Dentaltown September 2017 - 40

60
ISQ

LOW STABILITY

MEDIUM STABILITY
ISQ 60-65
Full splint
(immediate loading)

ISQ 65-70
Partial case

ISQ > 70
Single case

2-stage

1- or 2-stage

1-stage

RESTORATIVE
PROTOCOL

Traditional loading

Early loading

Immediate loading

Fig. 8. Temporary abutments

Fig. 9. Temporary abutments prepped

INDICATION

ISQ < 60
Implant at risk-
monitor ISQ

SURGICAL
PROTOCOL

A baseline implant stability quowith a cortical mineralized and demintient (ISQ) reading of the implants
eralized bone-grafting material (OCO
was taken with an Osstell IDx unit
Biomedical) to optimize the area for
(Fig. 7). The Osstell IDx is a fast,
regeneration. Primary closure was
noninvasive and easy-to-use system
achieved by suturing the tissue (Fig. 9).
that determines implant
The prefabricated immestability and accesses the
diate provisional restoration
process of osseointegration
was tried in to ensure a paswithout jeopardizing the
sive fit over the temporary
healing process. It provides
abutments. Once confirmed,
the necessary information
rubber dam material was
Fig. 7. Osstell
to ma ke wel l-fou nded
placed to prevent the resIDx reading
decisions.
toration from locking on
With more than 870
during the relining procedure
scientific references, we now know that
with white Triad (Dentsply). After the
high stability is greater than 70 ISQ,
material polymerized, the immediate
between 60-69 is medium stability
provisional restoration was removed and
and less than 60 ISQ is considered low
any excess material was removed with
stability. Since the readings on each of
the Torque Plus (Aseptico) lab handpiece
the eight placed dental implants were
and an acrylic bur (Komet). Once
above 70 and the quality of bone after
trimmed and polished, the provisional
leveling was good, temporary abutments
restoration was seated with Temp Bond
(OCO Biomedical) were tightened
Clear (Kerr).
into the dental implants (Fig. 8) and
The patient returned seven days
prepped with copious amounts of water
post-op for suture removal with very
for immediate provisionalization.
little discomfort, swelling or bruising.
Any residual areas around the
She was very pleased with her new upper
implants or in the sockets were grafted
denture and lower fi xed provisional

HIGH STABILITY

SEPTEMBER 2017 // dentaltown.com

Fig. 10. Lower immediate provisional
restoration

restoration (Fig. 10). Now that the
patient was no longer anesthetized,
the occlusion was checked again to
confi rm there were no interferences
in lateral and protrusive movements.
Approximately four to five months
post-operatively, the dental implants
were further tested for osseointegration
with the IDx by removing the temporary
abutments, placing an Osstell SmartPeg
and capturing the ISQ. Once confirmed,
impressions could be captured with
either polyvinylsiloxane material or
digital impressions.

Conclusion
Having the ability to take a patient
from start to finish in fewer appointments and the ability to accurately
assess implant stability within your
practice allows you to ideally fulfi ll
your patient's surgical and restorative
needs when it comes to dental implant
treatment. With the proper training
and appropriate materials, a dental provider may provide extraction, grafting,
implant placement and fixed provisional
restorations within one appointment. ■

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Table of Contents for the Digital Edition of Dentaltown September 2017