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ORIGINAL ARTICLE
a
Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
b
Central Laboratory, Center for Science and Medical Studies for Girls, King Saud University, Riyadh, Saudi Arabia
KEYWORDS Abstract Purpose: The purpose of this clinical and radiographic study was to evaluate the effect
Bone resorption; of age, gender and duration of edentulism on the amount of mandibular residual ridge resorption in
Duration of edentulism; a Saudi population.
Mandibular residual bone Material and methods: Partially and completely edentulous Saudi patients (50 male and 64
female) attending the outpatient clinics at College of Dentistry, King Saud University, Riyadh,
Saudi Arabia were included. Current age, gender of subjects and date of start of edentulism were
recorded. Digital panoramic dental radiograph less than 1 year old of each patient was examined.
The height of edentulous mandible was measured as described in the American College of
Prosthodontists Prosthodontic Diagnostic Index (PDI) classification. Students t-test and ANOVA
post hoc tests, Pearson’s correlation coefficient (r) and chi square (v2) analysis were performed as
indicated. Level of statistical significance was set at 0.05.
Results: Male patients showed a significantly greater mandibular bone height compared to
female patients. Age and bone height were statistically significantly negatively correlated
(p = 0.0001). However, age and mandibular bone height in only male patients was negatively cor-
related and reached statistical significance (p = 0.001) A negative correlation was observed between
duration of edentulism and mandibular bone height in both genders, but was not statistically sig-
nificant (p > 0.05).
https://doi.org/10.1016/j.sdentj.2018.12.006
1013-9052 Ó 2019 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006
2 H.A. AlSheikh et al.
Conclusions: In a Saudi population, men have greater mandibular bone height than women and
also exhibit a negative correlation between age and mandibular bone height that is statistically sig-
nificant. In contrast, women exhibited a negative correlation between age and mandibular bone
height, but was not statistically significant.
Ó 2019 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006
Mandibular residual ridge height 3
All data analysis was carried out using IBM SPSS version 23.
The mean, standard deviation (SD) and standard error of the Fig. 1 Measurements of mandibular bone height as described by
mean (SEM) were calculated for current age, gender, duration the American College of Prosthodontists (ACP) in a mandibular
of edentulism and bone height. Male and female data were completely edentulous case (a), mandibular bilaterally edentulous
compared using Students t-test and ANOVA post hoc test. case (b) and mandibular unilaterally edentulous case (c).
The significance of difference was assessed by p value. Pear-
son’s correlation coefficient (r) was used to determine the
Fig. 2 presents the frequency distribution histogram of age
extent and nature of correlation between the different param-
of both genders. Almost 50% of males and female patients
eters. Chi square (v2) analysis was performed using 2 2 or
were in the age group of less than 50 years. In Fig. 3, more
2 3 contingency tables to test the difference between male
mandibular bone height was evident in male than female
and female data. Level of significance was set at 0.05.
patients (24.57% and 21.62% respectively). Therefore, greater
bone resorption was evident in female than male patients. Both
3. Results male and female patients started edentulism (loss of teeth) at
about 40 years of age (Fig. 4).
Table 1 presents means of current age, age at start of eden- Table 2 presents results of assessment of site, type and area
tulism (start of loss of teeth) and mandibular bone height in of edentulism of both genders. In general, most of male and
both male and female patient groups. Comparable values of female patients (54% and 54.68% respectively) showed bilat-
current age and age at start of edentulism of both genders were eral than unilateral edentulism (37.5% and 36% respectively).
observed. However, they were not statistically significant Most of patients (91.23%) presented with partial edentulism
(p = 0.50 and p = 0.701 respectively). All types of residual that was little more in female (92.19%) than male (90%)
ridge bone height of Prosthodontic Diagnosis Index classifica- patients. Most of patients (52.63%) had lost molar teeth; that
tion existed in both genders (13.1–34.2 mm in male and 14.4– was observed more in female (59.38%) than male (44%)
28.7 mm in female patients) except Type IV. Male patients patients. However, there were no statistically significant differ-
showed a significantly higher mandibular bone height mea- ences in site, type and area of edentulism between genders
surements compared to the female patients (p = 0.0001). This (p > 0.05).
means that there was a statistically significant increase of Table 3 shows correlation of age and mandibular bone
mandibular RRR that was reported more in female than in height in both genders. In general, age correlated negatively
male patients. with bone height in both genders. This means that as age
Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006
4 H.A. AlSheikh et al.
Table 1 The current age, mandibular bone height and age at start of edentulism (start of loss of teeth) in both genders.
Variable Sex Mean Median SD SEM Percentile range p-value
Current Age (years) M 46.80 50.00 14.458 2.040 21.6–77.3 0.50
F 48.67 49.50 11.836 1.480 25.8–71.9
Age at Start of Edentulism (years) M 39.63 42.00 15.54 2.212 12.8–69.2 0.701
F 40.62 40.00 11.65 1.456 18.9–60.4
Mandibular Bone Height (mm) M 24.57 24.57 4.350 0.635 13.1–34.2 0.0001
F 21.62 21.6 3.242 0.406 14.4–28.7
M: Male; F: Female; SD: Standard Deviation; SEM: Standard Error of Mean.
