All Issue

2025 Vol.29, Issue 4

Original Article

Multi-Method Assessment of Inter-rater Reliability in Dental Implant Stability Measurements
Min-Ju Gu1
,
Seok-Hyeon Kim2
,
Yun-Gyu Yang2
,
Hyeong-Seok Oh2
,
Hae-Rin Jeong2
,
Dong-Woo Heo2
,
Jung-Bo Huh3*
1Resident, Department of Prosthodontics, Dental research institute, Pusan National University, Yangsan, Korea
2Student, School of Dentistry, Pusan National University, Yangsan, Korea
3Professor, Department of Prosthodontics, Dental research institute, Pusan National University, Yangsan, Korea
*Corresponding Author
31 December 2025. pp. 177-192
PDF XML Citation
Abstract

Purpose: Implant stability is a critical determinant of successful osseointegration. Common assessment methods include percussion testing, resonance frequency analysis, radiographic evaluation of marginal bone levels, and histometric analysis. Although many studies have assessed the reliability of individual methods, few have examined their concordance when applied by different examiners. This study aimed to evaluate the reproducibility of widely accepted implant stability measurement techniques by comparing results obtained by researchers who received identical training.

Materials and Methods: Five junior researchers from a dental school assessed the stability of implants placed in one beagle. The methods included Implant Stability Quotient (ISQ), Implant Stability Value (ISV), radiographic analysis, and histologic analysis—specifically, bone-to-implant contact (BIC) and interthread bone density (ITBD). Interrater reliability was calculated using the intraclass correlation coefficient (ICC) with a 95% confidence interval.

Results: All methods demonstrated statistically significant reliability (p < .05). BIC (ICC = 0.806) and ITBD (ICC = 0.854) exhibited high to very high reliability. ISQ (ICC = 0.774) and radiographic analysis (ICC = 0.638) showed moderate to high reliability. ISV (ICC = 0.447) exhibited low reliability.

Conclusion: BIC, ITBD, ISQ, and radiographic analysis demonstrated consistent reproducibility among trained examiners, with BIC and ITBD showing particularly high concordance. ISV measurements were comparatively less reliable. Within the limitations of this study—including a small sample size, the use of a single animal model, and limited measurement repetitions—histometric parameters demonstrated the strongest interrater agreement.

Keywords
Dental implant
Implant stability
Interrater reliability
Resonance frequency analysis
References
1

Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;6:387-416.

10.1016/S0300-9785(81)80077-4
2

Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scad J Plast Reconstr Surg 1977;16:1-132.

356184
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Barfeie A, Wilson J, Rees J. Implant surface characteristics and their effect on osseointegration. Br Dent J 2015;218:E9.

10.1038/sj.bdj.2015.171
4

Hao CP, Cao NJ, Zhu YH, Wang W. The osseointegration and stability of dental implants with different surface treatments in animal models: a network meta-analysis. Sci Rep 2021;11:13849.

10.1038/s41598-021-93307-434226607PMC8257659
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Meredith N. Assessment of implant stability as a prognostic determineant. Int J Prosthodont 1998;11:491-501.

9922740
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Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410.

10.1016/S0022-3913(83)80101-2
7

Atsumi M, Park SH, Wang HL. Methods Used to Assess Implant Stability: Current Status. Int J Oral 2007;22:743-54.

17974108
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Albrektsson T, Albrektsson B. Osseointegration of bone implants: A review of an alternative mode of fixation. Acta Orthop Scand 1987;58:567-77.

10.3109/17453678709146401
9

Adell R, Lekholm U, Brånemark PI, Lindhe J, Rockler B, Eriksson B, et al. Marginal tissue reactions at osseointegrated titanium fixtures. (II) A cross-sectional retrospective study. Int J Oral Maxillofac Surg 1986;15:53-61.

10.1016/S0300-9785(86)80011-4
10

Akesson L, Hakansson J, Rohlin M, Zoger B. An evaluation of image quality for the assessment of the marginal bone level in panoramic radiography. Swedish Dent J 1992;17:9-21.

8362363
11

Caulier H, Naert I, Kalk W, Jansen JA. The relationship of some histologic parameters, radiographic evaluations, and PerioTest measurements of oral implants: an experimental animal study. Int J Oral Maxillofac Implants 1997;12:380-6.

9197104
12

Al-Nawas B, Wagner W, Grötz KA. Insertion torque and resonance frequency analysis of dental implant systems in an animal model with loaded implants. Int J Oral Maxillofac Implants 2006;21:726-32.

17066633
13

Walker L, Morris HF, Ochi S. Periotest values of dental implants in the first 2 years after second-stage surgery: DICRG interim report no.8. Implant Dent 1997;6:207-12.

10.1097/00008505-199700630-00007
14

Truhlar RS, Morris HF, Ochi S. Stability of the bone-implant complex. Results of longitudinal testing to 60 months with the Periotest device on endosseous dental implants. Ann Periodontol 2000;5:42-55.

