Title
Bone quality analysis of jaw bones in type 2 diabetes and alocoholic liver cirrhosis: anatomical and microstructural evaluation
Creator
Rodić, Teodora M., 1989-
CONOR:
101036553
Copyright date
2022
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Autorstvo-Nekomercijalno-Bez prerade 3.0 Srbija (CC BY-NC-ND 3.0)
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Dozvoljavate samo preuzimanje i distribuciju dela, ako/dok se pravilno naznačava ime autora, bez ikakvih promena dela i bez prava komercijalnog korišćenja dela. Ova licenca je najstroža CC licenca. Osnovni opis Licence: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/deed.sr_LATN. Sadržaj ugovora u celini: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/legalcode.sr-Latn
Language
English
Cobiss-ID
Theses Type
Doktorska disertacija
description
Datum odbrane: 17.02.2023.
Other responsibilities
Academic Expertise
Medicinske nauke
University
Univerzitet u Beogradu
Faculty
Medicinski fakultet
Alternative title
Анализа квалитета виличних костију код типа 2 дијабетеса и алкохолне цирозе јетре: анатомска и микроструктурна анализа
Publisher
[T. Rodić]
Format
78 str.
description
MEDICINE- Skeletal biology / МЕДИЦИНА
- Биологија скелета
Abstract (en)
Increasing prevalence of type 2 diabetes mellitus (T2DM) in general population due to
the aging society, sedentary lifestyle, and obesity results in growing numbers of T2DM
patients in dental practice. Recent studies have suggested increased bone fragility in patients
with T2DM; however, the mechanisms of T2DM-associated bone changes in jaw bones are
still poorly understood. Indeed, patients with T2DM often present with a need for dental
implant placement in the edentulous alveolar bone. Furthermore, titanium fixation screws,
which need to be placed in the mandibular angle in case of a fracture located in that region
are sometimes required in T2DM patients. T2DM-related alterations in jaw bone quality,
which may have direct effects on osseointegration and implant survival in this patient
population, have not yet been investigated. The question remains as to whether alterations in
jaw bone quality in T2DM contribute to implant failure.
Alcoholic liver cirrhosis (ALC) has a proven negative influence on bone quality at
various skeletal sites, such as femur and spine. On the other hand, evidence about the
influence of ALC on jaw bone quality is scarce. Dental patients with a history of alcohol
abuse and possibly compromised liver function sometimes need surgical interventions on the
jaw bone, in post-traumatic cases, tooth extractions etc. Information about the jaw bone
quality in patients with ALC is needed to make an evidence-based decision about the
possibilities for oral and maxillofacial surgery in these patients.
There is still poor understanding of bone quality in patients with T2DM and ALC;
however, these patients, especially T2DM patients, are often met in the dental practice and
decisions to treat or not to treat them are usually based on personal opinion of a physician.
Therefore, there is a great need for evidence-based recommendations in clinical practice. In
that context, we believe that understanding how T2DM and ALC affect bone quality on
several hierarchical levels of observation could have significant clinical relevance in
medicine and dentistry. Currently, patients treated with different antidiabetic medications are
not distinguished clearly in clinical practice and the current clinical approach is not based on
strong evidence. Therefore, the focus on the effects of T2DM treatment options (Insulin vs.
OAD) on bone quality may also be of great practical value in oral and maxillofacial surgery.
And it is important to clarify whether T2DM and ALC should be considered absolute or
relative contraindications for oral interventions on bone, at least when it comes to the bone
tissue status of these patients.
The aim of this thesis was to explore bone quality of T2DM and ALC patients
compared with healthy control group on several hierarchical levels in the edentulous region
of the lower first molar and the mandibular angle, so as to provide structural evidence to
estimate possibilities of for common treatments in oral and maxillofacial surgery.
The following specific objectives were stated:
i. to compare the jaw bone microstructural, compositional, and cellular properties
between patients with T2DM and healthy controls;
ii. to investigate the influence of OAD vs. insulin in T2DM individuals in a site-specific
manner, and to
iii. to compare the jaw bone microstructural, compositional, and cellular properties
between individuals with ALC and healthy controls, in a site-specific manner...
Abstract (sr)
Повећана учесталост типа 2 дијабетес мелитуса (Т2ДМ) у општој популацији
због старења друштва, неактивног стила живота и гојазности доводи до повећаног
броја пацијената са Т2ДМ у стоматолошкој пракси. Недавна истраживања указују на
повећану ломљивост костију пацијената са Т2ДМ. Упркос томе, још увек се врло мало
зна о механизмима промена на костима које се јављају у Т2ДМ. Код пацијената са
Т2ДМ често постоји потреба за уградњом зубних имплантата у безуби алвеоларни
гребен. Осим тога, титанијумски шрафови за фиксацију, који се постављају у угао
доње вилице у случају прелома локализованог у том региону, су некада потребни код
пацијената са Т2ДМ. Промене у квалитету кости код Т2ДМ које могу имати директне
ефекте на осеоинтеграцију и опстанак имплантата у овој популацији пацијената још
увек нису истражени. Остаје питање да ли постоје промене у квалитету кости вилица у
Т2ДМ које могу допринети губитку имплантата.
