Patterns of Bone Loss And Destruction in Periodontics

Bone Loss And Patterns Of Bone Destruction

The Patterns of Bone Destruction in Periodontal Disease

• Horizontal bone loss
• Margins gutter
• Irregular bony margins
• Vertical or angular defects
• Osseous craters
• Bulbous bony contours
• Reverse architecture
• Ledges
• Furcation involvement
• Fenestration and dehiscence

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Read And Learn More: Periodontics Question And Answers

“Importance Of Identifying Bone Loss Patterns In Periodontics”

Horizontal Bone Loss

Horizontal Bone Loss is the most common pattern of bone loss in periodontal disease. The bone is reduced in height but the bony margin remains approximately perpendicular to tooth surface. The interdental septa and facial and lingual plates are affected, but not necessarily to an equal degree around the same tooth.

Vertical or Angular Defects

These are those defects occurs in oblique direction, leaving a hollowed out trough in bone alongside the root, the base of defect is located apical to surrounding bone. In most of the situation angular defects are accompanied by infrabony pockets.

Osseous Craters

They are concavities in the crest of the interdental bone confined within the facial and lingual walls. It is found to make up two-thirds of all mandibular defects, can be diagnosed by transgingival probing.

The following reasons have been suggested for the high frequency of interdental craters:

• Interdental areas are more prone to the accumulation of plaque and are more difficult to clean.
• The normal flat or even concave sublingual shape of the interdental septum in lower molars may favor crater formation.
• Vascular patterns from the gingiva to center of the crest may provide a pathway for inflammation.

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Bulbous Bony Contours

They are bony enlargements caused by exostoses, adaptation to function or buttressing bone formation. They are found more frequently in the maxilla than mandible.

Reversed Architecture

These defects are produced by loss of interdental bone, including the facial and lingual plates without concomitant of radicular bone, thereby reversing the architecture (more common in maxilla).

Ledges

They are plateau-like bone margins caused by resorption of thickened bony plates.

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Furcation Involvement

It refers to the invasion of the bifurcation and trifurcation of multirooted teeth by periodontal disease. Mandibular first molars are most common sites and also common are maxillary premolars.

The role of trauma from occlusion in the effect of furcation involvement is controversial; others include by careful probing with Naber’s probe and radiograph of this area is helpful, but can be obscured by varied factors such as, angulations of the beam and radiopacity of adjacent structures.

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Fenestration and Dehiscence

• Fenestrations are the isolated areas in which root is denuded of bone and marginal bone is intact while dehiscence are the denuded areas which extend through marginal bone.
• They are associated with extreme buccal or lingual version of teeth.
• These defects are important clinically because wherever these defects occur root is only covered by periosteum and overlying gingiva.
• These areas become crucial, if periodontal disease occur or if gingival recession takes place since they may complicate therapy and adversely affect area’s prognosis.

Marginal Gutter

It is a shallow linear defect between marginal bone of radical cortical plate or interdental crest, extending the length of one or more root surfaces, usually formed by resorption of socket side of plate and deposition of facial surface.

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Irregular Bony Margins

They are the abrupt irregularities in scalloped level of marginal bone and interdental septa.

Question 2. Write short note on bone loss and pattern of bone loss.
Answer. Bone loss in periodontal diseases is determined by the radiograph.

• It shows amount of remaining bone rather than amount of bone lost.
• Amount of bone loss is estimated to be the difference between the physiologic bone level of the patient and height of remaining bone.
• The distribution of bone loss is an important diagnostic sign. It points to the location of destructive local factors in different areas of mouth and in relation to different surfaces of same tooth.