Application of growth hormone to reduce osseointegration time in dental implants

Abstract

this study evaluate the beneficial effects of the treatment grow hormone on bone regeneration and osseointegration of dental implant surgeriesin elderly people. From a sample of 402 dentalimplants it was concluded that in all age and gender groups the reduction of the osseointegration time was quite significant.

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Abbreviations: GH, Growth hormone; PTH, parathyroid
hormone; OPG, osteoprotegerin; PRGF, plasma rich in growth factors
Introduction
The great desire of nearly all people is to have a long and healthy
life, which does not meanto add more years to the lifespan, but also to
increase the quality of life in said years. Starting from the age of 40 a
decrease in several hormones can be observed that seems to be related
to the aging process. The replacement therapy with these hormones at
physiological doses and after an individual evaluation to prove that the
benecial effects1 are always greater than the possible adverse effects
could be a strategy to delay the consequences of aging. Although no
hormone can be recognized undoubtedly as a “rejuvenating” agent or
that it may prolong life, some of its actions may be benecial.2 The
possible treatment of elderly people usingreplacement therapy with
growth hormone (GH) was rst demonstrated in the paper of Rudman
et al.3 Actuallythe possibilities of GH replacement therapy for the
aging process is showing a steady increase.
GH promotes body growth during infancy through puberty,
inducing fundamentally an increase inthe length of long bones acting
on the chondrocytes of the conjugation cartilage (or growth plate),
although it also stimulates the growth of soft tissues. In childhood,
a decit in the secretion of GH leads to pituitary dwarsm, whereas
its hypersecretion causes gigantism. In adults, excessive production
of GH leads to acromegaly, whereas its decit leads to a syndrome
characterized by a set of factors leading to early atherosclerosis and
an increased risk of cardiovascular diseases.4
Pulsatilesecretion of GH reaches a peak during puberty, a period
in which its pulse amplitude is greatest during slow-wave sleep.3 This
phase is the most important of all stages of sleep due to its inuence in
the GH increase. With aging, sleep fragmentation occurs and changes
in circadian rhythms appear, which leads to a decrease in slow-
wave sleep. This leads to a decrease in melatonin, GH andInsulin-
Like Growth Factor1 (IGF-1) levels.5 From the fourth decade of life
onwards a decrease of GH secretion levels can be observed, converting
the majority of elderly people into GH decient individuals (SDGA).
One of the actions of GH is the stimulation of the formation and/or
remodelling of bone tissue, and the increase of bone density. Recent
studies justies that GH can be used in the treatment of osteoporosis
in adults with GH deciency or also during a period of healthy aging.6
In addition, it has been shown that continuous treatment over a period
of time in patients with GH deciency is also able to increase bone
mineral density and is therefore recommended as a treatment to
obtain bone maturation in children in need of it.7 Another possibility
of GH administration is to contribute to accelerate the process of
osseointegration in fractures.8
Among the actions performed by GH are the formation
and remodelling of the bone tissue. The overproduction of GH
(achromegaly) is accompanied by an increase in bone mass9 whereas
in adults with GH deciency the bone mineral density is decreased,10
and these patients develop a higher risk of osteoporosis.11 In fact, both
local12and systemic8 GH administration is able to accelerate the bone
remodelling process.
Several studies have demonstrated the possible utility of GH as
a coadjuvant in the consolidation of fractures. Thus, the administration
of exogenous GH to rats in which an experimental tibial fracture had
J Dent Health Oral Disord Ther. 2020;11(4):116‒124. 116
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Application of growth hormone to reduce
osseointegration time in dental implants
Volume 11 Issue 4 - 2020
Ana Rego,1 Jesus A F Tresguerres,2 Jose M
Tallon,3,4 Paulo Gomes5
1Clínica do Mediterrâneo, Lisboa
2Department of Physiology, Medical School,University
Complutense,Spain
3Medical Clinic, Doctor, Tallon
4Sports Sciences Department, Exercise and Health, Universidade
de Trás-os-Montes e Alto Douro, Vila Real, Portugal
5NOVA IMS Information Management School, Lisbon, Portugal
Correspondence: Ana Rego, Clínica do Mediterrâneo, Lisboa,
Portugal, Tel 00351917469494Email ana@clmediterraneo.com
Received: August 02, 2020 | Published: August 24, 2020
Abstract
This studypretends to evaluate the benecial effects of the treatmentwith growth
hormone(compassive off-label use)on bone regeneration and osseointegration of dental
implant surgeriesin elderly people.A total of 140 patients, between 35 and 82 years of age,
undergoing dental surgery, receiving a total of 402 dentalimplants have been investigated.
