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Int J Oral Maxillofac Implants. 2018 Oct 3. doi: 10.11607/jomi.6964. [Epub ahead of print]

Resonance Frequency Analysis: Agreement and Correlation of Implant Stability Quotients Between Three Commercially Available Instruments.

Abstract

PURPOSE:

The purpose of this study was to analyze the implant stability quotient (ISQ) values recorded by three commercially available resonance frequency analysis (RFA) instruments from a large cohort of implants in order to determine their accuracy and agreement with one another both for static measurements of ISQ at a given time and for change in ISQ over time.

MATERIALS AND METHODS:

A cohort of n = 210 implants had their primary stability, secondary stability, or both evaluated in both the mesiodistal (MD) and buccolingual (BL) directions by means of ISQ using three different RFA instruments: Osstell Mentor (OM), Osstell Idx (OI), and the Penguin (PG). ISQ values were recorded both at the time of implant placement and at 3 months postinsertion prior to definitive restoration. All values were tabulated for a blinded statistical analysis using Bland Altman plots to determine if the outcome values were in agreement both for primary and secondary stability. In addition, a subgroup was evaluated to determine if change in ISQ was also in agreement. An intraclass correlation (ICC) was used to measure the reliability of the measurements for each instrument.

RESULTS:

Bland Altman plots confirmed that there was a high agreement for MD values between OM and OI, with 72.7% of readings being within one ISQ unit and 94.7% within four units. Comparing PG to OM, the respective values at one and four units were 15.3% and 82.3%, and comparing PG to OI, the respective values were 16.3% and 85.2%. In general, there was a greater uncertainty in the BL values having wider variability and demonstrating less agreement between instruments, with the percentage of readings falling within four units reducing to 85.9% (OM vs OI), 72.3% (PG vs OM), and 74.3% (PG vs OI). 92.3% of values were in agreement to within four units between instruments OM and OI for change in ISQ over time in the MD direction and 73% in the BP direction. The respective percentage changes of values in agreement within four units for PG vs OM were 76.9% and 60.3% and for PG vs OI were 80% and 53.8%. Paired t test from mixed effects revealed that there was a significant difference for mean MD values between PG vs OM; P = .015 with on average 0.823 units higher was recorded for PG. Similarly for PG vs OI, P = .008 with on average 0.871 units higher was recorded for PG. For mean BL values between PG vs OI, P = .000 with on average 1.161 units higher was recorded for PG, and finally, for OM vs OI, P = .005 with on average 0.597 units higher was recorded for OM. However, the maximum upper and lower bound estimated bias between any two instruments was only 1.86 units and 0.46 units both for PG vs OI in the BP direction, and it is doubtful that this is of clinical relevance even if statistically significant. ICC revealed that for static MD measurements, there was an 85% reliability between all three instruments. The highest reliability was between OM and OI instruments (97%), and the lowest reliability was when comparing results between PG and OM instruments (79%). For BL measurements, these reliability values were 66%, 71%, and 69%, respectively. When considering ICC for changes in ISQ values over time in the MD direction, there was a 70% reliability between all three instruments. The highest reliability was between OM vs OI instruments (94%), and the lowest reliability was when comparing results between PG vs OM instruments (58%). For BL measurements, these reliability values were 58%, 91%, and 46%, respectively.

CONCLUSION:

Differences exist between all three instruments to a greater or lesser extent, with the most notable differences between the Penguin and the two instruments from Osstell, which showed both good agreement and reliability to each other. While the differences apparent in evaluating ISQ with the Penguin were statistically significant, they were less than 1.86 units at the upper bound limit, and it is doubtful that this is of clinical significance. Of greater clinical importance is the much-increased variability and reduced reliability for BL values as to render these less clinically sound compared with MD values when trying to assess primary stability.

PMID:
30282089
DOI:
10.11607/jomi.6964

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