Purpose: The primary aims of this retrospective study were to: (1) evaluate bone quality in different segments of the edentulous jaw and correlate it with demographic data and (2) establish a quantitative and objective assessment of bone quality based on the Hounsfield scale. Materials and Methods: One hundred one randomly selected computerized tomographic (CT) scans were used for the analysis. Edentulous segments ranging from 10 to 30 mm were selected for evaluation, and the findings were analyzed and correlated to demographics. Implant recipient sites were evaluated visually for bone classification by 2 independent examiners. The same sites were subsequently evaluated digitally using the Hounsfield scale, and the results were correlated with the visual classification. Results: The 4 quadrants of the mouth displayed Hounsfield unit (HU) values ranging from –240 HU to 1,159 HU. The highest unit/mean density value (559 ± 208 HU) was found in the anterior mandible, followed by 517 ± 177 HU for the anterior maxilla, 333 ± 199 HU for the posterior maxilla, and 321 ± 132 HU for the posterior mandible. There was no association between the Hounsfield value and density and age or gender. When subjective bone quality was correlated to Hounsfield index findings, only the relationship between HU and type 4 bone was found to be significant. Conclusions: Knowledge of the Hounsfield value as a quantitative measurement of bone density can be helpful as a diagnostic tool. It can provide the implant surgeon with an objective assessment of bone density, which could result in modification of surgical techniques or extended healing time, especially in situations where poor bone quality is suspected. INT J ORAL MAXILLOFAC IMPLANTS 2006;21:290–297

http://coimplante.odo.br/Biblioteca/Planejamento/Quantitative%20evaluation%20with%20Hounsfield%20index%20-%20Shapurian%20et%20al.pdf

Quantitative evaluation of bone density using the Hounsfield index.

Authors’ affiliations: Daniel Buser, Department of Oral Surgery, University of Berne, Freiburgstrasse 7, CH30110 Berne, Switzerland Karl Dula, Dental School, University of Berne, Freiburgstrasse 7, CH-30110 Berne, Switzerland Kerstin Grondahl, Department of Oral and Maxillo-Facial Radiology, Sahlgrenska Academy, Goteborg University, PO Box 459, SE40503 Goteborg, Sweden David Harris, School of Dental Science, Trinity College Dublin. Lincoln Place, Dublin 2. Ireland Reinhilde Jacobs, Oral Imaging Cluster, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 7, B-3000 Leuven Belgium Ulf Lekholm, Branemark Kliniken, Tandvarden and Faculty of Dentistry, Goteborgs Universtet, Medicinaregatan 12, S-413 90 Goteborg, Sweden Richard Nakielny, Dept of Medical Imaging and Medijcal Physics (CT/MR scanning), Royal Hallamshire Hospital, Sheffield, S10 2JJ, UK Daniel van Steenberghe, Catholic University Leuven, Department of Periodontology, Kapucijnenvoer 7, B – 3000 Leuven Belgium Paul van der Stelt, Department of Oral and Maxillofacial Radiology. ACTA Louwesweg 1, 1066 EA Amsterdam, Netherlands

E.A.O. guidelines fo the use of diagnostic imaging in implant dentistry. A consensus workshop organized by the European Association for Osseointegration in Trinity College Dublin.

Objectives The association between osteoporosis and oral health remains a matter of controversy. It is important to confirm whether there is a role of osteoporosis in bone loss in the jaws, periodontal diseases, tooth loss, and other oral tissue changes. The objective of this article is to review and summarize the published literature on the associations between osteoporosis and various oral conditions such as bone loss in the jaws, periodontal diseases, and tooth loss. Methods A search of the computerized database MEDLINE was conducted. Clinical information concerning systemic osteoporosis and animal studies reporting possible associations between osteoporosis and changes in the dental and oral tissues were included. The review focus was on studies involving (1) methods for assessing bone mineral density (BMD); (2) methods for assessing osteoporosis-related changes in intraoral sites; (3) associations between mandibular BMD and skeletal BMD; (4) changes in the jaws, periodontal tissues, and temporomandibular joint concurrent with osteoporosis; (5) changes in the oral tissues following estrogen deficiency; and (6) effects of estrogen-hormone replacement therapy and/or calcium and vitamin D on oral health. Results Ninety-seven studies conducted in various parts of the world were identified. Evidence from prospective studies supports the contention that individuals with osteoporosis may be at increased risk for the manifestations of oral osteoporosis; however, such risk is not definitively proven. Studies suggest that findings on dental panoramic radiographs may be used to detect individuals with low BMD. Conclusions Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully provide early warning for osteoporosis risk.

Oral implications of osteoporosis.

This review comprises a short summary of up-to-date clinical knowledge on systemic osteoporosis in order to focus on the clinical dental studies on osteoporosis of the jaws, which have become available within the last 15 years. Diagnosis of jaw osteoporosis requires assessment of the bone mineral content (BMC)/density (BMD) using specially constructed jaw bone scanners and development of a corresponding gender-related set of normal BMC/BMD values for young adults, as in other sites of the skeleton. If other factors are excluded, jaw osteoporosis may involve the risk of minor accentuation of alveolar bone loss after wearing a full denture, in cases of periodontitis and in peri-implant areas. However, implant-supported overdentures conserve bone because of their positive load-related effect on the jaw. Estimation of BMC/BMD is also advisable for edentulous osteoporotic patients. Systemic treatment involving the bone metabolism affects the jaw BMC/BMD positively or negatively as in other skeletal sites, but the magnitude of this effect is site-specific. Future studies of the effect of bisphosphonates on the jaw BMC and alveolar bone loss, and analyses of the bone quality and jaw BMC/BMD in relation to implant treatment, without or with bone transplantation, are required.

General and oral aspects of osteoporosis: a review.

Background The accurate transfer of preoperatively determined implant positions to the patient mouth is very beneficial to the dental practitioner as well as patients. The objective of this paper was to review the gradual development of computer-assisted implant surgery.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/rcs.188

Computer‐assisted implantology: historical background and potential outcomes—a review

Mandibular bone density, vertebral density and resorption of the edentulous ridge were correlated in a group of 17 partially edentulous subjects.Bone density was quantified by Quantitative Computerized Tomography; resorption was evaluated on panoramic radiographs. Mean bone density in dentate areas was significantly higher than that in edentulous areas; mandibular bone density was not found to relate significantly to vertebral bone density, nor to ridge resorption. In programming osseointegrated implants in the partially edentulous mandible, CT may give a more accurate evaluation of trabecular bone. However, further studies are necessary to clarify its clinical utility.

Bone density in human dentate and edentulous mandibles using computed tomography.

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Bone density in human dentate and edentulous mandibles using computed tomography.