**13. Discussion**

The success of dental implants is affected by various factors according to the oral and general health of the patient, and it has been reported that the ISQ values vary in a range between 58 and 84, with a mean of 68 after 8–12 months [11].

When trying to provide not only predictability, but also expedient treatment, the use of an RFA device is invaluable. These devices provide a much better indicator of the level of osseointegration than all the other methods available. They are easy to use and only take a few moments to get ISQ values. Measurements are taken in the BL direction and in the MD direction while directing the transducer at an angle of 45 degrees to the peg (**Figure 13**).

**Figure 13.** *Angle to test stability showing "green" ISQ value.*

#### *RFA and Its Use in Implant Dentistry DOI: http://dx.doi.org/10.5772/intechopen.99054*

Intra-operatively it is a simple procedure and provides the data you need to make intelligent clinical decisions (**Figure 14**). At placement an ISQ value of 55 is equivalent to the use of torque value where a measurement of 30 would indicate sufficient primary stability in order to safely place a healing abutment for a 1 stage or early loading protocol. Any lower ISQ would indicate to the clinician that a two-stage protocol by burying the implant would be prudent. If a stability of 70 or above then immediately loading a single implant could be done safely.

In my clinical protocol, I take measurements at placement and then again at 8 weeks. At that time, I can make a determination of where the implant is in the healing spectrum. If the ISQ number has reached a minimum of 70, then I will proceed to the restorative phase with confidence. If it is somewhere between my initial measurement and 70, then I will wait another month and re-check.

Clinically this is not only tracked in my digital notes, but also on the Osstellconnect site (**Figure 15**). Conversely, if the ISQ number has dropped significantly below my initial reading at placement, it indicates a failing or failed implant and the decision to remove it is discussed with the patient. Even though this is an event that no one wants,

**Figure 14.** *Osstell IDX being used clinically.*

#### **Figure 15.**

*Screenshot of clinical interface on Osstell connect.*

at least it is identified early enough that a new implant can be placed and the patient only loses two months in the overall treatment time.

When compared with the use of RFA, Osstell™ system proved to be more reliable compared to Periotest® system in measuring dental implant stability in hard and in soft interfaces [12]. In 2020 when comparing the Osstell to the Penguin, Bural et al. saw no statistical difference in their readings [13].

Today, RFA is being used in clinical research to quantify differences in implant designs and surface technology. It was used to determine the difference in stability and bone loss associated with implants with differing crestal macro structures and thread designs [14].

Also, RFA was able to show that rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch [15].

These instruments are allowing clinical researchers to dissect the parameters and minutia that contribute to overall implant success. For example, the use of RFA has shown that there is no differences in stability of implant or failure rate between men and women [16].

Yet, in Peter Andersson's 2019 publication, he did find that women had lower ISQ values than men, which he and his colleagues attributed to the incidence of osteoporosis in female patients. These diametrically opposed outcomes will spur further studies into the differences in success between the sexes and what critical factors may be responsible.

He Also found that there was a significantly higher risk for failure for implants with an ISQ value below 70 and 75 than for implants with higher stability at placement. Moreover, the risk for failure increased further if the ISQ value was still below 70 and 75 after 3–4months of healing [17].

As you can imagine, research like this, is and will allow, us to treat more patients effectively and predictably.

The use of RFA is helping to develop better techniques for regeneration and help quantify the role that biologics like platelet-rich fibrin may have in enhancing healing and contributing to better implant stability [18].

Todays world of implantology if filled with wonderful technology to help practitioners and patients alike. CBCT technology, digital CAD/CAM and 3D printing all are used to provide the very best in patient care. RFA allows for a better understanding of primary stability, the healing process of osseointegration and takes the guesswork out of know when to restore.
