dynamically diagnosing the human periodontium and the dental implant-bone interface

periotest deviceabout Periotest device

References: ... 19891990 19911992 19931994 19951996 19971998 19992000 2001...

Examination of the damping behavior of IMZ implants
Int.J.Oral Maxillofac Implants 10, 410-414 (1995).
Alveolar Bone Loss diagnosis/Follow Up Studies/dental implants/Osseointegration/imz
The damping behavior of 392 IMZ implants with a diameter of 4 mm was examined by performing Periotest measurements during regular implant follow-up. The results were correlated with radiographically assessed peri-implant bone reduction. To guarantee statistical independence, only one randomly chosen implant per patient was considered in the examination. In 167 implants, the difference between the mean mandibular and maxillary Periotest values proved to be statistically significant. Age, sex, and radiographic length of the endosseous part of the abutment had no influence on the Periotest values. Assessment of the Periotest values can thus be considered an additional parameter for objective determination of IMZ implant success. However, exclusive use of the Periotest method without additional radiographic examinations does not seem to be justified

Assessment of the Periotest Device in Baseline Mobility Measurements of Craniofacial Implants
K. DERHAMI, J.F. Wolfaardt, A.Chan
Int.J.Oral Maxillofac.Impl. 10, 221-229 (1995).
The present study aimed to evaluate reliability of the Periotest instrument in baseline mobility measurement of craniofaeial implants in a human wet bone specimen. Sixteen 4.0 mm craniofacial Brånemark implants were placed in the most common sites for craniofacial implant placement. A 5.5 mm abutment was attached to each implant except one in the mastoid bone, which was connected with a bone-anchored hearing aid (BANA) abutment. Baseline Periotest values (PTVS) were recorded on each abutment at different vertical measurement points by three different clinicians using three Periotest devices. Baseline PTVs for each abutment ranged between,-I.23 and -5.90. Interoperator and interinstrumental variability did not influence PTVS; however, the vertical measurement point on the abutment proved to have a strong effeet on PTV recordings.
Reprint request: Dr Kalal Derhami, Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, Misericordia Hospital, 16940-87 Avenue, Edmonton, Alberta, Canada T5R 4H5

A method for assessing the damping characteristics of periodontal tissues: Goals and limitations
Quint Int 26, 191-197 (1995).
The Periotest method, an objective, noninvasive clinical diagnostic method, is a dynamic procedure that measures the resistance of the periodontium to a defined impact load. It has been reported that Periotest values depend to some extent on tooth mobility, but mainly on the damping characteristics of the periodontium. Nevertheless, the real clinical meaning of the measurements and some important limitations of the Periotest measuring principle still seem to be poorly understood. In the present study, the relationship between damping characteristics of periodontal tissues and tooth mobility was investigated. The best correlations between tooth deflection and Periotest values were found for teeth showing a certain degree of clinical mobility (R2 from 0.79 to 0.91). Nevertheless, this correlation was clearly lower when only healthy subjects were examined (R2 from 0.43 to 0.54). The better correlation found for forces greater than 1.0 N indicates that the damping characteristics assessed with the Periotest method are related to secondary tooth movemet. The Periotest methodology, measuring principle, and limitations are critically reviewed. 

Eine Methode zur Messung des Dämpfungsverhaltens in parodontalen Geweben - Ziele und Einschränkungen
Quintessenz 515-525 (1995).
Periodontometrie nach Mühlemann; Zahnbeweglichkeit; Zahnauslenkung
Afdeling Parodontologie, Faculteit Geneeskunde, Katholieke Universiteit, CapuciJnenvoer 7, B-3000 Leuven:
Die Periotestmethode, ein objektives, nichtinvases klinisches Verfahreen, ist ein dynamischer Test, der den Widerstand des Parodoritiums gegen eine definierte Aufprallkraft prüft. Es wurde berichtet, daß die Periotestwerte vom Grad der Zahnbeweglichkeit, hauptsächlich jedoch vom Dämpfungsverhalten des Parodontiurns abhängig sind. Dennoch scheinen die tatsächliche klinische Bedeutung der Messungen und einige wichtigen Einschränkungen des Periotest-Meßprinzips bisher unverstanden. In der vorliegenden Studie wurde der Zusammenhang zwischen dem Dämpffungsverhalten der parodontalen Gewebe und der Zahnbeweglichkeit untersucht. Die beste Korrelation zwischen der Zahnauslenkung (Mühlemann-periodontometer) und den Periotestwerten wurde bei Zähnen festgestellt, die einen gewissen Grad an klinischer Beweglichkeit zeigten (R2 von 0,79 bis 0,91). Diese Korrolation war jedoch deutlich geringer, wenn ausschließlich gesunde Patienten untersucht wurden (R2 von 0,43 bis 0,54). Die bessere Korrelation erreichte man bei einer Kraft, die größer als 1.0 N war. Dies läßt erkennen, dass das mit der Periotestmethode gemessene Dämpfungsverhalten mit der sekundären Zahnbeweglichkeit zusammenhängt. Außerdem werden die Periotestmethodik, das Meßpritizip und die Einschränkungen kritisch überprüft. 

