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Questions and Answers
What is the radius within which bacterial plaque can induce loss of bone?
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?
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?
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?
What is the rate of bone loss on the proximal surface in an individual with no oral hygiene?
What component modifies the extension of inflammation in periodontal disease?
What component modifies the extension of inflammation in periodontal disease?
During which period does the transition from gingivitis to periodontitis occur?
During which period does the transition from gingivitis to periodontitis occur?
What observation can be made when analyzing the rate of bone loss on the facial surface?
What observation can be made when analyzing the rate of bone loss on the facial surface?
Which of the following factors is NOT associated with the modification of inflammation extension in periodontal disease?
Which of the following factors is NOT associated with the modification of inflammation extension in periodontal disease?
Which of the following anatomical features does NOT affect the bone destructive pattern in periodontal disease?
Which of the following anatomical features does NOT affect the bone destructive pattern in periodontal disease?
Which type of osseous defect is characterized by craters as classified by Glickman?
Which type of osseous defect is characterized by craters as classified by Glickman?
Which classification system introduced horizontal and infrabony pocket defects?
Which classification system introduced horizontal and infrabony pocket defects?
Which type of defect is characterized as a three-walled defect in periodontal classification?
Which type of defect is characterized as a three-walled defect in periodontal classification?
What impact does gingival inflammation have on the rate of bone loss in periodontal disease?
What impact does gingival inflammation have on the rate of bone loss in periodontal disease?
What is a characteristic of horizontal bone defects in periodontal disease?
What is a characteristic of horizontal bone defects in periodontal disease?
What indicates a normal horizontal bone level when comparing it to the cemento-enamel junction?
What indicates a normal horizontal bone level when comparing it to the cemento-enamel junction?
Which of the following is not a type of vertical defect in periodontal disease?
Which of the following is not a type of vertical defect in periodontal disease?
Which step is crucial for identifying the bone level in the posterior region?
Which step is crucial for identifying the bone level in the posterior region?
What is a potential consequence of untreated bacterial plaque in periodontal disease?
What is a potential consequence of untreated bacterial plaque in periodontal disease?
What sign indicates an advanced stage of periodontal disease in relation to bone structure?
What sign indicates an advanced stage of periodontal disease in relation to bone structure?
Which of the following indicates a significant impact of gingival inflammation on periodontal health?
Which of the following indicates a significant impact of gingival inflammation on periodontal health?
Which classification best describes osseous defects characterized by angular or vertical patterns?
Which classification best describes osseous defects characterized by angular or vertical patterns?
What do bulbous bone contours typically signify in periodontal evaluation?
What do bulbous bone contours typically signify in periodontal evaluation?
In periodontal disease progression, what role does effective plaque control play?
In periodontal disease progression, what role does effective plaque control play?
What is the most common cause of alveolar bone loss in periodontal disease?
What is the most common cause of alveolar bone loss in periodontal disease?
Which change occurs when gingivitis progresses to periodontitis?
Which change occurs when gingivitis progresses to periodontitis?
Which systemic factor is NOT typically a cause of alveolar bone loss?
Which systemic factor is NOT typically a cause of alveolar bone loss?
What transitional pathway does inflammatory invasion of the bone surface initiate?
What transitional pathway does inflammatory invasion of the bone surface initiate?
Which of the following conditions is directly preceded by gingivitis?
Which of the following conditions is directly preceded by gingivitis?
What type of bacterial composition indicates advanced stages of periodontal disease?
What type of bacterial composition indicates advanced stages of periodontal disease?
What is a significant effect of ill-fitting prostheses in periodontal health?
What is a significant effect of ill-fitting prostheses in periodontal health?
Which of the following is NOT a recognized cause of alveolar bone loss?
Which of the following is NOT a recognized cause of alveolar bone loss?
When discussing periodontal disease, what does the composition of bacterial plaque influence?
When discussing periodontal disease, what does the composition of bacterial plaque influence?
