Can Finger-Generated Force Be Used Reliably to Connect the MulTipeg™ ?

It is known that several factors affect the ISQ values, and there are sometimes questions about if MulTipeg™ tightening torque is one of them.

Naturally, if the MulTipeg is not fully secured to the implant, an error could occur in the ISQ reading.
Recently, Pelegrine et.al published the following study “Can Finger-Generated Force Be Used Reliably to Connect the Transducer for Resonance Frequency Analysis in Determining Implant Stability?” in order to determine the minimum torque required to attach the MulTipeg to the implant to measure the implant stability quotient (ISQ) and to estimate if finger-generated torque would be reliable for this purpose.
An in vitro controlled model experiment was designed to measure the torques needed to tighten the MulTipeg to the implant to produce accurate and reproducible ISQ measurements. In a previous study, it was observed that torques between 10 and 17 Ncm are adequate for precise analysis of implant stability when using Smartpegs together with an Osstell RFA instrument. However, for the Penguin RFA instrument, no such studies were available for comparison. The present study was designed to answer two questions: “Should the same torque-tightening protocol be used for both instruments (Penguin and Osstell) to produce comparable results?” and “Are finger-generated torque tightening forces sufficient to achieve accurate measurements?”
Pelegrine et.al evaluated the minimum torque necessary to insert the MulTipeg into the implant to obtain accurate stability measurements, by inserting 100 implants into a uniform polyurethane block. MulTipegs were manually attached by either female or male operators using the standard connector provided by the manufacturer. In addition, MulTipegs were also placed using a connector adapted to a digital torque wrench with different torque settings.
The stability was measured for all groups using both the Osstell and the Penguin resonance frequency analyzers. The minimum, medium, and maximum finger grip torque were accessed on 100 volunteers.
For an accurate measurement of ISQ, the minimum torque necessary to insert the MulTipeg into the implant for Penguin was 5 Ncm. Therefore, when using Penguin, the maximum finger-generated tightening force is enough.
The male digital force was statistically higher than the female, but both groups reached sufficient force to tighten the Penguin MulTipeg to 5 Ncm.

The Penguin RFA MulTipegs are sensible measuring devices made in titanium with sealed magnets, which makes them reusable.
The Penguin RFA MulTipegs are autoclavable (20 cycles), laser marked with type number, have optimal platform fit and are ISQ Standard Calibrated™. The MulTipeg Driver is made of stainless steel and works like a screwdriver and a carrier for the MulTipeg. Since the MulTipeg has a magnet in its top it will attach safely inside the Driver.
As per the Penguin RFA Manual; The MulTipeg is mounted onto the implant by using the MulTipeg Driver. Use hand-tightening with 6-8 Ncm of tightening torque.

ISQ Standard Calibrated™
The peg-implant connection is a potential source of erroneous measurements due to possible misfit. Therefore, MulTipegs™ are designed to achieve the best possible fit with each implant type.
All MulTipegs™ types are calibrated against the ISQ Standard to detect any misfit or variance in ISQ, which in turn can be eliminated by elaborating the physical properties of the peg.
Another issue is that modern bone-level implants often use an internal connection for abutments and prosthetic devices. That is why some marginal bone overgrowth of the implant does not prevent a good fit. The MulTipegs™ are designed to bypass and avoid interaction with the marginal bone in order to prevent erroneous measurements.