Search Results (27)

Background/Objectives: The objective assessment of natural tooth mobility remains challenging in clinical practice. This pilot study aimed to investigate the feasibility, repeatability, and agreement of a modified implant stability measurement system adapted for natural teeth using a custom-fabricated titanium bracket and a modified SmartPeg. Methods: Sixteen systemically healthy patients (10 males, six females) and 94 single-rooted permanent teeth with varying mobility grades were included. The tooth mobility was assessed using the Miller Mobility Index, Periotest M, and resonance frequency analysis (RFA) with the Osstell Beacon device. For the Osstell measurements, a custom titanium bracket bonded to the buccal tooth surface allowed for the placement of a modified SmartPeg. Each tooth was measured twice under standardized conditions, and mean values were recorded. The statistical analyses included Spearman correlation analysis, Cohen’s kappa for agreement with Miller categories, and intraclass correlation coefficients (ICCs) to assess the measurement repeatability. Results: The mean Periotest value was 12.70 ± 13.69, and the mean ISQ (implant stability quotient) value was 69.45 ± 19.37. The repeated measurements demonstrated excellent intra-examiner repeatability for both devices (ICC > 0.95). The Periotest values showed substantial agreement with the Miller mobility grades (κ = 0.763; p < 0.001), whereas the Osstell values demonstrated weak agreement with these ordinal categories (κ = 0.094; p = 0.048). A strong negative correlation was observed between the Periotest and Osstell measurements irrespective of the scales (r = −0.865; p < 0.001). Conclusions: In natural dentition, the resonance frequency analysis demonstrated reproducible measurements under controlled experimental conditions and showed measurable associations with conventional mobility assessments. However, the method remains investigational. The findings do not establish clinical validity for the routine assessment of natural tooth mobility. Further studies with larger sample sizes and statistical models accounting for patient-level clustering are required before clinical implementation can be considered. This study is registered at ClinicalTrials.gov (NCT07188168). Full article

(1) Background: Dental implant instability represents a dynamic biomechanical process influenced by functional loading, peri-implant bone stiffness, and systemic conditions affecting bone metabolism. In patients with systemic bone disorders, altered material properties and impaired remodeling may reduce effective implant–bone interface stiffness, potentially increasing micromotion beyond what is detectable by conventional clinical indicators. The aim of this study was to develop and evaluate a predictive bioengineering model of implant instability based on Periotest-derived dynamic measurements. (2) Methods: A retrospective analysis was performed on 79 dental implants placed in patients with and without systemic bone disorders. Implant micromotion was quantified using Periotest values (PTVs). Linear and logistic regression analyses were applied to model the relationship between systemic bone status, implant location, and biomechanical instability (defined as PTV > +2.0). A load–stiffness–micromotion framework was used to provide mechanical interpretation of the findings. (3) Results: Implants placed in patients with systemic bone disorders exhibited significantly higher Periotest values compared to controls (+2.1 ± 1.3 vs. −0.4 ± 1.1; mean difference 2.5 PTV units, 95% CI 1.97–3.04; p < 0.001). High-risk biomechanical instability (PTV > +2.0) was observed in 46% of implants in the systemic group compared to 9% in controls. Multivariable logistic regression demonstrated that systemic bone disorders were independently associated with a 2.6-fold increase in the odds of high-risk instability after adjustment for implant location. The observed instability pattern was consistent with reduced effective peri-implant stiffness in systemically compromised bone. (4) Conclusions: Dental implant instability in systemically compromised patients can be interpreted as a load–stiffness imbalance at the implant–bone interface. The proposed predictive bioengineering framework links dynamic Periotest measurements with mechanical modeling and systemic bone status, enabling quantitative risk stratification beyond static stability assessments. Full article

