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      Correlation between the thickness of the crestal and buccolingual cortical bone at varying depths and implant stability quotients

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          Abstract

          Background/purpose

          Resonance frequency analysis (RFA) is clinically used in dentistry to access the stiffness of dental implants in surrounding bone. However, the clear advantages and disadvantages of this method are still inconclusive. The aim of this study was to investigate and compare implant stability quotient (ISQ) values obtained from RFA with parameters obtained from a cone beam computed tomography (CBCT) scan of the same region.

          Materials and methods

          Nineteen implants (Conelog) were inserted in the posterior maxillary and mandibular partially edentulous regions of 16 patients. At the time of implant placement, the ISQ values were obtained using RFA (Osstell). CBCT was used to measure the thickness of the crestal, cortical, buccolingual cortical, and cancellous bone at 3, 6, and 9 mm below the crestal bone level, as indicated by radiographic markers. The ratio of the thickness of the cortical to cancellous bone at varying depths was also calculated and classified into 4 groups (Group 1–4).

          Results

          There was a strong correlation between the crestal cortical bone thickness and ISQ values (P<0.001). The thickness of the buccolingual cortical bone and ratio of the cortical to cancellous bone thickness at 3 mm were significantly related to the ISQ (P = 0.018 and P = 0.034, respectively). Furthermore, the ISQs in Group 1 were the highest compared with those in Group 2 and Group 3, whereas the CBCT parameters at 6 and 9 mm did not have any specific correlation with the ISQ values.

          Conclusion

          This study showed that the ISQ values obtained from RFA highly correlated with the quantity and quality of bone 3 mm below the crestal bone level. The correlation between the ISQ and bone surrounding the implant site was dependent on the depth of measurement. Therefore, RFA can help to predict the marginal bone level, as confirmed in this study.

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          Most cited references44

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          Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study.

          Preservation of alveolar bone volume following tooth extraction facilitates subsequent placement of dental implants and leads to an improved esthetic and functional prosthodontic result. The aim of the present study was to assess bone formation in the alveolus and the contour changes of the alveolar process following tooth extraction. The tissue changes after removal of a premolar or molar in 46 patients were evaluated in a 12-month period by means of measurements on study casts, linear radiographic analyses, and subtraction radiography. The results demonstrated that major changes of an extraction site occurred during 1 year after tooth extraction.
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            Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis.

            Bone anchored implants are now being used in dentistry for supporting intraoral and craniofacial prostheses. Although high success rates have been reported, a small number of implants may fail during the early healing phase or lateral in function. Currently available clinical methods to determine implant stability and osseointegration are relatively crude and may entail percussing a fixture with a blunt instrument. Radiographs are of value, but a standardised technique is necessary to ensure repeatability. This investigation was designed to study the application of a non-invasive test method using resonance frequency analysis to make quantitative measurements of the stability of the implant tissue interface in-vitro and in-vivo. The resonance frequency of a small transducer was measured when attached to implants embedded at different heights in an aluminum block. A strong correlation (r = 0.94, p < 0.01) was observed between the observed frequency and the height of implantation fixture exposed. The change in stiffness observed in the bone surrounding an implant during healing was modelled by embedding implants in self-curing polymethylmethacrylate and measuring the resonance frequency at periods during polymerisation. A significant increase in resonance frequency was observed related to the increase in stiffness. Resonance frequency measurements were also made on implants in-vivo and the results correlated well with the in-vitro findings.
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              Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs.

              The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
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                Author and article information

                Contributors
                Role: InvestigationRole: MethodologyRole: ResourcesRole: VisualizationRole: Writing – original draft
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 December 2017
                2017
                : 12
                : 12
                : e0190293
                Affiliations
                [1 ] Dental Implant Center, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
                [2 ] Department of Maxillofacial Prosthodontic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
                [3 ] Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
                [4 ] Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Thailand
                The Ohio State University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-17-10242
                10.1371/journal.pone.0190293
                5745001
                29281715
                fbdc3e24-813c-400e-ab84-c6eece1e4a26
                © 2017 Chatvaratthana et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 March 2017
                : 10 December 2017
                Page count
                Figures: 3, Tables: 4, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004156, Mahidol University;
                Award Recipient :
                Funded by Mahidol University to Dutmanee Seriwatanachai. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Maxilla
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Maxilla
                Biology and Life Sciences
                Anatomy
                Digestive System
                Teeth
                Medicine and Health Sciences
                Anatomy
                Digestive System
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                Biology and Life Sciences
                Anatomy
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                Jaw
                Teeth
                Medicine and Health Sciences
                Anatomy
                Head
                Jaw
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                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Bone Imaging
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Bone Imaging
                Medicine and Health Sciences
                Radiology and Imaging
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                Bone Imaging
                Biology and Life Sciences
                Anatomy
                Digestive System
                Mouth
                Mandible
                Medicine and Health Sciences
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                Physical Sciences
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