Predicting Primary Implant Stability Using the Trabecular Bone Score

Size: px

Start display at page:

Download "Predicting Primary Implant Stability Using the Trabecular Bone Score"

Natalie Harrison
5 years ago
Views:

1 Predicting Primary Implant Stability Using the Trabecular Bone Score DAVID LONG, DDS LSU SCHOOL OF DENTISTRY DEPARTMENT OF PERIODONTICS

Critical first step toward successful integration.

2 What is is? The biomechanical phenomenon of mechanical stability between the implant and the surrounding bone at placement Primary Implant Stability Why is it important? Critical first step toward successful integration. Implants can only tolerate minimal micromovement (50-150um) during the early stages of healing Early Failure by Fibrous Encapsulation

3 What Factors Influence Primary Implant Stability? Implant Related Factors Surgical Protocol Anatomical Factors

Trabecular Bone Porous, soft Large marrow space, highly vascular Little

4 Anatomical Factor: Bone Cortical Bone Rigid, hard Limited marrow space and blood supply Resistant to rotary drilling High bone-to-implant contact Trabecular Bone Porous, soft Large marrow space, highly vascular Little resistance to rotary drilling Low bone-to-implant contact High risk of implant instability

Before surgery, can we accurately predict

commercially available CBCT machines Over

5 Before surgery, can we accurately predict bone quality? Current CBCTs: Inadequate resolution Micro-CT Gold Standard Resolution of commercially available CBCT machines Over and/or underestimation trabecular density Limitation in predicting bone quality prior to surgery

purpose was for evaluating bone strength in osteoporosis Bone Mineral Density

6 T R A B E C U L A R B O N E S C O R E ( T B S ) What is it? TBS measures the trabecular microarchitecture and density of bone Original purpose was for evaluating bone strength in osteoporosis Bone Mineral Density (BMD) scans only measures mass not 3D structure Bone Anisotropy: Trabecular structure dictates bone strength

7 T R A B E C U L A R B O N E S C O R E ( T B S ) How does it work? Fundamental concept: Radiographic images are complex 2D projections of 3D tissues X-ray pixels are indirect representations of 3D trabecula quantity, dimension, connectivity and proximity

correlation between TBS and primary implant stability Study Design: 13 implants in the posterior

0091) Simmons D, Le Nost P, Orellana D, Audebert A, Porras Smith L, Winzenrieth R, Lelong C, Hans D.

8 Can we use TBS in implant dentistry? LSU Pilot Study 2014: First time TBS technology applied in dentistry Purpose: To explore for correlation between TBS and primary implant stability Study Design: 13 implants in the posterior mandible evaluated Results: ISQ was shown to have a positive relationship to TBS values (p=0.0091) Simmons D, Le Nost P, Orellana D, Audebert A, Porras Smith L, Winzenrieth R, Lelong C, Hans D. Trabecular Bone Score: A New Technology to Asses Primary Stability from Intraoral Bone Images An in vivo Feasibility Study. J Dent Res 93(Sp Iss B), IADR 92nd Annual Meeting 2014 Capetown, South Africa.

9 C U R R E N T S T U D Y O B J E C T I V E Purpose: To further evaluate the relationship of TBS and primary implant stability observed in clinical measurements. Hypothesis: TBS values will show a direct relationship to implant stability

10 S T U D Y D E S I G N TBS obtained from dental radiographs ISQ Torque Statistical Analysis

11 R A D I O G R A P H I C D A T A C O L L E C T I O N I M A G E A C Q U I S I T I O N I M A G E P R O C E S S I N G TBS VALUE

12 M E A S U R E M E N T S O F P R I M A R Y S T A B I L I T Y I M P L A N T S T A B I L I T Y Q U O T I E N T I N S E R T I O N T O R Q U E ISQ values averaged Torque Groups: Low: 20 Ncm 3 Moderate: Ncm 3 High: 35 Ncm 3

13 S T A T I S T I C A L A N A L Y S I S I S T H E R E A N A S S O C I A T I O N B E T W E E N TBS and ISQ TBS and Torque TBS and Patient Gender and Age

14 R E S U L T S Implants n= 109 n = implant sites included n = 14 Mean age of study participants: 58.2 years old n = 28 n = 61

15 TBS RESULT S T B S A N D I S Q ISQ Pearson correlation testing: TBS and ISQ. Failed to show a significant relationship (r = , p= )

16 RESULT I S Q A N D S Y S T E M ISQ Implant System ANOVA testing: ISQ averages to Implant system. Statistically significant relationship found (p <0.0001)

RESULT T B S A N D T O R Q U E Low: 20 Ncm 3 Moderate: 21-34 Ncm 3 High: 35 Ncm 3 ANOVA

17 RESULT T B S A N D T O R Q U E Low: 20 Ncm 3 Moderate: Ncm 3 High: 35 Ncm 3 ANOVA testing: Torque groups to TBS. Failed to show a statistically significant relationship (p < )

RESULTS T O R Q U E A N D S Y S T E M Table of System by

35 Ncm 3 Total 4 0 2 6 % Implants with 35Ncm 3 33%

association between Torque groups and Implant system: (p

18 RESULTS T O R Q U E A N D S Y S T E M Table of System by Torque Group System Torque Group n 20 Ncm Ncm 3 35 Ncm 3 Total % Implants with 35Ncm 3 33% Fisher s exact test: Statistically significant association between Torque groups and Implant system: (p = ) % 68% 70% Total

19 TBS RESULTS T B S A N D A G E Pearson correlation testing : Age correlated to TBS values. Statistically significant relationship found (r = , p=0.0240) Weak negative linear correlation between TBS and Age Patient Age

20 D I S C U S S I O N TBS to ISQ TBS to Torque No correlation No correlation ISQ quantity of bone to implant contact Cortical bone thickness variations

Correlation Lowest Primary Stability Negative Correlation

21 D I S C U S S I O N Implant System to ISQ Implant System to Torque TBS to Age Correlation Highest Primary Stability Correlation Lowest Primary Stability Negative Correlation Implant design directly influences stability Supports TBS medical literature

22 C O N C L U S I O N TBS values do not correlate with implant stability measurements Implant-related factors directly influence primary stability TBS shows a negative linear correlation to patient age

23 F U T U R E A R E A S O F I N T E R E S T TBS development and calibration

24 THANK YOU Dr. Angela Palaiologou-Gallis Dr. Pooja Maney Dr. David Simmons Dr. Qingzhao Yu Dr. Thomas Lallier Ms. Lin Zhu Ms. Elizabeth Mayer Co-Residents Dr. Doris Tran Dr. Renaud Winzenrieth Mr. Christophe Lelong Mr. Pierre LeNost

Trabecular Bone Structure of the Calcaneus: : Comparison of high resolution MR Imaging at 1.5T and 3T using MicroCT as a standard of reference

Trabecular Bone Structure of the Calcaneus: : Comparison of high resolution MR Imaging at 1.5T and 3T using MicroCT as a standard of reference Catherine Phan 1 Maiko Matsuura 2 Timothy Dunn Jan Bauer 1