What main factor contributes to the transition from gingivitis to periodontitis?
What main factor contributes to the transition from gingivitis to periodontitis?
What is the most common pattern of bone loss associated with horizontal bone loss?
What is the most common pattern of bone loss associated with horizontal bone loss?
Which type of defect is characterized by a hollowed-out trough in the bone along the root?
Which type of defect is characterized by a hollowed-out trough in the bone along the root?
How are angular defects classified according to Goldman & Cohen?
How are angular defects classified according to Goldman & Cohen?
Which type of angular defect is described as having three walls and is also referred to as an intrabony defect?
Which type of angular defect is described as having three walls and is also referred to as an intrabony defect?
What is a significant factor that can obscure the visibility of vertical angular defects on radiographs?
What is a significant factor that can obscure the visibility of vertical angular defects on radiographs?
What percentage of individuals with interdental angular defects typically have single vertical defects?
What percentage of individuals with interdental angular defects typically have single vertical defects?
Where are three-wall defects most frequently found in the dental structure?
Where are three-wall defects most frequently found in the dental structure?
What is the primary method to determine the presence and configuration of vertical osseous defects?
What is the primary method to determine the presence and configuration of vertical osseous defects?
Which of the following statements is true regarding the rate of vertical defects as individuals age?
Which of the following statements is true regarding the rate of vertical defects as individuals age?
What is a characteristic feature of a one-walled defect also known as a hemiseptum?
What is a characteristic feature of a one-walled defect also known as a hemiseptum?
Bacterial plaque can contribute to the destruction of the periodontal ligament.
Bacterial plaque can contribute to the destruction of the periodontal ligament.
The rate of bone loss in periodontal disease decreases as gingival inflammation progresses.
The rate of bone loss in periodontal disease decreases as gingival inflammation progresses.
Osseo-classification systems are used to determine the extent of bone defects in periodontal disease.
Osseo-classification systems are used to determine the extent of bone defects in periodontal disease.
Gingival inflammation has no impact on the bone thinning process.
Gingival inflammation has no impact on the bone thinning process.
The penetration of inflammation from the gingiva into the bone occurs through blood vessels in the center of the septum.
The penetration of inflammation from the gingiva into the bone occurs through blood vessels in the center of the septum.
Marrow spaces in periodontal disease are typically filled with healthy cells and fluids.
Marrow spaces in periodontal disease are typically filled with healthy cells and fluids.
Chronic gingival inflammation can lead to the replacement of fatty bone marrow with fibrous type.
Chronic gingival inflammation can lead to the replacement of fatty bone marrow with fibrous type.
Inflammation from the pocket area significantly alters the relationship between collagen fibers in the periodontal structures.
Inflammation from the pocket area significantly alters the relationship between collagen fibers in the periodontal structures.
Bacterial plaque can induce loss of bone within a radius of 1 to 2mm.
Bacterial plaque can induce loss of bone within a radius of 1 to 2mm.
The rate of bone loss on the facial surface in individuals with no oral hygiene is 0.3mm a year.
The rate of bone loss on the facial surface in individuals with no oral hygiene is 0.3mm a year.
Periodontitis can occur without prior gingivitis.
Periodontitis can occur without prior gingivitis.
Bone loss is a continuous process and does not occur in episodic periods.
Bone loss is a continuous process and does not occur in episodic periods.
Bacterial plaque can induce significant bone loss in periodontal disease.
Bacterial plaque can induce significant bone loss in periodontal disease.
Horizontal bone defects are common in cases with narrow interproximal spaces.
Horizontal bone defects are common in cases with narrow interproximal spaces.
In aggressive periodontitis, large bone defects often exceed 2.5mm.
In aggressive periodontitis, large bone defects often exceed 2.5mm.
The presence of gingival inflammation does not affect the progression of periodontal disease.
The presence of gingival inflammation does not affect the progression of periodontal disease.
The primary factor leading to bone destruction in periodontal disease is gingival inflammation.
