Reliability verification of damping capacity assessment in peri-implant bone loss model: An experimental animal study

Reliability verification of damping capacity assessment in peri-implant bone loss model: An experimental animal study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Reliability verification of damping capacity assessment in peri-implant bone loss model: An experimental animal study Se-Wook Pyo, Gi Youn Kim, Jae-Seung Chang, Sunjai Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4432547/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Objectives : This in vivo animal study aimed to determine the diagnostic reliability of a damping capacity assessment by correlating the stability of dental implant with peri-implant bone loss using beagle dogs. Materials and Methods : Thirty-two bone level implants composed of two different types were immediately placed at four beagle dogs without bone grafting. All implants were submerged, connected to a healing abutment, and loaded by superstructure. Each phase lasted 4 weeks for a total of 12 weeks. Implant stability was measured every phase through a damping capacity assessment. Peri-implant bone loss, supporting bone volume, and bone to implant contact were also evaluated. Results : Two platform switched implants failed at 8 and 12 weeks after placement, respectively. For the surviving 30 implants, peri-implant bone loss was observed to vary from 0.25 mm to 6.96 mm. Implant stability indices were found to have a strong negative correlation with peri-implant bone loss. It also had positive correlations with supporting bone volume and bone to implant contact ratio. Conclusions : Damping capacity assessment appears to be effective as a diagnostic tool for various types of peri-implant bone resorption in this study. However, the diagnostic ability of early bone resorption of implants is controversial. Health sciences/Medical research/Pre clinical studies Health sciences/Diseases/Oral diseases/Peri implantitis bone to implant contact ratio damping capacity assessment dental implant implant stability peri-implant bone loss resonance frequency analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. INTRODUCTION For several decades, implant placement has been regarded as a viable alternative for tooth replacement. A common approach involved achieving implant stability through a process called osseointegration, which entailed a period of interim healing lasting approximately 3–6 months, during which no load was applied to the implant [ 1 – 4 ]. Recent advancements in implant design, surface modification, and surgical techniques in implant dentistry have greatly enhanced bone response during implant healing and significantly reduced the initial healing period [ 5 ]. As a result, there has been a significant improvement in osseointegration of implants. In line with these advancements, immediate implant placement has become feasible for implants with high primary stability, making it an increasingly attractive solution for both patients and clinicians [ 6 , 7 ]. This treatment alternative offers several advantages, including decreased treatment time and number of surgical interventions, therefore increasing patient satisfaction. However, immediate implant placement may lead to a higher implant failure rate due to unpredictable in future soft and hard tissue levels. Thus, careful case selection is needed to ensure a successful outcome [ 8 – 13 ]. Primary implant stability is known to be one of the key factors for success associated with placement and loading protocols [ 14 – 19 ]. Acquisition of sufficient primary stability enables immediate or early loading protocols. Various methods have been proposed and investigated clinically for evaluating implant stability [ 20 ]. Resonance frequency analysis (RFA) and damping capacity assessment (DCA) are the most commonly used methods for measuring implant stability because of their non-invasive quantification. RFA is a technique that measures the stiffness function of the bone/implant complex to assess implant stability [ 21 , 22 ]. Measured resonance frequency of a transducer attached to the implant is converted into a value called Implant Stability Quotient (ISQ). Typically, implant stability is measured with ISQ in range of 45 to 85. Implants with ISQ values above 60 may be suitable for early loading [ 23 ]. DCA measures deflection/deceleration of a tooth or implant that has been struck by a metal rod from inside the instrument's hand piece. The contact time of the accelerated pistil to the implant, which moves according to the strike, is calculated as a value called Periotest™ value (PTV), which ranges from − 8 to + 50 PTV units with decreasing stability of the tooth or implant [ 24 ]. PTVs above 10 are associated with failure of osseointegration [ 25 , 26 ]. Recently, a modified DCA device (Anycheck, Korea) designed to display implant stability index on a scale of 1 to 100 has proven its value for its ease of use in clinical or research fields [ 27 ]. Several studies have investigated the ability and usefulness of RFA and DCA to measure implant stability. They suggested that these methods correlated with each other and significantly reflected the peri-implant bone level. However, the RFA method in which the metal peg is directly connected to the implant is limited in its use once the prosthesis is installed. On the other hand, the DCA method using repeated impacts should be used carefully when the initial stability is low right after implant placement [ 20 , 28 , 29 ]. Furthermore, while there are numerous studies on implant stability measured by RFA, there is a lack of research using DCA. Therefore, more studies are needed to further explore the accuracy of implant stability measured by DCA and its potential clinical utility [ 25 , 30 ]. Thus, the purpose of this animal study was to determine the diagnostic capacity of DCA method and explore its potential for clinical application by analyzing the correlation between stability of dental implants and peri-implant bone loss. 2. RESULTS 2.1 Data analysis Two platform-switched implants with internal connection types in a test group failed at 8 and 12 weeks after placement, respectively. Sample size was adjusted except for the two failed implants (n = 30). Final implant stability indices measured at 12 weeks were mostly in the range of 60 to 80, except for two samples that were 44, and a mean ± standard deviation was 69.81 ± 8.13. The amount of peri-implant bone loss measured in four directions varied from 0.25 mm to 6.96 mm, and the mean value was 3.06 mm. The mean and standard deviation of supporting bone volume was 21.95 ± 2.83 mm 3 . The maximum value was 27.93 mm 3 and the minimum value was 15.44 mm 3 . Bone to implant contact was analyzed as the overall result of combining buccal and lingual values, ranging from a maximum of 74% to a minimum of 22.1%, with a mean value of 46.94%. The raw data of variables in this study can be found as Supplementary Table S1 online. Normality test results showed that most stability indices did not satisfy normality except for the RFA index at 8 weeks, whereas peri-implant bone loss of the parameters excluding the lingual side met the criteria for normality. Normality test results showed that both bone to implant contact and supporting bone volume satisfied the normality assumption. Since several factors failed to satisfy the normality test, non-parametric statistical analysis was selected (Table 1 ). 2.2 Correlation with stability indices for each variable In all samples, the peak insertion torque values of the implants were not significantly correlated with any variables. As a result of categorizing and grouping the data on the final implant stability indices and peri-implant bone loss, box plot graphs with a negative correlation trend was observed in both criteria (Fig. 1 ). When the mean value of peri-implant bone loss for all samples was classified based on the final stability index, the median value for the three samples with a stability index less than 65 was 5.37 mm, and the median value for the six samples with a stability index between 65 and less than 70 was 3.68 mm. The median value was observed to be 3.52 mm in 14 samples with a stability index between 70 and 75, and the median value was 1.39 mm in 7 samples with a stability index between 75 and 80. On the other hand, as a result of classifying the final stability index of all samples based on the mean value of peri-implant bone loss, the median value of the stability index for 10 samples with bone loss less than 2 mm was 77, and for 12 samples with bone loss from 2 mm to 4 mm, the median value was 70.7. A median value of 65.8 was observed in eight samples with bone loss greater than 4 mm. The peri-implant bone loss pattern measured in four directions was found to have a statistically significant correlation with the final stability index in all directions: buccal ( r = -0.736; p ≤ 0.0001), lingual ( r = -0.712; p ≤ 0.0001), mesial ( r = -0.688; p ≤ 0.0001), and distal ( r = -0.678; p ≤ 0.0001). Mean, maximum, and minimum values ​​of peri-implant bone loss calculated for each implant also showed statistically significant negative correlations with final implant stability indices (Fig. 2 ), with the minimum value showing the strongest negative correlation: mean ( r = -0.745; p ≤ 0.0001), maximum ( r = -0.721; p ≤ 0.0001), and minimum ( r = -0.800; p ≤ 0.0001). A statistically significant positive correlation ( r = 0.593; p = 0.0004) was observed between supporting bone volume and final implant stability index. The bone to implant contact ratio also showed a statistically significant positive correlation with the final stability index for both buccal ( r = 0.563; p ≤ 0.0001) and lingual ( r = 0.728; p ≤ 0.0001) sides. A relatively low correlation was confirmed on the buccal side than on the lingual side (Fig. 3 ). 2.3 Analysis related to implant stability indices and measurement methods A statistically significant correlation was observed between implant stability indices measured at 4 and 8 weeks with RFA and DCA methods. A moderate positive correlation ( r = 0.750; p ≤ 0.0001) was observed in results of 4 weeks. A high positive correlation ( r = 0.887; p ≤ 0.0001) was observed in results of 8 weeks. However, at 12 weeks, the stability index of the RFA method could not be measured due to the implant’s superstructure. Thus, a correlation could not be confirmed. Changes in implant stability over time were observed using difference in stability index measured using the same method. Correlations with other variables were also analyzed. As a result, the difference in stability index over time did not show a significant correlation with peri-implant bone loss or bone to implant contact ratio. However, it showed a correlation with three-dimensional volume of the supporting bone. Except for the difference in stability index between 4 and 8 weeks, all differences including the 12-week stability index, which were recent results, showed statistically significant correlation with supporting bone volume (Table 2 ). 