Bone Density Assessments of Dental Implant Sites: 1. Quantitative Computed Tomography

Purpose: This study was designed to evaluate variations of bone density in designated implant sites using quantitative computed tomography (QCT) and to compare the QCT measurements to subjective evaluation of bone density. Materials and Methods: Sixty-two designated implant sites in jaws of 9 human cadavers were used. Indicator rods, 2 mm in diameter, were placed in all sites. CT images representing 1-mm buccolingual slices immediately mesial and distal to the rods were selected. Bone density (in Hounsfield units) was assessed in a standardized implant area superimposed on the images and was also subjectively evaluated by 2 independent examiners using the Lekholm and Zarb classification. Results: QCT results demonstrated that bone densities may vary markedly when different areas of a designated implant site are compared. The Lekholm and Zarb ratings for the 2 examiners showed coefficients of correlation ranging between 0.5 to 0.7 for the relationships with the QCT values. Within each of the scores used for the subjective classification, however, a wide range of QCT values was observed. Discussion: The results emphasize the importance of the use of radiographic methods prior to implant placement that allow topographically precise assessments of bone density in the region of interest. Conclusion: Access to QCT values should constitute a valuable supplement to subjective bone density evaluations prior to implant placement.