CALCIUM AND ITS ROLE IN

PROSTHODONTICS
PRESENTED BY-
DR. SOUMIK KARMAKAR
1st YEAR PGT
DEPT. OF PROSTHODONTICS AND CROWN AND BRIDGE
GURU NANAK INSTITUTE OF DENTAL SCIENCES AND RESEARCH

UNDER THE ABLE GUIDANCE OF:

Prof. Dr. JAYANTA BHATTACHARYYA (HOD & PRINCIPAL)
Prof. Dr. SAMIRAN DAS
Prof. Dr. SOUMITRA GHOSH
Prof. Dr. PREETI GOEL
 CONTENTS
 Introduction
 Importance and distribution
 Daily requirements
 Sources
 Functions of calcium
 Absorption of calcium
 Calcium balance
 Calcium in cells and blood
 Factors regulating blood calcium level
 Conditions arising from irregularities in calcium metabolism
 Prosthodontic management of diseases
 Calcium and dental implants
 Conclusion
 References
 INTRODCTION
A few minerals are required for the normal growth and
maintenance of the body. Calcium is a very important
mineral in our body among them. As dentists it is vital for
us to have a complete understanding of the general
metabolism of calcium as it helps in the formation and
maintenance of the teeth and their supporting bony
structures. Diet containing insufficient amount of calcium
may lead to a low bone mineral density that may adversely
affect bone health.
 IMPORTANCE AND DISTRIBUTION
Importance of studying calcium metabolism has
increased because:-
(i)In old people, one of the major causes happens to be
osteoporosis which can cause fracture of bones
(ii)Calcium play vital roles in contraction of heart as
well as skeletal muscles and smooth muscles

Physiology, 3rd edition . Robert Berne

DISTRIBUTION
•Total calcium in the
human body is about 1 to
1.5 kg,
•99% of which is seen in
bone in the form of
calcium phosphate and 1%
is extracellular.
•The small minority of
calcium in plasma exists in
3 forms-
-45% in free ionized form
-45% bound to proteins
(90% albumin and 10%
globulin)
-10% complexed with
anions
DM Vasudevan Textbook of Biochemistry ,2nd edition, Physiology, 3rd edition . Robert Berne
 DAILY REQIREMENTS

“Recommended daily allowance” (RDA) given by the

National Research Council of the National Academy of
Sciences

 Infants(<1 year) = 300-500 mg/day

 Children (1-18 year) = 0.8-1.2 g/day
 Adult men and women = 800 mg/day
 Pregnancy and lactation = 1.0-2.0 g/day
SOURCES
• Milk is a good source for
calcium. Calcium content
of cow milk is
100mg/100ml
• Egg, fish and vegetables
are medium source for
calcium.
• Cereals(wheat, rice)
contain only small amount
of calcium. But cereals are
the staple diet in India.
Therefore, cereals form the
major source of calcium in
Indian diet.

DM Vasudevan Textbook of Biochemistry ,2nd edition

 FUNCTIONS OF CALCIUM
 i. Activation of enzymes: Calmodulin is a calcium binding regulatory protein.
Calmodulin can bind with 4 calcium ions. Calcium binding leads to activation
of enzymes. Some enzymes are activated directly by Ca++ without the
intervention of calmodulin
 ii. Muscles: Calcium mediates excitation and contraction of muscle fibers.
 iii. Calcium is necessary for transmission of nerve impulses through synaptic
region.
 iv. Secretion of hormones: Calcium mediates secretion of insulin,
parathyroid hormone, etc. from the cells.
 v. Second messenger: Calcium and cyclic AMP are second messengers of
different hormones. One example is glucagon
 vi. Coagulation: Calcium is known as factor IV in blood coagulation cascade.
 vii. Myocardium: Ca++ prolongs systole. In hypercalcemia, cardiac arrest is
seen in systole. This fact should be kept in mind when calcium is administered
intravenously. It should be given very slowly.
 viii. Bone and teeth: The bulk quantity of calcium is used for bone and teeth
formation. Bones also act as reservoir for calcium in the body.

