Volume 31, Issue S20 p. 48
ABSTRACTS
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Sex steroids and the rate of new bone formation in iliac grafts: a prospective clinical pilot study

Julia Half

Julia Half

Charité Universitätsmedizin Berlin, Berlin, Germany

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Claudia Sachse

Claudia Sachse

Charité Universitätsmedizin Berlin, Berlin, Germany

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Kajta Nelson

Kajta Nelson

Uniklinik Freiburg, Freiburg, Germany

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Max Heiland

Max Heiland

Charité Universitätsmedizin Berlin, Berlin, Germany

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Susanne Nahles

Susanne Nahles

Charité Universitätsmedizin Berlin, Berlin, Germany

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First published: 05 October 2020

IE4BO ORAL COMMUNICATION CLINICAL RESEARCH – SURGERY

Background: Extreme alveolar atrophy can be successfully treated with avascular iliac onlay bone grafting and dental implant placement. Histomorphometric studies revealed high interindividual differences in the rates of new bone formation. This variation may be based on subject-related factors. Gender related host factors (cf. nutrition, exercise, medication, hormonal status) known to influence bone metabolism in skeletal bone might influence the rate of new bone formation of alveolar bone.

Aim/Hypothesis: The aim of this prospective clinical pilot study was to evaluate the rate of new bone formation in iliac onlay grafts in dependence of the individuals hormone status in blood samples in women and men.

Materials and Methods: 27 partially or completely edentulous patients (18 women, 9 men) with a mean age of 55.6 years (range 20–71 years, remaining bone height <5 mm of the alveolar bone) underwent iliac onlay bone grafting and dental implant placement using a staged approach. Concentrations of serum estradiol (E2), total testosterone (T) and sex hormone binding globulin (SHBG) were measured by radioimmunoassay and electrochemiluminescence immunoassay. At the time of implant placement, histologic specimens were obtained from the iliac onlay grafts and analysed. Each biopsy was examined placing a region of interest (ROI) in the apical (n = 64) (close to residual bone) and coronal portion (n = 64) of the specimen. In each ROI, the area fraction of newly formed bone was measured in square micrometer and then quantitatively analysed as percentage of the total. Statistical analysis was performed using the Spearman correlation test.

Results: The grafting procedure was successfully performed in all patients. A total of 64 implants were placed. The mean overall new bone formation rate was 31.6% (3.2–81.7%); thereof, in the apical region, it was 38.5% (4.6–81.7%) and in the coronal region, it was 24.6% (3.2–72.9%). In women, the mean overall new bone formation rate was 32.9% (10.8–77.1%) in the apical region and 20.6% (3.2–51.2%) in the coronal region. In men, the mean overall new bone formation was 46.1% (4.6–81.7%) in the apical region and 30.1% (5–72.9%) in the coronal region. There was a difference between the rate of new bone formation E2 levels in women and in men. In women, higher E2 levels correlated with a decreased rate of new bone formation of iliac onlay grafts. In men, higher E2 levels enhanced new bone formation of iliac onlay grafts. No significance was found among T, SHBG and new bone formation in both genders.

Conclusions and Clinical Implications: Women with high serum E2 concentrations had a decreased rate of new bone formation in iliac onlay grafts, in men, serum E2 levels had the opposite effect. This is consistent with the hypothesis that gender related host factors affect new bone formation in iliac grafts. This possible skeletal site-specific answer from E2 on the alveolar bone needs to be further investigated to reliably predict new bone formation in iliac onlay grafts in women and men.

Keywords: iliac onlay graft, new bone formation, sex steroids, estrogen.

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