J Periodontal Implant Sci.  2010 Feb;40(1):19-24. 10.5051/jpis.2010.40.1.19.

A clinical study of alveolar bone quality using the fractal dimension and the implant stability quotient

• Lee DH
• Ku Y
• Rhyu IC
• Hong JU
• Lee CW
• Heo MS
• Huh KH

• KMID: 2094711
• DOI: http://doi.org/10.5051/jpis.2010.40.1.19

Abstract

PURPOSE
It has been suggested that primary implant stability plays an essential role in successful osseointegration. Resonance frequency analysis (RFA) is widely used to measure the initial stability of implants because it provides superior reproducibility and non-invasiveness. The purpose of this study is to investigate whether the fractal dimension from the panoramic radiograph is related to the primary stability of the implant as represented by RFA.
METHODS
This study included 22 patients who underwent dental implant installation at the Department of Periodontology of Seoul National University Dental Hospital. Morphometric analysis and fractal analysis of the bone trabecular pattern were performed using panoramic radiographs, and the implant stability quotient (ISQ) values were measured after implant installation using RFA. The radiographs of 52 implant sites were analyzed, and the ISQ values were compared with the results from the morphometric analysis and fractal analysis.
RESULTS
The Pearson correlation showed a linear correlation between the ISQ values of RFA and the parameters of morphometric analysis but not of statistical significance. The fractal dimension had a linear correlation that was statistically significant. The correlation was more pronounced in the mandible.
CONCLUSIONS
In conclusion, we suggest that the fractal dimension acquired from the panoramic radiograph may be a useful predictor of the initial stability of dental implants.

Keyword

Dental implantation; Fractals; Panoramic radiography

MeSH Terms

Dental Implantation
Dental Implants
Fractals
Humans
Mandible
Osseointegration
Radiography, Panoramic
Dental Implants

Figure

• 

  Figure 1 A small L-shaped transducer that is fastened by a screw to the implant transmitted vibrations to the fixture.

• 

  Figure 2 Age distribution of study subjects.

• 

  Figure 3 The location where the implants were installed.

• 

  Figure 4 Transformation of the radiographic bone image prior to calculation of the fractal dimension. (A) original panoramic radiograph of the bone (B) transformation of the digitized image into a binary image, and (C) transformation of the binary image into an outline image from which the fractal dimension is calculated.

• 

  Figure 5 The correlation between resonance frequency analysis (RFA) and the fractal dimension (FD).

• 

  Figure 6 The correlation between resonance frequency analysis (RFA) and the fractal dimension in the maxilla (FD).

• 

  Figure 7 The correlation between resonance frequency analysis (RFA) and the fractal dimension in the mandible (FD).

Reference

1. Friberg B, Jemt T, Lekholm U. Early failures in 4,641 consecutively placed Branemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implants. 1991. 6:142–146.

2. Shalabi MM, Wolke JG, Jansen JA. The effects of implant surface roughness and surgical technique on implant fixation in an in vitro model. Clin Oral Implants Res. 2006. 17:172–178.

3. Meredith N, Alleyne D, Cawley P. Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis. Clin Oral Implants Res. 1996. 7:261–267.

4. Meredith N, Friberg B, Sennerby L, Aparicio C. Relationship between contact time measurements and PTV values when using the Periotest to measure implant stability. Int J Prosthodont. 1998. 11:269–275.

5. Mandelbrot BB. The fractal geometry of nature. 1983. 3rd ed. New York: W.H. Freeman.

6. Weibel ER. Fractal geometry: a design principle for living organisms. Am J Physiol. 1991. 261:L361–L369.

7. Badwal RS. The application of fractal dimension to temporomandibular joint sounds. Comput Biol Med. 1993. 23:1–14.

8. Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH, Lee SP. Direct measurement of trabecular bone anisotropy using directional fractal dimension and principal axes of inertia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007. 104:110–116.

9. Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH. Comparison of trabecular bone anisotropies based on fractal dimensions and mean intercept length determined by principal axes of inertia. Med Biol Eng Comput. 2007. 45:357–364.