DM Vasudevan Textbook of Biochemistry ,2nd edition

 ABSORPTION OF CALCIUM
 Absorption is taking place from the first and second part of duodenum. Absorption requires a carrier
protein, helped by calcium-dependent ATPase.
Factors affecting absorption of calcium are:
i. Vitamin D: Calcitriol induces the synthesis of
the carrier protein (Calbindin) in the intestinal
epithelial cells, and so facilitates the absorption
of calcium.
ii. Parathyroid hormone: It increases calcium
transport from the intestinal cells.
iii. Acidity: It favors calcium absorption.
iv. Phytic acid: It is present in cereals. It reduces
uptake of calcium. Cooking reduces phytate
content.
v. Oxalates: They are present in leafy vegetables,
which cause formation of insoluble calcium
oxalates; so absorption is reduced.
vi. Phosphate: High phosphate content will cause
precipitation as calcium phosphate.

DM Vasudevan Textbook of Biochemistry ,2nd edition

 …continued
Calcium absorption in small intestine occurs by both active and
passive diffusion
Carrier mediated active diffusion (mainly in duodenum &
jejunum): The carrier molecule (Calbindin) resides in the brush
border of jejunal mucosa. A derivative of Vit-D (Calcitriol)
facilitates this carrier mediated transport
Passive diffusion (mainly in ileum): Small amount of calcium
molecules move according to a chemical gradient i.e from higher
concentration to lower one

Soluble inorganic forms are much better absorbed. Thus the

organic calcium of foods converted into inorganic form before it
can be absorbed. Insoluble inorganic compounds are never
absorbed. Calcium phosphates are not absorbed.
Physiology, 3rd edition . Robert Berne
 CALCIUM BALANCE
aka Calcium Homeostasis
Dietary absorption is the only means of obtaining calcium
There are several mechanisms whereby calcium is lost from
the body, including renal clearance, excretion of unabsorbed
calcium in faeces & dermal losses
If the amount of calcium absorption is greater than the
amount lost, excess calcium is deposited in the skeleton. This
is referred to as Positive calcium balance
If losses exceed absorption, calcium is mobilised from the
skeleton to optimally maintain the narrow limits of
extracellular fluid calcium and is referred to as Negative
calcium balance
A negative calcium balance if sustained over a period of time
will lead to Osteoporosis.
Calcium metabolism and osteoporotic ridge resorption: a protein connection , jpd, 1987
 CALCIUM IN CELLS AND BLOOD
Calcium is mainly extracellular. The cell membrane is
generally impermeable to calcium ion. Calcium influx
into the cell is by Na+/Ca++ exchange mechanism.
The second mechanism is Ca++-H+-ATPase dependent
pump, which expels calcium in exchange for H+
Normal blood level : 9-11 mg/dl
 Ionized calcium : about 5 mg/dl of calcium is in
ionized form and is metabolically active (About 4
mg/dl of calcium is bound to proteins in blood and is
nondiffusible).