Splints made of wire and composite: an investigation of lateral tooth mobility in vivo
K.A. EBELESEDER, K. GLOCKNER, C. PERTL, P. STÄDTLER Department of Conservative Dentistry, Karl-Franzens-University, Graz:
Endod Dent Traumatol 11, 288-293 (1995).
Wurzelamputation; Periotest; Composite Resins; Adolescence; Child; Linear Models; Orthodontic Wires; Percussion; Periodontal Ligament injuries; Statistics,Nonparametric; Time Factors; Tooth Luxation complications; Tooth Mobility etiology; Wound Healing; Periodontal Splints; Tooth Luxation therapy; Tooth Mobility diagnosis; Tooth Mobility therapy; Female; Human; Male; Trauma; Zahnauslenkung
In 103 posttraumatic splints, later tooth mobility was measured with Periotest immediately before and after the routine splint removal. The splints were made of composite resin and an 0.017 X 0.025" orthodontic steel wire. 481 teeth were measured. A statistic evaluation revealed that the immobilisation effect did not exceed normal tooth firmness. Fixation to one neighbouring tooth had less effect than fixation to two. Adjacent tooth gaps reduced the effect. Splint extensions had no influence. With the use of the Periotest device, more than 50% of all teeth with a true mobility of 20 Periotest-units or more were detectable as mobile in spite of the fixed splint 

Osseointegration of Branemark fixtures using a single-step operating technique. A preliminary prospective one-year study in the edentulous mandible
BERNARD, J.P., BELSER, U.C., MARTINET, J.P., BORGIS, S.A., Department of Oral Surgery, School of Dentistry, University of Geneva, Switzerland
Clin Oral Implants Res 6, 122-129 (1995).
Osseointegration; branemark; Mandible; implant;  Adult; Aged; Dental Plaque Index; Denture,Overlay; Feasibility Studies; Jaw,Edentulous surgery; Mandible surgery; Middle Age; Periodontal Index; Prospective Studies; Time Factors; Treatment Outcome; Dental Implantation,Endosseous methods; Dental Implants
The aim of the present prospective clinical study was to analyze the feasibility of inserting Branemark fixtures according to a one-stage procedure including transmucosal healing and to subsequently evaluate the predictability of osseointegration as well as the potential of such implants for stabilizing complete overdentures in the edentulous mandible. Five patients (2 women, 3 men), completely edentulous in the mandible and with a mean age of 60 years, volunteered for this study. Two fixtures of various length (10-20 mm) and 3.75 mm in diameter were inserted in the lower canine regions. A standard surgical procedure including a midcrestal incision was used. After the placement of the fixtures, healing abutments, which are normally used during second-stage surgery, were inserted instead of the usual cover screws. Three months after implant placement a clinical and radiographic examination was performed to confirm the presence or absence of osseointegration of the fixtures prior to exchanging the healing abutments with the spherical attachments. Finally, different clinical (Plaque Index, Bleeding Index, probing depth, Periotest mobility value) and radiographic (bone loss, peri-implant radiolucency) parameters were recorded 9 months after loading of the fixtures by means of a complete mandibular overdenture, retained by two ball attachments in the canine regions. All fixtures were perfectly stable (mean Periotest values of -2) and presented favorable peri-mplant soft tissue conditions, and no patient was complaining about any particular symptom. As far as retention and stability of their implant supported overdenture was concerned, the participants without exception considered the therapeutic result as being perfectly adequate. 

Influence of the suprastructure on the peri-implant tissues in beagle dogs
HURZELER, M.B., QUINONES, C.R., SCHUPBACH, P., VLASSIS, J.M., STRUB, J.R., CAFFESSE, R.G., Department of Stomatology, Health Science Center, Dental Branch, University of Texas-Houston, USA
Clin Oral Implants Res 6, 139-148 (1995).
Dogs; Titanium; implant; Metals; branemark; Mandible;  Acrylic Resins; Alveolar Bone Loss etiology; Alveolar Bone Loss radiography; Analysis of Variance; Composite Resins; Dental Plaque Index; Dental Porcelain; Dental Prosthesis,Implant Supported adverse effects; Denture,Partial,Fixed; Metal Ceramic Alloys; Osseointegration; Periodontal Index; Subtraction Technique; Dental Implants adverse effects; Dental Prosthesis Design; Dental Prosthesis,Implant Supported; Dental Implants; Omega Dental Ceramic
The purpose of this study was to compare clinical, radiographic and histological differences around titanium oral implants loaded with either acrylic-veneered metal or ceramo-metal fixed prostheses. Five beagle dogs were used in this investigation. At the beginning of the study, all mandibular premolars and first molars were extracted. After 3 months of healing, 2 Branemark implants were installed on each side of the mandibles. Three months later, abutments were inserted on each implant and a daily oral hygiene regime was initiated. One month after abutment connection, the implants on one side of the mandible were restored with an acrylic-veneered metal fixed prosthesis, whereas, on the other side a ceramo-metal fixed prosthesis was inserted. The prostheses were constructed in occlusion with the maxillary first molars. The following clinical parameters were measured around each implant at this time (i.e., baseline), and thereafter, at monthly intervals up to 5 months: Plaque Index; Gingival Index; implant mobility (using the Periotest); probing depth and clinical attachment level (using the Florida Probe). In addition, standardized radiographs were taken at baseline and 5 months after insertion of the prostheses and evaluated by subtraction radiography. Another Branemark fixture was installed on each side of the mandibles 3 months before the end of the study. These implants remained unloaded and submerged for the entire study period. Five months after prosthesis insertion, the animals were killed, and implants with their supporting peri-implant tissues were processed for histological evaluation. Analyses of the clinical, radiographic and histometric parameters revealed no significant differences between the acrylic-veneered and ceramometal loaded implants. 

