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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 297-300  

Assessment of the effect of bone density on implant stability: A clinical study


1 Department of Prosthodontics, Care Dental College, Guntur, Andhra Pradesh, India
2 Department of Prosthodontics, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
3 Department of Prosthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
4 Dr. Jagga Rao Konathala, MDS, Prosthodontics, Private Practitioner, Hyderabad, Telangana, India

Date of Submission01-Dec-2020
Date of Decision05-Dec-2020
Date of Acceptance06-Dec-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Raghunadh Sreerama
Department of Prosthodontics, Care Dental College, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_794_20

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   Abstract 


Background: In this study, we determined the effect of bone density on implant stability. Methodology: Two hundred and sixty dental implant sites in 128 patients were assessed for resonance frequency analysis (RFA) following implant insertion, at 6 months and 12 months. The implant stability quotient (ISQ) was determined. Results: The mean ± standard deviation bone density in anterior mandible was 862.8 ± 203.4 Hounsfield units (HU), in posterior mandible was 528.4 ± 115.6 HU, in anterior maxilla was 594.2 ± 95.2 HU, and in posterior maxilla was 438.1 ± 110.2 HU. The mean insertion torque in successful implants was 38.2 ± 7.1 Ncm and in failed implants was 22.4 ± 4.2 Ncm. The mean RFA value in successful implants was 65.4 ± 5.8 and in failed implants was 45.8 ± 4.1 ISQ. A statistically significant (P < 0.05) difference was obtained. Conclusion: Within the limitation of the study, we observed that successful implants exhibited higher RFA and insertion torque and were higher into failed implants suggesting a correlation of bone quality and implant stability parameters.

Keywords: Implant stability quotient, insertion torque, resonance frequency analysis


How to cite this article:
Sreerama R, Kolluru KC, Gottumukkala V, Innampudi CK, Konathala JR, Krishnaveni G. Assessment of the effect of bone density on implant stability: A clinical study. J Pharm Bioall Sci 2021;13, Suppl S1:297-300

How to cite this URL:
Sreerama R, Kolluru KC, Gottumukkala V, Innampudi CK, Konathala JR, Krishnaveni G. Assessment of the effect of bone density on implant stability: A clinical study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Sep 22];13, Suppl S1:297-300. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/297/317692




   Introduction Top


Dental implants have been widely used for the correction of missing few or multiple teeth have become popular in the last couple of years owing to several benefits. The higher survival rate and limited surgical intervention have led treatment of choice among dentists and patients.[1] Although it has significant higher success rate, numerous factors affect its survival rate. These are procedure-related and patient-related factors. The quantity, i.e., amount of bone present and quality, i.e., type of bone present determines the process of osseointegration. Type of dental implant used as well as the surgical method adopted is procedure-related factors.[2]

According to Misch bone density classification, Type D1 has higher survival rate which is usually found in mandibular anterior region. Type D2 is seen in the mandibular posterior region, Type D3 in maxillary anterior region and Type D4 poorest of all is encountered in maxillary posterior teeth region. Type D1 is strongest of all with 80% stronger trabeculae, Type D2 has combination of dense and porous bone with 40%–60% stronger trabeculae than Type D3 with 50% weaker trabeculae than D2, and Type D4 has poor density with trabeculae strength 10 times weaker than Type D1.[3]

Dental implant stability is the deciding parameter which ensures success rate of dental implant. Insertion torque, periotest, and resonance frequency analysis (RFA) are way of checking dental implant stability. The insertion torque method measures the quantity of torque required to insert the implant in the bone.[4] Periotest calculates the degree of the periodontal integration of teeth and the stiffness of the bone/implant interface. RFA calculates the bone/implant interface stiffness using Osstell instrument.[5] We assessed the effect of bone density on implant stability.


   Methodology Top


This study consisted of 260 dental implant sites in 128 patients of both genders conducted in the prosthodontics department. All enrolled patients were made aware of the study and their written consent was taken. Ethical clearance for the study was obtained before starting the study.

Data pertaining to all patients such as name, age, and gender were recorded. A thorough oral screening was done followed by computed tomography of the recipient implant site taken with Siemens Germany operating at standardized operating parameters (potential difference - 120 kVp, 90 mA tube current, 1 mm slice thickness, and slice intervals). The mean bone density of the potential implant site was measured using software Siemens. The bone density was measured in Hounsfield units (HU).