Review of Medical Physiology 17 th edition, Willium Ganong ; DM Vasudevan Textbook of Biochemistry ,2 nd edition
 FACTORS REGULATING BLOOD CALCIM LEVEL
(A) Vitamin D
 The active form of vitamin D is called
dihydroxycholecalciferol or calcitriol. The
calcitriol induces a carrier protein in the
intestinal mucosa, which increases the
absorption of calcium. Hence blood
calcium level tends to be elevated.
 Vitamin D is acting independently on
bone.
 Vitamin D increases the number and
activity of osteoblasts, the bone forming
cells. Secretion of alkaline phosphatase
by osteoblasts is increased by vitamin D.
 It is involved in minimizing the excretion
of calcium through kidney by decreasing
their excretion and enhancing
reabsorption.
Review of Medical Physiology 17 th edition, Willium Ganong ; DM Vasudevan Textbook of Biochemistry ,2 nd edition
(B) Parathyroid Hormone (PTH)
i. This hormone is secreted by the four parathyroid glands embedded in the thyroid tissue. The
chief cells of the gland secrete the PTH.
ii. The mature PTH has 84 amino acids. Storage of PTH is only for about 1 hour.
iii. Control of release of the hormone is by negative feedback by the ionized calcium in serum
Mechanism of action of PTH
i. PTH acts through cyclic AMP.
ii. PTH and bones: In the bone, PTH causes
demineralization or decalcification. It induces
pyrophosphatase in the osteoclasts. The
number of osteoclasts are also increased.
Osteoclasts release lactate into surrounding
medium which solubilizes calcium. PTH also
causes secretion of collagenase from osteoclasts.
This causes loss of matrix and bone resorption.
As a consequence, mucopolysaccharides and
hydroxyproline are excreted in urine.
iii. PTH and kidney: In kidney, PTH causes
decreased renal excretion of calcium and
increased excretion of phosphates. The action
is mainly through increase in reabsorption of
calcium from kidney tubules. It also targets
the 1α hydroxylase, whose function is to activate calcitriol.
Review of Medical Physiology 17 th edition, Willium Ganong ; DM Vasudevan Textbook of Biochemistry ,2 nd edition
 (C) Calcitonin
i. It is secreted by the thyroid parafollicular or
clear cells. Calcitonin is a single chain
polypeptide. It contains about 32 amino
acids.
ii. Calcitonin secretion is stimulated by serum
calcium.
iii. Calcitonin level is increased in medullary
carcinoma of thyroid and therefore is a
tumor marker.
iv. Calcitonin decreases serum calcium level. It
inhibits resorption of bone. It decreases
the activity of osteoclasts and increases
that of osteoblasts.
v. Calcitonin and PTH are directly
Calcitonin, Calcitriol
antagonistic.The PTHand
andPTH Act Together
calcitonin
When blood promote
together calcium the
tends to lower,
bone growthPTH
and secretion is stimulated and calcitonin is
inhibited; bone demineralization leads to entry of more calcium into blood. When blood
remodelling.
calcium is increased, PTH is inhibited and calcitonin is secreted, causing more entry of
calcium into bone. Bone acts as the major reservoir of calcium.
DM Vasudevan Textbook of Biochemistry ,2nd edition
 CONDITIONS ARISING FROM IRREGULARITIES IN
CALCIUM METABOLISM
1. Hypercalcemia
i. The term denotes that the blood calcium level is more
than 12 mg/dl. The major cause is hyper
parathyroidism .This may be due to a parathyroid
adenoma or an ectopic PTH secreting tumor.
ii. There is osteoporosis and bone resorption.
Pathological fracture of bone may result.
iii. In the blood, calcium and alkaline phosphatase
levels are increased, while phosphate level is lowered.
iv. In urine, calcium is excreted, which may cause
inhibition of elimination of chloride.
v. Calcium may be precipitated in urine, leading to
recurrent bilateral urinary calculi. Ectopic
calcification may be seen in renal tissue, pancreas
(pancreatitis), arterial walls, and muscle tissues
(myositis ossificans).
Signs and symtoms are- - stones (renal or biliary) -
bones(bone pain) -groans(abdominal pain, nausea,
vomiting) -thrones (polyuria) -psychiatric
Review of Medical Physiology 17 th edition, Willium Ganong ; DM Vasudevan Textbook of Biochemistry ,2 nd edition
overtones/moans(depression , anxiety)
2. Hypocalcemia and Tetany
i. When serum calcium level is less than 8.8 mg/ dl, it is hypocalcemia. If
serum calcium level is less than 8.5 mg/dl, there will be mild tremors. If it
is lower than 7.5 mg/dl, tetany, a lifethreatening condition will result.
ii. Tetany may be due to accidental surgical removal of parathyroid glands. Carpopedal spasm
iii. In tetany, neuromuscular irritability is increased. Main manifestations are
carpopedal spasm, laryngismus and stridulus. Laryngeal spasm may lead
to death.
iv. Clinical signs are Chvostek's sign (tapping over 5th cranial nerve causes
facial contraction) and Trousseau's sign (inflation of BP cuff causes
carpopedal spasm).
v. Serum calcium is lowered with corresponding increase in phosphate level.
Urinary excretion of both calcium and phosphate are decreased. Treatment
is to give intravenous injection of calcium salts.
Chvostek's sign
vi. It should be emphasized that vitamin D deficiency will not cause
tetany. The vitamin D deficiency causes rickets, where serum calcium Trousseau's sign
level is lowered marginally.

