Can the Bone Density Estimated by CBCT Predict the Primary Stability of Dental Implants? A New Measurement Protocol

Jawbone quality classification in dental implant planning and placement studies. A scoping review

Aim

Cone beam computed tomography has become an attractive method for implant planning. However, in most cases, not all the information is taken advantage of and often the radiographic evaluation of bone quality is based on subjective assessment by the individual clinician. Therefore, the aim of this study was to examine classifications of bone tissue characteristics and methods for assessing them in dental implant planning and placement studies.

Materials and Methods

Three databases (Pubmed, Scopus, Web of Science) were searched using specific index terms: "Bone quality, bone quantity, bone density, cone-beam CT and cone-beam computed tomography". Three reviewers selected titles and analyzed abstracts according to inclusion and exclusion criteria. Some descriptions of bone tissue characteristics (bone quality, density, and quantity) used before or during dental implant placement were selected and categorized.

Results

The search yielded 442 titles. A total of 32 articles were selected and read in full text. Seventeen articles were considered relevant. Different classification systems were found to evaluate bone tissue characteristics as well as different examination protocols. Thirteen publications included in this review reported on bone quality and quantity using the Lekholm and Zarb classification. However, only four studies implemented and/or proposed modifications of the Lekholm and Zarb system. Four other publications described bone quality according to different classification systems such as Misch, University of California Los Angeles (UCLA), or Trisi and Rao. The assessment methods were often briefly described (or not described at all in one publication). Of the articles analyzed, five presented observer performance, whereas three presented diagnostic accuracy of the assessment method.

Conclusion

Currently, there are different classification systems applied to dental implant planning and placement, particularly regarding whether bone quality or quantity affects treatment outcomes. However, most authors have not validated the diagnostic accuracy and reproducibility of the classification used. Therefore, it is necessary to develop a classification system consistent with characteristics of bone tissue, taking into consideration an adequate description of bone tissue assessment methods, their diagnostic accuracy, and observer performance.

Correlation between peri-implant bone mineral density and primary implant stability based on artificial intelligence classification

Currently, the classification of bone mineral density (BMD) in many research studies remains rather broad, often neglecting localized changes in BMD. This study aims to explore the correlation between peri-implant BMD and primary implant stability using a new artificial intelligence (AI)-based BMD grading system. 49 patients who received dental implant treatment at the Affiliated Hospital of Stomatology of Fujian Medical University were included. Recorded the implant stability quotient (ISQ) after implantation and the insertion torque value (ITV). A new AI-based BMD grading system was used to obtain the distribution of BMD in implant site, and the bone mineral density coefficients (BMDC) of the coronal, middle, apical, and total of the 1 mm site outside the implant were calculated by model overlap and image overlap technology. Our objective was to investigate the relationship between primary implant stability and BMDC values obtained from the new AI-based BMD grading system. There was a significant positive correlation between BMDC and ISQ value in the coronal, middle, and total of the implant (P < 0.05). However, there was no significant correlation between BMDC and ISQ values in the apical (P > 0.05). Furthermore, BMDC was notably higher at implant sites with greater ITV (P < 0.05). BMDC calculated from the new AI-based BMD grading system could more accurately present the BMD distribution in the intended implant site, thereby providing a dependable benchmark for predicting primary implant stability.

Cone-Beam Computed Tomography (CBCT)-Based Assessment of the Alveolar Bone Anatomy of the Maxillary and Mandibular Molars: Implication for Immediate Implant Placement

Purpose This study aims to examine specific aspects of socket morphology, including buccal and palatal/lingual bone width, interradicular bone (IRB) width, and assessments of root apices and furcation proximity to the vital structures of the maxillary and mandibular first and second molars using cone-beam computed tomography (CBCT). Materials and methods The study involved the analysis of 400 maxillary and mandibular first and second molars. Various measurements were taken to assess socket morphology, including mesiodistal (MD) and buccolingual (BL) width, buccal and lingual bone thickness at 2 mm apical to the alveolar crest, IRB width at 2 mm from the furcation, and the distance between the root apices and furcation to vital structures, such as the floor of the maxillary sinus (FMS) and inferior alveolar nerve (IAN). Results The mesiobuccal (MB) root of the second molar commonly intruded into the sinus, followed by the palatal root of the maxillary first molar. The mean FMS-F distance was 7.17 + 3.98 mm, and it was 7.2 + 2.72 mm for maxillary first and second molars, respectively. The mean IRB width was 2.77 + 0.96 and 2.29 + 0.74 mm for the first and second molars. The mandibular second molar had the shortest distance to the IAN in comparison to the first molar. For maxillary teeth, 7% of the first and 4% of the second molars presented alveolar anatomy adequate for immediate implant placement, compared to 84% and 50% of mandibular first and second molars. Conclusion Understanding the local alveolar bone anatomy of molars and its relationship to vital structures is crucial for the effective planning of implant treatments.

