X-RAY ASSESSMENT OF JAW BONE TISSUE IN PATIENTS WITH SYSTEMIC OSTEOPOROSIS BEFORE THE SURGICAL STAGE OF DENTAL IMPLANTATION

Abstract

The assessment of the initial state of bone tissue is important not only for the placement of implants in accordance with the chosen treatment plan, but also for predicting the results of their osseointegration. Until recently, systemic connective tissue diseases were a contraindication to implantation, although it is believed that osseointegrated contact between the surface of an unloaded implant and the surrounding bone tissue is also possible in the case of osteoporosis. However, the effectiveness of implantation in such cases is highly questionable, because with a decrease in the mineral density of bone tissue and changes in its metabolism, there is often an increase in destruction processes, which leads to pathological bone remodeling. The aim of the study – to conduct a comparative analysis of the condition, structure and mineral density of jaw bone tissue in patients with systemic osteoporosis, depending on the sex, before the surgical stage of dental implantation. Materials and Methods. The condition, structure and density of bone tissue before the surgical stage of dental implantation were determined in 87 patients who needed dental implantation. Orthopantomograms were used to analyze the state of bone tissue in the areas where the operation was planned, for which the type of bone quality was determined according to the C.E. Misch classification. To evaluate the structure and density of bone tissue, patients were examined using spiral computed tomography (SCR) on a Picker PQ 2.00 computed tomograph (Picker International Ink., USA). When processing the information from the CT studies, the image data were studied in different planes (to determine the width and height of the alveolar ridge), and the bone density was determined by the Hansfield scale. To assess the state of bone tissue, ultrasonic densitometry was performed using an Omnisense 7000S apparatus (Sunlight Medical, Israel). Results and Discussion. In women with osteoporosis of group I, the radiological characteristics of the bone in the areas of future dental implantation in 36,84% and 34,20% corresponded to bone type D3 and D4, respectively. In men with osteoporosis of group II, bone type D1 prevailed (28,57% of patients) and D2 – 33,33% of patients, as well as in subjects of group III without osteoporosis, in whom the frequency of bone type D1 was visualized in 53,57% of patients and D2 in 28,57% of patients, in the absence of bone type D4. Densitometric studies revealed a decrease in the width and height of the alveolar spines in patients with systemic osteoporosis, with a prevalence of this trend in women of group I. At the same time, the passage of an ultrasound wave along the mandible was significantly lower in patients with osteoporosis compared to those without BMD disorders: 1,9 times in women and 1,3 times in men, p,p1<0.01. Conclusions. Thus, metabolic disorders in systemic osteoporosis adversely affect the structures of the oral cavity, especially in women, which may be the reason for the low effectiveness of dental implants and indicate the need to improve orthopedic and surgical treatment by developing adequate osteotropic treatment.