Bone quality evaluation: comparison of cone beam computed tomography and subjective surgical assessment.

To examine the relationship between dental cone beam computed tomography (CBCT) gray scale values and Hounsfield units (HU), and whether the gray values of edentulous sites correlate with the subjective clinical bone quality assessed at surgery. Two radiographic phantoms containing varying concentrations of either dipotassium hydrogen phosphate or calcium hydroxyapatite (HA) were imaged using multislice CT or CBCT. Reconstructed DICOM data were analyzed to examine the relationship between CBCT gray values and HU. Presurgical CBCT scans from 52 patients who underwent implant placement in the posterior sextants were used. The gray values of the edentulous implant sites were measured and compared with the subjective bone quality assessed at surgery. There was a strong correlation between CBCT gray values and HU. CBCT gray values increased linearly with increasing calcium HA or bone equivalent density material. CBCT gray values measured at edentulous implant sites ranged from -455 to 642, with a trend of decreasing gray values with bone quality type. The median gray values for the four subjective bone types were: 362 (type 1), 214 (type 2), 76 (type 3), and -454 (type 4). CBCT gray values can be used to infer bone density and may provide a valuable aid to predict bone quality at potential implant sites.