# Association Between the Mandibular Inferior Cortical Shape on Panoramic Radiographs and the Prognosis of Hydroxyapatite Implant Placement

## TL;DR

This study finds that the shape of the lower jawbone in panoramic X-rays can predict the success of dental implants coated with hydroxyapatite, especially in older or osteoporotic patients.

## Contribution

The study introduces a novel association between mandibular cortical shape on panoramic radiographs and the prognosis of hydroxyapatite implant placement.

## Key findings

- Patients with eroded mandibular cortices had a 13.50 times higher risk of implant failure.
- An increase of 100 HU in trabecular bone CT values was linked to a 1.50 times higher failure risk in normal cortex cases.
- Implant survival was positively associated with the number of remaining teeth.

## Abstract

Objective

Dental implant therapy is a widely accepted treatment option for edentulous patients. However, implant success can be influenced by various factors, including systemic bone conditions such as osteoporosis. This study aimed to evaluate the association between the mandibular inferior cortical shape observed on panoramic radiographs and the prognosis of hydroxyapatite (HA)-coated implant placement in the maxilla.

Materials and methods

A total of 125 patients (381 maxillary implants) who underwent HA implant placement with a minimum five-year follow-up were included. The mandibular inferior cortical shape was classified using panoramic radiographs based on the mandibular cortical width (MCW) and mandibular cortical index (MCI). Preoperative trabecular bone CT values were measured using Simplant® software. Logistic regression analysis was performed to investigate the relationship between cortical shape, trabecular bone CT values, and implant prognosis.

Results

The overall implant survival rate was 93.2%. Patients with mildly to moderately or severely eroded mandibular cortices had a significantly higher risk of implant failure compared to those with normal cortices (OR = 13.50, p = 0.028). In cases with normal cortices, an increase of 100 HU in trabecular bone CT values was associated with a higher risk of implant failure (OR = 1.50, p = 0.003). Implant survival was positively associated with the number of remaining teeth, while implants placed in the maxillary posterior region tended to show lower survival.

Conclusion

Mandibular inferior cortical shape assessed via panoramic radiographs is significantly associated with the prognosis of HA-coated implant placement. Panoramic radiograph-based evaluation may serve as a useful screening tool for identifying patients at increased risk of implant failure and for supporting individualized treatment planning, particularly in elderly or osteoporotic populations.