Dental implants were inserted following all standardized surgical procedures. RFA was performed with an Osstell instrument following implant insertion, at 6 months and 12 months. RF values were recorded in terms of implant stability quotient (ISQ). High ISQ value (100) is showing high stability and low implant stability was given to lower number (1). The maximum insertion torque value was recorded with OsseoCare motor during implant placement [Figure 1], [Figure 2], [Figure 3], [Figure 4]. A successful implant showed no pain, suppuration and any pathologic processes, no evidence of periapical implant radiolucency, sufficient implant stability, the implant provided attachment to prosthetic part based on criteria proposed by Lekholm and Zarb.[6] The results of the study were subjected to statistically analyzed with 0.05 level of set as significant.
Figure 1: Pre operative photograph showing partially edentulous area i.r.t 36

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Figure 2: Preoperative cone-beam computed tomography radiograph showing 11.5 mm length and 5.6 mm width at crestal level i.r.t 36

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Figure 3: (a) Intraoperative photograph showing after incision flap was reflected using periosteal elevator. (b) Intraoperative photograph showing postoperative implant with abutment i. r.t 36

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Figure 4: Postoperative photograph showing the primary stability of the implant using OSSTEL (resonance frequency analysis)

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   Results Top


Out of 128 patients, 72 were male and 56 were female. Male had 140 and females had 120 dental implants. Male had eight and female had seven failed implants [Table 1].
Table 1: Gender wise distribution of patients

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[Table 2] and [Graph 1] show that mean ± standard deviation (SD) bone density in anterior mandible was 862.8 ± 203.4 HU, in posterior mandible was 528.4 ± 115.6 HU, in anterior maxilla was 594.2 ± 95.2 HU, and in posterior maxilla was 438.1 ± 110.2 HU. A statistically significant (P < 0.05) difference was found between different locations.
Table 2: Assessment of bone density at different location

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[Table 3] shows that the mean insertion torque in successful implants was 38.2 ± 7.1 Ncm and in failed implants was 22.4 ± 4.2 Ncm. A statistically significant difference was found (P < 0.05).
Table 3: Assessment of insertion torque in successful and failed implants

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[Table 4] shows that mean RFA value in successful implants was 65.4 ± 5.8 and in failed implants was 45.8 ± 4.1 ISQ. A statistically significant difference was found (P < 0.05).
Table 4: Resonance frequency analysis value in successful and failed implants

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[Table 5] and [Graph 2] show that mean ISQ value in the anterior mandible was 72.1, 71.4, and 73.6 at the time of surgery, at 6 months and 1 year, respectively. In the posterior mandible was 67.4, 66.7, and 69.7 at surgery, at 6 months and 1 year, respectively. In anterior maxilla at surgery, at 6 months and 1 year was 68.4, 69.2, and 70.1, respectively. In posterior maxilla was 57.6, 58.2, and 59.6 at surgery, at 6 months and 1 year, respectively. A statically significant difference was found (P < 0.05).
Table 5: Change in implant stability quotient value at different interval

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   Discussion Top


Bone density is indispensable for the dental surgeon to arrive at the best treatment strategy and to finalize suitable implant design to achieve primary stability.[7] The advancement of designing in implants, surface treatments, and study of bone architecture proved beneficial in the field of implantology. The implant stability is the principal prerequisite to establish the prosthetic management that shall be initiated, which needs to be assessed before force insertion.[8] The present study was conducted to determine the effect of bone density on implant stability.

In the present study, males were 72 in number having 140 dental implants and females were 56 in number having 120 dental implants. Male had eight and female had seven failed implants. Turkyilmaz and McGlumphy[5] in their study on 300 implants in 111 patients determined effect of bone density on implant stability. Results showed mean bone density (620 ± 251 HU), insertion torque (36.1 ± 8 Ncm), and RFA value (65.7 ± 9 ISQ) at implant placement. There was significant correlation between insertion torque and bone density, ISQ values and bone density, and ISQ values and insertion torque, and bone density was observed. The mean bone density, insertion torque, and RFA at implant insertion area was 645 ± 240 HU, 37.2 ± 7 Ncm, and 67.1 ± 7 ISQ, respectively, and in 20 failed implants was 267 ± 47 HU, 21.8 ± 4 Ncm, and 46.5 ± 4 ISQ, respectively, with statistically significant differences (P < 0.001).

