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BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Computed Tomography | Research

New classification for bone type at dental implant sites: a dental computed tomography study

Authors: Shiuan-Hui Wang, Jui-Ting Hsu, Lih-Jyh Fuh, Shin-Lei Peng, Heng-Li Huang, Ming-Tzu Tsai

Published in: BMC Oral Health | Issue 1/2023

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Abstract

Objective

This study proposed a new classification method of bone quantity and quality at the dental implant site using cone-beam computed tomography (CBCT) image analysis, classifying cortical and cancellous bones separately and using CBCT for quantitative analysis.

Methods

Preoperative CBCT images were obtained from 128 implant patients (315 sites). First, measure the crestal cortical bone thickness (in mm) and the cancellous bone density [in grayscale values (GV) and bone mineral density (g/cm3)] at the implant sites. The new classification for bone quality at the implant site proposed in this study is a “nine-square division” bone classification system, where the cortical bone thickness is classified into A: > 1.1 mm, B:0.7–1.1 mm, and C: < 0.7 mm, and the cancellous bone density is classified into 1: > 600 GV (= 420 g/cm3), 2:300–600 GV (= 160 g/cm3–420 g/cm3), and 3: < 300 GV (= 160 g/cm3).

Results

The results of the nine bone type proportions based on the new jawbone classification were as follows: A1 (8.57%,27/315), A2 (13.02%), A3 (4.13%), B1 (17.78%), B2 (20.63%), B3 (8.57%) C1 (4.44%), C2 (14.29%), and C3 (8.57%).

Conclusions

The proposed classification can complement the parts overlooked in previous bone classification methods (bone types A3 and C1).

