Bone healing/ dental crown & bridge courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

 RESERVOIR OF CALCIUM
 INSERTION OF MUSCLES
 LOCOMOTION
 PROVIDES BODY SUPPORT & STRENGTH
 PROTECTS VITAL STRUCTURES
 REGENERATION A CLASSICAL PROPERTY
OF BONES

 TUBULAR
 FLAT

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

 HAS DIAPHYSIS – CENTRAL PORTION
 EPIPHYSIS – ENDS OF BONE
 EPIPHYSEAL PLATE – GROWTH CENTRE
 PERIOSTEUM – HAS OUTER FIBROUS LAYER
& INNER CAMBIUM LAYER

 PERISOTEUM HAS GREATER OSTEOGENIC
POTENTIAL IN CHILDREN
 SO NON – UNION IS RARE IN FRACTURES OF
CHILDREN.
 INNNER PORTION OF BONE MARROW CAVITY IS
LINED BY ENDOSTEUM.
 HAVERSIAN SYSTEM OR OSTEON IS THE
FUNCTIONAL UNIT IN MATURE BONE.
 BONE CELLS CANNOT SURVIVE FROM 0.5MM
AWAY FROM CAPILLARY.

 ENDOCHONDRAL
 INTRA-MEMBRANOUS

 BONE DEVELOPES DIRECTLY
 MESENCHYMAL CELLS COALASE ,FORMS
CELL CONDENSATIONS AND DIFFERENTIATE
INTO BONE-FORMING CELLS

 A CELL CONDENSATION FORMS
CARTILLAGENOUS MATRIX WHICH
REPLACED BY BONE SUBCEQUENTLY

 8% - WATER
 92% - SOLID MATERIAL
 SOLID – 21% - ORGANIC PHASE
71%- INORGANIC PHASE

 90% - COLLAGEN
 THE REST PROTEOGLYCANS.
 THE COLLAGEN IS OF TYPE I &
TYPE II

 CYSTALLINE HYDROXYAPATITE
 Ca 10 Po 4 6(OH)2

 OSTEOBLASTS
 OSTEOCYTES
 OSTEOCLASTS

 DERIVED FROM INNER SURFACE OF
PERIOSTEUM, CAMBIUM LAYER OR
OSTEOPROGENITOR CELLS
 OSTEOBLASTS CAN ONLY FORM BONE &
THEY CANNOT DIVIDE.
 HAVE A BASOPHILIC NUCLEUS, RER
PROMINENT GOLGI APPARATUS & ALKALINE
PHOSPHATASE.
 It is responsible for production of matrix protiens
 It produces growth factors like TGF-beta,IGF
 LIFE SPAN 1-10 WEEKS
 15% BECOMES OSTEOCYTES

 FOUND DEEP WITHIN MINERALIZED
MATRIX.
 CONNECTED WITH EACH OTHER BY
CANALICULI.
 HELPS IN BONE NUTURITION BY TRASFER
OF OXYGEN & CALCIUM.
 LIFE SPAN FROM YEARS TO DECADES
 HAS SUBDUDED METABOLIC ACTIVITY
 MAINTAINS HOMEOSTASIS

 ARE MULTINUCLEAR CELLS DERIVED FROM
OSTEOPROGENITOR STEM CELL,
MONONUCLEAR PHAGOCYTE SYSTEM OR
PRE OSTEOCLASTS.
 FOR RESORPTION IT MUST HAVE A
RUFFLED BORDER.
 ZONE OF ATTACHMENT HAS ACID
PHOSPHATASE ,ARYL SULPHATASE
 HOWSHIPS LACUNAE

 SECRETE H+
& SECRETE IL-6 WHICH
STIMULATE THE CELL IN AN AUTOCRINE
MANNER.

