Posted at 10.15.2018
Implantology has observed an explosive growth over the last few years, from a technique employed on the fringe of acceptability to one embraced by the mainstream dentistry and dental care implants have surfaced as a greatly accepted form of tooth replacement unit. Implants are bio-acceptable materials with an inherent capacity to osseointegrate into the jaw bone to aid a oral prosthesis to restore satisfactory function and esthetics without influencing adjacent hard and very soft tissue set ups. The Success of any implant method depends on a series of patient related and process dependent parameters, such as general health conditions, biocompatibility of the implant materials, feature of the implant surface, surgical procedure and the product quality and quantity of the neighborhood bone1. Careful saving and examination of specialized medical and radiological information, interdisciplinary communication and precise planning play an important role in determining the final successful outcome.
Bone density is an integral factor to take into account when predicting implant steadiness2 Clinical studies show greater implant success in the mandible than in the upper maxilla, due to the bone characteristics. This success is inspired by bone quality i. e. bone density2. The bone relative density can be an important determining factor in implant treatment and can be assessed quite using different imaging techniques3. The quality of bone in the suggested implant site in terms of relative percentage and density of cortical and medullary bone has frequently been assessed by by using a grading scheme suggested by Lekholm and Zarb, which is applicable only to cross sectional images. This classification system has been implemented worldwide because it is simple to operate without substantial investment. Misch (2008) used computed tomography (CT) to objectively classify bone density into 5 types based on Hounsfield items (HU). This method allows for a precise and objective assessment of bone quality2
Several imaging techniques are designed for presurgical and postsurgical assessment, including devices developed specifically for dental implant imaging. Computerized tomograms are among the best available radiographs for identifying the bone quality. Together with the improvement of radiographic technology, computed tomography (CT), as well as cone- beam computed tomography (CBCT) are progressively being considered essential for optimal implant positioning, especially regarding complicated reconstructions4 Unlike regular two-dimensional radiographs, techniques like CBCT offer 3-D views of the oral cavity, face, and jaw from any route. The cone beam settings is well suited for the maxillofacial region because the proportions of the beam allow for a panoramic view, sparing patients rays exposure of split scans of the maxilla and mandible5. The entire features of CBCT are in its high resolution, potentially lower radiation dose and lower cost compared with standard Computerized Tomography2
The past two decades have seen continual efforts by manufacturers, experts and clinicians to enhance the success of implant treatment effects through progression in implant designs, materials and professional medical procedures6. One such aspect is co-relation of available bone relative density with most important implant stability. Principal implant stableness denotes the steadiness of a dental implant immediately after placement. Implant stableness can be examined objectively, noninvasively, and easily by the insertion torque test. 7 The insertion torque measurement technique, which files the torque after the implant has been located, provides home elevators the local bone quality8. A High initial stability may be an indication for immediate loading with prosthetic reconstruction. A minimal primary stability following implantation, can cause the implant's ability to move leading to failing. Bone density and implant stableness are essential factors for implant osseointegration, and has been widely demonstrated by several creators3. The insertion torque measurement technique, which reports the torque during implant positioning, provides information on the local bone quality. 1 Several studies have shown the partnership between bone density based on CT and main implant stability 9, 10. However, there are few studies about the relationship between bone relative density believed by CBCT and major implant stableness. The likelihood of predicting the primary implant balance and bone quality during the pre-surgical analysis of the implant positioning site may produce an implant treatment standard protocol with higher predictability. The bone relative density and Implant stability can be evaluated using CBCT and the insertion torque test which documents the torque during implant positioning and provides information of the local bone quality6, 8. Keeping in mind the aforesaid goals today's study was made to compare and evaluate the relationship between the bone density projected by CBCT and the principal implant stableness of the dental implants by measurements of the insertion torque and to determine their relationship.