Trial registration

The retrospective registration of this study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH 108-REC2-181.
Literature
1.
2.
Raikar S, Talukdar P, Kumari S, Panda SK, Oommen VM, Prasad A. Factors affecting the survival rate of dental implants: a retrospective study. J Int Soc Prev Community Dent. 2017;7(6):351.PubMedPubMedCentralCrossRef
3.
Kandasamy B, Kaur N, Tomar G, Bharadwaj A, Manual L, Chauhan M. Long-term retrospective study based on implant success rate in patients with risk factor: 15-year follow-up. J Contemp Dent Pract. 2018;19(1):90–3.PubMedCrossRef
4.
Chrcanovic BR, Albrektsson T, Wennerberg A. Bone quality and quantity and dental implant failure: a systematic review and meta-analysis. Int J Prosthodont. 2017;30(3):219–37.PubMedCrossRef
5.
Hsu Y-Y, Tsai M-T, Huang H-L, Fuh L-J, Hsu J-T. Insertion speed affects the initial stability of dental implants. J Med Biol Eng. 2022;42(4):516–25.CrossRef
6.
Cheng K-C, Liu P-H, Chen H-S, Lan T-H. Stress distribution of four-unit implant-supported fixed partial prosthesis with different numbers and positions of fixtures in maxilla anterior Region-3D FEA. J Med Biol Eng. 2022;42(4):526–33.CrossRef
7.
Esposito M, Hirsch J-M, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II) Etiopathogenesis. Eur J Oral Sci. 1998;106(3):721.PubMedCrossRef
8.
Lekholm U. Tissue integrated prosthesis: Patient selection and preparation In: Brånemark PI, Zarb GA, Albrektsson T, eds. 1985. p. 199–209.
9.
Norton MR, Gamble CJ. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res. 2001;12(1):79–84.PubMedCrossRef
10.
Hao Y, Zhao W, Wang Y, Yu J, Zou D. Assessments of jaw bone density at implant sites using 3D cone-beam computed tomography. Group. 2014;1:D1.
11.
Al-Ekrish AA, Widmann G, Alfadda SA. Revised, computed tomography-based Lekholm and Zarb Jawbone quality classification. Int J Prosthodont. 2018;31(4):342–5.
12.
Misch CJ. Bone classification, training keys to implant success. Dent Today. 1989;8(4):39.PubMed
13.
Vercellotti T. Essentials in piezosurgery: Clinical advantages in dentistry: Quintessence; 2009.
14.
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.PubMed
15.
de Oliveira RCG, Leles CR, Normanha LM, Lindh C, Ribeiro-Rotta RF. Assessments of trabecular bone density at implant sites on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(2):231–8.PubMedCrossRef
16.
Wang S-H, Shen Y-W, Fuh L-J, Peng S-L, Tsai M-T, Huang H-L, Hsu J-T. Relationship between cortical bone thickness and cancellous bone density at dental implant sites in the jawbone. Diagnostics. 2020;10(9):710.PubMedPubMedCentralCrossRef
17.
Rozé J, Babu S, Saffarzadeh A, Gayet-Delacroix M, Hoornaert A, Layrolle PJ. Correlating implant stability to bone structure. Clin Oral Implants Res. 2009;20(10):1140–5.PubMedCrossRef
18.
Isoda K, Ayukawa Y, Tsukiyama Y, Sogo M, Matsushita Y, Koyano KJ. Relationship between the bone density estimated by cone-beam computed tomography and the primary stability of dental implants. Clin Oral Implants Res. 2012;23(7):832–6.PubMedCrossRef
19.
Pitman J, Christiaens V, Cosyn J, Glibert M. Primary stability of conventionally tapered versus reverse tapered body shift implants under varying bone support conditions—an in-vitro study. J Med Biol Eng. 2022;42(4):429–35.CrossRef
20.
Huang H-L, Lin T-W, Tsai H-L, Wu Y-L, Wu AY-J. Biomechanical effects of bone atrophy, implant design, and vertical or tilted of posterior implant on all-on-four concept implantation: finite element analysis. J Med Biol Eng. 2022;42(4):488–97.CrossRef
21.
Miyamoto I, Tsuboi Y, Wada E, Suwa H, Iizuka T. Influence of cortical bone thickness and implant length on implant stability at the time of surgery—clinical, prospective, biomechanical, and imaging study. Bone. 2005;37(6):776–80.PubMedCrossRef
22.
Jaffin RA, Berman CL. The excessive loss of Branemark fixtures in type IV bone: a 5-year analysis. J Periodontol. 1991;62(1):2–4.PubMedCrossRef
23.
Song Y-D, Jun S-H, Kwon J-JJ, Implants M. Correlation between bone quality evaluated by cone-beam computerized tomography and implant primary stability. Int J Oral Maxillofac Implants. 2009;24(1):59–64.PubMed
24.
Jemt T, Lekholm U. Implant treatment in edentulous maxillae: a 5-year follow-up report on patients with different degrees of jaw resorption. Int J Oral Maxillofac Implants. 1995;10(3):303–11.PubMed
25.
Gupta A, Rathee S, Agarwal J, Pachar RB. Measurement of crestal cortical bone thickness at implant site: a cone beam computed tomography study. J Contemp Dent Pract. 2017;18(9):785–9.PubMedCrossRef
26.
