Evaluation of the effects of menopause on the quality and quantity of intraoral autogenous block graft donor sites using cone-beam computed tomography

BACKGROUND: Menopause is characterized by the permanent cessation of menstruation and the loss of estrogen-related protective effects on systemic bone metabolism. One of the major consequences of this hormonal alteration is accelerated bone loss and deterioration of bone microarchitecture. Reduced estrogen levels lead to a decrease in bone mineral density and markedly increase the likelihood of osteoporosis development. OBJECTIVE: The present study aims to systematically assess postmenopausal changes affecting both the volume of graft material that can be harvested from intraoral autogenous block graft donor regions and the relative radiographic bone density characteristics of these grafts, assessed using CBCT-derived Hounsfield Unit (HU) values. MATERIALS AND METHODS: The study population comprised patients who had undergone cone-beam computed tomography (CBCT) at the Faculty of Dentistry for various clinical purposes. Participants were categorized into two groups based on menopausal status. The first group included 30 female individuals between the ages of 20 and 40, while the second group consisted of 30 female patients over the age of 55 who had been diagnosed with menopause by a gynecologist, based on prior hormonal assessments (FSH, LH, and estrogen), and who had experienced at least five years since the onset of menstrual irregularity. Information regarding menopausal status, hormonal assessment findings (FSH, LH, and estrogen levels), medical history, and systemic conditions was retrospectively obtained from the patients' electronic medical records and archived clinical charts. In total, 60 patients were enrolled in the study. Hounsfield Unit (HU) measurements and graft volume estimations-derived using the Cavalieri principle-were extracted from the CBCT data. In the statistical evaluation, differences between the two independent groups were analyzed using the Student's t-test for variables with normal distribution, whereas the Mann-Whitney U test was applied to data that did not meet normality assumptions. RESULTS: The findings indicate that menopausal status, along with its accompanying physiological alterations, adversely affects intraoral autogenous block graft donor regions, specifically the ramus and tuberosity. However, in postmenopausal women, the symphysis donor site did not demonstrate any statistically significant variation. CONCLUSION: Hormone-related skeletal alterations that emerge in the postmenopausal period, particularly osteoporosis, should be recognized as a potential risk determinant in the context of surgical planning. This consideration is especially relevant for oral and maxillofacial surgeons performing procedures that utilize intraoral autogenous block graft donor sites.