Informed consent was signed by all of them. From this group, 58 patients(31 malesand 27
females) received a total of 209 implants and weretreated with local growth hormone in the
surgical bed during the procedure, and in 29 implants of this group,when surgical beds were
more extensive also with daily systemic application for one month.
Another 82 patients between 35 and 82 years of age (39 males and 43 female) werealso
submitted to implant surgery and received a total of 193 implants without growthhormone
treatment. For the evaluation of results, a simple apical radiography was used.
Osseointegration was determined by bone neoformation and density between and around
theimplant coils. Study showed that growth hormone treatment was able to induce a
statisticallysignicant decrease in the average time between the surgical approach and
osseointegration of theimplant. The median value for treated patients was 82 days whereas
the untreated needed amedian of 140 days. No differences were observed either regarding
gender or groups ofage.
It was concluded that in all age and gender groups the reduction of theosseointegration time
was very signicant when growth hormone treatment was used.
Keywords: growth hormone, implants, osseointegration
Journal of Dental Health, Oral Disorders & erapy
Research Article Open Access

Application of growth hormone to reduce osseointegration time in dental implants 117
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
occurred was capable of increasing the rigidity and load capacity
of the fractured bone.13,14These positive effects are also observed in
older animals.15,16All these data allow hope for its potential role in
the consolidation of complicated fractures, either by nature of injury
or because the individual responds poorly to conventional treatment
when having advanced age or osteoporosis.17,18,19
There are many studies that have proposed the administration of
GH for the treatment of osteoporosis, since it has been proven that
it is able to accelerate bone remodelling both in patients with adult
GH deciency and in healthy elderly.20,21Still with better results
given in combination with Parathyroid Hormone (PTH).22 The
administration of GH alone or combined with estrogens, is also
able to reverse vertebral osteopenia in ovariectomized rats.23
Also, in women in which osteoporosis is a serious problem, this
benecial effect has been observed, since the administration of GH
in postmenopausal osteopenic women increases bone mineral density
and markers of bone formation within 7 days of treatment. Similarly,
replacement therapy for 12 months24 or 24 months25 in adults with
GH deciency also increases bone mineral density and remodelling
markers. There is a recent and very important paper which followed
menopausal women with osteoporosis for ten years, in which a very
important effect has been observed with the treatment with GH.26All
this suggests that, probably in the near future, GH will be used alone
or in combination with other drugs forthe treatment of osteoporosis.
Similarly, several studies have shown that local administration of
GH at the time of surgery favours the transcortical osseointegration of
titanium implants in rabbits, both osteoporotic and non-osteoporotic,27
allowing a glimpse of its use in the eld of dentistry.
Materials and methods
209 implants were placed using local GH in the surgical wound in
58 patients (31 men and 27 women) and 193 implants without GH in
82control patients, (39 men and 43 women)for comparison, in people
between 35 and 82 years of age.
Threaded implants of various diameters and lengths were used,
both in external and internal connection, a single dose in local
application in the alveolus of GH 2mg implantation (Somatropin -
10mg/1.5ml). In 29 implants with more extensive surgeries, systemic
GH of 1mg (Somatropin 10mg/1.5mg) per day was administered 10
days before surgery and for 20 days afterwards.
When there was a need for bone growth or lling of empty
spaces, agglomerated regeneration biomaterials were applied in a
Plasma Rich in Growth Factors (PRGF) autologous brin clot. All the
implants were placed with an open ap technique on the rst time and
on the second time, with an exposure of the implant, with the punch
technique.
All patients signed an informed consent, both in the placement
of simple implants (without GH) and in those in which GH was
administered.They were all informed about the benets and the
possible risks of the compassionate off label use of GH.
