Εμμηνόπαυση, οστεοπόρωση και οδοντικά εμφυτεύματα
Authors: Στέφος Σπυρίδων 
Published: September 2021

Introduction. Rehabilitation with dental prosthetic restorations and implants is an important andcommonly accepted treatment in dentistry. Increasingly, scientific evidence supports the use ofosseointegrated dental implants to restore the oral cavity of partially or completely edentulouspatients. The main objective is to improve the quality of life. The menopausal period is a special time in the life of women with symptoms and medical problems, such as osteoporosis and osteopenia, which may hamper both women's dental treatment and, consequently, their quality of life. The placement of dental implants is a safe method for aesthetic and functional treatment of tooth loss. Menopause is characterized by loss of endogenous estrogen and osteoporosis, a systemic skeletal disease characterized by a decrease in bone mineral density and susceptibility to fractures. There is a few data about dental implant placement techniques in the special group of menopausal women with and without osteoporosis and their quality of life has not been studied in detail. Aim. For this reason, this PhD thesis entitled "MENOPAUSE, OSTEOPOROSIS AND DENTAL IMPLANTS", examines -for the first time in Greek women- the relationship and the possible interactions and intermittent effects that dental implants and dental prostheses can have on the oral health (OHIP, OHQoL) and mainly on the quality of life of menopausal women with or without osteoporosis or osteopenia. It also investigates the extent of information provided by dentists to menopausal women undergoing the mentioned dental prostheses, as well as the information on the possible side effects of therapeutic regimens given on menopause and osteoporosis. Materials and Methods. The material of our study consisted of a hundred menopausal women. The protocol of this cohort study was approved by the University of Ioannina, Greece. The patients come from theObstetrics and Gynecology Clinic of the University Hospital of Ioannina and the Department of Climacteric and Menopause of the Second Obstetrics and Gynecology Clinic of Aretaieio University Hospital of the National and Kapodistrian University of Athens, Greece. Participants in this multicenter study were interviewed and given their consent to participate in this study. The method involved collecting demographic data, the clinical trial conducted by a single examiner by personal communication. Questionnaires were administered in Greek to 100 participating menopausal / postmenopausal women (Greek women) aged 43 years and over, with osteopenia or with or without osteoporosis, with or without dental implants and implant restorations, or conventional prosthetic restorations, that participated in this study. Menopausal/postmenopausal were judged on the basis of either secondary, definitive amenorrhoea or based on follicular stimulation hormone values (FSH) (Early Menopause= 20-40mIU/mL, Menopause= >40mIU/mL), estradiol (>20pg/mL and <20pg/mL) and clinical risk factors (e.g. history of osteoporotic fractures). The Mean Value of women’s age who participated was 63,62 years old (deviation 43 - 94 years). During the clinical trial, patients included were fully and clearly informed orally and in writing to complete a standard questionnaire on quality of life, the Oral Health Impact Profile (OHIP-14), with extra questions. The questionnaire consisted of selected quality of life questions in such a way as to escalate from introductory questions to more personal ones. Participants were given the necessary time and conditions to feel comfortable completing the questionnaire, including medical and dental (mainly prosthodontic) questions. Data collection began with the development of a database that allowed the storage and processing of information on each patient and implant. The study form included aquestionnaire based on OHIP-14 and included some additional questions tailored to the needs of our study. Special consideration is given to quality of life before and after the placement of dentalimplants and restorations. Results. The questionnaires revealed a significant improvement concerning women’s life quality and well-documented information about the problems their dental implants and restorations may cause in association with menopause and/or osteoporosis. 1) Overall, participants have a statistically significant better "functional" and "psychological" feeling after prosthetic rehabilitation than before and with and without implants. The mean differences observed, which refer to a significant reduction in dental discomfort after prosthetic rehabilitation, are statistically significant. 2) We observe a significant improvement in "dietary difficulty" after prosthetic rehabilitation due to it, since "dietary difficulty" is the most annoying parameter before prosthetic rehabilitation. 3) Also, the "psychological distress" that manifests as stress in 29% of patients is due to functional reasons, while a much smaller proportion (10%) to cosmetic reasons.4) Even the "psychological distress" expressed as shame is due to aesthetic reasons that exist before prosthetic rehabilitation to 31%, while this percentage is then reduced to 16%. Overall, in 14% of women there are both categories (aesthetic and functional problems) but after the dental restoration this rate is significantly reduced (to 4%), due to prosthetic, conventional and implant restorations. 