The primary factor leading to bone destruction in periodontal disease is gingival inflammation.
The rate of vertical bone loss tends to increase with age.
The rate of vertical bone loss tends to increase with age.
Osseo-classification systems categorize defects based solely on their size.
Osseo-classification systems categorize defects based solely on their size.
The degree of fibrosis of gingiva does not affect the extension of inflammation.
The degree of fibrosis of gingiva does not affect the extension of inflammation.
The width of attached gingiva has no influence on periodontal disease progression.
The width of attached gingiva has no influence on periodontal disease progression.
Gingival inflammation can exacerbate the effects of periodontal disease on bone structure.
Gingival inflammation can exacerbate the effects of periodontal disease on bone structure.
The transition from gingivitis to periodontitis involves changes in the composition of bacterial plaque.
The transition from gingivitis to periodontitis involves changes in the composition of bacterial plaque.
The thickness of facial and lingual alveolar plates does not influence the bone destructive pattern in periodontal disease.
The thickness of facial and lingual alveolar plates does not influence the bone destructive pattern in periodontal disease.
Osseous craters are a type of defect classified by Glickman in 1964.
Osseous craters are a type of defect classified by Glickman in 1964.
Infrabony defects can be classified into several subclasses according to Goldman and Cohen.
Infrabony defects can be classified into several subclasses according to Goldman and Cohen.
Gingival inflammation has no impact on the rate of bone loss in periodontal disease.
Gingival inflammation has no impact on the rate of bone loss in periodontal disease.
Prichard expanded Glickman's classification by including factors like furcation involvement and anatomical aberrations.
Prichard expanded Glickman's classification by including factors like furcation involvement and anatomical aberrations.
The classification of osseous defects includes inconsistencies in margins and ledges as a defect type.
The classification of osseous defects includes inconsistencies in margins and ledges as a defect type.
One significant factor influencing the progression from gingivitis to periodontitis is the presence of plaque.
One significant factor influencing the progression from gingivitis to periodontitis is the presence of plaque.
Bulbous bone contours are typically indicative of healthy periodontal conditions.
Bulbous bone contours are typically indicative of healthy periodontal conditions.
Class II infra bony defects are associated with two-walled defects according to the grading system.
Class II infra bony defects are associated with two-walled defects according to the grading system.
The presence of fenestrations and dehiscences does not affect the bone morphology in periodontal disease.
The presence of fenestrations and dehiscences does not affect the bone morphology in periodontal disease.
The initial loss of alveolar bone in periodontal disease is directly caused by the presence of non-motile bacteria.
The initial loss of alveolar bone in periodontal disease is directly caused by the presence of non-motile bacteria.
Gingivitis, if untreated, can progress to periodontitis.
Gingivitis, if untreated, can progress to periodontitis.
The composition of bacterial plaque remains constant throughout the progression of periodontal disease.
The composition of bacterial plaque remains constant throughout the progression of periodontal disease.
The most common cause of bone destruction in periodontal disease is trauma from occlusion.
The most common cause of bone destruction in periodontal disease is trauma from occlusion.
In advanced stages of periodontal disease, the number of coccoid rods increases while other bacteria types decrease.
In advanced stages of periodontal disease, the number of coccoid rods increases while other bacteria types decrease.
Food impaction can contribute to alveolar bone loss.
Food impaction can contribute to alveolar bone loss.
Overhanging restorations have no effect on periodontal health.
Overhanging restorations have no effect on periodontal health.
Trauma from occlusion is a systemic factor that causes alveolar bone loss.
Trauma from occlusion is a systemic factor that causes alveolar bone loss.
The transition from gingivitis to periodontitis involves a decrease in inflammatory cell activity.
The transition from gingivitis to periodontitis involves a decrease in inflammatory cell activity.
An ill-fitting prosthesis can exacerbate bone loss in periodontal disease.
An ill-fitting prosthesis can exacerbate bone loss in periodontal disease.
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.
