],[32] It was confirmed by many studies that the primary stability is influenced mainly by implant diameter and not by implant length. [33],[34],[35],[36],[37] Placement of implants in the posterior maxilla can be compromised because of the proximity of the floor of the maxillary sinus or the presence of soft bone. SLActive (sandblasted, large-grit/acid-etched active surface) is a new chemically modified implant surface that is conditioned in nitrogen and immediately preserved in an isotonic saline solution. This process maintains its chemical purity and high surface activity. Hydrophilic properties increase early cellular activity and bone apposition, thus promoting faster osseointegration and increased bone-to-implant contact and further increase in the stability over time. It has been reported that implants with a sandblasted large-grit acid-etched active surface, when placed with the osteotome sinus floor elevation technique, can be subjected to an early loading protocol, provided their stability is confirmed by resonance frequency analysis. [38] Initial implant stability is mainly determined by the bone quantity and quality (trabecular/cancellous to cortical bone ratio). A positive correlation was found between primary stability and cortical thickness of the artificial bone. However, the thicker the cortical layer, the less the effect of both an undersized surgical approach, as also the presence of a roughened (etched) implant surface. [12] It was established by Ilser Turkyilmaz [5] et al. that using thinner drills for implant placement in the maxillary posterior region where bone density is relatively low may be a viable option to increase primary implant stability, which may result in better implant survival rates. It has been claimed that using Summer's technique of bone expansion and simultaneous implant placement results in less chance of heat generation and increases initial stability because of lateral condensation of bone. It is also claimed that this approach gives better primary stability, results in less chance of crestal bone loss around the implant, and so leads to less fear and anxiety related to implant failure. [39],[40],[41],[42] Although alveolar ridge expansion can be achieved by the osteotome technique, this kind of preparation seemed to put pressure on the crestal cortical bone layer, causing a significant peri-implant marginal bone loss. [43] The indications for the use of osteotome technique should be limited to those for which it was introduced, that is, knife-edge ridges and for bone with less density. It should not be considered a substitute or replacement for the conventional procedure of implant placement. [23] Underpreparation of an implant bone bed makes it possible to increase the moment of force needed to screw the implant into position. This moment of force is referred to as insertion torque. By increasing the insertion torque it is possible to improve an implant's primary stability. [24] High implant insertion torque produces compression and distortion on the peri-implant bone. This has been claimed to induce deleterious effects on the local microcirculation, which may lead to bone necrosis and possibly to failure of the implant. To achieve good primary stability without creating excessive compression in the peri-implant bone, it has been suggested that implants be inserted with a torque of at least 30 Ncm for immediately loaded full-arch prostheses in the mandible or partial prostheses in either arch. [44] Maintenance of low implant micromovement, especially in early healing periods, presents importance in promotion of direct bone in growth to implant surface, therefore, achievement of optimum primary implant stability. [6] Primary stability can be improved by adapting the surgical technique and by implant selection. For instance, the use of thinner drills and wider and tapered implant designs will result in a high primary stability. This improvement is due to lateral compression of the bone trabeculae and an increase of the interfacial bone stiffness. [18] To enhance the stability of the non-self-tapping implants at initial surgery, many surgeons placed these implants without using a surgical tap to prepare a threaded channel in the bone. This technique allows the placement of the implant in slight compression within the bone. In theory this compression enhances implant primary stability by developing circumferential or hoop stresses within the bone at the zone of the bone-implant interface. [3]


   Conclusion Top


The following conclusions can be drawn from the above review [Table 1]:
Table 1: Primary stability and factors affecting it

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  • Surgical technique and surface roughness have a huge impact on the primary stability of implants in low-density bone.
  • The outcome of implant stability assessment depends on environmental factors such as bone quality and implant geometry.
  • Bone density certainly influences implant stability at placement. A thick cortical bone is associated with high implant stability quotients and thus high loading capacity.
  • The bone quality and implant stability is lower in the posterior area; for this reason the posterior implant success rate is less than the anterior. In the anterior area, the thick cortical and the dense trabecular bone will increase primary stability, hence ISQ values would be higher in this area than the posterior region.
  • In case of a poor supportive capacity of bone (reduced bone density), an undersized drilling technique locally optimizes the bone density and consequently improves the primary stability.
  • Bi-cortical engagements are more effective than increasing implant diameter in improving implant stability.


