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perio 2 e2 ch24 book
bone loss and patterns of bone destruction
Terms in this set (57)
The average progression of bone loss in untreated periodontitis is ? mm per year, but the range varies substantially depending on the individual's susceptibility to the disease
destructive radius of action of the inflammatory process is estimated to be 1.5 to 2.5 mm
0.2 to 0.3
? bone loss is the most prevalent form of bone destruction in periodontitis. ? bone loss is most commonly observed in areas of greater bone volume. ? bone loss is classified according to the number of bony walls surrounding the defect
Trauma from occlusion may lead to periodontal bone loss around teeth t/f
true (When combined with biofilm-induced gingival inflammation, trauma from occlusion may accelerate the rate of bone loss and/or alter the course of the inflammatory process, possibly favoring the formation of vertical defects)
the existing bone level is the consequence of ? pathologic episodes, whereas changes ? in the soft tissue of the pocket wall reflect the presence of the inflammatory condition.
the degree of bone loss does not necessarily correlate with?
a. the depth of periodontal pockets
b. the severity of ulceration of the pocket wall
c. the presence or absence of suppuration
d. all of the above
d. all of the above
The most common cause of bone destruction in periodontitis is the extension of ? from the marginal gingiva into the supporting periodontal tissues.
t/f Periodontitis is always preceded*** by gingivitis, but not all gingivitis progresses to periodontitis
In advanced stages of disease, the number of motile organisms and spirochetes ?, whereas the number of coccoid rods and straight rods ?
Fibroblasts and lymphocytes predominate in stage ? gingivitis, whereas the number of plasma cells and blast cells ? gradually as the disease progresses
Seymour and colleagues58,59 have postulated a stage of "contained" gingivitis, in which T lymphocytes are preponderant; they suggest that, as the lesion becomes a B-lymphocyte lesion, it becomes progressively ?
transeptal fibers are present, even in cases of extreme periodontal bone loss t/f
t/f Bone destruction in periodontal disease is not a process of bone necrosis.It involves the activity of living cells along viable bone.
t/f With the exception of necrotic bone that is visible in distinct pathogenic processes such as necrotizing ulcerative periodontitis and bisphosphonate-related osteonecrosis of the jaws, all bone present in areas with periodontitis is viable, live bone.
t/f The amount of inflammatory infiltrate correlates with the degree of bone loss but not with the number of osteoclasts.
t/f the distance from the apical border of the inflammatory infiltrate to the alveolar bone crest correlates with both the number of osteoclasts on the alveolar crest and the total number of osteoclasts
a range of effectiveness of about ?mm to ? mm in which bacterial biofilm can induce loss of bone.
Beyond 2.5 mm, there is little or no effect of bone loss; interproximal angular defects can appear only in spaces that are wider than 2.5 mm, because narrower spaces would end up with ? bone loss
t/f Large defects that greatly exceed a distance of 2.5 mm from the tooth surface (as described in aggressive types of periodontitis) may be caused by the presence of bacteria in the tissues
In a study of Sri Lankan tea laborers with no oral hygiene and no dental care, Löe and colleagues found the rate of bone loss averages about ? mm per year for facial surfaces and about ?mm per year for proximal surfaces when periodontal disease was allowed to progress untreated.
loss of attachment can be equated with loss of bone, although attachment loss precedes bone loss by about ? months)
6 to 8
Löe and colleagues also identified the following three subgroups of patients with periodontal disease on the basis of the interproximal loss of attachment and tooth mortality
1. 8% rapid yearly loss of 0.1mm to 1mm
2. 81% moderately 0.05mm to 0.5mm
3. 11% minimal or no progression 0.05mm to 0.09mm
Periods of destructive activity are associated with subgingival ulceration and an acute inflammatory reaction that results in the rapid loss of alveolar bone; it has been hypothesized that this coincides with the conversion of a predominantly ?lesion to one with a predominantly ?cell infiltrate
?lesions are associated with an increase in the loose, unattached, motile, gram-negative, anaerobic pocket flora, whereas periods of ? coincide with the formation of a dense, unattached, nonmotile, gram-positive flora with a tendency to mineralize
The dense network ? fiber that is attached interdentally from tooth to tooth is one of the barriers that protects the interdental bone from the inflammatory process.
Several host factors released by inflammatory cells are capable of inducing bone resorption in vitro, and they play a role in periodontal disease. These include?
a. host-produced prostaglandins and their precursors
d.tumor necrosis factor alpha
e. all of the above
e. all of the above
When injected intradermally, prostaglandin ? induces the vascular changes that are seen with inflammation; when injected over a bone surface, it induces bone resorption in the absence of inflammatory cells, with few multinucleated osteoclasts.
