Periodontitis: Inflammation and Bone Destruction

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What term is used to describe plateau-like bone margins caused by the resorption of thickened bony plates?

Ledges (correct)

Furcation involvement

Reversed architecture

Equi-architecture

Which condition is produced by the loss of interdental bone, including the facial and/or lingual plates, without loss of radicular bone?

Positive architecture

Negative architecture (correct)

Equi-architecture

Furcation involvement

What is the most common site for furcation involvement in multirooted teeth?

Maxillary premolars

Mandibular molars (correct)

Mandibular premolars

Maxillary molars

When the level of radicular bone, facial, and lingual plates are equal, what is this condition called?

Equi-architecture Signup and view all the answers

Which grade of furcation involvement indicates total bone loss with a 'through and through' opening of the furcation?

Grade 3 Signup and view all the answers

Which of the following options correctly describes normal periodontal architecture?

Positive architecture Signup and view all the answers

What is key to the transition from gingivitis to periodontitis?

Change in plaque composition Signup and view all the answers

Which of the following correctly describes a less common pathway of inflammation spread?

Inflammatory exudate extends directly from gingiva to PDL then to bone. Signup and view all the answers

What is the initial pathway of inflammatory exudate in the common path?

From gingival epithelium to connective tissue Signup and view all the answers

Which of the following is NOT involved in the common path of inflammatory exudate spread?

Gingival sulcus Signup and view all the answers

During the common path of inflammation spread, what occurs after the exudate reaches the alveolar bone?

Penetration to the B.M space Signup and view all the answers

What is the consequence of inflammatory exudate reaching the bone marrow (BM) space?

Thinning of trabeculae Signup and view all the answers

What occurs to the BM space when replaced by leukocytes and exudates?

It enlarges and replaces fatty BM with fibrous BM Signup and view all the answers

How does bone loss occur during the transition from gingivitis to periodontitis?

Intermittently Signup and view all the answers

How does inflammatory exudate reach the PDL in the common path?

Through the outer periosteal surface of bone and loose tissue around blood vessel channels Signup and view all the answers

What is a characteristic outcome of inflammation reaching the PDL?

Horizontal bone loss and supra bony pocket Signup and view all the answers

What role do transseptal fibers have during periodontal bone destruction?

They continuously regenerate across the crest of the interdental septum Signup and view all the answers

What is a characteristic of exostoses?

They are bony outgrowths of varied size and shape. Signup and view all the answers

Which bone feature is associated with angular bone loss?

Increased thickness of facial and lingual alveolar plates. Signup and view all the answers

How does trauma from occlusion affect bone morphology?

It may change the dimension and shape of bone deformities. Signup and view all the answers

What results from peripheral buttressing in bone?

Bulging of bone contour (lipping). Signup and view all the answers

Which factor is directly associated with the destructive pattern in periodontal disease?

Thickness and crestal angulation of interdental septa. Signup and view all the answers

What is a possible outcome of root position in the jaw related to bone variations?

Uneven bone resorption patterns. Signup and view all the answers

What causes bulbous bone contours?

Bony enlargement caused by exostoses Signup and view all the answers

Where are bulbous bone contours more frequently found?

In the maxilla Signup and view all the answers

What characterizes fenestration in periodontal disease?

Isolated areas of root denuded of bone with intact margin Signup and view all the answers

What characterizes dehiscence in periodontal disease?

Loss of bone margin Signup and view all the answers

Which factor related to the morphology of a tooth can lead to fenestration?

Short root trunk Signup and view all the answers

What happens when the distance between teeth decreases?

Thickness of interdental bone decreases Signup and view all the answers

What pattern of alveolar bone destruction is typically seen around the first molars in interdental bone defects?

Vertical or angular Signup and view all the answers

Which of the following factors does NOT contribute to the extension of inflammation to supporting structures in juvenile periodontitis?

Horizontal bone loss Signup and view all the answers

The presence of tissue necrosis and pus in periodontal disease is typically originated from:

The walls of soft tissue pocket Signup and view all the answers

Osteoclasts are primarily involved in which process during bone destruction?

Removing the marginal portion of the bone Signup and view all the answers

Which of the following conditions is associated with bone necrosis?

Necrotizing ulcerative periodontitis Signup and view all the answers

Food impaction in interdental areas is considered:

A complicating factor in bone defects Signup and view all the answers

Which factor is NOT involved in host mediated bone destruction?

Bacteria Signup and view all the answers

Which of the following is a direct action mechanism of bone loss by plaque?

Direct destruction of the bone (non-cellular mechanism) Signup and view all the answers

What coincides with periods of remission in bone loss?

Formation of dense, unattached, non-motile, gram-positive organisms Signup and view all the answers

Which of the following is associated with bursts of destructive activity?

Changes in composition of bacterial plaque to motile gram-negative, anaerobic organisms Signup and view all the answers

Which mediator is released during the indirect action of bone loss by plaque, leading to progenitor cell differentiation into osteoclasts?

