Carl E Misch (1947-2017) was an American prosthodontist who devised the Misch Classification, which describes the quality and quantity of bone, to aid selection of an appropriate drill protocol. Bone Quality and Quantity are important factors affecting the success of osseointegration.
Misch gives a separate classification for bone quality (density) and bone quantity (volume)
Bone Quality (Density) Classification
(Misch objectifies density by suggesting a measurable density reading in Hounsfield units)
D1 – Dense cortical – (tactile analogue: Oak/Maple) – typically in ant. mandible – Hounsfield Units:>1250
D2 – Porous cortical & coarse trabecular – (tactile analogue: White pine/spruce) – typically in ant./post mandible, ant. maxilla – Hounsfield Units 850-1250
D3 – Porous cortical (thin) & fine trabecular – (tactile analogue: balsa wood) -post. mandible, ant/post maxilla – Hounsfield Units 350-850
D4 – Fine trabecular – (Tactile analogue: styrofoam) – post. maxilla – Hounsfield Units 150-350
Bone Quantity (Volume) Classification
Division A – bone height >10mm, width>5mm
Division B – bone height >10mm, width at crest 2.5-5mm
(may require bone grafting/osteoplasty)
Division C – bone height <10mm, width<2.5mm
(bone grafting likely to be required)
Division D – severely deficient bone volume in both height and width
(extensive bone manipulation required)
dentalsmackers 