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Systemic Osteoporosis and Reduction of the Edentulous Alveolar Ridge Srđan D

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Systemic Osteoporosis and Reduction of the Edentulous Alveolar Ridge Srđan D CORE Metadata, citation and similar papers at core.ac.uk Provided by Directory of Open Access Journals INTERNATIONAL International Journal of BioMedicine 3(3) (2013) 201-206 JOURNAL OF BIOMEDICINE DENTISTRY Systemic Osteoporosis and Reduction of the Edentulous Alveolar Ridge Srđan D. Poštić, PhD*1; Nada Vujasinović-Stupar2; Zoran Rakočević3 1 Clinic of Dental Prosthetic,University School of Dental Medicine, University of Belgrade 2 Insitute of rheumatology, Faculty of Medicine, University of Belgrade 3 Insitute of Radiology, University School of Dental Medicine,University of Belgrade Belgrade, Serbia Abstract Systemic osteoporosis can damage skeletal bones to different degrees or remain persistent in intensity. The aim of this study was to determine the intensity and correlation of the osteoporotic changes in the bone density of the skeleton and body mass index (BMI) with a reduction in edentulous mandibles. Material and Methods: In this study, 89 edentulous patients with decreased bone density comprised the experimental group, and 43 edentulous patients with normal bone densities formed the control. The age of the patients ranged between 53 and 73 years. Radiographs of the hands and panoramic radiographs were done for all the patients. The values of BMI, metacarpal index , density of lumbar spine (L2-L4), in the phalanx and segments of the mandibles as well as the heights of the edentulous alveolar ridges were measured, assessed and calculated. Results: The lowest value of the total skeletal density was established in the osteoporotic patients on the basis of the average T-score of -2.5 in men, and - 2.6 in women. Minimum values of the heights of the edentulous ridges (right/left, in mm) were measured in both osteoporotic female (21.84/22.39) and male (24.90/24.96) patients. By comparison of the densities of the metacarpal bones, proximal phalanx, segments of the edentulous mandibles and based on the numerical values of the heights of the edentulous ridges, χ²=3.81 was found in men and χ²=4.03 was found in women with normal bone densities; χ²=5.92 was found in men and χ²=6.25 was found in women with osteopenia; χ²=2.63 was found in men and χ²=3.85 was found in women with osteoporosis, on the P level of probability of 0.05. Conclusion: Systemic osteoporosis causes a decrease of the jawbone density and induces residual edentulous alveolar ridge reduction. Keywords: osteoporosis, jaw, bones, densitometry. Introduction studies showed the significant role played by the metabolic factors and osteoporosis on the initiation of the reduction of the Osteoporosis reduces bone mass and increases bone edentulous residual alveolar ridges [9]. fragility [1,2]. Data in the literature also indicate the problem of Reduced blood flow to the jaw - particularly in the lower a significant influence of systemic osteoporosis on bone atrophy jaw and difficulty in circulation associated with systemic and a reduction in the residual alveolar ridge of the jaw [3-6], osteoporosis can cause loss of bone substance in the edentulous inducing a much greater rate of resorption and the maximum residual alveolar ridges [15,16]. In addition, if there are signs form of a reduced ridge than it would seem at first sight, to be of alveolar bone resorption under a denture that fits comfortably the local factors that affect immediately after tooth extractions in the intimate underlying tissue, the causes, in the first place, [7,8]. However, there is still controversy concerning whether should be sought in systemic osteoporosis as tissue degradation osteoporosis significantly affects the absorption of edentulous [17,18]. alveolar ridges [7, 9-11] or whether its impact on the jaw reduction Difficulties in metabolism and systemic osteoporosis are is insignificant [12-14]. Also, the results based on the previous directly responsible for the appearance of a pronounced reduction in the residual alveolar ridges of the maxilla and mandible [19]. In most of these studies the technique of roentgen dental panoramic *Corresponding author: Doc dr Srđan D. Poštić, PhD. monitoring was used, which is confirmed in the literature as the Clinic of Dental Prosthetic, School of Dental Medicine, University of Belgrade.4, Rankeova , Belgrade, 11000, Serbia. correct approach in the diagnosis and therapy for many diseases Tel: +381-2435-719. of the oro-facial region of edentulous patients as well as in E-mail address: [email protected] patients with remaining teeth [20]. 