This split-mouth pilot study evaluated implant stability using resonance frequency analysis (ISQ), Periotest measurements (PTV), and CBCT imaging as a supportive descriptive modality. Twenty patients requiring implant placement in the anterior maxilla underwent bilateral augmentation with deproteinized bovine bone mineral, with an adjunctive polynucleotide–hyaluronic acid complex applied at one site and the contralateral site serving as control. Implants were placed after a standardized 6-month healing period. Implant stability was recorded at placement and during follow-up. Test sites showed slightly higher ISQ values and more negative PTV values at placement, followed by progressive stabilization in both groups during healing. Parallel trends of increasing ISQ and decreasing PTV values were observed over time. CBCT was used exclusively for intra-patient comparative and morphologic assessment. Within the limitations of this pilot design, implant stability measurements should be interpreted as functional indicators of the implant–bone complex during early healing. The combined use of ISQ and Periotest measurements may support longitudinal monitoring of implant stability in routine clinical practice. Further studies with larger cohorts and extended follow-up are warranted. Full article

Background: The macrogeometry and shape of dental implants strongly influence primary stability, which may at times result in excessively high insertion torque. This in vitro study aimed to evaluate whether increasing coronal thread density could reduce insertion torque without compromising primary stability. Methods: Two conical implants with identical macrogeometry and surface characteristics (Ø 4.2 × 11.5 mm) differed only in the thread pitch of the coronal 3 mm: a modified version (27% more coronal threads; Group 1) and a standard, commercially available version (Group 2). Thirty implants of each design were inserted into high-density (D1; 40 PCF; pounds per cubic foot) and low-density (D3; 20 PCF) polyurethane blocks (n = 120). Insertion torque (IT) and implant stability quotient (ISQ, measured by resonance frequency analysis) were recorded. Group comparisons used the Kruskal–Wallis test, and a generalized linear model (GLM) assessed the independent effects of IT and design on ISQ in D1 bone. Results: In D1 bone, Group 2 showed higher IT (median 74.0 vs. 63.5 N·cm; p < 0.001) and ISQ (mean 79.1 vs. 77.4; p ≤ 0.030). The GLM identified IT as a negative predictor of ISQ (β = −0.267 per 1 N·cm; p < 0.001), and Group 2 was associated with higher ISQ (+3.90; p < 0.001). In D3 bone, Group 2 again exhibited higher IT (median 37.5 vs. 33.0 N·cm; p < 0.001), while ISQ values were similar between designs (all p > 0.35). Conclusions: Increasing coronal thread density lowers insertion torque without reducing stability in softer bone and maintains sufficient ISQ for immediate loading in dense bone, making the design advantageous for varied bone qualities. Full article

The periodontal ligament (PDL) is essential for the physiological mobility and load distribution of natural teeth, yet its simulation in mechanical testing remains inconsistent and insufficiently standardized. The absence of a resilient suspension system can alter force transmission, affect failure patterns, and reduce the clinical relevance of in vitro outcomes. This study aimed to develop a reproducible CAD/CAM-based model for PDL simulation that provides elastic suspension of a tooth replica under laboratory conditions. A digitally defined offset was applied around a tooth replica to create a controlled PDL space, which was filled with polyether. To ensure precise seating of the specimens, a 3D-printed positioning device was used. Functional calibration was performed using Periotest measurements to identify the offset that reproduced physiological tooth mobility. A digital offset of 0.85 mm produced a radiographically confirmed polyether layer of 0.86 ± 0.05 mm and yielded Periotest values comparable to natural teeth in the horizontal direction (mean PTV = 2.99 ± 0.92). Vertical measurements demonstrated higher damping (mean PTV = −4.02 ± 0.56), consistent with the anisotropic behavior of natural PDL. The model showed high fabrication accuracy and predictable mechanical behavior, providing a physiologically relevant method for incorporating PDL simulation into laboratory mechanical testing. Full article

Background and Objectives: Dental implants are a reliable solution for tooth loss; however, systemic conditions like osteoporosis and diabetes, which affect bone quality, healing, and stability, underline the importance of understanding their impact on enhanced outcomes. This study evaluated the comparative effects of osteoporosis and diabetes on dental implant stability over 12 months, utilizing objective implant mobility and stability measures. Materials and Methods: This prospective cohort study involved 50 patients, divided into 21 with type 2 diabetes and 29 with osteoporosis, with implant stability assessed at 6 and 12 months using Osstell ISQ and Periotest M devices and statistical analysis identifying differences between groups and time intervals at a significance level of p < 0.05. Results: At 6 months, the osteoporosis group showed higher initial stability (mean ISQ: 67.04 ± 5.42) compared to the diabetes group (mean ISQ: 62.10 ± 5.46; p = 0.0215)), and by 12 months, both groups showed significant improvements in ISQ scores (osteoporosis: 68.93 ± 4.83; diabetes: 65.79 ± 3.87), with Periotest values indicating more significant reductions in implant mobility, particularly in diabetic patients (osteoporosis: −3.34 ± 1.59; diabetes: −2.81 ± 1.44; p = 0.0001). Conclusions: Osteoporosis and diabetes significantly impact implant stability through distinct osseointegration pathways, emphasizing the need for personalized treatment plans to improve patient outcomes. Full article