Reliability of Grayscale Value for Bone Density Determination in Oral Rehabilitation using Dental Implants

Introduction

Quality and quantity of jaw bones have been previously classified in literature using different methods. Imaging modalities such as computed tomography (CT), successfully determine bone density of jaws. This study aims to establish the role of cone-beam CT (CBCT) in determining the density of cortical and cancellous bones at different jaw sites.

Materials and Methods

Eighty-three possible implant sites in healthy patients were evaluated using NewTomGiano CBCT machine. Cross-sections were obtained and cortical and cancellous bone densities on different aspects of the virtual implant in terms of Hounsfield unit (HU) were determined using New Net Technologies software version 6.1 and were classified according to software from D1 to D4. Data were entered into SPSS software (version 19.0) and were statistically analyzed.

Results

The mean HU showed the highest value for cortical and cancellous in the anterior mandible (mean HU 1874.01 and 1131.73, respectively) followed by the posterior mandible (mean HU 1789.20 and 872.95, respectively) and least in posterior maxilla (mean HU 1068.26 and 830.04, respectively). Maximum D1 bone type was found in cortical bone and D2 bone type was noted in cancellous bone area. Males showed very highly significant cortical bone thickness (P < 0.001) whereas females showed more cancellous bone thickness but the results were nonsignificant.

Conclusion

A high degree of concordance between different regions of jaw bones with a strong correlation between the four bone types was obtained. Bone density plays a pivotal role in determining the prognosis of the implant. CBCT has proven to be beneficial in bone density analysis.

Evaluation of implant site preparation with piezosurgery versus conventional drills in terms of operation time, implant stability and bone density (randomized controlled clinical trial- split mouth design)

BACKGROUND

The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation.

METHODS

Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months.

RESULTS

a significant difference in terms of time of surgery (p < 0.005) and in implant stability at 4 months (p = 0.024) on the study side, while a non-statistical significance in terms of bone density was detected (p = 0.468).

CONCLUSION

The piezoelectric implant site drilling protocol seemed to be a reliable and repeatable technique. Despite the limited sample size and lengthier operative time, the piezoelectric inserts enhanced bone quality and implant stability. Clinical trial registration Current Controlled Trials (ClinicalTrials.gov) https://clinicaltrials.gov/ct2/show/NCT05512273 ; the date of registration: 23/08/2022. Retrospectively registered.

Validation of an implant stability measurement device using the percussion response: a clinical research study

Background

Several devices have been developed to measure implant-bone stability as an indicator of successful implant treatment; these include Osstell®, which measures the implant stability quotient (ISQ), and the more recent AnyCheck®, which relies on percussion for the implant stability test (IST). These devices make it possible to measure implant stability. However, no studies have compared the performance of AnyCheck® and Osstell® (i.e., IST and ISQ values) in clinical practice. Therefore, this study aimed to determine the correlation between primary and secondary implant stability using the Osstell® and AnyCheck® devices.

Methods

Ten patients (7 women; age [mean ± standard deviation]: 49.1 ± 13.3 years) with partially edentulous jaws who received a total of 15 implants were included. IST (AnyCheck®) and ISQ (Osstell®) values were measured immediately after implantation and at 1, 2, 3, 4, and 6 weeks post-implantation. Each measurement was performed three times, and the average value was used as the result. The correlation between measurements obtained using the two devices was determined using Spearman's rank correlation coefficient.

Results

The IST values ranged from 79.1 ± 2.87 to 82.4 ± 2.65. The ISQ values ranged from 76.0 ± 2.8 to 80.2 ± 2.35. Spearman's rank correlation coefficient was r = 0.64 immediately after implantation, r = 0.29 at 1 week, r = 0.68 at 2 weeks, r = 0.53 at 3 weeks, r = 0.68 at 4 weeks, and r = 0.56 at 6 weeks. A positive correlation was found in all cases, except at week 1 when the correlation was weak; the IST and ISQ values decreased the most during the first postoperative week and increased during the second week. The IST values were also slightly higher at all measurement points.

Conclusion

The ability to assess implant stability without removing the abutment during healing is essential for determining the timing of loading without the risk of bone resorption. The results of this study suggest that AnyCheck® is useful for determining primary and secondary implant stability.