For the evaluation of the results, the simple apical radiography
was used, always with the same apparatus, lm positioner, the same
intensity to be as accured and standardized as possible, assessing the
osseointegration by the neoformation and bone density around and
between the turns of the implant’s threading. Osseointegration occurs
when the image shows a similar density to normal bone, with absence
of hypodense zones; some hyperdense areas due to ankylosing might
be present.
Statistical analysis
A statistical analysis was carried out using the “t-student modied”
adapted to situations of non-equality of underline sub population
variances. The statistical analysis of the comparison of the three
averages of the groups, by resorting to a model of analysis of variance
to a factor (age) is not revealed feasible due to the small number of
observations in the group over 70 years old.
Results
When GHadministration in single or multiple implant placement
surgeries is used, the healing and osseointegration process is faster in
time, (median time, 82 days vs 140 days) as compared to controls in
which GHwas not used, as shown in Table 1.
In each of the Box Plot, Figure 1, three cases of “outliers” patients
are identied in the right parts of the data distribution. The clinical
study of the patients that generate these observed cases, revealed that
there were other factors that could explain the relatively high time
margin between placement and osseointegration.
For the other patients, no deterministic factors were found to
explain the remaining extreme values of time, observed between
placement and osteointegration.
Consequently, robust estimates of average time and variance of the
sample were obtained, between the various times of osseointegration,
recalculating mean time and variance “truncated to the right” by
excluding the three outlier cases, in each of the samples under study.
The exploratory analysis of Table 2 indicates that
1. The use of GH decreases the average time between implant
placement and osseointegration.
2. There is a visible discrepancy in the evaluation of the absolute
dispersion of the data in each of the situations
3. In each case the coefcient of asymmetry is less than one, which
means, the data has a high degree of symmetry.
It can be seen that there is a very signicant inuence of the use of
GH in the reduction of the osseointegration time of the implant (P<
10-5),Table 3.
Comparative statistical study of ages with application
of GH
The previous analysis of these data seems to reveal a small but not
signicant difference in the effect of age on the mean times between
placement and osseointegration when using GH, Figure 2. And the
inter-quartile range is quite similarly for the tow rst age group.
From Table 4, it can be concluded that there are nodifferences
in the degree of reduction of the osseointegration time by GH in the
different age groups, population of up to 50 years μ₁ and μ₂ in the
group of 51 to 70 years.
Additionally, Table 5shows the signicant reduction of
osteointegration times inall ages groups patients treated with GH, as
compared whit those without GH, around 60 days.

Application of growth hormone to reduce osseointegration time in dental implants 118
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
Table 1 Statistics order for the two osseointegration times
Nr. Min. days Max. days 1st Quartile Median 3rdQuartile Interquartile range
With GH 209 43 147 66 82 92 26
Without GH 193 66 271 126 140 1705 445
Figure 1 Box plot of the two situations, with or without GH-comparative analysis.
Table 2 Robust estimates mean time, variaance and asymmetry coefcient
 n Truncated average time Truncated variance Coefcient of skewness
With GH 197 806 3103 4
Without GH 185 1456 11048 6
Table 3 Robust estimate of mean time, standard errors and p value comparative statistaical study of mean time with and without GH
 n mean TSE p-value
With GH 197 80.6±1.3 
Without GH 185 145.6±2.4 
Difference  65±2.7 p˂10-5
Table 4 Statistics of osseointegration times
Age Nr. obser Min. Time Max. Time 1st Quartile Median 3rdQuartil Mean±Se
˂=50 59 55 120 64 75 91 77.9±1.9
From 51 to 70 years 120 43 128 66 84 93 81.8±1.7
>70 years 18 64 121 68 69 93 78.3±4.3
Total 197      
Figure 2 Box-plot of the three age groups, with GH-comparative analysis.

Application of growth hormone to reduce osseointegration time in dental implants 119
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
Table 5 Comparison of age with or without GH
Age  
˂=50 years From 51 to 71 years > 70 years
Treatment n1 Mean±Se n2 Mean±Se n3 Mean±Se
with GH 59 77.9±1.9 120 81.8±1.7 18 78.3±4.3
Without GH 81 147.6±4.6 86 144.9±3.4 18 134.3±2.3
Difference  69.7±2.9 (P10-5)  63.1±3.7 (p10-5)  56±4.8 (p˂5X10-4)
Statistical comparative study of gender with
application of GH
When we compare women with less than or equal to 50 years
of ageand women over 50 years of age on the action of GH taking
into consideration that it is generally in this age group that hormonal
alterations are likely to inuence osseointegration, the data points to a
non-signicantdifference in the time of osseointegration in these age
groups when subjected to treatment with GH, (p -value >0,10), Table
6.