Objective: The aim of this study was to allow researchers to evaluate the Periotest device as a reproducible tool that can be trusted to carry out accurately reproducible and comparable tooth mobility readings. Methods: A reproducibility test was initially conducted taking Periotest recordings for #16 every 10 min with 1 min intervals. Each time, three readings were recorded, and the average of the three was noted. This was followed by recordings for three different subject groups varying in age that were seen three times in 4 weeks, with 2-week intervals between each appointment; recordings were taken of #11, #13 and #16. Nonparametric analysis using the Wilcoxon signed-rank test was carried out. Results: For the reproducibility test, the values of all three readings for each recording session were either exactly the same or differed by up to ±2 Periotest value units. p-value results in the three patient groups showed no significant difference in Periotest values between appointments, with the minor exception of #16 in all three groups, but this was well within the limits of error of the device. Conclusions: Analysis of the Periotest readings in this study indicates that positive (higher) Periotest values correspond to increased tooth mobility. Full article

The aim of this prospective study is to investigate implant stability and the reliability of different measuring devices according to implant placement site and duration in patients aged over 65 years. The study evaluated 60 implants (diameter: 3.5/4.0/4.5/5.0 mm and length: 8.5/10.0/11.5 mm) in 60 patients aged ≥ 65 years. The implant placement sites were divided into six evenly distributed sections (n = 10), i.e., maxillary right-posterior, A; maxillary anterior, B; maxillary left-posterior, C; mandibular right-posterior, D; mandibular anterior, E; mandibular left-posterior, F. Participants visited the hospital six times: implant surgery, 1V; stitch removal, 2V; 1-month follow-up, 3V; 2-month follow-up, 4V; before final restoration delivery, 5V; and after final restoration delivery, 6V. The implant stability was evaluated with the Osstell Mentor (ISQ), Periotest M (PTV), and Anycheck (IST). The mean values of ISQ, PTV, and IST were analyzed (α = 0.05). ISQ, PTV, and IST results of 4V and 5V were significantly higher than those of 1V (p < 0.05). The lowest ISQ results occurred in the E location at 4V and 5V (p < 0.05). In all mandibular locations, IST results of 6V were significantly higher than those of 1V, 2V, 3V, and 4V (p < 0.05). ISQ results were negatively correlated with PTV and positively correlated with IST, and PTV was negatively correlated with IST. By considering various factors affecting the stability of the implant, it is necessary to determine the appropriate implant load application time. This could help increase the implant success rate in elderly patients. And as a diagnostic device for implant stability and the evaluation of osseointegration in elderly patients, Anycheck was also able to prove its relative reliability compared to Osstell ISQ Mentor and Periotest M. Full article

Background and Objectives: Progesterone and estrogen modify the bone metabolism directly related to the periodontium, this study aimed at answering the question whether fluctuations in the levels of these hormones or the use of their synthetic equivalents in modern contraceptives have a significant impact on the natural tooth mobility (TM) in its alveolus. Materials and Methods: Sixty healthy women who had never been pregnant and when interviewed reported either (1) having regular menstruations every 28–30 days or (2) taking oral two-phase two-ingredient hormonal contraceptives formed, respectively, groups M and S in the study. TM evaluated as the Periotest value (PTV) was checked in the menstruation, ovulation, and luteal phases of the menstrual cycle (group M) and on the days corresponding to the moment of the menstrual cycle in group S. Results: Although the PTV-s were within the limits of norm, the canines and the molars were always more stable than the other teeth. In group M, the TM was statistically comparable (p > 0.05) in the menstrual and ovulation phases, thus significantly increased (p < 0.001) in the luteal phase. The TM remained constant (p = 0.758) in all studies in group S. The results demonstrated that the canines and the molars in the luteal phase were significantly more mobile in group M than in group S (p < 0.001), although increased mobility of the teeth in group M affected the canines and the first molars to a significantly lesser degree than the other teeth. Conclusions: However, since women between 20 and 30 years old constitute the majority of ortho-dontic patients, possible determination of the optimum moment of force application in relation to the sex hormones cycle, namely, to its luteal phase, is clinically very promising. Full article

