# Microstructural Evaluation of Dental Implant Success Using Micro-CT: A Comprehensive Review
## 5 Correlation of Bone Microstructure with Implant Stability  
One of the critical elements in the successful implementation of dental implant treatment is the identification of the most suitable site for prosthetic reconstruction and the subsequent planning of surgical procedures [66; 67]. The condition of the bone that the implant will occupy also needs to be considered [67]. Recent research has demonstrated that the microarchitecture of trabeculae can impact the stability of dental implants, underscoring the importance of trabeculae assessment [24]. The success of a dental implantation procedure hinges on the attainment of adequate primary stability. The term primary stability refers to the implant's inability to move after insertion. This depends on the mechanical bond between the implant and the surrounding bone. In the event of inadequate primary stability, excessive micro-movement may occur at the bone-implant interface during the process of bone healing. Secondary stability, in contrast, represents the biological stability that emerges as a consequence of alveolar bone formation and remodeling on the implant surface [24; 43; 68]. Implant stability can be quantified through the use of either invasive or non-invasive methodologies [13]. Invasive methods include removal torque (RT), histological, and histomorphometry studies; however, these methods are only employed in experimental settings. Non-invasive methods include percussion testing, X-ray analysis, the Periotest(r), and resonance frequency analysis (RFA). While some of these non-invasive techniques have inherent limitations, RFA is a valuable tool for assessing implant stability and is frequently employed in clinical settings. An additional crucial element influencing the efficacy of osseointegration is bone density, which can be assessed through computed tomography (CT) or cone beam CT (CBCT) [43]. In the context of preoperative measures, it is standard practice to perform a CT scan, in this case, a CBCT scan, in order to ascertain the quality of the bone in the region where the implant is to be placed [69]. In a retrospective study conducted by [PERSON] et al. (2017) on factors affecting implant success, it was stated that early implant failure can occur due to a failure in the osseointegration process that occurs within a few weeks to months post-implantation. This can be attributed to a number of factors, including bone necrosis, bacterial infection, surgical trauma, inadequate initial stability, and early occlusal loading, which can all contribute to early failure. Subsequent failures in the osseointegration process may result from prolonged and excessive mastication forces, which can lead to the development of peri-implantitis, a condition characterized by infection and bone loss around the implant. The available evidence indicates that implant failure is more prevalent with shorter and wider implants, largely due to the influence of poor bone density and operator skill. Nevertheless, shorter or wider implants may be suitable for unfavorable locations, such as those with lower bone density. In such cases, it is essential to consider not only the bone quality and quantity but also their impact on the success of dental implant placement [70]. Another factor that can contribute to implant instability is marginal bone loss, which should be taken into account following dental implant placement. Marginal bone loss is a multi-factorial event occurring in the cervical region of dental implants. These include implant malposition, excessive surgical trauma, high adhesion of supracast tissues, stress overload, micro-motion, location and bacterial infiltration of the implant-support connection, and periodontal phenotype. In addition, bone density and maintenance of oral hygiene are also important factors. Regardless of the underlying cause, marginal bone loss is a significant contributing factor to the development of peri-implantitis [71; 72; 73].