10. Huh KH, Yi WJ, Jeon IS, Heo MS, Lee SS, Choi SC, et al. Relationship between two-dimensional and three-dimensional bone architecture in predicting the mechanical strength of the pig mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006. 101:363–373.

11. 1Ruttimann UE, Webber RL, Hazelrig JB. Fractal dimension from radiographs of peridental alveolar bone: a possible diagnostic indicator of osteoporosis. Oral Surg Oral Med Oral Pathol. 1992. 74:98–110.

12. Misch CE. Divisions of available bone in implant dentistry. Int J Oral Implantol. 1990. 7:9–17.

13. Trisi P, Rao W. Bone classification: clinical-histomorphometric comparison. Clin Oral Implants Res. 1999. 10:1–7.

14. Friberg B, Sennerby L, Roos J, Johansson P, Strid CG, Lekholm U. Evaluation of bone density using cutting resistance measurements and microradiography: an in vitro study in pig ribs. Clin Oral Implants Res. 1995. 6:164–171.

15. Rosenthal DI, Ganott MA, Wyshak G, Slovik DM, Doppelt SH, Neer RM. Quantitative computed tomography for spinal density measurement: factors affecting precision. Invest Radiol. 1985. 20:306–310.

16. Pouilles JM, Tremollieres F, Todorovsky N, Ribot C. Precision and sensitivity of dual-energy x-ray absorptiometry in spinal osteoporosis. J Bone Miner Res. 1991. 6:997–1002.

17. Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res. 2001. 12:79–84.

18. White SC, Rudolph DJ, Ma L. Influence of X-ray beam angulation and exposure on morphologic features of trabecular bone. Int J Oral Biol. 1999. 24:17–24.

19. Southard TE, Southard KA, Jakobsen JR, Hillis SL, Najim CA. Fractal dimension in radiographic analysis of alveolar process bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996. 82:569–576.

20. Wojtowicz A, Chaberek S, Pirino A, Montella A, Bandiera P, Kinsner A, et al. The trabecular structure of developing human mandible. Clin Orthod Res. 2001. 4:161–171.

21. Nair MK, Seyedain A, Webber RL, Nair UP, Piesco NP, Agarwal S, et al. Fractal analyses of osseous healing using tuned aperture computed tomography images. Eur Radiol. 2001. 11:1510–1515.

22. Heo MS, Park KS, Lee SS, Choi SC, Koak JY, Heo SJ, et al. Fractal analysis of mandibular bony healing after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002. 94:763–767.

23. Geraets WG, van der Stelt PF. Fractal properties of bone. Dentomaxillofac Radiol. 2000. 29:144–153.

24. Lee KI, Choi SC, Park TW, You DS. Fractal dimension calculated from two types of region of interest. Dentomaxillofac Radiol. 1999. 28:284–289.

25. Southard TE, Southard KA, Lee A. Alveolar process fractal dimension and postcranial bone density. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001. 91:486–491.

26. Wilding RJ, Slabbert JC, Kathree H, Owen CP, Crombie K, Delport P. The use of fractal analysis to reveal remodelling in human alveolar bone following the placement of dental implants. Arch Oral Biol. 1995. 40:61–72.

27. Bollen AM, Taguchi A, Hujoel PP, Hollender LG. Fractal dimension on dental radiographs. Dentomaxillofac Radiol. 2001. 30:270–275.

28. Meredith N, Book K, Friberg B, Jemt T, Sennerby L. Resonance frequency measurements of implant stability in vivo. A cross-sectional and longitudinal study of resonance frequency measurements on implants in the edentulous and partially dentate maxilla. Clin Oral Implants Res. 1997. 8:226–233.

29. Rasmusson L, Kahnberg KE, Tan A. Effects of implant design and surface on bone regeneration and implant stability: an experimental study in the dog mandible. Clin Implant Dent Relat Res. 2001. 3:2–8.