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Bone Loss and Patterns of Bone Destruction PDF
Bone Loss and Patterns of Bone Destruction PDF
Bone Destruction
Chapter 28
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Bone Loss and Patterns of Bone
Destruction
• Although periodontitis is an infectious disease of the
gingival tissue, changes that occur in bone are crucial
because the destruction of bone is responsible for
tooth loss.
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• Periodontitis is always preceded by gingivitis, but not all
gingivitis progresses to periodontitis. Some cases of
gingivitis apparently never become periodontitis, and others go
through a brief gingivitis phase and rapidly develop into
periodontitis. The factors that are responsible for the extension
of inflammation to the supporting structures and bring about
the conversion of gingivitis to periodontitis are not known at
this time.
• The extension of inflammation to the supporting structures of a
tooth may be modified by the pathogenic potential of plaque or
the resistance of the host.
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Rate of Bone Loss
the rate of bone loss may vary, depending on the type of disease
present. Löe and al identified three subgroups of patients with
periodontal disease based on interproximal loss of attachment
and tooth mortality:
1.Approximately 8% of persons had rapid progression of
periodontal disease, characterized by a yearly loss of
attachment of 0.1 to 1 mm.
2.Approximately 81% of individuals had moderately progressive
periodontal disease, with a yearly loss of attachment of 0.05 to
0.5 mm.
3.The remaining 11% of persons had minimal or no progression
of destructive disease (0.05 to 0.09 mm yearly).
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Periods of Destruction
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Periods of Destruction con….
• Bursts of destructive activity coincide with the
conversion of a predominately T-lymphocyte lesion
to one with a predominance of B-lymphocyte-plasma
cell infiltrate.
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Bone Formation in Periodontal Disease
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• but results from the predominance of resorption over
formation. New bone formation impairs the rate of
bone loss, compensating in some degree for the bone
destroyed by inflammation.
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• The presence of bone formation in response
to inflammation, even in active periodontal
disease, has an effect on the outcome of
treatment. The basic aim of periodontal
therapy is the elimination of inflammation to
remove the stimulus for bone resorption and
therefore allow the inherent constructive
tendencies to predominate.
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BONE DESTRUCTION CAUSED BY TRAUMA
FROM OCCLUSION
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BONE DESTRUCTION PATTERNS IN
PERIODONTAL DISEASE
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Bone Deformities (Osseous Defects)
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Vertical or Angular Defects
• Vertical or angular defects are those that occur in an
oblique direction, leaving a hollowed-out trough in the
bone alongside the root; the base of the defect is located
apical to the surrounding bone.
• In most instances, angular defects have accompanying
infrabony pockets; such pockets always have an
underlying angular defect.
• Angular defects are classified on the basis of the number
of osseous walls.
• The number of walls in the apical portion of the defect
may be greater than that in its occlusal portion, in which
case the term combined osseous defect is used
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Vertical or Angular Defects con..
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Osseous Craters
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Bulbous Bone Contours
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Reversed Architecture
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Ledges
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Furcation Involvements
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