Placement of implants with not enough bone
Placing the implant in the bone cortex, but having aminimum
amount of marrow, even if only on one side, the bone growth was
veried both on the side that had marrow and on the other side, having
bone growth both in thickness as in height (Figure 3). Where was
placed 4 implants.
Figure 3 Bone growth around the implant with the use of GH.
Recovery of implants with Peri Implantitis
In conjunction with biomaterials and PRGF, bone neoformation
was veried, whether in growth or in vertical lling (Figure 4) around
an implant with Peri Implantitis. Surgeries were performed on 6
implants.
Treatments with several stages
In the 1st stage GH was not used and external scarring occurred in
about 1 month and complete osseointegration at the end of 6 months,
in the 2nd stage local GH was used and external scarring occurred
in close to one week and complete osseointegration at the end of 2
months, in the 3rd stage local GH was used in the surgery and systemic
GH (10 days before the surgery and 20 days after it , (in the case
of very extensive surgery of the upper hemiarcade with extractions
and immediate placement of implants) external healing occurred in
two weeks and osseointegration in 3 months (Figure 5). Twenty-nine
implants were placed in 5 patients.
Figure 4 Recovery of implant with periimpantitis.
Dental extraction and implant placement
External scarring and complete osseointegration is faster even
when there is no complete closure of the wound due to lack of gingiva.
There were 13 implants placed.The scarring and osseointegration
is much slower (previous statistics) and vertical bone growth is
not veried in premises with less bone, sometimes causing serious
problems (Figure6), and even when it has been years since the
placement of the implants in areas of less bone, there is no bone
neoformation or complete osseointegration (Figure 7).
Placement of implants with infectious lesions
GH treatment very quickly accelerates the growth and
developmentof old lesions that were latent or hidden, generating a
rapid rejection of the implant with bone loss in the corresponding
space. This happened in 5 implants of 3 patients.
Discussion
It is known that from the fourth decade of life onwards there is
a decrease in GH levels, making the majority of elderly people
physiologically GHdecient which is associated with muscle
weakness, atherosclerosis, osteoporosis, etc.28
GH and mainly IGF-I promotes bone growth, in a dose-dependent
manner, by direct stimulation of metaphyseal chondrocytes.29,30When
GH is administered locally, it takes action on the chondroprogenitor
cells, promoting their differentiation and proliferation, whereas
IGF-I acts on already mature chondrocytes, stimulating both their

Application of growth hormone to reduce osseointegration time in dental implants 120
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
proliferation and matrix synthesis.31 IGF-I and II are the most abundant
growth factors in bone and are able to stimulate the proliferation and
differentiation of osteoblasts,32At the same time as they enhance
collagen synthesis and inhibit its degradation. The actions of these
IGFs are regulated to a certain extend by the Insulin-Like Growth
Factor-Binding Protein 3 (IGFBP-3), whose in vivo production is
under the direct control of GH.31
Figure 5 Use of GH at various stages of treatment.
Figure 6 Problems when implants are placed with lack of bone and without
GH.
It has been often observed that both resorption and bone
formation show high values in young subjects with high levels of
GH,8,21concluding that GH activates bone remodelling, by increasing
the differentiation of osteoclasts and osteoblasts, and the same can be
obtained with the treatment with GH.
Figure 7 There is no new bone formation without GH.
GH is very important in the longitudinal growth of bone
acting on the growth plates and stimulating the differentiation and
proliferation of osteoblasts. However, in the osseointegrationprocess
of titaniumimplants placed in situations of osteopenia/osteoporosis,
its effects haven’t been studied much. The systemic application of the
hormone on bone physiology has been widely evaluated in animals33–
39with satisfactory results in fracture healing, bone distraction,
situations of osteopenia and osteoporosis, and in GH deciencies.