MATERIALS AND METHODS
Twenty out- patients with absent sole/ multiple teeth who went to the Team of Dental & Maxillofacial Surgery, Dayananda Sagar University of Dentistry Sciences, Bangalore and who have been well suited for implant rehabilitation were considered and adopted for the analysis. Patients with uncontrolled systemic/ psychiatric condition, previous record of going through radiotherapy or chemotherapy, pregnant patients, instances of post implant removal and implants positioned in sinus lift up and immediate removal sites were excluded from the study.
pre-operative diagnosis: Patients preferred based upon these criteria underwent a thorough clinical assessment, and the details were noted using custom-made circumstance proforma. A written knowledgeable consent was from all patients and a standardized pre-surgical and medical protocol was adopted for all your patients. Pre-operative bone relative density of implant sites were evaluated using cone beam computerized tomographic scans. Bone density measurements were derived using 3DiagnoSys version 4. 1 Software (3DIEMME Bio imaging Technology). 3Diagnosys is a diagnostic imaging, analyses and 3D simulation software, designed for the Clinician. 3Diagnosys software helps to connect to the 3D-model of the Patient, which is obtained by importing TC/CBCT/RM images in DICOM format, in a straightforward and intuitive way. The various tools included in this software aren't bound to morphological reconstructions but can also remove from the DICOM data the densitometric worth for a bone functional evaluation. )Pre-operative evaluation of bone height and bone width was done using Cone Beam Computed Tomographic scan and appropriate implants were chosen to be positioned. The bone level and width measurements were achieved using the "Carestream Teeth Imaging Software v6. 13. 3. 3 CS imaging software"(Fov-15x9cm)". All CBCT scans were obtained using the "KODAK 9500machine" (10ma 90 Kvp, 200 micron resolution, 10. 9sec visibility, 605mgy per cm2).
The statistical analyses were performed using SPSS version 16. 0 software (SPSS Inc. , Tokyo, Japan). Spearman's relationship coefficient (rs) was determined to judge the correlation among density ideals and insertion torques. A value of P <0. 05 was considered to be statistically significant.
The density value ranged from 209. 91 to 667. 13Hu. The mean denseness value and insertion torque of most implants were 464. 69 + 135. 74 Hu and 49. 0 + 8. 20 respectively. There was highly significant relationship between bone relative density and insertion torque (rs 0. 89, P< 0. 001)
Over the previous decade, there has been significant changes in reconstruction with dental care implants. Rather than merely concentrating on the teeth or pearly whites to be substituted, today's implant specialist considers a broad and complex group of interwoven factors before formulating an implant treatment plan4. Medicine planning comprises of pre - operative depiction and quantification of accurate
bone elevation and contour which may be founded by radiographic assessment. 11 The success of dental implants relies greatly on both the quality and the amount of available bone for implant position3. Studies show higher failing rates for implants placed in bone of poor quality and quantity. 3
Bone density is an integral factor to take into account when predicting implant stability2 Clinical studies also show greater implant survival in the mandible than in the top maxilla, due to the bone characteristics. This survival is inspired by bone quality i. e. bone density2
The bone relative density is an important determining element in implant treatment and can be assessed reasonably using different imaging techniques5. The quality of bone in the suggested implant site in terms of relative proportion and thickness of cortical and medullary bone has frequently been assessed by utilizing a grading scheme suggested by Lekholm and Zarb, which is applicable only to cross sectional images. This classification system has been implemented worldwide since it is simple to operate without significant investment. Misch (2008) used computed tomography (CT) to objectively classify bone relative density into 5 types based on Hounsfield products (HU). This technique allows for a precise and objective diagnosis of bone quality3
Several imaging techniques are designed for presurgical and postsurgical examination, including devices developed designed for dental implant imaging. 12 They are being used to visualize the internal anatomy of the jaws in 3-dimensional perspectives, including the closeness of nasal fossae, neurovascular bundles, pneumatization of the maxillae, very soft tissue morphology and bone quality. Computerized tomograms are among the finest available radiographs for deciding the bone quality. Periapical and breathtaking radiographs are the least feasible options as the understated changes between the several bone types can not be quantified with them, also the lateral cortical plates have a tendency to obscure the trabecular thickness. With the advancement of radiographic technology, computed tomography (CT), as well as cone- beam computed tomography (CBCT) are progressively more being considered essential for optimal implant positioning, especially in the case of intricate reconstructions 13. Unlike conventional two-dimensional radiographs, techniques like CBCT offer 3-D views of the mouth, face, and jaw from any way. 1 The cone beam configuration is well suited for the maxillofacial region because the measurements of the beam allow for a breathtaking view, sparing patients rays exposure of different scans of the maxilla and mandible14. The overall benefits of CBCT are in its high res, potentially lower radiation dose and lower cost weighed against standard Computerized Tomography15
The past two decades have observed continual initiatives by manufacturers, experts and clinicians to increase the success of implant treatment benefits through advancement in implant designs, materials and clinical procedures2. One such aspect is co-relation of available bone relative density with primary implant stability. Key implant stability refers to the stability of your dental implant immediately after implantation. Implant balance can be evaluated objectively, noninvasively, and easily by the insertion torque test. 16 The insertion torque measurement technique, which documents the torque after the implant has been located, provides home elevators the local bone quality. High preliminary stabilization may be an indication for immediate loading with prosthetic reconstruction. If key stability is not high enough pursuing implantation, the implant's ability to move is high and can cause failure.
