BONE LOSS

1
BONE LOSSPATTERNS OF BONE DESTRUCTION

• BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION
• Most common cause
• Periodontitis is always preceded by gingivitis
• Not all gingivitis progress to periodontitis

2
BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION

• Advancedcases
• no.of motile organismspirochetes se where as
  coccoid rods straight rods se
• Fibroblastlymphocyte se in stage I gingivitis
• No. of plasma cellsblast cells ses gradually
• T-lymphocyte predominate(contained gingivitis)

3
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
• Fibrogenesisosteogenesis
  

4
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 periodontiumresults crestal
  resorption/loss of attachment

5
BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION
Contd.
6
BONE DISTRUCTION DUE TO GINGIVAL INFLAMMATION
Contd.

• inflammation
• bone
• marrow spaces
  replaces by leucocytefluid exudate,new blood
  vesselsproliferating fibroblast
• multinuclear osteoclastmononuclear
  phagocytosis bone surface (hawship lacunae)

7
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(GrantCho)
• Plaque can induce bone loss within 1.5-2.5mm
  beyond 2.5mm there is no effect(Waerhaugs
  measurement)
• I/P angular defects can appear in spaces wider
  than 2.5mm

8
RATE OF BONE LOSS

• Acc to Loeco-workers
• 8 severe periodontal diseases,yearly loss of
  attachment 0.1-1mm
• 81moderate periodontitis,CAL 0.05-0.5mm
• 11mild Periodontitis, 0.05-0.09mm

9
PERIOD OF DESTRUCTION

• Loss of collagenalv bone with deepening of
  periodontal pocket
• Theories
• Bursts of destructive activity associated with
  subgingival ulceration
• Brusts of distructive activity coincide with
  conversion of T B lymphocyte-plasma cells
• Period of exacerbation associated with
• increaseof
  loose,unattached,motile,gm-ve,anaerobic pocket
  flora.Periods of remission coincide with the
  formation of
• dense,unattached,nonmoti
  le,gm-positive flora with a tendency to
  mineralize.
• 4.Tissue invasion by one/several bacterial
  species is followed by an advanced local host
  defence

10
MECHANISM OF BONE DESTRUCTION

• Bacterial Host mediated factor
• Bacterial plaque bone progenitor cells
• mediators gingival cells
  osteoclasts
• Host induced factor(prostaglandintheir
  precursors,IL-1alphabeeta,TNF-alpha)inducing
  bone resorption(in vitro)
• NSAID such as ibuprofen inhibit PGE-2 production
• 
  slowing bone loss

11
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

12
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

13
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
• lossosteoporosis,osteopenia,hyperparathyroid
  ism,
• leukemia or langerhanscell histiocytosis

14
FACTORS DETERMINING BONE MORPHOLOGY IN
PERIODONTAL DISEASE

• Normal variation in Alveolar bone
• Exostoses
• Trauma from occlusion
• Buttressing Bone formation(Lipping)
• Food Impaction
• Aggressive Periodontitis

15
BONE DESTRUCTION PATTERNS IN P.DISEASES

• Horizontal bone loss
• Osseous defects
• Vertical/Angular defects

16
VERTICAL/ANGULAR DEFECTS
17
BONE DESTRUCTION PATTERNS IN P.DISEASES Contd

• Osseous Craters
  o.c.
• Bulbous Bone Contours
• Reverse Architecture

18
BONE DESTRUCTION PATTERNS IN P.DISEASES Contd

• Ledges
• Furcation Involvements

19
MCO-1

• 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

20
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

21
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

22
MCQ-4

• According to Waerhaugs 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

23
MCQ-5

• 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