Bone & Its Implication In Prosthodontics

1. Bone
Presented By:-
Dr. Soham Prajapati,
1st Year PG,
Dept. of Prosthodontics
& Maxillofacial Prosthesis
Including Oral Implantology
4-2-14 and 5-2-14
1

2. CONTENTS
• Definition
• Introduction
• Classification of Bone
• Chemical composition of Bone
• Mechanical Properties
• Structure of Bone
– Macroscopic Structure
– Microscopic Structure
• Ossification of Bone
2

3. CONTENTS
• Alveolar Bone
• Physiology Of Bone
• Wolf’s Law
• Function
• Metabolism
• Diseases Of Bone
• Prosthodontic Implication
• Conclusion
• References
3

4. DEFINITION
• The hard portion of the connective tissue which
constitutes the majority of the skeleton; it
consists of an inorganic or mineral component
and an organic component (the matrix and cells);
the matrix is composed of collagenous fibers and
is impregnated with minerals, chiefly calcium
phosphate (approx. 85%) and calcium carbonate
(approx. 10%), thus imparting the quality of
rigidity to bone—called also osseous tissue.
-GPT 8TH EDITION.
4

5. INTRODUCTION
• At birth, there are over 270 bones in an infant
human's body, but many of these fuse
together as the child grows, leaving a total of
206 separate bones in an adult.
• Largest Bone:- Femur
• Smallest Bone:- Auditory Ossicles
5

6. CLASSIFICATION OF BONE
Depending upon size and shape, they are classified into
(Tencate):-
6

7. CLASSIFICATION OF BONE
• According to Development of Bone:-
- Intracartilagineous
- Intramembraneous
7

8. CLASSIFICATION OF BONE (MISCH)
• Woven Bone
• Lamellar Bone
• Composite Bone
• Bundle Bone
8

9. CHEMICAL COMPOSITION OF BONE
9
Oral Histology (Development, Structure & Function) A.R.Ten Cate, 5th & 6th
edition

10. COMPOSITION OF BONE
• It consists of the tough
organic matrix to which
bone salts are deposited.
– Matrix
• Composed of collagen fibers,
which are embedded, in the
gelatinous ground substance.
• 90 % of the bone.
• Ground substance is formed
by extracellular fluid and
proteoglycons (chondriotin
sulfate and hyaluronic acid).
10

11. COMPOSITION OF BONE
- BONE SALTS
• Crystalline salts present in bones are called
Hydroxyapatites [Ca10(PO4)6(OH)2], which contains
calcium and phosphate.
• Others salts are also present.
• Strengthen the bone matrix.
11
Oral Histology (Development, Structure &
Function) A.R.Ten Cate, 5th & 6th edition

12. MECHANICAL PROPERTIES
• High Compressive Strength of about 170 MPa
• Poor Tensile Strength of 104–121 Mpa
• Very Low Shear Stress strength (51.6 MPa)
• It resists pushing forces well, but not pulling or
torsional forces.
• Bone is essentially brittle.
12

13. Macroscopic Structure of Bone
13

14. Macroscopic Structure of Bone
• Human skeleton composed of two
distinct kind of bone based on porosity :
- Dense Cortical (compact) Bone
- Spongy Cancellous Bone
14

15. Macroscopic Structure of Bone
Dense Cortical (compact) Bone
• Hard and dense material
forming about 80 % of bone
in the body.
• Cavity in the compact bone is
called medullary cavity and
contains yellow bone
marrow.
• Haversian System is present
15

16. Macroscopic Structure of Bone
Dense Cortical (compact) Bone
• Found in:
- Shaft of long bones
- Forms a shell around vertebral
bodies and other spongy bones
• Main function:
- Mechanical functions
- Protection of bone marrow
16

17. Dense Cortical (compact) Bone
In Compact bone there are 3
lamellaes :-
• Circumferential Lamallae
• Concentric Lamallae
• Interstitial Lamallae
17

18. Dense Cortical (compact) Bone
18

19. Macroscopic Structure of Bone
Spongy Cancellous Bone
• 15 % of the body’s total bone.
• Pores are interconnected and filled with
marrow.
• Bone matrix is arranged in the form of
plates (called trabeculae) arranged in
varied fashion.
• Found in:
- Cuboidal and flat bones
- End of long bones.
19

20. Macroscopic Structure of Bone
Body of the mandible.
The outer layer of compact bone
and an inner supporting network
of trabecular bone can be distinguished
clearly.
20

