calcium metabolism & its implications in prosthodontics

1. Calcium Metabolism
Presented by: Dr. Soumya Dudhani Guided by: Dr. Shwetha Shetty

2. Contents
• Introduction
• Role of calcium
• Hormones controlling calcium metabolism
• Clotting mechanism
• Hypocalcemia
• Hypercalcemia
• Prosthodontic implications
• Conclusion
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3. Introduction
• Ca metabolism refers to the movements and
regulation of calcium ions (Ca2+ ) into and out of various
body compartments, such as the gastrointestinal tract, the
blood plasma, the extracellular and the intracellular fluid
and bone.
• In this process, bone tissue acts as a calcium storage center
for deposits and withdrawals as needed by the blood, via
continual bone remodeling.
• Derangements of this mechanism lead to hypercalcemia or
hypocalcemia, both of which can have important
consequences on health.
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4. Role of
calcium
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5. Calcium Metabolism 5
Daily requirement: 0.8-1.5 g per day
Normal plasma concentration: 9-10 mg/dl
Sources: Dairy products, such as yogurt and cheese , sardines ,
salmon , soy products, kale, and fortified breakfast cereals

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+vitamin D
- phytates,
phosphates,
oxalates,
tetracyclines,
glucocorticoids
, phenytoin
+Vitamin D, PTH
- Calcitonin
About 300mg is
excreted half
in urine & half
in feaces

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Calcium
metabolism

8. Other hormones affecting Calcium
metabolism
• Growth hormone – Increases calcium retention and
increases the mineralization of bone
• Glucocorticoids - Increased urinary calcium and
hypocalcemia
• Negative calcium balance due to reduced intestinal calcium
absorption.
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9. Calcium cycling in bone tissue
• Bone formation – Osteoblasts
Synthesize a collagen matrix that holds Calcium Phospate in
crystallized form
Once surrounded by bone, become osteocyte
• Bone resorption – Osteoclasts
Change local pH, causing Ca++ and phosphate to dissolve from
crystals into extracellular fluids
Hormonal Regulators
• Calcitonin (CT) – Lowers Ca++ in the blood – Inhibits osteoclasts
stimulate osteoblast
• Parathormone (PTH) – Increases Ca++ in the blood – Stimulates
osteoclasts
• 1,25 Vitamin D3 – Increases Ca++ in the blood – Increase Ca++
uptake from the gut – Stimulates osteoclasts
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10. CLOTTING OF BLOOD:
Clotting of blood is an important haemostatic mechanism
because the clot formed
l) Prevents further bleeding.
2) Seals the wound against further infection.
Factor IV (calcium) Required for coagulation factors to bind to
phospholipid
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11. Calcium Metabolism 11
Deficiency: Macrocytic, megaloblastic anaemia (calcium needed for B12-
intrinsic factor binding).

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Causes of
hypocalcemia

14. Signs & symptoms
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15. Calcium Metabolism 15
In Children
A triad of
carpopedal spasm,
stridor,
convulsions (grand
mal, petit mal)
Soft tissue
calcification:
Cataract, basal
ganglia
calcification
(chorea, athetosis,
parkinsonism),
exostosis,
chondrocalcinosis,
pseudogout
Haematological
manifestation:
Macrocytic,
megaloblastic
anaemia (calcium
needed for B12-
intrinsic factor
binding).
Dental: Delayed
dentition, enamel
hypoplasia or
dysplasia, caries

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Causes of
hypercalcemia

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Signs & symptoms

19. • Hypercalcaemic Crisis It may be the mode of
presentation in primary hyperparathyroidism
especially in elderly. It presents with dehydration,
hypotension, abdominal pain, vomiting, fever, altered
sensorium. It is a medical emergency.
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20. Calcium Metabolism 20

