bone density seminar

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• Bone Density Division Of Available Bone In
  Implant Dentistry

Guided By - Dr. Amit Jagtap
Presented By - Dr. Dinesh Chavan
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Contents

• Introduction
• Bone density
• Biology Of Bone
• Clinical evidence documents influence of bone
  density on success rate
• Etiology of variable bone density
• Bone classification
• Bone density location
• Radiographic bone density

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• Available bone
• Review of literature
• Available Bone Height
• Available Bone Width
• Available Bone Length
• Available Bone Angulations
• Crown Height
• Divisions Of Available Bone
• Conclusion
• References

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Introduction
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Biology Of Bone
BONE - is highly specialized connective tissue
with a mineralized extracellular matrix that
function to provide support for the human
skeleton
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Biology Of Bone
Bone
Compact bone i.e. cortical bone
Spongy bone i.e. cancellous bone
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Clinical evidence documents influence of bone
density on success rate
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Clinical evidence documents influence of bone
density on success rate
Bone density
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Clinical evidence documents influence of bone
density on success rate

• Jaffin Berman
• 35 implant loss in
  any region of mouth when bone density was poor

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Etiology of variable bone density

• Bone volume

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Etiology of variable bone density

• Wolff s statement
• Every change in the form and function of bone or
  of its
• function alone is followed by certain definite
  changes in
• the internal architecture and equally definite
  changes in
• external conformation in accordance with
  mechanical
• laws.

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Etiology of variable bone density

• Cortical and trabecular bone are modified by
  modeling and remodeling.
• Modeling
• Remodeling

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Etiology of variable bone density

• MacMillan and Parfitt
• Bone is most dense around the teeth (cribriform
  plate) and more dense at the crest than at the
  apex
• Bone density decreases with tooth loss.

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Etiology of variable bone density

• Decrease in density depends on
• Time of edentulousness
• Original density of bone
• Muscle attachments
• Flexure and torsion of mandible
• Parafunction before and after tooth loss
• Hormonal influences
• Systemic conditions

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Etiology of variable bone density

• Frost reported a model of four zones
• Pathologic overload zone
• Mild overload zone
• Adapted window
• Acute disuse window

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Etiology of variable bone density

• Acute disuse window
• Modeling inhibited
• Remodeling is stimulated

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Etiology of variable bone density

• Adapted window (50 to 1500 microstrain)
• - Modeling Remodeling

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Etiology of variable bone density

• Mild overload zone (1500-3000 microstrain)
• Bone modeling stimulation
• Remodeling inhibition

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Etiology of variable bone density

• Pathologic overload zone
• Early implant loading

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Bone classification schemes related to implant
dentistry

• In 1970 Linkow Chercheve
• Class I bone structure
• Class II bone structure
• Class III bone structure

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Bone classification schemes related to implant
dentistry

• Linkow Chercheve they stated that

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Bone classification schemes related to implant
dentistry

• In 1985 Lekholm Zarb
• Quality 1
• Quality 2

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Bone classification schemes related to implant
dentistry

• Quality 3
• Quality 4

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Mish bone density classification

• In 1988 Misch

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Mish bone density classification

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Bone density Tactile Sense
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Bone density location
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Bone density location
mental foramen
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Radiographic bone density

• Bone density computed tomography (CT)
• The Mish bone density classification may be
  evaluated on CT images by correlation to a range
  of Hounsfield units
• D1 - grater than 1250 Hounsfield unit
• D2 - 850-1250 Hounsfield unit
• D3 350-850 Hounsfield unit
• D4 150-350 Hounsfield unit
• D5 less than 150 Hounsfield unit

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Available bone
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Review of literature

• Atwood Coy-
• Rate of resorbtion for endentulous mandible -
• posterior 4 times anterior

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Review of literature

• posterior maxilla bone loses volume faster than
  any other region

Maxillary sinus
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Review of literature

• Weiss Judy in 1974 Mandibular atrophy its
  influence on sub-periosteal implant therapy
• Kent in 1982 alveolar ridge deficiency
  designed for alloplastic bone agumentation
• Lekholm Zarb in 1985 five stages of jaw
  resorbtion ranging from minimum to extreme

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Review of literature
bone volume
Number of implant
bone height
crown height
Implant load
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Review of literature

• In 1985 Mish Judy -

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Available Bone
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Available Bone Height
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Available Bone Height

• More dense bone may accommodate a shot implant
  (i.e. 8mm)
• Least dense Weaker bone requires a longer
  implant

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Available Bone Height

• Angles class II patients have shorter mandibular
  height
• Angles class III patient exhibit the greatest
  height

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Available Bone Width
Facial plate
Lingual plate
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Available Bone Length

Distal
Mesial
Length
1.5 mm
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Available Bone Length
Interproximal contact
CEJ
2mm below the CEJ.
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Available Bone Length

