Trans-septal Fibers and Bone Loss Quiz
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Questions and Answers

What is the radius within which bacterial plaque can induce loss of bone?

  • 3.0 to 4.0 mm
  • 1.0 to 1.5 mm
  • 2.5 to 3.0 mm
  • 1.5 to 2.5 mm (correct)

    • Which condition is characterized by large defects exceeding 2.5 mm?

  • Aggressive periodontitis (correct)
  • Chronic periodontitis
  • Aphthous stomatitis
  • Localized gingivitis

    • What is the most common cause of bone destruction in periodontal disease?

  • Genetic predisposition
  • Extension of inflammation from marginal gingiva (correct)
  • Trauma to the teeth
  • Poor dental hygiene

    • What is the rate of bone loss on the proximal surface in an individual with no oral hygiene?

    <p>0.3 mm a year</p> Signup and view all the answers

    What component modifies the extension of inflammation in periodontal disease?

    <p>Host's immune response</p> Signup and view all the answers

    During which period does the transition from gingivitis to periodontitis occur?

    <p>Episodic with periods of inactivity</p> Signup and view all the answers

    What observation can be made when analyzing the rate of bone loss on the facial surface?

    <p>It is faster compared to the proximal surface</p> Signup and view all the answers

    Which of the following factors is NOT associated with the modification of inflammation extension in periodontal disease?

    <p>Degree of tooth decay</p> Signup and view all the answers

    Which of the following anatomical features does NOT affect the bone destructive pattern in periodontal disease?

    <p>Presence of periodontal bacteria</p> Signup and view all the answers

    Which type of osseous defect is characterized by craters as classified by Glickman?

    <p>Osseous craters</p> Signup and view all the answers

    Which classification system introduced horizontal and infrabony pocket defects?

    <p>Goldman and Cohen</p> Signup and view all the answers

    Which type of defect is characterized as a three-walled defect in periodontal classification?

    <p>Class III</p> Signup and view all the answers

    What impact does gingival inflammation have on the rate of bone loss in periodontal disease?

    <p>Accelerates the rate of bone loss</p> Signup and view all the answers

    What is a characteristic of horizontal bone defects in periodontal disease?

    <p>Presence of osseous craters</p> Signup and view all the answers

    What indicates a normal horizontal bone level when comparing it to the cemento-enamel junction?

    <p>Both lines are parallel and within 2.0 mm from the junction</p> Signup and view all the answers

    Which of the following is not a type of vertical defect in periodontal disease?

    <p>Exostoses</p> Signup and view all the answers

    Which step is crucial for identifying the bone level in the posterior region?

    <p>Identify the cemento-enamel junction of two adjacent teeth</p> Signup and view all the answers

    What is a potential consequence of untreated bacterial plaque in periodontal disease?

    <p>Development of reversed architecture bone</p> Signup and view all the answers

    What sign indicates an advanced stage of periodontal disease in relation to bone structure?

    <p>Presence of bony ledges</p> Signup and view all the answers

    Which of the following indicates a significant impact of gingival inflammation on periodontal health?

    <p>Increased rate of bone loss</p> Signup and view all the answers

    Which classification best describes osseous defects characterized by angular or vertical patterns?

    <p>Reversed architecture</p> Signup and view all the answers

    What do bulbous bone contours typically signify in periodontal evaluation?

    <p>Possible pathological changes</p> Signup and view all the answers

    In periodontal disease progression, what role does effective plaque control play?

    <p>It halts the progression of periodontal inflammation</p> Signup and view all the answers

    What is the most common cause of alveolar bone loss in periodontal disease?

    <p>Extension of gingival inflammation</p> Signup and view all the answers

    Which change occurs when gingivitis progresses to periodontitis?

    <p>Increase in motile organisms</p> Signup and view all the answers

    Which systemic factor is NOT typically a cause of alveolar bone loss?

    <p>High blood pressure</p> Signup and view all the answers

    What transitional pathway does inflammatory invasion of the bone surface initiate?

    <p>Initial bone loss</p> Signup and view all the answers

    Which of the following conditions is directly preceded by gingivitis?

    <p>Periodontitis</p> Signup and view all the answers

    What type of bacterial composition indicates advanced stages of periodontal disease?

    <p>Increased motile organisms</p> Signup and view all the answers

    What is a significant effect of ill-fitting prostheses in periodontal health?

    <p>Causes food impaction</p> Signup and view all the answers

    Which of the following is NOT a recognized cause of alveolar bone loss?

    <p>Healthy lifestyle</p> Signup and view all the answers

    When discussing periodontal disease, what does the composition of bacterial plaque influence?