Wang S-H, Ko Y-C, Tsai M-T, Fuh L-J, Huang H-L, Shen Y-W, Hsu J-T. Can male patient’s age affect the cortical bone thickness of jawbone for dental implant placement? A cohort study. Int J Environ Res Public Health. 2021;18(8):4284.PubMedPubMedCentralCrossRef
27.
Ko YC, Huang HL, Shen YW, Cai JY, Fuh LJ, Hsu JT. Variations in crestal cortical bone thickness at dental implant sites in different regions of the jawbone. Clin Implant Dent Relat Res. 2017;19(3):440–6.PubMedCrossRef
28.
Fuh LJ, Huang HL, Chen CS, Fu KL, Shen YW, Tu MG, Shen WC, Hsu JT. Variations in bone density at dental implant sites in different regions of the jawbone. J Oral Rehabil. 2010;37(5):346–51.PubMedCrossRef
29.
30.
Katranji A, Misch K, Wang HL. Cortical bone thickness in dentate and edentulous human cadavers. J Periodontol. 2007;78(5):874–8.PubMedCrossRef
31.
Ge J, Zheng J-W, Yang C, Qian W-T. Variations in the buccal-lingual alveolar bone thickness of impacted mandibular third molar: our classification and treatment perspectives. Sci Rep. 2016;6(1):16375.PubMedPubMedCentralCrossRef
32.
Huang HM, Lee SY, Yeh CY, Lin CT. Resonance frequency assessment of dental implant stability with various bone qualities: a numerical approach. Clin Oral Implants Res. 2002;13(1):65–74.PubMedCrossRef
33.
Salimov F, Tatli U, Kürkçü M, Akoğlan M, Öztunç H, Kurtoğlu C. Evaluation of relationship between preoperative bone density values derived from cone beam computed tomography and implant stability parameters: a clinical study. Clin Oral Implants Res. 2014;25(9):1016–21.PubMedCrossRef
34.
Holmes DC, Loftus JT. Influence of bone quality on stress distribution for endosseous implants. J Oral Implantol. 1997;23(3):104–11.PubMed
35.
Di Stefano DA, Arosio P, Capparè P, Barbon S, Gherlone EF. Stability of dental implants and thickness of cortical bone: clinical research and future perspectives A systematic review. Materials (Basel). 2021;14(23):7183.PubMedCrossRef
36.
Linck GKSB, Ferreira GM, De Oliveira RCG, Lindh C, Leles CR, Ribeiro-Rotta RF. The influence of tactile perception on classification of bone tissue at dental implant insertion. Clin Implant Dent Relat Res. 2016;18(3):601–8.PubMedCrossRef
37.
Alsaadi G, Quirynen M, Michiels K, Jacobs R, Van Steenberghe D. A biomechanical assessment of the relation between the oral implant stability at insertion and subjective bone quality assessment. J Clin Periodontol. 2007;34(4):359–66.PubMedCrossRef
38.
Alkhader M, Hudieb M, Khader Y. Predictability of bone density at posterior mandibular implant sites using cone-beam computed tomography intensity values. Eur J Dent. 2017;11(03):311–6.PubMedPubMedCentralCrossRef
39.
Dahiya K, Kumar N, Bajaj P, Sharma A, Sikka R, Dahiya S. Qualitative assessment of reliability of cone-beam computed tomography in evaluating bone density at posterior mandibular implant site. J Contemp Dent Pract. 2018;19(4):426–30.PubMedCrossRef
40.
Shen X, Chen X, Huang J, Xu R, Cheng J, Jiang H. Age-dependent role of SIRT6 in jawbone via regulating senescence and autophagy of bone marrow stromal cells. J Mol Histol. 2020;51:67–76.PubMedCrossRef
41.
Ko Y-C, Tsai M-T, Fuh L-J, Tsai M-J, Wang X-H, Huang H-L, Hsu J-T. Association between age of menopause and thickness of crestal cortical bone at dental implant site: a cross-sectional observational study. IInt J Environ Res Public Health. 2020;17(16):5868.CrossRef
42.
Liu J, Chen H-Y, DoDo H, Yousef H, Firestone AR, Chaudhry J, Johnston WM, Lee DJ, Emam HA, Kim D-G. Efficacy of cone-beam computed tomography in evaluating bone quality for optimum implant treatment planning. Implant Dent. 2017;26(3):405–11.PubMedCrossRef
43.
Nomura Y, Watanabe H, Honda E, Kurabayashi TJ. Reliability of voxel values from cone-beam computed tomography for dental use in evaluating bone mineral density. Clin Oral Implants Res. 2010;21(5):558–62.PubMedCrossRef
44.
Silva IMdCC, Freitas DQd, Ambrosano GMB, Bóscolo FN, Almeida SM. Bone density: comparative evaluation of Hounsfield units in multislice and cone-beam computed tomography. Braz Oral Res. 2012;26:550–6.PubMedCrossRef
45.
Varshowsaz M, Goorang S, Ehsani S, Azizi Z, Rahimian S. Comparison of tissue density in Hounsfield units in computed tomography and cone beam computed tomography. J Dent (Tehran). 2016;13(2):108.PubMed
Metadata
Title
New classification for bone type at dental implant sites: a dental computed tomography study
Authors
Shiuan-Hui Wang
Jui-Ting Hsu
Lih-Jyh Fuh
Shin-Lei Peng
Heng-Li Huang
Ming-Tzu Tsai
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03039-2

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