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Title A Positive Association Exists Between Primary Implant Stability And Mineral Bone Density Calculated With CBCT’s
Clinical Question In a patient requiring a dental implant, is the mineral bone density calculated in Hounsfield units on pre-operative CBCTs a reliable predictor of primary implant stability?
Clinical Bottom Line A positive association exists between primary implant stability and the mineral bone density of implant receptor sites calculated using pre-operative CBCTs. Additional studies with improved methodological quality and control of bias are needed to provide stronger evidence.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21635560Marquezan / 2011Implant patientsSystematic Review of Case Series
Key resultsImplant stability in the 7 case series was calculated using the implant stability quotient (ISQ), perio test value (PTV), or insertion torque (IT). Mineral bone density was measured on CBCTs in Hounsfield units (HU). P values ranged from 0 to 0.05. ISQ values and HU had a correlation coefficient of 0.46-0.882 (moderate correlation - strong correlation), while IT and HU had a correlation coefficient of 0.768-0.859 (strong correlation). All studies showed a positive association between mineral bone densities measured in Hounsfield Units and primary implant stability (ISQ, IT, or PTV).
Evidence Search ("Dental Implantation"[Mesh] OR "Dental Implants"[Mesh]) AND ("Bone Density"[Mesh]) OR (Mineral bone density AND primary implant stability)
Comments on
The Evidence
The 7 case series included in the systematic review were identified as having low or moderate methodological quality and control of bias. A significant heterogeneity existed between the methods of measuring implant stability. The results of the study did not discuss the cut off point that was considered too unstable at the time of placement based upon ISQ, IT, or PTV. The initial evidence shows that mineral bone density calculated using HU on a pre-operative CBCT might be useful in predicting primary implant stability. Additional RCT’s are needed to answer this clinical question more thoroughly.
Applicability The evidence is applicable to healthy patients seeking dental implant therapy.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Oral Surgery) (Periodontics)
Keywords Primary Implant Stability, Dental Implant, mineral bone density, CBCT, Cone beam computed tomography
ID# 2120
Date of submission: 12/19/2011spacer
E-mail caldwellg@uthscsa.edu
Author Gregory R. Caldwell, DDS, MS
Co-author(s) e-mail
Faculty mentor/Co-author Richard S. Finlayson, DDS
Faculty mentor/Co-author e-mail finalaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Grant Tippet (Daniel Hernandez) (San Antonio, Texas) on 11/30/2017
A PubMed search was conducted November 2017 and two different clinical studies supporting the original conclusions of this CAT were found. The most recent publication: Sennerby, L 2015 (PMID: 2473386) found a positive correlation between bone density and primary implant stability. Coutant JC, 2014( PMID: 25397790) reports primary stability of implants may be affected by implant design regardless of bone density.

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