Alveolar Process
Dr. Ye Myat Hein
Department of Periodontology, UDMM
Outline
• Definition
• Functions
• Alveolar processes
• Interdental septum
• Contour
• Blood supply
• Occlusal forces & alveolar bone
• Physiologic migration
• Remodeling of Alveolar Bone
• Fenestration and Dehiscence
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Fig. Bone as an organ. The bone
organ encompasses a number of
complex tissues that synergize
during health to execute a number of
functions. It serves as a source of
stem cells and a reservoir of
minerals and other nutrients; it
protects a number delicate organs;
and it acts as a mechanosensoring
unit that adapts to the environment
and individual demands. This figure
highlights three main tissues and
their respective cells that are
involved in these roles and the
maintenance of the structure and
function of bone as an organ. DFCT,
dense fibrous connective tissue;
LFCT, loose fibrous connective
tissue.
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Alveolar process
• The alveolar process is the portion of the maxilla and mandible that
forms and supports the tooth sockets (alveoli)
• forms when the tooth erupts to provide the osseous attachment to the
forming periodontal ligament;
• it disappears gradually after the tooth is lost
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• Because the alveolar processes develop and undergo
remodeling with tooth formation and eruption, they are tooth-
dependent bony structures
• Therefore the size, shape, location, and function of the teeth
determine their morphology.
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• Bone consists of two-thirds inorganic matter and
• one-third organic matrix
• The inorganic matter is composed principally of the minerals:
calcium and phosphate, along with hydroxyl, carbonate, citrate,
and trace amounts of other ions such as sodium, magnesium, and
fluorine.
• The mineral salts are in the form of hydroxyapatite crystals of
ultramicroscopic size and constitute approximately two-thirds of
the bone structure
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• The organic matrix consists mainly of collagen type I (90%),
with
• small amounts of noncollagenous proteins such as
• osteocalcin,
• osteonectin,
• bone morphogenetic protein (BMP)
• phosphoproteins, and proteoglycans
• Osteopontin & bone sialoprotein are cell adhesion proteins that
appear to be important for the adhesion of both osteoclasts and
osteoblasts
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• Osteonectin functions primarily to link collagen to the
mineralized matrix of bone.
• Osteopontin is an important glycoprotein of bone and is vital
for chemotaxis of bone forming cells.
• synthesized by a variety of mesenchymal cells, especially
fibroblasts, osteoblasts, osteoclasts and the differentiating
mesenchymal cells
• Osteopontin has been shown to respond to mechanical stimulus.
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• Bone sialoprotein is more specific to bone forming cells than
osteopontin.
• It plays a role in chemotaxis of osteoblasts.
• However, its primary role is to act as an initial nucleator to
hydroxyapatite crystal formation and is thus essential to the
mineralization process
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• In addition, paracrine factors, including
• cytokines,
• chemokines, and
• growth factors, BMPs (BMP-2 and BMP-7),transforming
growth factor-beta (TGF-β), insulin-like growth factor (IGF)
and platelet-derived growth factor (PDGF)
• These factors probably play a prominent role in the development
of the alveolar processes.
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Function
• To distribute and resorb forces generated by eg. mastication,
other tooth contacts
• Protection: Alveolar bone forms the tooth socket and provides a
good range of protection from various forces imposed on tooth.
• Attachment: It provides good surface area for insertion of
principal fibers of periodontal ligament.
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• Support: Alveolar bone acts as a good support for the tooth roots
both on the facial and palatal (lingual) sides.
• Shock absorber: By transmitting the forces to underlying tissues,
it acts as shock absorber and protects the tooth from direct stress
or tension
On the basis of function and adaptation, the alveolar process can be
divided into two parts:
1. Alveolar Bone Proper
2. Supporting Alveolar Bone
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Alveolar Bone Proper or Cribriform Plate
• It is a thin layer of bone that surrounds the root and gives
attachment to the periodontal ligament.
