Relationship Between Osteoporosis and Marginal Bone Loss in Osseointegrated Implants: A 2-Year Retrospective Study
- Autores: José Ramón Corcuera Flores, Ana M. Alonso-Domínguez, María Angeles Serrera Figallo, Daniel Torres Lagares, Lizett Castellanos Cosano, Guillermo Machuca-Portillo
- Localización: Journal of periodontology, ISSN 0022-3492, Vol. 87, Nº. 1, 2016, págs. 14-20
- Idioma: inglés
- Enlaces
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Resumen
Background: Fitting implants in osteoporotic patients has traditionally been controversial, and there is little scientific evidence relating osteoporosis to marginal bone loss (MBL). The aims of this study are as follows: 1) to evaluate the possibility of a correlation between osteoporosis, as measured by the mandibular cortical index (MCI), and MBL and 2) to assess how various systemic diseases, periodontitis, and placement of implants in regenerated bone are correlated with MBL and MCI.
Methods: This retrospective study examines 212 implants inserted in 67 patients. To take a possible cluster failure into account, an implant for each patient was selected (n = 67 implants). MBL was assessed. Osteoporosis was evaluated using the MCI. Both MBL and MCI were assessed from panoramic radiographs. χ2 test was performed (Haberman post hoc test). Significance was P <0.05.
Results: When the total sample implant (N = 212) was evaluated, a significant association was found between the presence of osteoporosis and MCI (P <0.001) and between the presence of diabetes mellitus and MCI (P <0.01). Significant associations were also found between MBL and placement of implants in regenerated sites (P <0.001) and between MBL and a previous history of periodontitis (P <0.05). When the sample is evaluated only in selected implants (one per patient, n = 67), significant differences appear to relate only to the MBL with the placement of implants in regenerated bone sites (P <0.001).
Conclusions: Osteoporosis (as evaluated by MCI) does not pose a risk for the development of greater MBL. Parameters adversely affecting the development of increased MBL are a previous history of periodontitis and especially the placement of implants at sites of bone regeneration.
Osteoporosis is defined as a systemic metabolic disease in which patients have low bone mass and display defects in bone microarchitecture.1 This increases bone fragility and can lead to a higher risk of fractures.1 Although the study of bone density remains the “gold standard” for assessing whether a patient has osteoporosis or not, a recent study on osteoporotic females with pathologic bone fractures demonstrate that osteoporosis can be identified reliably in a panoramic radiograph2 by using radiomorphometric indices such as the mandibular cortical index (MCI). This index allows patients to be categorized into three groups according to their degree of osteoporosis: 1) those with no bone pathology (C1), 2) the osteopenia group (C2), and 3) the osteoporosis group (C3).3 Peri-implantitis was first described by Mombelli et al.4 in 1987 as infectious and pathologic changes in peri-implant tissues. It can be diagnosed clinically (bleeding on probing, probing depth [PD] >5 mm, or three or more implant threads exposed)5,6 or radiologically (marginal bone loss [MBL]). MBL is defined as bone loss around the implant, and this study is based on that variable.
It should be noted that bone loss of 0.2 mm around implants in the first year is considered normal.7 Subsequently, bone loss of 0.1 mm per year on its own does not constitute any peri-implant disease.7 Clinically, an implant is diagnosed with peri-implantitis in the presence of pocket bleeding, PD >6 mm, or suppuration of peri-implant tissues.4,8,9 There are also radiologic methods for evaluating peri-implantitis based on MBL: some researchers used MBL from the implant shoulder (>1 mm) as a reference;10 others use the number of implant threads not in contact with bone11 (which might lead to confusion when different implant designs are evaluated); whereas others use a method based on MBL according to implant length.8 The classification described by Lagervall and Jansson9 is one of the most useful and reproducible for the radiologic detection of MBL. Risk factors for peri-implantitis include the presence of periodontal disease, poor plaque control, remnants of cement in the peri-implant sulcus, and diabetes.12 Numerous studies have established some relationship between alveolar and systemic bone loss related to measurements in the second metacarpal bone density in the hip or generalized bone mass. These comparisons have expanded to include titanium implants in the oral cavity versus those in the hip, but the comparison would not be accurate because dental implants are subject to the action of bacteria of the oral cavity, and those in the hip are not. In terms of tension and mechanical load, the circumstances could be considered similar,13 but several studies demonstrate a negative correlation between dental implant failure and osteoporosis.14-16 Dvorak et al.17 and Máximo et al.18 have studied the correlation between peri-implantitis and osteoporosis, and their results are inconclusive. Peri-implantitis might also be related to other factors, such as periodontal disease and guided bone regeneration (GBR) at the implant site,19-21 and to other systemic diseases, such as diabetes8 and cardiovascular disease.22,23 The aims of this study are as follows: 1) to evaluate the possibility of a correlation between osteoporosis (MCI) and MBL and 2) to assess whether various systemic diseases, periodontitis, and placement of implants in regenerated bone are correlated with either MBL or MCI.