The influence of splinting procedures on the periodontal and peri-implant tissue damping characteristics. A longitudinal study with the Periotest device
NAERT, I.E., ROSENBERG, D., VAN STEENBERGHE, D., TRICIO, J.A., NYS, M., Department of Prosthetic Dentistry, Faculty of Medicine, Catholic University of Leuven, Belgium
J Clin Periodontol 22, 703-708 (1995).
damping; Periotest; leuven; implant; Acrylic Resins; Adult; Aged; Aged,80 and over; Biomechanics; Cementation; Denture Design; Denture,Partial,Temporary; Follow Up Studies; Jaw,Edentulous,Partially rehabilitation; Longitudinal Studies; Metal Ceramic Alloys; Middle Age; Monitoring,Physiologic; Osseointegration; Dental Abutments; Dental Implantation,Endosseous; Dental Implants; Denture,Partial,Fixed; Periodontics instrumentation; Periodontium physiology
The aim of the present study was to evaluate the capability of the Periotest device in detecting and monitoring functional changes in the periodontal as well as in the pari-implant damping characteristics. In the first part of this study, 107 teeth were splinted by means of 40 full acrylic fixed prostheses (AFP) and another 37 teeth were splinted by means of 14 ceramometallic fixed prostheses (C-MFP). The Periotest measurements of individual teeth were done the day the fixed prostheses were cemented temporary (PT 1), and again after a mean observation period of 27.4 days (PT 2). In the 2nd part, 78 osseointegrated two-stage implants were splinted by means of 23 full acrylic fixed prosthesis (AFP) and other 18 implants were left without it. Using the same abutment length, Periotest measurements were performed, at abutment connections and before installation of the final prosthesis. In a 3rd part, using both implants and teeth as abutments, 29 osseointegrated implants were connected with 25 abutment teeth by means of 7 AFP. The measurements were performed at the beginning of the prosthetic treatment and 2, 4 and 6 weeks later. After splinting teeth by means of AFP for the observation period, no statistically significant reduction in PTs was found. When on the other hand, a C-MFP was used, PT 2 showed a significant reduction. The PTs at abutment connection went down after a period of time, during which some implants were interconnected by means of an AFP and others were not.
Der Einfluß der Verblockung auf die Dämpfungseigenschaften parodontaler und periimplantärer Gewebe. Eine Langzeitstudie mit dem Periotest© Gerät
Mit vorliegender Studie wurde beabsichtigt, das Potential des Periotest© Gerätes bei Entdeckung und Überwachung funktioneller Veränderungen parodontaler, wie auch periimplantärer Dämpfungseigenschaften zu bewerten. Im ersten Abschnitt dieser Studie wurden 107 Zähne mit Akrylatbrücken (arcrylic fixed protheses: AFP) und weitere 37 Zähne mit 14 Metallkeramikbrücken (ceramometallic fixed protheses: C-MFP) verblockt. Die Periotest© Messungen der einzelnen Zähne wurden am Tage vor der vorläufigen Zementierung (Periotestmessung 1) vorgenommen und nach einer mittleren Beobachtungszeit von 27,4 Tagen (Periotestmessung 2) wiederholt. Im zweiten Abschnitt wurden 78 osseointegrierte zwei Phasen-Implantate mit 23 Kunststoffbrücken (AFP) verblockt. Weitere 18 Implantate wurden unverblockt belassen. Die Periotest© Messungen wurden anläßlich der Fixation der Pfeilerpfosten und vor der Inkorporation der endgültigen Brücke, an Pfeilerpfosten gleicher Länge vorgenommen. Im dritten Abschnitt wurden sowohl Implantate als auch Zähne als Pfeiler angewandt. 29 osseointegrierte Implantate wurden mit 25 Pfeilerzähnen durch AFP verblockt. Die Messungen wurden zu Beginn der prothetischen Behandlung und 2,4 und 6 Wochen danach vorgenommen. Nach AFP-Verblockung der Zähne während der Beobachtungsperiode wurde keine wesentliche Reduktion der Periotestwerte konstatiert. Handelte es sich dagegen um ein C-MFP, waren die Werte der Periotestmessung 2  signitfikant reduziert. Die anläßlich der Fixation der Pfeilerpfosten gemessenen Periotestwerte verringerten sich nach einiger Zeit. Während dieses Zeitabschnittes waren einige Implantate durch AFP verblockt und andere nicht. Obwohl zwischen den Periotestwerten der beiden Versorgungsvarianten kein erheblicher Unterschied vorlag, war er bei den mit AFP verblockten Implantaten deutlicher. Auch nach einer Zeitspanne von 6 Wochen hatte eine Verblockung von Zähnen und Implantaten in dieser Studie zu keiner deutlichen, mit dem Periotest© meßbaren, Veränderung der Dämpfungseigenschaften der parodontalen Gewebe geführt.

Clinical evaluation of mandibular overdentures supported by multiple-bar fabrication: a follow-up study of two implant systems
VERSTEEGH, P.A., VAN BEEK, G.J., SLAGTER, A.P., OTTERVANGER, J.P., Department of Maxillofacial Prosthodontics, De Weezenlanden Hospital, Zwolle, The Netherlands
Int J Oral Maxillofac Implants 10, 595-603 (1995).
Follow Up Studies; implant; ITI; endosseous implants; Methods;  Alveolar Bone Loss etiology; Chi Square Distribution; Dental Implants adverse effects; Dental Implants economics; Dental Prosthesis Retention instrumentation; Denture,Overlay; Insurance,Dental; Middle Age; Multivariate Analysis; Osseointegration; Periodontal Index; Proportional Hazards Models; Prosthesis Failure; Prosthesis Related Infections etiology; Retrospective Studies; Survival Rate; Dental Implants; Dental Prosthesis Design
A retrospective follow-up study was undertaken to assess the clinical condition, complications, and prosthodontic aftercare of two different implant systems over a long period. Thirty-six patients treated with a total of 135 ITI type F endosseous implants, and 37 patients treated with the transmandibular implants and a total of 146 transmandibular posts, were studied during a mean follow-up period of 70 months and 44 months, respectively. The choice of implant type was mainly influenced by a change in financial support by the National Health Insurance Company in The Netherlands in 1987. Cumulative success rates were calculated using the Kaplan-Meier product limit method. In the analysis, the risk for failure of the implants was adjusted for differences in mandibular bone height. There were no differences between the two treatment groups with regard to age, gender, period of edentulousness, and mandibular bone height. During the follow-up period, plaque, bleeding, and hyperplasia scores demonstrated no significant differences between the two groups. The ITI type F group showed significantly more recession, and the transmandibular implant group demonstrated significantly increased Periotest values. After adjusting for differences in bone height, patients treated with ITI type F implants had a lower risk of failure (relative risk, 0.55; 95% confidence interval 0.32 to 0.95). However, neither of the implant systems fulfilled Albrektsson's criteria of success 

Einflussfaktoren auf das Dämpfungsverhalten von IMZ- und Branemark-Implantaten
Z Zahnärztl Implantol 11, 15-18 (1995). 