3. DISCUSSION DCA method is considered a valuable clinical tool, along with RFA method, for the prevention, diagnosis, and prediction of implant failures, which can aid in the maintenance and management of implants [ 21 , 31 , 32 ]. The validity of these technologies has been determined through methods such as mechanical testing, radiographic examinations, and histological evaluations [ 33 – 37 ]. This study aimed to evaluate the reliability of the final stability index through the DCA method for implants with various bone levels by evaluating the amount of bone loss around the implant, bone-implant contact ratio, and implant supporting bone volume. A previous in vitro study has shown significant different indice in implant stability measurements by DCA method at a peri-implant bone level of approximately 2 mm [ 27 ]. However, this suggests that measuring implant stability in a dynamic environment before osseointegration as opposed to after stable osseointegration can show significant differences. In this in vivo study, despite applying an immediate placement protocol to implants, it was intentional to perform early loading and exclude bone grafting to reproduce various bone resorption states. Most samples in each group showed a normal distribution. The final stability index was confirmed to follow a normal distribution except for two values below 60. However, other stability index groups did not follow a normal distribution due to an insufficient number of samples. Thus, non-parametric statistical analysis was used in this study. Ultimately, all implants involved in this experiment showed adequate results for implant stability measurements intended in this study. Thus, the animal study with immediate placement and early loading protocol could potentially be recognized as a single stability experimental model with a standard normal distribution for a variety of stability evaluations. In this study, effects of immediate implantation and early loading protocols were observed using two different types of implants. Although all implants exhibited a stable insertion torque of 10 to 40 Ncm during placement and were submerged without loading for 4 weeks, the fact that loading began early, after 4 weeks, may have influenced the results of implant failure. Depending on the implant design, early loading protocols without bone grafting could be disadvantageous even if the insertion torque was stable. In particular, in the case of conical internal connection type implants developed to evenly distribute the load throughout the entire surface of implant body, excessive early loading force could be a detrimental condition for osseointegration. However, external connection implants without a platform switching design might have provided relative stability even in the early stages of osseointegration due to the load transmitted through the abutment screw. The mean values of peri-implant bone loss for the 30 implants in this study ranged from 0.52 mm to 6.23 mm for an 8.5 mm long implant. As shown in Fig. 1 , when divided into three groups based on the 2mm interval of peri-implant bone loss, a significant difference of more than 4 was found in the median value of stability indices. This indicates that the same DCA measuring device demonstrated in our previous in vitro study is also effective in distinguishing 2 mm of peri-implant bone loss, even in vivo . Results of this study indicated a significant correlation between the amount of alveolar bone loss and the final ACV. The final ACV measured from all four aspects (buccal, lingual, mesial, distal) exhibited a negative correlation with the amount of alveolar bone loss. Particularly, in the table depicting the relationship between minimum values of alveolar bone loss and the final ACV, it could be observed that minimum values of alveolar bone loss were distributed closer to the upper end of the linear relationship. It was shown that if osseointegration was achieved by contact with the alveolar bone in only one direction around the implant, the implant stability could be maintained through that area. In this study, the 3-dimenstional supporting bone volume around the implant was quantitatively measured using micro-CT. The results of measuring the bone volume outside the implant in a cylindrical area bordered with a diameter of 4.25 mm, which is an increase of 25% of the body diameter of 3.0 mm excluding the threads, were expected to be related to the density or elasticity of the supporting bone around the implant. BIC was determined by histomorphometry as the area of the implant surface in contact with bone. The previous inconsistency in the correlation between implant stability measurements and BIC might be attributed to the use of 2-dimensional histomorphometric evaluations [ 38 – 41 ]. This is because one or a few tissue cross-sections cannot provide a comprehensive view of the implant-bone interface. In addition, unlike in other studies limited to marginal bone loss, the range of peri-implant bone loss in this study varied from 5.9–73.3%. Therefore, significant differences in BIC might have arisen due to this various pattern of peri-implant bone loss. As a result, both supporting bone volume and BIC showed significant correlations with the final implant stability indices. Previous in vivo studies have reported that RFA and DCA device values show moderate (between 0.3 and 0.7) or weak (less than 0.3) correlations [ 42 ]. In this study, the relationship between RFA and DCA devices in measuring implant stability at 4 and 8 weeks was established. A strong relationship (r = 0.856) was observed between O8 and A8 measured at 8 weeks, indicating that DCA devices and RFA devices have similar reliability in implant measurements. This is consistent with results reported in other studies [ 27 , 43 , 44 ]. However, the use of metal peg with RFA devices prevented the measurement of implant stability at 12 weeks when the superstructure was connected. Therefore, this study had limitations in comparing and evaluating the final implant stability between DCA and RFA devices. Furthermore, the change in implant stability over time showed a significant correlation with the supporting bone volume in outcomes such as A12-A4 and A12-A8, which included the final implant stability index measured at 12 weeks. A12-A4 showed a low positive correlation, while A12-A8 exhibited a moderate positive correlation. This suggests that as time progresses and osseointegration is completed, a higher correlation between supporting bone volume and implant stability becomes evident. Based on the results of this in vivo study, the following conclusions could be drawn. Various patterns of peri-implant bone loss have been observed when immediate implant placement and early loading protocols excluding bone grafting were used. Peri-implant bone loss evaluated by radiographic or histomorphometric analysis was significantly correlated with the implant stability index measured using the DCA method. However, the diagnostic ability of early bone resorption of implants is controversial because the clinical efficacy of the DCA method is determined by significant progression of peri-implant bone loss. 4. MATERIAL AND METHODS 4.1. Dental implants and abutment A total of 32 commercial dental implants with a diameter of 3.5 mm, a length of 8.5 mm, and a sandblasted and acid-etched surface (TSIII SA & USII SA Fixture, Osstem Implant, Seoul, Korea) with were used. Half of these bone level implants were of the platform switching type with an internal connection (TSIII SA) as a test group. The other half were of the platform matching type with an external connection (USII SA) as a control group. A solid type one-piece titanium abutment with a height of 5 mm was designed for the healing period and a two-piece type customized titanium abutment with a height of 6 mm and a diameter of 7 mm was fabricated for the functional loading period. 4.2. Experimental design This study was performed with the approval of the Ethics Committee of Animal Experimentation of the Institutional Animal Care and Use Committee (CRONEX-IACUC approval no. 201906003; Cronex, Hwasung, Korea). In addition, all the study procedures, including animal selection, management, preparation, and surgical protocols, was conducted following Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Therefore, all methods were carried out in accordance with relevant guidelines and regulations. The experimental design was referenced from a previous beagle dog study by Blanco et al. in 2012, which involved an immediate implantation and immediate loading protocol after tooth extraction [ 45 ]. Nevertheless, because the purpose of this study was different from previous studies, some methods such as implant type, placement position, loading time, and superstructures were modified. Since this was an experimental design that compared the implant stability and various bone resorption patterns of two types of commercially available implants with clinically proven success rates, a sample size of four animals was judged to be sufficient for verification. Four male beagle dogs (Orientbio, Seongnam, Korea) aged approximately one year were used in this study. Atropine (0.05 mg/kg) was injected subcutaneously. Xylazine (2 mg/kg) and ketamine hydrochloride (10 mg/kg) were administered intravenously. Enflurane (2%) was administered by endotracheal intubation. Conventional dental infiltration anesthesia (lidocaine 40 mg, 0.2% epinephrine) was administered at the surgical sites. Mandibular premolars and molar (P2, P3, P4, and M1) extractions were performed bilaterally. Crestal incisions were performed in the premolar–molar region of the mandible. Full-thickness mucoperiosteal flaps were elevated. Two consecutive implants with same connections were randomly assigned in 16 different regions, symmetrically divided into left and right, anterior and posterior regions, using a randomized block design to minimize differences between individuals and between implantation sites. As a result, four tapered implants were immediately placed on each side of mandible by a single clinician under sterile conditions. Peak insertion torque value was measured manually by a torque wrench. After implant placement, animals were fed with liquid foods to prevent masticatory trauma during healing. All implants were submerged for the first four weeks. After four weeks of implant placement, a healing abutment was connected to the implant with a constant force of up to 10 N·cm using a digital torque meter. After soft tissue healing, a final titanium prosthesis was loaded to the implant during the final four weeks. The titanium abutment screw was tightened up to 30 N·cm and the screw hole was filled with polytetrafluoroethylene and resin materials. At 12 weeks, experimental animals were sacrificed by administering concentrated sodium pentobarbital IV (Euthasol, Delmarva Laboratories, Inc., Midlothian, VA, USA). 4.3 Implant stability measurement Implant stability (three repeated sets) was measured using a damping capacity assessment device (Anycheck, Neobiotech, Seoul, Korea). This device measured the contact time between the metal tapping rod and the implant superstructure using six consecutive impacts in one set, displaying results as a stability index called the Anycheck value (ACV). Implant stabililty quotient (ISQ) was also acquired three times each as a reference using a resonance frequency analysis device (Osstell ISQ, Integration Diagnositcs, Goteborg, Sweden). Both implant stability measurements were performed every four weeks (Fig. 4 ). However, ISQ values were not obtained at 12 weeks when the superstructure was fixed to the implant. Using RFA, differences between indices measured at 8 weeks (O8) and 4 weeks (O4). Using DCA, differences between indices were measured at 4 weeks (A4), 8 weeks (A8), and 12 weeks (A12). 4.4. Evaluation of peri-implant supporting bone All samples including implants, hard tissues, and soft tissues were scanned using microcomputed tomography (micro-CT) to evaluate the morphology of the peri-implant supporting bone. Samples were reoriented and positioned along the implant axis and scanned on a micro-CT device (SkyScan1173; Bruker-CT, ​​Kartuizersweg 3B 2550 Kontich, Belgium) with the region of ​​interest in the center. SkyScan1173 control software version 1.6 (Bruker-CT) was used for measurement. Imaging conditions of 130 kVp, 60 µA, 1 mm aluminum filter, 500 ms exposure time, 2240 X 2240 pixels were used to obtain a total of 800 high-resolution images. After radiographic assessment, samples were fixed with 4% formalin, decalcified with 10% ethylene-diamine-tetra-acetic acid (pH 7.0), dehydrated through a graded series of ethanol solutions and 100% acetone, and embedded in methyl methacrylate. Tissue slides (25 µm) were then prepared in the buccolingual direction parallel to the axis of the implant with an EXAKT 400CS grinding machine (Leica, Wetzlar, Germany). Slides were then stained with basic fuchsin, toluidine blue, and Goldner’s trichrome. 