A volume of devices and techniques have been developed to determine implant balance, including reducing torque resistance analysis, the opposite torque test, the insertion torque test, the flexibility dimension test, and resonance consistency (RF) evaluation2. Implant stability can be examined objectively, noninvasively, and easily by the insertion torque ensure that you RF research. 17 The insertion torque measurement technique, which details the torque during implant location, provides home elevators the neighborhood bone quality1. A number of studies show the relationship between bone relative density based on CT and primary implant stability. 9, 10However, there are few studies about the relationship between bone relative density approximated by CBCT and principal implant stableness. In a report conducted by Isoda k et al; The bone quality examined by specific CBCT proved a high relationship with the principal stability of the implants. 8 CBCT is one of the significant imaging modalities you can use to assess the partnership between principal implant stableness and bone relative density which can further give an understanding into the prognosis of the implant treatment.
Implant stability can be evaluated objectively, non-invasively and easily utilizing the insertion torque test which reports the torque during implant position and information of the neighborhood bone quality 1. Remember the aforesaid goals the present study was designed to compare and evaluate the relationship between the bone density approximated by CBCT and the principal implant stableness of the oral implants by measurements of the insertion torque. It also aims to look for the correlation between bone density and primary balance of implant by insertion torque value.
In all conditions Implants were positioned under local anesthesia. Different implant systems were used and all were root form implants. Operative planning and isolation of medical field was accomplished matching to standard operative protocols. A Crestal incision was positioned and Mucoperiosteal flap was mirrored and alveolar bone was shown, and the implant location site was determined by the marking made out of the aid of the operative probe. Osteotomy site prep was finished with a Reduction gear hand part (1:16/64) with an exterior Irrigation attached to the handpiece. Implant osteotomy was performed using standard sequential drill parts according to the measurements of the implant. The osteotomy was proceeded till the required depth according to the chosen implants. The Implant was driven in to the osteotomy site using the manual torque wrench till the final depth was come to. All Implants put were of tapered design and their measures which range from 8 to 16 mm and diameters from 3-5 mm. After placing the implant, the implant steadiness was measured manually using the insertion torque test by a torque wrench with calibrations. The insertion torque reading was assessed and documented at the utmost torque amount of resistance achieved. The cover screw on the implant was then located and Flap closure was done. Post-operative OPG and IOPA was used. Schedule Antibiotics and anti-inflammatory drugs were recommended along with oral cleanliness maintenance instructions. Patients were recalled for regular follow ups. Long lasting prosthesis was given after 3 months.
SUMMARY & CONCLUSION
The study assessed the bone quality with denseness ideals obtained by cone beam computed tomography (CBCT) pre-operatively and driven their relationship with the insertion torque principles recorded through the Implant placement technique. In the observations and results obtained, We are able to conclude that, the present study demonstrates the relationship between the bone relative density values derived from Cone Beam computerized tomography (Hu), situated in the maxilla and mandible, and bone quality according to the Lekholm & Zarb classification. The primary implant stability assessed with the insertion torque test (ITV) depends upon bone density beliefs, bone quality and implant location. Implants Put into location with higher bone density have more steadiness, and we often will forecast the implant insertion torque based on the bone relative density ideals (Hu) and the implant location. Finally, with higher bone density worth (Hu) and higher principal implant stability assessed in ITV worth; Hounsfield products can be used as a diagnostic parameter to anticipate possible implant stability.
The results of the study show that CBCT may be used to examine the bone quality. Also attaining a good insertion torque and in so doing boosting the implant steadiness helps successful osseointegration and prosthetic treatment. Hence CBCT can be used as a predictor diagnostic tool for implant success. We suggest that a larger range of patients with a larger follow up will help a conclusive deciding factor that pre-operative CBCT is a predictor for major implant steadiness.