Current and Emerging Approaches to Osseointegration Assessment in Dental Implantology: Limitations, Clinical Utility, and Future Directions

This review evaluates existing methods for the measurement of osseointegration, which is the biological mechanism that assures longterm stability of dental implants. Invasive techniques, such as histology and pull-out torque measures, provide direct objective evaluation; however, they cannot be employed clinically due to their invasive nature. Non-invasive methods such as radiographic imaging, resonance frequency analysis, Periotest, and newer methods utilizing ultrasound have been used clinically. These are mainly based on indirect measurements or incomplete measures regarding bone-to-implant contact. Clinical measures of implant osseointegration are often subjective and vary significantly. Research into biochemical blood markers, biochemical markers in peri-implant fluids, and the use of digital technologies associated with decision-making shows promise for generating more personalized assessment outcomes and possibly predictive capacity. Many factors, including implant design, bone density, surgical technique, systemic disease, and others, influence the accuracy of measurement. Future research assessment will likely be based upon the usage of a multimodal protocol (involving mechanical, radiographic, biological, and computational data) so that the oral surgeon will consider all available data to assist decision-making, evaluation, and enhance long-term assessment of implants.