Discuss the Strategies for Dealing with Poor Bone Quality

Discuss the strategies for dealing with poor bone quality

Nilesh R Shah

The process of osseointegration has been documented since the sixties. Implant dentistry has progressed dramatically since then. With the mean age of the population increasing, demand for implant rehabilitation is rising. Implants are being used increasingly to restore function in areas of poor bone quality.

Many methods have been developed to increase success rates in these areas. The use of longer wider implants which have a roughened surface show encouraging success rates in poor bone quality. But there are very few long term studies about the effects of the surface topography.   There is also a tendency for health professionals to rely ‘on new science’ to ensure success, it is equally important that the old proven protocols are not readily dismissed In favour of new unfounded ones.

This essay will look critically at the various methods to maximise implant success and how these methods have been extrapolated to treat areas of poor bone quality.

What is poor bone quality?
The classification of bone quality and quantity was described in 1985 by Lekholm and Zarb (Lekholm and Zarb, 1985)The classification was based on their own clinical studies. They proposed a differentiation of jawbone quantity (A to E), and jawbone   quality (1 to 4) in the anterior regions of the jaw.

Quantity (shape):
A Unresorbed alveolar bone
B Some resorption of alveolar bone
C Complete resorption of alveolar bone
D Some resorption of basal bone
E Extreme resorption of basal bone

1 Primarily cortical bone
2 Thick cortex with dense cancellous bone
3 Thin cortex with dense cancellous bone
4 Thin cortex with low density cancellous bone

Fig 1 Quantity & quality according to Lekholm and Zarb (Lekholm and Zarb, 1985)

The classification was arrived at using radiographs, without any method of standardised assessment.

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