Bone density, Cone-beam computed tomography, Implants, Osseointegration
Citation Information :
Dahiya K, Kumar N, Bajaj P, Sharma A, Sikka R, Dahiya S. Qualitative Assessment of Reliability of Cone-beam Computed Tomography in evaluating Bone Density at Posterior Mandibular Implant Site. J Contemp Dent Pract 2018; 19 (4):426-430.
Introduction: The success of dental implants depends primarily on the primary implant stability and the bone density so that predictable osseointegration can be achieved. To achieve the desired results, systematic preoperative planning for implant placement is required. The sole aim of the study was to assess the reliability of preoperative bone density of mandibular posterior region for implant placement using computerized tomography-derived bone densities in Hounsfield units (HU).
Materials and methods: A total of 200 patients with 352 implant sites between 2014 and 2017 were assessed for the posterior mandibular area using cone-beam computed tomography (CBCT). Evaluation was done by two experienced observers independently.
Results: The mean bone density of males was 690.5 ± 104.12 HU and in females, it was 580.20 ± 120.2 HU. Overall, 21% of sites were of low bone density, 39.5% were of intermediate density, and 39.4% were of high density. Receiver operating characteristic (ROC) analysis presented that the CBCT intensity values had a high predictive power for predicting both highdensity sites and intermediate-density sites.
Conclusion: We can say from our results that, for predicting the bone densities in posterior mandible for determining implant sites, so as to achieve best osseointegration, CBCT values can be reliably used.
Clinical significance: It has been proved that bone density and implant stability are dependent on each other and osseointegration is important for the success of treatment. With advancements in dentistry and introduction of CBCT, treatment planning and prediction of appropriate implant sites could be made easy and more predictable. Thus, we can say that CBCT can be considered an alternative diagnostic tool for the bone density evaluation during treatment planning for implant placement.
Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc 2016 Apr-Jun;16(2):124-130.
Hiasa K, Abe Y, Okazaki Y, Nogami K, Mizumachi W, Akagawa Y. Preoperative computed tomography-derived bone densities in Hounsfield units at implant sites acquired primary stability. ISRN Dent 2011;2011:678729.
Farré-Pagés N, Augé-Castro ML, Alaejos-Algarra F, Mareque- Bueno J, Ferrés-Padró E, Hernández-Alfaro F. Relation between bone density and primary implant stability. Med Oral Patol Oral Cir Bucal 2011 Jan;16(1):e62-e67.
Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Canadian Dent Assoc 2006 Feb;72(1):75-80.
Rebaudi A, Trisi P, Cella R, Cecchini G. Preoperative evaluation of bone quality and bone density using a novel CT/ micro CT-based hard-normal-soft classification system. Int J Oral Maxillofac Implants 2010 Jan-Feb;25(1):75-85.
Molly L. Bone density and primary stability in implant therapy. Clin Oral Implants Res 2006 Oct;17 (Suppl 2):124-35.
Martinez H, Davarpanah M, Missika P, Celletti R, Lazzara R. Optimal implant stabilization in low density bone. Clin Oral Implants Res 2001 Oct;12(5):423-432.
Nackaerts O, Maes F, Yan H, Couto Souza P, Pauwels R, Jacobs R. Analysis of intensity variability in multislice and cone beam computed tomography. Clin Oral Implants Res 2011 Aug;22(8):873-879.
Lekholm U, Zarb GA. Patient selection and preparation. In: Branemark P, editor. Tissue-integrated prostheses. Osseointegration in clinical dentistry. 1st ed. Chicago: Quintessence; 1985. pp. 199-209.
Misch CE. Density of bone: effect on treatment plans, surgical approach, healing, and progressive bone loading. Int J Oral Implantol 1990;6(2):23-31.
de Oliveira RC, Leles CR, Normanha LM, Lindh C, Ribeiro- Rotta RF. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Feb;105(2):231-238.
Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001 Feb;12(1):79-84.
Trisi P, Rao W. Bone classification: clinical-histomorphometric comparison. Clin Oral Implants Res 1999 Feb;10(1):1-7.
Alkhader M, Hudieb M, Khader Y. Predictability of bone density at posterior mandibular implant sites using cone-beam computed tomography intensity values. Eur J Dent 2017;11:311-316.
Turkyilmaz I, Tözüm TF, Tumer C, Ozbek EN. Assessment of correlation between computerized tomography values of the bone, and maximum torque and resonance frequency values at dental implant placement. J Oral Rehabil 2006 Dec;33(12):881-888.
Shapurian T, Damoulis PD, Reiser GM, Griffin TJ, Rand WM. Quantitative evaluation of bone density using the Hounsfield index. Int J Oral Maxillofac Implants 2006 Mar-Apr;21(2): 290-297.
Fuh LJ, Huang HL, Chen CS, Fu KL, Shen YW, Tu MG, Shen WC, Hsu JT. Variations in bone density at dental implant sites in different regions of the jawbone. J Oral Rehabil 2010 May;37(5):346-351.