title: CBCT fractal dimension changes at the apex of immediate implants placed using undersized drilling.
abstract: OBJECTIVE
  To evaluate, on the base of cone beam computed tomography (CBCT) fractal dimension, bone quality changes surrounding the apical portion of immediate implants placed under higher insertion torque utilizing an undersized drilling technique.
  
  
  METHODS
  Three patients were enrolled in this study. Single implants were placed into fresh extraction sockets in the anterior maxilla and provisionalized immediately. Adequate stability was ensured on all the implants by a 28.5% undersizing of the apical portion of the osteotomy. Bone quality at the most apical 1.15 mm peri-implant bone portion were measured by CBCT at placement and after 6 months. This analysis was carried out by evaluating the box counting fractal dimension of 15 consecutive CBCT slices related to the most apical part of each implant.
  
  
  RESULTS
  All the three implants were successful after an 18-month follow-up period. The mean fractal dimension at the implant apex exhibited a 3% increase 6 months following placement.
  
  
  CONCLUSIONS
  Within the limitations of an explorative study, an undersized drilling resulting in high insertion torque would seem to induce no adverse changes in radiographic bone quality after 6 months of follow-up. The most favorable entity of drilling undersizing and its effect on peri-implant bone remodeling, should be evaluated on a larger patient population.
authors.affiliation: Postdoctoral Periodontal-Prosthesis Program, Department of Periodontics, University of Pennsylvania Dental School, Philadelphia, PA 19104-6030, USA. oscargm76@yahoo.es
authors.forename: Oscar
authors.initials: O
authors.lastname: González-Martín
authors.forename: Ernesto A
authors.initials: EA
authors.lastname: Lee
authors.forename: Mario
authors.initials: M
authors.lastname: Veltri
mesh_terms: D054893:Cone-Beam Computed Tomography; D019250:Dental Implants, Single-Tooth; D017709:Fractals; D006801:Humans; D057893:Immediate Dental Implant Loading; D008437:Maxilla / Q000000981:diagnostic imaging* / Q000601:surgery*; D010027:Osteotomy; D014081:Tooth Extraction; D019415:Torque; D016896:Treatment Outcome