This document discusses bone destruction patterns seen in periodontal disease. It summarizes the different types of bone defects that can occur, including intrabony defects (1, 2, or 3 wall), angular defects, craters, dehiscences, and furcation involvement. Factors that can influence bone loss are also reviewed, such as the radius of effectiveness of bacterial plaque, rates of bone loss with/without treatment, trauma from occlusion, food impaction, and medical conditions. A variety of classification systems for bone defects are presented. Both clinical examinations and radiographs are important for diagnosis, though radiographs have limitations in depicting bone topography fully. Early diagnosis of risk factors can help prevent progression of periodontal disease and bone

1. BONE DESTRUCTION PATTERNS
1
Dr. Soundarya Singh
Lecturer
Department of Periodontology
Subharti Dental College and Hospital
Meerut

2. 2

3. 3

4. Tissue necrosis & pus are present in periodontal disease,
Soft tissue wall of periodontal pockets
Not along the resorbing margin of the underlying bone.
4

5. RADIUS OF ACTION 5
Garant and Cho in 1979 locally produced bone
resorption factors may need to be present in proximity of
bone surface to exert their action.
Page and Schroeder in 1982 , on basis of Waerhaug’s
measurement made on human autopsy, postulated a
range of effectiveness of about 1.5 – 2.5 mm within which
bacterial plaque can induce loss of bone.

6. Beyond 2.5 mm there is
no effect.
Interproximal angular
defect can appear only in
spaces that are wider
than 2.5 mm because
narrower spaces would
be destroyed entirely.
Tal in 1984 corroborated
this with measurements
in human patients.
(Tal H. Relationship between interproximal distance of roots and
the prevalence of intrabony pockets. J Periodontol 1984: 55: 604–
607
6

7. RATE OF BONE LOSS 
 NO oral hygiene & NO dental care
Facial Surface : 0.2 mm a year
Proximal Surface : 0.3 mm a year
Rapid
progression
8 %
Loss of
attachment of
0.1- 1.0mm
Moderate
progression 81 %
Loss of
attachment of
0.05- 0.5mm
Minimal or
no
progression
11 %
0.05mm –
0.09mm
yearly 7

8. Mechanisms of Bone Destruction:
Several possible pathways by which products in plaque absorbed
by periodontal tissues could cause alveolar bone loss.
Hausman, 1974
8
Host factors:
• Prostaglandins
• IL-Iᵦ
• TNF-ᶛ

9. BONE LOSS IN PERIODONTITIS:
9

10. CHRONIC PERIODONTITIS:
Pocket depths are variable, and both horizontal and angular bone loss
can be found.
Tooth mobility often appears in advanced cases when bone loss has
been considerable.
Radiographically bone loss is usually horizontal.
10

11.  Clinically, there is a small amount of plaque, which forms a
thin bio-film on the tooth and rarely mineralizes to become
calculus.
Mobility first molars & incisors
 Distolabial migration of the incisors.
AGGRESSIVE PERIODONTITIS:
11

12.  The progression of bone loss and attachment loss may be self-arresting.
 Vertical loss of alveolar bone around first molars and incisors is seen. An
"arc-shaped" loss of alveolar bone extending from distal surface of second
premolar to mesial surface of second molar.
12

13. 13
GLICKMAN’S CONCEPT (1965, 1967)
 Pathway of spread of plaque-associated gingival lesion can change if
forces of abnormal magnitude acting on teeth harboring subgingival
plaque.
 This would imply the character of progressive tissue destruction of
periodontium at a "traumatized tooth" will be different from that a “non-
traumatized" tooth.

14. Based on this concept, the
periodontal structures can be
divided into two zones:
Zone of irritation
Zone of co-
destruction
14

15. In absence of inflammation, changes caused by TFO vary from
increased compression and tension of PDL and increased
osteoclasts of alveolar bone, necrosis of periodontal ligament,
resorption of bone and tooth structure.
TRAUMA FROM OCCLUSION:
15

16. Trauma from occlusion results in funnel-shaped widening of the
crestal portion of the periodontal ligament.
16

17. Interdental defects often occur where proximal contacts is abnormal or absent.
Pressure and irritation from food impaction contributes to inverse architecture.
FOOD IMPACTION:
 Poor proximal relationship be result of shift in bone position because of
extensive bone destruction preceding food impaction.
 In such cases food impaction is the complicating factor rather than the cause of
bone destruction.
17

18. 18

19. OSSEOUS DEFECTS
Suprabony
defect
Intrabony
defect
Infrabony
defect
1 wall
2 wall
3 wall
combination
Craters
Interradicular defects
Vertical
Horizontal
Class I
Class III
Class II
Subclass A
Subclass B
Subclass C
19

20. INTRABONY DEFECT
Depending on number of walls present , angular defects
were classified by Goldman and Cohen (1958) as
(i) Three osseous walls
(ii) Two osseous walls
(iii) One osseous wall
(iv) Combination
20

21. z
Glickman (1964) :
1) Vertical or angular defects
2) Osseous craters
3) Bulbous bone contours
4) Reverse architecture
5) Ledges
6) Furcation involvement
21

22. z
Crater
Trench
Cratered ramp
Ramp
Karn et al (1983) :
1) Horizontal bone loss
2) Crater
3) Trench
4) Moat
5) Ramp
6) Cratered ramp
7) Ramp into a crater or trench
22

23. 23
Concavities in the crest of alveolar
bone.
Confined to facial and lingual walls.
Reason for high frequency interdental
craters:
1. Interdentally area collects plaque and
is difficult to clean.
2. Normal flat or even concave
faciolingual shape of interdental
septum in lower molars favours
plaque formation.

