BONE DESTRUCTION CAUSED BY GINGIVAL INFLAMMTION

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CONTENTS

INTRODUCTION HISTOPATHOLOGY RADIUS OF ACTION PERIODS OF DESTRUCTION MECHANISMS OF BONE DESTRUCTION BONE FORMATION IN PERIODONTAL DISEASE
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Introduction

Equilibrium between bone formation and bone resorption Bone resorption >> Bone formation Bone destruction

Level of bone loss = past pathologic experiences Soft tissue changes of pocket 6/26/12 wall=present inflammatory condition

Causes of bone destruction

1) 2) 3)

Extension of gingival inflammation Trauma from occlusion Systemic diseases

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Sequence

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Histopathology

Gingival inflammation extends along:

i)collagaen fiber bundles ii)course of blood vessels into alveolar bone

Interproximally,inflammation spreads to

i) loose connective tissue ii) bone through vessel channels

Facially and lingually,inflammation spreads from 6/26/12

Effects
Gingival and trans septal fibers Destruction Granular fragments (interspersed among inflammatory cells and edema) Note:transseptal fibers are recreated across crest of the interdental septum
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Bone

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Contd
Note:

Fatty bone marrow-partial or total replacement by fibrous type of marrow Bone destruction bone necrosis

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Rate of bone loss

According to Loe et als study of untreated periodontal disease avg. rate of bone loss is -0.2mm/yr for facial surfaces -0.3mm/yr for proximal surfaces

3 subgroups of patients with periodontal dis

i)approx. 8%=rapid progression of pdl dis + loss of attachment of 0.16/26/12 1mm/yr

Periods of destruction

Episodic,intermittent manner with periods of inactivity or quiescence Result in- loss of collagen and alveolar bone thus deepening of pocket Reasons:

i)Subgingival ulceration + acute inflammatory reaction ii)Conversion of T-lymphocyte lesion 6/26/12 into B-lymphocyte-plasma cell infiltrate

iii)Periods of exacerbation- of loose,unattached,motile,gram negative anaerobic pocket flora and Periods of remissiondense,unattached,nonmotile,grampositive flora with tendency to mineralise. iv)Tissue invasion by several bacterial species.

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Mechanisms of Bone Destruction

Two factors:bacterial and host mediated Bacterial plaque products

i)Bone progenitor cells osteoclasts ii)Gingival cells mediators Note:Both cause bone resorption + act on osteoblasts/progenitors; thus inhibit action and reduce no.
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Rapidly progressing disease:bacterial

Host factors(PGE2,IL-,IL-,TNF-):

Inflammatory cells host factors bone resorption in vitro -PGE2(intradermal)vascular changes -PGE2(bone surface)bone resorption without inflammatory cells and with few osteoclasts. Note:NSAIDS(flurbiprofen and ibuprofen) inhibit PGE2 production slows bone loss
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Found near:

Bone Formation in Periodontal Disease

i)sites adjacent to active bone resorption ii)Trabecular surfaces

Alveolar bones response to inflammation: - bone resorption and formation

-Thus in bone destruction,bone resorption is more than bone formation

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