Abstract
Context: A key determinant for clinical success is the diagnosis of the bone density in a potential implant site. The percentage of boneimplant contact is related to bone density, and the axial stress contours around an implant are affected by the density of bone. Evidence Acquisition: A number of reports have emphasized the importance of the quality of bone on the survival of dental implants. The volume and density of the recipient bone have also been shown to be determining criteria to establish proper treatment plans with adequate number of implants and sufficient surface area. Previous clinical reports that did not alter the protocol of treatment related to bone density had variable survival rates. To the contrary, altering the treatment plan to compensate for soft bone types has provided similar survival rates in all bone densities. Results: When bone density decreases and bone become softer, the implant surface in contact with the bone decreases, therefore treatment plan should be modified by changing the drilling protocol, using gradual loading and reducing the force on the prosthesis or increasing the loading area with increasing implant number, implant position, implant size, implant design (deeper and more threads with more pitch, squared shape) and implant body surface condition. Conclusions: Once the prosthetic option, key implant position, and patient force factors have been determined, the bone density in the implant sites should be evaluated to modify the treatment plan. Inappropriate implant number or design in poor quality bone results in higher failure rates. Changing the treatment plan and implant design is suggested, based on bone density to achieve higher survival rates.
Highlights
Context: A key determinant for clinical success is the diagnosis of the bone density in a potential implant site
When bone density decreases and bone become softer, the implant surface in contact with the bone decreases, treatment plan should be modified by changing the drilling protocol, using gradual loading and reducing the force on the prosthesis or increasing the loading area with increasing implant number, implant position, implant size, implant design and implant body surface condition
Implication for health policy/practice/research/medical education: Providing the long-term survival rate and higher success rate of dental implant in poor bone quality/Ideal treatment planning based on making proper decisions; make a selection based on a scientific approach, rather than on advertising or marketing opinion
Summary
Available bone is important in implant dentistry and describes the external architecture or volume of the edentulous area considered for implants. The density of available bone in an edentulous site is a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction [1, 2]. Bone density is an implant treatment plan modifier in several ways- i.e. prosthetic factors, implant size, implant design, implant surface condition, implant number, and progressive loading need or method. For decreasing the force to bone implant surface contact, following methods have been suggested: 1) Changing the prostheses design 2) Changing the force direction applied to implant 3) Increasing the functional contact surface (by increasing the number of implant, Implant length, Implant design, Implant surface condition) 4) Progressive loading All of these methods are more important for soft bone with lower density. Implant treatment plan should be changed based on density of bone in implant site
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