title: Correlation Between Bone Density and Instantaneous Torque at Implant Site Preparation: A Validation on Polyurethane Foam Blocks of a Device Assessing Density of Jawbones.
abstract: OBJECTIVE
  Bone density at implant placement sites is one of the key factors affecting implant primary stability, which is a determinant for implant osseointegration and rehabilitation success. Site-specific bone density assessment is, therefore, of paramount importance. Recently, an implant micromotor endowed with an instantaneous torque-measuring system has been introduced. The aim of this study was to assess the reliability of this system.
  
  
  METHODS
  Five blocks with different densities (0.16, 0.26, 0.33, 0.49, and 0.65 g/cm(3)) were used. A single trained operator measured the density of one of them (0.33 g/cm(3)), by means of five different devices (20 measurements/device). The five resulting datasets were analyzed through the analysis of variance (ANOVA) model to investigate interdevice variability. As differences were not significant (P = .41), the five devices were each assigned to a different operator, who collected 20 density measurements for each block, both under irrigation (I) and without irrigation (NI). Measurements were pooled and averaged for each block, and their correlation with the actual block-density values was investigated using linear regression analysis. The possible effect of irrigation on density measurement was additionally assessed.
  
  
  RESULTS
  Different devices provided reproducible, homogenous results. No significant interoperator variability was observed. Within the physiologic range of densities (> 0.30 g/cm(3)), the linear regression analysis showed a significant linear correlation between the mean torque measurements and the actual bone densities under both drilling conditions (r = 0.990 [I], r = 0.999 [NI]). Calibration lines were drawn under both conditions. Values collected under irrigation were lower than those collected without irrigation at all densities. The NI/I mean torque ratio was shown to decrease linearly with density (r = 0.998). The mean error introduced by the device-operator system was less than 10% in the range of normal jawbone density.
  
  
  CONCLUSIONS
  Measurements performed with the device were linearly correlated with the blocks' bone densities. The results validate the device as an objective intraoperative tool for bone-density assessment that may contribute to proper jawbone-density evaluation and implant-insertion planning.
authors.forename: Danilo Alessio
authors.initials: DA
authors.lastname: Di Stefano
authors.forename: Paolo
authors.initials: P
authors.lastname: Arosio
mesh_terms: D000704:Analysis of Variance; D015519:Bone Density / Q000502:physiology*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D003762:Dental Instruments / Q000592:standards*; D003799:Dental Stress Analysis / Q000295:instrumentation* / Q000592:standards; D006801:Humans; D011140:Polyurethanes; D015203:Reproducibility of Results; D019415:Torque
chemical_list: D015921:Dental Implants; D011140:Polyurethanes; C028279:polyurethane foam