Periotest (R) measurements and osseointegration of mandibular ITI implants supporting overdentures
Clin Oral Impl Res 6, 73-82 (1995).
Die Periotest(R)-Werte von Implantaten im Unterkiefer wurden vor und nach Belastung mit einer Hybridprothese aufgenommen und miteinander verglichen. Es wurden 30 zahnlose Patienten (Durchschnittsalter 69 Jahre) mit 60 Bonefit-ITI-Implantaten ausgewählt. Gemessen wurden die Periotestwert 1) nach einer Einheilphase von 3 Monaten und 2) nachdem die Hybridprothese während 12 Monaten getragen worden war. Beide Male wurden auch die parodontalen Parameter aufgenommen. Zusätzlich entnahm man bei 17 Eingriffen während der Implantation je eine Biopsie aus derselben Region des Unterkieferknochens. Von diesen Knochen wurde die Knochendichte analysiert. Die histomorphometrische Evaluation wurde mit der Punktzählmethode durchgeführt. Nach Abschluss der Einheilphase lagen alle PT im Streubereich von -1 bis -8 (Mittelwert: -4.08). Ein Jahr später zeigten sich wiederum überall negative Werte, diesmal in der Bandbreite von -2 bis -8 mit einem Mittelwert von -4.97. Der Unterschied war statistisch signifikant (p<0.05). Die 17 Biopsien des Unterkieferknochens wurden auf ihre Dichte untersucht. Die Knochendichte lag zwischen 22.4% und 90.9%. Man fand keine Korrelation zwischen Knochendichte und den Periotestwert. Man konnte jedoch eine signifikante Korrelation zwischen Ausmass der Unterkieferatrophie und der Knochendichte feststellen
The Periotest values of mandibular implants, registered before and after loading by overdentures, were compared. Thirty edentulous patients with 60 Bonefit ITI implants were selected with an average age of 69 years. The Periotest values were measured 1) after a healing period of 3 months and 2) after the overdentures had been worn for a period of 12 months. Periodontal parameters were recorded at both examinations. Furthermore, 17 biopsies of mandibular bone taken from the implant sites during implant surgery were analyzed to assess the bone density. The histomorphometric evaluation was done using a point count method. At the end of the healing period, all registered Periotest values were negative, ranging from -1 to -8 with an average of 4.08. One year later, all measurements showed negative values again, ranging from -2 to -8 with an average of 4.97. The difference was statistically significant. Seventeen biopsies of mandibular bone were evaluated to determine the density. The range of bone density was from 22.4% and 90.9%. There was no correlation found between bone density and Periotest values. However, a significant correlation could be observed between mandibular atrophy and bone density. (School of Dental Medicine; Institute of Anatomy, University of Bern, Switzerland) 

Frontzahnbeweglichkeit nach direkter Klebung von Lingualretainern. Ein Vergleich von In-vitro- und In-vivo-Messungen [The mobility of the anterior teeth after the direct bonding of lingual retainers. A comparison of in-vitro and in-vivo measurements]
SCHWARZE, J., BOURAUEL, C., DRESCHER, D., Poliklinik fur Kieferorthopädie, Rheinische Friedrich- Wilhelms-Universität Bonn
Fortschr Kieferorthop 56, 25-33 (1995).
Lingual retainers are today widely used in the long-term stabilization of incisors. In that they are left in place for a period of years, the question arises to what extent lingual retainers allow sufficient physiological movement. To answer this question first an in-vitro study of the inflexibility of various retainers under horizontal and vertical load was carried out. Next the retainer which limited physiological movement to the least degree was studied in-vivo. Both dynamic and static mobility measurements of the lower jaw front teeth were carried out on 5 patients before and after bonding the retainers. A self developed measuring instrument was used to make the static measurements and a periotest device was employed in the dynamic measurements. The in-vitro tests indicated that, with the exception of the retainer made of multistranded 0.0155" wire or glass fiber, a significant reduction in tooth mobility can be expected with all the retainers. However, the static in-vivo measurement carried out with the 0.0155" wire resulted in a distinct reduction in tooth movement. The dynamic measurements using the periotest device confirmed this finding. With regard to clinical practice within the framework of long-term retention, highly flexible retainers appear to be the most suitable and are to be recommended 

Mechanical state assessment of the implant-bone continuum: a better understanding of the Periotest method
TRICIO, J., LAOHAPAND, P., VAN STEENBERGHE, D., QUIRYNEN, M., NAERT, I. (Department of Periodontology, Faculty of Medicine, Catholic University of Leuven, Belgium),
Int J Oral Maxillofac Implants 10, 43-49 (1995).
The aim of this study was to obtain a better understanding of the Periotest method when used to detect subclinical mobility of osseointegrated implants. Four hundred two screw-shaped implants were tested with the Periotest device at the time of abutment connection. Several factors, including jaw location, implant and abutment length, and gender, were related to Periotest values (PTs). Implants located in the anterior region of the mandible showed the lowest mean PT (- 3.2). The influence of abutment and implant length upon PTs could be detected in the maxilla. In the mandible, only abutment length had influence on PTs. Women showed higher mean Periotest scores in the maxilla compared with men. This difference was not found in the mandible. The Periotest method, its clinical limitations, and the meaning of a given PT are also discussed 

References: ... 1989 19901991 19921993 19941995 19961997 1998  19992000 2001...

