The document discusses patterns of bone loss and destruction in periodontal disease. It states that while periodontitis is caused by bacterial plaque, bone loss is what leads to tooth loss. The most common type of bone loss is horizontal loss where bone height is reduced but the bone margin remains perpendicular to the tooth. Other patterns include intrabony (angular) defects, osseous craters in the interdental bone, bulbous bone contours, reversed architecture where facial/lingual plates are lost before root bone, and furcation involvement in multi-rooted teeth. Trauma from occlusion can also cause bone loss, especially when combined with inflammation.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
When occlusal forces exceed the adaptive capacity of the tissues, tissue injury results. The resultant injury is termed as trauma from occlusion.
TFO refers to tissue injury, not the occlusal force. An occlusion that produces such injury is termed as traumatic occlusion.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
When occlusal forces exceed the adaptive capacity of the tissues, tissue injury results. The resultant injury is termed as trauma from occlusion.
TFO refers to tissue injury, not the occlusal force. An occlusion that produces such injury is termed as traumatic occlusion.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
efficiency of pendulum applaincefor molar distalization related to second &am...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
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Self ligatingbrackets /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
this ppt depicts pattern of bone destruction. its a very good slide show showing the process of bone formation, bone destruction and their patterns in periodontal diseases.
explained here is bone loos and patterns of bone loos in alveolar bone to various insults . Dr Harshavardhan pawal also gives emphasis on rate on bone loss and radius of action .
BONE LOSS AND PATTERNS OF BONE DESTRUCTION ishu.pptxDr. Ishu SINGLA
Presentation on topic Bone Loss And Patterns of Bone Destruction.
This is for reading and knowledge purpose only. Text is taken from Standard books only.
Trauma from occlusion in Periodontics.pptxSUBHRADIPKAYAL
Contents
1. Definitions
2. Introduction
3. Classification of Trauma from occlusion
4. Stages of tissue response
5. Clinical features
6. Radiological features
7. Trauma from occlusion and plaque associated periodontal disease
8. Treatment of TFO
9. References
Definitions
• When occlusal forces exceed the adaptive capacity of tissues, tissue injury results. The resultant injury is termed as trauma from occlusion. - Carranza 10th edition
• Trauma from occlusion is a term used to describe pathologic alterations or adaptive changes which develop in the periodontium as a result of undue force produced by the masticatory muscles. - Lindhe 6th edition
• Stillman (1917) as “a condition where injury results to the supporting structures of the teeth by the act of bringing the jaws into a closed position”.
• WHO (1978) defined trauma from occlusion as “damage in the periodontium caused by stress on the teeth produced directly or indirectly by teeth of the opposing jaw”.
• Injury resulting in tissue changes within the attachment apparatus as a result of occlusal force(s). - AAP Glossary of periodontal terms 2001; 4th Edition
Introduction
• The periodontal ligament has a cushioning effect on forces applied to teeth as means to accommodate forces exerted on the crown.
• When there is increase in occlusal forces, changes occur in the periodontium in order to accommodate such forces.
• Changes occur in magnitude, direction, duration and frequency of increased occlusal forces.
Increased magnitude of occlusal forces
• Widening of periodontal ligament space.
• An increase in number and width of periodontal ligament fibers.
• An increase in the density of alveolar bone.
Changes in direction of occlusal forces
• Reorientation of the stresses and strains within the periodontium.
• The principal fibers of the periodontal ligament are arranged so that they best accommodate occlusal forces along the long axis of the tooth.
• Lateral (horizontal) and torque (rotational) forces are more likely to injure the periodontium.
Duration and frequency of occlusal forces
• Constant pressure on the bone is more injurious than intermittent forces.
• The more frequent the application of an intermittent force, the more injurious the force is to the periodontium.
Classification
According to mode of onset
1. Acute
2. Chronic
According to the capacity of the periodontium to resist to occlusal forces
1. Primary
2. Secondary
Acute trauma from occlusion
• Acute trauma from occlusion results from an abrupt occlusal impact such as that produced by biting on a hard object. Restorations or prosthetic appliances that interfere with or alter the direction of occlusal forces on the teeth may also induce acute trauma.
• Clinical features
1. Tooth pain
2. Sensitivity to percussion
3. Tooth mobility
Chronic trauma from occlusion
• It is more common than acute trauma from occlusion and is of greater clinical significance.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
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By Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
perio-lec3
1. Bone Loss and Patterns of
Bone Destruction
Chapter 28
1
2. Bone Loss and Patterns of Bone
Destruction
• Although periodontitis is an infectious disease of the
gingival tissue, changes that occur in bone are crucial
because the destruction of bone is responsible for
tooth loss.
• The height and density of the alveolar bone are
normally maintained by an equilibrium, regulated by
local and systemic influences between bone
formation and bone resorption. When resorption
exceeds formation, bone height, density, or both are
reduced.