Background and Objectives: To evaluate the stability of a dental implant and the effectiveness of a newly designed damping capacity assessment device by improving the number of blows and strength evaluated by a prospective clinical study. Materials and Method: The stability of dental implants was measured in 50 implants in a total of 38 patients. Measurements were performed using Anycheck and Periotest M devices, twice in total, divided into buccal and lingual directions. In addition, measurements were performed on the day of surgery, two weeks, one month, two months, and three months after surgery for a total of five times. After the standardization of the measured values, the differences and changes over time for each device were observed. Result: No difference in standardized values between the two devices was observed at any time point. In both devices, stability decreased at two weeks postoperatively but gradually increased thereafter. No differences were observed in the values according to the measurement direction. Conclusions: The damping capacity of Anycheck was similar to that of Periotest M. After a slight decrease in stability two weeks after implant placement, implant stability increased over time. Full article

Background and Objectives: The gold standard for a successful prosthetic approach is the osseointegration of an implant. However, this integration can be a problem in cases where the implant needs to be removed. Removing the implant with minimal damage to the surrounding tissues is important. Osteocytes cannot survive below −2 °C, but epithelial cells, fibroblasts, and other surrounding tissue cells can. Remodeling can be triggered by cryotherapy at temperatures that specifically affect osteocyte necrosis. In this study, we aimed to develop a method for reversing the osseointegration mechanism and for protecting the surrounding tissues by bone remodeling induced by CO₂ cryotherapy. Materials and Methods: In this study, eight 2.8 mm diameter, one-piece mini implants were used in New Zealand rabbit tibias. Two control and six implants were tested in this study. After 2 months of osseointegration, a reverse torque force method was used to remove all osseointegrated implants at 5, 10, 20, and 30 Ncm. The osseointegration of the implants was proven by periotest measurements. Changes in bone tissue were examined in histological sections stained with toluidine blue after rabbit sacrifice. The number of lacunae with osteocyte, empty lacunae, and lacunae greater than 5 µm and the osteon number in a 10,000 µm² area were calculated. Cryotherapy was applied to the test implants for 1 min, 2 min, and 5 min. Three implants were subjected to cryotherapy at −40 °C, and the other implants were subjected to cryotherapy at −80 °C. Results: Empty lacunae, filled osteocytes, lacunae >5 µm, and the osteon count around the implant applied at −40 °C were not significantly different from the control implants. The application of −40 °C for 1 min was found to cause minimal damage to the bone cells. The implants, which were applied for 1 min and 2 min, were successfully explanted on the 2nd day with the 5 Ncm reverse torque method. Test implants, which were applied cold for 5 min, were explanted on day 1. Tissue damage was detected in all test groups at −80 °C. Conclusions: The method of removing implants with cryotherapy was found to be successful in −40 °C freeze–thaw cycles applied three times for 1 min. To prove implant removal with cryotherapy, more implant trials should be conducted. Full article

The aim of this study is to identify a method that can maximize implant primary stability (IPS) and bone density under the controlled drilling conditions of the same diameter and length in low-density bones through an ex vivo study. A total of 87 dental implants were placed with standard drilling, under-drilling, and osseodensification drilling in 13 fresh porcine sternums. The Periotest value and the implant stability quotient were measured to evaluate the primary stability. The difference in the Hounsfield unit (HU) between the hole and peripheral bone up to a distance of 1 mm was measured. Osseodensification and under-drilling technique increased the IPS, compared with conventional drilling technique with statistical significance under the drilling conditions of the same diameter and length. Osseodensification technique with the counter-clockwise direction had higher HU gaps than the standard drilling and osseodensification technique with clockwise direction. Due to the effect of bone densification, the gap of HU was increased by a minimum of 43 HU and a maximum of 180 HU. Within the limitations of this ex vivo study, it was found that the osseodensification technique with counter-clockwise direction is effective to increase IPS and bone mineral density in low-density bone. Full article

