The relationship between skeletal and mandibular/alveolar bone quality after solid organ transplantation
Bahar Oduncuoglu1, Ayse Gulsahi2, Neslihan Arhun3, Turan Colak4, Mehmet A. Haberal5.
1Periodontology, Baskent University, Ankara, Turkey; 2Oral Maxillofacial Radiology, Baskent University, Ankara, Turkey; 3Restorative Dentistry, Baskent University, Ankara, Turkey; 4Nephrology, Baskent University, Ankara, Turkey; 5Transplantation, Baskent University, Ankara, Turkey
Introduction: Solid organ transplantation is an effective treatment for patients with end-stage renal disease or liver insufficiency. Liver and renal transplantations affect osteoporosis, but their mechanisms are different. Thus, the aim of the present study was to investigate the effect of liver and renal transplantation on osteoporosis, mandibular bone changes and periodontal and dental status with respect to healthy control group.
Materials and Methods: 11 liver and 15 renal transplant patients who had panoramic radiographs along with bone mineral density(BMD) measurements at maximum 1 year interval composed experimental groups. A healthy age- and gender-matched control group was composed of 15 subjects. The Mandibular Cortical Index(MCI): C1 had an even, clear endosteal margin; C2 showed mild; and C3 had severe erosion. Trabecular bone pattern(TBP) was classified as dense, heterogeneous, sparse and sparse with ground glass appearance(A-D). All teeth showing a suspected carious lesion(D), missing teeth(M), and teeth with fillings or crowns(F) were recorded and their sum determined DMF. Periodontal health statuses were evaluated on panoramic images depending on the alveoler bone level/loss around the roots(0-3). Patients were categorized as normal, osteopenic and osteoporotic on the basis of femoral-neck and lumbar-spine vertebra BMD.
Results: There were no significant differences between study groups with respect to BMD, MCI and periodontal health. The number of patients with dense type TBP significantly higher in control group compared to both liver and renal transplants. DMF scores were significantly higher in liver group than renal transplants and controls. The number of M was significantly lower in controls compared to liver transplants(p<0.05) (Table 1). There was no statistically significant difference between genders in each experimental group with respect to all parameters (Table 2). Male liver transplant patients' DMF scores were significantly higher than renal transplant and controls (p<0.05). The MCI(C3) of female renal transplants were significantly higher compared to controls. The TBP scores of controls were significantly lower than transplants (p<0.05).
Discussion: This retrospective research is the first research comparing BMD, mandibular bone quality and periodontal/dental health status in solid organ transplanted patients with respect to healthy controls.
Conclusion: Mandibular bone quality seems to be affected by transplantation with higher MCI and TBP scores. Dental and periodontal treatment needs observed to be higher in both liver and renal transplants compared to controls. Dental care givers should be aware that dental and periodontal health status could be worse, and importance of oral hygiene should be emphasized to all transplant patients and candidates.
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