    <p>Bone loss rate</p> Signup and view all the answers

    What main factor contributes to the transition from gingivitis to periodontitis?

    <p>Changes in plaque composition</p> Signup and view all the answers

    What is the most common pattern of bone loss associated with horizontal bone loss?

    <p>Bone is reduced perpendicularly to the tooth surface</p> Signup and view all the answers

    Which type of defect is characterized by a hollowed-out trough in the bone along the root?

    <p>Vertical or angular defect</p> Signup and view all the answers

    How are angular defects classified according to Goldman & Cohen?

    <p>Based on the number of osseous walls</p> Signup and view all the answers

    Which type of angular defect is described as having three walls and is also referred to as an intrabony defect?

    <p>Three walled defect</p> Signup and view all the answers

    What is a significant factor that can obscure the visibility of vertical angular defects on radiographs?

    <p>Thick bony plates</p> Signup and view all the answers

    What percentage of individuals with interdental angular defects typically have single vertical defects?

    <p>60%</p> Signup and view all the answers

    Where are three-wall defects most frequently found in the dental structure?

    <p>On the mesial surfaces of upper and lower molars</p> Signup and view all the answers

    What is the primary method to determine the presence and configuration of vertical osseous defects?

    <p>Surgical exposure</p> Signup and view all the answers

    Which of the following statements is true regarding the rate of vertical defects as individuals age?

    <p>Vertical defects increase with age</p> Signup and view all the answers

    What is a characteristic feature of a one-walled defect also known as a hemiseptum?

    <p>Has only one osseous wall</p> Signup and view all the answers

    Bacterial plaque can contribute to the destruction of the periodontal ligament.

    <p>True</p> Signup and view all the answers

    The rate of bone loss in periodontal disease decreases as gingival inflammation progresses.

    <p>False</p> Signup and view all the answers

    Osseo-classification systems are used to determine the extent of bone defects in periodontal disease.

    <p>True</p> Signup and view all the answers

    Gingival inflammation has no impact on the bone thinning process.

    <p>False</p> Signup and view all the answers

    The penetration of inflammation from the gingiva into the bone occurs through blood vessels in the center of the septum.

    <p>True</p> Signup and view all the answers

    Marrow spaces in periodontal disease are typically filled with healthy cells and fluids.

    <p>False</p> Signup and view all the answers

    Chronic gingival inflammation can lead to the replacement of fatty bone marrow with fibrous type.

    <p>True</p> Signup and view all the answers

    Inflammation from the pocket area significantly alters the relationship between collagen fibers in the periodontal structures.

    <p>True</p> Signup and view all the answers

    Bacterial plaque can induce loss of bone within a radius of 1 to 2mm.

    <p>False</p> Signup and view all the answers

    The rate of bone loss on the facial surface in individuals with no oral hygiene is 0.3mm a year.

    <p>False</p> Signup and view all the answers

    Periodontitis can occur without prior gingivitis.

    <p>False</p> Signup and view all the answers

    Bone loss is a continuous process and does not occur in episodic periods.

    <p>False</p> Signup and view all the answers

    Bacterial plaque can induce significant bone loss in periodontal disease.

    <p>True</p> Signup and view all the answers

    Horizontal bone defects are common in cases with narrow interproximal spaces.

    <p>False</p> Signup and view all the answers

    In aggressive periodontitis, large bone defects often exceed 2.5mm.

    <p>True</p> Signup and view all the answers

    The presence of gingival inflammation does not affect the progression of periodontal disease.

    <p>False</p> Signup and view all the answers

    The primary factor leading to bone destruction in periodontal disease is gingival inflammation.

    <p>True</p> Signup and view all the answers

    The rate of vertical bone loss tends to increase with age.

    <p>True</p> Signup and view all the answers

    Osseo-classification systems categorize defects based solely on their size.

    <p>False</p> Signup and view all the answers

    The degree of fibrosis of gingiva does not affect the extension of inflammation.

    <p>False</p> Signup and view all the answers

    The width of attached gingiva has no influence on periodontal disease progression.

    <p>False</p> Signup and view all the answers

    Gingival inflammation can exacerbate the effects of periodontal disease on bone structure.

    <p>True</p> Signup and view all the answers

    The transition from gingivitis to periodontitis involves changes in the composition of bacterial plaque.

    <p>True</p> Signup and view all the answers

    The thickness of facial and lingual alveolar plates does not influence the bone destructive pattern in periodontal disease.

    <p>False</p> Signup and view all the answers

    Osseous craters are a type of defect classified by Glickman in 1964.

