Alveolar Bone GN PDF

In partnership with Alveolar Bone Jiann Khaw Tutor Dentist  To outline The clinical and Aim radiographic anatomy of alveolar bone 2 Learning Outcomes: At the end of this session, you should be able to: 1. Identify structure and function of alveolar...

In partnership with Alveolar Bone Jiann Khaw Tutor Dentist  To outline The clinical and Aim radiographic anatomy of alveolar bone 2 Learning Outcomes: At the end of this session, you should be able to: 1. Identify structure and function of alveolar bone 2. Identify features of alveolar bone from healthy to disease 3. Recognise relevance of radiographic assessment in periodontal disease GDC Learning Outcome: 1.1.5, 1.2.5 C1.5, C1.17 3  Alveolar process = alveolar bone Alveolar Bone Structure and Func,on MAORI WHALE BONE CLUB, KOTIATE PARAOA  Bone is much thinner on Buccal side Periodon7um 1.Gingiva 2.Periodontal ligament 3.Cementum B plu 4.Alveolar Bone Demineralised section of tooth in 5 situ. Source: Berkovitz et al.  Week 18 - alveolar bone laid down initially. Development of alveolar bone Schematic diagrams of tooth development. AM: ameloblasts, BO: alveolar bone, DE: dentin, DP: dental pulp, DF: dental follicle, ED: embryonic day, EN: enamel and OD: odontoblasts. Diagram by Nakao & Tsuji (2008) 6 Structure Supports the teeth. Alveolar Bone / Process Only present where there is teeth Forms in relation to teeth 7  Structure Basal Bone / Buccal Body of Palatal Maxilla Alveolar Bone Structurally similar and continuous with basal bone "File:624 Diagram of Compact Bone-new.jpg" by OpenStax College is licensed under CC BY 3.0 Longitudinal cross-section of Maxillary canine in alveolar bone. Source: Berkovitz et. al. 8  Thicker bone posterior region to support the molars for mastication. Resorption - Perio/trauma Structure Incisors Canines Pre-moalrs Molars UPPER LOWER Subjected to ! continuous and rapid remodeling from tooth eruption and mastication Buccolingual sections through maxilla and mandible demonstrating distribution of alveolar bone in relation to roots of teeth. Source: Berkovitz et al. 9  Support Protection - tooth and root Attachment - PDL (fibrous) attached Shock absorber - absorbs forces Func7on Suppo rt Protecti on Attachm ent Shock absorber 10 Func7on A2achment – Sharpey’s :bres Histology slide showing Sharpey's [bres (horizontal lines) attachment in alveolar bone (A) forming periodontal ligament. Cementum (B). Source: Berkovitz et al. 11 Alveolar Bone Health to Disease Inuit Snow Goggle, Carved bone Healthy Maximum up to 3mm (borderline) Height of Cemento-Enamel Junc7on (CEJ) to alveolar bone crest is between 1 to 2mm Image source: Lira-Junior & Figueredo Picture of maxillary anterior teeth with healthy gingivae. Source: Pocketdentistry.com 13 Unhealthy When biofilm acculimates; response is the shrinking of Puffy gingiva bone. = resorption Slightly darker pink margins Plaque Recession Disease: Periodon77s Image source: Lira-Junior & Figueredo Source: J. Khaw 14  Upper central incisors closing behind lower incisors - causes increased force on specific outstanding tooth (trauma) Outcome - lose Buccal alveolar bone, can be significant and consistent. Orthodontic patients - movement of teeth too quickly, not enough time for bone to remodel Defect: Dehiscence Source: J. Khaw Mrzezo. (2015) Risk factors of gingival recession. Available at: https://pocketdentistry.com/9-mucogingival-grafting-procedures-an -overview / (Accessed: April 2021) 15  Loose bone will only occur after extraction when Localised bone is loosened and