Educator Insight: Drs. Pamela McClain and Rachel Shallhorn

Striving for implant stability

ISQ values increase the chance for success and help us guide the treatment of the patient.

Could you please each introduce yourself to our readers and tell us a little bit about your background?

Dr. McClain: I’m a Periodontist and have been practicing for 28 years. I am a past President of the American Academy of Periodontology and a Diplomate of the American Board of Periodontology. We have been very fortunate to participate in clinical research in our practice, including several FDA trials. I’ve also had the opportunity to provide continuing education through lecturing at various venues in the United States and abroad. I’m thrilled that I’ve been able to practice with my father, Dr. Robert G. Schallhorn, for 20 years, and now with my niece, Rachel Schallhorn.

Dr. Schallhorn: I’m a private practice Periodontist. I’ve been in private practice for about 6.5 years. I did my specialty training at the University of Texas, San Antonio. I’ve been involved in clinical research, published several articles related to periodontal disease, and also done some lecturing. I’m also a past President of the Rocky Mountain Society of Periodontists.

How do you use Osstell in your clinic?

Dr. McClain: We use it to get a baseline measurement at the time of implant placement on all of our implant cases. Osstell helps us decide if the case is a good case for early loading, or whether we need to bury the implant. Most implants we do are single stage.

Dr. Schallhorn: We use Osstell to determine when we’re ready to restore the implant. To me it’s an objective tool to really assess our implant stability. On most cases, we take a second reading around 3 months post-surgical. If I don’t feel the implant is ready at that time, I will recheck every 4 to 6 weeks after that.

What are the main benefits you see from using Osstell and ISQ values?

Dr. McClain: It’s an objective tool to determine implant stability, and it’s a way we can track stability over time. It’s an additional piece of information for the decision-making during surgery. The biggest advantage is to have an objective measurement tool in cases where the bone quality is less than optimal. ISQ values increase the chance for success and help us guide the treatment of the patient.

So in your experience, what kind of ISQ value are you targeting?

Dr. Schallhorn: 70 or above.

Dr. McClain: I agree. Depending on the implant size, a minimum measurement of 60 is necessary, but if the value is over 70, I feel much more confident about the implant stability.

Do you communicate around the ISQ value with the patients? Do you explain it to them?

Dr. McClain: Yes, and we also communicate the value with the restorative dentist. We’ve been doing this for over 6 years and have found it to be a good objective tool to inform our colleagues about when the patient is ready for the restorative phase.

Before using Osstell, how did you assess implant stability?

Dr. Schallhorn: It was subjective. You basically relied on torque value on placement and then tactile feel, which is not a very good measurement.

How much does a failure cost?

Dr. Schallhorn: You need to consider the monetary cost, but also time, and how it impacts the patient’s confidence in you. I would say a failure is pretty costly in many respects.

What do you think will change in implant dentistry over the next 5 years? What trends are you seeing in the industry?

Dr. Schallhorn: I see a trend moving toward shorter treatment times and quicker loading protocols. I would say, once a week people ask me about “teeth in a day.” So everyone wants it fast, and they want it now. If there’s a viable option for shortening treatment times, we would certainly consider it to get our patients their end results quicker. But we want to be pretty sure that it is going to work by good indicators of stability before we commit to a shorter protocol.

Who has inspired you the most in your career? How and why?

Dr. McClain: My father, Dr. Robert Schallhorn, who was a pioneer in Perio-dontics with his innovative bone-grafting techniques and the research he did that really changed how we practice Periodontics today. He has been a wonderful mentor and teacher for me in my career.

Dr. Schallhorn: I’d second that, but I would say Pam as well — not only as a Periodontist, but also as a person.

This article was provided by Osstell.