Interleukin-1 alpha Signup and view all the answers

Which of the following statements is FALSE regarding the periods of bone destruction and remission?

T-lymphocyte lesions convert to B-lymphocyte-plasma cell infiltrates during periods of remission. Signup and view all the answers

What is the optimum distance from the bone surface for local factors to cause bone resorption?

1.5-2.5 mm Signup and view all the answers

At what rate does bone loss occur per year on facial surfaces in patients with poor oral hygiene?

0.2 mm per year Signup and view all the answers

According to Loe, what is the yearly connective attachment loss (CAL) range for moderate periodontitis?

0.05 - 0.5 mm Signup and view all the answers

Based on Waerhaug's measurement, what distance beyond the bone surface results in no bone resorption effect?

2.5 mm Signup and view all the answers

What percentage of patients experience severe periodontitis with a yearly CAL of 0.1 - 1 mm?

8% Signup and view all the answers

Study Notes

Extension of Inflammation

The transition from gingivitis to periodontitis occurs when inflammation extends from the marginal gingiva to the supporting structure.
Bone loss occurs in episodes.

Pathway of Inflammatory Exudate

Interproximal

The common path involves inflammatory exudate extending from the gingiva to the alveolar bone, destroying transseptal fibers, and reaching the periodontal ligament (PDL) and bone marrow space, leading to horizontal bone loss and supra bony pocket.
The less common pathway involves inflammatory exudate extending directly from the gingiva to the PDL and then to the bone.

Facial or Lingual

The common path involves inflammatory exudate extending from the gingival epithelium to the connective tissue, reaching the outer periosteal surface of the bone, and penetrating the bone marrow space, leading to horizontal bone loss and supra bony pocket.
The less common pathway involves inflammatory exudate extending directly from the gingiva to the PDL and then to the bone.

Clinical Importance of Fibers

Transseptal fibers are present even in cases of extreme periodontal bone loss.
During surgical procedures, these fibers form a firm covering over the bone, which is encountered after removing the superficial granulation tissue.

Periodontal Bone Defects

Ledges

Plateau-like bone margins caused by resorption of thickened bony plates.

Reversed Architecture

Loss of interdental bone, including facial and/or lingual plates, without loss of radicular bone, resulting in a reversal of the normal architecture.

Furcation Involvement

Invasion of the bifurcation and trifurcation of multirooted teeth by periodontal disease.
Classified into four grades: incipient, partial, total, and through and through opening of the furcation.

Bulbous Bone Contours

Bony enlargements caused by exostoses or buttressing bone formation.

Fenestration and Dehiscence

Isolated areas of root denuded of bone with intact margin (fenestration) or loss of bone margin (dehiscence).

Factors Determining Bone Morphology in Periodontal Disease

Morphology of the tooth (thickness of root, thickness of bone, and short root trunk).
Position of the tooth in the arch (thickness of lingual plate, thin buccal plate).
Distance between teeth (thin interdental bone).

Exostoses (outgrowths of bone).
Normal variation of bone (thickness, width, and crestal angulation of interdental septa, thickness of facial and lingual alveolar plates, presence of developmental anomalies, and increased thickness of alveolar bone margins).
Trauma from occlusion (factor in determining the dimension and shape of bone deformities).
Buttressing bone formation (bone formation in an attempt to buttress bony trabecular weakened by resorption).

Bone Destruction

Controlled by the pathogenic potential of plaque, host resistance, degree of fibrosis of gingiva, width of attached gingiva, amount of gingival fibers, reactionary fibrogenesis and osteogenesis, and reparative activity.
Not a process of necrosis, but involves the activity of vital cells as osteoclasts and mononuclear cells.

Mechanisms of Bone Destruction

By bacteria and host-mediated factors released by inflammatory cells.
Direct action: bacteria inside plaque differentiate progenitor cells into osteoclasts.
Indirect action: release of mediators that act as co-factors in bone resorption, destroy bone by chemical action, and inhibit maturation of osteoblasts.

Periods of Destruction and Remission in Bone Loss

Bursts of destructive activity are associated with subgingival ulceration, acute inflammatory reaction, and changes in the composition of bacterial plaque.
Periods of remission coincide with the formation of dense, unattached, non-motile, gram-positive organisms and tissue invasion by one or several bacterial species.

Radius of Action

Local factors causing bone resorption should be present close to the bone surface (1.5-2.5 mm) to exert their action.

Rate of Bone Loss

In patients with poor oral hygiene, the rate of bone loss is 0.2 mm per year for facial surfaces and 0.3 mm per year for proximal surfaces.
According to Loe, yearly clinical attachment loss (CAL) can be classified into mild, moderate, and severe periodontitis.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the extension of inflammation from marginal gingiva to the supporting structure, leading to periodontitis, and the pathway of inflammatory exudate affecting bone resorption.