Relationship between Mandibular Alveolar Bone Density on CBCT Images and the Success of Implant Osseointegration: A Prospective Clinical Study
Keywords:
Cone Beam Computed Tomography, Bone Density, Dental ImplantAbstract
Primary and secondary implant stability are critical determinants of successful osseointegration, and preoperative assessment of alveolar bone density using Cone Beam Computed Tomography (CBCT) has been proposed as a non-invasive predictor of implant outcomes. This prospective clinical study evaluated the relationship between preoperative CBCT-derived mandibular alveolar bone density and osseointegration success, as measured by the Implant Stability Quotient (ISQ). A total of 104 dental implants were placed in 72 partially edentulous patients. Preoperative CBCT bone density was measured in Hounsfield Units (HU) and classified according to the Misch classification (D2, D3, D4). Implant stability was measured using resonance frequency analysis at placement (ISQ0) and at 12 weeks (ISQ12). Mean bone density was 633.7 ± 215.0 HU, with most sites classified as D3 (75.9%). Mean ISQ12 was 71.9 ± 7.0. A significant positive correlation was found between HU and ISQ12 (r = 0.644, p < 0.001). Mean ISQ12 differed significantly across density classes (F = 22.820, p < 0.001), with all pairwise differences significant. The overall success rate was 89.4%, differing significantly across classes (100% D2, 92.4% D3, 44.4% D4; χ² = 21.886, p < 0.001). Multivariable logistic regression confirmed that higher HU was independently associated with greater odds of success (OR = 1.006, 95% CI: 1.000–1.011, p = 0.044). Preoperative CBCT-derived bone density is significantly and independently associated with implant stability and osseointegration success, supporting its clinical utility in preoperative risk stratification.
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