Break Point
by Richard A. Fagin, D.D.S.

No, this is not a tennis article. The break point is the point in time when a newly placed dental implant goes from decreasing stability to increasing stability.

In the osseointegration process, two factors play an important role:

1. Primary stability - Mechanical stability of implant against the bone. Taking bone quality into consideration, achievement of primary stability is predictable thanks to key features of implant system design such as thread pitch, precision of implant dimensions, precision drills, and precise placement.

2. Secondary stability - Is the result of the biologic healing process, and is not under the control of the clinician. Although the clinician can set the stage with good operative technique the achievement of full secondary stability is subject to numerous variables, the most significant of all being the speed of the osseointegration process.

The sum of the primary and secondary stability is referred to as total stability.

Fig.1 - After initial implant placement the mechanical stability declines due to osteoclastic activity, and the secondary stability increases due to formation of new bone. The delay in the secondary stability (or decline in the primary stability) results in a total "stability dip". The point where this changes to a positive direction is known as the break point. This process accounts for the traditional delayed loading protocol of dental implants.

Fig.2 - Some recent advances in surface technology introduced by Strauman's dental implant system have shown promise in promoting even faster osseointegration and leading to earlier secondary stability. The SLActive implant surface is more hydrophilic and allows for earlier intimate contact with blood proteins involved with bone formation. Early studies show a break point occurring at 2 weeks with the new surface.



Earlier secondary stability is always noteworthy because it opens options to the stability-critical protocols such as early and immediate loading.

Further clinical studies are under way and as with so many aspects of implant dentistry it is exciting as to the possibilities and benefits this will bring to our patients, not only for the single tooth replacement but more complex cases as well.

References: Information and diagrams provided courtesy of ? copyright - Institut Straumann AG

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