The Impact of Red Blood Cell Count and Hemoglobin Levels on Bone Remodeling in Mandibular Angle Osteotomy

Previous studies have identified bone remodeling in the mandibular angle region (MAR) as a key factor influencing outcomes after mandibular angle osteotomy (MAO). This study investigates hematologic predictors-red blood cell (RBC) count and hemoglobin (Hb) levels-and their correlation with postoperative MAR bone remodeling.

A retrospective analysis was conducted on 135 patients who underwent MAO between January 2015 and December 2022. Bone remodeling was assessed using cone beam computed tomography (CBCT) imaging at two time points: T1 (immediately postoperatively) and T2 (at least 12months postoperatively). Quantification of bone remodeling was performed using Geomagic Wrap 2021. Patients were categorized into bone stability (S), bone regeneration (RG), and bone resorption (RS) groups based on MAR deviations (thresholds:  > + 0.1 mm regeneration, < - 0.1 mm resorption, within ± 0.1 mm stability). Statistical analyses, including Kruskal-Wallis tests with post hoc analysis and logistic regression models, were performed to assess associations between RBC count, Hb levels, and bone remodeling outcomes.

Patients with higher preoperative RBC and Hb levels exhibited significantly greater bone remodeling than those with lower levels (p < 0.05). Remodeling was particularly evident in the mandibular angle region. Multivariate analysis confirmed RBC and Hb levels as independent predictors of favorable bone remodeling. A 1 × 10¹² increase in RBC count was associated with a 2.558-fold higher likelihood of postoperative bone regeneration (OR: 2.558, 95% CI: 1.098-5.958, P = 0.030), while a 1 g/L increase in Hb levels increased the probability of bone regeneration by 1.036 times (OR:1.036, 95% CI: 1.006-1.066, P = 0.017).

This study highlights RBC count and Hb levels as potential biomarkers influencing bone remodeling after MAO. These findings suggest that hematologic parameters should be considered during preoperative planning to optimize surgical outcomes and reduce the need for revision procedures.

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