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This review comprises a short summary of up-to-date clinical knowledge on systemic osteoporosis in order to focus on the clinical dental studies on osteoporosis of the jaws, which have become available within the last 15 years. Diagnosis of jaw osteoporosis requires assessment of the bone mineral content (BMC)/density (BMD) using specially constructed jaw bone scanners and development of a corresponding gender-related set of normal BMC/BMD values for young adults, as in other sites of the skeleton. If other factors are excluded, jaw osteoporosis may involve the risk of minor accentuation of alveolar bone loss after wearing a full denture, in cases of periodontitis and in peri-implant areas. However, implant-supported overdentures conserve bone because of their positive load-related effect on the jaw. Estimation of BMC/BMD is also advisable for edentulous osteoporotic patients. Systemic treatment involving the bone metabolism affects the jaw BMC/BMD positively or negatively as in other skeletal sites, but the magnitude of this effect is site-specific. Future studies of the effect of bisphosphonates on the jaw BMC and alveolar bone loss, and analyses of the bone quality and jaw BMC/BMD in relation to implant treatment, without or with bone transplantation, are required.

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OBJECTIVES: To clarify in young adults with severe periodontitis (1) whether the bone mineral content (BMC) or density (BMD) in the mandible/other skeletal sites and the systemic bone metabolism differed from normal and (2) whether mandibular/forearm BMC did change during the 5 to 10-year follow-up. MATERIAL AND METHODS: 24 young otherwise normal patients with verified severe periodontitis were included, of which 20 attended the follow-up visit. Mandibular/forearm BMC was measured at both visits by dual-photon absorptiometry, supplemented with femoral neck/lumbar spine BMD measurements at follow-up visit by dual-energy X-ray absorptiometry. Serum alkaline phosphatase/ionized calcium, urinary excretion of pyridinoline/deoxy-pyridinoline were analysed at the follow-up visit. A conventional periodontal examination was performed at both visits. RESULTS: Mandibular BMC was significantly below normal mean BMC at both visits. The mandibular Z-scores were < or = -2.00 in 33.3% (8/24). BMC/BMD in the remaining sites and the values for bone markers did not differ from normal. Mandibular/forearm BMC was stable while a significant aggravation of alveolar bone loss occurred during the trial without change of probing depth. CONCLUSIONS: Severe periodontitis in young adults seems to be a local disorder associated with relatively low BMC in the jaws without systemic alterations of BMC/BMD and bone metabolism.

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UNLABELLED: The purpose of this study were to analyse 1) the changes in the bone mineral content (BMC) in mandibles with implant-supported overdentures when compared with the physiologic age-related mandibular BMC loss, 2) whether the BMC changes were different in groups without or with a bar connecting the implants and 3) whether the presence of mandibular osteoporosis affects the loss of bone height around the implants. The material consisted of 22 long-term edentulous healthy persons, 18 women and 4 men from 54 to 78 years of age with 1 Astra Tech Dental Implant in both canine regions, connected by a bar in half of the patients. BMC measurements were performed in vivo by dual-photon scanner at baseline, just after attachment insertion, at 2-year and 5-year visits. Mandibular osteoporosis was estimated by comparing baseline BMC values with normal mandibular BMC values for young adults of same gender. Loss of bone height around implants was measured on periodically identical intraoral radiographs. The fixed parts of the implant-system were stable during the trial in all patients. IN CONCLUSION: 1) the increased function after this treatment seems to cause a load-related bone formation which minimizes the physiologic age-related mandibular BMC loss, 2) this effect seems to be independent of attachment system and 3) mandibular osteoporosis prior to implant treatment may be a risk factor for bone loss around implants. However, this treatment can be recommended also in osteoporotic persons.

