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Bone density and implants – Kate Scheer W&H UK

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  Posted by: The Probe      14th July 2019

Bone quality and quantity are factors that play a significant role in the success of dental implants. Where the bone proves insufficient, osseointegration may not take place to the required degree.[1]

However, while the extent to which bone quality affects dental implants remains an area of continuing debate, bone density has been recognised as a crucial factor for primary stability.[2]Questions over the role of bone quality may in part be due to the difficulty of properly assessing the quality of the bone in the first place. Human jawbones vary considerably in density, not just between individuals, but even within a given anatomical area. This frustrates efforts to accurately assess the nature of the microarchitecture of a given surgical site, particularly using non-invasive means.[

While precisely gauging the nature of the bone can be difficult, patient histories can provide some valuable clues.

Factors that can affect bone density

It is worth remembering that some patients may not always be in a position to have a dental implant placed immediately following the loss of a tooth. There are numerous reasons for this, ranging from financial considerations, to more pressing medical needs that must to be taken care of first, a delay in accessing a practitioner suitably versed in implant dentistry, or simply being unable to set aside the time required for treatment. Clinicians should be understanding of factors that may preclude patients from receiving treatment as early as possible. However, while such delays may be unavoidable due to other circumstances, the biological clock is relentless. Following the loss or extraction of a tooth, changes to the structure of the region are an inevitability. For instance, changes to the shape and dimensions of the root trunk and alveolar ridge occur to varying degrees; with the width of the ridge increasing in most cases (though in a minority of patients, it can collapse).[4]The underlying bone structure will change due to resorption, resulting in a loss of density and possible reshaping. Resorption occurs at a higher rate during the first two years following tooth loss.[5]Bone loss occurs to a considerably greater extent in the mandible compared to the maxilla.[6]

Osteoporosisis a systemic condition of the skeleton. Patients with osteoporosis exhibit reduced bone mass, deterioration of the microarchitecture of the bone, reduced bone strength and a greater susceptibility to fracturing and breakage. Osteoporosis may increase the severity of alveolar bone loss.[7]

While osteoporosis is often regarded as a condition afflicting post-menopausal women, due to its prevalence in that demographic (around 50%), it should be remembered that this is not exclusively the case.[8]Around 20% of men over the age of 50 break bones due to the condition, and it can occur in far younger patients (usually due to another underlying medical condition).[9]

Insufficient intake of calcium and vitamin D can adversely affect bone strength. Biology and lifestyle choices can affect this, but are usually something that can be addressed by the patient without undue difficulty. For example, vegan and lactose intolerant patients cannot rely on dairy products, which are widely known as a rich source of calcium. However, there are various other foods containing calcium, including leafy vegetables, nuts, seeds and soya. Another option is vitamin supplements or fortified foods.

Most people in the UK can get the amount of vitamin D necessary for calcium regulation and bone repair, simply through moderate sunlight exposure during the summer months. Some patients may get less sunlight exposure than optimal due to being housebound, religious or culturally required clothing, albinism, work patterns, etc. A simple supplement can offset this.

Medications. Drugs that affect testosterone production, or how the body responds to it, can reduce bone density. These can include various medications that are prescribed for epilepsy, breast cancer, prostate cancer, and gender re-assignment.[10]Smoking and heavy alcohol consumption are also risk factors for osteoporosis.[11]

Low body weight (BMI below 19kg/m2) can result in a reduction of bone density.[12]Patients who are anorexic, or have recovered from anorexia are also more likely to have less bone density, particular if they had the disorder during their teenage years while their bones were still developing.[13]Conversely, obesity has been observed to actually reduce the risk of osteoporosis compared to those of an average BMI.[14]

While reduced bone density might increase the likelihood of reduced implant stability, it is not necessarily a contraindication. In any case, the Osstell BeaconTMand Osstell IDx from W&H provide a precise Implant Stability Quotient (ISQ) value, ranging from 1 to 100 – making it clear and easy to accurately measure primary implant stability and observe osseointegration based on secondary stability readings. The Osstell ISQ module is also available as an additional function of W&H’s new Implantmed S1-1023 surgical unit, making it an all-in-one surgical solution. With such a dependable and precise method of determining implant stability, you will have invaluable diagnostic information that can help determine the best time to load and to monitor the osseointegration process.