4.4.1 Radiographic analysis To analyze the pattern of peri-implant bone loss, four types of dimensions were measured from implant shoulder to the most coronal bone-to-implant contact in micro-CT sections. A distance calibration was performed using ImageJ version 1.53 image processing and analysis software for every radiograph to compensate for linear distortion. The following linear measurements were performed parallel to the long axis of each implant at four points: buccal, lingual, mesial, and distal sections (Fig. 5 ). To analyze supporting bone volume, projection images obtained from micro-CT were reconstructed into cross-sectional slices using NRecon software version 1.7.0.4 (Bruker-CT) and analyzed with CTAn software version 1.17.7.2 (Bruker-CT). Region of interest (ROI), including the trabecular compartment around the implant, was selected and defined as a cylinder from the implant axis and a length of 8.5 mm from the top of the implant. Limit of ROI was defined as an outer cylindrical border of 4.25 mm in diameter with the same axis as the implant body, which had a diameter of approximately 3.0 mm excluding threads. A value of 375 µm was selected for the outer circumference of the circular band because it was 25% of the radius of the implant body, a commonly used distance. All images were individually evaluated. ROI mask was applied to each image. A threshold of 50–80 Hounsfield units in the ROI was used to identify bone (Fig. 6 ). 4.4.2 Histomorphometric analysis Tissue slide images were captured and analyzed with a light microscope (Olympus BH2 with S Plan FL2 lens, Tokyo, Japan) and a computer-digitized image analysis system (Leica Imaging System, Cambridge, England). Bone-to-implant contact (BIC) was calculated as linear percentage of the interface with direct contact between bone and the implant to the total interface of the implant in the cancellous bone. Considering the damping effect on buccal impact when evaluating implant stability, the measurement of BIC was divided into buccal and lingual parts based on the long axis of the implant. 4.5 Statistical analysis The Shapiro-Wilk test was performed to test the normality of each variable. Spearman's rank correlation analysis was also performed to analyze the correlation between results of implant stability and peri-implant bone level results analyzed by various methods. In addition, univariate linear regression analysis was performed to determine the effect of each outcome on implant stability. The significance level set in the analysis was 5% ( p = 0.05). All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Declarations Acknowledgments: The authors thank Genoss Co., Ltd. for providing technical support and data analysis services in micro-CT and histomorphometric measurements. Funding: This research was supported by the Yonsei University College of Dentistry Fund (grant number: 6-2021-0018). Author Contributions: Conceptualization, S.-W. Pyo; methodology, S.-W. Pyo and S. Kim; software, G.Y. Kim; validation, J.-S. Chang; formal analysis, S. Kim; investigation, G.Y. Kim; resources, J.-S. Chang; data curation S. Kim; writing—original draft preparation, S.-W. Pyo ; writing—review and editing, S. Kim; visualization, G.Y. Kim; supervision, S. Kim; project administration, S.-W. Pyo; funding acquisition, S.-W. Pyo. Data availability: Data is provided within the manuscript or supplementary information files. Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Brånemark, P. I. et al. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 3 , 81-100, doi:10.3109/02844316909036699 (1969). Schroeder, A., Pohler, O. & Sutter, F. [Tissue reaction to an implant of a titanium hollow cylinder with a titanium surface spray layer]. SSO Schweiz Monatsschr Zahnheilkd 86 , 713-727 (1976). Brånemark, P. I. et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 16 , 1-132 (1977). Schroeder, A., van der Zypen, E., Stich, H. & Sutter, F. The reactions of bone, connective tissue, and epithelium to endosteal implants with titanium-sprayed surfaces. J Maxillofac Surg 9 , 15-25, doi:10.1016/s0301-0503(81)80007-0 (1981). Belser, U. C., Schmid, B., Higginbottom, F. & Buser, D. Outcome analysis of implant restorations located in the anterior maxilla: a review of the recent literature. Int J Oral Maxillofac Implants 19 Suppl , 30-42 (2004). Attard, N. J. & Zarb, G. A. Immediate and early implant loading protocols: a literature review of clinical studies. J Prosthet Dent 94 , 242-258, doi:10.1016/j.prosdent.2005.04.015 (2005). Ostman, P. O. Immediate/early loading of dental implants. Clinical documentation and presentation of a treatment concept. Periodontol 2000 47 , 90-112, doi:10.1111/j.1600-0757.2007.00244.x (2008). Chen, S. T., Wilson, T. G., Jr. & Hämmerle, C. H. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants 19 Suppl , 12-25 (2004). Araújo, M. G., Sukekava, F., Wennström, J. L. & Lindhe, J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 32 , 645-652, doi:10.1111/j.1600-051X.2005.00726.x (2005). Barone, A., Ricci, M., Tonelli, P., Santini, S. & Covani, U. Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing. Clin Oral Implants Res 24 , 1231-1237, doi:10.1111/j.1600-0501.2012.02535.x (2013). Avila-Ortiz, G., Elangovan, S., Kramer, K. W., Blanchette, D. & Dawson, D. V. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res 93 , 950-958, doi:10.1177/0022034514541127 (2014). Araújo, M. G., Silva, C. O., Misawa, M. & Sukekava, F. Alveolar socket healing: what can we learn? Periodontol 2000 68 , 122-134, doi:10.1111/prd.12082 (2015). Buser, D., Chappuis, V., Belser, U. C. & Chen, S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000 73 , 84-102, doi:10.1111/prd.12170 (2017). Jaffin, R. A. & Berman, C. L. The excessive loss of Branemark fixtures in type IV bone: a 5-year analysis. J Periodontol 62 , 2-4, doi:10.1902/jop.1991.62.1.2 (1991). Chiapasco, M., Gatti, C., Rossi, E., Haefliger, W. & Markwalder, T. H. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 8 , 48-57, doi:10.1111/j.1600-0501.1997.tb00007.x (1997). Lazzara, R. J., Porter, S. S., Testori, T., Galante, J. & Zetterqvist, L. A prospective multicenter study evaluating loading of osseotite implants two months after placement: one-year results. J Esthet Dent 10 , 280-289, doi:10.1111/j.1708-8240.1998.tb00505.x (1998). Szmukler-Moncler, S., Salama, H., Reingewirtz, Y. & Dubruille, J. H. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res 43 , 192-203, doi:10.1002/(sici)1097-4636(199822)43:23.0.co;2-k (1998). Testori, T. et al. A multicenter prospective evaluation of 2-months loaded Osseotite implants placed in the posterior jaws: 3-year follow-up results. Clin Oral Implants Res 13 , 154-161, doi:10.1034/j.1600-0501.2002.130205.x (2002). Schrott, A., Riggi-Heiniger, M., Maruo, K. & Gallucci, G. O. Implant loading protocols for partially edentulous patients with extended edentulous sites--a systematic review and meta-analysis. Int J Oral Maxillofac Implants 29 Suppl , 239-255, doi:10.11607/jomi.2014suppl.g4.2 (2014). Bischof, M., Nedir, R., Szmukler-Moncler, S., Bernard, J. P. & Samson, J. Implant stability measurement of delayed and immediately loaded implants during healing. Clin Oral Implants Res 15 , 529-539, doi:10.1111/j.1600-0501.2004.01042.x (2004). Meredith, N., Alleyne, D. & Cawley, P. Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis. Clin Oral Implants Res 7 , 261-267, doi:10.1034/j.1600-0501.1996.070308.x (1996). Meredith, N. A review of nondestructive test methods and their application to measure the stability and osseointegration of bone anchored endosseous implants. Crit Rev Biomed Eng 26 , 275-291, doi:10.1615/critrevbiomedeng.v26.i4.20 (1998). Meredith, N. Assessment of implant stability as a prognostic determinant. Int J Prosthodont 11 , 491-501 (1998). Schulte, W. et al. [Periotest--a new measurement process for periodontal function]. Zahnarztl Mitt 73 , 1229-1230, 1233-1226, 1239-1240 (1983). Olivé, J. & Aparicio, C. Periotest method as a measure of osseointegrated oral implant stability. Int J Oral Maxillofac Implants 5 , 390-400 (1990). Schulte, W. & Lukas, D. Periotest to monitor osseointegration and to check the occlusion in oral implantology. J Oral Implantol 19 , 23-32 (1993). Pyo, S. W., Kim, H. G., Kwon, O., Otgonbold, J. & Lee, K. W. Reliability Verification of Damping Capacity Assessment Through In Vitro Analysis of Implant Micromotion in Peri-implant Bone Loss Model. Int J Oral Maxillofac Implants 36 , 106-114, doi:10.11607/jomi.8168 (2021). Friberg, B., Jemt, T. & Lekholm, U. Early failures in 4,641 consecutively placed Brånemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implants 6 , 142-146 (1991). Cochran, D. L., Morton, D. & Weber, H. P. Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants. Int J Oral Maxillofac Implants 19 Suppl , 109-113 (2004). Nedir, R., Bischof, M., Szmukler-Moncler, S., Bernard, J. P. & Samson, J. Predicting osseointegration by means of implant primary stability. Clin Oral Implants Res 15 , 520-528, doi:10.1111/j.1600-0501.2004.01059.x (2004). Meredith, N., Friberg, B., Sennerby, L. & Aparicio, C. Relationship between contact time measurements and PTV values when using the Periotest to measure implant stability. Int J Prosthodont 11 , 269-275 (1998). Winkler, S., Morris, H. F. & Spray, J. R. Stability of implants and natural teeth as determined by the Periotest over 60 months of function. J Oral Implantol 27 , 198-203, doi:10.1563/1548-1336(2001)0272.3.Co;2 (2001). Martinez, H., Davarpanah, M., Missika, P., Celletti, R. & Lazzara, R. Optimal implant stabilization in low density bone. Clin Oral Implants Res 12 , 423-432, doi:10.1034/j.1600-0501.2001.120501.x (2001). O'Sullivan, D., Sennerby, L. & Meredith, N. Influence of implant taper on the primary and secondary stability of osseointegrated titanium implants. Clin Oral Implants Res 15 , 474-480, doi:10.1111/j.1600-0501.2004.01041.x (2004). Gedrange, T. et al. An evaluation of resonance frequency analysis for the determination of the primary stability of orthodontic palatal implants. A study in human cadavers. Clin Oral Implants Res 16 , 425-431, doi:10.1111/j.1600-0501.2005.01134.x (2005). Ito, Y. et al. Relevance of resonance frequency analysis to evaluate dental implant stability: simulation and histomorphometrical animal experiments. Clin Oral Implants Res 19 , 9-14, doi:10.1111/j.1600-0501.2007.01419.x (2008). Degidi, M., Perrotti, V., Strocchi, R., Piattelli, A. & Iezzi, G. Is insertion torque correlated to bone-implant contact percentage in the early healing period? A histological and histomorphometrical evaluation of 17 human-retrieved dental implants. Clin Oral Implants Res 20 , 778-781, doi:10.1111/j.1600-0501.2008.01599.x (2009). Nkenke, E. et al. Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants. Clin Oral Implants Res 14 , 601-609, doi:10.1034/j.1600-0501.2003.00937.x (2003). Fanuscu, M. I., Chang, T. L. & Akça, K. Effect of surgical techniques on primary implant stability and peri-implant bone. J Oral Maxillofac Surg 65 , 2487-2491, doi:10.1016/j.joms.2007.04.017 (2007). Cha, J. Y. et al. Influence of the length of the loading period after placement of orthodontic mini-implants on changes in bone histomorphology: microcomputed tomographic and histologic analysis. Int J Oral Maxillofac Implants 24 , 842-849 (2009). Jun, S. H., Chang, B. M., Weber, H. P. & Kwon, J. J. Comparison of initial stability parameters and histomorphometric analysis of implants inserted into extraction sockets: human fresh cadaver study. Int J Oral Maxillofac Implants 25 , 985-990 (2010). Krafft, T., Winter, W., Wichmann, M. & Karl, M. In vitro validation of a novel diagnostic device for intraoperative determination of alveolar bone quality. Int J Oral Maxillofac Implants 27 , 318-328 (2012). Andreotti, A. M. et al. Relationship Between Implant Stability Measurements Obtained by Two Different Devices: A Systematic Review. J Periodontol 88 , 281-288, doi:10.1902/jop.2016.160436 (2017). MA, A. A. et al. Correlation of Implant Stability Between Two Noninvasive Methods Using Submerged and Nonsubmerged Healing Protocols: A Randomized Clinical Trial. J Oral Implantol 46 , 571-579, doi:10.1563/aaid-joi-D-19-00130 (2020). Blanco, J., Carral, C., Liñares, A., Pérez, J. & Muñoz, F. Soft tissue dimensions in flapless immediate implants with and without immediate loading: an experimental study in the beagle dog. Clin Oral Implants Res 23 , 70-75, doi:10.1111/j.1600-0501.2011.02183.x (2012). Tables Table 1. Normality test for all variables in this study using the Shapiro-Wilk test. Normality Surgical condition Stability index variable Peak insertion torque A4 A8 A12 O4 O8 p -value 0.0016* <0.0001* 0.0003* <0.0001* 0.0043* 0.3852 Normality Peri-implant bone loss variable B L M D mean max min p -value 0.0853 0.016* 0.5324 0.7176 0.6746 0.6017 0.1876 Normality Bone to implant contact ratio Supporting bone volume variable B L mean BV p -value 0.266 0.0726 0.481 0.1391 - A significant result of p < 0.05 (*) indicates a non-normal distribution. Table 2. The variation in implant stability over time O8-O4 A8-A4 A12-A4 A12-A8 Mean ±SD 4.58±6.94 4.82±8.81 3.89±9.18 -0.53±5.17 Mean value of pIBL r -0.062 0.150 -0.058 -0.063 p -value 0.7489 0.4333 0.7648 0.7421 Mean value of BIC r 0.251 -0.024 0.171 0.124 p -value 0.1834 0.8996 0.3690 0.5164 Supporting bone volume r 0.339 0.350 0.494 0.560 p -value 0.0670 0.0577 0.0049 * 0.0010 * - pIBL: peri-implant bone loss, BIC: bone to implant contact ratio, - A significant result of p < 0.05 (*) indicates a correlation. Additional Declarations No competing interests reported. Supplementary Files SupplementaryTableS1.docx Cite Share Download PDF Status: Published Journal Publication published 31 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 02 Jun, 2025 Reviews received at journal 29 May, 2025 Reviewers agreed at journal 06 May, 2025 Reviewers agreed at journal 24 Jul, 2024 Reviews received at journal 23 Jul, 2024 Reviewers agreed at journal 19 Jul, 2024 Reviewers invited by journal 06 Jun, 2024 Editor assigned by journal 26 May, 2024 Editor invited by journal 22 May, 2024 Submission checks completed at journal 20 May, 2024 First submitted to journal 16 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4432547","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":307237457,"identity":"c85aafae-7122-4c55-89ea-cbba988bd210","order_by":0,"name":"Se-Wook Pyo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYDCCA0CcAMT8DAxsRGthbABpkWwgSQuINjhArBa+473HHzzccVjO+EaO2cMfDHbyBLVInjmX2JB45rCx2Y0cc2MehmTDBkJaDG7kGDYkth1O3Aa0RZqBgTmBoC0G999AtGyekWMm+YOhnggtN3ggWjZI5JhJ8DAcJqxF8kyO4YzEM+nGEmeelUnzGBwn7Be+42cMPv7cYS3H3568TfJHRTXhEAMDxoZmBgYBkJMMiNMA0lIHTDEHiFU+CkbBKBgFIw0AAGTHQMF7mjlfAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Prosthodontics, Gangnam Severance Dental Hospital","correspondingAuthor":true,"prefix":"","firstName":"Se-Wook","middleName":"","lastName":"Pyo","suffix":""},{"id":307237458,"identity":"3bd46420-8c18-40c6-97c2-e0d10864e4a3","order_by":1,"name":"Gi Youn Kim","email":"","orcid":"","institution":"Department of Prosthodontics, Gangnam Severance Dental Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gi","middleName":"Youn","lastName":"Kim","suffix":""},{"id":307237459,"identity":"beef8c9e-2d74-4821-a62a-36cdcdf5828b","order_by":2,"name":"Jae-Seung Chang","email":"","orcid":"","institution":"Department of Prosthodontics, Gangnam Severance Dental Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jae-Seung","middleName":"","lastName":"Chang","suffix":""},{"id":307237460,"identity":"be5c582f-31ea-47ac-9117-13dc8fa39958","order_by":3,"name":"Sunjai Kim","email":"","orcid":"","institution":"Department of Prosthodontics, Gangnam Severance Dental Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sunjai","middleName":"","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2024-05-16 17:16:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4432547/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4432547/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-11144-1","type":"published","date":"2025-07-31T16:21:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57485752,"identity":"cfcecff1-747e-42f8-8798-13b3f2f389ca","added_by":"auto","created_at":"2024-05-31 10:10:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74298,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot graphs visualized using data grouping to determine distribution and trends between Anycheck value (ACV) and peri-implant bone loss (pIBL). Distribution of ACV data divided into three groups based on pIBL 2mm and 4mm as the boundary (a). Distribution of pIBL data divided into four groups based on the final stability indices referred as ACV (b).\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/bcf263013ba2d9ff5e72a900.png"},{"id":57485753,"identity":"329ebaaa-cf7b-4f84-90bd-8ca2d34aa517","added_by":"auto","created_at":"2024-05-31 10:10:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":108096,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of correlation between mean, maximum, and minimum values of peri-implant bone loss (pIBL) and final implant stability index (ACV).\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/a0e5c1d58f82c8788541f982.png"},{"id":57485286,"identity":"3bba9d0c-15cb-4550-9aed-929a0757bab1","added_by":"auto","created_at":"2024-05-31 10:02:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45332,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution correlation of bone to implant contact ratio (BIC) with final implant stability indices (ACV).\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/3d0471365f88a9b273bd95e4.png"},{"id":57485281,"identity":"a1e873d7-d37d-440f-80ec-16b8115d1d62","added_by":"auto","created_at":"2024-05-31 10:02:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":877207,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of implant stability by damping capacity assessment (a) and resonance frequency analysis (b) every four weeks.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/c65e4691e36e4660964ee90d.png"},{"id":57485285,"identity":"312d31be-e22a-484c-b660-7ff550079d97","added_by":"auto","created_at":"2024-05-31 10:02:27","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":243458,"visible":true,"origin":"","legend":"\u003cp\u003ePeri-implant bone loss was evaluated by measuring linear dimensions in four directions from the implant shoulder to the most coronal point of surrounding bone attached implant threads on micro-CT cross sections: Buccolingual section (a) and mesiodistal section (b).\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/69ca4fa6c1ec7105157e596c.png"},{"id":57485283,"identity":"7d5d1691-9879-4a04-aeda-cfb3cd609844","added_by":"auto","created_at":"2024-05-31 10:02:27","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":335822,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative 3D micro-CT images of implant and peri-implant supporting bone volume.\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/4722d16785c0c31df99559c7.png"},{"id":88268314,"identity":"2fd04c4c-d5df-4428-9111-eec9234c2304","added_by":"auto","created_at":"2025-08-04 16:50:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3302697,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/a1d3073d-0399-4242-9f49-988d32564981.pdf"},{"id":57485280,"identity":"29393bfd-a285-4666-a03c-5228c366a9af","added_by":"auto","created_at":"2024-05-31 10:02:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26273,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4432547/v1/96ef9001121d6d7c9c684014.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reliability verification of damping capacity assessment in peri-implant bone loss model: An experimental animal study","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eFor several decades, implant placement has been regarded as a viable alternative for tooth replacement. A common approach involved achieving implant stability through a process called osseointegration, which entailed a period of interim healing lasting approximately 3\u0026ndash;6 months, during which no load was applied to the implant [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent advancements in implant design, surface modification, and surgical techniques in implant dentistry have greatly enhanced bone response during implant healing and significantly reduced the initial healing period [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As a result, there has been a significant improvement in osseointegration of implants. In line with these advancements, immediate implant placement has become feasible for implants with high primary stability, making it an increasingly attractive solution for both patients and clinicians [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This treatment alternative offers several advantages, including decreased treatment time and number of surgical interventions, therefore increasing patient satisfaction. However, immediate implant placement may lead to a higher implant failure rate due to unpredictable in future soft and hard tissue levels. Thus, careful case selection is needed to ensure a successful outcome [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrimary implant stability is known to be one of the key factors for success associated with placement and loading protocols [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Acquisition of sufficient primary stability enables immediate or early loading protocols. Various methods have been proposed and investigated clinically for evaluating implant stability [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Resonance frequency analysis (RFA) and damping capacity assessment (DCA) are the most commonly used methods for measuring implant stability because of their non-invasive quantification. RFA is a technique that measures the stiffness function of the bone/implant complex to assess implant stability [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Measured resonance frequency of a transducer attached to the implant is converted into a value called Implant Stability Quotient (ISQ). Typically, implant stability is measured with ISQ in range of 45 to 85. Implants with ISQ values above 60 may be suitable for early loading [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. DCA measures deflection/deceleration of a tooth or implant that has been struck by a metal rod from inside the instrument's hand piece. The contact time of the accelerated pistil to the implant, which moves according to the strike, is calculated as a value called Periotest\u0026trade; value (PTV), which ranges from \u0026minus;\u0026thinsp;8 to +\u0026thinsp;50 PTV units with decreasing stability of the tooth or implant [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. PTVs above 10 are associated with failure of osseointegration [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Recently, a modified DCA device (Anycheck, Korea) designed to display implant stability index on a scale of 1 to 100 has proven its value for its ease of use in clinical or research fields [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have investigated the ability and usefulness of RFA and DCA to measure implant stability. They suggested that these methods correlated with each other and significantly reflected the peri-implant bone level. However, the RFA method in which the metal peg is directly connected to the implant is limited in its use once the prosthesis is installed. On the other hand, the DCA method using repeated impacts should be used carefully when the initial stability is low right after implant placement [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Furthermore, while there are numerous studies on implant stability measured by RFA, there is a lack of research using DCA. Therefore, more studies are needed to further explore the accuracy of implant stability measured by DCA and its potential clinical utility [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, the purpose of this animal study was to determine the diagnostic capacity of DCA method and explore its potential for clinical application by analyzing the correlation between stability of dental implants and peri-implant bone loss.