DM Vasudevan Textbook of Biochemistry ,2nd edition

 Vitamin D insufficiency, renal diseases (defective formation of calcitriol),
and dietary deficiency of calcium, will result in mild decrease in serum
calcium. Chronic calcium deficiency will lead to deformities of bones,
especially in weight bearing bones

The Oral manifestations are enamel hypoplasia, delayed eruption, and

there may be multiple unerupted teeth.
The Dental management is prevention of caries with periodic check-up,
advice regarding diet and oral hygiene instructions. As pulp chambers
are large, caries easily involve the pulp causing pulpitis, requiring
endodontic treatment. Delayed eruption and hypodontia cause
malposition and has to be treated by orthodontics.
Treatment of hypocalcemia -The main treatments available for these
patients is Vitamin D or its analogs, calcium salts and drugs that
increase renal tubular reabsorption of calcium, to obtain adequate,
normal serum calcium levels.
CALCIUM AND ITSROLE IN PROSTHODONTICS: A SHORT REVIEW
*Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir International Journal of Current
Research Vol. 10, Issue, 03, pp.67137-67140, March, 2018 ; DM Vasudevan Textbook of Biochemistry ,2nd edition
 3.Rickets
Occurs in children between 6 months to 2
years of age. Affects long bones. Lack of
calcium causes failure of mineralization
resulting into formation of cartilagenous
form of bone.
The oral manifestations are hypoplasia and
hypocalcification.

Dental management is by full mouth

pulpectomies, placement of posterior
stainless steel crowns, and anterior
composite
CALCIUM AND ITSROLEresin restorations.A SHORT REVIEW
IN PROSTHODONTICS:
*Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir International Journal of Current
Research Vol. 10, Issue, 03, pp.67137-67140, March, 2018 ; Review of Medical Physiology 17 th edition, Willium Ganong
4.Osteomalacia
Osteomalacia is softening of the bones,
caused by not having enough vitamin D or by
problems with the metabolism of this vitamin.
These softer bones have a normal amount of
collagen that gives the bones its structure, but
they are lacking in calcium.
Occurs in adults -Flat bones affected -Softening
and distortion of skeletal bones
The common oral manifestation is in the form
of severe periodontitis.

Review of Medical Physiology 17 th edition, Willium Ganong

 5. Hyperparathyroidism
They are of two types, primary and secondary
Primary hyperparathyroidism: Usually caused by a tumor or hyperplasia of the gland that produces an increase in
PTH secretion resulting in hypercalcemia and hypophosphatemia.
Secondary hyperparathyroidism: When the parathyroid glands are stimulated to produce increased amounts of
hormones to correct abnormally low serum calcium levels in different physiologic or pathologic conditions like renal
failure, intestinal malabsorption syndrome, decrease of Vitamin D production, thus resulting in parathyroid
hyperplasia.
Signs and symptoms -subperiosteal resorption of the phalanges of the index and middle fingers
-musculoskeletal problems (weakness, back pain, muscle soreness),
-gastrointestinal complaints, e. g. , vomiting, nausea, constipation, loss of appetite.
-Metastatic calcifications seen in subcutaneous soft tissues, sclera, dura and region around joints.
-Brown tumor. Affect mandible, clavicles, ribs and pelvis.
-Osteitis fibrosa cystica- develops from central degeneration and fibrosis of long standing brown
tumor.
 Oral manifestations: loss of bone density, mobile
teeth,drifting of teeth, complaint of vague jaw bone pain,
sensitive teeth, soft tissue calcifications and dental Brown tumor
abnormalities such as development defects, alterations
in dental eruption. Loss of lamina dura(early manifestation)
 Dental management: The clinical management of these
patients does not require any special consideration.
There is a higher risk of bone fracture, so we must take
precaution in surgical treatments.
Oral manifestations of parathyroid disorders and its dental management, journal of dental and allied sciences, 2014 ; Review of Medical
Physiology. 17 th Edition. William Ganong; Essentials of oral pathology , Swapan kr Purkait, 3 rd edition
6. Osteoporosis
Osteoporosis may be defined simply as a condition of insufficient bone This deficiency undermines skeletal strength,
resulting in fractures that occur with minimal stress in the spine, distal radius & ulna & in the femoral neck.
Osteoporosis is more severe and starts early in Indians, compared to Westerners

Etiologic factors:Decreased estrogen levels in postmenopausal women, Inactivity, Alcohol abuse, High phosphate diets,
Low calcium diets, Vit D deficiency, Corticosteroids, Smoking, Caffeine intake, Dietary protein imbalance, Stress.
Interleukin-1 and 6 also play important roles in the genesis of the condition.

