الفهرس 
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Abstract
Implant success and osseointegration depend on multiple factors: surgical and prosthetic factors, the implant design, and patient-related factors. It can be difficult to define which of them is determining the success or failure of the treatment. The different quantity and quality of bone at the implant receiving sites and the patient response are unavoidable factors. Some patients are more prone to implant failure, in particular those with systemic conditions that might increase the risk of implant failure. Several micronutrients are hypothesized to have an influence on the skeletal system, particularly on alveolar bone and on dental implant osseointegration. Which in turn affects dental implant stability and can be a cause of dental implant early failure, particularly. Many studies and systemic reviews mention specific vitamin D and magnesium roles in dental implant osseointegration and early implant failure.
- The aim of the current study was to evaluate radiographically and histologically the correlation between bone quality and serum vitamin D status.
- This study was conducted on adult patients with a total of 143 implant placement sites. Patients were selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University
All patients were assessed for 25-hydroy vitamin D level preoperative using Enzyme Immunoassay (EIA) test categorized by mean serum vitamin D status as follows:
(1) Sufficient, 25 (OH) D >30 ng/mL
(2) Insufficient, 25 (OH) D 10–29 ng/mL
(3) Deficient, 25 (OH) D <10ng/mL
All CBCT (pre-operative) were taken by I-CAT scanner with same standard protocol of scanning. PLANMECA software used to measure the average grey level values around planned implant.
Virtual implant site was planned using implant tool on cross-sectional images and chosen to allow for 2 mm of distance from vital structures according to future prosthetic plan and gray values was measured at (outside) around 1 mm of virtual implant and all readings were taken by one investigator, tabulated for statistical analysis in relation to 3 vitamin D status groups (deficient –insufficient –sufficient) and serum vitamin D level.
All patients were treated with the same implant system, same protocol and by the same surgeons under local anesthesia. Bone biopsies were obtained from one implant site from each patient using trephine bur (1.7 mm diameter and 7 mm length) replacing the first drill of the implant bed preparation. Bone biopsies were histologically processed by same protocol and stained with Masson trichrome and histomorphometric analysis was done for immature collagen per mature collagen.
- The study results showed,
*Radiographically, we found statistically significant relation between mean grey level values 1mm outside implant placement site and serum vitamin D status 3 groups (sufficient –insufficient – deficient) using analysis of variance (ANOVA). The mean grey level values in sufficient group were significantly higher than bone density in deficient.
*Histological, we found statistically significant difference in percentage of immature collagen per mature collagen in relation to vitamin D status groups (sufficient –insufficient – deficient) in histomorphometric analysis of bone biopsies obtained from both maxillary and madibular implant sites.
Conclusion and recommendations
from this observation prospective study, we can conclude that:
• Bone density of the alveolar bone in CBCT was negatively affected by decreased serum vitamin D level specifically in posterior mandible and maxilla.
• The percentage of mineralization defects in alveolar bone increased by decrease of serum vitamin D level.
To overcome limitations presented in our study, we recommended some modifications that may lead to identifying the correlation between serum vitamin D status and bone density like:
• measuring serum vitamin D and obtaining CBCT at 2 times one in first week of extraction and second after 6 months after extraction are needed to confirm the presence of an association between low serum levels of vitamin D and decreased bone density.
• It would be appropriate to assess whether supplementation of vitamin D in the weeks after extraction could lead to an increase in bone density.
• Limiting studies to single region dental implant position as the measurement of bone density greatly verified between different regions like posterior maxilla and anterior mandible.