24. (Ochsenbein C :A Primer for osseous surgery, Int J Periodontics Restorative Dent 6(1):9,1986)
Ochsenbein divided bony craters into
three basic Types :
Crater type Dimension
Shallow crater 1 -2 mm
Medium crater 3 -4 mm
Deep crater 5 mm or more
24

25. 25

26. •PLANE: Both alveolar bone and supporting bone is lost to same degree
such that margins of deformity are at same level. Considered horizontal bone
loss about one tooth or portion of a tooth.
•HEMISEPTA: Associated with an inconsistent osseous margin. Hemisepta
occur between anterior as well as posterior teeth, and they are found in
combination with all other types of bony deformities.
26

27. These are outgrowths of
bone of varied size and
shape.
Palatal exostosis has
been found in 40% of
human skulls.
(Nery EB, Corn H,
Eisenstein IL, 1977)
EXOSTOSIS
27

28. z
BUTTRESSING BONE
FORMATION
Bone formation sometimes occurs
in an attempt to buttress the boy
trabeculae weakened by
resorption.
When it occurs on the external
surface, it is referred to as
“peripheral buttressing bone”
formation. may cause bulging of
the bone contour, which
sometimes accompanies the
production of osseous craters and
angular defects
28
(Glickman I ,Smulow J: Buttressing bone formation in the periodontium, J Periodontal 36 : 365,1965 )

29. z
This bulging of bone contours, termed as “Lipping”
Buttressing bone formation described as development of
thickened or exostotic buccal alveolar bone in response
to heavy occlusal forces.
29

30. 30
 Defects produced by
loss of interdental
bone.
 Includes facial plates
and lingual plates
without concomitant
loss of radicular bone.
 Maxilla more common.

31. 31

32. THICKENED MARGIN: An enlargement of facial
or lingual marginal alveolar plate, instead of a thin,
tapering, slightly rounded bony margin.
• MARGINAL GUTTER: A shallow
linear defect between marginal bone of
radical cortical plate or interdental crest,
extending the length of one or more root
surfaces.
32

33. 33
• Bony enlargements caused
by exostosis, adaptation to
function or buttressing bone
formation.
• Maxilla > Mandible

34. FENESTRATION :Isolated areas
in which root is denuded of bone &
root surface covered only by
Periosteum & overlying gingiva .
DEHISCENCE:
When the denuded areas extend
through marginal bone,
defect is called Dehiscence.
34

35. FURCATION INVOLVEMENT:
35

36. It is the invasion of bifurcations and trifurcations of
multirooted tooth by periodontal disease. (AAP 1992)
Furcation Defects
GRADE 1 GRADE 2
GRADE 3 GRADE 4
36

37. z
GOLDMAN’S & COHEN CLASSIFICATION(1958)
Grade I :
Incipient.
Grade II :
Cul-de-
sac
Grade III:
Through
and
through
37

38. 38
 Most common pattern .
 Bone is reduced in height .
 Bone margins remain
perpendicular to tooth surface.
 Interdental septa , facial and lingual
cortical plates are affected.

39. 39
 Occur in oblique direction .
 Leaves a hollowed out trough in
the bone alongside root .
 Base of defect is apical to the
surrounding bone.
 Angular defect and intrabony
periodontal defect.

40. 40

41. Peri-implantitis : Infectious disease that causes inflammation of the surrounding gum
and bone of an already integrated dental implant, leading to the loss of supporting bone
 Smoking definitely causes constriction of blood vessels which
leads to bone loss.
 Medical issues such as diabetes, osteoporosis and poor
immune systems are more at risk for developing bone loss
around dental implants .
41

42. Careful probing reveals presence of pocket depth greater than that of
normal gingival sulcus.
Location of base of pocket in relative to mucogingival junction and
attachment level on adjacent teeth, the number of bony walls and
presence of furcation defects.
CLINICAL:
42

43. Transgingival probing, or sounding, under local anesthesia confirms
the extent and configuration of infrabony component of the pocket or
of furcation defects.
Probe should be "walked" along tissue-tooth interface, so as to feel the
bony topography.
Probe may also be passed horizontally through the tissue to provide
three-dimensional information regarding bony contours.
43

44. • Shows amount of remaining bone rather than amount lost.
• Amount of bone loss is estimated as-
Difference between the physiologic bone loss of the patient & the height of
the remaining bone.
• Distance from CEJ to the alveolar crest-
In adolescents- 2mm
May be greater in older patients
RADIOGRAPHIC DIAGNOSIS:
44

45. • Although radiographs cannot accurately reflect the bony morphology buccal
and lingual, they provide useful information on interproximal bone levels.
• However, even at this level, the exact topography of defects cannot be
assessed accurately from radiographs.
45

46. CBCT
 Cone beam CT (CBCT) is still underused for periodontal diagnosis.
 Research comparing use of three-dimensional (3D) volumetric images and 2D images in
artificial bone defects have shown that CBCT has a sensitivity of 80–100% in detection and
classification of bone defects.
 While intraoral radiographs present a sensitivity of 63–67%.
 When compared with periapical and panoramic images, CBCT has also shown an
absence of distortion ,overlapping and dimensions it presents are compatible with the
actual size.
Vandenberghe B 2007
46

47. • So there is a need for early diagnosis and identification of these factors
such as local factors, TFO, Smoking, Stress, Systemic Disorders,
prevention of which would further prevent progression of the disease”.
Conclusion
Prevention is
better than
cure”
47

48. PAGE NO.1099
48

49. THANK YOU
49
Dr. Soundarya Singh
Lecturer
Department of Periodontology
Subharti Dental College and Hospital
Meerut