The Importance of Correlation between CBCT Analysis of Bone Density and Primary Stability When Choosing the Design of Dental Implants—Ex Vivo Study

This study aims to determine the correlation between the mean value of bone density measured on the CBCT device and the primary stability of dental implants determined by resonant frequency analysis. An experimental study was conducted on a material of animal origin: bovine femur and pig ribs. Two types of implants were used in this study: self-tapping and non-self-tapping of the same dimensions. Results of the experimental study showed a statistically significant correlation between bone density expressed in HU units and the primary stability of self-tapping and non-self- tapping dental implants expressed in ISQ units in bovine femur bones and self-tapping implants and pig rib bones. There was no statistically significant correlation between non-self-tapping dental implants in pig rib bones. Self-tapping and non-self-tapping implants did not show statistical significance in the primary stability in bones of different qualities. The analysis of bone density from CBCT images in the software of the apparatus expressed in HU units can be used to predict the degree of primary stability of self-tapping and non-self-tapping dental implants in bones of densities D1 and D2, and self-tapping dental implants in bones of the lower quality D4.

The Assessment of the Usefulness of Platelet-Rich Fibrin in the Healing Process Bone Resorption

The main subject of this research was the use of PRF in dental surgery aimed at preventing changes in alveolar height and width after tooth extraction. Due to the large growth factor content, it seems to be particularly useful in bone loss management starting from the simplest loss occurring after tooth extraction through loss resulting from tooth resection ending with loss caused by large bone cysts. The study was performed on 50 patients. The extraction of two maxillary or mandibular homonymous teeth was carried out in each patient, where PRF was placed in one alveolus while the other alveolus was left empty. Then, the alveoli were surgically managed with a split flap technique. On the extraction day, after 10 days, and after 6 months, the alveolar process was measured, soft tissues healing was assessed, and imaging examinations were analyzed. It was proved that the healing of soft tissues in the PRF group was better. In the PRF group after 6 months from surgery, the newly formed bone had higher grayscale values in volumetric tomography (CBCT). Moreover, the reduced atrophy of the alveolar process at the site of the extracted tooth was proved in this study.

The Effect of Bone Density Measured by Cone Beam Computed Tomography and Implant Dimensions on the Stability of Dental Implants

ABSTRACT

The aim of this study was to evaluate the effect of bone density value in Hounsfield unit derived from cone beam computed tomography (CBCT), and implant dimensions in relation to implant stability parameters namely the resonance frequency analysis and the insertion torque (IT) value. It included 24 patients who received 42 dental implants (DI). The bone density of the planned implant site was preoperatively measured using cone beam computed tomography. The implant stability was measured using Osstell implant stability quotient (ISQ). The ISQ values were recorded immediately postoperatively and after 16 weeks. The IT value was categorized as 35 N/cm or > 35 N/cm. The mean (standard deviation) primary stability was 79.58 (5.27) ISQ, which was significantly higher than the secondary stability 74.31 (6.34) ISQ (P < 0.0001). There was a significant moderate positive correlation of bone density with primary stability (r = 0.4, P = 0.0099) and no correlation with secondary stability (r = 0.003, P = 0.9867). The bone density of DI with 35 N/cm IT was significantly lower than with > 35 N/cm IT (P = 0.0390). Better stability was recorded with wider implants. Whereas the length of the DI showed a nonsignificant correlation with primary and secondary stability (P = 0.7633 and 0.4670, respectively). The DI dimensions showed a nonsignificant correlation with the IT. Cone beam computed tomography may be considered as a reliable method to assess bone density and predict the implant stability. The diameter of DI affected the implant stability favorably, whereas DI length showed no effect.

Analysis of biological and structural factors implicated in the clinical success of orthodontic miniscrews at posterior maxillary interradicular sites

OBJECTIVE

This study aims to evaluate success factors implicated in clinical orthodontic miniscrew stability after their interradicular placement in maxilla.

MATERIALS AND METHODS

Six hundred seventy-six miniscrews were inserted in maxillary interradicular sites in a sample of 276 patients (109 males and 167 females; mean age 19 ± 1.7 years) and immediately loaded. Percentage failure rate was recorded, and the influence of the following factors was investigated: structural (miniscrew length, diameter and body shape), operative (side of insertion site, pilot hole drilling or not) and biological (maximal insertion torque [MIT] and type of gingiva). A chi-square test with Monte Carlo correction was performed to detect the influence of these variables on the failure rate of orthodontic miniscrews. Then both multivariate logistic regression and post hoc analysis were performed, followed by classification and regression tree (CART) analysis.

RESULTS

The average success rate was 88%. The principal factors implicated in the failure rate were miniscrew length, MIT values and type of gingiva. Specifically, 8 mm miniscrew length, alveolar mucosa and 5-10 Ncm MIT values were linked to higher failure rates. According to CART, the main variable influencing failure is miniscrew length (≤ 8 mm for higher failure rates). For others, MIT values of 5-10 Ncm are linked to higher failure rates (p < 0.05).

CONCLUSION

Orthodontic miniscrews inserted in the maxilla display good success rates. However, clinicians should be discouraged from using miniscrews of length ≤ 8 mm and MIT values < 10 Ncm, even with longer miniscrews.

CLINICAL RELEVANCE

Information about factors related to failure rate of miniscrews placed at posterior maxillary interradicular sites is given.