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OBJECTIVE: To clarify the relationships between the varying clinical or radiographic features of cherubism. STUDY DESIGN: Nonparametric statistics were used in a long-term follow-up of 18 patients through 2 generations from 6 Danish families. RESULTS: The radiographic grade of cherubism was significantly related to sex, maximal buccal bone expansion, course of cherubism, and number of aplasia or ectopic impacted teeth, but it was not related to families. Normal dentition in nonaffected regions was present or was obtained in 14 of 14 patients (age, >14 years). Surgical treatment did not provoke growth of lesional tissue in 22 of 22 cases. Radiographically, the bone structure in the lesional areas was related to age in all grades of cherubism: new bone formation in radiolucent areas (age, >20 years), normal bone structure with multilocular sketches (age, 32 to 39 years), and completely normal bone structure (age, >41 years), also found in 7 of 7 carriers of cherubism (age, >32 years). CONCLUSIONS: This group analysis verifies the knowledge of cherubism previously based on cumulative reviews of findings in single-family and case reports.

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BACKGROUND: The purpose was to analyze changes in the mandible and the forearm bone mineral content and oral state in patients on home parenteral nutrition due to short bowel syndrome in relation to the bone mineral values and oral findings in a normal population. METHODS: The bone mineral content was measured by dual-photon absorptiometry and the dental and periodontal state were studied in 15 adults patients (12 women, and 3 men, aged 26 to 65 years). All patients were on free oral intake as a supplement to the parenteral nutrition. RESULTS: Forty-seven percent of the patients (2 males, 2 young and 3 elderly females) showed mandibular osteoporosis (Z-scores < -2.00), and all young females showed Z-scores < 0. Moreover, 34% of the patients showed osteoporosis in the forearm bones (Z-scores < -2.00) and also radiographic signs of osteoporotic fractures of the columna. The dental and the periodontal state in the patients did not differ clearly from that of the normal Danish population of the same age. CONCLUSIONS: Such patients seem to have a high risk of developing systemic osteoporosis, including the jaws, but apparently do not show a higher risk for deterioration of the dental or periodontal state than age-matching normals from the same population.

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Osteoporosis is suspected as a risk factor in periodontal disease, but previous studies have failed to establish a relationship. Possible explanations for this could be lack of precise methods for assessment of osteoporosis in the jaws and confounding of the result by other factors such as age, gender, or smoking. In the present study 12 female patients with osteoporotic fractures (Group O) and 14 normal women (Group N) were examined clinically for plaque (VPI), gingival bleeding (GBI), and loss of attachment on the 6 Ramfjord index teeth. Bone mineral content (BMC) of the mandible and forearm was determined by dual photon scanning. Results were presented as arithmetic means +/- standard error, and differences between groups were tested by 2-sample t-test. The two groups were comparable with respect to age (O: 68.3 +/- 1.8 years, N: 68.1 +/- 1.5 years), menopausal age (O: 47.5 +/- 1.8 years, N: 47.2 +/- 1.3 years), and smoking habits (O: 4 smokers, N: 3 smokers). The osteoporotic women had significantly lower BMC values than controls in the mandible (O: 0.63 +/- 0.04 in U/cm2; N: 0.78 +/- 0.02 in U/cm2, P < 0.01) and forearm (O: 1.05 +/- 0.05 in U/cm; N: 1.28 +/- 0.05 in U/cm, P < 0.01). No significant differences were found with respect to plaque (O: 46.67 +/- 10.00%, N: 36.67 +/- 6.67%) and gingival bleeding (O: 46.67 +/- 11.67%, N: 43.33 +/- 10.00%), whereas significantly greater loss of attachment was seen in osteoporotic women (O: 3.65 +/- 0.18 mm, N: 2.86 +/- 0.19 mm, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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Changes in the bone mineral content (BMC) of edentulous mandibles after augmentation with porous hydroxyapatite (HA), in blocks (B) in one side and in granules (G) in the opposite side, were measured in vivo by dual-photon absorptiometry. The BMC changes in each side at the 1-, 2-, and 3-year follow-up were expressed in percent of the 1-week postoperative BMC value. In unexposed augmentations new bone formation seems to occur during the first year in the HA-B sides, followed by the biologic age-related BMC loss; while the HA-G sides show pronounced resorption of hydroxyapatite and bone during the entire period. Although porous HA-B and HA-G are unsuitable for residual ridge augmentation, porous HA-B may be used for implantation in areas without risk for exposure of HA resulting from loading of covering soft tissues.