Periotestwerte Tübinger Implantate
Gesellschaft für Orale Implantologie (Hrsg.): Jahrbuch für Orale Implantologie, Quintessenz Verlag, Berlin (1994). 

Tooth mobility and resolution of experimental periodontitis. An experimental study in the dog
GIARGIA, M., ERICSSON, I., LINDHE, J., BERGLUNDH, T., NEIDERUD, A.M.,(Department of Periodontology, Faculty of Odontology, University of Gothenburg, Sweden)
J Clin Periodontol 21, 457-464 (1994).
The aim of the present experiment was to study alterations in the mobility of teeth that occurred during resolution of experimentally induced periodontitis lesions in the dog. 5, 1- year-old, beagle dogs were used in the study. The left and right 4th, 3rd, and 2nd mandibular premolars (4P4, 3P3, 2P2) served as experimental teeth. Periodontal tissue breakdown was initiated by placing plaque-collecting cotton-floss ligatures around the neck of the experimental teeth. The ligatures were replaced to the level of the receding gingival margin 1 x every month. On Day 120, the ligatures were removed and debridement was performed. A groove, parallel to the long axis of the mesial root, was prepared in the mesio-buccal surface of the crowns of 2P and P2. Guided by the groove and with a probing force of 0.5 N, a probe was inserted into the buccal gingival pocket of the mesial root and was attached to the buccal surface. Biopsies including both the mesial and distal root of 2P and P2 and the surrounding hard and soft tissues were harvested. The biopsy procedure was repeated in a similar manner 15 days (i.e. Day 135) and 3 months (i.e. Day 225) after ligature removal in the 4th (4P4) and 3rd (3P3) premolar regions. After fixation, decalcification and sectioning, the biopsy material was exposed to histometric and morphometric measurements. Assessment of the mobility of the experimental teeth was performed on Days 120, 135 and 225 using the Periotest system. 

Evaluation of the peri-implant epithelial tissue of percutaneous implant abutments supporting maxillofacial prostheses
Int J Oral Maxillofac Implants 9, 197-206 (1994).
The use of commercially pure titanium endosseous implants has become state-of-the-art treatment for patients with craniofacial defects. This study defined criteria that can be used in assessing the peri-implant abutment epithelium. The criteria were then used to examine overall tissue reaction. In this investigation, seven patients with percutaneous craniofacial implants were evaluated. Two of these patients exhibited adverse skin reactions that were associated with heavy sebaceous crusting, skin cultures positive for Staphylococcus aureus, higher Periotest values, and thicker peri-abutment tissue with greater mobility. It was determined that these factors can predispose the patient to local infection, which, if ignored, can result in failure of the implant. This study indicates that adequate patient hygiene is crucial to maintaining healthy tissues in the peri-implant abutment site 

Relationship between the stiffness of the dental implant-bone system and the duration of the implant-tapping rod contact
KANEKO, T.M., (Research Laboratory, Nikon Corporation, Tokyo, Japan)
Med Eng Phys 16, 310-315 (1994).
The physical basis of the Periotest percussion diagnosis is theoretically studied by modelling the dental implant-bone system as a simple lumped parameter system. An expression of the effective stiffness k(eff) is derived as a function of the contact time tau. The validity of k(eff) obtained is verified by a comparison with experimental values estimated from other methods. Relationships between k(eff) and the pure stiffness for the Kelvin-Voigt and Maxwell models are also derived. It is suggested that an increase of viscosity as well as stiffness will decrease tau 

Determination of the tooth mobility change during the orthodontic tooth movement studied by means of Periotest and MIMD (the mechanical impedance measuring device for the periodontal tissue)
NAKAGO, T., MITANI, S., HIJIYA, H., HATTORI, T., NAKAGAWA, Y.,(Department of Orthodontics, Okayama University Dental School, Japan)
Am J Orthod Dentofacial Orthop 105, 92-96 (1994).
Two mechanical devices were selected to attempt to assess any changes in tooth mobility when orthodontic force was applied. A Periotest for assessing mobility and a mechanical impedance measuring device (MIMD) were the instruments chosen to diagnose the changes in the periodontal condition. The relative mobility of four canines after orthodontic tooth movement manipulation was assessed over a 4-week period. Both devices were able to detect very small changes in tooth mobility and could follow the changes during tooth movement. According to the Periotest unit, the tooth mobility changes were not within the clinically abnormal range, despite the initial retraction load from a sectional arch, applied in a horizontal direction with about 150 gm for each tooth. In all instances, the contiguous maxillary first premolar had been removed 1 to 2 months before force application. The tooth mobility observed in this investigation could be different from that caused by periodontal disease or traumatic injury. Just after orthodontic tooth movement manipulation, the Periotest values, as measured on the Periotest, of tooth mobility decreased and the resistance as measured by the mechanical impedance measuring device (MIMDM) was increased. Thus, initially, there is a greater resistance to movement with decreased mobility. After the experimental period of 4 weeks, there was an increase in the mobility, as measured by the Periotest and the mechanical resistance decrements were observed. However, the Periotest units showed some different changes occasionally that did not seem to reflect the state of tooth movement. This needs to be investigated further over a longer period of time. On the basis of the results obtained, it does appear that it is feasible to use these devices to determine mobility changes in patients at various stages of orthodontic treatment 

Beweglichkeit von Prothesenpfeilern unter dem Einfluss verschiedenartiger Konstruktionselemente
Dtsch Zahnärztl Z 49, 25-29 (1994). 

