Resonance frequency analysis (RFA) and insertional torque (IT) stability comparisons of implants placed using osteotomes versus drilling techniques: A preliminary case study

Objective: Poor bone density in the posterior maxilla often presents challenges in achieving implant stability. Insertional torque (IT) and resonance frequency analysis (RFA) have been used to objectively monitor the process of osseointegration. This study was designed to quantitatively assess the primary and secondary stability of fixtures placed using the osteotome or conventional drilling technique, in soft bone. The study also assessed if there was a correlation between IT and RFA measurements. Method and Materials: Sixteen implants of a standardized dimension were randomly assigned to two groups: osteotome or conventional drilling. IT was taken at the time of placement. RFA was recorded at baseline and 30, 60, and 90 days. Results: Average IT and RFA were 36 Ncm (range 25-45 Ncm) and 61.5 implant stability quotient (ISQ; range 44-72 ISQ), respectively. RFA in the osteotome group increased from day 0 to day 30 (63.5 to 68.0 ISQ) whereas it decreased in the conventional drilling group (65.9 to 56.6 ISQ). At 90 days, both groups showed similar results. No statistically significant difference between IT and RFA was found across all time intervals. Conclusion: IT and ISQ values were shown to fluctuate depending on various local anatomical factors such as density of the bone. Additional clinical and radiographic studies are needed in type 1 to 4 bone to determine the utilization of RFA and IT for routine implant surgery. Adequate stability measurements are critical for implant placement. Future guidelines and knowledge of stability and bone density values may help in establishing loading protocols and improving success rate. Keywords: dental implant, cone beam computed tomography, implant stability, insertional torque, osteotome, resonance frequency analysis