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[5]bone density for dental implants [ 5 ].pptx
1. Bone density for dental
implants
Dr.Ahmad Jawed “Safi”
Safi dental clinic
2. Factors related to bone density
Treatment planning
Drilling speed during osteotomy prep
Saline irrigation flow during osteotomy pre
Implant design with predictable success rate
Implant surface for predictable osseointegration
Surgical approach for implant insertion
Healing protocol(submerged or open)
The number of implants required to support multiple
unit prosthesis
Primary stability of the implant
Loading protocol- immediate/early/delayed
Safi dental clinic
3. Lekhom and Zarb classification
for jawbone qualities
Quality 1– homogenous compact bone
Quality 2– thick layer of compact bone
surrounding a core of dense trabecular bone
Quality 3- a thin layer of cortical bone surrounding
a dense trabecular bone of favorable strength
Quality 4- a thin layer of cortical bone surrounding
a core of low-density trabecular bone
Safi dental clinic
5. Misch bone density
classification
The anterior maxilla region (second premolar to second
premolar) usually has D3 bone but in few cases D2
bone
The posterior maxilla region(molar region)usually has
D4 bone but in cased of sinus grafting it has D3 bone
after six months of grafting
The anterior mandible (first premolar to first premolar)
usually has D2 bone but the resorbed bone had D1
bone
The posterio mandible(second premolar and
molars)usually has D3 but in some cases D2
Safi dental clinic
7. Determination of bone density
Computed tomography(CT)
Tactile determination during bone drilling
Bone gauge (measurable )
Safi dental clinic
8. D1/Type 1 bone (dense cortical
bone)
Advantages
Strongest bone in the mouth
Implant achieves highest primary stability
Implant achieves highest BIC percentage
Fewer implants can be inserted to support multiple unit
prosthesis
Requires only 3 t 4 months for osseointegration
(primary healing)
One-stage non-submerged protocol can be practiced in
selective cases
Immediate loading protocol can be practiced
Progressive bone loading is not required
Safi dental clinic
9. Disadvantages
Least amount of vascularity
Slow lamellar bone formation
Chance of bone over heating during osteotomy
Highest rate of failure in implant surgery
Longest time taken for implant placement
Require drilling at high speed (2500 rpm)
Require tapping
May require crestal bone modification/for broader
implant platform
Safi dental clinic
11. D2/Type 2 bone
Advantages
Strong bone with good regeneration capacity
Implant achieves adequate primary stability
One-stage non-submerged surgical protocol can
be followed
Requires 4-6 months of healing period
Progressive bone loading strengthens the peri-
implant bone
Fewer implants are needed to support a multiunit
prosthesi
Safi dental clinic
12. Continue…
Disadvantages
May require tapping for implants with non-
cutting thread implants
May require crestal bone modification
Safi dental clinic
14. D3/type 3 bone
Advantages
Faster osteotomy preparation at lower speed
Bone tapping is optional
Crestal bone drilling is optional
Excellent vascularity
Chance of bone overheating are small
Safi dental clinic
15. Continue…
Disadvantages
Healing period of 6-8 months
Implant may achieves inadequate primary stability
More implants are required to be inserted to
support multiunit prosthesis
Immediate/early bone loading protocol should be
avoided
Longer progressive loading period is required to
improve bone quality
Safi dental clinic
17. D4/type 4 bone
Advantages
Only initail or no drilling is done but only
osteotomes can be used
No tapping is done
No crestal bone preparation is done
Least chance of surgical implant failure
Safi dental clinic
18. Continue..
Disadvantages
Often difficult to achieve adequate primary
stability for the implant
Long healing period (8-10 months)
More implants need to be inserted to support
a multiunit prosthesis
Long period of progressive loading is required
Highest rate of prosthetic implant failure
Safi dental clinic
25. Role of available bone in dental
implants
Mish and Judy classification of bone
avialibility
Division A (Abundant) bone
Division B (barely adequate)bone
Division C (compromised) bone
Division D (deficient bone)
Safi dental clinic
26. Division A (abundant bone)
Division A bone is three-dimentionally
abundant for the ideal impalnt insertion
Bone is this category should be
5 mm or more in width
12 mm or more in height
7 mm or more in length
Less than 30o in angulation
15 mm or less in crown height
Safi dental clinic
27. Prosthetic option for division A
bone
Is the best bone for any prosthetic option
May need osteoplasty for implant overdenture
to achieve more vertical height
Safi dental clinic
32. Division B (barely adequate
bone)
Bone in this category should be
2.5 – 5 mm in width
12 mm or more in height
6 mm or more in length
Less than 20 degree in angulation
15 mm or less in crown height
Safi dental clinic
33. Prosthetic option for division B
bone
By osteoplasty of ridge we could reach to the
division A bone
Lateral bone augmentation can also be
performed
Safi dental clinic
36. Division C (compromised
bone)
Bone in division C category should be
0 – 2.5 mm in width ( c-w bone)
Less than 12 mm in height (c-h bone)
More than 30 degree in angulation (c-a bone)
More than 15 mm in crown height
Safi dental clinic
37. Treatment options
Osteoplasty for c-w to achieve a wider
platform to insert implant
The preferred option for the c-w is lateral
bone augmentation
Safi dental clinic
40. Division D bone (deficient
bone)
This is the bone with severe atropy
E.g. flat maxilla and pencil-think mandible
More than 20 mm crown height
Safi dental clinic
41. Treatment options for deficient
ridge
Vertical block grafting
Nerve transpositoning
Sinus/nasal floor elevation
Ridge split
All on 4/6
Safi dental clinic
42. Prosthetic options for division D
bone
Implant overdenture is the treatment of choice
Safi dental clinic