 Structural break in the continuity of bone
 Complete -------incomplete
 Simple
 Compound
 Comminuted-bone is splintered
 Stress fracture
 Pathologic
 Greenstick

 WHEN FORCE GENERATED IS SUFFICIENT TO
OVERCOME THE INHERENT STRENGTH OF
BONE FRACTURE OCCURS.
 OTHER TISSUES RESPOND TO INJURY BY
FORMATION OF SCAR
 BONE HEALS THRU ACTUAL REGENERATION.

 PRIMARY BONE REPAIR
 SECONDARY BONE REPAIR

 Haematoma or induction theory
 Collagen fibers embedded in dilute gel of
proteoglycans
 Periosteal or proliferative theory
 Osteoprogenitor stem cell callus collars primary
callus response

 1 bony trabecule cemented to shaft
 2 intermediate cartillage layer
 3 outer osteogenic layer

 GAP HEALING
 CONTACT HEALING

 ININTIAL REACTION
 SOFT CALLUS
 CARTILAGENOUS CALLUS.
 HARD CALLUS
 REMODELLING

 INFLAMMATORY REACTION- HAEMOTOMA
STAGE (O TO 5 DAYS AFTER FRACTURE)
 CALLUS FORMATION ( 4 TO 40 DAYS AFTER
FRACTURE)
 REMODELLING PHASE (25 TO 5O DAYS
AFTER FRACTURE)

 MDGF
 PDGF
 CGF-1
 CGF-2
 HYALURONIC ACID
 BMP
 OAF
 TGF-BETA

 MDGF-macrophages in the haematoma secrete
this it is mitogenic for osteoblast like cells
 PGDF-from human platelets.
 3-5th
day following fracture a repair BLASTEA
(granulation tissue ) developes

 CGF-cartilage growth factor –
 Hyaluronic acid
 BGF- important for bone maturation
 OAF-monocytes react with T-lymphocytes to
produce OAF which is a lymphokine

 It has complex cell matrix interactions
 BMP-a glycoprotien
 Bmp-3OSTEOGENIN
 Helps in the osteoconductive properties of bone matrix
 Takes 3—6 months in humans
 This time period is known as SIGMA
 CUTTING CONE IS FUNCTIONAL ACTIVITY
OCCURING REMODELLING OF CARTICAL BONE
.osteoclasts resorbing bone and osteoblasts
depositing bone…

 Gaps less than 0.3mm lamellar bone developes.
 Gaps 0.3 to 1mm woven bone developes
 Stronger at a given time

 Interfragmentary gap is 0.
 BRU-BONE REPAIR UNIT.advancing group of
osteoclasts followed by vessels and cells which
forms osteoblasts.

 HYPOXIA
 CELL DEATH
 HAEMETOMA FORMATION
 INITIATION OF CELLULAR PROLIFERATION
 LOW OXYGEN TENSION AND LOW PH
CONTRIBUTES TO HYALINE CARTILLAGE
FORMATION

 EXTERNALLY AND INTERNALY
 Osteoclasts seen for the first time
 Internal callus more osteons are seen

 Cartillagenous callus forms woven bone by
calcification
 Calcification starts from periphery.
 Finaly lamellar bone is formed

 Wolf”s law-change in the functional state of bone
causes structural or architectural changes in the
tissues through bioelectric field production.

 Impairment or delay in the natural healing of bone
 Mobility of bone ends after interval of 10 weeks,
Atrophic hypertrophic

 Distraction of fractured margins of bone
 Traction from muscles
 Soft tissue interposition
 Fracture hematoma not able to bridge the gap

 Results in excessive motion of the fracture site
 Leads to secondary bone healing
 Motion is excessive causes disruption of fragile
capillaries that migrate to fracture hematoma
 Studies have shown that limited movement of the
fracture site may also be beneficial

 Accute or chronic osteomyelitis
 Alters the local ph
 Affects the orientation of fibroblasts along fracture
site

 Decreased vascularity results in decreased
oxygen tension
 Mandibular blood supply changes from centrifugal
to centripetal as age advances.

 Deficiencies of vitaman C-D.
 Anemia
 Ingestion of steroids
 Aging
 Changes in vascularity

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