Romanian Medical Journal (Sep 2018)
TRABECULAR BONE SCORE AND DENTAL IMPLANT
Abstract
The article brings in the same plan and unified views related to two different phenomena: dental implant (DI) and osteoporosis. 1. DI and osteoporosis. Successful DI depends on bone quality. One of the relative contraindications of DI is osteoporosis. However, there are studies showing that DI can be done in patients with osteoporosis. In cases of osteoporosis, success depends on the lack of previous antiosteoporotic bisphosphonate treatments. 2, Diagnosis of osteoporosis. It is based on the T-score obtained for Bone Mineral Density (BMD) in DEXA (dual X ray absortiometry) tests; they must be -2.5? The problem of diagnosis can be solved by a new DEXA technique: trabecular bone score.3. Trabecular bone score (TBS) is the mathematical estimation of vertebral microarhitectomy.The vertebra are formed by trabecular bone (the long bone is predominantly the cortical bone). TBS is obtained by DEXA analysis with specific software. A value < -2.5 means osteoporosis. Our data showed that through TBS analysis the prevalence of osteoporosis diagnosis increased by about 40% in patients who have BMD within the limits considered by osteopenia or normal. 4. Relationship between mandible/maxillary and trabecular bone. Mandible and the maxillary are mixed bones. At the surface it presents as a cortical bone, in depth, it presents with trabecular bone structure. The cortical bone (both of mandible & maxillary) is defined as that white structure without a trabecular pattern. The trabecular bone is that part of the mandible that is found between two cortical plates. It is appropriate to make an implant when the cortical bone is more abundant. It is also stated that the implants performed in over 60% trabecular (cancellous) bone are more efficient than those performed in less than 30% of the trabecular bone. The phenomenon arises from the fact that the trabecular bone is more metabolically active and contains more osteoblasts. TBS obtained by DEXA for the vertebrae can be surrogate for the assessment of the trabecular bone in the mandible and maxillary. 5. Drugs that improve the trabecular bone score. Following the re-analysis of the TBS-BMD difference by the TBS technique, the perception of antiosteoporotic drugs has changed. More important is to improve TBS than increase BMD. Thus, teriparatide, then denosumab, strontium, SERM, and lastly bisphosphonates would be preferentially used. Furthermore, teriparatide was the only treatment available for post-bisphosphonates jaw necrosis.
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