Richard S. Truhlar

Distribution of Bone Quality in Patients Receiving Endosseous Dental Implants

Knowledge of the distribution of bone quality in the various jaw regions assists the clinician in dental implant treatment planning. Bone quality was assessed with radiographs and tactile sensation for 2,839 implants at the time of placement into four anatomic regions of the jaw. The Lekholm-Zarb classification system was used. Overall, bone quality types 1 and 4 were found much less frequently than types 2 and 3. Although variations in density existed in each region, quality 2 bone dominated the mandible, and quality 3 bone was more prevalent in the maxilla. For both anterior and posterior jaw regions, types 2 and 3 bone predominated. The anterior mandible had the densest bone, followed by the posterior mandible, anterior maxilla, and posterior maxilla.

Second – stage failures related to bone quality in patients receiving endosseous dental implants: Dicrg interim report no. 7

The quality of bone plays an important role in the long-term clinical success of dental implant treatment. An interim evaluation of the relationship between bone quality and the incidence of failure at second-stage surgery is presented. The data include 2,131 root form implants placed by the Dental Implant Clinical Research Group over the past three years. Trends to date suggest differences in the rates of osseointegration among the various bone qualities. Quality 1 bone experienced the greatest failure rate, whereas quality 2 and quality 3 bone had the lowest failure rates. (Implant Dent 1994;3:252–255)

ASSESSMENT OF IMPLANT MOBILITY AT SECOND-STAGE SURGERY WITH THE PERIOTEST: DICRG INTERIM REPORT NO. 3

Many of the presently used methods of evaluating osseointegration at implant uncovering are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. Investigators involved in a long-term clinical study of dental implants being conducted by the Dental Implant Clinical Research Group used the Periotest to evaluate the mobility associated with all study implants at second-stage surgery and correlate the Periotest values with various bone densities. The Periotest values for 1,838 root form implants ranged from —8 to +25. Implants that appeared to be osseointegrated at uncovering recorded a mean Periotest value of −3.37 ± 3.25, while nonosseointegrated implants had a mean Periotest value of +13.87 ± 14.27. Mean Periotest values were −3.82 ± 3.04 for quality 1 bone, −3.70 ± 3.06 for quality 2 bone, −3.31 ± 3.18 for quality 3 bone, and −1.29 ± 3.57 for quality 4 bone. The Periotest has the potential of being a valuable instrument for assessing the status of osseointegration at second-stage surgery. (Implant Dent 1994;3:153–156)

A review of panoramic radiography and its potential use in implant dentistry.

Radiographic follow-up of dental implants is one of the most important clinical parameters a practitioner can assess. Recent advances in the design of panoramic radiograph machines have increased their potential use in the longitudinal clinical evaluation of dental implants. Changes from the earliest designs allow for a projection geometry that more closely approximates the shape of the human jaw. The fundamentals of panoramic radiography are reviewed including common errors in patient positioning, their effect on the radiographic image, and how to correct the errors. Comparative advantages and disadvantages of intraoral periapical and bitewing films as compared with panoramic radiographs are discussed, specifically focusing on the amount of radiation exposure, ability to detect bone loss/bone defects, and inherent problems with both systems. (Implant Dent 1993;2:122–130)

Bone quality in patients receiving endosseous dental implants

Die Qualitat von Knochen spielt eine wichtige Rolle im klinischen Langzeiterfolg von zahnarztlicher Implantatbehandlung. Mehrere Knochenklassifikationssysteme, die zum Groβteil auf anatomischer und histologiscner Information beruhen, wurden vorgeschlagen. Im Jahr 1991 begann die Dental Implant Clinical Research Group ein klinische Langzeitstudie in Zusammenarbeit mit dem Department of Veterans Affairs, um den Einfluβ von Implantatdesign, Anwendung, und Plazierungsort auf klinischen Langzeiterfolg und Alveolarkammhohe zu erforschen. Als Bestandteil dieser Untersuchung wurde die Qualitat des Knochens mittels Rontgenaufnahmen und taktiler Sensation wahrend der Implantatplazierung uber drei Jahre hin untersucht. Nach uber 1900 Untersuchungen zeigen die Resultate einen Bereich fur die Knochenqualitat in jeder anatomischen Region an. Der Unterkiefer ist generell dichter als der Oberkiefer. Der anteriore Unterkiefer hat den dichtesten Knochen, gefolgt von dem posterioren Unterkiefer, dem anterioren Oberkiefer, und dem posterioren Oberkiefer. Knochen mit der Qualitat 2 und 3 dominierte in allen anatomischen Regionen. Die Signifikanz unterschiedlicher Knochenqualitaten und wie sie die Behandlungsplanung und Prognose beeinflussen konnen wird La calidad del hueso juega un papel important en el exito a largo alcance en el tratamiento con implantes dentales. Diferentes clasificaciones de la calidad del hueso han sido presentadas, todas, basadas en la anatomia e histologia del area. En el 1991 el Dental Implant Research Group inicio un estudio longitudinal clinico con la cooperacion del Departamento de Asuntos al Veterano para investigar la influencia del diseno, aplicacion, posicion del implante, comportamiento clinico y la respuesta en el alto de la cresta alveolar. Como parte de la investigacion, la calidad del hueso fue evaluada usando radiografias y la sensacion tactilar al momento de la insercion de los implantes por un periodo de tres anos. Despues de 1900 evaluaciones, los resultados indicaron que hay un margen de calidad osea en cada una de las areas anatomicas evaluadas. El hueso en el area anterior tiende a ser mas denso que en el area posterior. La mandibula es mas densa que la maxila.Orenstein IH, Synan WJ, Truhlar RS, Morris HF, Ochi S, Dental Implant Clinical Research Group.