It is the most prevalent metabolic bone disease that is associated with an increased risk for fractures (vertebra, hip and forearm).
Women above 50 years of age have a 40% risk for these fractures. The basic abnormality is decrease in bone mass, which attains a
peak by the age of 30 and starts declining by 35 to 45 years of age in both men and women. After the age of 45, calcium absorption is
reduced and calcium excretion is increased; so, there is net negative balance for calcium. This is reflected in demineralization. After
the age of 60, osteoporosis is seen. Then there is reduced bone strength and an increased risk of fractures.

Treatment – -Estrogen therapy remains controversial because of uncertainty about long-term benefits
-Vit D is another widely used therapeutic adjunct because of its important role in bone metabolism. Treatment is to give
calcium with vitamin D
-The most controversial experimental therapy is the use of fluoride. Fluoridic bone displays increased crystallinity, which
may actually result in decreased elasticity predisposing to fracture
-Increasing calcium intake by means of dairy foods & supplementation is the most practiced method in the prevention &
management of osteoporosis to optimize calcium balance

Calcium metabolism and osteoporotic ridge resorption, JPD, 1987 ; DM Vasudevan Textbook of Biochemistry ,2 nd edition
 Osteoporosis and Residual Ridge Resorption (RRR):
RRR after tooth loss is a well described biological reaction. A
decrease in biomechanical loading on bone reduces the stresses
within the bone and results in resorption within the bone and
its periosteal surface. The single case control study seems to
indicate that the bone mineral content status in the jaws is
lower in patients with symptomatic osteoporosis than in
healthy age and menopausal age-matched females and that
osteoporosis may produce a risk factor for severe resorption of
the maxillary residual ridge, while this relationship is not clear
cut in the mandible. (Habets LLMH et al., 1998)

CALCIUM AND ITSROLE IN PROSTHODONTICS: A SHORT REVIEW

*Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir International Journal of Current
Research Vol. 10, Issue, 03, pp.67137-67140, March, 2018
Increased intake of proteins in the diet has a calciuretic effect (increased
urinary calcium excretion). By the time osteoporosis is generally diagnosed,
50 -75% of the original bone material has been lost from the skeleton.
Therapeutic & preventive measures, such as increased calcium
supplementation with a watch on dietary protein intake are helpful
Recommendations relevant to the prevention
& management of osteoporosis are:
Avoid a high protein diet & maintain daily protein intake levels of
50-60 grams to promote a positive calcium balance
 Maintain the RDA of 800mg of calcium for men & non-pregnant
women
Participate in regular exercise programs appropriate to age &
health status
Avoid risk factors related to osteoporosis such as smoking,
excessive alcohol, & the generous use of caffeine- containing
beverages
Calcium metabolism and osteoporotic ridge resorption, JPD, 1987
Calcium and vitamin D supplements :
Office of dietary supplements recommend that no more than
600 mg of calcium should be taken at a time because calcium
absorbed decreases with increase in amount of calcium in the
supplements. They cause bloating and constipation in some
people and so taking them with food helps nullify these side
effects. Different forms of supplements are-calcium carbonate,
calcium citrate and calcium lactate.
Excessive intake leads to kidney stones, prostate cancer,
constipation, calcium build up in blood vessels, impaired
absorption of iron and zinc.
For adults 5 micrograms of vitamin D is the recommended
dietary allowance that may prevent osteomalacia in the absence
of sunlight. Hazards and toxicity excessive consumption leads
to milk alkali syndrome with symptoms ranging from
hypercalcemia to renal failure.
PROSTHODONTIC MANAGEMENT OF DISEASES