The influence of implant type, material, coating, diameter, and length on periotest values at second-stage surgery: DICRG interim report no. 4. Dental Implant Clinical Research Group
OCHI, S., MORRIS, H.F., WINKLER, S., (Department of Veterans Affairs Medical Center, Dental Research, Ann Arbor, Michigan, USA)
Implant Dent 3, 159-162 (1994).
Many of the presently used methods of evaluating osseointegration at second- stage surgery are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. In 1991 the Dental Implant Clinical Research Group initiated a long-term clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on clinical performance and crestal bone height. As part of this investigation, the Periotest values for 1, 565 root form implants were determined at second-stage surgery and correlated with type, material, coating, diameter, and length. Hydroxyapatite-coated implants and increased implant diameter and length produced Periotest values that indicated a greater extent of stability as compared with noncoated implants with shorter diameters and lengths. Hydroxyapatite-coated cylinder-type implants yielded the most favorable Periotest readings. Not only does the Periotest have the potential of being a valuable instrument for assessing implant mobility at second- stage surgery, but it also appears to have the capability of determining slight differences in the implant-bone complex 

Influence of arch bar splinting on periodontium and mobility of fixed teeth
OIKARINEN, K.S., NIEMINEN, T.M., Department of Oral and Maxillofacial Surgery, University of Oulu, Finland
Acta Odontol Scand 52, 203-208 (1994).
Altogether 17 patients treated with arch bar splints fixed onto teeth were tested at the time of splint removal and approximately 5 months later. Patients were treated with intermaxillary fixation (IMF) because of either orthognathic surgery (7 patients) or mandibular fractures (10). The CPITN index was used for estimating the periodontal status, and tooth mobility was measured with Periotest. Seven patients in the orthognathic surgery group could also be examined before splinting. Periodontal status, as shown with relative proportions of various CPITN indexes, worsened due to splinting but regained its original level at control examination a minimum of 5 months after splint removal. Since the mean Periotest values did not differ between the first and control examinations in the seven patients undergoing orthognathic surgery, the analysis of the effect of splinting on tooth mobility was performed from the values obtained immediately after splint removal and at control visit. Splinting was shown to increase Periotest values more in female patients, in younger ones, and in those who were splinted for a shorter period. Teeth with the smallest roots showed greater differences in Periotest values than those with large roots, and the greatest differences in mobility were observed in incisors 

Assessment of implant mobility at second-stage surgery with the Periotest: DICRG Interim Report No. 3. Dental Implant Clinical Research Group
TRUHLAR, R.S., MORRIS, H.F., OCHI, S., WINKLER, S., Department of Periodontics, School of Dental Medicine, State University of New York, USA
Implant Dent 3, 153-156 (1994).
Many of the presently used methods of evaluating osseointegration at implant uncovering are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. Investigators involved in a long-term clinical study of dental implants being conducted by the Dental Implant Clinical Research Group used the Periotest to evaluate the mobility associated with all study implants at second-stage surgery and correlate the Periotest values with various bone densities. The Periotest values for 1,838 root form implants ranged from -8 to +25. Implants that appeared to be osseointegrated at uncovering recorded a mean Periotest value of - 3.37 +/- 3.25, while nonosseointegrated implants had a mean Periotest value of +13.87 +/- 14.27. Mean Periotest values were - 3.82 +/- 3.04 for quality 1 bone, -3.70 +/- 3.06 for quality 2 bone, -3.31 +/- 3.18 for quality 3 bone, and -1.29 +/- 3.57 for quality 4 bone. The Periotest has the potential of being a valuable instrument for assessing the status of osseointegration at second-stage surgery 

References: ... 1989 19901991 19921993 19941995 19961997 1998  19992000 2001...

Reconstruction of the Permaxilla with autogenous iliac bone in combination with osseointegrated implants
APARICIO, C., BRÅNEMARK, P.-I., KELLER, E.E., OLIVÉ, J. Minnesota, Schweden, Spanien,
Int J Oral Maxillofac Impl 8, 61-67 (1993).
Die gleichzeitige Verwendung von autologen Knochentransplantaten und zahnärztl Implantat eröffnet neue Alternativen zur Reconstruction von grossen Gewebedefekten. 1 Patient mit Segmentosteotomie. Beckenkammtranspl 2 spezial Brånemark Implante festsitzend Suprakonstruktion 

Dämpfungsmessung an Implantatpfeilern und natürlichen Zähnen
Dtsch Zahnärztl Z 48, 184-187 (1993).
160 parodontal betreute Implantate und 118 natürliche Zähne vertikale trichterförmige Knocheneinbrüche scheinen den Periotestwert zu beeinflussen 

In vitro consistency of the Periotest instrument
CHAI, J.Y., YAMADA, J., PANG, I.-C., Advanced Education Prosthodontics, Northwestern University Dental School, Chicago, IL, USA ,J Prosthod 2, 9-12 (1993).
Consistency in measuring PT can be achieved. the consistency decreases as mobility increases. The consistency of measuring the damping characteristics using the Periotest (Siemens AG, Bensheim, Germany) was studied. Periotest values (PT) of three rods embedded in various depths of impression material were recorded by seven dentists. There is no statistically significant difference among the subjects in measuring PT of any of the three rods. However, the variation in the occlusal-gingival position of impact resulted in statistically significant different PT measurements of each of the three rods. Assessment of mobility of the same objects using a clinical criterion was found to be less consistent as the mobility of the object increased. In vitro PT measurements are consistent provided that the position of impact is controlled 