    <p>True</p> Signup and view all the answers

    Infrabony defects can be classified into several subclasses according to Goldman and Cohen.

    <p>False</p> Signup and view all the answers

    Gingival inflammation has no impact on the rate of bone loss in periodontal disease.

    <p>False</p> Signup and view all the answers

    Prichard expanded Glickman's classification by including factors like furcation involvement and anatomical aberrations.

    <p>True</p> Signup and view all the answers

    The classification of osseous defects includes inconsistencies in margins and ledges as a defect type.

    <p>True</p> Signup and view all the answers

    One significant factor influencing the progression from gingivitis to periodontitis is the presence of plaque.

    <p>True</p> Signup and view all the answers

    Bulbous bone contours are typically indicative of healthy periodontal conditions.

    <p>False</p> Signup and view all the answers

    Class II infra bony defects are associated with two-walled defects according to the grading system.

    <p>True</p> Signup and view all the answers

    The presence of fenestrations and dehiscences does not affect the bone morphology in periodontal disease.

    <p>False</p> Signup and view all the answers

    The initial loss of alveolar bone in periodontal disease is directly caused by the presence of non-motile bacteria.

    <p>False</p> Signup and view all the answers

    Gingivitis, if untreated, can progress to periodontitis.

    <p>True</p> Signup and view all the answers

    The composition of bacterial plaque remains constant throughout the progression of periodontal disease.

    <p>False</p> Signup and view all the answers

    The most common cause of bone destruction in periodontal disease is trauma from occlusion.

    <p>False</p> Signup and view all the answers

    In advanced stages of periodontal disease, the number of coccoid rods increases while other bacteria types decrease.

    <p>False</p> Signup and view all the answers

    Food impaction can contribute to alveolar bone loss.

    <p>True</p> Signup and view all the answers

    Overhanging restorations have no effect on periodontal health.

    <p>False</p> Signup and view all the answers

    Trauma from occlusion is a systemic factor that causes alveolar bone loss.

    <p>False</p> Signup and view all the answers

    The transition from gingivitis to periodontitis involves a decrease in inflammatory cell activity.

    <p>False</p> Signup and view all the answers

    An ill-fitting prosthesis can exacerbate bone loss in periodontal disease.

    <p>True</p> Signup and view all the answers

    Study Notes

    Reformation of Trans-Septal Fibers

    • Trans-septal fibers can be recreated above the bone margin but may be infiltrated by inflammation.
    • Inflammation can extend to the crestal bone surface.

    Radius of Action

    • Bacterial plaque can induce bone loss within a radius of 1.5 to 2.5 mm.
    • Interproximal angular defect spaces must exceed 2.5 mm to prevent complete bone destruction, leading to horizontal defects.
    • Large defects over 2.5 mm are observed in aggressive periodontitis and Papillon-Lefèvre syndrome.

    Rate of Bone Loss

    • In individuals lacking oral hygiene, facial surface bone loss occurs at a rate of 0.2 mm per year.
    • Proximal surface bone loss occurs at a rate of 0.3 mm per year.

    Extension of Gingival Inflammation

    • Extension from marginal gingiva into supporting periodontal tissues is the primary cause of bone destruction in periodontal disease.
    • Periodontitis generally follows gingivitis, but not all cases of gingivitis develop into periodontitis.
    • The shift from gingivitis to periodontitis involves changes in bacterial plaque composition.

    Period of Destruction

    • Bone loss occurs episodically, alternating with periods of inactivity, leading to collagen and alveolar bone loss and deepening periodontal pockets.
    • The causes of this destructive period are not fully clarified.
    • Factors influencing the extension of inflammation include pathogenicity of plaque, host resistance, width of attached gingiva, degree of gingival fibrosis, and peripheral reactive fibrogenesis and osteogenesis.

    Patterns of Bone Loss

    • Horizontal Bone Loss:

      • This is the most common bone loss pattern, resulting in bone margins being approximately perpendicular to tooth surfaces.
      • Affects interdental septa and facial/lingual bone plates unequally.

    • Vertical or Angular Defects:

      • Angular defects create a hollowed trough alongside the root with the base located apically.
      • Often associated with intrabony periodontal pockets.

    Classification of Angular Defects

    • Classified based on the number of osseous walls:
      • One-walled defects.
      • Two-walled defects.
      • Three-walled defects.
      • Combined osseous defects.

    Radiographic Detection

    • Vertical defects can often be observed on radiographs, though thick bony plates may obscure them.
    • Surgical exposure is essential for accurate assessment of vertical osseous defects.

