Factors On: Implantology
Bone is a living tissue that serves two primary functions – support and metabolism. I has a collagen protein matrix that is impregnated with mineral salts, including calcium phosphate (85%), calcium carbonate (10%) and small quantities of calcium fluoride and magnesium fluoride. The protein in the collagen fibers that form the bone matrix is extremely complex. To maintain normal bone structure, there must be sufficient amounts of both proteins and minerals.
Three different types of cells – osteoblasts, osteocytes, and osteoclasts – are related to bone metabolism and physiology. The three are closely related with each other and transform very easily from one type to the other.
Osteoblasts are associated with the process of osteogenesis.
When osteoblasts become embedded in the bone matrix, they transform into osteocytes. This osteocytes have prolongations that extend from the osteocyte through a network of fine ducts. During a bone formation, this prolongations extend beyond their normal limit. This system of ducts connect the osteocytes with each other and with the space in the tissue. Tissue fluid in this spaces mixes with the fluid from the ducts, allowing a metabolic exchange between the blood stream and osteocytes.
Osteoclasts, are giant cells. They are responsible for osteoclasia, which is removal of bone tissue. After the process of bone resorption is completed, osteoclasts disappear.
Bone is a primary reservoir of calcium and other minerals. It has a tremendous turnover capability for responding to the metabolic needs of the body and is critical in maintaining a stable serum calcium level. Because calcium participates in many reactions in the organism, it has an essential life-support function. It works in conjunction with the lungs and kidneys to help maintain the body’s pH balance through the production of additional phosphates and carbonates.
In addition, the metabolic environment is an extremely important component of the biomechanical structure of bone. Bone undergoes continuous turnover in response to biomechanical reactions, with the skull and jaws unquestionably affected by this turnover. The structural integrity of bone may be compromised in times of metabolic calcium needs, altering bone structure and mass, and leading to bone fragility. This phenomenon can be noted in the bone structure of post- menopausal women who experience a decrease in estrogen hormones. As a bone mass is lost, interconnectivity between bone trabeculae is also lost. Because normal interconnectivity plays an important role in making bone a biomechanically rigid, tight structure, its decrease leads to fragility.
In a metabolically compromised individual, there can be a reduction in the normal turnover process. It can lead to fatigue damage of the bony tissue. All this factors can result in bone fragility and implant loss.
It is very important to realize that a compromised status may not be recognized by the patient until the clinician attempts to place implants.
This would be a reason for most general testing, blood exams that the clinician can ask before a dental implant placement. Even if it is just one implant.
All this exams is better for the dental tourism traveler to do at his home hospitals, so maxillofacial surgeon in Costa Rica can receive the whole information about the patient for the correct surgery planning.
Dr. Natalia Demianko
DDS / 2015