We found that mean ± SD bone density in anterior mandible was 862.8 ± 203.4 HU, in posterior mandible was 528.4 ± 115.6 HU, in anterior maxilla was 594.2 ± 95.2 HU, and in posterior maxilla was 438.1 ± 110.2 HU. Oliscovicz et al.[9] in their study used 32 Conexão® implants, eight conical, and 24 cylindrical. All were placed in Nacional® polyurethane using 15, 20, and 40 PCF densities. Results exhibited the best performance was the interaction implant CA x 40PCF substrate with difference from the other implants inserted in all substrates.

We found that the mean insertion torque in successful implants was 38.2 ± 7.1 Ncm and in failed implants was 22.4 ± 4.2 Ncm. The mean RFA value in successful implants was 65.4 ± 5.8 and in failed implants was 45.8 ± 4.1 ISQ. Cornelini et al.[10] inserted 40 implants in 20 patients, the mean ISQ values were 72 at implant surgery and 74.5 after 1 year, which was not statistically significant (P > 0.05).

We observed that mean ISQ value in the anterior mandible was 72.1, 71.4, and 73.6 at the time of surgery, at 6 months and 1 year, respectively. In posterior mandible was 67.4, 66.7, and 69.7 at surgery, at 6 months and 1 year, respectively. In the anterior maxilla at surgery, at 6 months and 1 year was 68.4, 69.2, and 70.1, respectively. In the posterior maxilla was 57.6, 58.2, and 59.6 at surgery, at 6 months and 1 year, respectively. Sjostrom et al.[11] studied 192 implants after bone-graft healing. Results showed that the ISQ value was 60.2 ± 7.3 at insertion time and 62.5 ± 5.5 after 6 months of prosthetic part insertion having significant difference between both periods. A ISQ of 61.9 ± 9.5 and 60.2 ± 7.3 was observed between implant insertion and abutment attachment with nonsignificant difference. A ISQ value of 62.5 ± 5.5 and 61.8 ± 5.5 was found at 6 months and 3 years of bridge loading, respectively.

The shortcoming of the study is small sample size and short follow-up.


   Conclusion Top


Authors found that insertion torque and RFA was higher in successful implants as compared to failed implants suggesting correlation of bone quality and implant stability parameters.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Strietzel FP, Reichart PA, Kale A, Kulkarni M, Wegner B, Küchler I, et al. Smoking interferes with the prognosis of dental implant treatment: A systematic review and meta-analysis. J Clin Periodontol 2007;34:523-44.  Back to cited text no. 1
    
2.
Levin L, Schwartz-Arad D. The effect of cigarette smoking on dental implants and related surgery. Implant Dent 2005;14:357-61.  Back to cited text no. 2
    
3.
Chong L, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial stability of tapered implants. J Oral Implantol 2009;35:130-5.  Back to cited text no. 3
    
4.
Kahraman S, Bal BT, Asar NV, Turkyilmaz I, Tözüm TF. Clinical study on the insertion torque and wireless resonance frequency analysis in the assessment of torque capacity and stability of self-tapping dental implants. J Oral Rehabil 2009;36:755-61.  Back to cited text no. 4
    
5.
Turkyilmaz I, McGlumphy EA. Influence of bone density on implant stability parameters and implant success: A retrospective clinical study. BMC Oral Health 2008;8:1-8.  Back to cited text no. 5
    
6.
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 Publishing Company; 1985. p. 199-209.  Back to cited text no. 6
    
7.
Johansson P, Strid KG. Assessment of bone quality from placement resistance during implant surgery. Int J Oral Maxillofac Implants 1994;9:279-88.  Back to cited text no. 7
    
8.
Friberg B, Sennerby L, Roos J, Lekholm U. Identification of bone quality in conjunction with insertion of titanium implants. A pilot study in jaw autopsy specimens. Clin Oral Implants Res 1995;6:213-9.  Back to cited text no. 8
    
9.
Oliscovicz NF, Shimano AC, Marcantonio Junior E, Lepri CP, Reis AC. Effect of implant design and bone density in primary stability. Braz J Oral Sci 2013;12:158-63.  Back to cited text no. 9
    
10.
Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate loading of implants with 3-unit fixed partial dentures: A 12-month clinical study. Int J Oral Maxillofac Implants 2006;21:914-8.  Back to cited text no. 10
    
11.
Sjostrom M, Sennerby L, Nilson H, Lundgren S. Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants: A 3-year report of a prospective clinical study. Clin Implant Dent Relat Res 2007;9:46-59.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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