    Incidence and Features of Vertical Defects

    • Vertical defects are more prevalent with age; approximately 60% of individuals with interdental angular defects have single vertical defects.
    • Radiographically detected defects are commonly seen on distal and mesial surfaces, with three-wall defects more frequently found in molars.

    Causes of Alveolar Bone Loss

    • Main causes include:
      • Extension of gingival inflammation.
      • Trauma from occlusion.
      • Systemic factors.
      • Orthodontic treatment.
      • Periodontitis and periodontal abscess.
      • Food impaction and overhanging restorations.
      • Ill-fitting prostheses and adjacent tooth extractions.

    Normal Variation in Alveolar Bone

    • Anatomic features impacting bone destruction patterns in periodontal disease include:
      • Thickness and width of interdental septa.
      • Thickness of facial and lingual alveolar plates.
      • Presence of fenestrations and dehiscence.
      • Alignment and proximity of teeth.

    Osseous Defects Classification

    • Glickman's classification includes:
      • Osseous craters.
      • Hemiseptal defects.
      • Infrabony defects.
      • Bulbous bone contours.
      • Inconsistent margins and ledges.
      • Reversed architecture.
    • Prichard expanded this classification to include furcation involvement and anatomic variations.
    • Goldman and Cohen categorized defects further into horizontal and vertical classifications.

    Extension of Gingival Inflammation

    • Inflammation from the gingiva can extend to the periodontal ligament, facially and lingually, along the outer periosteum.
    • Extension can proceed from the periosteum into the bone and vertically into the periodontal ligament.

    Marrow Space Involvement

    • Gingival inflammation causes the replacement of marrow spaces with leukocytes, fluid exudates, new blood vessels, and proliferating fibroblasts.
    • This results in increased osteoclasts and mononuclear cells, leading to thinning bone trabeculae and enlargement of marrow spaces, ultimately resulting in destruction and reduction of bone height.

    Histopathology of Inflammation

    • Inflammation extends from the gingiva into suprabony areas along blood vessels and between collagen bundles.
    • Transseptal fibers are penetrated by inflammation, leading to destruction of the cortical layer of the septum and invasion into bone marrow.

    Radius of Action of Plaque

    • Bacterial plaque has a radius of action of 1.5 to 2.5 mm, within which it can cause loss of bone.
    • For interproximal angular defects, spaces must exceed 2.5 mm to avoid complete bone destruction, resulting in horizontal bone defects.

    Rate of Bone Loss

    • Individuals with poor oral hygiene experience bone loss at specific rates:
      • Facial surface: 0.2 mm per year
      • Proximal surface: 0.3 mm per year

    Transition from Gingivitis to Periodontitis

    • Periodontitis often follows gingivitis, but not all cases of gingivitis progress to periodontitis.
    • The transition is marked by changes in bacterial plaque composition and an increase in pathogenic organisms such as motile bacteria and spirochetes.

    Mechanisms of Bone Loss

    • Episodes of acute destruction contribute to progressive bone loss in marginal gingivitis, influenced by factors such as plaque pathogenicity and host resistance.
    • The width of attached gingiva and the degree of gingiva fibrosis also affect inflammation extension.

    Causes of Alveolar Bone Loss

    • Alveolar bone loss can result from various factors:
      • Extension of gingival inflammation
      • Trauma from occlusion
      • Systemic factors
      • Orthodontic treatment
      • Periodontitis
      • Periodontal abscess
      • Food impaction
      • Overhanging restorations
      • Adjacent tooth extractions
      • Ill-fitting prostheses

    Anatomic Features Impacting Bone Destruction

    • Anatomic characteristics affecting periodontal disease destructive patterns include the thickness and width of interdental septa, as well as root position and proximity to other tooth surfaces.

    Classification of Osseous Defects

    • Glickman’s classification includes:
      • Osseous craters
      • Hemiseptal defects
      • Infrabony defects
      • Bulbous bone contours
      • Reversed architecture

    Radiographic Appearance

    • The crest of the alveolar ridge should be 0.5 to 2.0 mm apical to the cemento-enamel junction.
    • To evaluate bone levels in the posterior region, identify the cemento-enamel junction, visualize a connecting line between two adjacent teeth, and assess the horizontal relationship of the bone crest.

    Treatment of Bone Defects

    • The management of bone defects must consider the patterns of destruction and the potential for regeneration through appropriate periodontal therapies.

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    Description

    This quiz explores the re-formation of trans-septal fibers and their relationship with inflammatory processes affecting the crestal bone surface. It highlights the radius of action for bacterial plaque and its impact on bone loss in various defect spaces.

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