Complementary Viewpoints About Bone Quality in the Context of Prosthetic and Implant Success: A Narrative Review

The quality of trabecular and cortical bone is significant for preventing fractures and ensuring implant success, particularly given the rising prevalence of osteoporosis associated with population ageing. However, consensus on the clinical application of bone quality assessments remains elusive. This narrative review examines available methods for assessing bone quality prior to skeletal and maxillofacial surgeries, and explores their impact on prosthesis selection and implant outcomes. A comprehensive literature search was conducted in MEDLINE database to synthesize clinical data on Dual-energy X-ray Absorptiometry (DXA), Computed Tomography (CT), Cone Beam CT (CBCT), Magnetic Resonance Imaging (MRI), and Quantitative Ultrasound (QUS). Current literature reveals that while DXA and MRI are increasingly utilized for orthopedic assessment, CBCT remains the standard in dentistry. The findings emphasize that bone quality, encompassing microarchitecture and turnover, is as critical as mineral density for initial stability and osseointegration. Furthermore, a significant correlation exists between systemic and local bone density, suggesting that maxillary assessments may reflect overall bone health. Integrating these viewpoints enhances preoperative planning and highlights the potential for opportunistic osteoporosis screening in dental settings.