Assessment of oral implant mobility
CHAVEZ, H., ORTMAN, L.F., DEFRANCO, R.L., MEDIGE, J., School of Dental Medicine, State University of New York at Buffalo, USA ,
J Prosthet Dent 70, 421-426 (1993).
load that the PT placed on the implant (eigentlich piezoelectric load cell on stiff bench) during mobility-meas. was ~ 5 N, depending on the compliance of the test object. srew implant (Swede-Vent entspr. Bånemark) in vitro model embedded in blocks of self-cured aceylic resin. axial testing machine measured the lateral displacement under a range of loads (0 to 5 N) at a crosshead speed of 0.2 mm/minute = 0.003 mm/s. A linear regression between this stationär deviation and Periotest value on the same models demonstrated a high level of correlation (r=0.984; b~0.01mm/PT). Each PT unit corresponded to a deflection of approximately 0.01 mm when a (slowly) traverse force of 5N was applied. ~enst ! in vivo with 56 Bånemark implants. clinically successful: -6 to 02. corresponding to the in vitro modell displacement (5N load) of 0.038 mm to 0.113 mm. These data demonstrate that clinically successful implants are not immobile medline.
ost of the implant literature suggests that successful dental implants are immobile and any detected mobility indicates implant failure. This study evaluated the ability of the Periotest instrument to measure implant mobility in a controlled in vitro model with a sample of 56 in vivo implants. In the in vitro portion of the study, implant model mobility was determined by an axial testing machine (0 to 5 N at 0.2 mm/minute) and the Periotest instrument. The comparison showed a high level of correlation (Pearson's r 0.984). The load that the Periotest placed on the implants during mobility measurements was approximately 5 N, depending on the compliance of the test object. The in vivo portion evaluated the range of mobility of 56 clinically successful endosseous implants. The range of mobility as determined by the Periotest instrument was -6 to +2. This range corresponds to an in vitro model displacement (5 N load) of 0.038 mm to 0.113 mm with a mean of 0.066 mm +/- 0.018 mm (SD). These data demonstrate that clinically successful implants are not immobile, but have a range of mobility 

Parodontale Parameter und deren Korrelation bei IMZ-Implantaten im zahnlosen Unterkiefer
Dtsch Zahnärztl Z 48, 207-211 (1993).

Dynamics of Periotest method of diagnosing the dental implant-bone interface
KANEKO, T.M., (Tokyo, Japan) ,
J Mater Sc 4, 256-259 (1993).
the physical basis of the pt method has been investigated on the basis of lumped parameter system models. theoretical values of the force to which an implant is subjectedby tapping have been favourably compared experimental results from literatur. 7.9N < F0 < 23N für -8 < PT < 13. 

Die Zahnbeweglichkeit lässt sich in allen Gebissphasen mit Periotest sinnvoll und reproduzierbar bestimmen
Prakt Kieferorthop 7, 117-128 (1993).
Die vorliegende Studie untersucht mit dem Periotestverfahren die physiologische Beweglichkeit der Zähne im Milch-. im Wechsel- und im bleibenden Gebiss. Das Untersuchungsgut bestand aus 80 parodontal gesunden Probanden; 39 davon im Milchgebiss mit einem durchschnittlichen Alter von 6,0 + 0, 3 Jahren, 23 im Wechselzahngebiss mit einem Alter von 8,3 + 0,3 Jahren und 19 im bleibenden Gebiss mit einem Durchschnittsalter von 27,0 + 6,2 Jahren. Im Wechselgebiss wurde zusätzlich die Abhängigkeit des Periotestwertes von der Wurzellänge der Milchzähne und der Milchmolaren im Unterkiefer überprüft. Dafür wurden die Wurzel- und die Kronenlänge aus einem Orthopantogramm bestimmt. Dadas Verhältnis Wurzel-/ Kronenlänge geringere Messfehler zeigte als die absoluten Längenmasse, wurde es zur unabhängigen Variablen der Korrelationsberechnung. Nach Einteilung der Periotestwerte in klinische Lockerungsgrade ergibt sich für die Milchzähne der Lockerungsgrad II (PTW 15 bis 25) im Schneidezahnbereich und der Lockerungsgrad 0 (PTW 2 bis 9) im Seitenzahnbereich beider Kiefer. Im Wechselgebiss unterscheidet sich die physiologische Beweglichkeit der Zähne gegenüber dem Milchgebiss nur im Schneidezahnbereich, da die bleibenden Schneidezähne geringere Periotestwerte aufweisen ( Lockerungsgrad I (PTW 9 bis 16). Im Schneidezahnbereich haben die männlichen Probanden in dieser Phase höhere Periotestwerteals die weiblichen, was wahrscheinlich durch den früheren Zahnwechsel bei Mädchen bedingt ist. Bei der röntgenologischen Auswertung sind die geringsten Messfehler im Längenverhältnis Wurzel-/ Kronenlänge zu finden; auberdem korreliert dieses Verhältnis am besten mit dem Periotestwert. Lineare Korrelationskoeffizienten zwischen Periotestwerten und Röntgenvariablen treten am deutlichsten beim 2.Milchmolaren in Erscheinung, wo der Messfehler (aufgrund der relativ geringen Wurzelresorption) am kleinsten ist. Die Periotestwerte der männlichen Untersuchungsgruppe liegen hier im Durchschnitt zirka 2 unter denen der weiblichen. Dieser geschlechtsspezifische Unterschied ist im bleibenden Gebiss am deutlichsten zu erfassen. Insgesamt sind die Periotestwerte im Milchgebiss signifikant höher als die Wechsel- und die im bleibenden Gebiss; das heibt, die Zahnbeweglichkeit nimmt im Laufe der Gebissentwicklung ab. Die Oberkieferzähne zeigen in allen drei Phasen der Gebissentwicklung höhere Periotestwerte als diejenigen des Unterkiefers 

Okklusion und parodontale Reaktion
Dtsch Zahnärztl Z 48, 354-361 (1993). 