10.1902/annals.2000.5.1.42
15

Derhami K, Wolfaardt JF, Faulkner G, Grace M. Assessment of the Periotest device in baseline mobility measurements of craniofacial implants. Int J Oral Maxillofac Implants 1995;10:221-9.

7744442
16

Zechner W, Watzak G, Gahleitner A, Busenlechner D, Tepper G, Watzek G. Rotational panoramic versus intraoral rectangular radiographs for evalutation of peri-implant bone loss in the anterior atrophic mandible. Int J Oral Maxillofac Implants 2003;18:873-8.

14696663
17

Kullman L, Al-Asfour A, Zetterqvist L, Andersson L. Comparison of radiographic bone height assessments in panoramic and intraoral radiographs of implant patients. Int J Oral Maxillofac Implants 2007;22:96-100.

17340902
18

Sennerby L, Meredith N. Implant stability measurements using resonance frequency analysis: Biological and biomechanical aspects and clinical implications. Periodontology 2000;47:51-66.

10.1111/j.1600-0757.2008.00267.x
19

Lachmann S, Jäger B, Axmann D, Gomez-Roman G, Groten M, Weber H. Resonance frequency analysis and damping capacity assessment. Part I: An in vitro study on measurement reliability and a method of comparison in the determination of primary dental implant stability. Clin Oral Implants Res 2006;17:75-9.

10.1111/j.1600-0501.2005.01173.x
20

Lachmann S, Laval JY, Jäger B, Axmann D, Gomez-Roman G, Groten M, et al. Resonance frequency analysis and damping capacity assessment. Part 2: Peri-implant bone loss follow-up. An in vitro study with the Periotest and Osstell instruments. Clin Oral Implants Res 2006;17:80-4.

10.1111/j.1600-0501.2005.01174.x
21

Lee HN, Kim MS, Lee JY, Zihan X, Ryu JJ, Shim JS. Reliability of implant stability measuring devices depending on various clinical conditions: an in vitro study. J Adv Prosthodont 2023;15:126-6.

10.4047/jap.2023.15.3.12637441716PMC10333099
22

Schulte W, Lukas D. Periotest to monitor osseointegration and to check the occlusion in oral implantology. J Oral Implantol 1993;19:23-32.

8246291
23

Zix J, Hug S, Kessler-Liechti G, Mericske-Stern R. Measurement of dental implant stability by resonance frequency analysis and damping capacity assessment: comparison of both techniques in a clinical trial. Int J Oral Maxillofac Implants 2008;23:525-30.

18700378
24

Aparicio C, Lang NP, Rangert B. Validity and clinical significance of biomechanical testing of implant/bone interface. Clin Oral Implants Res 2006;17:2-7.

10.1111/j.1600-0501.2006.01365.x
25

Geckili O, Bilhan H, Cilingir A, Mumcu E, Bural C. A comparative in vitro evaluation of two different magnetic devices detecting the stability of osseo-integrated implants. J Periodontal Res 2012;47:508-13.

10.1111/j.1600-0765.2011.01462.x
26

Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part I: Surgical results. J Prosthet Dent 1990;63:451-7.

10.1016/0022-3913(90)90237-7
27

Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc 2016;16:124-30.

10.4103/0972-4052.17653927141160PMC4837777
28

Meredith N, Shagaldi F, Alleyne D, Sennerby L, Cawley P. The application of resonance frequency measurements to the stability of titanium implants during healing in the rabbit tibia. Clin Oral Implants Res 1997;8:234-43.

10.1034/j.1600-0501.1997.080310.x
1

Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;6:387-416.

10.1016/S0300-9785(81)80077-4
2

Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scad J Plast Reconstr Surg 1977;16:1-132.

356184
3

Barfeie A, Wilson J, Rees J. Implant surface characteristics and their effect on osseointegration. Br Dent J 2015;218:E9.

10.1038/sj.bdj.2015.171
4

Hao CP, Cao NJ, Zhu YH, Wang W. The osseointegration and stability of dental implants with different surface treatments in animal models: a network meta-analysis. Sci Rep 2021;11:13849.

10.1038/s41598-021-93307-434226607PMC8257659
5

Meredith N. Assessment of implant stability as a prognostic determineant. Int J Prosthodont 1998;11:491-501.

9922740
6

Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410.

10.1016/S0022-3913(83)80101-2
7

Atsumi M, Park SH, Wang HL. Methods Used to Assess Implant Stability: Current Status. Int J Oral 2007;22:743-54.

17974108
8

Albrektsson T, Albrektsson B. Osseointegration of bone implants: A review of an alternative mode of fixation. Acta Orthop Scand 1987;58:567-77.

10.3109/17453678709146401
9

Adell R, Lekholm U, Brånemark PI, Lindhe J, Rockler B, Eriksson B, et al. Marginal tissue reactions at osseointegrated titanium fixtures. (II) A cross-sectional retrospective study. Int J Oral Maxillofac Surg 1986;15:53-61.

10.1016/S0300-9785(86)80011-4
10

Akesson L, Hakansson J, Rohlin M, Zoger B. An evaluation of image quality for the assessment of the marginal bone level in panoramic radiography. Swedish Dent J 1992;17:9-21.