• Maxillary 1st premolar

4mm
5mm
8mm
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Available Bone Angulations

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Available Bone Angulations

• The alveolar bone angulations represents the root
  trajectory in relation to the Occlusal plane

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Available Bone Angulations

• 2nd premolar 10 degrees to horizontal plane
• 1st molar area 15 degree
• 2nd molar area 20 to 25 degree

submandibular fossa
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Crown Height
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Divisions Of Available Bone
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Division A Bone

• More than 5mm width
• Height greater than 12 mm
• Mesiodistal length of bone is grater than 7mm
• Crown height of 15mm or less
• Angulation of load does not exceed 25 degree
  between the Occlusal plane the implant body

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Division A root form implant advantage

• Greatest surface area
• Improved stress distribution
• Designed for variable bone density
• Greatest range of prosthetic options
• Less fracture of implant components
• More esthetic condition
• More crown cement retention
• One- or -two stage healing design
• Less abutment screw loosening

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Prosthetic options for Division A

• Mandatory for FP-1
• FP-2
• RP-4 RP-5 may need osteoplasty

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Prosthodontic classification

• FP-1
• FP-2
• FP-3
• RP-4
• RP-5

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Division B

• Division B available bone width may be ranges
  from 2.5 to 5 mm
• B 4 to 5mm
• B-w 2.5 to 4mm

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Division B

• The minimum length of division B ridge is 6mm
• Angle of load should be within 20 degree
• Crown height less than 15mm

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Division B Treatment Options

• Osteoplasty
• Insert division B implant (Small diameter)
• Augmentation

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Prosthesis type for Division B

• Grafted ridge FP-1 or FP-3 prosthesis
• Osteoplasty FP-2 FP-3 or FP-4 prosthesis

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Division C Bone

• Width may be less than 2.5mm
• Bone height less than 12mm
• Crown height more than 15mm
• Angulations grater than 30 degree

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Division C Bone
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Division C Bone

• subcategory of division C is C-a
• - Angulation is grater than 3o
  degree

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Treatment planning for division C bone

• Osteoplasty (C-w bone)
• Root form implants
• Subperiosteal implant
• Augumentation procedure

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Treatment planning for division C bone

• Disk design implant
• Ramus frame implant (C-h bone)
• Transosteal implant (C-h bone anterior)

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Prosthetic option Division C bone

• Overdenture RP -4 RP -5
• FP -2 or FP -3
• Partially edentulous or low stress
  condition
• Change bone division (Augumentation)
• Denture (maxilla)

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Division D Bone

• Severe atrophy
• Basal bone loss
• - Flat maxilla
• - pencil-thin mandible
• gt 20mm crown height

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Division D bone treatment potion

• Autogenous bone graft

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Articles

• Effect of Implant Design on Initial Stability of
  Tapered Implants Journal of Oral Implantology
• June 2009
• Implant design is one of the parameters for
  achieving successful primary stability. This
  study aims to examine the effect of a
  self-tapping blades implant design on initial
  stability in tapered implants. Polyurethane
  blocks of different densities were used to
  simulate different bone densities. The two
  different implant designs included one with
  self-tapping blades and one without self-tapping
  blades. Implants were placed at 3 different
  depths apical third middle third and fully
  inserted at 3 different densities of polyurethane
  blocks. A resonance frequency (RF) analyzer was
  then used to measure stability of the implants.

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Cont..

• In conclusion fully inserted implants without
  self-tapping blades have higher initial stability
  than implants with self-tapping blades. However
  the association strength between implant design
  and initial stability is less relevant than other
  factors such as insertion depth and block
  density. Thus if bone quality and quantity are
  optimal they may compensate for design
  inadequacy.

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Variations in bone density at dental implant
sites in different regions of the jawbone Journal
of Oral RehabilitationVolume 37 Issue 5

• The survival rate of dental implants is markedly
  influenced by the quality of the bone into which
  they are placed. The purpose of this study was to
  determine the trabecular bone density at
  potential dental implant sites in different
  regions of the Chinese jawbone using computed
  tomography (CT) images The CT data demonstrate
  that trabecular bone density varies markedly with
  potential implant site in the anterior and
  posterior regions of the maxilla and mandible.
  These findings may provide the clinician with
  guidelines for dental implant surgical procedures
  (i.e. to determine whether a one-stage or a
  two-stage protocol is required).

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Conclusion
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References

• Dental implant prosthodontics- Carl E. Misch
• Osseointigration occlusalrehabilitation -
  Sumiya
• 
  Hobo
• Contemporary implant dentistery - 3rd edition
  Misch
• Journal of Oral Implantology June 2009 vol 35
  issue 3 Effect of Implant Design on Initial
  Stability of Tapered Implants
• Journal of Oral RehabilitationVolume 37
  Issue5 Pages 346 - 351Variations in bone density
  at dental implant sites in different regions of
  the jawbone
• Information from Web

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Thank you