\u003c/p\u003e"},{"header":"2. RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data analysis\u003c/h2\u003e \u003cp\u003eTwo platform-switched implants with internal connection types in a test group failed at 8 and 12 weeks after placement, respectively. Sample size was adjusted except for the two failed implants (n\u0026thinsp;=\u0026thinsp;30). Final implant stability indices measured at 12 weeks were mostly in the range of 60 to 80, except for two samples that were 44, and a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation was 69.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.13. The amount of peri-implant bone loss measured in four directions varied from 0.25 mm to 6.96 mm, and the mean value was 3.06 mm. The mean and standard deviation of supporting bone volume was 21.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83 mm\u003csup\u003e3\u003c/sup\u003e. The maximum value was 27.93 mm\u003csup\u003e3\u003c/sup\u003e and the minimum value was 15.44 mm\u003csup\u003e3\u003c/sup\u003e. Bone to implant contact was analyzed as the overall result of combining buccal and lingual values, ranging from a maximum of 74% to a minimum of 22.1%, with a mean value of 46.94%. The raw data of variables in this study can be found as Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e online.\u003c/p\u003e \u003cp\u003eNormality test results showed that most stability indices did not satisfy normality except for the RFA index at 8 weeks, whereas peri-implant bone loss of the parameters excluding the lingual side met the criteria for normality. Normality test results showed that both bone to implant contact and supporting bone volume satisfied the normality assumption. Since several factors failed to satisfy the normality test, non-parametric statistical analysis was selected (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Correlation with stability indices for each variable\u003c/h2\u003e \u003cp\u003eIn all samples, the peak insertion torque values of the implants were not significantly correlated with any variables. As a result of categorizing and grouping the data on the final implant stability indices and peri-implant bone loss, box plot graphs with a negative correlation trend was observed in both criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When the mean value of peri-implant bone loss for all samples was classified based on the final stability index, the median value for the three samples with a stability index less than 65 was 5.37 mm, and the median value for the six samples with a stability index between 65 and less than 70 was 3.68 mm. The median value was observed to be 3.52 mm in 14 samples with a stability index between 70 and 75, and the median value was 1.39 mm in 7 samples with a stability index between 75 and 80. On the other hand, as a result of classifying the final stability index of all samples based on the mean value of peri-implant bone loss, the median value of the stability index for 10 samples with bone loss less than 2 mm was 77, and for 12 samples with bone loss from 2 mm to 4 mm, the median value was 70.7. A median value of 65.8 was observed in eight samples with bone loss greater than 4 mm.\u003c/p\u003e \u003cp\u003eThe peri-implant bone loss pattern measured in four directions was found to have a statistically significant correlation with the final stability index in all directions: buccal (\u003cem\u003er\u003c/em\u003e = -0.736; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001), lingual (\u003cem\u003er\u003c/em\u003e = -0.712; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001), mesial (\u003cem\u003er\u003c/em\u003e = -0.688; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001), and distal (\u003cem\u003er\u003c/em\u003e = -0.678; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001). Mean, maximum, and minimum values ​​of peri-implant bone loss calculated for each implant also showed statistically significant negative correlations with final implant stability indices (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), with the minimum value showing the strongest negative correlation: mean (\u003cem\u003er\u003c/em\u003e = -0.745; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001), maximum (\u003cem\u003er\u003c/em\u003e = -0.721; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001), and minimum (\u003cem\u003er\u003c/em\u003e = -0.800; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003eA statistically significant positive correlation (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.593; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0004) was observed between supporting bone volume and final implant stability index. The bone to implant contact ratio also showed a statistically significant positive correlation with the final stability index for both buccal (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.563; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001) and lingual (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.728; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001) sides. A relatively low correlation was confirmed on the buccal side than on the lingual side (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analysis related to implant stability indices and measurement methods\u003c/h2\u003e \u003cp\u003eA statistically significant correlation was observed between implant stability indices measured at 4 and 8 weeks with RFA and DCA methods. A moderate positive correlation (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.750; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001) was observed in results of 4 weeks. A high positive correlation (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.887; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.0001) was observed in results of 8 weeks. However, at 12 weeks, the stability index of the RFA method could not be measured due to the implant\u0026rsquo;s superstructure. Thus, a correlation could not be confirmed.\u003c/p\u003e \u003cp\u003eChanges in implant stability over time were observed using difference in stability index measured using the same method. Correlations with other variables were also analyzed. As a result, the difference in stability index over time did not show a significant correlation with peri-implant bone loss or bone to implant contact ratio. However, it showed a correlation with three-dimensional volume of the supporting bone. Except for the difference in stability index between 4 and 8 weeks, all differences including the 12-week stability index, which were recent results, showed statistically significant correlation with supporting bone volume (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. DISCUSSION","content":"\u003cp\u003eDCA method is considered a valuable clinical tool, along with RFA method, for the prevention, diagnosis, and prediction of implant failures, which can aid in the maintenance and management of implants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The validity of these technologies has been determined through methods such as mechanical testing, radiographic examinations, and histological evaluations [\u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This study aimed to evaluate the reliability of the final stability index through the DCA method for implants with various bone levels by evaluating the amount of bone loss around the implant, bone-implant contact ratio, and implant supporting bone volume. A previous \u003cem\u003ein vitro\u003c/em\u003e study has shown significant different indice in implant stability measurements by DCA method at a peri-implant bone level of approximately 2 mm [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, this suggests that measuring implant stability in a dynamic environment before osseointegration as opposed to after stable osseointegration can show significant differences. In this \u003cem\u003ein vivo\u003c/em\u003e study, despite applying an immediate placement protocol to implants, it was intentional to perform early loading and exclude bone grafting to reproduce various bone resorption states. Most samples in each group showed a normal distribution. The final stability index was confirmed to follow a normal distribution except for two values below 60. However, other stability index groups did not follow a normal distribution due to an insufficient number of samples. Thus, non-parametric statistical analysis was used in this study. Ultimately, all implants involved in this experiment showed adequate results for implant stability measurements intended in this study. Thus, the animal study with immediate placement and early loading protocol could potentially be recognized as a single stability experimental model with a standard normal distribution for a variety of stability evaluations.\u003c/p\u003e \u003cp\u003eIn this study, effects of immediate implantation and early loading protocols were observed using two different types of implants. Although all implants exhibited a stable insertion torque of 10 to 40 Ncm during placement and were submerged without loading for 4 weeks, the fact that loading began early, after 4 weeks, may have influenced the results of implant failure. Depending on the implant design, early loading protocols without bone grafting could be disadvantageous even if the insertion torque was stable. In particular, in the case of conical internal connection type implants developed to evenly distribute the load throughout the entire surface of implant body, excessive early loading force could be a detrimental condition for osseointegration. However, external connection implants without a platform switching design might have provided relative stability even in the early stages of osseointegration due to the load transmitted through the abutment screw.\u003c/p\u003e \u003cp\u003eThe mean values of peri-implant bone loss for the 30 implants in this study ranged from 0.52 mm to 6.23 mm for an 8.5 mm long implant. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, when divided into three groups based on the 2mm interval of peri-implant bone loss, a significant difference of more than 4 was found in the median value of stability indices. This indicates that the same DCA measuring device demonstrated in our previous \u003cem\u003ein vitro\u003c/em\u003e study is also effective in distinguishing 2 mm of peri-implant bone loss, even \u003cem\u003ein vivo\u003c/em\u003e. Results of this study indicated a significant correlation between the amount of alveolar bone loss and the final ACV. The final ACV measured from all four aspects (buccal, lingual, mesial, distal) exhibited a negative correlation with the amount of alveolar bone loss. Particularly, in the table depicting the relationship between minimum values of alveolar bone loss and the final ACV, it could be observed that minimum values of alveolar bone loss were distributed closer to the upper end of the linear relationship. It was shown that if osseointegration was achieved by contact with the alveolar bone in only one direction around the implant, the implant stability could be maintained through that area.