 
   References Top

1.Atsumi M, Park SH, Wang HL. Methods used to assess implant stability: Current status. Int J Oral Maxillofac Implants 2007;22:743-54.  Back to cited text no. 1
[PUBMED]    
2.Meredith N. Assessment of implant stability as a prognostic determinant. Int J Prosthodont 1998;11:491-501.  Back to cited text no. 2
[PUBMED]    
3.O'Sullivan D, Sennerby L, Jagger D, Meredith N. Comparison of two methods of enhancing implant primary stability. Clin Implant Dent Relat Res 2004;6:48-57.  Back to cited text no. 3
    
4.Brånemark P, Zarb G, Albrektsson T. Introduction to osseointegration. In: Brånemark PI, Zarb GA, Albrektsson T, editors. Tissue- Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence; 1985. p. 11-76.  Back to cited text no. 4
    
5.Turkyilmaz I, Aksoy U, McGlumphy EA. Two alternative surgical techniques for enhancing primary implant stability in the posterior maxilla: A clinical study including bone density, insertion torque, and resonance frequency analysis data. Clin Implant Dent Relat Res 2008;10:231-7.  Back to cited text no. 5
    
6.Turkyilmaz I, Sennerby L, McGlumphy EA, Tözüm TF. Biomechanical aspects of primary implant stability: A human cadaver study. Clin Implant Dent Relat Res 2009;11:113-9.  Back to cited text no. 6
    
7.Getrange T, Hietschold V, Mai R, Wolf P, Nicklisch M, Harzer W. An evaluation of resonance frequency analysis for the determination of the primary stability of orthodontic palatal implants. A study in human cadavers. Clin Oral Implants Res 2005;16:425-31.  Back to cited text no. 7
    
8.Rodrigo D, Aracil L, Martin C, Sanz M. Diagnosis of implant stability and its impact on implant survival: A prospective case series study. Clin Oral Implants Res 2010;21:255-61.  Back to cited text no. 8
    
9.Bischof M, Nedir R, Szmukler-Moncler S, Bernard JP, Samson J. Implant stability measurement of delayed and immediately loaded implants during healing. A clinical resonance-frequency analysis study with sandblasted-and-etched ITI implants. Clin Oral Implants Res 2004;15:529-39.  Back to cited text no. 9
    
10.Monov G, Fuerst G, Tepper G, Watzak G, Zechner W, Watzek G. The effect of platelet-rich plasma upon implant stability measured by resonance frequency analysis in the lower anterior mandibles. Clin Oral Implants Res 2005;16:461-5.  Back to cited text no. 10
    
11.Strnad J, Urban K, Povysil C, Strnad Z. Secondary stability assessment of titanium implants with an alkali-etched surface: A resonance frequency analysis study in beagle dogs. Int J Oral Maxillofac Implants 2008;23:502-12.  Back to cited text no. 11
    
12.Tabassum A, Meijer GJ, Wolke JG, Jansen JA. Influence of surgical technique and surface roughness on the primary stability of an implant in artificial bone with different cortical thickness: A laboratory study. Clin Oral Implants Res 2010;21:213-20.  Back to cited text no. 12
    
13.Wang K, Li DH, Guo JF, Liu BL, Shi SQ. Effects of buccal bi-cortical anchorages on primary stability of dental implants: A numerical approach of natural frequency analysis. J Oral Rehabil 2009;36:284-91.  Back to cited text no. 13
    
14.Alsabeeha NH, De Silva RK, Thomson WM, Payne AG. Primary stability measurements of single implants in the midline of the edentulous mandible for overdentures. Clin Oral Implants Res 2010;21:563-6.  Back to cited text no. 14
    
15.Huang HL, Chang YY, Lin DJ, Li YF, Chen KT, Hsu JT. Initial stability and bone strain evaluation of the immediately loaded dental implant: An in vitro model study. Clin Oral Implants Res 2011;22:691-8.  Back to cited text no. 15
    
16.Roze J, Babu S, Saffarzadeh A, Gayet-Delacroix M, Hoornaert A, Layrolle P. Correlating implant stability to bone structure. Clin Oral Implants Res 2009;20:1140-5.  Back to cited text no. 16
    
17.Merheb J, Van Assche N, Coucke W, Jacobs R, Naert I, Quirynen M. Relationship between cortical bone thickness or computerized tomography-derived bone density values and implant stability. Clin Oral Implants Res 2010;21:612-7.  Back to cited text no. 17
    
18.Ramakrishna R, Nayar S. Clinical assessment of primary stability of endosseous implants placed in the incisor region, using resonance frequency analysis methodology: An in vivo study. Indian J Dent Res 2007;18:168-72.  Back to cited text no. 18
[PUBMED]  Medknow Journal  
19.Mesa F, Munoz R, Noguerol B, de Dios Luna J, Galindo P. Multivariate study of factors influencing primary dental implant stability. Clin Oral Implants Res 2008;19:196-200.  Back to cited text no. 19
    
20.O'Sullivan D, Sennerby L, Meredith N. Measurements comparing the initial stability of five designs of dental implants: A human cadaver study. Clin Implant Dent Relat Res 2000;2:85-92.  Back to cited text no. 20
    
21.Chong L, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial stability of tapered implants. J Oral Implantol 2009;35:130-5.  Back to cited text no. 21
    
22.O'Sullivan D, Sennerby L, Meredith N. Influence of implant taper on the primary and secondary stability of osseointegrated titanium implants. Clin Oral Implants Res 2004;15:474-80.  Back to cited text no. 22
    
23.Padmanabhan TV, Gupta RK. Comparison of crestal bone loss and implant stability among the implants placed with conventional procedure and using osteotome technique: A clinical study. J Oral Implantol 2010;36:475-83.  Back to cited text no. 23
    
