Correlating Radiographic Fractal Analysis at Implant Recipient Sites with Primary Implant Stability: An In Vivo Preliminary Study

Objectives The aim of this study was to demonstrate a possible correlation between radiographic trabecular bone quantified with fractal dimensions analysis and values of primary implant stability deliberated using the Osstell(®) monitor (Integration Diagnostics AB, Goteborgsvagen, Sweden) with the density of bone specimens harvested from the implant recipient sites and calculated using the mass and volume of the bone bloc specimens. Material and methods Fifty implants of the same brand, diameter, and length were inserted with the same surgical procedures; 25 implants in the molar premolar region of the maxilla and 25 implants in the mandibular posterior region of only healthy male patients between 20 and 50 years of age. Prior to the placement of the implants, biopsies were taken from the selected site for density calculation using a calibrated trephine. Two photostimulable phosphor digital periapical radiographs were obtained for each patient and two regions of interest were selected for a fractal dimension analysis: one site before implantation and the same site immediately postoperatively adjacent to the implant. Results There were correlations between the fractal dimensions and implant stability quotient as well as between fractal dimensions and bone density. No significant difference was found between the fractal dimensions of pre- and postoperative periapical radiographs for the same region of interest and between implant stability quotient values of the maxillae and mandible sites. Conclusion All executed analyses were helpful in assessing the bone density in the recipient site of implant placement using fractal dimensions, offering complementary information about predictable bone density assessed on a periapical radiograph.