\u003c/p\u003e \u003cp\u003eIn this study, the 3-dimenstional supporting bone volume around the implant was quantitatively measured using micro-CT. The results of measuring the bone volume outside the implant in a cylindrical area bordered with a diameter of 4.25 mm, which is an increase of 25% of the body diameter of 3.0 mm excluding the threads, were expected to be related to the density or elasticity of the supporting bone around the implant. BIC was determined by histomorphometry as the area of the implant surface in contact with bone. The previous inconsistency in the correlation between implant stability measurements and BIC might be attributed to the use of 2-dimensional histomorphometric evaluations [\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This is because one or a few tissue cross-sections cannot provide a comprehensive view of the implant-bone interface. In addition, unlike in other studies limited to marginal bone loss, the range of peri-implant bone loss in this study varied from 5.9\u0026ndash;73.3%. Therefore, significant differences in BIC might have arisen due to this various pattern of peri-implant bone loss. As a result, both supporting bone volume and BIC showed significant correlations with the final implant stability indices.\u003c/p\u003e \u003cp\u003ePrevious \u003cem\u003ein vivo\u003c/em\u003e studies have reported that RFA and DCA device values show moderate (between 0.3 and 0.7) or weak (less than 0.3) correlations [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In this study, the relationship between RFA and DCA devices in measuring implant stability at 4 and 8 weeks was established. A strong relationship (r\u0026thinsp;=\u0026thinsp;0.856) was observed between O8 and A8 measured at 8 weeks, indicating that DCA devices and RFA devices have similar reliability in implant measurements. This is consistent with results reported in other studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, the use of metal peg with RFA devices prevented the measurement of implant stability at 12 weeks when the superstructure was connected. Therefore, this study had limitations in comparing and evaluating the final implant stability between DCA and RFA devices. Furthermore, the change in implant stability over time showed a significant correlation with the supporting bone volume in outcomes such as A12-A4 and A12-A8, which included the final implant stability index measured at 12 weeks. A12-A4 showed a low positive correlation, while A12-A8 exhibited a moderate positive correlation. This suggests that as time progresses and osseointegration is completed, a higher correlation between supporting bone volume and implant stability becomes evident.\u003c/p\u003e \u003cp\u003eBased on the results of this \u003cem\u003ein vivo\u003c/em\u003e study, the following conclusions could be drawn. Various patterns of peri-implant bone loss have been observed when immediate implant placement and early loading protocols excluding bone grafting were used. Peri-implant bone loss evaluated by radiographic or histomorphometric analysis was significantly correlated with the implant stability index measured using the DCA method. However, the diagnostic ability of early bone resorption of implants is controversial because the clinical efficacy of the DCA method is determined by significant progression of peri-implant bone loss.\u003c/p\u003e"},{"header":"4. MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Dental implants and abutment\u003c/h2\u003e \u003cp\u003eA total of 32 commercial dental implants with a diameter of 3.5 mm, a length of 8.5 mm, and a sandblasted and acid-etched surface (TSIII SA \u0026amp; USII SA Fixture, Osstem Implant, Seoul, Korea) with were used. Half of these bone level implants were of the platform switching type with an internal connection (TSIII SA) as a test group. The other half were of the platform matching type with an external connection (USII SA) as a control group. A solid type one-piece titanium abutment with a height of 5 mm was designed for the healing period and a two-piece type customized titanium abutment with a height of 6 mm and a diameter of 7 mm was fabricated for the functional loading period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Experimental design\u003c/h2\u003e \u003cp\u003e This study was performed with the approval of the Ethics Committee of Animal Experimentation of the Institutional Animal Care and Use Committee (CRONEX-IACUC approval no. 201906003; Cronex, Hwasung, Korea). In addition, all the study procedures, including animal selection, management, preparation, and surgical protocols, was conducted following Animal Research: Reporting of \u003cem\u003eIn Vivo\u003c/em\u003e Experiments (ARRIVE) guidelines. Therefore, all methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003eThe experimental design was referenced from a previous beagle dog study by Blanco et al. in 2012, which involved an immediate implantation and immediate loading protocol after tooth extraction [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Nevertheless, because the purpose of this study was different from previous studies, some methods such as implant type, placement position, loading time, and superstructures were modified. Since this was an experimental design that compared the implant stability and various bone resorption patterns of two types of commercially available implants with clinically proven success rates, a sample size of four animals was judged to be sufficient for verification.\u003c/p\u003e \u003cp\u003eFour male beagle dogs (Orientbio, Seongnam, Korea) aged approximately one year were used in this study. Atropine (0.05 mg/kg) was injected subcutaneously. Xylazine (2 mg/kg) and ketamine hydrochloride (10 mg/kg) were administered intravenously. Enflurane (2%) was administered by endotracheal intubation. Conventional dental infiltration anesthesia (lidocaine 40 mg, 0.2% epinephrine) was administered at the surgical sites. Mandibular premolars and molar (P2, P3, P4, and M1) extractions were performed bilaterally. Crestal incisions were performed in the premolar\u0026ndash;molar region of the mandible. Full-thickness mucoperiosteal flaps were elevated.\u003c/p\u003e \u003cp\u003eTwo consecutive implants with same connections were randomly assigned in 16 different regions, symmetrically divided into left and right, anterior and posterior regions, using a randomized block design to minimize differences between individuals and between implantation sites. As a result, four tapered implants were immediately placed on each side of mandible by a single clinician under sterile conditions. Peak insertion torque value was measured manually by a torque wrench. After implant placement, animals were fed with liquid foods to prevent masticatory trauma during healing. All implants were submerged for the first four weeks. After four weeks of implant placement, a healing abutment was connected to the implant with a constant force of up to 10 N\u0026middot;cm using a digital torque meter. After soft tissue healing, a final titanium prosthesis was loaded to the implant during the final four weeks. The titanium abutment screw was tightened up to 30 N\u0026middot;cm and the screw hole was filled with polytetrafluoroethylene and resin materials. At 12 weeks, experimental animals were sacrificed by administering concentrated sodium pentobarbital IV (Euthasol, Delmarva Laboratories, Inc., Midlothian, VA, USA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Implant stability measurement\u003c/h2\u003e \u003cp\u003eImplant stability (three repeated sets) was measured using a damping capacity assessment device (Anycheck, Neobiotech, Seoul, Korea). This device measured the contact time between the metal tapping rod and the implant superstructure using six consecutive impacts in one set, displaying results as a stability index called the Anycheck value (ACV). Implant stabililty quotient (ISQ) was also acquired three times each as a reference using a resonance frequency analysis device (Osstell ISQ, Integration Diagnositcs, Goteborg, Sweden). Both implant stability measurements were performed every four weeks (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, ISQ values were not obtained at 12 weeks when the superstructure was fixed to the implant. Using RFA, differences between indices measured at 8 weeks (O8) and 4 weeks (O4). Using DCA, differences between indices were measured at 4 weeks (A4), 8 weeks (A8), and 12 weeks (A12).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Evaluation of peri-implant supporting bone\u003c/h2\u003e \u003cp\u003eAll samples including implants, hard tissues, and soft tissues were scanned using microcomputed tomography (micro-CT) to evaluate the morphology of the peri-implant supporting bone. Samples were reoriented and positioned along the implant axis and scanned on a micro-CT device (SkyScan1173; Bruker-CT, ​​Kartuizersweg 3B 2550 Kontich, Belgium) with the region of ​​interest in the center. SkyScan1173 control software version 1.6 (Bruker-CT) was used for measurement. Imaging conditions of 130 kVp, 60 \u0026micro;A, 1 mm aluminum filter, 500 ms exposure time, 2240 X 2240 pixels were used to obtain a total of 800 high-resolution images. After radiographic assessment, samples were fixed with 4% formalin, decalcified with 10% ethylene-diamine-tetra-acetic acid (pH 7.0), dehydrated through a graded series of ethanol solutions and 100% acetone, and embedded in methyl methacrylate. Tissue slides (25 \u0026micro;m) were then prepared in the buccolingual direction parallel to the axis of the implant with an EXAKT 400CS grinding machine (Leica, Wetzlar, Germany). Slides were then stained with basic fuchsin, toluidine blue, and Goldner\u0026rsquo;s trichrome.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e4.4.1 Radiographic analysis\u003c/h2\u003e \u003cp\u003eTo analyze the pattern of peri-implant bone loss, four types of dimensions were measured from implant shoulder to the most coronal bone-to-implant contact in micro-CT sections. A distance calibration was performed using ImageJ version 1.53 image processing and analysis software for every radiograph to compensate for linear distortion. The following linear measurements were performed parallel to the long axis of each implant at four points: buccal, lingual, mesial, and distal sections (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo analyze supporting bone volume, projection images obtained from micro-CT were reconstructed into cross-sectional slices using NRecon software version 1.7.0.4 (Bruker-CT) and analyzed with CTAn software version 1.17.7.2 (Bruker-CT). Region of interest (ROI), including the trabecular compartment around the implant, was selected and defined as a cylinder from the implant axis and a length of 8.5 mm from the top of the implant. Limit of ROI was defined as an outer cylindrical border of 4.25 mm in diameter with the same axis as the implant body, which had a diameter of approximately 3.0 mm excluding threads. A value of 375 \u0026micro;m was selected for the outer circumference of the circular band because it was 25% of the radius of the implant body, a commonly used distance. All images were individually evaluated. ROI mask was applied to each image. A threshold of 50\u0026ndash;80 Hounsfield units in the ROI was used to identify bone (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e4.4.2 Histomorphometric analysis\u003c/h2\u003e \u003cp\u003eTissue slide images were captured and analyzed with a light microscope (Olympus BH2 with S Plan FL2 lens, Tokyo, Japan) and a computer-digitized image analysis system (Leica Imaging System, Cambridge, England). Bone-to-implant contact (BIC) was calculated as linear percentage of the interface with direct contact between bone and the implant to the total interface of the implant in the cancellous bone. Considering the damping effect on buccal impact when evaluating implant stability, the measurement of BIC was divided into buccal and lingual parts based on the long axis of the implant.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eThe Shapiro-Wilk test was performed to test the normality of each variable. Spearman's rank correlation analysis was also performed to analyze the correlation between results of implant stability and peri-implant bone level results analyzed by various methods. In addition, univariate linear regression analysis was performed to determine the effect of each outcome on implant stability. The significance level set in the analysis was 5% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Genoss Co., Ltd. for providing technical support and data analysis services in micro-CT and histomorphometric measurements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Yonsei University College of Dentistry Fund (grant number: 6-2021-0018).