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The purpose of this study was to clarify if symptomatic osteoporosis is a risk factor for severe residual ridge reduction of the jaws. The analysis included 12 edentulous women with osteoporotic fractures, otherwise normal, and 16 normal edentulous women matched with respect to age, menopausal age, and period of edentulousness. The bone mineral content measured in vivo by dual-photon scanner was significantly lower in the mandible and the forearm bones (that is, in the skeleton) of the osteoporotic group than it was in the normal group. No significant difference between the two groups was demonstrated with respect to the size of the mandibular sagittal area, measured on identical lateral cephalograms, while the sagittal maxillary area was significantly smaller in the osteoporotic group. Symptomatic osteoporosis therefore seems to be a severe risk factor for smaller residual ridge reduction off the maxillae, while this does not seem to be the case in the mandible.

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Long-term high-dose glucocorticosteroid treatment may be suspected as causing profound marginal periodontal bone loss due to the immunosuppressive/antiinflammatory effects and due to the osteoporotic side-effects. This study comprised an analysis of the loss of the mandibular and forearm bone mineral content (BMC), measured in vivo by dual-photon scanner, in relation to the concomitant changes of the periodontal indices (visible plaque, gingival bleeding, loss of attachment) in 17 acute nephrotic dentate patients undergoing intensive steroid treatment for 12 months. The measurements were performed at start of treatment, when all patients were considered healthy as regards the skeleton, and at the 6-month and 12-month follow-up. The mean BMC loss at the standard sites of the mandible and the forearm bones was 5.6%/year at both sites. No significant changes could be demonstrated in the periodontal indices (P greater than 0.10), and no relation was found between the mandibular BMC loss and the periodontal condition (R = 0.06, P greater than 0.10). In conclusion, profound marginal periodontal bone loss does not seem to be a prominent side-effect of long-term glucocorticosteroid treatment, although the degree of induced osteopenia in the mandible corresponds to that in other cortical bones of the skeleton.

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The bone mineral content (BMC) in mandibles can now be measured in vivo with high precision by a specially constructed dual-photon scanner. This study analyzed, over a 2-year period, the BMC loss of endentulous mandibles in a group of young and older women after vestibulolingual sulcoplasty with free skin grafts, and its relationship to the initial mandibular BMC and the age-related mandibular BMC loss. BMC in the denture-wearing site and the standard site of the mandible was measured by this method. A significant negative relationship was found between the initial BMC values in the standard site and the BMC loss (in percent) in the denture-wearing site in both age groups, and a significant positive relationship between the BMC loss (in percent) in the two sites of the mandible in the elder group. The rate of residual ridge reduction may be predicted from the initial mandibular BMC value and seems to be dependent on the age-related mandibular BMC loss.

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Fifty-five asymptomatic mandibular third molars (M3) in 34 dental students (mean age 20.6 years at the start of the study) were followed radiographically for 4 years. Based on clinical evaluation the 55 teeth included 20 almost erupted, 13 partly erupted and 22 non-erupted M3. The following were assessed on the radiographs: root development, level of eruption, sagittal angulation, resorption, pericoronitis/bony pockets/paradental cysts and widening of the periodontal space/dentigerous cysts. The state of 21 teeth (38 per cent) was radiographically changed at the end of the observation period. The most remarkable finding was that 15 teeth changed their sagittal angulation, all in a distal direction; five mesioangular to vertical, five vertical to distoangular, five mesioangular to distoangular. Radiographically, 13 M3 moved to a more advanced level of eruption. No real pathological osseous lesions and no root resorption were observed at initial or follow-up examinations. It is concluded that there are frequent essentially unpredictable changes in the position of M3 after the age of 19 years which may influence decisions on their removal or preservation.

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Changes in the bone mineral content (BMC) of edentulous mandibles with osseointegrated ITI implants supporting overdentures were measured in vivo by dual-photon absorptiometry. The BMC measurements were performed 3 weeks postoperatively and at the 2-year follow-up visit. Measurements were made in the ITI site (anteriorly), the premolar region just behind the fixtures, and the standard site of the mandible for obtaining reference values of the age-related MBC loss. The increased function of the mandible after this treatment seems to cause a load-related bone formation that minimizes, or in some cases may counteract, the physiologic age-related BMC loss leading to osteoporosis.

