Does bone mineral density influence the primary stability of dental implants? A systematic review.

OBJECTIVE The aim of this systematic review was to investigate the influence of bone mineral density on the primary stability of dental implants. MATERIAL AND METHODS A search of health science databases (Cochrane Library, MEDLINE-PubMed, ISI Web of Knowledge, EMBASE, LILACS) and grey literature was performed, including papers published until January 2011. The main key words used were "bone density" (MeSH/DeCS), "dental implant" (MeSH/DeCS), "implant stability", "implant stability quotient", "ISQ", "resonance frequency analysis", "RFA", "Osstell", "Periotest value", "PTV", "Periostest", "insertion torque", "placement torque", "cutting torque". The inclusion criteria comprised observational clinical studies performed in patients who received dental implants for rehabilitation; studies that evaluated the association between bone mineral density and implant primary stability; bone density assessment performed by measurement of Hounsfield units using cone beam computed tomography; and dental implant primary stability evaluated by ISQ value, PTV value or insertion torque measurement. The articles selected were carefully read and classified as low, moderate and high methodological quality, and data of interest were tabulated. RESULTS Ten articles met the inclusion criteria, but only seven were included because of overlapping patients. They were classified as low or moderate methodological quality and control of bias, and presented positive association between primary stability and bone density. CONCLUSIONS There is a positive association between implant primary stability and bone mineral density of the receptor site. However, the methodological quality and control of bias of the studies should be improved to produce stronger evidences.