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PRESENTED BY: JUHI SAINI MDS IST PROF
According to Orbans . . . The alveolar bone is defined as that
part of the MAXILLA & MANDIBLE that forms & supports the sockets of the teeth.
According to Tencate . . . The alveolar bone is constituted
strictly of the ALVEOLAR PROCESS which is firmly attached to the basal bone of the jaws.
BASED ON DEVELOPMENT ENDOCHONDRAL INTRAMEMBRANOUS .
CANCELLOUS (SPONGY) 2.1.IMMATURE (WOVEN) .COMPACT (CORTICAL) BASED ON THEIR MICROSCOPIC STRUCTURE MATURE 2.
giving attachment to muscles. providing a framework for bone marrow.ALVEOLAR BONE •The part of the maxilla or mandible that supports and protects the teeth is known as alveolar bone. •Alveolar bone functions as a mineralised supporting tissue. . and acting as a reservoir for ions (especially calcium).
alveolar bone is poorly developed. •Where teeth are congenitally absent (as in anodontia). following tooth extraction. •Alveolar bone requires functional stimuli to maintain bone mass. allowing it to remodel according to the functional demands placed upon it.•One of the most important biological properties of bone is its "plasticity'. •Alveolar bone is dependant on the presence of teeth for its development and maintenance. . Thus. it atrophies.
STRUCTURE OF ALVEOLAR BONE The maxilla and mandible of the adult human can be subdivided into two portions: (a) The alveolar process that involves in housing the roots of erupted teeth and (b) The basal body that does not involve in housing the roots. .
Cortical plate Supporting alveolar bone Spongy bone Alveolar bone proper Alveolar bone .
•The SECOND part is the bone. This has been called SUPPORTING ALVEOLAR BONE . two parts of the alveolar process can be distinguished. •The FIRST consists of thin lamellae of bone that surrounds the root of the tooth and gives attachment to the principal fibers of periodontal ligament.•As a result of its functional adaptation. which surrounds the alveolar bone proper and gives support to the socket. This is ALVEOLAR BONE PROPER.
. which consists of 2.CORTICAL PLATE.SUPPORTING ALVEOLAR BONE 1. also known as cancellous bone.SPONGY BONE. which fills area between these compact bone and forms outer and inner plates of alveolar processes. plates and alveolar bone proper.
•Helps to move the teeth in better occlusion. •Supplies vessels for PDL and cementum. •Adapts the strength to varying load. •Houses and protects developing permanent tooth germs while supporting the teeth. .ALVEOLAR BONE ROLES •It holds tooth firmly in position to masticate.
the alveolar bone constitutes the attachment apparatus of the teeth. The main function is to distribute and reabsorb forces generated by forces of mastication and other tooth contacts .Together with root cementum and periodontal membrane. .
. and are generally much thinner in maxilla than in mandible. •In the maxilla the outer cortical plate is perforated by many small openings through which blood and lymph vessels pass.• CORTICAL PLATES •Cortical plates are continous with compact layer of the maxillary and mandibular body. especially on buccal side. •They are thickest in the premolar and molar regions of the lower jaw.
circumferential or basic lamellae reach the body of the mandible into the cortical plates. notably in premolars and molar regions of the maxilla. . and the cortical plate is fused with the alveolar bone proper. I •In the lower jaw. cortical plates consist of longitudinal lamellae and haversian system. •Histologically. defects of the outer alveolar wall are fairly common.•In the region of the anterior teeth of both the jaws. the supporting bone is usually very thin. •No spongy / cancellous bone is found here. •In such areas.
The interdental septa are bony partition that separate adjacent alveoli coronally at cervical region. the septa are thinner and here the cortical plates are fused and cancellous bone is frequently missing. .INTERDENTAL SEPTA Interdental septa consist of cancellous bone bordered by the socket wall cribriform plates of approximating teeth and facial and lingual cortical plates.
veins.(Ritchey B. as well as by the position of the teeth in the jaw and their degree of eruption. The mesiodistal and faciolingual dimension and shape of the interdental septum are governed by the size and convexity of the crowns of the approximating teeth . . Orban) The interdental and interradicular septa contain the perforating canals of Zuckerkandl and Hirschfeld which house interdental or interradicular arteries. lymph vesels and nerves.
Type 1: The interdental and interradicular trabeculae are regular and horizontal in a ladder like arrangement. Seen most commonly in the mandible.SPONGY / CANCELLOUS BONE It fills the area between the cortical plates and the ABP. Radiographic studies permit the classification of spongiosa of the alveolar process into two main types. .
Type 2: Shows irregularly arranged numerous delicate interdental and interradicular trabeculae. . lacks a distinct trajectory pattern which seems to be compensated by greater number of trabeculae in any given area. functionally satisfactory. Although. Maxilla has more cancellous bone than mandible. This type of arrangement is more common in maxilla. Wide variations occur in trabecular pattern which is affected by occlusal forces.