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Seventy dental students (mean age: 20 years) with 130 asymptomatic, non-ectopic, impacted mandibular 3rd molars were followed for 4 years. At the initial visit 26 were impacted in soft tissue, 30 were partially impacted in bone, and 74 were completely impacted in bone. The following items were registered at each visit: regional pocket depths, signs and symptoms of pathology, degree of impaction, presence of upper 3rd molar. No signs or symptoms of pathology were observed in any of the subjects at the 2 visits. The 4-year visit revealed that 49 3rd molars had been removed, the reason being pericoronitis or caries in 30%, mild symptoms in 39% and for prophylactic reasons in 31%. Of the remaining 81 3rd molars: 71% of the soft tissue impactions, 25% of partial bony impactions, and 8% of complete bony impactions showed complete and normal eruption. The remaining 3rd molars were either static or had advanced in the degree of eruption. It is concluded that non-ectopic, impacted 3rd molars in the given age group may have a chance to completely erupt. The treatment for asymptomatic impacted 3rd molars in young adults, therefore, might be observation instead of prophylactic removal.

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A new, precise, non-invasive method for measuring the bone mineral content (BMC) of the mandible in vivo by dual-photon absorptiometry has recently been introduced. The purpose of the present analysis was to examine the precision in vitro and in vivo and the accuracy in vivo for assessment of BMC in the maxilla. The precision was determined by repeated measurements in vitro on a cranium and in vivo on two test persons with and without a bone specimen fixed to a palatal plate. The accuracy in vivo was determined from the BMC measurements of the two test persons and of nine edentulous persons, scanned before and after augmentation of the maxillary alveolar ridge with hydroxyapatite. The analyses indicated that the precision for maxillary BMC assessments was high (0.9% in vitro and 2.0% in vivo) and the accuracy in vivo was 6.6%, corresponding to the accuracy in vitro for skeletal BMC measurements by dual-photon absorptiometry. The present method therefore seems to be well-suited for follow-up analyses of the BMC changes in the jaws after augmentation of the alveolar ridges with bone or hydroxyapatite.

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The purpose was to obtain the normal sex- and age-related reference values for the bone mineral content (BMC) in the bones of the mandible and the forearms, as estimated by dual-photon absorptiometry; to examine the effect of tooth loss on the mandibular BMC, i.e., BMC in the basal part of the mandible; and to analyze the rate of the sex- and age-related BMC loss in the mandible in normal old edentulous individuals greater than or equal to 70 years of age and its relationship to the corresponding BMC loss in the forearm bones. The following groups were measured: young dentate adults (n = 100; women (W): men (M) = 1:1), young, long-term edentulous W (n =15), and old edentulous individuals (n = 24 W, 10 M). In the old group the BMC measurements were repeated after 2- or 3-year period (n = 18 W, 10 M). The analyses indicate that the mandibular BMC reference values differ by sex and age; but correction for the state of dentition seems of minimal benefit. The average BMC loss (%) in the bones of the mandible and the forearms seems to be higher in old W (1.5 and 1.4% per year) than in old M (0.9 and 0.7% per year), but of the same magnitude in each sex. The relationship between the BMC loss (%) in the two sites was significant (P less than 0.01) but rather weak. Thus, it seems important to follow the sex- and age-related BMC loss in the mandible separately.

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A new method for measuring the bone mineral content (BMC) of the mandible by dual-photon absorptiometry (DPA) has recently been introduced. The purpose of the present investigation therefore was to examine the long-term precision for 32 months in vitro and in vivo for assessment of BMC in the mandible and to examine the relationship in vivo among BMC of the mandible, the forearms, and the lumbar spine as measured by DPA and/or single-photon absorptiometry (SPA). For comparison, the relationship between forearm BMC as measured by DPA and SPA was studied. The long-term precision of the mandibular BMC was 0.8% in vitro, independent of age and change of radioactive source, and 2.1% by assessment in vivo. A significant relationship (P less than 0.01) was found between BMC of the lumbar spine and the forearms and between the two sets of forearm BMC measured by DPA and SPA. Thus, relative BMC changes of the forearms can be compared without respect to type of forearm bone scanner used. The BMC changes of the mandible can only be evaluated by scanning of the mandible itself. The present DPA bone scanner is suitable for follow-up analyses of the BMC changes of the mandible and the forearms.

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