• This layer of bone shows as a thin continuous radio-opaque
white line on radiograph and is called the lamina dura
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Supporting Alveolar Bone
• It is a portion of the alveolar process that surrounds the alveolar
bone proper and gives support to the sockets.
• It consists of;
(a) compact or cortical bone found on the vestibular and oral
aspects of the alveolar process,
(b) cancellous bone (spongy bone) that lies between the alveolar
bone proper and cortical bone
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• Alveolar processes are subdivided into various parts depending on
their anatomical relationships to the teeth they surround.
(i) The bone located between the roots of adjacent teeth is
known as the interproximal bone or the interdental septum.
(ii) The bone located between the roots of multirooted teeth is
known as the interradicular bone.
(iii) The alveolar process located on the facial or lingual surfaces
of the roots of teeth is known as the radicular bone
20
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Different terminology for alveolar bone proper
• Cribriform plate (anatomic term)
• Bundle bone (histologic term)
• Lamina dura ( radiographic term)
Different terminology for supporting alveolar bone
• Spongy bone ( anatomic term)
• Trabecular bone ( radiographic term)
• Cancellous bone (histologic term)
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Interdental Septum
• The interdental septa are the bony partitions that separate adjacent
alveoli.
• Coronally, at the cervical region, the septa are thinner and here
the inner cortical plates are fused and cancellous bone is
frequently missing.
• Apically the septa are thicker and generally contain intervening
cancellous bone and sometimes haversian bone.
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• In health, the angle at which the interproximal crestal bone
meets the adjacent teeth depends on the positioning of the
adjacent teeth.
• In general, the line of the interproximal crestal bone will be
parallel to line drawn between the adjacent cemento-enamel
junction.
• If the teeth have erupted to the same occlusal height, the
interproximal bone will be horizontal in contour.
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• However, if one tooth has tilted or erupted farther than the
adjacent tooth (extrusion, intrusion), the crestal bone will be
tilted parallel to the line drawn between the adjacent cement-
enamel junctions.
• This is an important factor in radiographic interpretation of
bony defects.
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Contour of Alveolar Bone (OSSEOUS
TOPOGRAPHY)
• The contour of crestal margin of the process is often described as
scalloped, yet this is not always the case.
• The marginal contour varies with the shape of the root.
• When a root surface is flat, the alveolar contour is straight or flat.
• When the root surface is convex, the contour is scalloped.
• If the root surface is concave, the bone margin may arch coronally.
• When the bone is thin, the scalloping is accentuated and when the bone
is thick, the scalloping is reduced.
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• Alveolar bone undergoes constant physiologic remodeling in
response to occlusal forces.
• Osteoclasts and osteoblasts redistribute bone substances to meet
new functional demands.
• Bone is removed from where it is no longer needed and is added
where the needs arise.
• When an occlusal force is applied to a tooth, several things
happen depending upon the direction, intensity and duration of
the force.
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Fig. Bone remodeling. The bone remodeling cycle involves a complex series of sequential steps that are highly regulated. The
“activation” phase of remodeling is dependent on the effects of local and systemic factors on mesenchymal cells of the
osteoblast lineage. These cells interact with hematopoietic precursors to form osteoclasts in the “resorption” phase.
Subsequently, there is a “reversal” phase during which mononuclear cells are present on the bone surface. They may complete
the resorption process and produce the signals that initiate bone formation. Finally, successive waves of mesenchymal cells
differentiate into functional osteoblasts, which lay down matrix in the “formation” phase. (Source: McCauley & Nohutcu
(2002). Reproduced from American Academy of Periodontology.)
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• A considerable amount of internal remodeling takes place by
means of resorption and formation
• Regulated by local and systemic influences.
• Local influences include functional requirements on the tooth
and age-related changes in bone cells.
• Systemic influences are probably hormonal (e.g., parathyroid
hormone, calcitonin, vitamin D3).
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• The bone on the buccal, lingual and palatal aspects of the alveolar
process varies in thickness from one region to another.
• In the maxillary alveolar process, the bone plate is thick at the
palatal aspect and on the buccal aspect of the molars, but thin in
the buccal anterior region.
