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Dental Tribune Middle East & Africa Edition July-August 2015

26 Dental Tribune Middle East & Africa Edition | July-August 2015implant tribune > Page 27 Immediate implant placement and loading in the anterior maxilla Is insertion torque and implant stability quotient (ISQ) an influence of a big value? A two clinical cases report. By Rabih Abi Nader1 , Lebanon, Carine Tabarani2 , Lebanon A bstract Immediate implant loading is considered nowadays a successful viable treatment, even though many criteria’s needs to be considered in order to insure implant proce- dures success, especially in the anterior maxilla. The aim of this article is to assess the influence of the stability quo- tient and insertion torque on the immediately placed and loaded implants in anterior maxilla by exposing two clinical cases and reviewing it through a literature review. Keywords Immediate implant, stability quotient, insertion torque, ante- rior maxilla. 1. DDS, MSc Oral Surg. Dipl., Oral Path. Lebanese University Faculty of Dental Medicine, Bei- rut, Lebanon. 2. DDS, MSc Oral Surg. Dipl., Oral Path.
 Senior lecturer. Saint Joseph University Faculty of Dental Medicine, Beirut, Leba- non. Nowadays the use of immediate implant loading protocol is con- sidered an attractive option in order to preclude dramatic post extraction bone resorption. Buccal alveolar plate loss fol- lowing tooth extraction in the maxillary anterior may lead to palatal implant positioning with esthetic complications. Immediate loading of implant- supported restorations replacing single missing tooth could be a successful procedure.17 Many clinical reports suggest that im- plants for the mandible have higher survival rates than those for the maxilla.16 Immediate placement and load- ing of single implants placed in fresh extraction sites carried no risk of failure in the present cases. The purpose of this article is to compare the parameters associ- ated with the implant insertion torque for enhancing implant primary stability at implant in- sertion during immediate im- plant placement and to identify the relation between these pa- rameters. Literature review The successful outcome of any implant procedure requires a series of the patient-related and procedure-dependent param- eters. - Insertion torque A torque corresponds to the as- sociation of the cutting part of the tip of implant in the bone and to the friction between im- plant surface and the hole in the bone. It depends also on how sharp is the cutting tip of the im- plant, in the surface texture and design of the implant and on the blood supply. The diameter also plays an important role, since a narrow implant will have a low- er torque.6 A study conducted by Turky- ilmaz et al. showed a strong cor- relation between the primary stability and insertion torque values of Branemark system at the time of implant placement5. An insertion torque should be around 30-40 N/cm in order to have good implant stability. An insertion torque less than 30 N/ cm seems to significantly impair the immediate implant loading by interfering with the primary stability. - Implant stability quotient (ISQ) Implant stability can be meas- ured by non-invasive clinical test methods (insertion torque, periotest, resonance frequency analysis (RFA).19 RFA with Ostell instrument, has been introduced by Meredith20 and used in clinical studies. The resonance frequency analysis (RFA) calculates the stiffness of he bone and implant interfaces from a resonance frequency as a reaction to oscillation placed on the implant-bone system. A correlation between implant stability quotient (ISQ) and im- plant micromobility was estab- lished.7-8 The implant oscilla- tion under a given transducer frequency is mainly dependent on the character of the implants bony fixation with the implant stability quotient (ISQ) as a unit of measurement and ranges with the increasing stiffness of the interface from 0 to 100 unites.20 - Maxillary v/s Mandible anat- omy Anatomical site plays an impor- tant role in the success of the im- mediate implant placement and loading. The bone in the maxilla is con- sidered anatomically different than mandibular area. There- fore more risk of implants fail- ure. It has been proven using CT tool that local bone density has a prevailing influence on primary implant stability which is impor- tant for implant success.15 It is well proven that the bone around the implant has better quantity and quality in the man- dible than the maxilla.18 - Surgical procedure influence Bone drilling is associated with the rise of temperature in the drilled site.3-4 Immediate implant placement will lower the extent of the treatment time and will prevent the rise of temperature Figure 1: Extra oral view of the right lateral incisor showing a traumatic occlusion. Figure 3: Implant placed more palatal and extended apically into periapical bone. Figure 2: A periapical radiograph showing a horizontal fracture of the root and a limited radiolucency in the apical area.

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