Residual Ridge Resorption Overview

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Questions and Answers

What is one of the primary functions of protein in the body?

To convert sunlight into energy

To provide insulation against cold temperatures

To build and maintain tissue (correct)

To regulate blood sugar levels

Which macronutrient is primarily responsible for supplying energy, alongside its role in tissue maintenance?

Carbohydrates

Vitamins

Fats

Proteins (correct)

Which of the following substances is NOT classified as a macronutrient?

Fats

Vitamins (correct)

Carbohydrates

Proteins

What group of substances includes proteins that are crucial for energy and tissue maintenance?

Proteins Signup and view all the answers

Which statement correctly describes the role of dietary factors in metabolism?

Food consists of nutrients that interact to sustain bodily functions. Signup and view all the answers

What is the orientation change of the maxilla in edentulous patients compared to the mandible?

It inclines inward and narrows progressively. Signup and view all the answers

What appearance do many patients develop due to the changes in the edentulous mandible and maxilla?

Prognathic Signup and view all the answers

Which statement correctly describes the mandible in edentulous patients?

It inclines outward and becomes progressively wider. Signup and view all the answers

What effect do the morphological changes of the edentulous mandible and maxilla have on facial appearance?

They create a wider lower face structure. Signup and view all the answers

What is the impact of the changes in the edentulous maxilla on the face compared to the mandible?

It may cause the patient to appear less prognathic. Signup and view all the answers

What is the most notable characteristic of extraction wound healing?

Residual ridge alveolar bone undergoes lifelong catabolic remodeling. Signup and view all the answers

Which statement best describes the remodeling of residual ridge alveolar bone after extraction wound healing?

It experiences progressive resorption and catabolic remodeling over time. Signup and view all the answers

What implication does lifelong catabolic remodeling of the alveolar bone have for dental practices?

Dental implants may require frequent adjustments due to bone loss. Signup and view all the answers

How does the catabolic remodeling process impact the long-term prognosis of extraction sites?

It can lead to complications in future dental restorations or extractions. Signup and view all the answers

Which factor contributes to the lifelong catabolic remodeling of the residual ridge alveolar bone?

Aging and systemic health factors. Signup and view all the answers

What effect does a denser bone have on the rate of resorption?

It slows down the rate of resorption. Signup and view all the answers

Which factors are included under metabolic factors affecting bone health?

Nutritional disturbances and hormonal causative factors. Signup and view all the answers

Why does the density of bone influence the rate of resorption?

Denser bones allow for less surface area for resorption. Signup and view all the answers

How can nutritional disturbances affect the quality of bone?

They can result in decreased bone density and compromised quality. Signup and view all the answers

What does a slow rate of resorption indicate about the bone's structural characteristics?

The bone is typically dense and stable. Signup and view all the answers

What is the primary effect of thyroid hormone on bone cells?

It regulates the metabolic rate of cells impacting both osteoblasts and osteoclasts. Signup and view all the answers

How does thyroid hormone influence cellular metabolism?

By affecting the metabolism of cells, including osteoblasts and osteoclasts. Signup and view all the answers

What role do osteoclasts play that is influenced by thyroid hormones?

They contribute to the breakdown of bone tissue. Signup and view all the answers

Which statement accurately describes the relationship between metabolism and bone cell activity?

Both osteoblasts and osteoclasts activity are influenced by overall cellular metabolism. Signup and view all the answers

What could be a potential consequence of altered thyroid hormone levels?

Disruption in the activity of osteoblasts and osteoclasts affecting overall bone health. Signup and view all the answers

What is the primary focus of RRR research?

Improving prevention or control methods of disease Signup and view all the answers

Which approach is deemed most critical concerning disease management?

Prevention strategies Signup and view all the answers

In the context of disease control, which statement is most accurate?

Prevention should be prioritized in disease management. Signup and view all the answers

What is implied as a secondary consideration in RRR research regarding disease?

Methods for better prevention or control Signup and view all the answers

What conclusion can be drawn about the significance of research in RRR?

It prioritizes the search for preventive measures. Signup and view all the answers

Study Notes

Residual Ridge Resorption (RRR)

Residual bone is the portion of maxillary or mandibular bone remaining after tooth loss.
Residual ridge is the portion of residual bone and its soft tissue covering remaining after tooth removal.
Residual ridge crest is the most prominent continuous surface of the residual ridge.
Residual ridge resorption is the diminishing quantity and quality of residual ridge after tooth extraction.
RRR is a chronic, progressive, and irreversible process.
The rate of RRR is fastest in the first 6 months after extraction.
Bone resorption continues throughout life at a slower rate.
Post-extraction, inflammatory reactions occur, and the socket is temporarily sealed by blood clotting.
Tissue integrity is restored within a week, and new bone formation is evident in the socket within two weeks.
The socket is progressively filled with new bone within 6 months.
Residual ridge alveolar bone undergoes lifelong catabolic remodeling post-extraction.