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• In the mandibular alveolar process, the bone plate at the
buccal aspects of the incisor and premolar region is
considerably thinner than at the lingual aspect.
• In the molar region, the bone is thicker at the buccal than at the
lingual surfaces.
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Blood Supply
• The vascular supply of bone is derived from intra-alveolar
arteries, vessels that penetrate the cortical plates.
• In circumstances under which cortical bone and alveolar bone
proper are fused as on the facial aspect of the anterior teeth, the
blood supply is derived chiefly from supra-periosteal vessels.
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Occlusal Forces and Alveolar Bone
• There are two aspects to the relationship between occlusal forces
and alveolar bone.
• The bone exists for the purpose of supporting teeth during function
and in common with the remainder of the skeletal system, depends
upon the stimulation it receives from function for the preservation
of its structure.
• Therefore, there is a constant and sensitive balance between
occlusal forces and structure of alveolar bone.
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• The tooth is displaced against the resilient periodontal alignment,
in which it creates an area of tension and compression.
• When the force is released, the tooth, ligaments and bone spring
back to their original positions.
• Osteoblasts and newly formed osteoid line the socket in areas
of tension,
• osteoclast and bone resorption occur in areas of pressure.
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• Occlusal forces that influences the number, density and alignment
of cancellous trabeculae.
• Forces that exceed the adaptive capacity of the bone produce
injury called trauma from occlusion.
• When occlusal forces are increased, the cancellous trabeculae are
increased in number and thickness, and bone may be added to the
external surfaces of labial and lingual plates.
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• When occlusal forces are reduced, bone is resorbed, bone height is
diminished and the number and thickness of the trabeculae are
reduced.
• The periodontal ligament also atrophies, appearing thinned, and
the fibers are reduced in number and density and disoriented.
• This is termed disuse or a functional atrophy
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Physiologic Migration of Teeth
• With tear and wear, proximal contact areas of teeth are flattened
and the teeth tend to move mesially.
• This is referred to as physiologic mesial migration which is
gradual process with intermittent period of activity, rest and repair.
• By the age 40, it affects a reduction of 0.5 cm in the length of
dental arch from the midline to third molars.
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• Alveolar bone is reconstructed in compliance with the physiologic
mesial migration of teeth.
• Bone resorption is increased in areas of pressure along the
mesial surface of teeth and new layers of bundle bone are
formed in areas of tension on distal surface.
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Remodeling of Alveolar Bone (Lability of
Alveolar Bone)
• In contrast to its apparent rigidity, alveolar bone is the least
stable of the periodontal tissues.
• Its structure is in a constant state of flux.
• The physiologic lability / remodeling of alveolar bone is
maintained by a sensitive balance between bone formation
and bone resorption, regulated by local and systemic
influences.
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• Bone is resorbed in areas of pressure and formed in area of
tension.
• The cellular activity that affects the height, contour and density of
alveolar bone is manifested in three areas:
(1) adjacent to the periodontal ligament
(2) in relation to the periosteum of the facial and lingual plates
(3) along the endosteal surface of the marrow spaces.
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Fenestration & Dehiscence
• Two defects of the alveolar cortical plate, dehiscence and
fenestration, have clinical and therapeutic significance.
• Isolated area of root portion is not covered by bone and only
covered by periosteum and overlying gingiva but marginal
bone is intact.
• Fenestration - a circumscribed defect in cortical plate
exposing facial or lingual root surface.
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Clinical picture showing dehiscence
and fenestration
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• When the denuded area extended through the marginal bone, this
defect - dehiscence
• a cleft like absence of alveolar cortical plate resulting in
denuded root surface.
• Occur more often on facial bone than lingual and also on anterior
than posterior teeth.
• Frequently found as bilateral
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Predisposing factors
• The cause is unknown, but
• Trauma from occlusion (suspect) and
• Prominent root contour,
• Malposition and labial protrusion of root combined with
thin bony plate
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Any Q?
Thank you