21. MICROSOPIC STRUCTURE OF BONE
• Osteogenic Cells
– Osteoblasts
– Osteocytes
– Bone lining cells
• Osteoclasts
21

22. IMMATURE BONE/WOVEN BONE
• Lacks lamellar structure
• Bundles of collagen fibres
run in various directions
through the matrix=>woven
• All the immature bone that
is formed during the
prenatal life is subsequently
repLaced by the mature
bone.
22

23. MATURE BONE
• Also called as lamellar bone
• Characterized by a orderly arrangement which is the
result of repeated addition of uniform lamellae to
bone surfaces during appositional growth.
• Lamellae are 4 – 12 µm thick
• Direction of collagen fibers in any given lamellae lies
at right angle to that of the fibrils in the adjacent
lamellae.
23

24. Some microscopic features of mature bone to
differentiate from immature bone
• Evenly acidophilic staining
• Regular arrangement of its lamellae
• Osteocyte cells are very few, more evenly
arranged
24

25. OSTEON
• Represents the basic structural unit of the
compact bone.
• It consists of haversian canal in the center which
harbors a blood vessels.
• This is surrounded by concentric, mineralized
lamellae to form the osteon; known as concentric
lamellae.
• Spaces between the different osteon is filled with
interstitial lamellae.
25

26. 26

27. OSTEOID
• In histology, osteoid is the unmineralized, organic
portion of the bone matrix that forms prior to the
maturation of bone tissue.
• When the osteoid becomes mineralized, it and
the adjacent bone cells have developed into new
bone tissue.
• The predominant fiber-type is Type I collagen and
comprises ninety percent of the osteoid. The
ground substance is mostly made up of
chondroitin sulfate and osteocalcin.
27

28. HISTOLOGY OF BONE
• Osteogenic Cells
– Osteoblasts
– Osteocytes
– Bone lining cells
• Osteoclasts
28

29. Osteoblast
•Bone forming cells
•Secrete type – I
collagen and non-
collagenous proteins
•Exhibit high levels of
akaline phosphatase
•Under light microscope,
appear cuboidal to
polygonal in shape.
•Secretes BMP’s 2 & 7,
TGF – b, IGF , PDGF 29

30. BONE LINING CELLS
• Derived from osteoblasts
• Provides nutrition to osteocytes
• Communicate by gap junctions
30

31. Osteocytes
As the osteoblasts secrete the bone matrix, some of
the osteoblasts get entrapped in lacunae and are called
as “osteocytes”.
31

32. • Bone resorbing cells that are large,
multinucleated and generally occur in clusters.
• Lie against the bone surface, occupying
hollowed out depressions called Howship’s
Lacunae that they have created.
Osteoclast
32

33. • During resorption the
osteoclasts excavate
the layer of bundle
bone pass through the
cement line and resorb
the supporting bone.
• The part of osteoclasts
that is in contact with the
bone is thrown in to a
ruffled border and denotes
.
Osteoclast
33

34. Osteoclast
34

35. Sequence of resorptive events (Tencate)
1. Attachment of osteoblast to the mineralized surface of bone.
2. Creation of sealed acidic environment through action of the
proton pump, which demineralizes bone & exposes the organic
matrix.
3. Degradation of exposed organic matrix to its constituent amino
acids by the action of acid phosphatase & cathepsin B
4. Endocytosis at the ruffled of inorganic and organic bone
degradation products.
5. Tanslocation of degradation products in transport vesicles and
extracellular release along the membrane opposite the ruffled
border (transcytosis)
Osteoclast
35

36. OSSIFICATION OF BONE
• All bone is of mesodermal origin.
• The process of bone formation is called
ossification.
• Types of bone formation:-
• Endocondral ossification
• Intramembranous ossification
36

37. Endocondral ossification
• Formation of most bone is preceded by the
formation of a cartilaginous model, which is
subsequently replaced by bone. This kind of
ossification is called Endocondral Ossification.
• Bones formed in this way are called Cartilage
Bones.
37

38. Intramembranous ossification
• When bone is laid directly in a fibrous manner,
this process is called Intramembranous
ossification.
• Bones formed in this way are called
membrane bones.
• E.g. vault of the skull, the mandible, and the
clavicle.
38

