REVISITING BONE DENSITY: A REVIEW ON MISCH CLASSIFICATION

Abstract

Dental implants have been the treatment trend for more than a decade. They are the most predictable modern solution for missing teeth. The success of dental implants however, depends primarily on alveolar bone quantity and quality. Compromised bone quality and quantity are considered as potential risk factors for biological complications of the implant which can eventually cause early implant loss. The external architecture of the alveolar bone and its volume are usually evaluated by default during treatment planning for dental implants. The internal architecture is often not critically evaluated. The external and internal architecture of bone regulates almost all the facets of implant dentistry practice. From implant design selection, surgical approach, healing time to type of future prosthetic reconstruction, every aspect is dependent on bone density at the planned site. Various classifications have been described till date to describe the bone quantitatively and qualitatively. An example includes, Lekholm and Zarb listed four types of bone quality found in the anterior regions of the jawbone. This classification, widely used in modern implant dentistry, is essentially qualitative and defines bone quality based on the relationship between compact cortical and the trabecular bones. Misch and associates developed a quantitative classification for the bone density which is the most commonly used classification till date. Time and again new classifications have emerged, yet the Misch classification of bone density seems to be popularly used and considered the gold standard for bone density. This review aims to describe the attributes of the Misch classification and its clinical significance.