Take-home messages

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.

The validation process of the IDI Evolution bone density diagnosis system has unequivocally shown that TMM3 site-specific bone density measurements are quantitative, reproducible and operator independent.

As mentioned, the validation comes from several independent experiments: the density reading not only correlates with the physical density (mass/volume) of bone tissue but also with the histomorphometric density (trabeculae per area/volume) and with the radiographic one (CBCT gray values).

The IDI Evolution research group then investigated a matter of fundamental relevance. Is the IDI measurement system even capable of distinguishing different cortical-trabecular combinations? The question is extremely important. If so, this would mean that the IDI system can objectively define different bone classes, and it could therefore pave the way for a new bone classification based not on subjective sensations but on quantitative, site-specific measurements.

The answer is affirmative: in 2021, an investigation carried in collaboration with the University of Chieti research group showed that the IDI Evolution system distinguishes between different cortical-trabecular combinations in vitro, using cortico-spongy polyurethane foam blocks to simulate the various combinations of cortical thickness and trabecular density encountered in everyday clinical practice.

Furthermore, the experiment was repeated in 2024 by tweaking the measurement protocol, i.e., by not removing the cortical layer during the measurement process. Once again, the answer was affirmative: the system was able to effectively detect the cortical layer, even in relation to its different thickness, and the various cortical-trabecular combinations used.

These studies are of utmost importance because, on the one hand, they pave the way for the possibility that thanks to the IDI Evolution bone diagnosis system, bone classes can be defined objectively and reproducibly; on the other hand, they show how the TMM3 micromotor can already be a valuable tool for the oral surgeon in everyday practice, to objectively determine the density of the site where the implant will be placed, providing essential information even when CBCT scans of the arch of interest have not been acquired.

References

Arosio P, Sartori M, Arosio F, Garagiola U, Di Stefano DA. Using a Bone Density Measuring Micromotor to Distinguish Different Cortical/Cancellous Combinations in Vitro: A Study Using Polyurethane Foam Blocks. Int J Oral Maxillofac Implants. 2024 Apr 24;39(2):310-318. doi: 10.11607/jomi.10467. 
Link to the article 
IF: 2,000 (2025)

Di Stefano DA, Piattelli A, Iezzi G, Orlando F, Arosio P. Cortical Thickness, Bone Density, and the Insertion Torque/Depth Integral: A Study Using Polyurethane Foam Blocks. Int J Oral Maxillofac Implants. 2021 May-Jun;36(3):423-431. doi: 10.11607/jomi.8419. 
Link to the article 
IF: 2,000 (2025)


Different combinations of cortical thickness and trabecular density, indicated by the HH HN HS, NN, NS, SS, are correctly distinguished by the IDI Evolution bone density diagnosis system as clusters of significantly different density measurements.

What is the importance for clinical research?

These studies show that the IDI Evolution bone density diagnosis system is not just a tool that simply measures bone density (which in itself is already an extremely significant scientific advancement): it also effectively detects different cortical-trabecular combinations, i.e., combinations with different cortical thicknesses and different trabecular densities. This paves the way to investigate if density measurements collected in the clinical setting group into clusters: this would lead to the definition of a new bone classification, based on quantitative, objective, reproducible, and site-specific measurements. These studies are still ongoing. The impact for subsequent studies would be immense: investigations could be conducted based on objective bone classification diagnoses, with significant consequences on the of reproducibility and predictability of the rehabilitation protocols, to the outmost benefit of the patient.

What is the impact on everyday operations?

Using TMM3 as a bone density measurement system in the context of daily clinical practice means exploiting a validated method of site-specific bone density measurement that goes beyond a simple densitometric measurement. It can instead provide crucial information regarding bone quality and provide additional information to those from CBCT scans, when these are available.

In support of IDI Evolution devices

TMM3 is a completely validated tool for diagnosing both bone density and bone quality; its use is therefore highly recommended to have objective and site-specific data regarding the quality of the bone thickness in which the implant will be inserted.

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