Hi,

I think it could be possible to predict bone response to functional loading as a function of bone-quality. However, I don't think conventional dental radiographs really provide enough information, as an increased radiopacity could be attributable to bone thickness as well as bone mineral density. Also, in terms of functional loading of implants and the transmission of forces from implants to surrounding bone, a radiograph is accurate upto 0.1mm (100 µm), however when considering bone-implant interfaces, 100-200 nm is the critical "interfacial zone" of bonding between the implant surface and the bone. Also, 2D imaging cannot predict anything about a 3D system unfortunately.

Some useful techniques could be something like confocal microscopy:

T.F. Watson, W.M. Petroll, H.D. Cavanagh, J.V. Jester, In vivo confocal microscopy in clinical dental research: An initial appraisal, Journal of Dentistry, Volume 20, Issue 6, December 1992, Pages 352-358)

Or, three-dimensional radiography:

http://www.siltanen-research.net/HyvonenKalkeLassasSetalaSiltanen2010.pdf

Best regards

Dear Agamy, if you use density obtained by helicoidal tomography it is possible to predict immediate loanding....and with cone beam computed tomography with dental slice software, there is a tool called Hounsfield Line , than it is possible to preoperatively determine immediate loading

Relationship between the bone density estimated by cone-beam computed

tomography and the primary stability of dental implants

Kei Isoda

Yasunori Ayukawa

Yoshihiro Tsukiyama

Motofumi Sogo

Yasuyuki Matsushita

Kiyoshi Koyano

Dear Eduardo and Shah

Thank you very much for your answers.

The Hounsen Units as you mentioned can demonstrate the bone dentistry . yet you can always find better response in posterior maxilla for example than anterior mandible in the same patient to immediate loading and better healing . the matter is not only dependent on bone density but also on blood supply that can support better healing. Can you predict how the bone will respond to immediate loading based only on radiographs whether CBCT or 3D CT/ or you need to depend on other factors such as resonance frequency by Osstel device for example or perhaps you may suggest some blood detected factors ?

Although preoperative radiographs can give useful indications on bone quality, bone mineralizations and possible zones with poor bone quality, in my opinion they are not able to indicate possible warnings for bone resorption. The latter issue could be addressed only after implant positioning. In fact the loading transmission mechanisms that affect possible activation of bone resorption strictly depend on implant geometry and on its positioning with respect to bone structure as well as wth respect to loading directions. Just as an example small skew conditions induced by an imoerfect implant positioning not eliminable in clinical aoplications could induce terrible effects on loading transmission mechanisms and on perimplant stress patterns at bone/implant interfaces (widely affecting resorption mechanics).

Dear Giuseppo

thank you for your reply. the important thing is when can you decide if such inconsistent conditions will lead to resorption?. the response from one patient to another differ to clinically similar conditions. so again can you predict the response only from radiographs or you need other measures.