GH is an anabolic hormone that stimulates not only osteoblasts
proliferation and differentiation,40 but also osteoclasts,41 thus, GH is
capable of stimulating bone turnover.8 GH is also able to enhance
bone fracture repair, both in young16,42and old animals,13 when given
systemically. Hedner et al.43applied GH in jaws of rats with bone
defects, demonstrating that there was an increase in bone formation
with application of local GH for 4 weeks. In case of fractures or
osteotomy, GH has shown also positive effects on the repair, as proven
by Cacciafesta et al.,44which have shown that in the animals treated
with GH there is a signicant increase almost doubling the volume of
newformed bone as compared with the placebo group,Actually GH
administration could be effective in the consolidation of hip fractures
in humans.45
Several authors have found an increase in cortical thickness
after treatment with GH not only in normal rats,46 but also in aged
rats,15,16in ovariectomized rats,23 and also in old ovariectomized
rats35,47Accordingly, with Andreassen and Oxlund,18 GH treatment
does not seem to have effects on trabecular bone in absence of linear
growth.
In addition, when GH administration has been associated with
other hormones, such as PTH, additive effects on vertebrae have
been observed in old ovariectomized rats, in which an increase in
both cortical and trabecular mass was also seen. GH seems to induce
a subperiosteal apposition whereas PTH induces an endosteal and
cancellous deposition.17
Elena Martin Monge in her study in 200948 valued the local
application of growth hormone on the process of osseointegration of
a titanium implant of threaded surface in the tibia of ovariectomized
rabbits submitted toa hypo-calcic diet (experimental osteoporosis) and
in the tibia of healthy rabbits.The “impulse effect” of the application
of local GH would produce an initial acceleration of intracortical
remodelling, starting with resorption and continuing with bone
formation. Following the model proposed by Tresguerres et al (In
which 4 U.I. of rhGH were applied in the surgical process of inserting
titanium plates, and in other casesbicortical screw implants).Local

Application of growth hormone to reduce osseointegration time in dental implants 121
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
application of GH increases osteoid tissue formation and bone growth
in animal models.49–54
Oxlund & Andreassen55injected for 14 days, 2 or 20mg/Kg/day of
rhGH on the surface of the diaphysis of the intact tibia of ten month
old rats and ina fracture healing process.After 21 days an increase
in bone load capacity and strength was found, as well as in the size
and volume of the fracture callus; after 98 days, the ability of bone
loading, versus a control group, remained increased.
Table 6 Statistical comparative of two female age groups with GH
Age N. of observations Mean±Se Mean difference±Se
Female with GH ˂=50 years 39 80.1±2.0
2.8±2.9 (p-value >0,10)
From 51 to 70 years 49 77.3±2.1
In humans, the application of GH activates bone remodelling
units, increasing the differentiation of osteoclasts and osteoblasts, and
once activated, they go through a “complete” remodelling cycle56.
It is known that the effect of treatment with GH in adults, not only
markedly accelerates bone turnover by increasing the activation
of new bone metabolic units, but also stimulates periosteal bone
apposition, which entails the enlargement of the bone width.
The combination of these two different effects can, simultaneously,
increase both the bone mineral content and the bone projection area.
The systemic application of the hormone has been studied
in humans56–60 with satisfactory results in fracture healing,
osteodistraction, situations of osteopenia and osteoporosis, and GH
deciencies.Already in 1998, Wüster et al.56carried out a review on the
application of GH in healthy individuals; in patients with osteoporosis,
in elderly people and in cases of GH deciency (GHD) (in which
the bone mass is decreased). They observed that after administering
GH to the patients with GHD there was an increase in bone turnover
(remodulation), mineral density initially decreased, during the rst
year of treatment, due to the increase in bone remodelling.
In the same way as other authors52–54the local application of
lyophilized GH was carried out directly on the implant bed, soaking
with the blood clot. In addition, since administration is in a single
dose, side effects would not occur.
