Calciolari, E; (2017) Intramembranous bone healing and the effect of osteoporosis on the jawbones. Doctoral thesis , UCL (University College London).

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Abstract

Osteoporosis is the most common chronic bone metabolic disease that may interfere with bone regeneration processes. In order to optimize bone regenerative treatments, we need to understand how this disease can affect the cascade of events occurring during osseous formation. This PhD thesis aimed to investigate the effect of osteoporosis on the jawbones, its influence on intramembranous osseous healing and how different titanium surfaces may opportunely modulate bone formation. Firstly, a systematic review on the effect of osteoporosis on the jawbones and on the accuracy of panoramic morphometric indices to screen for reduced bone mineral density were presented. Despite the poor quality of the available studies, our data showed that a correlation between jawbone and skeletal density in osteoporotic patients might be expected. While available data do not fully support the prescription of panoramic radiographs for osteoporosis screening, when available, they might be used as an opportunistic tool to detected patients at risk of reduced bone density. Secondly, we described at a histological and proteomic level, in a model for guided bone regeneration, the mechanisms and signalling pathways characterizing intramembranous osseous regeneration, aiming to evaluate at which level experimental osteoporosis might affect them. Herein, we showed that guided bone regeneration in the presence of an osteoconductive graft could be successfully achieved also in osteoporotic-like conditions. However, an increased inflammatory and stress response and a reduced/delayed activation of pathways regulating the differentiation of osteoblast precursors were documented in osteoporotic-like animals. Finally, the proteins and related signalling pathways associated with hydrophobic (SLA) and hydrophilic (SLActive) surfaces were investigated in a dome model for GBR. Although a lack of functional differences between the two surfaces was suggested, differences in the modulation of pathways involved in inflammatory response, differentiation of osteoblast precursors and skeletogenesis were detected at early healing periods.

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