5) The vast majority of participants accept the benefits of implants over cost (43% state that, in economic terms, the cost/benefit ratio was positive while an additional 44% described it as "reasonable") and only 13% of participants reported a rather negative cost/benefit ratio. 6) Dental practice in the treatment of patients with osteoporosis/osteopenia is as follows: 95% of participants reported that their attending dentist recommended implant placement, while three out of four also reported that their dentist informed them of the possible implant problems that may arise from osteoporosis. 7) We also conclude that participants were informed about the problems that may arise with implant placement either by osteoporosis or by osteoporosis’ treatment in cases following treatment with either bisphosphonates or a combination of bisphosphonates and nonbisphosphonates. 8) Bisphosphonate treatmt does indeed appear to cause significantly more problems with implant placement compared to other types of medication. This is because bisphosphonate treatment has the highest rate (80%) of implant placement problems (4 out of 5 participants), while non-bisphosphonate treatment has 30% implant placement problems. Still, 33% of combined treatment with non-bisphosphonates and bisphosphonates cause implant placementproblems, with only 13.5% of women experiencing problems when they do not receive treatment for osteoporosis. This correlation yields statistically significant results (Υ2=11.158,ΒΔ=3, p=0.011<0.02). 9) The highest proportion of implant problems (39.1%) was reported to participants with an osteoporosis diagnosis. The corresponding rate in participants with a diagnosis of osteopenia was only 21.4%. 10) Participants following hormone replacement therapy reported that there were problems with implant placement in 19% while those who did not follow this treatment reported problems in 27.3%. 11) Smoking (regardless of the number of cigarettes) has been found to cause problems in 21.1-25% of women, as well as 26.2% of non-smokers. 12) The level of education is related to hormone replacement therapy. Thus, women graduates of Higher Education Institutions, Technological Educational Institutions and Postgraduate Programms are receiving hormone replacement therapy and are working or unemployed, while on the other hand, Primary/Secondary/High School graduates with occupational status referred to as home do not receive hormone replacement therapy. The occupational category of retired participants seems to be the category where the 50% receive hormone replacement therapy. 13) Women with osteoporosis and taking bisphosphonates or a combination of bisphosphonates - non bisphosphonates are aware of the problems associated with implant placement. Women with osteopenia or without osteoporosis have no problems with implant placement and there was no need to be informed of potential problems. Multivariate Factor Analysis of Correlations Between Variables “Smoking Classes”, “Diagnosis of Osteoporosis”, “Information from a Dentist about Implantation Due to Osteoporosis Drugs”, “Information from a Dentist about dental Implantation Problems because of osteoporosis” and “Type of pharmaceutical treatment for osteoporosis”, overall, has a statistically significant result: Υ2=728.251, ΒΔ=225, p=0.000<<0.01. 14) It was concluded that receiving hormone replacement therapy appears to be related to non-treatment for osteoporosis, since 41.9% of participants receiving hormone replacement medication do not receive any osteoporotic medication. What is more, 35.5% of participants taking hormone replacement medications also reported receiving non-bisphosphonates. Finally, bisphosphonates and combinations of bisphosphonates and non-bisphosphonates were obtained from participants who were also receiving hormone replacement therapy, at significantly lower rates: 12.9% and 9.7%,respectively. This correlation yields statistically significant results (Υ2=10.530, ΒΔ=3, p=0.015<0.02). We can say that there is a tendency (correlation) when taking hormone replacement therapy, the likelihood of osteoporosis treatment is increasing. We could formulate thehypothesis of a dipole for “drug treatment” or "non-drug treatment" that seems to dominateour sample's perceptions. Conclusions. It was found that there is important improvement in women's quality of life, concerning the parameters of “mouth pain”, “chewing pain”, “stress”, “eating difficulty”, “meal break”, “relaxation”, “shame”, “irritability”, “satisfaction with life”, “dysfunction”, “speech”, “taste”, “tooth sensation” and “workplace behaviour”, after prosthodontic rehabilitations. In addition, the dental practice with appropriate information and treatment in the group of menopausal women with or without osteoporosis or osteopenia is usual and adequate. It is also significant the information for the side effects of the medication for osteoporosis in cases with dental implants, especially if the patient uses biphosphonates. The level of education is the important parameter in receiving or not hormone replacement therapy or other treatment as well for the osteoporosis.