Block bone substitutes have better augmentation stability for guided bone regeneration (GBR) than particulate bone substitutes. This study sought to determine whether GBR with an L-shaped porcine block bone (DPBM-C) differs from GBR with an L-shaped bovine block bone (DBBM-C) based on clinical, radiographic, and volumetric outcomes for peri-implant dehiscence defects. A total of 42 peri-implant defects were grafted with 20 L-shaped DPBM-C and 22 DBBM-C groups. The horizontal and vertical thicknesses of the augmented hard tissue were measured using sagittal cone-beam computed tomography, and the volumetric tissue change was evaluated by stereolithography image superimposition. Postoperative discomfort, early wound healing outcomes, and implant stability were also assessed. Among the clinical (subjective pain and swelling, wound dehiscence, membrane exposure, and periotest values), radiographic (changes in horizontal and vertical hard tissue thickness), and volumetric parameters of the L-shaped DPBM-C and DBBM-C groups during the healing period, only the periotest values showed a statistically significant difference (0.67 ± 1.19, p = 0.042). Within the limitations of this study, an L-shaped DPBM-C is not inferior to an L-shaped DBBM-C based on their clinical, radiographic, and volumetric outcomes for GBR of peri-implant dehiscence defects. Full article

The microthread neck concept has been applied to dental implants. This study investigated the pullout strength and destruction volume of orthodontic microimplants with and without the microthread neck design. Fifteen microimplants (diameter: 1.5 × 10 mm) of three types (Types A and B: without microimplant neck; Type C: with microimplant neck) were tested. The insertion torque (IT), Periotest value (PTV), horizontal pullout strength (HPS), and horizontal destruction volume (HDV) of each type were measured. Kruskal–Wallis H test and Dunn’s post-hoc comparison test were performed to compare the measured values of the three types of microimplants. The correlations of the measured values were used to perform the Spearman’s correlation coefficient analysis. The ITs of Types B (8.8 Ncm) and C (8.9 Ncm) were significantly higher than those of Type A (5.2 Ncm). Type B yielded the lowest PTV (4.1), and no statistical differences in PTV were observed among the three types. Type A had a significantly lower HPS (158.8 Ncm) than Types B (226.9 Ncm) and C (212.8 Ncm). The three types did not exhibit any significant differences in the HDV. The results of the Spearman’s correlation coefficient test revealed that HDV (ρ = 0.710) and IT (ρ = 0.813) were strongly correlated with HPS, whereas for PTV and HPS, it was not. HPS was strongly and significantly correlated with HDV. The orthodontic microimplant with a microimplant neck design did not perform better than that without a microthread in the mechanical strength test. Full article

Background: Implant primary stability can be affected by several factors related to implant macrogeometry, local anatomy, and surgical techniques. The aim of this research was to study primary stability on polyurethane foam sheets of wide-threaded implant design compared to narrow-threaded implants. Materials and methods: Two different implant designs were positioned on D3 density polyurethane blocks in a standardized environment: the wide-threaded implant and the narrow-threaded implant, for a total of 160 specimens. Moreover, for each group, two different sizes were considered: 3.8 mm × 12 mm and 4.8 mm × 12 mm. The insertion torque (IT) values, the removal strength (RT), and the Periotest analyses were evaluated. Results: A significantly higher IT and RT was reported for wide-threaded implants and two-stage implants (p < 0.01), compared to the narrow-threaded implants. The diameters seemed to provide a significant effect on the primary stability for both implants’ geometry (p < 0.01). A higher mean of the one-stage implant was evident in the Periotest measurements (p < 0.01). Conclusions: Both of the implants showed sufficient stability in polyurethane artificial simulation, while the wide-threaded implant design showed a higher primary stability on alveolar cancellous synthetic bone in vitro. Additionally, the prosthetic joint connection seemed to have a determinant effect on Periotest analysis, and the one-stage implants seemed to provide a high stability of the fixture when positioned in the osteotomy, which could be important for the immediate loading protocol. Full article