ALVEOLAR BONE
Dr.M.J.Renganath
Senior Lecturer
Dept of Periodontics & Implantology
ALVEOLAR BONE
• INTRODUCTION
• DEVELOPMENT AND ANATOMY
• COMPOSITION
• RADIOGRAPHIC FEATURES
• PATHOLOGIES INVOLVING LOSS OF ALVEOLAR BONE
• REPAIR AND REGENERATION
INTRODUCTION
• Alveolar bone is defined as the parts of maxilla and mandible that form and
support the socket of teeth.
Jan Lindhe
INTRODUCTION
• Along with cementum and PDL, alveolar bone constitutes the attachment of the teeth.
• Forms when tooth erupts to provide osseous attachment to the forming PDL.
• Disappears gradually after tooth is lost.
• Develops and undergo remodeling with tooth formation, hence tooth-dependent.
• Size, shape, location and function of teeth determine their morphology.
DEVELOPMENT
• Formed during fetal growth by intramembranous ossification.
• During embryogenesis, the skeleton forms by either a direct or indirect
ossification process.
• 1. Intramembraneous 2. Endochondral
• In intramembranous ossification, bone develops directly from sheets of
mesenchymal connective tissue.
• In endochondral ossification, bone develops by replacing hyaline cartilage
• For mandible and the maxilla, mesenchymal progenitor cells condensate and
undergo direct differentiation into osteoblasts, a process known as
intramembranous osteogenesis.
INTRAMEMBRANEOUS
ENDOCHONDRAL
ANATOMY
Alveolar bone
Alveolar bone proper Supporting alveolar bone
Cortical plate Spongy bone
Alveolar process consists of:
1.External plate of cortical bone
2.Inner socket wall- Alveolar bone proper
3.Cancellous trabeculae- Supporting alveolar bone
CORTICAL BONE AND CANCELLOUS
BONE
TRABECULAE
2 main types
Type1:
• The interdental and interradicular trabeculae are regular & horizontal in a
ladder like arrangement.
• This type is seen most often in mandible.
Type 2:
• Shows irregularly arranged, numerous, delicate interdental and interradicular
trabeculae.
• This type is more common in maxilla.
HAVERSIAN SYSTEM
• Consists of the haversian canal and the Volkmann’s canal.
• Haversian canal located in the center of the osteon.
• Volkmann’s canal are the connecting vessels which connect the Haversian canal.
• They provides nutrition to the bone.
HAVERSIAN CANAL
COMPOSITION
Composition of
Alveolar bone
Extracellular Cellular
Inorganic (67%)
Osteocyte
Organic (33%)
Osteoblast
Collagen (28%) Osteoclast
Non-collagen
(5%)
EXTRACELLULAR MATRIX
Inorganic matter:
• Calcium
• Phosphate
• Hydroxyl
• Carbonate
• Citrate
• Trace amounts of sodium, magnesium and fluorine.
Organic matrix:
• Type 1 collagen- 90%
• Noncollagenous proteins such as :
• Osteocalcin
• Osteonectin
• Bone morphogenetic protein
• Phosphoproteins
• proteoglycans
Osteoblasts:
• Produce the organic matrix of bone
• Differentiated from pluripotent follicle cells.
• Comprise a mixed population of preodontoblasts with large nuclei and fibroblast
like cells with small nuclei
Osteocytes:
• Arise from odontoblasts which becomes entrapped into bone.
• Located in bony lacunae and are connected by long cell projections.
• Immature osteocytes are smaller than osteoblasts, but have a similar structure.
• Mature osteocytes have a reduced set of organelles.
Osteoclasts:
• Large, multinucleated giant cells, located on the surface pits of the
bone(Howship’s lacunae).
• Arise by fusion of hematopoietic, mononuclear precursors of bone marrow.
• Resorption of bone is facilitated by acidic phosphatases and other hydrolytic
enzymes.
Periosteum:
• Outer aspect of cortical bone is surrounded by a layer of C.T membrane called
Periosteum.
• Consists an inner layer of osteoblast surrounded by osteoprogenitor cells.
• Outer layer is of vascular and neural components.
• Contains collagen fibers that binds to underlying bone.
Bundle bone:
• Part of alveolar bone proper that gives attachment to the principle fibers of PDL
• Sharpey’s fibers predominantly
• Contains few fibrils in the intercellular substances.
• Not unique to the jaws alone.
• Occurs through out the skeletal system of ligaments and muscles.
Lamina dura:
• Bundle bone that appears as thin radio-opaque line, surrounding the roots of
the teeth,
• Radiographic density due to mineral orientation around fiber bundles.
• Disappears after extraction of tooth.
• May also gets altered in systemic diseases.
Osseous topography:
• The height & thickness of facial and lingual bony plates are affected by
1. Alignment of the teeth.
2. Angulation of root to bone
3. Occlusal forces
CONDITIONS INVOLVING LOSS OF
ALVEOLAR BONE
I. Extension of gingival inflammation
II. Trauma from occlusion
III. Systemic factors
IV. Orthodontic treatment
V. Periodontitis
VI. Periodontal abscess
VII.Food impaction
VIII.Overhanging restoration
IX. Adjacent tooth extraction
X. Ill-fitting prosthesis
PATHWAYS OF INFLAMMATION
BONE RESORPTION
Decrease in blood calcium
Mediated by receptors on chief cells of parathyroid gland
Release parathyroid hormone(PTH)
Osteoblast stimulation to release il1and il6
Monocytes in bone area
Multinucleated osteoclasts
Resorbs bone
REPAIR AND REGENERATION
• Remodelling is the major pathway of bony changes in shape, resistance to
force, repair of wounds.
• The bone remodelling occurs throughout the life.
• Bone remodelling involves osteoblasts and osteoclasts which form and resorb
the mineralized connective tissue of the bone.
• Regulation of bone remodelling involves harmones and local factors acting in an
autocrine and the paracrine manner.
• Bone contains 99% of body`s calcium ions.
• Hence the major source for calcium release when the calcium blood level
decreases, which is monitored by parathyroid gland.
REMODELLING
• Alveolar bone is least stable of the periodontal tissues because of the constant
state of flux
• Internal remodelling takes place by means of resorption and formation
regulated by local and systemic factors
• Local factors include functional requirements on the tooth and age related
changes in the bone cells
• Systemic factors are hormonal (PTH), calcitonin, vitamin D3
• The combined process of bone formation and resorption by simultaneous
activity of osteoblasts and osteoclasts is called as coupling.
• RANK is activated by its ligand RANK-L.
• RANK-L is produced by osteoblasts/ stromal cells.
• RANK & RANK-L binding leads to activation of Osteoclasts
• OPG binds to RANK-L and prevents downstream activation.
• Hence no osteoclastogenesis.
REMODELLING
VARIOUS BONE DESTRUCTIVE PATTERNS IN
PERIODONTAL DISEASE:
• Horizontal bone loss
• Vertical/Angular defects
• Osseous craters
• Bulbous bone contours
• Reversed architecture
• Ledges
• Furcation involvement
HORIZONTAL BONE
VERTICAL BONE LOSS
LOSS
BONE WALL DEFECTS
INTERDENTAL OSSEOUS CRATERS
BONY EXOSTOSIS
REVERSED
Ledges
ARCHITECTURE
FURCATION INVOLVEMENT
FENESTRATION AND DEHISCENCE
ILL FITTING PROSTHESIS
