title: A correlation between bone (B), insertion torque (IT), and implant stability (S): BITS score.
abstract: BACKGROUND
  Although criteria for assessing bone quality have been reported, an overall score that correlates bone quality with the primary stability and secondary stability of implants is not yet available.
  
  
  OBJECTIVE
  The purpose of this article was to propose a scoring index that will establish a correlation among the bone density values from computed tomography, maximum insertion torque values, and resonance frequency analysis in different phases of implant treatment.
  
  
  METHODS
  In this study, 60 implant sites were evaluated to assess bone density (Hounsfield units), insertion torque values (Ncm), and primary stability and secondary stability (implant stability quotient values obtained by using resonance frequency analysis). On the basis of computed tomography data, the bone was classified as D1 to D4. The insertion torque was noted and classified into 2 groups, A and B. The implant stability quotient values obtained from resonance frequency analysis depicting primary stability and secondary stability were classified into 5 groups. The primary score noted was a result of the values obtained for the 3 parameters at the time of implant placement. The secondary score was obtained by considering the values of the bone density and resonance frequency analysis recorded at different time intervals.
  
  
  RESULTS
  Bone densities of D2, D3, and D4 were noted, dividing the bone type into 3 groups. The maximum torque noted in the study was 40 Ncm. The difference between various insertion torque values and bone types was found to be statistically nonsignificant. Higher mean implant stability quotient values were obtained for primary and secondary stability for the D2 bone than for D3 and D4 bone. When analyzed according to the time of insertion, the mean values increased at second stage surgery in all bone types. The difference in mean values among all bone types was found to be statistically significant (P<.001). A comparison of primary and secondary implant stability quotient values in all bone types did not find any statistical significance (P=.780). A score was recorded at the time of implant placement and at the time of second stage surgery, and the prosthetic treatment was planned accordingly.
  
  
  CONCLUSIONS
  The score highlights the importance of considering the association of bone quality, insertion torque values, and stability as denoted by implant stability quotient throughout treatment. Based on the variation in the score noted at recall visits, alterations in the treatment plan can be made with respect to the healing period and prosthetic design.
authors.affiliation: Professor and Department Head, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India. Electronic address: drmanishaherekar@gmail.com.
authors.forename: Manisha
authors.initials: M
authors.lastname: Herekar
authors.affiliation: Postgraduate student, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India.
authors.forename: Megha
authors.initials: M
authors.lastname: Sethi
authors.affiliation: Postgraduate student, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India.
authors.forename: Tousif
authors.initials: T
authors.lastname: Ahmad
authors.affiliation: Private practice, prosthodontics and implantology, Candolim, Goa, India.
authors.forename: Aquaviva Sebasteao
authors.initials: AS
authors.lastname: Fernandes
authors.affiliation: Professor, Department of Prosthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India.
authors.forename: Viraj
authors.initials: V
authors.lastname: Patil
authors.affiliation: Dean, Professor, and Head of Department, Department of Oral and Maxillofacial Surgery, Tatyasaheb Kore Dental College and Research Centre, Warnanagar, Maharashtra, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Kulkarni
mesh_terms: D015519:Bone Density / Q000502:physiology*; D003758:Dental Implantation, Endosseous / Q000145:classification*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D017268:Dental Prosthesis Retention / Q000145:classification*; D006801:Humans; D061646:Operative Time; D016348:Osseointegration / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D019415:Torque; D014732:Vibration
chemical_list: D015921:Dental Implants