Restoration of esthetics and function with implant-supported prostheses requires substantial bone manipulation. The biomechanical response to altered function and applied loads depends on the metabolic status of the patient. Bone metabolism is an important aspect of clinical medicine that is directly applicable to implant dentistry.
The skeletal system is composed of highly specialized mineralized tissues that have structural and metabolic functions. Structurally, lamellar, woven, composite and bundle bone are unique types of osseous tissue adapted to specific functions. Bone modeling and remodeling are distinct physiologic responses to integrated mechanical and metabolic demands. Biomechanical manipulation of bone is the physiologic basis of reconstruction.
However, before addressing facial considerations, the clinician must assess the patient’s overall health status. Implantology is bone-manipulative therapy, and favorable calcium metabolism is an important consideration. Because of the interaction of structure and metabolism, a thorough understanding of bone structure and function is fundamental to patient selection, risk assessment, treatment planning, and retention of desired dentofacial relationships.
Bone is the primary calcium reservoir in the body, and approximately 99 percent of the calcium in the body is stored in the skeleton. The continual flux of bone mineral responds to a complex interaction of endocrine, biomechanical, and cell-level control factors that maintain the serum calcium level at about 10 mg/dL (10 mg%). Calcium homeostasis is the process by which mineral equilibrium is maintained. Maintenance of serum calcium levels at about 10 mg/dL is an essential life support function. Calcium homeostasis is the mechanism of the body for maintaining the primordial mineral environment in which cellular processes evolved.
Calcium metabolism is one of the fundamental physiologic processes of life support. When substantial calcium is needed to maintain the critical serum calcium level, bone structure is sacrificed. The alveolar processes and basilar bone of the jaws also are subject to metabolic bone loss. Even in cases of severe skeletal atrophy, the outer cortex of the alveolar process and the lamina dura around the teeth are preserved. This preservation is analogous to the thin cortices characteristic of osteoporosis Calcium homeostasis is supported by three temporally related mechanisms: (1) rapid (instantaneous) flux of calcium from bone fluid (which occurs in seconds); (2) short-term response by osteoclasts and osteoblasts (which extends from minutes to days); and (3) long-term control of bone turnover (over weeks to months).
Precise regulation of serum calcium levels at about 10 mg/dL is essential for nerve conductivity and muscle function. A low serum calcium level can result in tetany and death. A sustained high serum calcium level often is a manifestation of hyperthyroidism and some malignancies. Hypercalcemia may lead to kidney stones and dystrophic calcification of soft tissue. Normal physiology demands precise control of the serum calcium level. Instantaneous regulation of calcium homeostasis is accomplished in seconds by selective transfer of calcium ions into and out of bone fluid. Bone fluid is separated from the extracellular fluid by osteoblasts or relatively thin bone-lining cells (the latter are thought to be atrophied remnants of osteoblasts).
A decrease in the serum calcium level stimulates secretion of parathyroid hormone (PTH), which enhances transport of calcium ions from bone fluid into osteocytes and bone-lining cells. The active metabolite of vitamin D enhances pumping of calcium ions from bone-lining cells into the extracellular fluid. By means of this sequence of events, calcium is transported across the bone-lining cells, resulting in a net flux of calcium ions from bone fluid to fluid. Within physiologic limits, support of calcium homeostasis is possible without resorption of bone. Radioisotope studies have confirmed that bone contains a diffuse mineral component that can be mobilized or redeposited without osteopathic and osteoclastic activity.
Short-term control of serum calcium levels affects rates of bone resorption and formation within minutes through the action of the three calcific hormones: PTH, 1,25-DHCC, and calcitonin. Calcitonin, a hormone produced by interstitial cells in the thyroid gland, is believed to help control hypercalcemia by transiently suppressing bone resorption. Parathyroid hormone, T1 acting in concert with 1,25-DHCC, accomplishes three important tasks: it (1) enhances osteoclast recruitment from promonocyte precursors; (2) increases the resorption rate of existing osteoclasts; and (3) may of suppress the rate at which osteoblasts form bone.
Long-term regulation of metabolism has profound is effects on the skeleton. Biomechanical factors (e.g., m normal function, exercise, posture, habits), non-calcific hormones (e.g., sex steroids, growth hormone), and by the metabolic mechanisms previously discussed dictate mass, geometric distribution, and the mean age of bone. Mass and geometric distribution of bone are influenced strongly by load history (biomechanics) and sex hormone status. Parathyroid hormone is the primary regulator of the frequency of remodeling. Because the adult skeleton is composed almost entirely of secondary (remodeled) bone, the PTH-mediated activation frequency determines mean bone age. Bone age is an important determinant of fragility because old bone presumably has been weakened.
Omega Dental Specialists are experts in understanding bone metabolism occurs and will plan your care with this as a careful consideration.
Implant procedure and payment
In many cases, insurance plans can partially cover the costs of implants. We can be helpful in providing payment plans, and our office can help arrange third-party financing. Each person is a unique case and we will strive to assist you.
About Omega Dental
With our variety of dental specialists under one roof, Omega Dental Specialists Houston provides patients with treatment options for any need. Our dedicated staff is experienced in several specialty divisions, including Endodontics, Pediatric Dentistry (Pedodontics), Dental Implants and Orthodontics. Our technologically advanced office is equipped with some of the most modern instruments and machinery available in dentistry. Omega Dental is open seven days a week to help you to take care of your oral health no matter what your busy schedule.