The Interrelation between Cortical Bone Thickness and Primary and Secondary Dental Implant Stability: a Systematic Review

Objectives: Dental implants have emerged as a reliable and long-lasting solution for missing teeth, offering advantages over traditional prosthetic options. The aim of this systematic review was to thoroughly explore the correlation between cortical bone thickness of the jaws and bone-level dental implant primary and secondary stability. Material and Methods: A comprehensive literature search was conducted in MEDLINE (PubMed), ClinicalKey and the Cochrane Library from 1 January, 2019 to 21 June, 2024. This review focused on patients undergoing dental implant placement with varying cortical bone thicknesses and implant stability levels. Quality and risk-of-bias assessment evaluated by Cochrane risk of bias tool. Results: Out of 160 screened articles, 28 were reviewed in full, and 6 met the inclusion criteria, involving 209 patients and 418 implants. Implant stability quotient (ISQ) values showed no significant correlations during baseline and secondary assessments (P > 0.05). Correlations were noted between implant stability, bone density, alveolar ridge width, and implant size (P < 0.01). ISQ and insertion torque value (ITV) were strongly correlated at insertion (P < 0.001) but not at follow-ups (P = 0.059 at 2 months, P = 0.817 at 6 months, P = 0.029 at 12 months). ISQ values increased over time (P < 0.001). Implants in native bone showed higher ISQ values at baseline (P = 0.011), 8 weeks (P = 0.013), and 12 weeks (P < 0.001). Regions with thicker cortical bone demonstrated superior primary stability. Conclusions: Thicker cortical bone enhances primary implant stability, as indicated by higher insertion torque and implant stability quotient values.