2
3. BONE DESTRUCTION CAUSED BY EXTENSION
OF GINGIVAL INFLAMMATION
• The most common cause of bone destruction in periodontal
disease is the extension of inflammation from the marginal
gingiva into the supporting periodontal tissues.
• The inflammatory invasion of the bone surface and the initial
bone loss that follows mark the transition from gingivitis to
periodontitis.
3
4. • Periodontitis is always preceded by gingivitis, but not all
gingivitis progresses to periodontitis. Some cases of
gingivitis apparently never become periodontitis, and others go
through a brief gingivitis phase and rapidly develop into
periodontitis. The factors that are responsible for the extension
of inflammation to the supporting structures and bring about
the conversion of gingivitis to periodontitis are not known at
this time.
• The extension of inflammation to the supporting structures of a
tooth may be modified by the pathogenic potential of plaque
or the resistance of the host.
4
5. Rate of Bone Loss
the rate of bone loss may vary, depending on the type of disease
present. Löe and al identified three subgroups of patients with
periodontal disease based on interproximal loss of attachment
and tooth mortality:
1.Approximately 8% of persons had rapid progression of
periodontal disease, characterized by a yearly loss of
attachment of 0.1 to 1 mm.
2.Approximately 81% of individuals had moderately progressive
periodontal disease, with a yearly loss of attachment of 0.05 to
0.5 mm.
3.The remaining 11% of persons had minimal or no progression
of destructive disease (0.05 to 0.09 mm yearly).
5
6. Periods of Destruction
• The destructive periods result in loss of collagen and alveolar
bone with deepening of the periodontal pocket. The reasons
for the onset of destructive periods have not been totally
elucidated, although the following theories have been offered.
• Bursts of destructive activity are associated with subgingival
ulceration and an acute inflammatory reaction, resulting in
rapid loss of alveolar bone.
6
7. Periods of Destruction con….
• Periods of exacerbation are associated with an
increase of the loose, unattached, motile, gram-
negative, anaerobic pocket flora, and periods of
remission coincide with the formation of a dense,
unattached, non motile, gram-positive flora with a
tendency to mineralize.
• Tissue invasion by one or several bacterial species is
followed by an advanced local host defense that
controls the attack.
7
8. Mechanisms of Bone Destruction
The factors involved in bone destruction in periodontal
disease are bacterial and host mediated.
• 1- Bacterial plaque products induce the
differentiation of bone progenitor cells into
osteoclasts and stimulate gingival cells to release
mediators that have the same effect.
• 2- Plaque products and inflammatory mediators can
also act directly on osteoblasts or their progenitors,
inhibiting their action and reducing their numbers.
• 3- in rapidly progressing diseases such as localized
juvenile periodontitis, bacterial microcolonies or
single bacterial cells may be present between collagen
fibers and over the bone surface, suggesting a direct
effect.
8
9. Mechanisms of Bone Destruction
4- Several host factors released by inflammatory cells are capable
of inducing bone resorption in vitro and can play a role in
periodontal disease. These include host-produced
prostaglandins, interleukin 1-α and -β, and tumor necrosis
factor (TNF)-α.
When injected intradermally, prostaglandin E2 induces the
vascular changes seen in inflammation; when injected over a
bone surface, it induces bone resorption in the absence of
inflammatory cells and with few multinucleated osteoclasts.
9
10. Bone Formation in Periodontal Disease
• Areas of bone formation are also found
immediately adjacent to sites of active bone
resorption ,
• The response of alveolar bone to inflammation
includes bone formation and resorption;
10
12. • but results from the predominance of resorption over
formation. New bone formation impairs the rate of
bone loss, compensating in some degree for the bone
destroyed by inflammation.
• These periods of remission and exacerbation
(or inactivity and activity, respectively)
appear to coincide with the quiescence or exacerbation of
gingival inflammation, manifested by changes in the
extent of bleeding, amount of exudate, and composition
of bacterial plaque.
12
13. • The presence of bone formation in response
to inflammation, even in active periodontal
disease, has an effect on the outcome of
treatment. The basic aim of periodontal
therapy is the elimination of inflammation to
remove the stimulus for bone resorption and
therefore allow the inherent constructive
tendencies to predominate.
13
14. BONE DESTRUCTION CAUSED BY TRAUMA
FROM OCCLUSION
• Another cause of periodontal destruction is trauma from
occlusion.
• Trauma from occlusion can produce bone destruction in the
absence or presence of inflammation.
• In the absence of inflammation, the changes caused by trauma
from occlusion vary from increased compression and tension
of the periodontal ligament and increased osteoclasis of
alveolar bone to necrosis of the periodontal ligament and bone
and resorption of bone and tooth structure. These changes are
reversible in that they can be repaired if the offending forces
are removed.
