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Bone destruction in periodontal disease

.. .
1

:
1.
2.

3. (trauma from occlusion)

4.
5.

:
1.
2. Bone destruction patterns
3. Classification of FI
4. Bone destruction by extension of gingival inflammation
5.
6. Bone destruction caused by trauma from occlusion
7. Bone destruction caused by systemic disorders
8. Factors determining bone morphology
9.

(power point)

(quiz) 1

Bone Destruction in Periodontal disease

(alveolar bone)


(formation) (resorption)
local systemic influences
(physiologic) senile atrophy
local factors local factors 2
1. gingival inflammation
Local factors bacterial plaque, calculus
(height) alveolar bone
2. Trauma from occlusion
Local factors
lateral bone loss
bone past pathologic experience
soft tissue inflammatory condition
degree bone loss
- periodontal pocket depth
- severity of pocket wall ulceration
- pus exudate

Bone destruction patterns

bone destruction
1. Horizontal bone loss
2. Vertical bone loss
3. Osseous crater
4. Reverse architecture
5. Furcation involvement

1. Horizontal bone loss

(height) alveolar
bone ( 1) bone proximal facial/lingual

1
2. Vertical or angular bone loss

base vertical bone loss alveolar crest ( 2)

vertical bone loss interproximal

facial / lingual

vertical bone loss bony wall

5
2.1) Three bony walls : 3
mesial ( 3)

3
2.2) Two bony walls : 2 ( 4)
interdental crater buccal Lingual

2.3) One bony wall : hemiseptum ( 5)

5
2.4) Four bony wall : cup-shape
circumferential bone loss ( 6)

2.5) Combined type :

apical portion coronal portion 3 bony wall
2 bony wall ( 7)

7
3. Osseous crater
osseous crater proximal
interdental bone crest ( 8)

concavity

craters 35% defect (62%)

mandible 2 crater
1) interproximal plaque

2) flat concave lower molars crater

3) vascular pattern center crest pathway
for inflammation
4. Reverse architecture

bone loss

5. Furcation involvement (FI)

(bi- trifurcation)
upper first molars maxillary premolars FI

- horizontal
- vertical

Classification of FI
horizontal (Hamp et al., 1975)
1) Class 0 : involved furcation ( 9)

9
2) Class 1 : involved furcation horizontal 3 .
( 10)

10

3) Class 2 : involved furcation 3 . horizontal

( 11)

11
4) Class 3 : involved furcation trough-and-through ( 12)

12

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classification vertical subclass A, B C

1) Sub class A : 1-3 .
( 13)

13
2) Sub class B : 4-6 .
( 14)

14
3) Sub class C : 7 . ( 15)

15

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uj FI
plaque FI
trauma
from occlusion crater-like angular deformities FI
cervico-enamel projection CEP FI

Bone destruction by extension of gingival inflammation

chronic
inflammation gingivitis periodontitis
plaque extension
2
1. Pathogenic potential of plaque
2. Host defense mechanisms

horizontal bone
loss vertical bone loss Selikowitz
(1981) 0.1
bite wing
collagen fiber
bundles blood vessels alveolar bone
maxillary sinus
interproximal transeptal fibers bone
vessel channels ( 16 A) horizontal bone loss

( 1 16 A) PDL
vertical bone loss ( 3 16A)

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facial / lingual outer periosteal surface

marrow space vessel channels outer cortex ( 16 B) horizontal bone loss
( 1 16B)
PDL Vertical bone loss ( 3 16B)

16 A B
marrow cell leukocytic fluid exudate , new blood vessels
proliferating fibroblast
cell
1. Osteoclast : mineral portion
2. Mononuclear cell : organic matrix
Radius of action
Page Schroeder
.. 1982
1. 1.5-2.5 . bacterial plaque
2. 2.5 .
radius of action type bone loss interdental septa (
17)

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17
A = narrow B = average C = wide
Mechanisms
Local agents
- Prostaglandins
- Osteoclast-activating factor (OAF)
- Proteolytic enzymes collagenase, hyaluronidase

Bone destruction caused by trauma from occlusion

Trauma from occlusion PDL, cementum alveolar bone

PDL , PDL thrombosis
cementum
PDL PDL thrombosis
vertical bone loss

Trauma from occlusion secondary cause

: trauma from occlusion compression tension
PDL osteoclast necrosis PDL bone resorption bone
tooth structure

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funnel-shaped widening of PDL crestal portion

:
attachment angular bone loss

Bone destruction caused by systemic disorders

Systemic disorders defense mechanisms
generalized skeletal disturbances
hyperparathyroidism, leukomia, Hand-Schueller-Christian disease bone
destruction

Factors determining bone morphology

1. Normal variation in alveolar bone
2. Exostoses
3. Trauma from occlusion
4. Buttressing bone formation
5. Food impaction
6. Juvenile periodontitis
Normal variation in alveolar bone : normal variation
bone loss crestal angulation interdental septa,
facial / lingual plates , fenestration dehiscence ,
( 18 , 19)

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18

A normal

19
B fenestration

C dehiscence

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Exostoses : small / large

nodules, sharp ridge, spike-like projection, 40% palatal
( 20)

20
Trauma from occlusion :
margin of alveolar bone vertical
buttressing bone
Buttressing bone formation : buttressing
external surface central buttressing Bone formation
pheripheral buttressing bone formation lipping bulging of
bone contour osseous crater angular defect

21

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Food impaction :
interproximal reverse architecture contact point
2
marginal ridge
Juvenile periodontitis : aggressive localized juvenile
periodontitis pattern
vertical first molars incisors

local factors
gingival inflammation trauma from occlusion , radius of
action , rate of bone loss mechanism

horizontal bone loss, furcation involvement

classification

Clinical Periodontology , 8th ed., Carranza and Newman, 1990.

Clinical Periodontology and Implant Dentistry, 3rd ed., Lidhe; Karring and Lang , 1998.
Color Atlas of Periodontal surgery, Teruo ITO Jeffrey D. Johnson, 1994.
Color Atlas of Dental Medicine 1, Periodontology, 2nd revised and expanded edition,
K.H. Rateitschak, 1986.
5. Bone destruction in Periodontal disease.

1.
2.
3.
4.

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(DPER 482)

Bone Destruction in Periodontal disease

1.
2. , ,

3. (trauma from occlusion)

4.
5.

..

23 2548
08.00-09.00 .