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Alveolar Bone
1. P R E S E N T E D B Y
D R . S H E E M A
1 S T Y E A R P G
1
Alveolar bone in health and
diseases
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2. Contents
2
๏ Introduction and development
๏ Molecular biology of
development
๏ Alveolar bone
๏ Structure and composition
๏ Cells
๏ Matrix
๏ Remodeling
๏ Resorption
๏ Osteoimmunology
๏ Bone destruction caused by
gingival inflammation
๏ Radius of action
๏ Lipopolysaccharides mediated
bone destruction
๏ Effect of Prostaglandins on
bone
๏ Trauma from occlusion
๏ Bone in periodontitis
๏ Bone loss patterns
๏ Therapeutic approaches to
treat pathological bone loss
๏ Bone graft materials
๏ Guided bone regeneration
๏ Conclusion
๏ References
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7. Alveolar bone
7
โ Alveolar process is defined as the part of the maxilla and
mandible that form and support the tooth socketโ
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8. Structure of the alveolar bone
8
๏ Alveolar bone proper
๏ Supporting alveolar bone
๏ Cortical plates
๏ Spongy bone
๏ Interdental septum
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20. Matrix
20
๏ Collagen :
๏ Type I > 95%
๏ Type V 5 %
๏ Type III and type XII โ (Lukinmaa 1992)
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21. Non collagenous proteins
21
๏ Osteocalcin:
๏ Also know as bone gla protein
๏ Regulates mineral maturation of bone
๏ Calcium binding protein
๏ Regulated by Vit D3 and PTH
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22. Osteopontin and bone sailoprotein
22
๏ BSP โ mineralizing tissues
๏ Osteopontin โ generalized distribution
๏ Vit D3 โ up regulates Osteopontin, suppress BSP
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35. RANK and RANKL
35
๏ Elevated expression in inflamed periodontal tissue โ Cochran DL
2008
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36. Osteoprotegerin (OPG)
36
๏ Natural inhibitor of RANKL
๏ Blocks RANK + RANKL
๏ OPG produced by PDL cells, gingival fibroblasts and epithelial
cells (Kanzaki 2002)
๏ Reduced OPG adjunct to granulation tissue (Crotti 2003)
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37. RANKL and OPG ratio
37
๏ Increased ratio in inflamed tissues
๏ Increased RANKL
๏ Decreased OPG
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38. Bone destruction caused by gingival inflammation
38
๏ Gingival inflammation extends along the collagen fiber bundles
and follow the course of the blood vessels through the loosely
arranged tissue around them into the alveolar bone โ Hansen ER
1966
๏ Bone destruction in periodontal disease is not a process of bone
necrosis โ Kronfeld 1935
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40. Radius of action
40
๏ Garant and Cho 1979 โfactor may need to present closely
๏ Page and Schroder 1982 โ 1.5-2.5mm
๏ Large defects greatly exceeding 2.5 mm from tooth โ presences
of bacteria in tissue โ Sagelie R 1983
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41. Rate of bone loss
41
๏ Loe et.al 1986 โ study in Sri lankan tea labors
๏ Bone loss 0.2mm on facial and 0.3mm for proximal surface per
year
๏ 8% rapid bone loss โ 0.1-1.0mm
๏ 81% moderate bone loss โ 0.05-0.5
๏ 11% minimal bone loss โ 0.05-0.09
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42. Lipopolysaccahrides mediated bone destruction
42
๏ LPS โ initiation of host response
๏ Recruitment of immuno-inflammatory cells and activation of
Osteoclasts โ Genco CA 2004
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43. Effect of Prostaglandins
43
๏ PG bone loss associated with periodontitis โ Zubery et al 1998
๏ NSAIDโs less bone loss โ Willams RL 1985
๏ NSAIDโs reduces development of gingivitis and alveolar bone
loss โ Howell 1993
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45. 9/16/2016
45
๏ Glickmanโs concept(1965)
๏ The pathway of the spread of a plaque-associated gingival lesion can be
changed if forces of an abnormal magnitude are acting on teeth
harboring subgingival plaque
๏ Waerhaugโs concept(1979)
๏ Angular bony defects & infrabony pockets occur equally at periodontal
sites of teeth which are not affected by TFO
46. Bone loss in periodontitis
46
๏ Chronic periodontitis
๏ Aggressive periodontitis
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47. Bone in Diabetes
47
๏ Diabetes decreases gene expression of osteoblasts โ Bouillon
1991
๏ AGEโs inhibits osteoblast differentiation โ Mc Carthy et al 2001
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57. Ramp
57
๏ Loss of alveolar bone and supporting bone, but margins
being at different levels
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58. Furcation involvement
58
๏ Larato 1970 โ mandibular 1st molar most common maxillary pre
molars least common
๏ No. furcation involvement increases with age
๏ Tal H 1984 โ high prevalence in upper molars
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60. 60
๏ Hamp, Nyman & Lindhe`s Classification (1975)
๏ Horizontal destruction of supporting bone
Class I, II, III
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61. 61
๏ Tarnow and Fletcher(1984)
๏ Grade A โ Vertical loss of 1 โ 3mm
๏ Grade B โ Vertical loss of 4 โ 6 mm
๏ Grade C โ Vertical Loss of 7 + mm
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62. Bone loss after flap surgery
62
๏ 2mm of flap reflection โ 0.5mm bone loss
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68. Conclusion
68
๏ In healthy bone processes are coupled by complex interplay of
osteoblasts and osteoclasts along with local and systemic
biochemical, as well as biomechanical factors. Knowledge of
bone loss and its causes associated with periodontal disease gives
us insight for successful treatment
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69. References
69
๏ Carranza 10th edition
๏ Orbans โ Text book of oral histology 12th edition
๏ Lindhe 5th edition
๏ Connective tissue of periodontium โ Mark Bartold, Sampath narayana
๏ Molecular and cellular biology of alveolar bone. Jaro and McKee.
Perio2000; 24; 2000; 99-126.
๏ The extracellular matrix of periodontium. Angelo Mariotti, Perio
2000:3,1993;39-63
๏ Mechanism and control of pathologic bone loss in periodontitis, Mark
Bartold Perio 2000: 53, 2010, 55-69
๏ Mechanism of alveolar bone destruction in periodontitis. Schwartz,
perio 2000:14,1997, 158-172
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