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The relationship between systematic metabolism and the structure and deposition of human jaw bone Esteves, Andrea P. Z.
Abstract
The high rate of resorption of the residual ridge in an edentulous jaw may be related to the continuous process of systemic and local bone remodelling in the body throughout life. The aim of this study was to determine the relationship between the histological appearance and deposition of bone in edentulous jaws and the systemic bone metabolism in humans. A convenient sample of 21 apparently healthy patients scheduled for endosseous oral implants (a Ia modem Brânemark) as they presented for treatment volunteered for the study. Prior to surgery, one gram of tetracycline per day was ingested by the patients to label new fronts of bone deposition. The patients were instructed to take the tetracycline for two days starting 22 days before surgery, and again for another two days after a 14 day interval. The two layers of tetracycline accumulation in the bone were used to estimate the daily quantity of bone formation during the 22 day period. A sample of blood was withdrawn from each patient before surgery and assayed using a radioimmunoassay to detect serum osteocalcin, a non-collagenous bone protein that reflects the metabolic activity of bone formation. Along with the blood, a sample of urine was obtained to measure the concentration of Type I collagen cross-linked N telopeptide that reflects the metabolic activity of bone resorption. A cylindrical core of bone (2x3mm) was taken from each of the 54 implant sites with a surgical trephine as the bone was prepared to receive the implants. Static and dynamic histomorphometric parameters of cortical bone were measured using the “point-counting” method. There was no apparent correlation between systemic metabolism and the histological appearance or turnover of jaw bone. The histomorphometric parameters measured on each specimen of bone showed substantial variations both between and within patients, while the porosity of the bone decreased from the anterior to the posterior parts of both jaws. Women presented relatively lower values for osteocalcin and higher values for Type I collagen cross-linked N-telopeptide, which supports the view that women are at greater risk of bone loss. Moreover, there was a direct correlation between the values of osteocalcin and Type I collagen cross-linked N-telopeptide, verifying the supportive role of both assays as markers of bone turnover. It seems that inter- and intra-variation is an intrinsic and widespread characteristic in the structure of jaw bone, and this phenomenon is not necessarily indicative of bone metabolic disorders. We estimated from the variance in bone structure that a sample size of 125 subjects would be necessary in order to offer sufficient statistical power for stochastic contrasts of jaw porosity. Many (45%) of the specimens had woven bone, which suggests that the residual ridges have been subjected to abnormal mechanical stress. Nevertheless, all of the implants that have been exposed intraorally appear to have integrated successfully in the jaws despite the porous structural characteristic of the bone. The widespread variation in normal porosity and the limited number of subjects in the study may be the reason why we could not find any relationship between the jaw bone and systemic bone metabolism. However, the fact that the release of products of bone turnover in the serum and urine did not reflect either the histological appearance or the osteogenic activity of the specimens of bone suggests that the influence of systemic metabolism is less accentuated in the jaws than in other bones (e.g. iliac crest).
Item Metadata
Title |
The relationship between systematic metabolism and the structure and deposition of human jaw bone
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
1994
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Description |
The high rate of resorption of the residual ridge in an edentulous jaw may be
related to the continuous process of systemic and local bone remodelling in the body
throughout life. The aim of this study was to determine the relationship between the
histological appearance and deposition of bone in edentulous jaws and the systemic bone
metabolism in humans.
A convenient sample of 21 apparently healthy patients scheduled for endosseous
oral implants (a Ia modem Brânemark) as they presented for treatment volunteered for
the study. Prior to surgery, one gram of tetracycline per day was ingested by the patients
to label new fronts of bone deposition. The patients were instructed to take the
tetracycline for two days starting 22 days before surgery, and again for another two days
after a 14 day interval. The two layers of tetracycline accumulation in the bone were used
to estimate the daily quantity of bone formation during the 22 day period.
A sample of blood was withdrawn from each patient before surgery and assayed
using a radioimmunoassay to detect serum osteocalcin, a non-collagenous bone protein
that reflects the metabolic activity of bone formation. Along with the blood, a sample of
urine was obtained to measure the concentration of Type I collagen cross-linked N
telopeptide that reflects the metabolic activity of bone resorption. A cylindrical core of
bone (2x3mm) was taken from each of the 54 implant sites with a surgical trephine as
the bone was prepared to receive the implants. Static and dynamic histomorphometric
parameters of cortical bone were measured using the “point-counting” method.
There was no apparent correlation between systemic metabolism and the histological appearance or turnover of jaw bone. The histomorphometric parameters
measured on each specimen of bone showed substantial variations both between and
within patients, while the porosity of the bone decreased from the anterior to the posterior
parts of both jaws. Women presented relatively lower values for osteocalcin and higher
values for Type I collagen cross-linked N-telopeptide, which supports the view that women
are at greater risk of bone loss. Moreover, there was a direct correlation between the
values of osteocalcin and Type I collagen cross-linked N-telopeptide, verifying the
supportive role of both assays as markers of bone turnover.
It seems that inter- and intra-variation is an intrinsic and widespread characteristic
in the structure of jaw bone, and this phenomenon is not necessarily indicative of bone
metabolic disorders. We estimated from the variance in bone structure that a sample size
of 125 subjects would be necessary in order to offer sufficient statistical power for
stochastic contrasts of jaw porosity. Many (45%) of the specimens had woven bone,
which suggests that the residual ridges have been subjected to abnormal mechanical
stress. Nevertheless, all of the implants that have been exposed intraorally appear to
have integrated successfully in the jaws despite the porous structural characteristic of the
bone. The widespread variation in normal porosity and the limited number of subjects in
the study may be the reason why we could not find any relationship between the jaw
bone and systemic bone metabolism. However, the fact that the release of products of
bone turnover in the serum and urine did not reflect either the histological appearance or
the osteogenic activity of the specimens of bone suggests that the influence of systemic
metabolism is less accentuated in the jaws than in other bones (e.g. iliac crest).
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Extent |
2034710 bytes
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Genre | |
Type | |
File Format |
application/pdf
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Language |
eng
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Date Available |
2009-02-27
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Provider |
Vancouver : University of British Columbia Library
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Rights |
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.
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DOI |
10.14288/1.0087453
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
1994-11
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Campus | |
Scholarly Level |
Graduate
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Aggregated Source Repository |
DSpace
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Rights
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.