P3-PERIO-PATTERNS OF BONE LOSS

Extension of inflammation from marginal gingiva into supporting periodontal tissues

Cause of bone destruction in periodontitis

Gingivitis

Periodontitis is always preceded by

Periodontitis

An inflammatory condition of the teeth and their supporting structures

Bone loss

It is is the ultimate and last consequence of the inflammatory process

The depth of periodontal pockets

The severity of ulceration of the pocket wall

The presence or absence of suppuration

The degree of bone loss does not necessarily correlate with:

SUPRABONY

SUPRABONY OR INFRABONY

The base of the pocket is coronal to the level of the alveolar bone

INFRABONY

SUPRABONY OR INFRABONY

The base of the pocket is apical to the crest of the alveolar bone so that the bone is adjacent to the soft-tissue wa

INFRABONY

SUPREBONY OR INFRABONY

The pattern of bone destruction is vertical (angular)

SUPRABONY

SUPRA OR INFRA

The pattern of destruction of the underlying bone is horizontal.

SUPRABONY

SUPRA OR INFRA

Interproximally, transseptal fibers that are restored during progressive periodontitis are arranged horizontally in the space between the base of the pocket and the alveolar bone

INFRABONY

SUPRABONY OR INFRABONY

Interproximally, transseptal fibers are oblique rather than horizontal. They extend from the cementum beneath the base of the pocket along the alveolar bone and over the crest to the cementum of the adjacent tooth

INFRABONY

SUPRA OR INFRA

On the facial and lingual surfaces, periodontal ligament fibers follow the angular pattern of the adjacent bone. They extend from the cementum beneath the base of the pocket along the alveolar bone and over the crest to join with the outer periosteum.

SUPRABONY

SUPRABONY OR INFRABONY

the facial and lingual surfaces, periodontal ligament fibers beneath the pocket follow their normal horizontal–oblique course between the tooth and the bone.

Radius of Action

Garant and Cho suggested that locally produced bone resorption factors may need to be present in the proximity of the bone surface to exert their action.

1.5 to 2.5 mm

According to page and schroeder what is the range of effectiveness on whixh bacterial biofilm can induce loss of bone

little or no effect

What will happend if it is beyodn 2.5 mm?

horizontal bone loss

Interproximal angular defects appear only in spaces wider than 2.5 mm. Narrower spaces end up with

0.2 mm per year

Löe and colleagues, found: Average rate of bone loss on facial surfaces

0.3 mm per year

Loe and colleagues, found: Average rate of bone loss on proximal surfaces

0.1 mm to 1mm

About 8% of persons had rapid progression of periodontitis with a yearly loss of attachment of

0.05 mm to 0.5 mm

About 81% of individuals had moderately progressive periodontitis with a yearly loss of attachment of

0.05 mm to 0.09 mm

About 11% of persons had minimal or no progression of destructive disease with a yearly loss of attachment of

episodic/episodes

Periodintal destruction occurs in an

Inactivity or quiescence

Destruction burst

Two periods of destruction

no tissue breakdown

During the quiescence there is

loss of collagen and alveolar bone

deeper pockets

during the destructive period

Destructive period

Associated with subgingival ulceration and acute inflammatory reaction.

Leads to rapid loss of alveolar bone

B-lymphocyte–plasma cell infiltrate

In destructive period, Conversion of predominantly T-lymphocyte lesion to predominantly

Destructive lesions

increase in loose, unattached, motile, gram-negative anaerobic pocket flora

remission periods

dense, unattached, nonmotile, gram-positive flora with tendency to mineralize

transseptal fibers

The dense network of_____ attached interdentally from tooth to tooth protects interdental bone from the inflammatory process

transseptal fibers

Even after initial destruction, these fibers continually re-form.

They are the fibers encountered during periodontal flap surgery.

Interproximally

Facially and Lingually

Pathways of Inflammation into Supporting Periodontal Tissues

1. From the gingiva into the bone

2. From the bone into the periodontal ligament

3. From the gingiva into the periodontal ligament

Interproximal area

1. From the gingiva along the outer periosteum

2. From the periosteum into the bone

3. From the gingiva into the periodontal ligament

Facial and Lingual plates

Bacterial biofilm products

Induce differentiation of hematopoietic progenitor cells in bone marrow into osteoclasts.

Host factors

Released by inflammatory cells and capable of inducing bone resorption in vitro.

○ Prostaglandins and their precursors

○ Interleukin-1α

Interleukin-1β

○ Tumor necrosis factor alpha

Important mediators includ

induces vascular changes seen in inflammation

When Prostaglandin E2 injected intradermally → .

induces bone resorption without inflammatory cells, with few multinucleated osteoclasts

When Prostglanding E2 injected over a bone surface

Flurbiprofen

Ibuprofen

What NSAIDS can inhibit Prostglanding E2