.(Weinman JP. It is referred to as cribriform plate because of perforation. into which the extrinsic collagen fiber bundles of the PDL insert.sicher H) The ABP appears as an opaque line called LAMINA DURA.BUNDLE BONE (LAMINA DURA) AND CRIBRIFORM PLATE Bundle bone is the part of alveolar bone. The alveolar bone is perforated by many openings through which the blood vessels. lymphatics and nerves of PDL pass. The apparent density is due to thick bone without trabeculations that x-ray must penetrate and not due to any increase in mineral content.
facial bone is thicker than normal. On teeth in lingual version. .with intervening vertical depressions that taper towards the margin. On teeth in labial version .OSSEOUS TOPOGRAPHY The bony contour normally conforms to the prominence of the roots. The bone margin is located farther apically on the roots which forms relatively acute angles with the alveolar bone(Hirschfeld I).the margin of the labial bone is located farther apically.
HAVERSIAN SYSTEM Circumferential lamellae Concentric lamellae Interstitial lamellae .
. Circumferential lamellae enclose the entire adult bone. generally oriented parallel to the long axis of the bone. Concentric lamellae make up the bulk of compact bone and form the basic metabolic unit of bone. the osteon. forming its outer perimeter. each canal houses a capillary. The osteon is a cylinder of bone. In the center of each is a canal. which is lined by a single layer of bone cells that cover the bone surface. the Haversian canal. Adjacent Haversian canals are interconnected by Volkmann canals.
OSTEON PRIMARY OSTEONS Recently formed osteons that SECONDARY OSTEONS They become partially have not remodelled. which is indicative of old bone. become resorbed and replaced by adjacent osteons. .
•Interstitial lamellae are interspersed between adjacent concentric lamellae and fill the spaces between them. . They are actually fragments of preexisting concentric lamellae .
which have the potential to differentiate into osteoblasts.PERIOSTEUM AND ENDOSTEUM Tissue covering outer surface of bone is termed Periosteum. and an outer layer rich in blood vessels and nerves and composed of collagen fibers and fibroblasts. . The inner layer is the osteogenic layer. The periosteum consists of an inner layer composed of osteoblasts surrounded by osteoprogenitor cells. The endosteum is composed of a single layer of connective tissue. and the outer layer is the fibrous layer. where as tissue lining the internal bone cavities is called Endosteum.
. which results in its observed attenuation. Its name. Its radiographic appearance is caused by the fact that the x-ray beam passes tangentially through the thickness of the thin bony wall many times.RADIOGRAPHIC FEATURES LAMINA DURA The tooth sockets are bounded by a thin radiopaque layer of dense bone. is derived from its radiographic appearance. lamina dura ("hard layer").
the alveolar crest.5 mm from the cementoenamel junction of the adjacent teeth. . The level of this bony crest is considered normal when it is not more than 1. ALVEOLAR CREST The gingival margin of the alveolar process that extends between the teeth is apparent on radiographs as a radiopaque line.
In the posterior maxilla the trabecular pattern is usually quite similar to that in the anterior maxilla. dense pattern. . forming a fine. and the marrow spaces are consequently small and relatively numerous.CANCELLOUS BONE It is composed of thin radiopaque plates and rods (trabec-ulae) surrounding many small radiolucent pockets of marrow. The trabeculae in the anterior maxilla are typically thin and numerous. granular. although the marrow spaces may be slightly larger.
resulting in a coarser pattern. The trabecular plates are also fewer than in the maxilla. . In the posterior mandible the periradicular trabeculae and marrow spaces may be comparable to those in the anterior mandible but are usually somewhat larger. and the marrow spaces are correspondingly larger. with trabecular plates that are oriented more horizontally.CANCELLOUS BONE In the anterior mandible the trabeculae are somewhat thicker than in the maxilla.
COMPOSITION OF BONE .
The organic matrix consists mainly of collagen type I(Muhlemann HR.osteonectin.and proteoglycans.Zander HA). .with small amounts of noncollagenous proteins such as osteocalcin .phosphoproteins.
NON COLLAGENOUS PROTEINS They constitute the remaining 10%of the total organic content of bone matrix. glutamic acid is predominant in bone sialoprotein and aspartate is predominant in osteopontin. . osteopontin and bone sialoprotein were previously termed as bone sialoproteins I and II respectively. osteocalcin is the first noncollagenous protein to be recognized and represents less than 15%of the noncollagenous protein.