not removed. Root perforated/pierced Buccal gingiva due to trauma. Defect: Fenestra7on Edney, M. (2000) Interesting presentation of a retained upper deciduous incisor with apical fenestration. Br Dent J 188, 369–370. Mrzezo. (2015) Risk factors of gingival recession. Available at: Available at: https://doi.org/10.1038/sj.bdj.4800483 (Accessed: https://pocketdentistry.com/9-mucogingival-grafting-procedures-an April 2021) -overview / (Accessed: April 2021) 16  Radiographic changes Age changes to alveolar bone: Osteoporosis  bone loss (low density) Brittleness  decreased water content Sponge bone become thin trabecular, wide marrow spaces Source: J. Khaw 17 Alveolar Bone Radiographic appearance Damien Hirst Self Portrait Radiograph  Radiographic features Alveolar bone crest / Alveolar crest Insert or Drag and Drop Image Here Lamina dura Whiter area/compact bone Periodontal ligament space Dark space Cancellous bone / Spongy bone Image source: Dentist in Richmond webpage. 19 Radiographic features of alveolar bone in healthy state Alveolar crest Cemento- enamel Junction (CEJ) Alveolar crest Bitewing radiograph (leD) Periapical radiograph 20  DPT / OPG Radiographic features of alveolar bone in healthy state Aprox. 1-2mm in healthy state. CEJ Alveolar crest "Dental X-ray" by icethim is licensed under CC BY 2.0 Dental Panoramic Tomography (DPT) or OrthoPantomoGraph 21 (OPG)  Bone loss - darker/black Increase in height between alveolar crest and cement-enamel junction CEJ - disease/unhealthy Radiographic features of alveolar bone in disease state Calculus spur Widening of periodont al ligament space Loss of bone in furcatio n region Disease state Healthy 22 Radiographic features of alveolar bone in disease state x 23  Classification guidelines To classify amount of bone loss - HAVE to use radiographs Radiographic relevance of alveolar bone crest height in severity of Periodon77s classiKca7on 24  Stage III Stage III Stage II 25  % bone loss / patients age How quick the periodontal disease is for specific patient Radiographic relevance of alveolar bone crest height in severity of Periodon77s classiKca7on 26  X = percentage of bone loss from CEJ Percentage bone loss - 50% ish Y = percentage of bone remaining?? 50 / patients age y x 27  Structure and Features of Function health to disease Alveolar Bone Summary Relevance Radiographic in Dentistry relevance Link to: Diagnosis of Periodontitis Foundation of dental health Adaptation of diagram by S.Balian (2021) 28 Bibliography: 1. Berkovitz, BKB; Holland, GR & Moxham, BJ. (2018) Oral Anatomy, Histology and Embryology. 5 th Edi,on. London: Elsevier. 2. Bri,sh Society of Periodontology (2018) BSP [owchart implemen,ng the 2017 classi:ca,on of Periodontal Disease to reach diagnosis in clinical prac,ce. London: Bri,sh Society of Periodontology. Available at: h2ps://www.bsperio.org.uk/assets/downloads/111_153050_bsp-[owchart-implemen,ng-the-2017-cla ssi:ca,on.pdf (Accessed: 2 October 2024). 3. Bri,sh Society of Periodontology. (2016) The Good Prac,,oner’s guide to Periodontology. London: BSP. Available at: h2ps://www.bsperio.org.uk/assets/downloads/good_prac,,oners_guide_2016.pdf (Accessed: 2 October 2024). 4. Edney, M. (2000) Interes,ng presenta,on of a retained upper deciduous incisor with apical fenestra,on. Br Dent J, 188, pp. 369–370. DOI: 10.1038/sj.bdj.4800483 5. Nakao, K. and Tsuji, T. (2008) Dental regenera,ve therapy: Stem cell transplanta,on and bioengineered tooth replacement. Japanese Dental Science Review, 44 (1), pp. 70-75. DOI: 10.1016/j.jdsr.2007.11.001 29