• When combined with inflammation, trauma from occlusion
aggravates the bone destruction caused by the inflammation
and causes bizarre bone patterns.
14
15. Trauma from Occlusion:
• Trauma from occlusion may be a factor in
determining the dimension and shape of bone
deformities. It may cause a thickening of the
cervical margin of alveolar bone or a change in
the morphology of the bone.
15
16. BONE DESTRUCTION PATTERNS IN
PERIODONTAL DISEASE
• Periodontal disease alters the morphologic features of
the bone in addition to reducing bone height.
• An understanding of the nature and pathogenesis of
these alterations is essential for effective diagnosis and
treatment.
• Horizontal Bone Loss
• Bone Deformities (Osseous Defects)
• Vertical or Angular Defects
• Osseous Craters
• Bulbous Bone Contours
• Reversed Architecture
• Ledges
• Furcation Involvements
16
17. Horizontal Bone Loss
• Horizontal bone loss is the most common
pattern of bone loss in periodontal
disease. The bone is reduced in height,
but the bone margin remains roughly
perpendicular to the tooth surface. The
interdental septa and facial and lingual
plates are affected, but not necessarily to
an equal degree around the same tooth
17
19. Bone Deformities (Osseous Defects)
• Different types of bone deformities can result
from periodontal disease. These usually occur in
adults and have been reported in human skulls
with deciduous dentitions. Their presence may
be suggested on radiographs, but careful
probing and surgical exposure of the areas is
required to determine their exact conformation
and dimensions.
19
20. Vertical or Angular Defects
• Vertical or angular defects are those that occur in an
oblique direction, leaving a hollowed-out trough in the
bone alongside the root; the base of the defect is located
apical to the surrounding bone.
• In most instances, angular defects have accompanying
infrabony pockets; such pockets always have an
underlying angular defect.
• Angular defects are classified on the basis of the number
of osseous walls.
• The number of walls in the apical portion of the defect
may be greater than that in its occlusal portion, in which
case the term combined osseous defect is used
20
21. Vertical or Angular Defects con…..
• Vertical defects occurring interdentally can
generally be seen on the radiograph,
although thick, bony plates sometimes
may obscure them. Angular defects can
also appear on facial and lingual or palatal
surfaces, but these defects are not seen
on radiographs. Surgical exposure is the
only sure way to determine the presence
and configuration of vertical osseous
defects.
21
22. Vertical or Angular Defects con…..
• vertical defects increase with age. Approximately 60% of
persons with interdental angular defects have only a
single defect. Vertical defects detected radiographically
have been reported to appear most commonly on the
distal surfaces and mesial surfaces.
• However, three-wall defects are more frequently found
on the mesial surfaces of upper and lower molars.
• The three-wall vertical defect was originally called an
intrabony defect. This defect appears most frequently on
the mesial aspects of second and third maxillary and
mandibular molars. The one-wall vertical defect is also
called a hemiseptum.
22
30. Osseous Craters
• Osseous craters are concavities in the crest of the interdental bone
confined within the facial and lingual walls. Craters have been found
to make up about one third (35.2%) of all defects and about two
thirds (62%) of all mandibular defects. They are twice as common in
posterior segments as in anterior segments.
• The following reasons for the high frequency of interdental craters
have been suggested:
The interdental area collects plaque and is difficult to clean.
The normal flat or even concave faciolingual shape of the interdental
septum in lower molars may favor crater formation.
Vascular patterns from the gingiva to the center of the crest may
provide a pathway for inflammation
30
32. Bulbous Bone Contours
• Bulbous bone contours are bony
enlargements caused by exostosis,
adaptation to function, or buttressing bone
formation. They are found more frequently
in the maxilla than in the mandible.
32
34. Reversed Architecture
• Reversed architecture defects are
produced by loss of interdental bone,
including the facial plates, lingual plates,
or both, without concomitant loss of
radicular bone, thereby reversing the
normal architecture. Such defects are
more common in the maxilla.
34
36. Ledges
• Ledges are plateau-like bone margins
caused by resorption of thickened bony
plates
36
37. Furcation Involvements
• The term furcation involvement refers to the
invasion of the bifurcation and trifurcation of
multirooted teeth by periodontal disease.
• The prevalence of furcation involved molars is
not clear. Whereas some reports indicate that
the mandibular first molars are the most
common sites and the maxillary premolars are
the least common, others have found higher
prevalence in upper molars.
• The number of furcation involvements increases
with age
37
38. Furcation Involvements con….
Furcation involvements have been classified as
grades I, II, III, and IV according to the amount
of tissue destruction.
• Grade I is incipient bone loss,
• Grade II is partial bone loss.
• Grade III is total bone loss with through-and-
through opening of the furcation.
• Grade IV is similar to grade III, but with gingival
recession exposing the furcation to view.
38