Take-home messages

  • The IDI Evolution bone density measurement system has allowed for the first time in the history of clinical research to draw the topological map of trabecular bone density of the maxillae.
  • The results of IDI Evolution's research on the distribution of bone density in the maxillae support personalized implantology for each patient: site-specific density measurement, performed with TMM3, is fundamental for customizing the implant insertion protocol and therefore the entire prosthetic rehabilitation.

Thanks to the IDI Evolution devices for site-specific bone density measurement, a fundamental clinical result has been achieved in understanding the distribution of bone density in the maxillae.

It has long been known that the anterior sectors of the maxillae have a greater density than the posterior ones, and that the density of the mandible is greater than that of the maxilla; this knowledge has always guided the implantologist in the choice of the implant and in the preparation of the implant site.

However, before this research, no one had ever measured punctually, for each dental position, the bone density in a representative sample of patients, and accurately determined the distribution of bone density.

The IDI Evolution measurement system has allowed this result to be achieved, since it allows a site-specific determination of bone density at the exact point where the implant will be inserted.

The research was based on a specific database of measurements, relating to 6060 implant insertions and 2048 patients, which was then analyzed in collaboration with researchers from the Vita-Salute University of Milan: position by position, researchers calculated the average density and its dispersion (variation), and built a real "topological map" (see figure), that was published in 2019 in the prestigious Implant Dentistry journal: something no one had ever done before.

Even more interestingly, researchers have shown that in a normal population of patients, bone density at a given position is not predictable, as it can vary - compared to the mean value - even by +/- 30%. 

These results show that the bone density of each patient at each position of the arches must be measured case by case; therefore, the use of "standardized" implant protocols should be evaluated with extreme caution. Instead, implant therapy should be highly personalized according to the characteristics and needs of each individual patient.

In this context, the use of a site-specific density measurement system, such as TMM3, becomes of fundamental importance: not only it has allowed the achievement of this fundamental result for clinical research, but it is a daily tool that can make implant insertion truly personalized.

References

Di Stefano DA, Arosio P, Pagnutti S, Vinci R, Gherlone EF. Distribution of Trabecular Bone Density in the Maxilla and Mandible. Implant Dent. 2019 Aug;28(4):340-348. doi: 10.1097/ID.0000000000000893. 
Link to the article
IF: 1,214 (2025)


Distribution of trabecular bone density in the mandible (A) and in the maxilla (B). The shape of the distribution is bell-shaped in the maxilla, but not in the mandible. Density varies continuously from point to point.

What is the importance for clinical research?

Before this study was carried out, the distribution of trabecular bone density for each position of the maxillae was unknown; this study draws it for the first time, showing it varies continuously from position to position and has a dispersion of measurements that calls for caution concerning excessive standardization of implant insertion protocols. The combination of this result with those of further studies related to the cortical component could pave the way for a new, more objective bone classification than previous ones, which allows for complete customization of the implant insertion protocol, provided that the implant has been correctly characterized from a biomechanical point of view.

What is the impact on everyday operations?

  • TMM3 gives the oral surgeon a fundamental tool for defining the correct implant insertion protocol, complementing the other diagnostic information at his disposal.
  • Using TMM3 for measuring bone density allows treating patients according to their specific, personal condition, thus increasing the likelihood of short- and long-term success of the entire prosthetic rehabilitation.

In support of IDI Evolution devices

TMM3 collects fundamental data for designing and carrying out any implant insertion; surgeons can exploit, in their clinical practices, a tool that is contributing significantly to the advancement of clinical research: the scientific and clinical results it has allowed achieving, represent its validation as a reliable system that makes implantology even more reproducible and predictable.

Other Publications

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We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

The relationship between the extent of cortical undersizing, the primary stability it allows to achieve, the early and late marginal bone resorption it may induce has still not been clarified: studies on this matter are contradictory and inconclusive.
However, IDI Evolution systems are the only ones capable of site-specific discrimination and operator-independent assessment of different combinations of cortical thickness and cancellous density, providing a measure of implant primary stability, the Torque-Depth Integral, which also evaluates the mechanical stress exerted on the cortical thickness.

Read moreabout We have paved the way to provide objective protocols for undersizing the cortical layer, making the clinical procedure reproducible, and the outcome predictable in terms of MBL

We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

The research carried out by IDI Evolution shows that TMM3 measures even bone quality, that is the combination of a given cortical layer thickness and a given trabecular density.

Read moreabout We have demonstrated that the IDI bone density diagnosis system can distinguish between different cortical-trabecular combinations, paving the way for a new objective bone classification

We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used

The Integral of the torque-depth curve, measured by TMM3 during implant insertions, varies predictably in relation to how underprepared the implant tunnel is.
The variation of the Integral is also predictable when altering the implant geometry, both in terms of shape (conical, cylindrical, etc.) and dimensions (diameter/length).
The mathematical algorithms describing these variations are also influenced by bone density.

Read moreabout We have defined an objective method for rationally choosing both the protocol for preparing the implant site and the shape and dimensions of the implant to be used