BONE LOSS AND PATTERNS OF BONE

DESTRUCTION

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 Learning Objectives:

Section I
• Bone destruction caused by extension of gingival inflammation
• Bone destruction caused by trauma from occlusion
• Bone destruction caused by systemic disorders
Section II
• Factors determining bone morphology in periodontal disease
• Bone destruction patterns in periodontal disease

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BONE DESTRUCTION CAUSED BY

• Extension of Gingival Inflammation

• Trauma from Occlusion
• Systemic Disorders

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 BONE DESTRUCTION CAUSED BY EXTENSION OF
GINGIVAL INFLAMMATION

• Most common cause

• Gingivitis – Periodontitis (Pathogenic potential of Plaque & Host

resistance)

• Histopathology

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• Radius of Action – 1.5 to 2.5mm

• Rate of Bone Loss –

Rapid – 0.1 to 1.0mm
Moderate – 0.05 to 0.5mm
Minimal – 0.05 to 0.09mm

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• Periods of Destruction –
1. Subgingival Ulceration & Acute inflammatory reaction
2. T – B cell
3. Increase in bacterial type
4. Tissue invasion

• Mechanisms of Bone Destruction

• Bone Formation in Periodontal Disease

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 BONE DESTRUCTION CAUSED BY TRAUMA FROM
OCCLUSION

• Changes reversible
• Aggravates destruction caused by inflammation

BONE DESTRUCTION CAUSED BY SYSTEMIC

DISORDERS
Osteoporosis ? Hyperparathyroidism,leukemia

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 FACTORS DETERMINING BONE MORPHOLOGY IN
PERIODONTAL DISEASE
• Normal variation in Alveolar bone

• Exostoses

• Trauma from Occlusion

• Buttressing bone formation (Lipping)

• Food impaction

• Aggressive Periodontitis

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 BONE DESTRUCTION PATTERNS IN PERIODONTAL
DISEASE
• Horizontal Bone Loss
• Bone Deformities (Osseous Defects)
Vertical / Angular Defects
Osseous Craters
Bulbous Bone Contours
Reversed Architecture
Ledges
Furcation Involvement

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• Horizontal bone loss: is most common pattern
of bone loss in periodontal disease. The bone
is reduced in height, but the bone margin
remains approximately perpendicular to the
tooth surface

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• Bone deformities (osseous defects):can result
from periodontal disease. These usually occur
in adults, but they have also been reported in
human skulls with deciduous dentitions. There
presence may be suggested on radiographs,
but careful probing and surgical exposure of
the areas are required to determine their
exact conformation and dimensions

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• Vertical or Angular defects: occur in oblique direction,
leaving a hollowed out trough in the bone along side the
root; the base of the defect is located apical to the
surrounding bone.
• Goldman and Cohen classified angular defects on the
basis of the number of osseous walls which may be one,
two and three walls.
• The number of walls in the apical portion of defect is
often greater than that in its occlusal portion, in which
case the term combined osseous defect is used

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 Angular defect

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 Angular defect

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 One wall vertical defect

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Circumferential vertical defect

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• Osseous craters: are concavities in the crest of
the interdental bone that is confined within
the facial and lingual walls. Craters have been
found to make up about one-third of all
defects and two third of all mandibular
defects and to occur twice as often in
posterior segments as in anterior segments.

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• Reasons for high frequency of interdental craters
1.The interdental area collects plaque and is difficult
to clean
2.The normal flat or even slightly concave
facialingual shape of the interdental septum in the
lower molars may favor crater formation
3.Vascular patterns from the gingiva to the center of
the crest may provide a pathway for inflammation

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 Osseous craters

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• Reversed Architecture: Defects are produced
by a loss of interdental bone, including the
facial plates and lingual plates, without a
concomitant loss of radicular bone, thereby
reversing the normal architecture . Mostly
occurs in NUP and more common in maxilla

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 Reversed architecture

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• Ledge: are plateau like bone margins that are
caused by the resorption of thickened bony
plates

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 Ledges

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 Furcation involvement
• Furcation involvement refers to the invasion of the
bifurcation and trifurcation of multirooted teeth by
periodontal disease.
• Classified as Grade I through IV according to the
amount of tissue destruction. Grade I involves
incipient bone loss; grade II involves partial bone loss
(cul de sac); and grade III involves total bone loss
with a through and through opening of the furcation
• Grade IV is similar to grade III but includes gingival
recession that exposes the furcation to view
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Long Questions:
1. Furcation involvement – classification, clinical & radiographic features,
treatment/ management

Short Notes:
1. Radius of action
2. Bone destruction in trauma from occlusion
3. Buttressing bone formation
4. Patterns of bone destruction
5. Osseous defects
6. Vertical / angular defects
7. Osseous craters
8. Reversed architecture

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 THANK YOU

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