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Dental Implant Placement and Osteoporosis

Osseointegrated implants have significantly improved aesthetic restorative procedures, and osseointegration has evolved into a predictable, scientific phenomenon. As evidenced in many educational forums, the paradigm has shifted from the process of osseointegration to site development with bone/soft tissue augmentative techniques and immediate load. Although the focus on the controlled aspect of healing has departed in pursuit of the aforementioned clinically relevant concerns, residual considerations exist from a scientific and demographic viewpoint. It has been repeatedly identified that the population of the United States will change significantly in the next 10 to 15 years with the “Baby Boomer Generation” surpassing the 65-year mark. A significant number of these people will seek treatment for single and multiple missing teeth. Development of a predictable treatment method is obviously the goal for any elective or emergent medical/dental treatment. Implant rehabilitation has, therefore been scrutinized in patients diagnosed with decreased bone density and osteoporosis due to its dependency on bone physiology and anatomy.

Many studies have attempted to link osteoporosis with decreased bone density—particularly of the maxilla and mandible. Ortman found that women demonstrated more residual ridge resorption when measured on panoramic radiographs compared to men of the same age.1 This study did not, however, survey skeletal changes or determine definitive periods of endentulism. Bone dissolution appears to be a site specific process not correlated to the normal post-extraction changes of residual ridge resorption. In fact, areas of the hip and spine appear to be more vulnerable to the devastating effects of osteoporosis. The literature does corroborate that the decrease in bone density—specifically of the maxilla or mandible—is correlated with the factors of periodontal disease, diet, and the period of edentulism.2 One study evaluated edentulous women who had known bone fractures and osteoporosis compared with edentulous women with no known fractures.3 The results of this study indicated that patients with preexisting fractures also demonstrated significantly smaller and more resorbed maxillae than those who did not have fractures.

Additional factors that influence implant survival include the effects of smoking tobacco. Cigarette smoking has been readily associated with detrimental effects on sites treated with dental implants (eg, impaired wound healing and suboptimal soft tissue health). Tobacco consumption by smokers has also resulted in a progressive loss of bone density.4 Bone density is, therefore, affected by cigarette smoking, and it can be further substantiated that increased osseointegration failure rates occur in smokers.5 Since the degree of resorption in the anterior mandible and quality of bone in this area do not differ markedly from those with or without osteoporosis, the degree of success in these patients with an implant supported restoration in this region does not differ markedly in comparison to shoe who do not manifest osteoporosis.6 As a result, the maxilla and posterior mandible appear to be the primary obstacle for patients with poor bone density who require full arch, single, or multiple tooth replacements. Additional data from sophisticated methods of bone density and osteoporotic evaluations are required to infer a more exacting presurgical diagnosis for implant candidates.

*Assistant Professor, Department of Otolaryngology, University of Nebraska Medical Center, Omaha, Nebraska.

 

References:

  1. Ortman LF, Hausmann E, Dunford RG. Skeletal osteopenia and residual ridge resorption. J Prosthet Dent 1989;61(3):321-325.
  2. Zarb G, Lekholm U, Albrektsson T, Tenenbaum H. Osteoporosis, and Dental Implants. Carol Stream, IL: Quintessence Publishing, 2002.
  3. van Wowern N, Kollerup G. Symptomatic osteoporosis: A risk factor for residual ridge reduction of the jaws. J Prosthet Dent 1992;67(5):656-660.
  4. Hooper JL, Seeman E. The bone density of femal twins discordant for tobacco use. N Engl J Med 1994;330(6):387-392.
  5. Bain CA, Moy PK. The associateion between the failure of dental implants and cigarette smoking. Int J oral Maxillofac Impl 1993;8(6):609-615.
  6. Bryant SR. The effects of age, jaw site, and bone condition on oral implant outcomes. Int J Prosthdont 1998;11(5):470-479.
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