In addition, ? drugs (e.g., flurbiprofen, ibuprofen) inhibit prostaglandin E2 production, thereby slowing bone loss in naturally occurring periodontal disease
areas of bone formation are found immediately adj. to sites of active bone resorption and along trabecular surfaces at a distance from the inflammation in apparent effort to reinforce the remaining bone
what is this called?
buttressing bone formation
The periods of remission and exacerbation (or inactivity and activity, respectively) appear to coincide with the quiescence or exacerbation of gingival inflammation t/f
In the absence of inflammation, the changes caused by trauma from occlusion vary from?
a increased compression and tension of the periodontal ligament
b increased osteoclasis of alveolar bone to necrosis of the periodontal ligament and bone
c the resorption of bone and tooth structure
d all of the above
t/f These changes are reversible
d all of the above/ true
t/f When it is combined with inflammation, trauma from occlusion may aggravate the bone destruction caused by the inflammation and results in bizarre bone patterns.
?When it is combined with inflammation, trauma from occlusion may aggravate the bone destruction caused by the inflammation and results in bizarre bone patterns.
osteoporosis (Periodontitis and osteoporosis share a number of risk factors (e.g., aging, smoking, certain diseases, medications that interfere with healing))
Periodontal bone loss may also occur with generalized skeletal disturbances like?
c histiocytosis X
d none of the above
e all of the above
e all of the above
Thickness, width, and crestal angulation of the interdental septa
Thickness of the facial and lingual alveolar plates
Presence of fenestrations and dehiscences
Alignment of the teeth
Root and root trunk anatomy
Root position within the alveolar process
Proximity with another tooth surface
anatomic features that affect the bone destructive pattern of periodontal disease
(A) Lower incisor with thin labial bone. Bone loss can become vertical only when it reaches ? bone in apical areas.
(B) Upper molars with thin facial bone, where only ? bone loss can occur.
(C) Upper molar with a thick facial bone that allows for ? bone loss
thicker/ horizontal/ verticle
are outgrowths of bone of varied size and shape.
have been described in rare cases as developing after the placement of free gingival grafts
Angular osseous defects—as often seen in the interdental areas of the posterior dentition—cannot form in thin radicular facial, or lingual alveolar bone t/f
Bone formation sometimes occurs in an attempt to buttress bony trabeculae that are weakened by resorption. When this occurs within the jaw, it is termed ? buttressing bone formation. When it occurs on the external surface, it is referred to as ?buttressing bone formation
t/f Interdental bone defects often occur where the proximal contact is light or absent
Aggressive periodontitis usually results in attachment and bone loss around ? particularly in cases where the disease is observed in teenagers
incisors and first molars
bone loss is usually ? in nature around incisors, a ?pattern of alveolar bone destruction is found around the first molars in aggressive periodontitis.
horizontal/ vertical or angular
bone loss is the most common pattern of bone loss in periodontal disease
remains approximately perpendicular to the tooth surface.
oblique direction, leaving a hollowed-out trough in the bone alongside the root; the base of the defect is located apical to the surrounding bone
have accompanying infrabony periodontal pockets; infrabony pockets
vertical/ angular defects
Continuous defects that involved more than one surface of a tooth, in a shape that is similar to a trough, are called ? defects
The number of walls in the apical portion of the defect is often greater than that in its occlusal portion, in which case the term combined ? defect
Surgical exposure is the only sure way to determine the presence and configuration of vertical osseous defects t/f
Vertical defects increase with age t/f
Approximately ?% of people with interdental angular defects have only a single defect
Vertical defects detected radiographically have been reported to appear most often on the distal and mesial surfaces.
However, three-wall defects are more frequently found on the ? surfaces of the upper and lower molars.
are a specific type of two-wall defect; they present as concavities in the crest of the interdental bone that is confined within the facial and lingual walls
Craters have been found to make up about one-third (35.2%) of all defects and about two-thirds (62%) of all ? defects; they occur ? as often in posterior segments as in anterior segments
mandibular / twice
The following reasons for the high frequency of ? have been suggested
The interdental area collects biofilm and is difficult to clean.
The normal flat or even slightly concave buccolingual shape of the interdental septum in the lower molars may favor crater formation.
Vascular patterns from the gingiva to the center of the crest may provide a pathway for inflammation.
t/f Bulbous bone contours are bony enlargements that are caused by exostoses
t/f found more frequently in the maxilla than in the mandible
Negative architecture is more common in the maxilla of patients with periodontitis. t/f
alveolar bone architecture is the result of a loss of interdental bone, without a concomitant loss of radicular (buccal or lingual/palatal) bone, thereby reversing the normal (or positive) architecture
Reverse (or negative)
? are plateau-like bone margins that are caused by the resorption of thickened bony plates
refers to the invasion of the bifurcation and trifurcation of multirooted teeth by periodontitis
in furcation involvement that the mandibular first molars are the ? common sites and that the maxillary premolars are the
t/fThe number of furcation involvements increases with age
grade ? involves partial bone loss (cul-de-sac)
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