Association between panoramic radiomorphometric indices measured on cone-beam computed tomography-reconstructed standardized panoramic images and implant primary stability

Objectives: This study aimed to investigate the associations between panoramic radiomorphometric indices measured on cone-beam computed tomography (CBCT)-reconstructed standardized panoramic images and implant primary stability, with adjustment for within-patient clustering and clinical covariates.Materials and Methods: This retrospective study analyzed patients who received dental implants (Osstem TS III) placed by a single operator between September 2022 and March 2025.Standardized panoramic images were reconstructed from CBCT datasets.Mandibular cortical index (MCI), mental index (MI), infra-mental foramen index (IMI), panoramic mandibular index (PMI), antegonial index (AI), and gonial index (GI) were measured.Primary stability was quantified by resonance frequency analysis as the implant stability quotient (ISQ).Because the indices are patient-level measurements whereas ISQ is measured per implant, linear mixed-effects models with a random intercept for patient were used, adjusted for jaw, region, age, sex, implant diameter, and implant length.Multiplicity was addressed by false discovery rate correction.Results: Ninety-two implants from 60 patients (33 male, 27 female; mean age, 61.3 years) were analyzed.The intraclass correlation coefficient for ISQ within patients was 0.44.Adjusted marginal mean ISQ differed across MCI classes (C1, 75.9;C2, 67.6; C3, 58.0; P<0.001).In adjusted models, IMI (β=4.73;95% confidence interval [CI], 2.47-6.99;P<0.001) and MI (β=6.83;95% CI, 2.94-10.71;P<0.001) were significantly associated with ISQ, as was PMI to a lesser degree (P=0.016),whereas AI and GI were not.In exploratory jaw-stratified analyses, associations persisted at mandibular sites but not at maxillary sites.Results were unchanged in sensitivity analyses.Conclusion: MCI, MI and IMI measured on CBCT-reconstructed standardized panoramic images were associated with implant primary stability.These indices may provide supplementary patient-level information but cannot independently predict implant primary stability, and validation on conventional panoramic radiographs is required before clinical application.