Prosthodontic management of the osteoporotic patient

(Bandela et al., 2015)
 While fabricating the removable dentures the main area of focus should
be on reduction of the forces on residual ridge.
 Mucostatic or open mouth impression techniques, selective pressure
impression technique, should be employed to reduce mechanical forces
while impression making.
 Semi anatomic or non anatomic teeth with narrow buccolingual width
should be selected.
 Optimal use of soft liners, extended tissue intervals by keeping the
dentures out of mouth for 10 hours a day can be advised. While fabricating
fixed partial denture in periodontally compromised abutments it may
accelerate the bone loss in osteoporotic patients. So, the fabrication of
FPD should follow treatment of osteoporosis rather than preceding it.
Osteoporosis: its prosthodontic considerations –a review, JCDR, 2015
Impression Techniques for Resorbed Ridges: The different techniques available
are:
1. The Functional Impression Technique
2. The Neutral Zone Technique
 Functional Impression Technique :
Functional impression can be used very effectively to create stability in cases exhibiting extreme
resorption. Though retention is usually poor in such cases yet the clinician can set out to
achieve stability in these patients. The prosthesis should remain stable within the oral cavity
and not move at the slightest movement of the tongue
A functional impression can be made after doing the border moulding using a stable custom tray.
Temporary soft liners and tissue conditioners can be used as functional impression materials
as they exhibit the property of delayed setting and a continuous flow over a longer period of
time thereby recording all possible movements of the mandibular musculature.
The extensions of the custom tray should be verified accurately and border moulding done. After
completion of the procedure, instead of using the regular impression material for making
definitive impressions, a functional impression material can be used. The material is mixed
and placed on the impression surface of the custom tray.
The material is initially moulded using the regular movements of secondary impression making
technique Once the material attains an initial set, the patient is instructed to read a news
paper aloud, drink water 3 -4 times and swallow saliva at regular intervals etc. The functional
impression material stays within the oral cavity for a period of 45 -60 min. All oral activities of
the patient are encouraged.
Once the
Jain M. material
Impression has achieved
techniques a final set,
for the resorbed the tray
mandibular is Aremoved
arch: and thestability.
guide to increased impression
J Sci Socis2015;
poured
42: 88The
-91.
Neutral Zone Impression Technique:
Though all of us realize the importance of neutral zone yet no
one tries to use it for increasing the stability in complete
denture prosthesis. If done correctly, the neutral zone can
increase the stability and retention to a great extent.
Recording the neutral zone is itself quite simple.
After taking jaw relations, the maxillary and mandibular cast is
mounted using a face bow transfer. Thereafter, the
mandibular wax rim is cut off and wire loops in the shape of
letter “v” are made on the lower record base up to the height
of the mandibular wax rim. Now the maxillary record base is
placed in the oral cavity.
Functional impression material is placed within these loops on
the lower record base and it is placed within the oral cavity
The patient is instructed to say words like “ooo”, “aaa”, and
“eee”. Pronouncing these words leads to recording of neutral
zone existing in the mouth. Functional impression is added
incrementally at regular intervals in these loops till the time
the record base shows adequate retention within the mouth.
Plaster indices are prepared around the recorded neutral zones
and thereafter, the loops are dismantled from the record base.
After placing these indices, a new occlusal rim is made within
the area of plaster indices, which serves as a guide for future
Jain M. Impression techniques for the resorbed mandibular arch: A guide to increased stability. J Sci Soc 2015; 42: 88 -91.
teeth arrangement.
 CALCIUM AND DENTAL IMPLANTS
• The alterations in bone metabolism associated to osteoporosis can also impair bone
healing around dental implants and affect their osseointegration.
• Some animal studies have confirmed a reduced bone-to-implant contact, reduced
mechanical properties, and a delay in bone healing in osteoporotic-like conditions.
• It is not an absolute contraindication for implants.
• Dental implants can be successfully placed in osteoporotic patients, but clinicians
should follow a few recommendations for a more predictable outcome.
• Clinicians should assess and try to control risk factors that can affect bone metabolism
and bone density such as -deficiencies of vitamin D and calcium, smoking, alcohol
abuse, the presence of systemic diseases (such as diabetes mellitus).
• The clinician should take into consideration under preparation of the site longer healing
periods before siting the prosthesis and a careful implant/bone loading distribution.
• Jaw bone mineral density can be assessed using computed tomography
• The use of phosphate ceramic-coated implants, hydroxyapatite-coated implants,
bisphonate-coated implants, and hydrophilic titanium surfaces promote better bone
healing when the host bone is osteoporotic, but this data is yet to be thoroughly
investigated.
The effect of osteoporosis on dental treatments. AUGUST 12, 2015 BY IMPLANT PRACTICE US
Effect of osteoporosis medications on the success/survival of dental implants:
• Several medications have been used to treat osteoporotic patients. Antiresorptive treatments slow bone
loss and bone anabolic agents stimulate bone formation.
• Bisphonates, and in particular alendronate, are antiresorptive medications for osteoporosis and
represent the gold standard in fracture prophylaxis.
• They can be administered either orally or intravenously.
• These medications inhibit the formation and activation of osteoclasts and induce their apoptosis, thus
reducing bone turnover.
• They may potentially reduce the regenerative capacity of bone around dental implants.
• The slower osseous remodeling allows more time for secondary mineralization, so that there is an
increase in bone density and stiffness together with an increase in microdamage of bone
• Intravenous bisphonate treatment in cancer patients is an absolute contraindication for implant
placement.
• Osteoporosis treatment with oral bisphonates is not considered an absolute contraindication for dental
implants.
• Vitamin D has no effect on osseointegration of implants in diabetic rats

