BONE LOSS

•INTRODUCTION

•ETIOLOGY

•FACTORS DETERMINING BONE

MORPHOLOGY

•BONE DESTRUCTION PATTERNS

INTRODUCTION :-
ETIOLOGY :-
EXTENSION OF GINGIVAL INFLAMMATION

TRAUMA FROM OCCLUSION

SYSTEMIC DISORDERS
EXTENSION OF GINGIVAL INFLAMMATION

The most common cause of bone destruction in

periodontal disease is extension of inflammation
from the marginal gingiva into the supporting PD
tissue.
Periodontitis is always preceded by gingivitis,
but not all gingivitis progresses to periodontitis
The transition from gingivitis to periodontitis
is associated with changes in composition of
bacterial plaque.
The recurrence of episode of acute destruction
over time may be one mechanism leading to
progressive bone loss in marginal gingivitis.

The extension of inflammation is modified by

pathogenic potential of plaque or resistance of
host
•Degree of fibrosis of gingiva
•Width of attached gingiva
•Peripheral reactive fibrogenesis and
osteogenesis .
•“walling off “ by fibrin-fibrinolytic system.
Histopathology
 After inflammation reaches the bone by
extension from the gingiva,it spreads into the
marrow spaces

And replaces the marrow with leukocytic and

fluid exudate,new blood vessel, & proliferating
fibroblasts.

Multinuclear osteoclasts and mononuclear

phagocytes increase in number ,the bone
surfaces appear ,lined with howship’s lacunae.
In marrow spaces ,resorption proceed, causing
a thinning of surrounding bony trabeculae and
enlargement of marrow spaces

Destruction of bone and reduction in height

Radius of action

1.5 to 2.5 mm within which bacterial plaque

induce loss of bone.
Interproximal angular defect can appear in
spaces that are wider than 2.5 mm because bone
marrow spaces would be destroyed entirely.
 Rate of bone loss
Range of bone loss varies depending on the type of
disease present.

Periods of destruction
• bursts of destructive activity associated with sub
gingival ulceration and acute inflammatory reaction,
resulting in rapid bone loss.
•Bursts of destructive activity coincide with the
conversion of T-lymphocyte lesion to B-lymphocyte
•Exacerbation are associated with loose ,
unattached ,motile gram negative ,anaerobic
pocket flora and period of remission coincide
with the formation of dense ,unattached
,nonmotile, grame positive flora with tendency to
mineralize.
•Tissue invasion by one or several bacterial
species is followed by an advanced local host
defense that controls the attack.
Mechanisms of bone destruction
The factors involved in bone destruction in
periodontal disease are bacteria and host mediated
And they produced osteoclasts and also direct
effect by bacterial colonies
Several host factors released by inflammatory cells
are prostaglandins , interleukin 1-alpha and beta
,and tumor necrosis factor
Bone formation in periodontal disease

Areas of bone formation are found adjacent to

areas of bone resorption and along trabecular
surfaces at a distance from the inflammation –
BUTTRESSING BONE FORMATION
Intermittent bone formation and destruction.
Bone destruction caused by trauma from
occlusion

Trauma from occlusion can produce bone

destruction in absence or presence of inflammation

In the absence of inflammation the changes are

caused by increased compression and tension of pdl
and increased osteoclasis of alveolar bone to
necrosis of pdl and bone and resorption of bone.
This changes are reversible which may cause angular
shape bone loss.
In the presence of inflammation the changes cause
bizarre patterns.
Bone destruction caused by systemic disorders

System influence on the response of alveolar

bone has been termed as BONE FACTOR IN
PERIODONTAL DISEASE ( IRVING GLICKMAN
IN 1950 )
Relationship between periodontal bone loss and
osteoporosis.
Osteoporosis is physiological condition of post
menopausal women ,resulting in loss of bone
mineral content and structrual bone changes.
Bone loss may also occur in generalized skeletal
disturbances like hyperparathyroidism ,leukemia.
FACTORS AFFECTING BONE
MORPHOLOGY IN PERIODONTAL
DISEASE
Normal variation in alveolar bone
Exostoses
Trauma from occlusion
Buttressing bone formation
Food impaction
Juvenile periodontitis
BONE DESTRUCTION PATTERN :-
Horizontal bone loss
Most common pattern
It occurs when the path of inflammation is to
the crest bone.
The crest of the bone is perpendicular to the
tooth surface.
This type of bone loss produce suprabony
pocket.
Vertical bone loss

Less common pattern

It occurs when the pathway
of inflammation travels
directly into the pdl space.
This type of bone loss
produce infrabony pocket.
It occurs intradentally which
can see on radiograrh.
It increases with age.
Osseous craters
Osseous craters are concavities in the crest
of the interdentally bone confined within the
facial and lingual walls
Reasons for high frequency :
The interdental area collects
Plaque and is difficult to
clean.
Normal flat or even concave
faciolingual shape of
interdental septum in lower
molar
Vascular pattern
Bulbous bone contours
They are bony enlargements caused by
exostoses,addeptation to function or butteresting
bone
They are more in maxilla than mandible.

Reversed architecture
They are produced by loss of
interdental bone including the
facial plates, lingual plates
Or both without concomitant
loss of radicularbone.
More in maxilla
ledges
Ledges are plateau like bone margins caused by
resorption of thickened bony plates.
Furcation involvement
Furcation refers to the invasion of the bifurcatoin
and trifurcation of multirooted teeth by
periodontal disease.
Mandibular 1st molars are most common site and
maxillary premolar are least common.
Grade 1 – incipient bone loss
Grade 2 – partial bone loss
Grade 3 – total bone loss ( through & through
opening of furcation
Grade 4 – similar to grade 3 but with gingival
recession
Microscopically –
It is simply a phase of rootward extension of
periodontal pocket
In its early stage , widening of the periodontal
space with cellular and fluid exudates
Extension of the inflammation into the bone leads
to bone resorption and reduction in height.
Bone destruction pattern may produced horizontal
or angular , and very frequently crater develop
in interradicular area.