The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 16 , ISSUE 8 ( August, 2015 ) > List of Articles


An Intraoperative Site-specific Bone Density Device: A Pilot Test Case

Danilo Alessio Di Stefano, Paolo Arosio, Monica Moschioni, Luca Maria Banfi

Citation Information : Stefano DA, Arosio P, Moschioni M, Banfi LM. An Intraoperative Site-specific Bone Density Device: A Pilot Test Case. J Contemp Dent Pract 2015; 16 (8):697-703.

DOI: 10.5005/jp-journals-10024-1743

Published Online: 01-02-2016

Copyright Statement:  Copyright © 2015; The Author(s).



This paper reports a case of all-on-four rehabilitation where bone density at implant sites was assessed both through preoperative computed tomographic (CT) scans and using a micromotor working as an intraoperative bone density measurement device.


Implant-supported rehabilitation is a predictable treatment option for tooth replacement whose success depends on the clinician's experience, the implant characteristics and location and patient-related factors. Among the latter, bone density is a determinant for the achievement of primary implant stability and, eventually, for implant success. The ability to measure bone density at the placement site before implant insertion could be important in the clinical setting.

Case description

A patient complaining of masticatory impairment was presented with a plan calling for extraction of all her compromised teeth, followed by implant rehabilitation. A week before surgery, she underwent CT examination, and the bone density on the CT scans was measured. When the implant osteotomies were created, the bone density was again measured with a micromotor endowed with an instantaneous torque-measuring system. The implant placement protocols were adapted for each implant, according to the intraoperative measurements, and the patient was rehabilitated following an all-on-four immediate loading protocol.


The bone density device provided valuable information beyond that obtained from CT scans, allowing for site-specific, intraoperative assessment of bone density immediately before implant placement and an estimation of primary stability just after implant insertion.

Clinical significance

Measuring jaw-bone density could help clinicians to select implant-placement protocols and loading strategies based on site-specific bone feature

How to cite this article

Arosio P, Moschioni M, Banfi LM, Di Stefano DA. An Intraoperative Site-specific Bone Density Device: A Pilot Test Case. J Contemp Dent Pract 2015;16(8): 697-703.

PDF Share
  1. Osseointegration and its experimental background. J Prosthet Dent 1983;50(3):399-410.
  2. Mechanisms of endosseous integration. Int J Prosthodont 1998;11(5):391-401.
  3. Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation. Interv Med Appl Sci 2013;5(4):162-167.
  4. Effect of implant design on initial stability of tapered implants. J Oral Implantol 2009;35(3):130-135.
  5. 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 1991;6(2):142-146.
  6. Cutting torque measurements in conjunction with implant placement in grafted and nongrafted maxillas as an objective evaluation of bone density: a possible method for identifying early implant failures. Clin Implant Dent Relat Res 2004;6(1):9-15.
  7. Assessment of implant stability as a prognostic determinant. Int J Prosthodont 1998;11(5):491-501.
  8. Surgical determinants of clinical success of osseointegrated oral implants: a review of the literature. Int J Prosthodont 1998;11(5):408-420.
  9. An update on the clinical documentation on currently used bone anchored endosseous oral implants. Dent Update 1997;24(5):194-200.
  10. Cone beam CT for presurgical assessment of implant sites. J Calif Dent Assoc 2003;31(11):825-833.
  11. Bone density assessments of dental implant sites: 1. Quantitative computed tomography. Int J Oral Maxillofac Implants 2003;18(2):224-231.
  12. Bone density assessments of oral implant sites using computerized tomography. J Oral Rehabil 2007;34(4):267-272.
  13. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(2):231-238.
  14. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001;12(1):79-84.
  15. Quantitative evaluation of bone density using the Hounsfield index. Int J Oral Maxillofac Implants 2006;21(2):290-297.
  16. Bone quality evaluation: comparison of cone beam computed tomography and subjective surgical assessment. Int J Oral Maxillofac Implants 2012;27(5):1271-1277.
  17. Deriving Hounsfield units using grey levels in cone beam computed tomography. Dentomaxillofac Radiol 2010;39(6):323-335.
  18. Reliability of voxel values from cone-beam computed tomography for dental use in evaluating bone mineral density. Clin Oral Implants Res 2010;21(5):558-562.
  19. Contemporary implant dentistry. St Louis: Mosby Year-Book; 1993. Density of bone: effect of treatment planning, surgical approach, and healing; p. 469-485.
  20. Bone classification: clinical-histomorphometric comparison. Clin Oral Implants Res 1999;10(1):1-7.
  21. Evaluation of bone density using cutting resistance measurements and microradiography: an in vitro study in pig ribs. Clin Oral Implants Res 1995;6(3):164-171.
  22. Identification of bone quality in conjunction with insertion of titanium implants. A pilot study in jaw autopsy specimens. Clin Oral Implants Res 1995;6(4):213-219.
  23. Correlation between the bone density recorded by a computerized implant motor and by a histomorphometric analysis: A preliminary in vitro study on bovine ribs. Clin Implant Dent Relat Res 2015; 17suppl 1:e35-44.
  24. A possible novel objective intraoperative measurement of maxillary bone density. Minerva Stomatol 2013;62(7-8):259-265.
  25. Correlation between initial BIC and the insertion torque-depth Integral recorded with an instantaneous torquemeasuring implant motor: an in vivo study. Clin Implant Dent Relat Res 2015 [in press].
  26. Influence of bone density on implant stability parameters and implant success: a retrospective clinical study. BMC Oral Health 2008;8:32.
  27. Evaluation of bone height and bone density by computed tomography and panoramic radiography for implant recipient sites. J Oral Implantol 2000;26(2):114-119.
  28. Short communication: use of a diagnostic software to predict bone density and implant stability in preoperative CTs. Clin Implant Dent Relat Res 2012;14(4):553-557.
  29. The reliability of cone-beam computed tomography to assess bone density at dental implant recipient sites: a histomorphometric analysis by micro-CT. Clin Oral Implants Res 2013;24(8):871-879.
  30. Comparison between microcomputed tomography and cone-beam computed tomography radiologic bone to assess atrophic posterior maxilla density and microarchitecture. Clin Oral Implants Res 2014;25(6):723-728.
  31. Does bone mineral density influence the primary stability of dental implants? A systematic review. Clin Oral Implants Res 2012;23(7):767-774.
  32. Relationship between the bone density estimated by cone-beam computed tomography and the primary stability of dental implants. Clin Oral Implants Res 2012;23(7):832-836.
  33. Accuracy and complications using computer-designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature. Clin Implant Dent Relat Res 2012;14(3):321-335.
  34. Accuracy of virtually planned and template guided implant surgery on edentate patients. Clin Implant Dent Relat Res 2012;14(4):527-537.
  35. Accuracy of implant placement with a stereolithographic surgical template. Int J Oral Maxillofac Implants 2012;27(3):655-663.
  36. Accuracy of CAD/CAM-guided surgical template implant surgery on human cadavers: Part I. J Prosthet Dent 2010;103(6):334-342.
  37. Accuracy of computer-aided template-guided oral implant placement: a prospective clinical study. J Periodontal Implant Sci 2014;44(4):184-193.
  38. Fiveyear follow-up of wide-diameter implants placed in fresh molar extraction sockets in the mandible: immediate versus delayed loading. Int J Oral Maxillofac Implants 2010;25(3):607-612.
  39. Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study. Int J Oral Maxillofac Implants 2008; 23(4):753-758.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.