Histomorphometric Analysis of Bone Density in Relation to Tactile Sense of the Surgeon During Dental Implant Placement

Amir Reza Rokn, Akram Labibzadeh*, Amir Alireza Rasouli Ghohroudi, Ahmad Reza Shamshiri, Somaye Solhjoo
Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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© 2018 Rokn et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Tehran University of Medical Sciences, Periodontology department, Iran; Tel: +989128158893; Fax: +982122451377; E-mail:



A correct diagnosis and optimal treatment planning is essential for success in implant dentistry. Proper diagnosis of bone quality is an important part of the diagnostic procedure.


The purpose of this study was to correlate the tactile sense of the surgeon in the assessment of bone density to the histomorphometric analysis of bone quality.


In this study, 56 bone samples from 33 patients were harvested from implant sites with trephine drills. The samples were analyzed with Image J software. In the samples following parameters were measured: BV/TV, superficial cortical plate thickness, the number and thickness of haversian canals in cortical bone and the number, thickness and distance of trabecules in cancellous bone. The clinical hardness of bone during drilling was evaluated by surgeon according to Misch. GEE analysis with exchangeable correlation structure and linear model was used to evaluate the relationship between the tactile sense of the surgeon and histomorphometric parameters and all analysis was adjusted for two confounding variables: gender and location.


There were 51.79% implants in D2 samples and 48.21% in D3. Bone classification according to Misch was significantly correlated to distance of trabecules in cancellous bone (P-value=0.05), and shown marginally significant correlation with mean superficial cortical bone thickness (P-value =0.07) and number of haversian canals (P-value =0.005) in cortical bone.


There were differences between our results and others. The authors believed that these differences mainly are because of confounding factors, that in this study were eliminated. The clinical finding during surgery can approximately explain the histologic properties of bone.


It is concluded that tactile sense of the surgeon can exhibit the histologic properties of the bone, and we are able to estimate the healing prognosis of the bone in implant placement.

Keywords: Tactile sense, Histomorphomtry, Bone density, Dental implants, Optimal treatment planning, Osseointegration.