Implant stability is affected by local bone microstructural quality

Wirth, Andreas; Goldhahn, Jörg; Flaig, Cyril; Arbenz, Peter; Müller, Ralph; Lenthe, G. Harry van

doi:10.1016/j.bone.2011.05.001

Cited by 84 publications

(54 citation statements)

References 27 publications

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“…[1][2][3][4][5] The concept of bone quality has recently evolved from a densitybased approach towards a structural approach, as it has been shown that trabecular bone microarchitecture affects implant stability. 6 The pre-operative analysis of trabecular structure could therefore predict patient outcome and be used to select (un)favourable implant sites. Conventional histomorphometry has been used as the gold standard for analysing bone microarchitecture, such as the percentage of bone tissue.…”

Section: Introductionmentioning

confidence: 99%

Comparison of mandibular bone microarchitecture between micro-CT and CBCT images

Panmekiate¹,

Ngonphloy²,

Charoenkarn³

et al. 2015

Dentomaxillofacial Radiology

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Objectives: To compare microarchitecture parameters of bone samples scanned using micro-CT (mCT) to those obtained by using CBCT. Methods: A bone biopsy trephine bur (3 3 10 mm) was used to remove 20 cylindrical bone samples from 20 dry hemimandibles. Samples were scanned using mCT (mCT 35; SCANCO Medical, Brüttisellen, Switzerland) with a voxel size of 20 mm and CBCT (3D Accuitomo 170; J. Morita, Kyoto, Japan) with a voxel size of 80 mm. All corresponding sample scans were aligned and cropped. Image analysis was carried out using BoneJ, including the following parameters: skeleton analysis, bone surface per total volume (BS/TV), bone volume per total volume (BV/TV), connectivity density, anisotropy, trabecular thickness and spacing, structure model index, plateness and fractal dimension. Pearson and Spearman correlation coefficients (R) were calculated. CBCT values were then calibrated using the slope of the linear fit with the mCT values. The mean error after calibration was calculated and normalized to the standard deviation of the mCT values. Results: R-values ranged between 0.05 (plateness) and 0.83 (BS/TV). Correlation was significant for both Spearman and Pearson's R for 8 out of 16 parameters. After calibration, the smallest normalized error was found for BV/TV (0.48). For other parameters, the error range was 0.58-2.10. Conclusions: Despite the overall correlation, this study demonstrates the uncertainty associated with using bone microarchitecture parameters on CBCT images. Although clinically relevant parameter ranges are not available, the errors found in this study may be too high for some parameters to be considered for clinical application.

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Section: Introductionmentioning

confidence: 99%

Comparison of mandibular bone microarchitecture between micro-CT and CBCT images

Panmekiate¹,

Ngonphloy²,

Charoenkarn³

et al. 2015

Dentomaxillofacial Radiology

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“…3 Owing to various issues related to the use of grey values in CBCT for absolute or relative density estimations, 4 alternative methods for quantitative bone analysis have been explored. 5 Recently, the application of bone structure (or microarchitecture) analysis, 6 which has been used ex vivo on bone samples visualized in two dimension (histomorphometry) or three dimension (micro-CT), 7,8 has been considered for CBCT. Various studies have evaluated the correlation between bone parameters obtained through high-resolution micro-CT or CBCT scanning.…”

Section: Introductionmentioning

confidence: 99%

Effect of exposure parameters and voxel size on bone structure analysis in CBCT

Pauwels¹,

Faruangsaeng²,

Charoenkarn³

et al. 2015

Dentomaxillofacial Radiology

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Objective: To evaluate the effect of exposure parameters and voxel size on bone structure analysis in dental CBCT. Methods: 20 cylindrical bone samples underwent CBCT scanning (3D Accuitomo 170; J. Morita, Kyoto, Japan) using three combinations of tube voltage (kV) and tube currentexposure time product (mAs), corresponding with a CT dose index of 3.4 mGy: 90 kV and 62 mAs, 73 kV and 108.5 mAs, and 64 kV and 155 mAs. Images were reconstructed with a voxel size of 0.080 mm. In addition, the 90 kV scan was reconstructed at voxel sizes of 0.125, 0.160, 0.200, 0.250 and 0.300 mm. The following parameters were measured: bone surface (BS) and bone volume (BV) per total volume (TV), fractal dimension, connectivity density, anisotropy, trabecular thickness (Tb. Th.) and trabecular spacing (Tb. Sp.), structure model index (SMI), plateness, branches, junctions, branch length and triple points. Results: For most parameters, there was no significant effect of the kV value. For BV/TV, "90 kV" differed significantly from the other kV settings; for SMI, "64 vs 73 kV" was significant. For BS/TV, fractal dimension, connectivity density, branches, junctions and triple points values incrementally decreased at larger voxel sizes, whereas an increase was seen for Tb. Th., Tb. Sp., SMI and branch length. For anisotropy and plateness, no (or little) effect of voxel size was seen; for BV/TV, the effect was inconsistent. Conclusions: Most bone structure parameters are not affected by the kV if the radiation dose is constant. Parameters dealing with the trabecular structure are heavily affected by the voxel size. Dentomaxillofacial Radiology (2015Radiology ( ) 44, 20150078. doi: 10.1259 Cite this article as: Pauwels R, Faruangsaeng T, Charoenkarn T, Ngonphloy N, Panmekiate S. Effect of exposure parameters and voxel size on bone structure analysis in CBCT. Dentomaxillofac Radiol 2015; 44: 20150078.

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“…Poor bone quality caused by osteoporosis can reduce implant stability, and increase the risk of suture anchor pullout failure in cases of rotator cuff repair. 15) Failure at the anchor-bone interface is not uncommon, and some recent clinical studies have assessed the suitability of this interface with respect to bone quality. [1][2][3][4][5] BMD has been proposed as a good predictor of the mechanical integrity of trabecular bone.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus

Moon¹,

Jung²,

Park³

et al. 2015

Clinics in Shoulder and Elbow

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Background: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. Methods: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. Results: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). Conclusions: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI. (Clin Shoulder Elbow 2015;18(2):86-90)

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Implant stability is affected by local bone microstructural quality

Cited by 84 publications

References 27 publications

Comparison of mandibular bone microarchitecture between micro-CT and CBCT images

Comparison of mandibular bone microarchitecture between micro-CT and CBCT images

Effect of exposure parameters and voxel size on bone structure analysis in CBCT

Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus

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