Use of digital panoramic radiology in presurgical implant treatment planning to accurately assess bone density.

Statement of problem. No cost-effective method of ascertaining bone density from 2-dimensional radiographic images is currently available for dental implants before surgery. Purpose. The purpose of this in vivo study was to use digital panoramic radiology and dental computed tomography (CT) to evaluate the bone density of specific points in the jaw near the tooth-bearing areas. The objective was to determine whether digital panoramic radiology can be used in assessing bone density as an alternative to a more expensive and complex dental CT. Material and methods. This study involved determining bone densities at predetermined anatomic landmarks near tooth-bearing areas of the jaws of 20 participants, using digital panoramic radiology in gray-level scale with a lead step wedge. Subsequently, the bone densities of the same points were determined in Hounsfield units (Hu) with dental CT. The data collected after interpretation of the panoramic radiograph and CT were tabulated and analyzed statistically. Results. Bone density measured using CT correlated with the first 3 steps of (A, B, and C) the digital scale of gray. Further analysis conducted using the Mann-Whitney U test showed a significant association between step A to detect D4 bone, step B to detect D3 bone, and step C to detect D2 type bone. Conclusions. The digital scale of gray obtained from a lead step wedge can be effectively used with digital orthopanoramic radiology to assess bone density before the placement of implants, but with certain restrictions.