4. Discussion
Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006
Mandibular residual ridge height 5
Table 3 Correlation of current age and mandibular bone Table 4 Correlation between duration of edentulism and
height in both gender. mandibular bone height in both genders.
Gender Correlation between current Gender Correlation between duration of
age and mandibular bone height edentulism and mandibular Bone height
Male r 0.478 Males r 0.257
p-value 0.001 p-value 0.085
Female r 0.167 Females r 0.53
p-value 0.188 p-value 0.679
Total r 0.353 Total r 0.176
p-value 0.0001 p-value 0.066
r: Correlation Coefficient.
Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006
6 H.A. AlSheikh et al.
residual ridge bone height of 11 to 15 mm; and Type IV: resid- denture or early implant placement for implant-supported
ual ridge bone height of 10 mm or less (McGarry et al., 1999). overdentures instead of the conventional complete denture
All of those measurements were done at the least vertical therapy. This attempt should be made specifically for female
height of the mandible. This method was selected to be used patients who were found to experience more mandibular
in our study. In our study, all types of residual ridge bone reduced bone height than male patients that could be due to
height were demonstrated except Type IV. problems associated with osteoporosis and menopause. In
In the present study, as age increased, the mandibular bone completely edentulous cases, whether or not prolonged dura-
height significantly decreased. This finding was expected as was tion of wearing mandibular complete dentures results in an
reported by previous studies (Al-Jabrah and Al-Shumailan, increased mandibular bone resorption is still controversial.
2014; Gupta et al., 2010; Jagadeesh and Patil, 2013; Jayaram Therefore, further studies are needed to evaluate the effect of
and Shenoy, 2017). all variables such as gender, age including pre- and post-
In this study, most of patients showed bilateral than unilat- menopausal stages of female patients, duration of partial and
eral partial edentulism. Loss of molar teeth was more evident complete edentulism, and duration of wearing dentures on
in female than male patients. However, there were no statisti- mandibular bone height.
cally significant differences in site, type and area of edentulism
between genders. 5. Conclusions
In our study, there was a statistically significant decrease in
mandibular bone height in female patients. Therefore, gender
of patients involved in this study had a significant effect on Within the limitation of this study, the following conclusions
the mandibular bone height. This finding is supported by other were drawn:
studies that reported a greater bone resorption in women than
men (Al-Jabrah and Al-Shumailan, 2014; Liang et al., 2014). 1. There was a statistically significant decrease in mandibular
Vaishnav et al. (2010) also reported resorption of the wall of bone height that was reported more in female than in male
mandibular canal that was more in edentulous women than Saudi patients.
men due to hormonal reasons. 2. Both male and female Saudi patients started edentulism
In our study, a negative correlation between age and (loss of teeth) at about 40 years of age.
mandibular bone height in both genders, but was found statis- 3. As duration of edentulism was increased, the mandibular
tically significant in male patients. In our study, osteoporosis bone height decreased.
was excluded. Therefore, the mandibular RRR may be mainly 4. A negative statistically significant correlation existed
due to the effect of menopause in older female patients. between age and mandibular bone height in Saudi male
In the present study, as the duration of edentulism patients.
increased, the mandibular bone height decreased. This is also 5. Future studies are needed to evaluate the effect of all vari-
supported by a previous study which reported an increase in ables such as gender, age including pre- and post-
mandibular RRR as the duration of edentulism increased menopausal stages of female patients, duration of partial
(Al-Jabrah and Al-Shumailan, 2014). Another study reported and complete edentulism, and duration of wearing dentures
an early reduction in mandibular bone height that was fol- on mandibular bone height in Saudi population.
lowed by a slower resorption as the duration of edentulism
increased (Jayaram and Shenoy, 2017). In this study, a nega-
tive correlation between duration of edentulism and mandibu- Conflict of interest
lar bone height was also evident in both genders, but was not
statistically significant. As length of edentulism period in male There is no conflict of interest.
patients increased, a constant reduction of mandibular height
was reported (Jagadeesh and Patil, 2013). However, that study
Ethical statement
was limited only to men to eliminate variables associated with
osteoporosis and menopause in women (Jagadeesh and Patil,
2013). In our study, systemic diseases such as osteoporosis, This research does not require ethical approval. I followed the
that may influence bone condition, were excluded. This was Helsinki declaration.
done because osteoporosis results in a decrease of the jawbone
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Please cite this article in press as: AlSheikh, H.A. et al., Mandibular residual ridge height in relation to age, gender and duration of edentulism in a Saudi population:
A clinical and radiographic study. Saudi Dental Journal (2019), https://doi.org/10.1016/j.sdentj.2018.12.006