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, S.-W. Pyo; methodology, S.-W. Pyo and S. Kim; software, G.Y. Kim; validation, J.-S. Chang; formal analysis, S. Kim; investigation, G.Y. Kim; resources, J.-S. Chang; data curation S. Kim; writing\u0026mdash;original draft preparation, S.-W. Pyo ; writing\u0026mdash;review and editing, S. Kim; visualization, G.Y. Kim; supervision, S. Kim; project administration, S.-W. Pyo; funding acquisition, S.-W. Pyo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBr\u0026aring;nemark, P. I.\u003cem\u003e et al.\u003c/em\u003e Intra-osseous anchorage of dental prostheses. I. Experimental studies. \u003cem\u003eScand J Plast Reconstr Surg\u003c/em\u003e\u003cstrong\u003e3\u003c/strong\u003e, 81-100, doi:10.3109/02844316909036699 (1969).\u003c/li\u003e\n\u003cli\u003eSchroeder, A., Pohler, O. \u0026amp; Sutter, F. [Tissue reaction to an implant of a titanium hollow cylinder with a titanium surface spray layer]. \u003cem\u003eSSO Schweiz Monatsschr Zahnheilkd\u003c/em\u003e\u003cstrong\u003e86\u003c/strong\u003e, 713-727 (1976).\u003c/li\u003e\n\u003cli\u003eBr\u0026aring;nemark, P. I.\u003cem\u003e et al.\u003c/em\u003e Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. \u003cem\u003eScand J Plast Reconstr Surg Suppl\u003c/em\u003e\u003cstrong\u003e16\u003c/strong\u003e, 1-132 (1977).\u003c/li\u003e\n\u003cli\u003eSchroeder, A., van der Zypen, E., Stich, H. \u0026amp; Sutter, F. The reactions of bone, connective tissue, and epithelium to endosteal implants with titanium-sprayed surfaces. \u003cem\u003eJ Maxillofac Surg\u003c/em\u003e\u003cstrong\u003e9\u003c/strong\u003e, 15-25, doi:10.1016/s0301-0503(81)80007-0 (1981).\u003c/li\u003e\n\u003cli\u003eBelser, U. C., Schmid, B., Higginbottom, F. \u0026amp; Buser, D. Outcome analysis of implant restorations located in the anterior maxilla: a review of the recent literature. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e19 Suppl\u003c/strong\u003e, 30-42 (2004).\u003c/li\u003e\n\u003cli\u003eAttard, N. J. \u0026amp; Zarb, G. A. Immediate and early implant loading protocols: a literature review of clinical studies. \u003cem\u003eJ Prosthet Dent\u003c/em\u003e\u003cstrong\u003e94\u003c/strong\u003e, 242-258, doi:10.1016/j.prosdent.2005.04.015 (2005).\u003c/li\u003e\n\u003cli\u003eOstman, P. O. Immediate/early loading of dental implants. Clinical documentation and presentation of a treatment concept. \u003cem\u003ePeriodontol 2000\u003c/em\u003e\u003cstrong\u003e47\u003c/strong\u003e, 90-112, doi:10.1111/j.1600-0757.2007.00244.x (2008).\u003c/li\u003e\n\u003cli\u003eChen, S. T., Wilson, T. G., Jr. \u0026amp; H\u0026auml;mmerle, C. H. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e19 Suppl\u003c/strong\u003e, 12-25 (2004).\u003c/li\u003e\n\u003cli\u003eAra\u0026uacute;jo, M. G., Sukekava, F., Wennstr\u0026ouml;m, J. L. \u0026amp; Lindhe, J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. \u003cem\u003eJ Clin Periodontol\u003c/em\u003e\u003cstrong\u003e32\u003c/strong\u003e, 645-652, doi:10.1111/j.1600-051X.2005.00726.x (2005).\u003c/li\u003e\n\u003cli\u003eBarone, A., Ricci, M., Tonelli, P., Santini, S. \u0026amp; Covani, U. Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e24\u003c/strong\u003e, 1231-1237, doi:10.1111/j.1600-0501.2012.02535.x (2013).\u003c/li\u003e\n\u003cli\u003eAvila-Ortiz, G., Elangovan, S., Kramer, K. W., Blanchette, D. \u0026amp; Dawson, D. V. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. \u003cem\u003eJ Dent Res\u003c/em\u003e\u003cstrong\u003e93\u003c/strong\u003e, 950-958, doi:10.1177/0022034514541127 (2014).\u003c/li\u003e\n\u003cli\u003eAra\u0026uacute;jo, M. G., Silva, C. O., Misawa, M. \u0026amp; Sukekava, F. Alveolar socket healing: what can we learn? \u003cem\u003ePeriodontol 2000\u003c/em\u003e\u003cstrong\u003e68\u003c/strong\u003e, 122-134, doi:10.1111/prd.12082 (2015).\u003c/li\u003e\n\u003cli\u003eBuser, D., Chappuis, V., Belser, U. C. \u0026amp; Chen, S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? \u003cem\u003ePeriodontol 2000\u003c/em\u003e\u003cstrong\u003e73\u003c/strong\u003e, 84-102, doi:10.1111/prd.12170 (2017).\u003c/li\u003e\n\u003cli\u003eJaffin, R. A. \u0026amp; Berman, C. L. The excessive loss of Branemark fixtures in type IV bone: a 5-year analysis. \u003cem\u003eJ Periodontol\u003c/em\u003e\u003cstrong\u003e62\u003c/strong\u003e, 2-4, doi:10.1902/jop.1991.62.1.2 (1991).\u003c/li\u003e\n\u003cli\u003eChiapasco, M., Gatti, C., Rossi, E., Haefliger, W. \u0026amp; Markwalder, T. H. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e8\u003c/strong\u003e, 48-57, doi:10.1111/j.1600-0501.1997.tb00007.x (1997).\u003c/li\u003e\n\u003cli\u003eLazzara, R. J., Porter, S. S., Testori, T., Galante, J. \u0026amp; Zetterqvist, L. A prospective multicenter study evaluating loading of osseotite implants two months after placement: one-year results. \u003cem\u003eJ Esthet Dent\u003c/em\u003e\u003cstrong\u003e10\u003c/strong\u003e, 280-289, doi:10.1111/j.1708-8240.1998.tb00505.x (1998).\u003c/li\u003e\n\u003cli\u003eSzmukler-Moncler, S., Salama, H., Reingewirtz, Y. \u0026amp; Dubruille, J. H. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. \u003cem\u003eJ Biomed Mater Res\u003c/em\u003e\u003cstrong\u003e43\u003c/strong\u003e, 192-203, doi:10.1002/(sici)1097-4636(199822)43:2\u0026lt;192::aid-jbm14\u0026gt;3.0.co;2-k (1998).\u003c/li\u003e\n\u003cli\u003eTestori, T.\u003cem\u003e et al.\u003c/em\u003e A multicenter prospective evaluation of 2-months loaded Osseotite implants placed in the posterior jaws: 3-year follow-up results. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e13\u003c/strong\u003e, 154-161, doi:10.1034/j.1600-0501.2002.130205.x (2002).\u003c/li\u003e\n\u003cli\u003eSchrott, A., Riggi-Heiniger, M., Maruo, K. \u0026amp; Gallucci, G. O. Implant loading protocols for partially edentulous patients with extended edentulous sites--a systematic review and meta-analysis. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e29 Suppl\u003c/strong\u003e, 239-255, doi:10.11607/jomi.2014suppl.g4.2 (2014).\u003c/li\u003e\n\u003cli\u003eBischof, M., Nedir, R., Szmukler-Moncler, S., Bernard, J. P. \u0026amp; Samson, J. Implant stability measurement of delayed and immediately loaded implants during healing. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e15\u003c/strong\u003e, 529-539, doi:10.1111/j.1600-0501.2004.01042.x (2004).\u003c/li\u003e\n\u003cli\u003eMeredith, N., Alleyne, D. \u0026amp; Cawley, P. Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e7\u003c/strong\u003e, 261-267, doi:10.1034/j.1600-0501.1996.070308.x (1996).\u003c/li\u003e\n\u003cli\u003eMeredith, N. A review of nondestructive test methods and their application to measure the stability and osseointegration of bone anchored endosseous implants. \u003cem\u003eCrit Rev Biomed Eng\u003c/em\u003e\u003cstrong\u003e26\u003c/strong\u003e, 275-291, doi:10.1615/critrevbiomedeng.v26.i4.20 (1998).\u003c/li\u003e\n\u003cli\u003eMeredith, N. Assessment of implant stability as a prognostic determinant. \u003cem\u003eInt J Prosthodont\u003c/em\u003e\u003cstrong\u003e11\u003c/strong\u003e, 491-501 (1998).\u003c/li\u003e\n\u003cli\u003eSchulte, W.\u003cem\u003e et al.\u003c/em\u003e [Periotest--a new measurement process for periodontal function]. \u003cem\u003eZahnarztl Mitt\u003c/em\u003e\u003cstrong\u003e73\u003c/strong\u003e, 1229-1230, 1233-1226, 1239-1240 (1983).\u003c/li\u003e\n\u003cli\u003eOliv\u0026eacute;, J. \u0026amp; Aparicio, C. Periotest method as a measure of osseointegrated oral implant stability. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e5\u003c/strong\u003e, 390-400 (1990).\u003c/li\u003e\n\u003cli\u003eSchulte, W. \u0026amp; Lukas, D. Periotest to monitor osseointegration and to check the occlusion in oral implantology. \u003cem\u003eJ Oral Implantol\u003c/em\u003e\u003cstrong\u003e19\u003c/strong\u003e, 23-32 (1993).\u003c/li\u003e\n\u003cli\u003ePyo, S. W., Kim, H. G., Kwon, O., Otgonbold, J. \u0026amp; Lee, K. W. Reliability Verification of Damping Capacity Assessment Through In Vitro Analysis of Implant Micromotion in Peri-implant Bone Loss Model. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e36\u003c/strong\u003e, 106-114, doi:10.11607/jomi.8168 (2021).\u003c/li\u003e\n\u003cli\u003eFriberg, B., Jemt, T. \u0026amp; Lekholm, U. Early failures in 4,641 consecutively placed Br\u0026aring;nemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e6\u003c/strong\u003e, 142-146 (1991).\u003c/li\u003e\n\u003cli\u003eCochran, D. L., Morton, D. \u0026amp; Weber, H. P. Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e19 Suppl\u003c/strong\u003e, 109-113 (2004).\u003c/li\u003e\n\u003cli\u003eNedir, R., Bischof, M., Szmukler-Moncler, S., Bernard, J. P. \u0026amp; Samson, J. Predicting osseointegration by means of implant primary stability. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e15\u003c/strong\u003e, 520-528, doi:10.1111/j.1600-0501.2004.01059.x (2004).\u003c/li\u003e\n\u003cli\u003eMeredith, N., Friberg, B., Sennerby, L. \u0026amp; Aparicio, C. Relationship between contact time measurements and PTV values when using the Periotest to measure implant stability. \u003cem\u003eInt J Prosthodont\u003c/em\u003e\u003cstrong\u003e11\u003c/strong\u003e, 269-275 (1998).\u003c/li\u003e\n\u003cli\u003eWinkler, S., Morris, H. F. \u0026amp; Spray, J. R. Stability of implants and natural teeth as determined by the Periotest over 60 months of function. \u003cem\u003eJ Oral Implantol\u003c/em\u003e\u003cstrong\u003e27\u003c/strong\u003e, 198-203, doi:10.1563/1548-1336(2001)027\u0026lt;0198:Soiant\u0026gt;2.3.Co;2 (2001).\u003c/li\u003e\n\u003cli\u003eMartinez, H., Davarpanah, M., Missika, P., Celletti, R. \u0026amp; Lazzara, R. Optimal implant stabilization in low density bone. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e12\u003c/strong\u003e, 423-432, doi:10.1034/j.1600-0501.2001.120501.x (2001).\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Sullivan, D., Sennerby, L. \u0026amp; Meredith, N. Influence of implant taper on the primary and secondary stability of osseointegrated titanium implants. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e15\u003c/strong\u003e, 474-480, doi:10.1111/j.1600-0501.2004.01041.x (2004).\u003c/li\u003e\n\u003cli\u003eGedrange, T.\u003cem\u003e et al.\u003c/em\u003e An evaluation of resonance frequency analysis for the determination of the primary stability of orthodontic palatal implants. A study in human cadavers. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e16\u003c/strong\u003e, 425-431, doi:10.1111/j.1600-0501.2005.01134.x (2005).\u003c/li\u003e\n\u003cli\u003eIto, Y.\u003cem\u003e et al.\u003c/em\u003e Relevance of resonance frequency analysis to evaluate dental implant stability: simulation and histomorphometrical animal experiments. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e19\u003c/strong\u003e, 9-14, doi:10.1111/j.1600-0501.2007.01419.x (2008).\u003c/li\u003e\n\u003cli\u003eDegidi, M., Perrotti, V., Strocchi, R., Piattelli, A. \u0026amp; Iezzi, G. Is insertion torque correlated to bone-implant contact percentage in the early healing period? A histological and histomorphometrical evaluation of 17 human-retrieved dental implants. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e20\u003c/strong\u003e, 778-781, doi:10.1111/j.1600-0501.2008.01599.x (2009).\u003c/li\u003e\n\u003cli\u003eNkenke, E.\u003cem\u003e et al.\u003c/em\u003e Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e14\u003c/strong\u003e, 601-609, doi:10.1034/j.1600-0501.2003.00937.x (2003).\u003c/li\u003e\n\u003cli\u003eFanuscu, M. I., Chang, T. L. \u0026amp; Ak\u0026ccedil;a, K. Effect of surgical techniques on primary implant stability and peri-implant bone. \u003cem\u003eJ Oral Maxillofac Surg\u003c/em\u003e\u003cstrong\u003e65\u003c/strong\u003e, 2487-2491, doi:10.1016/j.joms.2007.04.017 (2007).