Ambiguity in bone tissue characteristics as presented in studies on dental implant planning and placement: A systematic review

Department of Oral Medicine, School of Dentistry, Federal University of Goiás, Goiás, Brazil.
Clinical Oral Implants Research (Impact Factor: 3.89). 12/2010; 22(8):789-801. DOI: 10.1111/j.1600-0501.2010.02041.x
Source: PubMed


To survey definitions of bone tissue characteristics and methods of assessing them in studies of dental implant planning and placement.
Three databases were searched using specified indexing terms. Three reviewers selected from the titles and retrieved abstracts in accordance with inclusion and exclusion criteria. Descriptions of bone tissue characteristics (bone quality, density and quantity) used before or during dental implant placement were searched for and categorized.
The search yielded 488 titles. One hundred and fort-nine publications were selected and read in full text. One hundred and eight were considered relevant. There were many different definitions and classification systems for bone tissue characteristics and examination protocols. Approximately two-third of the included publications reported the Lekholm & Zarb classification system for bone quality and quantity. However, only four studies implemented the Lekholm & Zarb system as originally proposed. A few publications described bone quality in accordance with the Misch or Trisi and Rao classifications systems. Assessment methods were often described only briefly (or not at all in one-fifth of the publications). Only one study presented the diagnostic accuracy of the assessment method, while only two presented observer performance.
The differing definitions and classification systems applied to dental implant planning and placement make it impossible to compare the results of various studies, particularly with respect to whether bone quality or quantity affect treatment outcomes. A consistent classification system for bone tissue characteristics is needed, as well as an appropriate description of bone tissue assessment methods, their diagnostic accuracy and observer performance.

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    • "The presence of compact bone and bone resistance decreases from bone type I to bone type IV. Several articles have corroborated the validity of Lekohlm and Zarb classification by analyzing its correlation with the outcomes of histomorphometric analysis, measurements of bone mineral density and variables of computed microtomography (CT) (Bergkvist et al., 2010; Pereira et al., 2013; Ribeiro-Rotta et al., 2011). Periera et al. have found a correlation between the Lekohlm and Zarb classification and the histomorphometric parameters of bone volume, density, bone surface, thickness of the bone trabeculae, and inter-trabecular space (Pereira et al., 2013). "
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    ABSTRACT: The primary stability of dental implants is essentially influenced by the quality and quantity of hosting bone. To study the effects of adaptation of the drilling protocol to the biological quality of bone estimated by bone density and cortical/cancellous bone ratio, 8.5 mm-short implants were placed in different bone types by adapting the drilling protocol to result in a socket under-preparation by 0.2, 0.4, 0.7, 1 and 1.2 mm in bone types I, II, III, IV and V, respectively. The effect of the drilling protocol was studied on implant insertion torque and osseointegration. Additionally, we analyzed the relationship of demographic data and social habits to bone type and insertion torque. Then the correlation between insertion torque and bone quality was tested. One hundred ninety two patients (mean age: 62 ± 11 years) participated with 295 implants. The most common bone type at implant site was type III (47.1%) followed by type II (28.1%). Data analysis indicated that gender, age, and social habits had neither correlation with bone type nor with insertion torque. The insertion torque was 59.29 ± 7.27 Ncm for bone type I, 56.51 ± 1.62 Ncm for bone type II, 46.40 ± 1.60 Ncm for bone type III, 34.84 ± 2.38 Ncm for bone type IV and 5 Ncm for bone type V. Statistically significant correlation was found between bone type and insertion torque. The followed drilling protocol adapts socket under-preparation to the needs of establishing a sufficient primary stability for implant osseointegration.
    Full-text · Article · Mar 2014 · Annals of anatomy = Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft
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    • "Other less-popular methods to quantify and qualify bone quality have included trabecular patterns on preoperative radiographs [6], the cutting resistance technique [7], resonance frequency analysis [8] and the hand-felt perceptions of drilling resistance [9]. These methods are however unable to provide exact data with respect to bone tissue characteristics, and it has been difficult to establish clear classification definitions using these methods [10]. "
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    ABSTRACT: The subject was a 53-year-old male. An alveolar bone sample was obtained from the site of the lower left first molar, before dental implant placement. Although the details of the trabecular structure were not visible with conventional computed tomography, micro-computed tomography (microCT) three-dimensional images of the alveolar bone biopsy sample showed several plate-like trabeculae extending from the lingual cortical bone. Histological observations of the bone sample revealed trabeculae, cuboidal osteoblasts, osteoclasts and hematopoietic cells existing in the bone tissue at the implantation site. Bone metabolic markers and calcaneal bone density were all within normal ranges, indicating no acceleration of the patient’s bone metabolism. Using microCT, and histological and histomorphometrical techniques, a great deal of valuable information about the bone tissue was obtained from a biopsy sample extracted from the patient’s planned implant site.
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