Periodontal bone defects: Classification, diagnosis
Plan :
-Introduction
1-Physiological balance of the alveolar bone
2-Etiology of bone defects
-inflammation
-occlusal trauma
3-Mechanisms of bone resorption
-Gap resorption
-Halisterese
-Vascular growth
4-Classification and forms of bone destruction in periodontal disease
4-1-horizontal bone lysis
4-2-Bone defects (bone damage)
4-2-1-lesions of the interdental bone
4-2-1-1-bone craters
4-2-1-2-Hemisepta
4-2-1-3-infraosseous lesions
4-2-1-4-furcation involvement
4-2-2-marginal bone lesions
4-2-2-1-irregular edge
4-2-2-2-Protrusions
4-2-2-3-Window
4-2-2-4-Exostosis
4-2-2-5-Bulbous outline of the bone
5-Diagnosis
5-1Clinic
5-2-Radiographic
5-2-1-Panoramic
5-2-2-Reto-alveolar
5-2-3-Cone Beam
Conclusion
Bibliography
Introduction: The key to the problem of chronic destructive periodontal disease lies in the changes in the bone. Changes in other tissues of the periodontium are also important, but when the final analysis of the facts is made, it is the destruction of the bone that is responsible for tooth loss.
1-Physiological balance of the alveolar bone: the height of the alveolar bone is normally maintained by a constant balance between bone formation and resorption which is itself regulated by local and general influences. Bone lysis, in periodontal disease, can be the result of any of the following transformations:
-increased resorption in the presence of normal or increased formation.
-decrease in formation in the presence of normal resorption.
-increased resorption combined with decreased formation.
2-Etiology of bone defects: Bone destruction in periodontal disease can be caused mainly by local factors but also by general factors.
-inflammation : chronic inflammation is the most common cause of bone destruction in periodontal disease.
-Occlusal trauma : Occlusal trauma can cause bone destruction in the absence of any inflammation, or in combination with it.
3-Mechanisms of bone resorption : the following types of bone resorption have been described:
1- lacunar resorption (osteoclasia) : bone destruction comes from the action of osteoclasts. Osteoclasts destroy bone in different ways:
1-initial decalcification of bone mineral salts, caused by a lowering of the PH.
2-proteolytic action of the organic matrix, causing the release of calcium salts.
3-simultaneous destruction of organic and inorganic components.
4-phagocytosis of the organic matrix after the disappearance of inorganic salts resulting from alterations of the local physicochemical balance.
2-Halisteresis (osteolysis) : during this process the bone divides into its different components without undergoing the action of osteoclasts. This non-cellular destruction is explained by a softening and liquefaction of the organic matrix followed by a filtration of the inorganic components, loss of the inorganic components caused by disorders of the physicochemical balance and followed by a dedifferentiation of the organic component into connective tissue.
Opinions differ as to whether bone resorption can occur without the action of osteoclasts.
3-Increased vascularization : The increase in osteoclastic resorption has been attributed to the pressure due to hyperemia. The increase in circulation within the bone promotes its resorption, while blood or lymphatic stasis promotes its formation.
4-Classification and form of bone destruction in periodontal disease:
4-1-Horizontal bone lysis : This is the most common form of destruction in periodontal disease. The height of the bone is reduced and its edge becomes horizontal or slightly angulated. The interdental septa and the vestibular and lingual tables are affected, but to varying degrees of severity around the same tooth.
4-2-Bone defects (bone lesions)
4-2-1-interdental bone lesion
- Bony craters : these are concavities located inside the interdental ridge, bordered by two vestibular and lingual walls and less frequently located between the dental surface and the vestibular or lingual bony table.
- Hemisepta : The portion of interdental septum that remains after the mesial or distal portion has been destroyed by disease is called hemisepta.
- Infrabony lesion : Such lesions appear as cavities in the bone located along one or more exposed roots between one, two, three or four bony walls.
- Furcation involvement
4-2-2-Marginal bone lesion
- Irregular margin : These are angular or U-shaped lesions that are caused by resorption of the vestibular or lingual alveolar cortex, or by differences in height between the vestibular or lingual marginal margins and the height of the interdental septa.
- Protrusions : These are plateau-like bony edges that are caused by the resorption of thickened bony tables.
- Fenestration and dehiscence : isolated parts where the root is exposed, and where its surface is covered only by the periosteum and the overlying gingiva, in the case where the bony edge is intact, are called fenestration; if these exposed parts extend to the edge, they are called dehiscences.
- Exostosis : Exostoses are bone growths of varying size and shape. They occur more often on the vestibular surface than on the lingual surface and do not appear to serve any function.
- Bulbous contour of the bone : these are bone thickenings caused by exostoses, functional adaptation or buttress formation of the bone.
Diagnosis :
Clinical diagnosis : The presence of bone defects can be revealed by radiography , but it is necessary to carefully probe the area in question and expose it surgically to determine their structure and size.
Radiological diagnosis :
-Panoramic radiography : provides a global view of the alveolar arches. This is the screening examination par excellence. Indicated for assessing the overall bone level or detecting the most significant lesions, it gives way to intra-oral images for more precise images.
-Retroalveolar : retroalveolar images are simple radiographs that are very rich in information and perfectly indicated for periodontal structures. Well targeted, these images can complement a panoramic examination when monitoring the treatment of periodontal disease. The long cone assessment is therefore the radiographic examination of choice in periodontology.
– Cone Beam Computed Tomography (CBCT) : CBCT was specifically developed to explore the orofacial sphere and more particularly the teeth and their anatomical environment. International recommendations recommend replacing CT scanning with CBCT examination in the dental setting. 3D imaging is useful in exploring craters and furcation defects. By providing information on the 3D morphology of inter-radicular and endo-periodontal lesions, sectional imaging could improve surgical planning and better estimate the regeneration potential.
Periodontal bone defects: Classification, diagnosis
Conclusion: Destructive periodontal disease causes transformations in the alveolar bone leading to its destruction which is responsible for tooth loss.
Periodontal bone defects: Classification, diagnosis
Bibliography:
-IRVING Glickman Clinical periodontology prevention, diagnosis and treatment of periodontal diseases in the context of general dentistry. Edition cdp 57, rue Dulong-75017 Paris.
-Philipe Bouchard periodontology implant dentistry Surgical therapeutic volume.
Periodontal bone defects: Classification, diagnosis
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.