Presented by:

SIMRATJOT KAUR

Guide :
DR. KAMALPREET CHHINA
HOD AND VICE PRINCIPAL
BRS DENTAL COLLEGE AND HOSPITAL
 Available bone in an edentulous site is a determinant
factor in treatment planning.
 Assessment of bone quantity and bone quality, such as
the height of the alveolar process, bucco-lingual width,
angulation and detection of possible undercuts and
concavities, is a pre-requisite for pre-operative
planning.
 Assessment for implant site before surgery is done by
clinical and radiographic means.
 Clinical examination includes: bone sounding (ridge
mapping) to assess the size and shape of the alveolar
bone.
 Radiography is an non invasive technique for
determining the alveolar bone quantity as well as
quality.
 The various techniques available are :
 Panoramic radiographs.
 Intraoral periapical radiographs
(IOPA).
 Computerized tomography
 Panoramic radiographs provide information on the
gross anatomy of the jaws and related anatomical
structures .
 Drawbacks are :

Due to inherent distortions , these images are less well suited for estimating the
amount of alveolar bone, particularly in the horizontal planes.

inborn unsharpness, which impedes detailed diagnosis in the jaw bone.

 The intraoral periapical image is valuable for an
estimate of the mesio-distal dimension of the
potential implant site, as well as preliminary estimate
of the vertical dimensions
 so a combination of panoramic and intraoral views is
often recommended for a preliminary evaluation of
the intended implant site.
 Limitations are :

Do not provide information on the buccolingual width or angulation and

concavities in the alveolar process
 Computerized tomography is a digital and
mathematical imaging technique that creates
tomographic sections where the tomographic layer is
not contaminated by blurred structures from adjacent
anatomy.
 Also it enables differentiation and quantification of
soft and hard tissues.
 It was invented by Sir Hounsfield and was announced
to the imaging world in 1972.
 It provides a unique means
of postimaging analysis of
proposed surgery or
implant sites by
reformatting the image
data to create tangential
and cross sectional
tomographic images of
implant site.

 CT denta scan images are

inherently three
dimensional.
 Denta scan enables the following preoperative criterias
necessary for the success of implants.

• Identification of disease
• Determination of the bone quality
• Determination of bone quantity
• Identification of critical structures at
the proposed region
• Determination of position and
orientation of the dental implants.
 To assess the bone quantity (bone density) and bone
quality of the implant site using a CT Denta Scan.
 15 implant sites in cases with missing mandibular
posterior teeth were selected from amongst the
patients reporting at department of Periodontology
and Implantology, from BRS Dental College and
Hospital, Panchkula.
 Ethical approval for the study was obtained from the
ethical committee.
 A signed consent was taken from all patients.
 Detailed medical and dental history of each patient
was taken and periodontal assessment was done
clinically to rule out the active periodontal disease.

 Edentulous area selected for implant placement was

evaluated clinically for bucco-lingual and mesio-distal
width and any undercut on the lingual side.
 Ridge analysis was done clinically and from the
prepared cast.
 Denta scan was used to assess the height and width of
edentulous site which was the basis for selection and
prognosis of implant site.
For each implant site , bone density
was recorded in buccal and lingual
cortical and cancellous bone at the
coronal, middle and cervical third.

Total mean bone density for cortical

and cancellous bone was calculated.

Bone type of the individual patient

were graded according to the Misch
Classification Scale in Hounsfield
units.
Bone type Description Density

D1 Dense cortical >1250 Hounsfield

units.
D2 Porous cortical and coarse 850-1250 Hounsfield
trabecular units

D3 Porous cortical (thin) and 350-850 Hounsfield

fine trabecular units

D4 Fine trabecular 150-350 Hounsfield

units

D5 Soft bone with incomplete <150 Hounsfield

mineralization units
 Average N Minimum Maximum Mean std.
deviation

buccalcortical 15 851.00 1569.67 1245.3111 215.46353

lingualcortical 15 682.67 1499.67 1262.9111 254.71775

cortical 15 960.67 1466.17 1254.1111 144.85563

cancellous 15 103.33 601.67 329.1556 188.12473

 Out of the 15 selected implant sites in posterior
mandibular region, 10 sites were of D2 bone type and 5
sites had D3 type of bone.
 Even the D3 type bone density values were towards the
upper range, nearer to the D2 type.

Bone density type Patients

D3 5

D2 10
 Graphic representation of the mean bone density of the edentulous sites.

Mean bone density

No. of implants

 mean density
 5 patients

10 patients
 Dental implant treatment has revolutionized oral
rehabilitation in partially and fully edentulous
patients.
 Radiographic assessment is essential to estimate the
morphological characteristics of the proposed implant
site and the location of the anatomical structures.
 The recognition of increased implant failures in poorer
quality bone (Jaffin & Berman 1991; Triplett et al, 1991)
demands the clinician to have an appreciation of bone
quality pre-operatively.
 The purpose of the pre implant examination is :
 To decide whether the implant treatment is
appropriate for the patient
 Whether it is possible to accomplish this
treatment.
 To estimate the prognosis of the implant
placement
 Aid in preparing the treatment plan
 In this study,
 average cortical bone density ranged from 960.0 – 1466.17 HU and
 the average cancellous bone density ranged from 103.33 – 601.67 HU.
 Total mean bone density for each site - 790 – 1200 HU.
 The results showed that out of 15 selected implant sites in posterior
mandibular region, 10 sites were of D2 type bone and 5 were D3 bone type.
The initial bone density
 As the bone density decreases, the strength of bone
also decreases.

 To decrease the incidence of microfracture of bone,

the strain to the bone should also be reduced.

 So the stress to the implant area should also be

reduced as the bone density decreases.
 The load on implant may also be influenced by the
direction of the force applied. Therefore, as bone
density decreases, the angle of load on the implant
body should be more axial.

 The width of implant also may decrease stress by

increasing the surface area. Therefore, D4 bone often
requires wider implants compared to D1 and D2 bone,
which may require onlay grafts to increase the width of
bone when other stress factors are high.
 As the strength of the bone is directly related to bone
density, diagnosis of bone density around an implant
is key determinant for the clinical success of an
implant.

 The CT Denta Scan is an excellent diagnostic tool in

the prognosis and treatment planning of implant site
due to its capability of determining all five of the
radiologic objectives of preprosthetic implant imaging.