BONE CELLS OSTEOBLASTS These are mononucleated cells that synthesize collagenous & non . . about 5-10 um thick. The osteoblast secretes the organic matrix of bone.It exhibits a high level of alkaline phosphatase on their outer plasma membrane.collagenous bone matrix proteins. which initially is represented by an unmineralised layer known as OSTEOID.
creating a space around it . Osteocytic processes are present within these canaliculi. Embryonic bone and repair bone .show more osteocytes as they they are formed rapidly.they get entrapped within the matrix they secrete . .within the bone matrix .the osteocyte reduces in size .and are called osteocytes.called the osteocytic lacuna.OSTEOCYTES As the osteoblasts form the bone matrix . Narrow extensions of these lacunae form channels called canaliculi.
BONE CELLS .
the bone surface is completely lined by a layer of flattened cells termed bone-lining cells. . they protect it from any resorptive activity from osteoclasts. By covering the surface of bone. These show little sign of synthetic activity as evidenced by their organelle content.BONE LINING CELLS When bone surfaces are neither in the formative nor resorptive phase. They are regarded as post prolifcrative osteoblasts.
in the periodontal ligament. or in the marrow spaces.OSTEOPROGENITOR CELLS The cells that eventually give rise to osteoblasts are termed osteoprogenitor cells ( FRIEDENSTEIN ). . They reside in the layer of cells beneath the osteoblast layer in the periosteal region.
osteoprogenitor cells Determined osteogenic precursor cells Inducible osteogenic precursor cells .
They are derived from haemopoietic cells of the monocyte/ macrophage lineage by fusion of mononuclear precursors. (Bernard GW) Resorbing surfaces of alveolar bone show resorption concavities (Howship's lacunae). in which lie the multinucleated osteoclasts. osteoclasts may be up to 100 um in diameter and have on average 10-20 nuclei. Characteristically.OSTEOCLASTS Osteoclasts are the cells responsible for bone resorption. .
. and where rcsorption is occurring. the ruffled border is composed of many tightly packed microvilli adjacent to the bone surface. That part of the cell that lies adjacent to bone. striated appearance at the light microscope level (the so-called 'ruffled border'). This border provides a large surface area for the resorptive process. At the ultrastructural level. A useful marker for osteoclasts is tartarate-resistant acid phosphatase. often has a foamy.
respectively.PHYSIOLOGICAL REMODELLING The ability of the alveolar bone to remodel rapidly facilitates positional adaptation of teeth in response to functional forces and in the physiological drift of teeth that occurs with the development of jaw bones. Bone remodeling involves the co-ordination of activities of cells . which form and resorb the mineralized connective tissues of bone. the osteoblasts and the osteoclasts. (Sodek J) .
BONE REMODELLING .
BONE FORMATION It involves the proliferation and differentiation of stromal stem cells along an osteogenic pathway that leads to the formation of osteoblasts. . The alkaline phosphatase and collagen I expression are characteristic of the osteogenic lineage .
Sequestering of mineral ions and amino acids within the osteoclast. such as acid phosphatase and cathepsin B. Creation of a sealed acidic environment through the action of the proton pump.BONE RESORPTION Tencate described the resorptive process : Attachment of osteoclasts to the mineralized surface of bone. which demineralizes bone and exposes the organic matrix. Degradation of exposed organic matrix by the action of released enzymes. .
BLOOD SUPPLY Maxilla receives blood Mandible receives blood supply from superior alveolar artery . inferior . supply from alveolar artery.
More frequently in apical and interradicular region . . there are also AV anastomoses that bypass the capillaries.VENOUS DRAINAGE It accompanies arterial supply. Venules receive blood via abundant capillary network.
From there they pass through alveolar bone to inferior dental canal in mandible or infraorbital canal in maxilla and then to submaxillary lymphnodes. .LYMPHATIC DRAINAGE Those draining region just beneath the JE pass into PDL and accompany blood vessels into periapical region(Box KF).
Fibrosseous integration. are interposed between the two surfaces. . in which soft tissues such as fibers and/or cells.IMPLANT BONE INTERFACE Osseointegration: when the bone is in intimate but not ultrastructural contact with implant.
PATHWAYS OF INFLAMMATION Inflammation extends along the collagen fiber bundles & follows the course of blood vessels. through the loosely arranged tissues around them in to alveolar bone. .
inflammation spreads along the outer periosteal surface of the bone and penetrates into the marrow through the vessel channels in the outer cortex. .Facially & lingually.
causing thinning of the surrounding bony trabeculae &enlargement of marrow spaces.•Once inflammation reaches the bone. followed by destruction of bone and reduction in bone height. it spreads into the marrow spaces and replaces the marrow with: -a leukocytic and fluid exudate -new blood vessels -proliferating fibroblasts •Resorption precedes from within the marrow cavities. .
Saglie R.Newman MG) .range of effectiveness of dental plaque to induce loss of bone is within about 1. Large defects exceeding a distance of 2.RADIUS OF ACTION Page & Schroeder.5 to 2.5 mm.(Carranza .5 mm from the tooth surface may be caused by the presence of bacteria in the tissues.