The effect of osteoporosis on dental treatments AUGUST 12, 2015 BY IMPLANT PRACTICE US
Complications caused by bisphonates:
• One of the most serious complications that have been related to the use of
bisphonates is the development of osteonecrosis of the jaws.
• To reduce the incidence of osteonecrosis before an implant surgery, risk
factors that increase the possibility of developing serious complications
should be identified such as
-smoking
-oral mucosal irritation associated to denture wearing
-periodontitis
-treatment with corticosteroids
-diabetes mellitus
• Furthermore, it is important to reduce the surgical trauma as much as
possible, to use abundant irrigation when drilling the bone, and to suture in
order to promote primary intention closure of the wound
 A study was conducted on 5 edentulous patients. Branemark Ti. Unite 3. 75
mm diameter implants were used. Each patient recieved 6 control implants
and 1 bisphonate coated implant. In all the 5 patients, bisphonate implants
(Bisphonate-coated titanium screws as dental implants) had the highest
ISQ(Implant
Bisphosphonate Stability
coated titanium Quotient)
screws value.
as dental implants in patients. Per Aspenberg , Jahanmehr Abtahi, Pentti Tengvall.
Calcium phosphate coating on implants:
• Metal implants have been coated with layers of calcium
phosphates mainly composed of hydroxyapatite. Following
implantation, the release of calcium phosphate into the
peri-implant region increases the saturation of body fluids
and precipitates a biological apatite onto the surface of the
implant.
• This layer of biological apatite might contain endogenous
proteins and serve as a matrix for osteogenic cell attachment
and growth.
• The bone healing process around the implant is therefore
enhanced by this biological apatite layer.
• The biological fixation of titanium implants to bone tissue
is faster with a calcium phosphate coating than without.
Surface treatments of titanium dental implants for rapid osseointegration L. Le Guéhennec et al Dent mat , july 2007
Discussion regarding implant w.r.t osteoporosis :
• The available evidence on the risks associated with the treatment of
osteoporotic patients is poor and needs further investigation.
• Both the pathogenesis and the medications of osteoporosis can
interfere with the success of dental treatments involving osseous
healing of the jawbones.
• There is no absolute contraindication in placing dental implants in
osteoporotic patients, but a longer osseointegration healing period
should be taken into consideration. A correct patient selection is
also crucial.
• The association between BP use and osteonecrosis of the jaw
should not be overlooked.
• Attention should be paid to ensure an atraumatic surgical
technique, an adequate postoperative control, and an adequate
occlusal adjustment of the prosthesis.
 CONCLUSION

Disturbances in calcium intake and excretion result in

deranged metabolism accounting for abnormal serum levels.
As a result of the essential role played by these minerals in
intra and extracellular metabolism is disturbed, the clinical
manifestations of related disease states are extensive.
Thus, an understanding of the basic mechanism of
calcium metabolism and pathophysiology of various
related disorders is helpful in guiding therapeutic decisions.
 REFERENCES
 Calcium metabolism and osteoporotic ridge resorption: a protein connection , jpd, 1987
 CALCIUM AND ITSROLE IN PROSTHODONTICS: A SHORT REVIEW
 *Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir International
Journal of Current Research Vol. 10, Issue, 03, pp.67137-67140, March, 2018
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