24.Trisi P, Todisco M, Consolo U, Travaglini D. High versus low implant insertion torque: A histologic, histomorphometric, and biomechanical study in the sheep mandible. Int J Oral Maxillofac Implants 2011;26:837-49.  Back to cited text no. 24
    
25.Inaba M. Evaluation of primary stability of inclined orthodontic mini-implants. J Oral Sci 2009;51:347-53.  Back to cited text no. 25
    
26.Sennerby L, Roos J. Surgical determinants of clinical success of osseointegrated oral implants: A review of the literature. Int J Prosthodont 1998;11:408-20.  Back to cited text no. 26
    
27.Adell R, Lekholm U, Brânemark PI. Surgical procedures. In: Brânemark PI, Zarb GA, Albrektsson T, editors. Tissue-Integrated Prostheses. Osseointegration in Clinical Dentistry. Chicago: Quintessence; 1985. p. 211-32.  Back to cited text no. 27
    
28.Venturelli A. A modified surgical protocol for placing implants in tbe maxillary tuberosity: Clinical results at 36 months after loading with fixed partial dentures. Int J Oral Maxillofac Implants 1996;11:743-9.  Back to cited text no. 28
    
29.Adell R, Eriksson B, Lekholm U, Brânemark PI, Jemt T. A long-term follow-up study of osseointegrated implants in the treatment of the totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347-59.  Back to cited text no. 29
    
30.Friberg B, Jemt T, Lekholm U. Early failures in 4,641 consecutively placed Brânemark dental implants: A study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implants 1991;6:142-6.  Back to cited text no. 30
    
31.Jaffin RA, Berman CL. The excessive loss of Brânemark fixtures in type IV bone: A 5-year analysis. J Periodontol 1991;61:2-4.  Back to cited text no. 31
    
32.Lekholm U, van Steenberghe D, Herrman 1, Bolender C, Folmer T, Gunne J, et al. Osseointegrated implants in the treatment of partially edentulous jaws. A prospective 5-year multicenter study. Int J Oral Maxillofac Implants 1994;9:627-35.  Back to cited text no. 32
    
33.Himmlová L, Dostálová T, Kácovský A, Konvic¡ková S. Influence of implant length and diameter on stress distribution: A finite element analysis. J Prosthet Dent 2004;91:20-5.  Back to cited text no. 33
    
34.Kessler-Liechti G, Zix J, Mericske-Stern R. Stability measurements of 1-stage implants in the edentulous mandible by means of resonance frequency analysis. Int J Oral Maxillofac Implants 2008;23:353-8.  Back to cited text no. 34
    
35.Karl M, Graef F, Heckmann S, Krafft T. Parameters of resonance frequency measurement values: A retrospective study of 385 ITI dental implants. Clin Oral Implants Res 2008;19:214-8.  Back to cited text no. 35
    
36.Zix J, Kessler-Liechti G, Mericske-Stern R. Stability measurements of 1-stage implants in the maxilla by means of resonance frequency analysis: A pilot study. Int J Oral Maxillofac Implants 2005;20:747-52.  Back to cited text no. 36
    
37.Zix J, Hug S, Kessler-Liechti G, Mericske-Stern G. Measurement of dental implant stability by resonance frequency analysis and damping capacity assessment: Comparison of both techniques in a clinical trial. Int J Oral Maxillofac Implants 2008;23:525-30.  Back to cited text no. 37
    
38.Markovi´c A, C¡oli´c S, Draži´c R, Gac¡i´c B, Todorovi´c A, Stajc¡i´c Z. Resonance frequency analysis as a reliable criterion for early loading of sandblasted/acid-etched active surface implants placed by the osteotome sinus floor elevation technique. Int J Oral Maxillofac Implants 2011;26:718-24.  Back to cited text no. 38
    
39.Summer RB, Mawr B. A new concept in maxillary implant surgery: The osteotome technique. Compend Contin Educ Dent 1994;15:152-61.  Back to cited text no. 39
    
40.Summer RB, Mawr B. The osteotome technique: Part 2-the ridge expansion osteotomy procedure. Compend Contin Educ Dent 1994;15:422-34.  Back to cited text no. 40
    
41.Summer RB, Mawr B. The osteotome technique: Part 3-less invasive methods of elevating the sinus floor. Compend Contin Educ Dent 1994;15:698-708.  Back to cited text no. 41
    
42.Summer RB, Mawr B. The osteotome technique: Part 4-future site development. Compend Contin Educ Dent 1995;16:1090-9.  Back to cited text no. 42
    
43.Strietzel FP, Nowak M, Kuchler I, Freidmann A. Peri-implant alveolar bone loss with respect to bone quality after use of the osteotome technique: Results of a retrospective study. Clin Oral Implants Res 2002;13:508-13.  Back to cited text no. 43
    
44.Testori T, Del Fabbro M, Szmukler-Moncler S, Francetti L, Weinstein RL. Immediate occlusal loading of osseotite implants in the completely edentulous mandible. Int J Oral Maxillofac Implants 2003;18:544-51.  Back to cited text no. 44
    


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