39. Various stages of intramembranous
Ossification
39

40. Various stages of intramembranous
Ossification
40

41. Various stages of intramembranous
Ossification
41

42. Various stages of Endochondral
Ossification
42

43. Various stages of Endochondral
Ossification
43

44. Various stages of Endochondral
Ossification
Four Stages in Formation of bony lamellae.
44

45. Conversion of Cancellous Bone to
Compact Bone
45

46. How Bone Grows?
GROWTH OF BONES AT SUTURES
46

47. How Bone Grows?
Scheme to show Skull Bones grow
47

48. How Bone Grows?
• Bone Growth
of Long Bones
48

49. How Bone Grows?
• Bone Growth
of Long Bones
49

50. Bone Marrow
• Medullary cavities filled with marrow.
• Red, when active production of stem cells or a
reserve population of mesenchymal stem cells.
• Yellow, when aging causes the cavity to be
converted into a site for fat storage.
• Function:-
– Generate principle cells in the body
– Highly osteogenic material that can stimulate bone
formation.
50

51. ALVEOLAR BONE
• The alveolar process is that part of the maxilla
and mandible that forms and supports the
tooth sockets (alveoli).
51

52. STRUCTURE OF ALVEOLAR BONE
• ALVEOLAR BONE PROPER
• SUPPORTING ALVEOLAR BONE
• INTERDENTAL SEPTUM
52

53. ALVEOLAR BONE PROPER
 It consists of a thin lamella of bone that
surrounds the root of the tooth and give
attachment to the principle fibers of the
periodontal ligament.
 It is perforated by many openings that carry
nerves and blood vessels into the periodontal
ligament. Therefore it is called as “ cribriform
plate”.
Histologically it is also called as “ bundle bone”.
53

54. ALVEOLAR BONE PROPER
• The alveolar bone proper
is also called lamina dura
because of its radio-
opacity.
• On radiograph it appears
as a dense white line
• The thickness and density
of the lamina dura varies
with the amount of the
occlusal stress to which
the tooth is subjected.
54

55. SUPPORTING ALVEOLAR BONE
• It is that part of the
bone which surrounds
the alveolar bone
proper and gives
support to the sockets.
• It consists of two parts:
1. Cortical plates
2. Spongy bone
55

56. INTERDENTAL SEPTUM
• Consists of cancellous
bone bordered by the
socket walls of
approximating teeth &
the facial & lingual
cortical plates.
56

57. PHYSIOLOGY OF BONE
57

58. Bone Modeling
• Refers to sculpting and shaping of bones after
they have grown in length.
• Process involves independent, uncoupled action
of osteoclasts and osteoblasts.
• e.g. orthodontic tooth movement
wound healing (during stabilization of
endosseous implants) and in response to bone
loading.
• Can change both the size and shapes of the bone.
58

59. Bone Remodeling
• Refers to sequential, coupled actions by these
two types of cells (osteoclasts and
osteoblasts).
• Does not change the size and shape of bone.
• Removes a portion of old bone and replaces it
with new bone.
• Occurs throughout lifetime.
59

60. Bone Remodeling
• Activation is controlled locally, possibly by an
auto regulatory mechanism such as autocrine
or paracrine factors generated in bone
microenvironment.
• E.g wound healing
60

61. 61

62. 62

63. FUNCTIONS OF REMODELING
1. To prevent the accumulation of damaged or
fatigued bone by regenerating new bone.
2. To allow the bone to respond to changes in
mechanical forces.
3. To facilitate mineral homeostasis.
63

64. Bone Formation
64

65. Bone Resorption
65

66. Bone Resorption
66

67. WOLF’S LAW
• Wolff’s Law [Julius Wolff, German anatomist,
1836-1902]
• “For a uniform or constant fact or principle,
more specifically, that a bone, either normal
or abnormal, will develop the structure most
suited to resist those forces acting on it.”
GPT, 8TH EDITION
67

68. WOLF’S LAW
68

69. Functions
• Protective Function
– Provides the framework
– Protects the soft and vital organs of the body.
• Mechanical Function
– Support the Body
– Their attachment to the muscles and tendons, the
bone acts as levers in bringing about the
movements.
69

70. Functions
• Hemopoietic Function
– Red bone marrow in the bones is the site of
production of blood cells.
• Metabolic Function
– Metabolism and homeostasis of calcium and
phosphate in the body.
70

71. METABOLISM OF CALCIUM AND
PHOSPHORUS.
71

72. 72

73. 73

74. 74

75. Diseases of Bones
75

76. Osteoporosis
• Defined as a condition characterized by low
bone mass and deterioration of bone tissue,
leading to enhanced bone fragility and an
increase in fracture risk.
76

