Bone density and types

Dr. Mahvesh hasan FCPS II Resident Dept. Of Operative Dentistry DIKIOHS

Osseointegration
Osseointegration refers to a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant.

 A direct bone-to-metal interface without interposition of non-bone tissue Branemark showed that titanium implants could become permanently incorporated within bone that is, the living bone could become so fused with the titanium oxide layer of the implant that the two could not be separated without fracture.

 Currently, an implant is considered as osseointegrated when there is no progressive relative movement between the implant and the bone with which it has direct contact.

Classification of bone tissue

WOVEN BONE
It is relatively weak , disorganized and poorly mineralized. It plays a crucial role in wound healing by Rapidly filling osseous defects Providing initial continuity for fractures and endosteas implants Strengthening bone weakened by surgery or trauma The first bone formed in response to wound healing is the woven bone type

 Woven bone is not found in the adult skeleton under normal steady state conditions Remodelled to lamellar bone or rapidly resorbed prematurely loaded
LAMELLAR BONE Strong, highly organized well-mineralized tissue makes up more than 99 % of the adult human skeleton

Bone Remodelling
Remodelling is a process of resorption and formation at the same site that replaces previously existing bone and primarily affects the internal turnover of bone including the region where teeth are lost or the bone next to an endosteal implant
The greater the magnitude of stress applied to the bone the greater the strain observed in the bone. Bone modelling and remodelling are primarily controlled in part or whole by the mechanical environment of strain

 Stress is determined by the magnitude of force divided by the functional area over which it is applied
Strain is defined as the change in length of a material divided by the original length

Biomechanical functions of maxilla and mandible

The maxilla and mandible have different biomechanical functions The mandible as an independent structure is designed as a force absorption unit. Therefore when teeth are present the outer cortical bone is denser and thicker and and the trabecular bone is more corse and dense

Biomechanical functions of maxilla and mandible

Biomechanical functions of maxilla and mandible

The maxilla is a force distribution unit. Any strain to the maxilla is transferred by the zygomatic arch and palate away from the brain and orbit As a consequence the maxilla has a thin cortical plate and fine trabecular supporting the teeth Bone density in the jaws decreases after tooth loss

The most dense bone is usually observed in the anterior mandible, followed by anterior maxilla and posterior mandible and the least dense bone is typically found in posterior maxilla.

Cortical and trabecular bone

Dense or porous cortical bone is found on the outer surfaces of bone and includes the crest of an edentulous ridge
Coarse and fine trabecular bone types are found within the outer shell of cortical bone and occasionally on the crestal surface of an edentulous residual ridge

Misch Bone Density Classification

D 1 bone is primarily dense cortical bone
D 2 bone has dense-to-porous cortical bone on the crest and within the bone has coarse trabecular bone D 3 bone types have a thinner porous cortical crest and fine trabecular bone in the region next to the implant D 4 bone has almost no crestal bone. The fine trabecular bone composes almost all of the total volume of bone next to the implant

Misch Bone Density Classification

Misch Bone Density Classification

The bone density may be determined by

Tactile sense during surgery General location Radiographic evaluation

Bone Density Determined By General Location

D 1 bone is almost never observed in the maxilla and is rarely observed in most mandibles. In the anterior mandible D 1 bone is observed approximately 6 % of the time. D 2 bone is the most common bone density observed in the mandible The anterior mandible consisits of D 2 bone approximately two thirds of the time

Bone Density Determined By General Location

The bone density D 3 is very common in the maxilla . More than half the patients have D 3 bone in the upper arch
The softest bone D 4 is most often found in the posterior maxilla ( approximately 40 %) specially in molar regions A more accurate determination of bone density is made with computerized tomograms before surgery or tactilely during implant surgery

Summary
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

Summary
A key determinant for clinical success is the diagnosis of bone density in a potential implant site
The strength of bone is directly related to bone density