The correlation of CBCT analysis derived bone density parameters with primary implant stability – a clinical study

  • Mirko Mikić University of Montenegro, Faculty of Medicine, Department of Dentistry, Podgorica, Montenegro
  • Zoran Vlahović University of Priština – Kosovska Mitrovica, Faculty of Medicine, †Department of Dentistry, Kosovska Mitrovica, Serbia
  • Dragoslav Nenezić University of Montenegro, Faculty of Medicine, Department of Dentistry, Podgorica, Montenegro
  • Goran Videnović University of Priština – Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia
  • Danijela Ilić University of Priština – Kosovska Mitrovica, Faculty of Medicine, Department of Preventive Medicine, Kosovska Mitrovica, Serbia
  • Raša Mladenović University of Priština – Kosovska Mitrovica, Faculty of Medicine, †Department of Dentistry, ‡Department of Preventive Medicine, Kosovska Mitrovica, Serbia
Keywords: bone, density, tomography, computed, cone beam, implants, dental, treatment, outcome

Abstract


Background/Aim. There are numerous studies on the usefulness of computed tomography (CT) in the assessment of the bone volume and morphology and on the relationship between CT and primary implant stability. But there is the scarcity of data about the correlation between bone density and the value of primary implant stability. The aim of this study was to examine the correlation of cone beam CT (CBCT) analysis derived bone density with primary stability value. Methods. Clinical prospective experimental study was conducted on 38 healthy patients missing one tooth in the lateral region. It was planned to install Bredent Blue Sky Narrow self-taping dental implants with dimensions 3.5 × 10 mm. During preoperative preparation, a CBCT scan was performed on Planmeca apparatus, followed by preimplantation measurements and planning in the CBCT apparatus software (Romexis). The mean value of the average bone density was automatically generated and expressed in Hounsfield units (HU). Upon implant placement, we performed measurements of the primary implant stability using Osstell apparatus. Results. Of the 38 patients included in the study, there were 68.4% male patients and 31.6% female patients. The arithmetic mean of the measured bone density of all subjects in the study amounted to 536.2 HU. The arithmetic mean of dental implant primary stability for all subjects in the study was 68.7 ISQ. There was a statistically significant strong positive connection between HU and ISQ (r = 0.744, p < 0.001). Higher HU values were connected to higher ISQ values. In the multivariate linear regression model, statistically significant predictors of higher ISQ values: males (B = 4.669; p = 0.047) and higher HU values (B = 0.032; p < 0.001). Conclusion. In our clinical study, there was a statistically significant strong positive correlation between the bone density expressed in HU units, measured in the software of the CBCT device and the primary stability of dental implants expressed in ISQ units.

References

Pauwels R, Jacobs R, Singer SR, Mupparapu M. CBCT-based bone quality assessment: are Hounsfield units applicable?. Dentomaxillofac Radiol 2015; 44(1): 20140238.

Chou IC, Lee SY, Jiang CP. Effects of implant neck design on primary stability and overload in a type IV mandibular bone. Int J Numer Method Biomed Eng 2014; 30(11): 1223‒37.

Möhlhenrich SC, Kniha K, Heussen N, Hölzle F, Modabber A. Ef-fects on primary stability of three different techniques for im-plant site preparation in synthetic bone models of different densities. Br J Oral Maxillofac Surg 2016; 54(9): 980–6.

Vlahovic Z, Mihailovic B, Lazic Z, Golubovic M. Comparative ra-diographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: An experimental study on domestic pigs. Vojnosanit Pregl 2013; 70(6): 586‒94.

Becker W, Hujoel P, Becker BE. Resonance frequency analysis: Comparing two clinical instruments. Clin Implant Dent Relat Res 2018; 20(3): 308–12.

Heinemann F, Hasan I, Bourauel C, Biffar R, Mundt T. Bone sta-bility around dental implants: Treatment related factors. Ann Anat 2015; 199: 3‒8.

Spies BC, Bateli M, Ben Rahal G, Christmann M, Vach K, Kohal RJ. Does Oral Implant Design Affect Marginal Bone Loss? Re-sults of a Parallel-Group Randomized Controlled Equivalence Trial. Biomed Res Int 2018; 2018: 8436437.

Rokn A, Ghahroudi AR, Mesgarzadeh A, Miremadi A, Yaghoobi S. Evaluation of stability changes in tapered and parallel wall implants: a human clinical trial. J Dent (Tehran) 2011; 8(4): 186–200.

Bilhan H, Bilmenoglu C, Urgun AC, Ates G, Bural C, Cilingir A, et al. Comparison of the Primary Stability of Two Implant Designs in Two Different Bone Types: An In Vitro Study. Int J Oral Maxillofac Implants 2015; 30(5): 1036‒40.

Greenberg AM. Cone beam computed tomography scanning and diagnosis for dental implants. Oral Maxillofac Surg Clin North Am 2015; 27(2): 185–202.

Misch CE. Density of bone: effect on treatment planning, sur-gical approach and healing. In: Misch CE, editor. Contempo-rary implant dentistry. 3rd ed. St. Louis: Mosby; 2007. p. 469–85.