In these . OSTEOCONDUCTION This occurs when non – vital implant material serves as a scaffold for the ingrowth of precursor osteoblasts into the defect that is followed by gradual resorption of implant material.OSTEOGENESIS This occurs when osteoblasts &the precursor osteoblasts are transplanted with graft material into the defects. they may estabilish centres of bone formation. . OSTEOINDUCTION This process involves new bone formation by the differentiation of local uncommitted cells into bone forming cells under the influence of one or more inducing agents.
.CLINICAL IMPLICATIONS FENESTRATIONS & DEHISCENCE Fenestrations are the isolated area in which the root is denuded of bone & root surface is covered by periosteum & gingiva. Dehiscence is when denuded area extends through the marginal bone.
FENESTRATION DEHISCENCE .
and are frequently bilateral. •Prominent root contours. are more common on anterior teeth than on posterior teeth. malposition.(Elliot JR.•They occur more often on the facial bone than on the lingual. and labial protrusion of the root combined with a thin bony plate are predisposing factors.Bowers GM) .
PATTERNS OF BONE DESTRUCTION HORIZONTAL BONE LOSS Bone is reduced in height. Bone margin remains perpendicular to tooth surface. .
the base of the defect is located apical to the surrounding bone. .VERTICAL BONE LOSS Vertical or angular defects are those that occur in an oblique direction. leaving a hollowed out thorough in the bone along side the root.
Angular defects are classified as follows: Three wall bony defects Two wall bony defects One wall bony defects .
VERTICAL BONE LOSS .
OSSEOUS CRATERS Osseous craters are concavities in the crest of the interdental bone confined within the facial and lingual walls. Craters have been found to be made up about one third of all defects and about two thirds of all mandibular defects. (Melcher AH) .
When it occurs within the jaw. . When it occurs on the external surface.BUTTRESSING BONE FORMATION Bone formation sometimes occurs in an attempt to buttress bony trabeculae weakened by resorption.(Glickman I) The latter may cause bulging of the bone contour. it is termed as central buttressing bone formation. it is known as peripheral buttressing bone formation. termed lipping.
BULBOUS BONY CONTOURS These are bony enlargements caused by exostoses. or buttressing bone formation. adaptation to function. .
without concomitant loss of radicular bone. including the facial and/or lingual plates. thereby reversing the normal architecture. Such defects are more common in the maxilla. (Neilson JI) .REVERSE ARCHITECTURE These defects are produced by loss of interdental bone.
.LEDGES Ledges are plateau-like bone margins caused by resorption of thickened bony plates.
The mandibular first molars are the most sites.(Larato DC) common .FURCATION The term furcation involvement refers to the invasion of the bifurcation and trifurcation of multirooted teeth by periodontal disease.
tissue injury results. Although trauma from occlusion does not alter the inflammatory process. Widening of the marginal periodontal ligament space. The resultant injury is termed trauma from occlusion. a narrowing of the interproximal alveolar bone. . it changes the architecture of the area around the inflamed site. and a shelf-like thickening of the alveolar margin.TRAUMA FROM OCCLUSION When occlusal forces exceed the adaptive capacity of the tissue. An occlusion that produces such injury is called a traumatic occlusion.
SYSTEMIC DISORDERS CAUSING BONE LOSS Osteoporosis – post menopausal Hyperparathyroidism – Brown s tumour Leukemia Langerhans cell histiocytosis .
AGE RELATED CHANGES
More irregular periodontal surface of bone. Less regular insertion of collagen fibres. Diminished vascularity Increasing number of interstitial lamellae
Fewer cells in the osteogenic layer
Decreased trabeculation Osteoporosis
sensitive to pressure and tension. Enables Orthodontic tooth movement. Adaptation of the bone to function is qualitative as well as quantitative. Increase in the functional forces leads to the formation of the new bone, decrease in the functional forces leads to the decrease in the volume of the bone.
During healing of the fracture immature type of the bone is
formed,characterized by the greater number, size and irregular arrangement of the osteocytes than are found in mature bone.
In periodontal destruction both vertical & horizontal type of the
bone loss can be seen & is related to the bacterial plaque and pocket formation.
Synthetic materials. . used for the ridge augmentation & for filling the bone defects produced by the periodontal diseases. Alveolar bone of the maxilla & mandible develops for the support of the teeth. when teeth are lost it undergoes gradual atrophy.including non resorbable hydroxyapatite & resorbable tricalcium phosphate.
. Progressive loss of bone is difficult to control.CONCLUSION The basic understanding of the structure of alveolar bone & remodeling in response to various stimuli can help us to better understand the progression of periodontal disease. once lost it is very difficult to repair or regenerate.
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