Алкохолна цироза јетре (АЦЈ) има доказано негативан утицај на квалитет
костију на различитим местима скелета, попут бутне кости и кичме. Међутим, докази о
утицају АЦЈ на квалитет кости вилице су оскудни. Стоматолошким пацијентима који
конзумирају алкохол и потенцијално имају оштећену функцију јетре понекад су
потребне хируршке интервенције на костима вилица (нпр. у посттрауматским
случајевима, вађење зуба итд.). У том смислу су неопходни подаци о квалитету кости
вилице код пацијената са АЦЈ, пре свега да би се донела одлука заснована на доказима
о могућностима оралне и максилофацијалне хирургије код ових пацијената.
Jош увек се мало зна о квалитету кости код особа са Т2ДМ и АЦЈ. Ипак, ови
пацијенти, нарочито они са Т2ДМ, често се срећу у стоматолошкој пракси, где се
одлуке о томе да ли да се они хируршки збрину или не често заснивају на субјективној
процени лекара. Због тога у клиничкој пракси постоји потреба за препорукама
заснованим на доказима. У том смислу, разумевање како Т2ДМ и АЦЈ утичу на
квалитет кости на неколико хијерархијских нивоа посматрања би могло имати велики
клинички значај у медицини и стоматологији. Данас се не прави јасна разлика између
пацијената третираних различитим антидијабетицима, и савремени клинички приступ
није базиран на чврстим доказима. Због тога би истраживање ефекта различитих
терапијских опција код Т2ДМ (инсулин и орални антидијбетици (ОАД)) на квалитет
кости такође могло бити од великог практичног значаја у оралној и максилофацијалној
хирургији. Важно је и разјаснити да ли би Т2ДМ и АЛЦ требало посматрати као
апсолутну или као релативну контраиндикација за оралнохируршке интервенције на
кости, бар када је у питању коштани статус ових пацијената. Штавише,
микроархитектурне и микроструктурне карактеристике виличних костију особа са
Т2ДМ које узимају инсулин или ОАД су такође од клиничког значаја.
Општи циљ ове тезе је био да се на неколико хијерархијских нивоа посматрања
истражи квалитет кости у безубој регији доњег првог молара и угла доње вилице код
особа са Т2ДМ и АЦЈ у поређењу са здравом контролном групом, како би се поставила
основа за унапређење процеса клиничког одлучивања у оралној хирургији,
имплантологији и максилофацијалној хирургији код ових пацијената...
Authors Key words
ype 2 diabetes mellitus, alcoholic liver cirrhosis, jaw, bone, microstructure,
mineralization, osteocytes
Authors Key words
тип 2 дијабетес мелитус, алкохолна цироза јетре, вилица, кост,
микроструктура, минерализација, остеони
Classification
611.714:616.379-008.64(043.3)
616.36‑004:611.714(043.3)
Type
Tekst
Abstract (en)
Increasing prevalence of type 2 diabetes mellitus (T2DM) in general population due to
the aging society, sedentary lifestyle, and obesity results in growing numbers of T2DM
patients in dental practice. Recent studies have suggested increased bone fragility in patients
with T2DM; however, the mechanisms of T2DM-associated bone changes in jaw bones are
still poorly understood. Indeed, patients with T2DM often present with a need for dental
implant placement in the edentulous alveolar bone. Furthermore, titanium fixation screws,
which need to be placed in the mandibular angle in case of a fracture located in that region
are sometimes required in T2DM patients. T2DM-related alterations in jaw bone quality,
which may have direct effects on osseointegration and implant survival in this patient
population, have not yet been investigated. The question remains as to whether alterations in
jaw bone quality in T2DM contribute to implant failure.
Alcoholic liver cirrhosis (ALC) has a proven negative influence on bone quality at
various skeletal sites, such as femur and spine. On the other hand, evidence about the
influence of ALC on jaw bone quality is scarce. Dental patients with a history of alcohol
abuse and possibly compromised liver function sometimes need surgical interventions on the
jaw bone, in post-traumatic cases, tooth extractions etc. Information about the jaw bone
quality in patients with ALC is needed to make an evidence-based decision about the
possibilities for oral and maxillofacial surgery in these patients.
There is still poor understanding of bone quality in patients with T2DM and ALC;
however, these patients, especially T2DM patients, are often met in the dental practice and
decisions to treat or not to treat them are usually based on personal opinion of a physician.
Therefore, there is a great need for evidence-based recommendations in clinical practice. In
that context, we believe that understanding how T2DM and ALC affect bone quality on
several hierarchical levels of observation could have significant clinical relevance in
medicine and dentistry. Currently, patients treated with different antidiabetic medications are
not distinguished clearly in clinical practice and the current clinical approach is not based on
strong evidence. Therefore, the focus on the effects of T2DM treatment options (Insulin vs.
OAD) on bone quality may also be of great practical value in oral and maxillofacial surgery.
And it is important to clarify whether T2DM and ALC should be considered absolute or
relative contraindications for oral interventions on bone, at least when it comes to the bone
tissue status of these patients.
The aim of this thesis was to explore bone quality of T2DM and ALC patients
compared with healthy control group on several hierarchical levels in the edentulous region
of the lower first molar and the mandibular angle, so as to provide structural evidence to
estimate possibilities of for common treatments in oral and maxillofacial surgery.
The following specific objectives were stated:
i. to compare the jaw bone microstructural, compositional, and cellular properties
between patients with T2DM and healthy controls;
ii. to investigate the influence of OAD vs. insulin in T2DM individuals in a site-specific
manner, and to
iii. to compare the jaw bone microstructural, compositional, and cellular properties
between individuals with ALC and healthy controls, in a site-specific manner...
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