77. Osteopetrosis
• Also known as marble bone disease and
Albers-Schonberg disease is an extremely rare
inherited disorder whereby the bones harden,
becoming denser
77

78. HyperParathyroidism
• 2 types: 1. Primary hyperparathyroidism
2. Secondary hyperparathyroidism
• Age: middle aged females
• RADIOGRAPHIC FEATURES:
• generalized osteoporosis is seen
• Thinning of the cortical plates & increased
resorption of medullary bone
• HISTOLOGIC FEATURES:
• Osteoclastic resorptions of bony trabecuale as
well as formation of new bone by osteoblasts.
78

79. HyperParathyroidism
79

80. Osteogenesis imperfecta
• Osteogenesis imperfecta (OI) literally means
imperfectly formed bones. People with OI
have an error (mutation) in the genetic
instructions on how to make strong bones. As
a result, their bones break easily
• One of the genes that tells the body how to
make a specific protein (type I collagen) is
defective in people with OI.
80

81. Paget’s Disease
• Also c/a Osteitis Deformans
• Disease characterized by abnormal deposition
and resorption of bone resulting in distortion
and weakening of affected bones.
• Unknown etiology
• Age: above 40 years
81

82. Paget’s Disease
HISTOLOGIC FEATURES:
• Areas of bone deposition and resorption seen
giving a “mosaic” or a jig-saw puzzle
appearance …hallmark
82

83. Fibrous Dysplasia
• Characterized by replacement of normal bone by excessive
proliferation of cellular fibrous connective tissue intermixed with
bony trabeculae
ETIOLOGY:
1. Idiopathic
2. Trauma
3. Viral
4. Altered mesenchymal cells
5. Mutation of GNAS -1 gene
RADIOGRAPHIC FEATURES
• Ground glass appearance/orange peel appearance on radiographs
• Expansion of cortical plates
83

84. Osteoarthritis
• Also known as
– degenerative arthritis
– degenerative joint disease
– osteoarthrosis,
• It is a group of mechanical abnormalities
involving degradation of joints,including
articular cartilage and subchondral bone.
• Symptoms may include joint pain, tenderness,
stiffness, locking, and sometimes an effusion
84

85. Osteoarthritis
• When bone surfaces become less well
protected by cartilage, bone may be exposed
and damaged. As a result of decreased
movement secondary to pain, regional
muscles may atrophy, and ligaments may
become more lax.
85

86. Role of Estrogen and Bone
• Estrogen defend against PTH- mediated
resorption of bone.
• In estrogen- deficient conditions, such as
after menopause, the effect of PTH on
bone contributes to the development of
osteoporosis.
• Estrogen replacement therapy, which
should be accompanied by progesterone,
is useful for women at high risk for
developing osteoporosis.
86

87. DIABETES AND BONE
• Diabetes show no distinct pattern or
consistent pattern.
• Severe bone loss and periodontal abscess are
common in diabetic patients with poor oral
hygiene.
87

88. DIABETES AND BONE
• Children with Type I diabetes tend to have
more bone destruction around the first molar
and incisors, but this destruction becomes
more generalized in older ages.
• In juvenile diabetics, extensive periodontal
destruction often occurs due to the age of this
patients.
88

89. OSSEOUS TOPOGRAPHY IN DISEASE
• There are four chief types of bone defects that
present in the alveolar bone:
1. Horizontal defects
2. Vertical, or angular defects
3. Fenestrations
4. Dehiscenses
89

90. Horizontal defects
• Generalized bone loss occurs most frequently
as horizontal bone loss. Horizontal bone loss
manifests as a somewhat even degree of bone
resorption so that the height of the bone in
relation to the teeth has been uniformly
decreased.
90

91. Vertical or Angular defects
• Vertical defects occur adjacent to a tooth and
usually in the form of a triangular area of
missing bone, known as triangulation.
91

92. FENESTRATIONS
• Isolated areas in which the root is denuded of
bone & the root surface is covered only by
periosteum & overlying gingiva are termed
fenestrations.
92

93. DEHISCENCE
• When the denuded areas extends through the
marginal bone then defect is called a
dehiscence.
93

94. • Etiology is unknown
• PREDISPOSING FACTORS are prominent root
contours, malposition, labial protrusion of the
root combined with a thin bony plate.
• Seen more often on facial bone than on lingual
bone
• More common on anteriorly than posteriorly
• Occurs bilaterally
94

