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BONE LOSS&PATTERNS OF BONE DESTRUCTION
BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION
Most common cause Periodontitis is always
preceded by gingivitis Not all gingivitis progress to
periodontitis
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BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION
Advancedcases: no.of motile organism&spirochetes se where as
coccoid rods &straight rods seFibroblast&lymphocyte se in stage I gingivitisNo. of plasma cells&blast cells ses graduallyT-lymphocyte predominate(contained
gingivitis)
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BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION Contd….
Extension of inflammation supporting tissue modified
pathologic potential plaque Resistance of the host
Degree of fibrosis of gingivaWidth of attached gingivaFibrogenesis&osteogenesis
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BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION Contd….
HISTOPATHOLOGYInflammation extends through collagen fibersLoosely arranged tissue around alveolar boneInflammatory infiltrate concentrated in the
marginal periodontium&results crestal resorption/loss of attachment
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BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION Contd….
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BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION Contd….
inflammation bone marrow spaces replaces by
leucocyte+fluid exudate,new blood vessels&proliferating fibroblast
multinuclear osteoclast&mononuclear phagocytosis &bone surface (hawship lacunae)
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RADIUS OF ACTIONLocally produced bone resorption factors may
have to be present in the proximity of the bone surface to be able to exert their action(Grant&Cho)
Plaque can induce bone loss within 1.5-2.5mm beyond 2.5mm there is no effect(Waerhaug’s measurement)
I/P angular defects can appear in spaces wider than 2.5mm
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RATE OF BONE LOSS
Acc to Loe&co-workers1. 8% severe periodontal diseases,yearly loss of
attachment 0.1-1mm2. 81%moderate periodontitis,CAL 0.05-0.5mm3. 11%mild Periodontitis, 0.05-0.09mm
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PERIOD OF DESTRUCTION Loss of collagen&alv bone with deepening of
periodontal pocket Theories…1. Bursts of destructive activity associated with
subgingival ulceration2. Brusts of distructive activity coincide with conversion
of T B lymphocyte-plasma cells3. Period of exacerbation associated with *increaseof loose,unattached,motile,gm-
ve,anaerobic pocket flora.Periods of remission coincide with the formation of
*dense,unattached,nonmotile,gm-positive flora with a tendency to mineralize.
4.Tissue invasion by one/several bacterial species is followed by an advanced local host defence
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MECHANISM OF BONE DESTRUCTION
• Bacterial & Host mediated factor• Bacterial plaque bone progenitor cells
mediators gingival cells osteoclasts• Host induced factor(prostaglandin&their
precursors,IL-1alpha&beeta,TNF-alpha)inducing bone resorption(in vitro)
• NSAID such as ibuprofen inhibit PGE-2 production
slowing bone loss
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BONE FORMATION IN PERIODONTAL DISEASE
• Areas of bone formation are also found immediately adjacent to active bone resorption
• The response of alveolar bone to inflammation includes bone formation &resorption
• New bone formation retards the rate of bone loss,compensating in some degree for the bone destroyed by inflammation
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BONE DESTRUCTION CAUSED BY TRAUMA FROM OCCLUSION
• TFO caused destruction in the +ce/-ce of inflammation
• In the absence of inflammation: se compression &tension of the PDL& se osteoclasis of alv bone to necrosis of PDL &bone & resorption of bone & tooth st.
• Persistent TFO funnel shaped widening of the crestal portion of the PDL with resorption of the adjacent bone
• With inflammation TFO aggravates the bone destruction & causes bizarre bone patterns
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BONE DESTRUCTION CAUSED BY SYSTEMIC DISORDER
• Bone factor in periodontal disease: systemic influence on
the response of alv bone (Irving Glickman 1950)
• Bone factor is not in current use
• The possible relationship between periodontal bone loss&osteoporosis,osteopenia,hyperparathyroidism, leukemia or langerhans’cell histiocytosis
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FACTORS DETERMINING BONE MORPHOLOGY IN PERIODONTAL
DISEASE• Normal variation in Alveolar bone• Exostoses• Trauma from occlusion• Buttressing Bone formation(Lipping)• Food Impaction• Aggressive Periodontitis
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BONE DESTRUCTION PATTERNS IN P.DISEASES
• Horizontal bone loss
• Osseous defects• Vertical/Angular defects
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VERTICAL/ANGULAR DEFECTS
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BONE DESTRUCTION PATTERNS IN P.DISEASES Contd
• Osseous Craters o.c.
• Bulbous Bone Contours
• Reverse Architecture
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BONE DESTRUCTION PATTERNS IN P.DISEASES Contd
• Ledges
• Furcation Involvements
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MCO-1
• Which of the following is related with advanced stage of periodontal diseases
(a) Fibroblast and lymphocyte predominate(b) No.of plasma cells and blast cells decreases
gradually in C.T.(c) No.of motile organism and spirochete
decreases(d) No.of coccoid rods and straight rods
decreases
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MCQ-2
• On interproximal surface of tooth ,the pathways of inflammation from gingiva to supporting structures in periodontitis is
(a) Bone to gingiva(b)Periodontal ligament to bone(c)Gingiva to periodontal ligament(d) Periosteum to bone
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MCQ-3
• Which is one of the following have better prognosis of periodontal regeneration
(a)One walled defect(b)Two walled defects(c)Three walled defects(d)Horizontal defects
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MCQ-4
• According to Waerhaug’s concept the bacterial plaque can induce loss of bone in a range of
(a)1.0-1.5mm(b)1.5-2.5mm(c)2.5-3.5mm(d)3.5-4.5mm
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MCQ-5
• What are the changes can be observed in the periodontal ligament due trauma from occlusion
(a) Widening of periodontal ligament(b) Thinning of periodontal ligament(c) Necrosis of periodontal ligament(d) Shortening of periodontal ligament