Literature reviews and meta-analyses have found the effects of osteoporosis on implant success to be inclusive. Implants are generally regarded as feasible for patients with low bone density, though it should be factored into treatment and observation.[15],[16]

 

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

 

 

Reference

[1]Li J., Yin X., Huang L., Mouraret S., Brunski J., Cordova L., Salmon B., Helms J. Relationships among bone quality, implant osseointegration, and Wnt signaling. Journal of Dental Research.2017; 96(7): 822-831. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480808/January 17, 2019.

[2]Merheb J., Temmerman A., Rasmusson L., Kübler A., Thor A., Quirynen M. Influence of skeletal and local bone density on dental implant stability in patients with osteoporosis. Clinical Implant Dentistry and Related Research.2016; 18(2): 253-260. https://onlinelibrary.wiley.com/doi/full/10.1111/cid.12290January 17, 2019.

[3]Li J., Yin X., Huang L., Mouraret S., Brunski J., Cordova L., Salmon B., Helms J. Relationships among bone quality, implant osseointegration, and Wnt signaling. Journal of Dental Research.2017; 96(7): 822-831. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480808/January 17, 2019.

[4]Leblebicioglu B., Hegde R., Yildiz V., Tatakis D. Immediate effects of tooth extraction on ridge integrity and dimensions. Clinical Oral Investigations.2015; 19(8): 1777-1784. https://link.springer.com/article/10.1007%2Fs00784-014-1392-1January 17, 2019.

[5]Stomatol A., Knezoviê D., Zlatariê A., Laziê B., Knezoviê-Zlatariê D. A S C Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers. Acta stomatologica Croatica. 2002; 36(2): 261-265.

https://hrcak.srce.hr/file/6144January 17, 2019.

[6]Emami E., Freitas de Souza R., Kabawat M., Feine J. The impact of edentulism on oral and general health. International Journal of Dentistry. 2013; 2013: 498305. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664508January 17, 2019.

[7]Giro G., Chambrone L., Goldstein A., Rodrigues J., Zenóbio E., Feres M., Figueiredo L., Cassoni A., Shibli J. Impact of osteoporosis in dental implants: a systematic review. World Journal of Orthopedics. 2015; 6(2): 311-315. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363814/January 17, 2019.

[8]Gambacciani M., Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Menopause Review.2014; 13(4): 213-220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520366/January 17, 2019.

[9]National Osteoporosis Society. All about osteoporosis and bone health. National Osteoporosis Society. 2016. https://nos.org.uk/media/1622/all-about-osteoporosis-august-2016.pdfJanuary 17, 2019.

[10]National Osteoporosis Society. All about osteoporosis and bone health. National Osteoporosis Society. 2016. https://nos.org.uk/media/1622/all-about-osteoporosis-august-2016.pdfJanuary 17, 2019.

[11]Sampson H. Alcohol and other factors affecting osteoporosis risk in women. National Institute of Alcohol Abuse and Alcoholism. 2003. https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htmJanuary 17, 2019.

[12]National Osteoporosis Society. All about osteoporosis and bone health. National Osteoporosis Society. 2016. https://nos.org.uk/media/1622/all-about-osteoporosis-august-2016.pdfJanuary 17, 2019.

[13]Zipfel S., Seibel M., Löwe B., Beumont P., Kasperk C., Herzog W. Osteoporosis in eating disorders: a follow-up study of patients with anorexia and bulimia nervosa. The Journal of Clinical Endocrinology & Metabolism. 2001; 86(11): 5227-5233. https://academic.oup.com/jcem/article/86/11/5227/2849361January 17, 2019.

[14]Sampson H. Alcohol and other factors affecting osteoporosis risk in women. National Institute of Alcohol Abuse and Alcoholism. 2003. https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htmJanuary 17, 2019.

[15]Radi I., Ibrahim W., Iskandar S., Nabi N. Prognosis of dental implants in patients with low bone density: a systematic review and meta-analysis. The Journal of Prosthetic Dentistry. 2018; 120(5): 668-677. https://www.thejpd.org/article/S0022-3913(18)30094-5/fulltextJanuary 17, 2019.

[16]Giro G., Chambrone L., Goldstein A., Rodrigues J., Zenóbio E., Feres M., Figueiredo L., Cassoni A., Shibli J. Impact of osteoporosis in dental implants: a systematic review. World Journal of Orthopedics. 2015; 6(2): 311-315. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363814/January 17, 2019.

 


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