8362363
11

Caulier H, Naert I, Kalk W, Jansen JA. The relationship of some histologic parameters, radiographic evaluations, and PerioTest measurements of oral implants: an experimental animal study. Int J Oral Maxillofac Implants 1997;12:380-6.

9197104
12

Al-Nawas B, Wagner W, Grötz KA. Insertion torque and resonance frequency analysis of dental implant systems in an animal model with loaded implants. Int J Oral Maxillofac Implants 2006;21:726-32.

17066633
13

Walker L, Morris HF, Ochi S. Periotest values of dental implants in the first 2 years after second-stage surgery: DICRG interim report no.8. Implant Dent 1997;6:207-12.

10.1097/00008505-199700630-00007
14

Truhlar RS, Morris HF, Ochi S. Stability of the bone-implant complex. Results of longitudinal testing to 60 months with the Periotest device on endosseous dental implants. Ann Periodontol 2000;5:42-55.

10.1902/annals.2000.5.1.42
15

Derhami K, Wolfaardt JF, Faulkner G, Grace M. Assessment of the Periotest device in baseline mobility measurements of craniofacial implants. Int J Oral Maxillofac Implants 1995;10:221-9.

7744442
16

Zechner W, Watzak G, Gahleitner A, Busenlechner D, Tepper G, Watzek G. Rotational panoramic versus intraoral rectangular radiographs for evalutation of peri-implant bone loss in the anterior atrophic mandible. Int J Oral Maxillofac Implants 2003;18:873-8.

14696663
17

Kullman L, Al-Asfour A, Zetterqvist L, Andersson L. Comparison of radiographic bone height assessments in panoramic and intraoral radiographs of implant patients. Int J Oral Maxillofac Implants 2007;22:96-100.

17340902
18

Sennerby L, Meredith N. Implant stability measurements using resonance frequency analysis: Biological and biomechanical aspects and clinical implications. Periodontology 2000;47:51-66.

10.1111/j.1600-0757.2008.00267.x
19

Lachmann S, Jäger B, Axmann D, Gomez-Roman G, Groten M, Weber H. Resonance frequency analysis and damping capacity assessment. Part I: An in vitro study on measurement reliability and a method of comparison in the determination of primary dental implant stability. Clin Oral Implants Res 2006;17:75-9.

10.1111/j.1600-0501.2005.01173.x
20

Lachmann S, Laval JY, Jäger B, Axmann D, Gomez-Roman G, Groten M, et al. Resonance frequency analysis and damping capacity assessment. Part 2: Peri-implant bone loss follow-up. An in vitro study with the Periotest and Osstell instruments. Clin Oral Implants Res 2006;17:80-4.

10.1111/j.1600-0501.2005.01174.x
21

Lee HN, Kim MS, Lee JY, Zihan X, Ryu JJ, Shim JS. Reliability of implant stability measuring devices depending on various clinical conditions: an in vitro study. J Adv Prosthodont 2023;15:126-6.

10.4047/jap.2023.15.3.12637441716PMC10333099
22

Schulte W, Lukas D. Periotest to monitor osseointegration and to check the occlusion in oral implantology. J Oral Implantol 1993;19:23-32.

8246291
23

Zix J, Hug S, Kessler-Liechti G, Mericske-Stern R. Measurement of dental implant stability by resonance frequency analysis and damping capacity assessment: comparison of both techniques in a clinical trial. Int J Oral Maxillofac Implants 2008;23:525-30.

18700378
24

Aparicio C, Lang NP, Rangert B. Validity and clinical significance of biomechanical testing of implant/bone interface. Clin Oral Implants Res 2006;17:2-7.

10.1111/j.1600-0501.2006.01365.x
25

Geckili O, Bilhan H, Cilingir A, Mumcu E, Bural C. A comparative in vitro evaluation of two different magnetic devices detecting the stability of osseo-integrated implants. J Periodontal Res 2012;47:508-13.

10.1111/j.1600-0765.2011.01462.x
26

Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part I: Surgical results. J Prosthet Dent 1990;63:451-7.

10.1016/0022-3913(90)90237-7
27

Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc 2016;16:124-30.

10.4103/0972-4052.17653927141160PMC4837777
28

Meredith N, Shagaldi F, Alleyne D, Sennerby L, Cawley P. The application of resonance frequency measurements to the stability of titanium implants during healing in the rabbit tibia. Clin Oral Implants Res 1997;8:234-43.

10.1034/j.1600-0501.1997.080310.x
Information
  • Publisher :The Korean Academy of Oral & Maxillofacial Implantology
  • Publisher(Ko) :대한구강악안면임플란트학회
  • Journal Title :Journal of implantology and applied sciences
  • Journal Title(Ko) :대한구강악안면임플란트학회지
  • Volume : 29
  • No :4
  • Pages :177-192
  • Received Date : 2025-08-20
  • Revised Date : 2025-09-21
  • Accepted Date : 2025-11-02
  • DOI :https://doi.org/10.32542/implantology.2025019
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