95. Prosthodontic Implication
95

96. Residual Ridge Resorption
Atwood’s classification
96

97. Residual Ridge Resorption
• Order 1 : pre-extraction
• Order 2 : post extraction
• Order 3 : high, well rounded
• Order 4 : Knife edge
• Order 5 : low well rounded
• Order 6: depressed
97

98. Residual Ridge Resorption
98
Cawood JI, Howell RA Classification

99. Residual Ridge Resorption
99
• The posterior edentulous mandible resorbs at
a rate about four times faster than the
anterior edentulous mandible.
• However, the original height of available bone
in the mandible is twice as much as the
maxilla. Therefore the resultant maxillary
atrophy, although slower, affects the potential
implant patient with equal frequency

100. Pre-Prosthetic Surgery
According to GPT (1999) PRE- PROSTHETIC SURGERY –
“Surgical procedures designed to
facilitate fabrication of prosthesis
or to improve the prognosis of
Prosthodontic care”
100

101. Different Pre-Prosthetic Surgery
I. Basic pre-prosthetic surgical procedures
A. Removal of Teeth
- Erupted
- Unerupted
- Partially erupted
- Root stumps
- Cysts
B. Bony recontouring of alveolar ridges
- Simple alveoloplasty associated with removal of multiple teeth.
- Intraseptal alveoloplasty
- Maxillary tuberosity reduction
- Buccal exostosis and excessive undercuts
- Lateral palatal exostosis
- Mylohyoid ridge reduction
- Genial tubercle reduction
101

102. Different Pre-Prosthetic Surgery
C. Tori Removal
- Maxillary tori
- Mandibular tori
D. Soft Tissue Procedures:
- Maxillary tuberosity reduction
- Mandibular retromolar pad reduction
- Lateral palatal soft tissue excess
- Unsupported hypermobile tissue
- Inflammatory fibrous hyperplasia
- Inflammatory papillary hyperplasia of the palate.
- Labial frenectomy
- Lingual frenectomy
E. Immediate Dentures
- One stage
- Two stage
F. Overdenture surgery
102

103. Different Pre-Prosthetic Surgery
II. Advanced pre-prosthetic surgical procedures:
A. Mandibular Augmentation:
- Superior Border Augmentation
- Inferior Border Augmentation
- Pedicled or Interpositional Grafts
- Hydroxyapatite Augmentation of the mandible
B. Maxillary Augmentation
- Onlay Bone Grafting
- Interpositional Bone Grafts
- Maxillary Hydroxyapatite Augmentation
- Tuberoplasty
C. Soft tissue surgery for ridge extension of the mandible
- Transpositional flap vestibuloplasty (Lip Switch)
- Vestibule and floor of the mouth extension procedure
- Relocation of the mental nerve
D. Soft tissue surgery for maxillary ridge augmentation
- Submucous vestibuloplasty
- Maxillary skin grafting vestibuloplasty
103

104. Implants And Bone
104
According to MISCH

105. Implants And Bone
105

106. Implants And Bone
106
• D1; bone is primarily dense cortical bone.
• D2; bone has dense to thick porous
cortical bone on the crest and within
coarse trabecular bone.
• D3; has a thinner porous cortical crest and
fine trabecular bone

107. Implants And Bone
107
• D4; has almost no crestal cortical bone.
The fine trabecular bone composes almost
all of the total volume of bone next to
implant.
• D5; A very soft bone with incomplete
mineralization, may be addressed as D5

108. Implants And Bone
• Five important things to remember are:-
– Available Bone Height
– Available Bone Width
– Available Bone Length
– Available Bone Angulation
– Crown Height
108

109. Implants And Bone
Available Bone Height
– The minimum height of
available bone necessary for
long- term survival of
endosteal implants is related
in part to the density of
bone.
– The more dense bone may
accommodate a shorter
implant (i.e., 8 mm), and the
least dense, weaker bone
requires a longer implant
(i.e., 12 mm).
109

110. Implants And Bone
Available Bone Width
– The width of available bone is measured
between the facial and lingual plates at the
crest of the potential implant site. The crest
of the edentulous ridge is supported by a
wider base.
110

111. Implants And Bone
Available Bone Length
– The mesiodistal length of
available bone in an
edentulous area often is
limited by adjacent teeth or
implants.
– As a general rule the implant
should be at least 1.5 mm
from an adjacent tooth. This
dimension not only allows
surgical error but also
compensates for the width
of an implant or tooth
defect, which is usually less
than 1.4 mm.
111