Bone Structure and Function

Osteocytes: Cells responsible for bone metabolic activity.
Intercellular substance (bone matrix): Consists of fibrils (calcified cementing substance) primarily polymerized glycoprotein, bound to mineral salts (calcium carbonate and phosphates).

Pathology of RRR

Gross pathology: Reduction in the size of the bony ridge under the mucoperiosteum.
RRR is categorized into different configurations in a system of six orders, based on the Atwood order. These are related to the pre- and post- extraction states and include high/low and well-rounded configurations.
Microscopic pathology: Osteoclastic activity on the external surface of the residual ridge crest.

Pathogenesis of RRR

Following extraction, sharp edges of remaining bone are rounded off by external osteoclastic resorption.
Bone crest becomes increasingly narrow.
A knife-edged crest becomes shorter and flatter, then low, or depressed over time.
The process of RRR is chronic, progressive, irreversible, and cumulative.

RRR Classification (American College of Prosthodontists, based on bone height - mandible only)

Type I: Residual bone height of 21mm or greater.
Type II: Residual bone height of 16-20mm.
Type III: Residual bone height of 11-15mm.
Type IV: Residual bone height of 10mm or less.

Direction of Bone Resorption

Maxilla: Resorption is upward and inward.
Mandible: Resorption is outward and wider.
The different patterns of resorption (centripetal in maxilla, centrifugal in mandible) affect the overall appearance of the jaw.

Patterns of Bone Resorption

In mandible, significant proportions of bone loss occur in the labial side of the anterior residual ridge, with equal loss on the buccal and lingual aspects in the premolar region, and lingual loss in the posterior molar region.
In maxilla, bone loss primarily occurs on the labial/buccal side.

Maxilla vs Mandible

Anterior mandible resorbs up to four times faster than maxilla.
Maxillary and mandibular denture areas differ.

Consequences of RRR

Loss of sulcus width and depth
Displacement of muscle attachments
Altered inter-alveolar ridge relationship
Formation of sharp, spiny, or uneven ridges
Exposure of the mandibular nerve
Foraminal location problems
Impacted upon ability to retain dentures.

Etiology of RRR

Disequilibrium between osteoblasts and osteoclasts.
Increased osteoclastic activity.
Factors affect bone formation and resorption: Systemic factors and local factors. These factors include hormonal, nutritional, and other systemic factors.

Systemic Factors

Estrogen
Thyroxin
Growth hormone
Androgens
Calcium
Phosphorus
Vitamin D
Protein
Fluoride

Local Biochemical factors

Endotoxins
Osteoclast-activating factor (OAF)
Prostaglandins
Human gingival bone-resorption stimulating factors
Heparin

Anatomic Factors

Amount of bone: Quantity of bone (high/low, broad/narrow, rounded/spiny).
Quality of bone: Density of bone (denser bone is less prone to resorption).

Metabolic Factors

Nutritional and some hormonal factors
Dietary Factors- Protein, Vitamins and Minerals

Pituitary Glands & Hypophysis

Hypophysis is the master gland of the endocrine system.
Dysfunction impacts general health and oral cavity.

Thyroid Glands

Important for metabolism
Hyperthyroidism lead to negative nitrogen balance and osteoporosis.
Thyroxin impacts kidneys, causing calcium and phosphorus excretion, decreasing bone density.

Parathyroid Glands

Maintain blood calcium levels through bone mobilization.

Islets of Langerhans

Insulin deficiency, poor tissue healing and rapid bone loss.
Diabetes mellitus associated with reduced healing.

Suprarenal Glands

Corticoids (e.g., cortisone) have adverse effects on bone.
Prolonged use of corticoids is a concern in certain conditions.

Gonads

Sex hormones are important for bone health.
Declining hormone levels in aging are associated with increased bone resorption.

Metabolic Factors (Dietary)

Dietary proteins, carbohydrates, fats, vitamins and minerals crucial to bone health.
Protein is essential during bone development and repair.
Vitamins and minerals are also essential for bone building.

Treatment and Prevention of RRR

Prevention of tooth loss: Maintaining natural teeth is key.
Optimal tissue management: Healthy tissue prior to denture insertion.
Impression procedures: Minimal pressure techniques.
Denture design: Adequate coverage, relief from non-stress bearing zones, appropriate size to reduce force per unit area
Maintaining Interocclusal distance: To avoid increased resorption.

Other Considerations

Overdentures: Impacted upon ability to reduce the amount of resorption.
Preprosthetic surgery: Bone or tissue alterations.
Nutritional factors and diet counseling.
Immediate dentures: Effectiveness in reducing resorption.
Patient Habits (e.g., bruxism) influence patterns of resorption.

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Description

This quiz provides an overview of Residual Ridge Resorption (RRR), detailing the processes and stages that occur after tooth extraction. Learn about the changes in residual bone, the timeline of bone resorption, and the significance of tissue restoration. Perfect for dental students and professionals looking to deepen their understanding of post-extraction healing.