202 Srđan D. Poštić et al. / International Journal of BioMedicine 3(3) (2013) 201-206 A low BMI has also been described as one of the risk factors Table 2. that may indicate the beginning or the presence of atrophy and Distribution of patients into groups by degree of reduction and resorption of the alveolar ridges, with the fact that patients with height of edentulous residual ridge (P=0.752) low bone mineral density (BMD) may not always have reduced T-score Reduction Height of edentulous edentulous alveolar ridge, and vice versa. It is also acceptable L1-L4 of edentulous ridges of ridge of mandible mandibles (mm) that patients without supple bone structure and anatomically Small Moderate Intensive Right Left minor dimensions of the bones usually have significantly marked signs of resorption of the jawbone when compared with a subject Normal 33 10 0 25.24 25.44 with normal BMD and increased BMI [21-24]. Osteopenia 5 13 5 25.16 25.19 The null hypothesis H0 in this study is that there were Osteoporosis 2 12 41 23.41 23.64 significant differences in the bone density of different bones within each group with normal bone density, osteopenia or with Metacarpal Index osteoporosis. The MI was calculated based on the measurement of the The aim of this study was to determine the intensity and differences between the width of trabecular-spongy part of the correlation of the osteoporotic changes in the bone density of bone and the width of the cortical bone in the middle segment of the skeleton and body mass index (BMI) with a reduction in the second metacarpal bone according to the formula, edentulous mandibles. MI = width of the spongy portion – cortical thickness/ numerical value of the overall diameter of the middle shaft of the second metacarpal [2,4]. Material and Methods Measurement of the bone density of the second metacarpals Patients: This study examined all the 132 edentulous patients from Measurements of the density of the second metacarpal bones 53 to 73 years of age. All patients were treated as outpatients in were provided based on the AP carpal radiographs. On the the Clinic. The experimental group with reduced BMD included radiographic appearances of each of second metacarpal on the AP 89 edentulous patients (50 females and 39 males). The control radiographs of hands, transparent foil was positioned according to group consisted of 43 edentulous patients (25 males and 18 the dimensions of the metacarpal contour. Each foil had a number females) with normal bone density (Table 1). All the patients had of squares of identical dimensions (2x2mm). A light beam from been edentulous for at least three months or more. The longest the densitometer (DT 11 05, England) was transmitted through period of edentulism was six months in one patient. each square. Data on the metacarpal density were provided as a sum of all of the measured densities through the quadrants which Table 1. were approximated to the average value [4,11,16]. Distribution of patients’ age by different groups of bone mineral Measurement of the bone density of the proximal phalanx: density. Measurements of the density of the second proximal phalanx Women Men bones were provided based on the AP carpal radiographs. On the T score Average age SD Average age SD radiographic appearances of each of proximal phalanx on the AP Normal bone density 67.41 5.27 65.12 6.11 n=43 radiographs of hands, transparent foil was positioned according Osteopenia 69.45 7.93 67.32 8.47 to the dimensions of the bone conours. Each foil had a number of n=34 squares of identical dimensions (2x2mm). A light beam from the Osteoporosis 70.27 8.11 74.89 9.05 densitometer (DT 11 05, England) was transmitted through each n=55 square. Data on the proximal phalanx density were provided as a In order to collect data, the parameters of weight (in kg) sum of all of the measured densities through the quadrants which and height (in cm) were measured, antero-posterior carpal were approximated to the average value [4,11,16]. radiographs (APCR) (Siemens Rtg apparatus, tube Dofoks RX Measurement of the bone density of the lower jaw 150/30-50, focus 2 mm), and standardized panoramic radiographs The region wherein the lower jaw was missing the lower (Kodak T-MAT G) were taken of all the patients in accordance first molar was determined in this study for measurements of with the predetermined distance on a scale on the plastic chin- both of bone density and edentulous ridge height. Transparent holder of the panoramic X-ray unit (Orthopantomograph 10, films with mesh (squares of dimension 2mm x 2mm) were Serial No. 01492, Siemens, Germany) under the determined then positioned onto each of the panoramic radiograph of each conditions (68 KV and 5 mA). patient. Numerical values of the digital light-optical densities DXA were recorded using a densitometer (DT 11 05, England) by Data on the BMD at the system level were obtained by transmission of a light beam through each square of the region of scanning the lumbar vertebrae with dual X-ray absorptiometry interest [4,11,16,33,34,35]. (DXA) (Lunar DPX-L scanner, General Electric, USA). On the Measurement of heights of the edentulous ridges basis of the generally accepted definition of WHO, the patients Two parameters were analyzed on the panoramic were divided into a group with normal bone density, a group radiographs: heights of the mandibular edentulous ridges in with osteopenia and a group with osteoporosis (Table 2) [25].
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