Data obtained in the present study are consistent with previous
ones showing improvements achieved by GH administration regarding
biomechanical properties of the bone.18,35,46
If we try to investigate the pathways by which GH is able to
stimulate bone formation, it has been demonstrated that it is able to
stimulate the differentiation from mesenchymal stem cells towards
the osteoblast lineage, even in aged animals.61
In addition, GH seems to modulate the activity of Runx2, a
transcription factor that is needed for chondrocyte maturation and
osteoblasts differentiation.62
GH is able to enhance osteoclast activity,63but it is also capable to
increase osteoprotegerin (OPG), an endogenous inhibitor of osteoclast
differentiation and activation. The effect is exerted through its binding
to RANKL, preventing its union to RANK and leading to a decrease
of osteoclastogenesis.64
The age related decline in GH levels observed with aging, could lead
to reduced plasma calcium levels, resulting in a compensatory increase
of PTH, leading to an increase in bone resorption. Administration of GH
could reduce the secondary hyperparathyroidism, since it can increase
the intestinal calcium reabsorption,65 increasing calcium availability
by the bone. Furthermore, GH administration could also restore PTH
levels, as demonstrated by Joseph et al.66 in postmenopausal women
with osteoporosis.
GH is able to stimulate angiogenesis,67,68which is the rst step in
the osteogenic process. In another study from our group, GH was able
to reduce in the aorta of old animal’s medium layer cross-sectional
area that showed an increase, and to increase its relaxing responses
which showed a reduction.69
Also, Landin-Wilhelmsen et al.,57 did nd signicant differences
in BMD or BMC at the end of the study with 80 osteoporotic women
who had previously received Hormone Replacement Therapy, and
who were given for 18 months 1 u/day of GH, or 2.5U/day. They
concluded that GH produced a delayed, prolonged and dose-dependent
effect in postmenopausal osteoporosis, and that it could be used as an
anabolic agent in the treatment of this disease.More recently Krantz
et al.26demonstrated also very positive effects of GH treatment for 10
years in osteoporosis of menopausal women.
In the reviewed papers, we have not found any study of the use of
GH in osteoporotic subjects in which implants were placed with any
type of surface covered.
In the scant literature found on local application of GH, this
is done in the form of an osmotic pump or local subcutaneous
injection43,55,70and when used with implants, the authors consulted
impregnated the surface of the implant, either titanium or ceramic,
with the GH49,51,71Downes et al.50used a polymethylmethacrylate
cement for local application, obtaining good results, but in their case,
titanium implants were not used.
The safety of potential GH administration in aged people is
controversial. Since the very important paper of Rudman et al.72many
elderly people have been treated with GH, mainly in the USA, for
several “off label” indications including aging itself, and no report to
our knowledge about any increase in cancer appearance has appeared
until today.However, some side effects have been detected with GH
treatment in adults as an increased risk for carpal tunnel syndrome,
uid retention or insulin resistance, but only when high doses of the
hormone were used.73,74
Conclusion
In this work carried out in dental implantology, it can undoubtedly
be concluded that the use of GH is benecial in healing and
osseointegration, both locally and systemically, as demonstrated in
the statistical study presented.In addition, the analysis by age groups
showed a small difference, statistically signicant, with slightly
longer average times between implantation and osseointegration in
the age group of 50 to 70 years.

Application of growth hormone to reduce osseointegration time in dental implants 122
Copyright:
©2020 Rego et al.
Citation: Rego A, Tresguerres JAF, Tallon JM, et al. Application of growth hormone to reduce osseointegration time in dental implants. J Dent Health Oral Disord
Ther. 2020;11(4):116‒124. DOI: 10.15406/jdhodt.2020.11.00529
In the comparative analysis of implant placement with or without
GH, there is great evidence for the three age groups regarding the
reduction of osseointegration times in patients treated with GH
(p-value close to zero).In addition, a very similarly central spread of
osseointegration time is veried for the rst two age groups (patients
aged <50 years and between 50 and 70 years). Which means, its
application would be more advisable in the age group over 50 years.
When specically studying women of over 50 years old, we
observed that without GH there is a signicant difference between the
times of osseointegration and when GH is used, that difference does
not exist, because the use of GH will compensate for its decit that is
veried from the fourth decade of life making its use more benecial
in this group of people.
However, it was also observed in this study for Clinical practice
that with previous injuries the use of GH also exacerbated them
more quickly. In the remaining situations there are indications of
the benecial inuence of the GH in decreasing the average time of
osseointegration, but the sample is very small in statistical terms, to
do it with reliability, lacking studies that can be more statistically
concluding.
Funding
None.
Acknowledgments
None.
Conicts of interest
None.
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