The Influence of Tactile Perception on Classification of Bone Tissue at Dental Implant Insertion

Background: Various ways of using the Lekholm and Zarb (L&Z) classification have added to the lack of scientific evidence of the effectiveness of this clinical method in the evaluation of implant treatment. Purpose: The study aims to assess subjective jawbone classifications in patients referred for implant treatment, using L&Z classification with and without surgeon's hand perception at implant insertion. The association between bone type classifications and quantitative parameters of primary implant stability was also assessed. Materials and Methods: One hundred thirty-five implants were inserted using conventional loading protocol. Three surgeons classified bone quality at implant sites using two methods: one based on periapical and panoramic images (modified L&Z) and one based on the same images associated with the surgeon's tactile perception during drilling (original L&Z). Peak insertion torque and implant stability quotient (ISQ) were recorded. Results: The modified and original L&Z were strongly correlated (rho=0.79; p<.001); Wilcoxon signed-rank test showed no significant difference in the distribution of bone type classification between pairs using the two methods (p=.538). Spearman correlation tested the association between primary stability parameters and bone type classifications (-0.34 to -0.57 [p<.001]). Conclusions: Tactile surgical perception has a minor influence on rating of subjective bone type for dental implant treatment using the L&Z classification.