21. Osteoporosis
• Osteoporosis has been defined by WHO in 1994 as “a disease
characterized by low bone mass and microarchitectural
deterioration of bone tissue leading to enlarged bone fragility
and a consequent increase in fracture risk”. It’s a disorder
where the bone mineral density is 2.5 standard deviation below
the mean peak value in young adults.
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osteoporosis
generalized
Primary
Type – I Post-
menopausal
Type – II Age
related
secondary
localized

22. • Risk factors:
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Modifiable : smoking,
sedentary life style,
intestinal disorders
which lead to
inadequate absorption
of Ca, P, deficiency of
Vitamin-D and renal
disorders
Non-modifiable: age,
gender, familial
history, menopausal
status & ethnicity

23. • bisphosphonates are the drug of choice for Osteoporosis.
• they reduce the osteoclastic activity and suppress bone
remodeling and turnover & also cause delayed wound healing
due to reduction in collagen expression by the fibroblasts.
• Prolonged usage might lead to adverse effects such as
Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ).
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24. Prosthodontic implications
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25. In complete denture
• Humphries et al., conducted a study on bone
resorption of mandibular alveolar bone in elderly edentulous
adults and they concluded that women above 50 years with
osteoporosis required new dentures three times more
frequently than women of same age.
• The most common systemic bone condition occurring in both
sexes is osteoporosis. It is likely to appear earlier in women
than men.
• Back pain, loss of face height , stooping & in advanced stage
fractures. The atrophy of bone is particularly noticeable in
residual alveolar ridge more as when the ridge is subjected to
the continuous pressure of dentures.
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26. Knowledge of physiology of bone makes it possible to institute
procedures of fabrication of CD that will assure a denture that would be
more acceptable to support
1. Recording tissues at rest Mucostatic or open mouth impression
techniques, selective pressure impression technique, should be
employed to reduce mechanical forces
2. Decreasing size of food table semi anatomic or non anatomic teeth
with narrow buccolingual width
3. Developing occlusion that eliminates as much as possible horizontal
forces & those that produce torque
4. Extending denture bases for maximum coverage within tissue limits
5. Biting with knife & fork that is placing small masses of food over the
posterior teeth where supporting bone is best suited to resist force
6. Removing dentures for at least 8 hours for tissue rest
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27. • Even if the initial prosthesis has retention and stability,
osteoporotics would suffer from post‐insertion problems of
looseness and ulceration, problems with phonetics and
aesthetics, and faulty denture‐induced pathologies sooner, as
their rate of RRR is higher.
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28. IMPLANT
• osteoporosis affects trabecular bone more than cortical bone and the maxilla has more
trabecular bone content than the mandible, the maxilla is more susceptible to the
effects of systemic osteoporosis.
• While maxillary implant treatment planning we should modify the implant geometry and
use larger implant diameter and with surface treatment with hydroxyapatite.
• Reduced bone density does affects length of healing thereby necessitates need of
progressive bone loading.
• Daily calcium uptake should be up to 1500 mg/day pre and post surgically. Thus,
osteoporosis is not a contraindication for implant surgery as an accurate analysis of
bone quality by means CBCT can be performed
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29. Implant supported overdenture
• the implant supported overdentures are the treatment of
choice to persons with osteoporosis after total tooth loss
because of their bone sparing effect
FPD
• 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.
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30. Conclusion
• As dentists, it is vital for us to have a complete understanding of
the general metabolism of calcium as it is the mineral that help in
the formation and maintenance of the teeth and their supporting
bony structure .
• An adequate calcium intake by good nutritional diet rather than
taking nutritional supplements throughout life is preferred for
maintenance of the skeleton & teeth.
• The best way to handle this problem is to avoid delaying or
postponing dental treatments. Regular dental visits are essential
in correcting problems in oral and dental health caused by weak
bones.
• A healthy lifestyle is necessary in strengthening and maintaining
good bone health,
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31. References:
• Osteoporosis: Its Prosthodontic Considerations - A Review
• The effect of osteoporosis on residual ridge resorption and
masticatory performance in denture wearers
• Dental Implants in Patients With Osteoporosis – A Review
• Manual of Practical medicine- 4th edition
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32. Thank you
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