112. Implants And Bone
Available Bone Angulation
– Ideally, the bone is perpendicular to the plane
of occlusion, aligned with the forces of
occlusion, and is parallel to the long axis of
the prosthodontic restoration.
– The maxillary anterior teeth are the only
segment in either arch that do not receive a
long-axis load to the tooth roots but instead
usually are loaded at a 12-degree angle.
112

113. Implants And Bone
Available Bone Angulation
– In Mandible, second premolar region the
angulation may be 10 degrees to a horizontal
plane; in the first molar area, 15 degrees; and
in the second molar region, 20 to 25 degree.
– In edentulous areas with a wide ridge, one
may select wider root-form implants. Such
implants may allow up to 25 degrees of
divergence with the adjacent implant(s),
natural teeth, or axial forces of occlusion with
moderate compromise.
113

114. Implants And Bone
Crown Height
– It affects the appearance of the final
prosthesis and also affects the amount of
moment force on the implant and
surrounding crestal bone during occlusal
loading.
– The crown height is measured from the
occlusal or incisal plane to the crest of the
ridge and may be considered a vertical
cantilever.
114

115. Implants, Strain And Bone
115

116. Implants And Bone
116
• As Bone density decreases, incidence of micro
fracture increases, so the strain to the bone is
decreases.
• Factor of load is also influenced by direction of
the implant placed.
• Increased implant number decreased stress
in functional loading area.

117. Implants and Bone
• For every 0.5-mm increase in width there is an
increased surface area between 10-15%.
• Because the greatest stresses are concentrated at
the crestal region of the implant, width is more
significant than length.
• D4 bone benefits from relatively longer implants
for initial fixation.
117

118. Bone grafting material
• Natural bone graft
• Synthetic bone graft
118

119. Natural bone graft material
• Auto graft:- iliac crest
• Allograft:-cadavers , bone bank
• There are three types of bone allograft
available:
Fresh or fresh-frozen bone
Freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone
allograft (DFDBA)
119

120. Synthetic bone grafts material
• Xenografts:-bovine
• Alloplastic grafts:-hydroxylapatite,
bioactive glass
120

121. OSSEOUS INTEGRATION
• The process and resultant apparent direct
connection of an exogenous material’s surface
and the host bone tissues, without intervening
fibrous connective tissue present.
- GPT, 8TH EDITION
121

122. Osseointegration and Prosthodontics
• Osseointegration, the direct structual and
function adhesion between bone and implant
surface, is a prerequisite for the long term
succes of dental implants.
122

123. Osseointegration and Prosthodontics
• Six important factors for estrablishing reliable
osseointegration:
– Implant material
– Implant design
– Surface quality
– Bone status
– Surgical technique
– Loading conditions.
123

124. CONCLUSION
• Bones are rigid organs that constitute part of
the endoskeleton of vertebrates. They support
and protect the various organs of the body,
produce red and white blood cells and store
minerals. Bone tissue is a type of dense
connective tissue. Bones come in a variety of
shapes and have a complex internal and
external structure, are lightweight yet strong
and hard, and serve multiple functions.
124

125. References
• Oral Histology (Development, Structure & Function) A.R.Ten
Cate, 5th & 6th edition
• Essential Of Complete Denture – Winkler,2nd edition
• Contemporary Implant Dentistry - Carl.E.Misch,3rd & 4th
edition
• Bone : Biology , Harvesting , Grafting for Dental Imlants
Arun K. Garg
• TextBook of Histology – Inderbir Singh
• Color Atlas of Dental Medicine, Wolf Rateitachak and
Hassell,3rd Edition
• Peterson’s Priciple of oral and Maxillofacial Surgery, Volume 1,
Michael Miloro Edition 125

126. References
• Atwood DA: Reduction Of Residual Ridges: A Major Oral
Disease Entity. J Prosthet Dent 1971;26:266-279.
• Modeling And Remodeling Of Human Extraction Sockets – By -
J Clin Periodontal 2008; 35: 630–639
• Molecular And Cellular Periodontology 2000, Vol. 24, 2000,
99–126 Copyright C Munksgaard 2000
• Caranza- clinical periodontology 9 edition
• Bone Loss and Bone Turnover in Diabetes
• Jesse C. Krakauer, Malachi J. McKenna, Nancy Fenn Buderer,
D. Sudhaker Rao, Fred W. Whitehouse, and A. Michael Parfitt ,
DIABETES, VOL. 44, JULY 1995
• GPT, 8TH EDITION
126

127. Thank You
127