Failures in the osseointegration of endosseous implants
SALONEN, M.A., OIKARINEN, K., VIRTANEN, K., PERNU, H., Department of Prosthodontics and Stomatognathic Physiology, Institute of Dentistry, University of Oulu, Finland ,
Int J Oral Maxillofac Impl 8, 92-97 (1993).
A total of 68 patients, 26 men and 42 women, aged 21 to 86 years, were treated with 204 endosseous implants (TPS, ITI, Bonefit, or Biolox) from 1985 to 1990. They were examined at their latest recall visit approximately 22.5 months after surgery, the range varying greatly between the implant systems used (from 4 to 60 months). Fourteen implants were lost during the observation period because of failures in osseointegration. There were no statistically significant differences in success rates between the implant systems during the observation period. The Periotest values, however, differed between the Bonefit and ITI implants in maxillae (P < .001) and mandibles (P < .01), and between successful and failed TPS implants (P < .001, unpaired t test). In four of the failures, all ITI implants, the prosthetic restorations (fixed dentures and single crowns) had been lost. All other failures were treated by using the previous complete denture. Possible causes of failure included advanced age and poor general health of the patient, complications in the surgical procedures, and compromised oral hygiene 

Reproducibility and detection threshold of peri-implant diagnostics
STEENBERGHE, D.V., QUIRYNEN, M., Department of Periodontology, School of Dentistry, Catholic University, Leuven, Belgium
Adv Dent Res 7, 191-195 (1993).
There is an increasing awareness that, for clinical monitoring of oral implants, there is a need for reliable diagnostics and possibly prognostic parameters. Indeed, reports have too often limited results to an inventory of failures, while no mention was made of progressive marginal bone loss or other symptoms of a future failure. Several parameters, such as marginal bone level assessment and/or probing attachment level, give a precision of up to 0.5 mm. Both measurements also seem related. The damping characteristics of the individual implant/bone unit also offer a highly reproducible diagnostic tool. The Periotest allows for detection of subclinical mobilities, and 95% of repeated measurements fall within a range of one unit on the arbitrary scale. So far, these three parameters offer no prognostic value AD: Department of Periodontology, School of Dentistry, Catholic University, Leuven, Belgium AB: There is an increasing awareness that, for clinical monitoring of oral implants, there is a need for reliable diagnostics and possibly prognostic parameters. Indeed, reports have too often limited results to an inventory of failures, while no mention was made of progressive marginal bone loss or other symptoms of a future failure. Several parameters, such as marginal bone level assessment and/or probing attachment level, give a precision of up to 0.5 mm. Both measurements also seem related. The damping characteristics of the individual implant/bone unit also offer a highly reproducible diagnostic tool. The Periotest allows for detection of subclinical mobilities, and 95% of repeated measurements fall within a range of one unit on the arbitrary scale. So far, these three parameters offer no prognostic value 

Clinical evaluation data from a comparative dental implant investigation in dogs
STEFLIK, D.E., WHITE, S.L., PARR, G.R., SISK, A.L., SCHOEN, S.P., LAKE, F.T., HANES, P.J., Department of Oral Pathology, Medical College of Georgia School of Dentistry, Augusta, USA ,
J Oral Implantol 19, 199-208 (1993).
This report presents one- year clinical evaluation data from 120 ceramic and titanium cylindrical and titanium blade-type implants placed in the mandibles of 30 adult dogs. Ninety-six of the implants supported fixed bridges. The bone and gingival health was evaluated by the following indices: crevicular fluid volume index; gingival bleeding index; plaque accumulation index; clinical mobility index; and a quantitative mobility index utilizing the Periotest instrument. Results from this investigation suggest that, overall, the ceramic implants exhibited more fractures and had more mobile implants than did the titanium implant systems. Overall, complete one-year clinical evaluation data demonstrate healthy tissue responses to 112 of the 120 implants. Further, the Periotest instrument appears to offer a more quantitative assessment of clinical mobility. Also, it appears that the clinical evaluation protocol utilized in this study is a valid procedure to use for the assessment of clinical serviceability 

Reproducibility and detection threshold of peri-implant diagnostics
VAN STEENBERGHE, D., QUIRYNEN, M., Department of Periodontology, School of Dentistry, Catholic University, Leuven, Belgium ,
Adv Dent Res 7, 191-195 (1993).
There is an increasing awareness that, for clinical monitoring of oral implants, there is a need for reliable diagnostics and possibly prognostic parameters. Indeed, reports have too often limited results to an inventory of failures, while no mention was made of progressive marginal bone loss or other symptoms of a future failure. Several parameters, such as marginal bone level assessment and/or probing attachment level, give a precision of up to 0.5 mm. Both measurements also seem related. The damping characteristics of the individual implant/bone unit also offer a highly reproducible diagnostic tool. The Periotest allows for detection of subclinical mobilities, and 95% of repeated measurements fall within a range of one unit on the arbitrary scale. So far, these three parameters offer no prognostic value AD: Department of Periodontology, School of Dentistry, Catholic University, Leuven, Belgium AB: There is an increasing awareness that, for clinical monitoring of oral implants, there is a need for reliable diagnostics and possibly prognostic parameters. Indeed, reports have too often limited results to an inventory of failures, while no mention was made of progressive marginal bone loss or other symptoms of a future failure. Several parameters, such as marginal bone level assessment and/or probing attachment level, give a precision of up to 0.5 mm. Both measurements also seem related. The damping characteristics of the individual implant/bone unit also offer a highly reproducible diagnostic tool. The Periotest allows for detection of subclinical mobilities, and 95% of repeated measurements fall within a range of one unit on the arbitrary scale. So far, these three parameters offer no prognostic value 

Periotest to monitor osseointegration and to check the occlusion in oral implantology
SCHULTE, W., LUKAS, D., (Poliklinik für Zahnärztliche Chirurgie und Parodontologie),
J Oral Implantol XIX, 23-32 (1993). call for reprints
Periotest; Osseointegration; Methods; implant; osseo integration; occlusal
This paper reports on Periotest, its technique's history and its possible applications. Periotest is a new diagnostic method, developed by an interdisciplinary research group embracing dentists, physicists, mathematicians and computer engineers. Periotest will - apart from periodontal questions -mainly assist oral implantology 

References: ... 1989 19901991 19921993 19941995 19961997 1998  19992000 2001...


update: 2002-VII-4.