\u003c/li\u003e\n\u003cli\u003eCha, J. Y.\u003cem\u003e et al.\u003c/em\u003e Influence of the length of the loading period after placement of orthodontic mini-implants on changes in bone histomorphology: microcomputed tomographic and histologic analysis. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e24\u003c/strong\u003e, 842-849 (2009).\u003c/li\u003e\n\u003cli\u003eJun, S. H., Chang, B. M., Weber, H. P. \u0026amp; Kwon, J. J. Comparison of initial stability parameters and histomorphometric analysis of implants inserted into extraction sockets: human fresh cadaver study. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e25\u003c/strong\u003e, 985-990 (2010).\u003c/li\u003e\n\u003cli\u003eKrafft, T., Winter, W., Wichmann, M. \u0026amp; Karl, M. In vitro validation of a novel diagnostic device for intraoperative determination of alveolar bone quality. \u003cem\u003eInt J Oral Maxillofac Implants\u003c/em\u003e\u003cstrong\u003e27\u003c/strong\u003e, 318-328 (2012).\u003c/li\u003e\n\u003cli\u003eAndreotti, A. M.\u003cem\u003e et al.\u003c/em\u003e Relationship Between Implant Stability Measurements Obtained by Two Different Devices: A Systematic Review. \u003cem\u003eJ Periodontol\u003c/em\u003e\u003cstrong\u003e88\u003c/strong\u003e, 281-288, doi:10.1902/jop.2016.160436 (2017).\u003c/li\u003e\n\u003cli\u003eMA, A. A.\u003cem\u003e et al.\u003c/em\u003e Correlation of Implant Stability Between Two Noninvasive Methods Using Submerged and Nonsubmerged Healing Protocols: A Randomized Clinical Trial. \u003cem\u003eJ Oral Implantol\u003c/em\u003e\u003cstrong\u003e46\u003c/strong\u003e, 571-579, doi:10.1563/aaid-joi-D-19-00130 (2020).\u003c/li\u003e\n\u003cli\u003eBlanco, J., Carral, C., Li\u0026ntilde;ares, A., P\u0026eacute;rez, J. \u0026amp; Mu\u0026ntilde;oz, F. Soft tissue dimensions in flapless immediate implants with and without immediate loading: an experimental study in the beagle dog. \u003cem\u003eClin Oral Implants Res\u003c/em\u003e\u003cstrong\u003e23\u003c/strong\u003e, 70-75, doi:10.1111/j.1600-0501.2011.02183.x (2012).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Normality test for all variables in this study using the Shapiro-Wilk test.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003eNormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.166666666666668%\"\u003e\n \u003cp\u003eSurgical condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61%\" colspan=\"5\"\u003e\n \u003cp\u003eStability index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.854757929883139%\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21035058430718%\"\u003e\n \u003cp\u003ePeak insertion torque\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003eA8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003eA12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003eO4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003eO8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.854757929883139%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21035058430718%\"\u003e\n \u003cp\u003e0.0016*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003e0.0003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003e0.0043*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186978297161936%\"\u003e\n \u003cp\u003e0.3852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.81198003327787%\"\u003e\n \u003cp\u003eNormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"87.18801996672212%\" colspan=\"7\"\u003e\n \u003cp\u003ePeri-implant bone loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.166666666666666%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003emax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003emin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.166666666666666%\"\u003e\n \u003cp\u003e0.0853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.016*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.5324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.7176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.6746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.6017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.333333333333334%\"\u003e\n \u003cp\u003e0.1876\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003eNormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52%\" colspan=\"3\"\u003e\n \u003cp\u003eBone to implant contact ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.166666666666664%\"\u003e\n \u003cp\u003eSupporting bone volume\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17%\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17%\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.166666666666664%\"\u003e\n \u003cp\u003eBV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.833333333333334%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18%\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17%\"\u003e\n \u003cp\u003e0.0726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17%\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.166666666666664%\"\u003e\n \u003cp\u003e0.1391\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e- A significant result of \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05 (*) indicates a non-normal distribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e The variation in implant stability over time\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.693631669535286%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\"\u003e\n \u003cp\u003eO8-O4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\"\u003e\n \u003cp\u003eA8-A4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.662650602409638%\"\u003e\n \u003cp\u003eA12-A4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.662650602409638%\"\u003e\n \u003cp\u003eA12-A8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.693631669535286%\" colspan=\"2\"\u003e\n \u003cp\u003eMean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\"\u003e\n \u003cp\u003e4.58\u0026plusmn;6.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\"\u003e\n \u003cp\u003e4.82\u0026plusmn;8.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.662650602409638%\"\u003e\n \u003cp\u003e3.89\u0026plusmn;9.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.662650602409638%\"\u003e\n \u003cp\u003e-0.53\u0026plusmn;5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.398625429553263%\" rowspan=\"2\"\u003e\n \u003cp\u003eMean value of pIBL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e-0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e-0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.727272727272727%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.7489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.4333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.7648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.7421\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.398625429553263%\" rowspan=\"2\"\u003e\n \u003cp\u003eMean value of BIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.727272727272727%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.1834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.8996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.3690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.5164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.398625429553263%\" rowspan=\"2\"\u003e\n \u003cp\u003eSupporting bone volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.63573883161512%\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.727272727272727%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.0670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.454545454545453%\"\u003e\n \u003cp\u003e0.0577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.0049 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.681818181818183%\"\u003e\n \u003cp\u003e0.0010 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e- pIBL: peri-implant bone loss, BIC: bone to implant contact ratio,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- A significant result of \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05 (*) indicates a correlation.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"bone to implant contact ratio, damping capacity assessment, dental implant, implant stability, peri-implant bone loss, resonance frequency analysis","lastPublishedDoi":"10.21203/rs.3.rs-4432547/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4432547/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: This \u003cem\u003ein vivo\u003c/em\u003e animal study aimed to determine the diagnostic reliability of a damping capacity assessment by correlating the stability of dental implant with peri-implant bone loss using beagle dogs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e: Thirty-two bone level implants composed of two different types were immediately placed at four beagle dogs without bone grafting. All implants were submerged, connected to a healing abutment, and loaded by superstructure. Each phase lasted 4 weeks for a total of 12 weeks. Implant stability was measured every phase through a damping capacity assessment. Peri-implant bone loss, supporting bone volume, and bone to implant contact were also evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Two platform switched implants failed at 8 and 12 weeks after placement, respectively. For the surviving 30 implants, peri-implant bone loss was observed to vary from 0.25 mm to 6.96 mm. Implant stability indices were found to have a strong negative correlation with peri-implant bone loss. It also had positive correlations with supporting bone volume and bone to implant contact ratio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Damping capacity assessment appears to be effective as a diagnostic tool for various types of peri-implant bone resorption in this study. However, the diagnostic ability of early bone resorption of implants is controversial.\u003c/p\u003e","manuscriptTitle":"Reliability verification of damping capacity assessment in peri-implant bone loss model: An experimental animal study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 10:02:23","doi":"10.21203/rs.3.rs-4432547/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-02T05:49:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T02:05:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160080839988259819557829488057591066010","date":"2025-05-06T05:07:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111869296367431467025233151273194298550","date":"2024-07-24T07:18:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-23T06:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201863931670483986740757287120621537009","date":"2024-07-20T02:14:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-06T13:01:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-27T02:03:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-22T10:57:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T09:12:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-16T17:15:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af1ba0c3-dd02-42ed-a823-4b4e86a6be92","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32450677,"name":"Health sciences/Medical research/Pre clinical studies"},{"id":32450679,"name":"Health sciences/Diseases/Oral diseases/Peri implantitis"}],"tags":[],"updatedAt":"2025-08-04T16:45:08+00:00","versionOfRecord":{"articleIdentity":"rs-4432547","link":"https://doi.org/10.1038/s41598-025-11144-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-31 16:21:36","publishedOnDateReadable":"July 31st, 2025"},"versionCreatedAt":"2024-05-31 10:02:23","video":"","vorDoi":"10.1038/s41598-025-11144-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-11144-1","workflowStages":[]},"version":"v1","identity":"rs-4432547","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4432547","identity":"rs-4432547","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}