BONE LOSS&PATTERNS OF BONE
DESTRUCTION
 BONE DISTRUCTION DUE
GINGIVAL INFLAMMATION
TO
 Most common cause
 Periodontitis is always preceded by
gingivitis
 Not all gingivitis progress to
periodontitis
BONE DISTRUCTION DUE TO GINGIVAL
INFLAMMATION
Advancedcases:
 no.of motile organism&spirochetes se where as
coccoid rods &straight rods se
 Fibroblast&lymphocyte se in stage I gingivitis
 No. of plasma cells&blast cells ses gradually
 T-lymphocyte predominate(contained gingivitis)
BONE DISTRUCTION DUE TO GINGIVAL
INFLAMMATION Contd….
Extension of inflammation
supporting tissue
modified
pathologic potential plaque
Resistance of the host
Degree of fibrosis of gingiva
Width of attached gingiva
Fibrogenesis&osteogenesis
BONE DISTRUCTION DUE TO GINGIVAL
INFLAMMATION Contd….
HISTOPATHOLOGY
 Inflammation extends through collagen fibers
 Loosely arranged tissue around alveolar bone
 Inflammatory infiltrate concentrated in the
marginal periodontium&results crestal
resorption/loss of attachment
BONE DISTRUCTION DUE TO GINGIVAL
INFLAMMATION Contd….
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)
RADIUS OF ACTION
Locally 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
RATE OF BONE LOSS
Acc to Loe&co-workers
1. 8% severe periodontal diseases,yearly loss of
attachment 0.1-1mm
2. 81%moderate periodontitis,CAL 0.05-0.5mm
3. 11%mild Periodontitis, 0.05-0.09mm
PERIOD OF DESTRUCTION
 Loss of collagen&alv bone with deepening of
periodontal pocket
 Theories…
1. Bursts of destructive activity associated with
subgingival ulceration
2. Brusts of distructive activity coincide with conversion
of T
B lymphocyte-plasma cells
3. Period of exacerbation associated with
*increaseof
loose,unattached,motile,gmve,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
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
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
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
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
•
•
•
•
•
•
FACTORS DETERMINING BONE
MORPHOLOGY IN PERIODONTAL
DISEASE
Normal variation in Alveolar bone
Exostoses
Trauma from occlusion
Buttressing Bone formation(Lipping)
Food Impaction
Aggressive Periodontitis
BONE DESTRUCTION PATTERNS IN
P.DISEASES
• Horizontal bone loss
• Osseous defects
• Vertical/Angular defects
VERTICAL/ANGULAR DEFECTS
BONE DESTRUCTION PATTERNS IN
P.DISEASES Contd
• Osseous Craters
• Bulbous Bone Contours
• Reverse Architecture
o.c.
BONE DESTRUCTION PATTERNS IN
P.DISEASES Contd
• Ledges
• Furcation Involvements
MCO-1
•
(a)
(b)
(c)
(d)
Which of the following is related with
advanced stage of periodontal diseases
Fibroblast and lymphocyte predominate
No.of plasma cells and blast cells decreases
gradually in C.T.
No.of motile organism and spirochete
decreases
No.of coccoid rods and straight rods
decreases
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
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
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
MCQ-5
•
(a)
(b)
(c)
(d)
What are the changes can be observed in
the periodontal ligament due trauma from
occlusion
Widening of periodontal ligament
Thinning of periodontal ligament
Necrosis of periodontal ligament
Shortening of periodontal ligament