Lekholm U, Zarb GA. Patient selection and preparation. In: Branemark PI, Zarb GA, Albrektsson T, editors. Tissue-Integrated Prostheses: Osseointegration In Clinical dentistry. Chicago: Quintessence; 1985. p. 199–209.

Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001; 12(1): 79‒84.

Engfors I, Örtorp A, Jemt T. Fixed implant-supported prosthe-ses in elderly patients: a 5-year retrospective study of 133 edentulous patients older than 79 years. Clin Implant Dent Relat Res 2004; 6(4): 190‒8.

De Backer H, Van Maele G, De Moor N, Van den Berghe L. Sin-gle tooth replacement: Is a 3-unit fixed partial denture still an option? A 20 year retrospective study. Int J Prosthodont 2006; 19(6): 567–73.

Turkyilmaz I. Clinical and radiological results of patients treat-ed with two loading protocols for mandibular overdentures on Branemark implants. J Clin Periodontol 2006; 33(3): 233‒8.

Jemt T, Lekholm U. Implant treatment in edentulous maxilla: a five-year fol- low-up report on patients with different degrees of jaw resorption. Int J Oral Maxillofac Implants 1995; 10(3): 303–11.

Kaptein ML, De Lange GL, Blijdorp PA. Peri-implant tissue health in reconstructed atrophic maxillae--report of 88 pa-tients and 470 implants. J Oral Rehabil 1999; 26(6): 464–74.

Grunder U. Immediate functional loading of immediate im-plants in edentulous arches: two-year results. Int J Periodon-tics Restorative Dent 2001; 21(6): 545–51.

Marković A, Calvo-Guirado JL, Lazić Z, Gómez-Moreno G, Ćala-san D, Guardia J, et al. Evaluation of Primary Stability of Self-Tapping and Non-Self-Tapping Dental Implants. A 12-Week Clinical Study. Clin Implant Dent Relat Res 2013; 15(3): 341‒9.

Homolka P, Beer A, Birkfellner W, Nowotny R, Gahleitner A, Tschabitscher M, et al. Bone Mineral Density Measurement with Dental Quantitative CT Prior to Dental Implant Placement in Cadaver Mandibles: Pilot Study. Radiology 2002; 224(1): 247‒52.

Fanuscu MI, Chang TL. Three-dimensional morphometric anal-ysis of human cadaver bone: microstructural data from maxilla and mandible. Clin Oral Implants Res 2004; 15(2): 213‒8.

Hanazawa T, Sano T, Seki K, Okano T. Radiologic measure-ments of the mandible: a comparison between CT-reformatted and conventional tomographic images. Clin Oral Implants Res 2004; 15(2): 226‒32.

Beer A, Gahleitner A, Holm A, Tschabitscher M, Homolka P. Cor-relation of insertion torques with bone mineral density from dental quantitative CT in the mandible. Clin Oral Implants Res 2003; 14(5): 616‒20.

Ikumi N, Tsutsumi S. Assessment of correlation between com-puterized tomography values of the bone and cutting torque values at implant placement: a clinical study. Int J Oral Maxil-lofac Implants 2005; 20(2): 253–60.

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; 33(12): 881‒8.

Turkyilmaz I, Tumer C, Ozbek EN, Tözüm TF. Relations be-tween the bone density values from computerized tomogra-phy, and implant stability parameters: a clinical study of 230 regular platform implants. J Clin Periodontol 2007; 34(8): 716–22.

Strub JR, Jurdzik BA, Tuna T. Prognosis of immediately loaded implants and their restorations: a systematic literature review. J Oral Rehabil 2012; 39(9): 704–17.

Vlahović Z, Mikić M. 3D Printing Guide Implant Placement: A Case Report. Balk J Dent Med 2017; 21(1): 65‒8.

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; 21(2): 290–7.

Tatli U, Salimov F, Kürkcü M, Akoğlan M, Kurtoğlu C. Does cone beam computed tomography-derived bone density give pre-dictable data about stability changes of immediately loaded implants?: A 1-year resonance frequency follow-up study. J Craniofac Surg 2014; 25(3): e293–9.

Fuster-Torres MA, Peñarrocha-Diago M, Peñarrocha-Oltra D. Rela-tionships between bone density values from cone beam com-puted tomography maximum insertion torque, and resonance frequency analysis at implantplacement: a pilot study. Int J Oral Maxillofac Implants 2011; 26(5): 1051–6.

Hiasa K, Abe Y, Okazaki Y, Nogami K, Mizumachi W, Akagawa Y. Preoperative Computed Tomography-Derived Bone Densi-ties in Hounsfield Units at Implant Sites Acquired Primary Stability. ISRN Dent 2011; 2011: 678729

Marquezan M, Osório A, Sant'Anna E, Souza MM, Maia L. Does bone mineral density influence the primary stability of dental implants? A systematic review. Clin Oral Implants Res 2012; 23(7): 767‒74.

Herekar M, Sethi M, Ahmad T, Fernandes AS, Patil V, Kulkarni H. A correlation between bone (B), insertion torque (IT), and implant stability (S): BITS score. J Prosthet Dent 2014; 112(4): 805–10.

Published
2021/08/24
Section
Original Paper