Positive association between implant primary stability and bone mineral density

Cross section of a dental implant

Primary stability plays an important role in successful osseointegration of dental implants. The aim of this review was to investigate the influence of  bone mineral density on the primary stability of dental implants.

The authors performed searches of the Cochrane Library, MEDLINE-PubMed, ISI Web of Knowledge, EMBASE, and LILACS  and SIGLE databases without language restriction. Experts were also contacted to identify unpublished and ongoing studies and references of selected articles were screened.  Observational studies performed in patients who received dental implants for rehabilitation that evaluated the association between bone  mineral density and implant primary stability where bone density assessment was performed by measurement of Hounsfield units using cone beam computed tomography; and dental implant primary stability evaluated by ISQ value, PTV value or insertion torque measurement  were included.

Seven articles were finally included. The articles identified were of low to moderate methodological quality and presented positive association between primary stability and bone density.

The authors concluded

 There is a positive association between implant primary stability and bone mineral density of the receptor site. However, the methodological quality and control of bias of the studies should be improved to produce stronger evidence.

Marquezan M, Osório A, Sant’Anna E, Souza MM, Maia L. Does bone mineral density influence the primary stability of dental implants? A systematic review. Clin Oral Implants Res. 2011 Jun 2. doi: 10.1111/j.1600-0501.2011.02228.x. [Epub ahead of print] PubMed PMID: 21635560.


While this review had a well conducted search and has a good methodological approach and shows a positive associate of implant stability with bone mineral density there are issues in relation to the measurement of bone mineral density measurement that need to be considered. Because, as the authors note   ‘ in implant dentistry it has been assumed that bone quality is equivalent to bone mineral density’ .  However In endocrinology and traumatology, bone densitometry is taken as the gold standard . This issue of the potential subjectivity of the way  bone quality is measured raises important  issues in relation to  review.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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