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Gnana Sekar
COMPOSITION OF BONE .
REMODELLING OF BONE
BONE COUPLING
REFERENCES
WHAT IS A BONE ?????
COMPOSITION : Inorganic material – 65%
Hydroxyapatite
Organic material – 35%
Collagen (Type – I) 88% - 89%
Noncollagen 11% - 12%
- Glycoproteins 6.5% - 10%
- Proteoglycans 0.8%
- Sialoproteins - 0.35%
- Lipids - 0.4%
Osteopontin (OPN) - also known as bone sialoprotein I (BSP-1 or BNSP) –plays role in
mineralization and bone remodelling.
What is alveolar bone ???
Meckel’s cartilage
For its development & maintenance
Morphology of Alv. Bone depends on
Size
Shape
position of teeth
Alveolar
Basal bone
process
Supporting
Cortical plates
alveolar
buccal ,lingual
Alveolar bone
bone proper Spongy bone
1 Alveolar bone proper :
It consists of a thin lamella of bone that A
surrounds the root of the tooth and give B
attachment to principle fibers of the
periodontal ligament. C
Anatomically called as –
Histologically called as –
Radiologically called as -
Bundle bone
2.supporting alveolar bone :
Type : II :- shows irregularly
arranged, numerous delicate
interdental and interradicular
trabecular.
Type-II More common in maxilla.
Histology of Alveolar bone :
Figure shows Haversian system
The interdental and interradicular
septa contain the perforating canals
of Zuckerkandl and Hirschfeld
(Nutrient canals),which house the
interdental and interradicular
arteries ,veins ,lymph vessels and
nerves.
Tooth
Nutrient canal
CREST OF ALVEOLAR BONE :
The shape of the outlines of the crest of the alveolar septa in the
roentgenogram is dependent on the position of the adjacent teeth.
In
lth
H ea
Diagram of relation between CE junction of
adjacent teeth shape of crest of alveolar septa
Nerve Supply of Alveolar Bone
Blood Supply of Alveolar Bone
Lymphatic Drainage of Alveolar Bone
Osteoprogenitor cells :
Undifferentiated mesenchymal cells and
hemotopoetic stem cells – under certain
circumstances they divide and transform in to
osteoblasts and osteoclasts.
y
RUNX2 is a key transcription factor associated with osteoblast differentiation.
β-catenin is a subunit of the cadherin protein complex
and acts as an intracellular signal transducer
in the Wnt signaling pathway.
colony stimulating factor 1 (CSF1), also known as macrophage colony-stimulating factor (M-CSF), is a
secreted cytokine which influences hematopoietic stem cells to differentiate into macrophages or other related cell types
RANKL
Member of the tumor necrosis factor (TNF) cytokine family.
Also known as –
Tumor necrosis factor ligand superfamily member 11 (TNFSF11),
TNF-related activation-induced cytokine (TRANCE),
osteoprotegerin ligand (OPGL), and
osteoclast differentiation factor (ODF)
Bone marrow expresses low levels of RANKL, it plays a critical role for adequate bone metabolism,
this surface-bound molecule (also known as CD254) found on osteoblasts serves to activate
osteoclasts, which are critically involved in bone resorption.
Osteoclastic activity is triggered via the osteoblasts' surface-bound RANKL activating the osteoclasts'
surface-bound receptor activator of nuclear factor kappa-B (RANK).
stimulation of osteoclast diffrentiation and bone resorption (lacey et.al 1998 ,kong et al 1999 )
RANK is the receptor for RANK-Ligand (RANKL) and part of the RANK/RANKL/OPG
signaling pathway that regulates osteoclast differentiation and activation
TRAF6 stimulates the activation of the c-jun N-terminal kinase (JNK) and nuclear
factor kappa-b (NF-kB) pathways
Acts as a decoy and blocks the binding of RANKL to RANK and thus prevents
Osteoclastogenesis
OSTEOGENIC LINE OF CELLS :
Osteoblasts :
Osteoblasts exhibit high level of alkaline phosphatase on their outer
plasma membrane - believed to contribute - initiation of bone
mineralization. BMP 2,7 -osteoinductive
PDG-F
During osteogenesis osteoblasts secrete GF
IGF’S
TGF-β
FUNCTIONS :
Communicate with each other and with other cells on surface
of the bone via dendritic process encapsulated in canaliculi
Play role in calcium homeostasis
Exchange of metabolic and
biochemical messages occurs
between blood stream and canaliculi
Acts as mechanosensors instructing osteoclasts where
to resorb and osteoblasts where and
when to form (BOULPAEP AND BORON 2005 :
MANOLAGAS 2000 )
Osteoclasts : (2-10 or as many as 50 nuclei)
Generally occur in clusters.
They have prominent mitochondria,
lysozomes, vacuoles and
few endoplasmic reticulum.
Activity is controlled by PTH
They are found against the
bone surface, occupying shallow
depressions called Howship’s lacunae
surfaces or in deep resorption cavities
called cutting cones.
Morphologic Characteristics
Ruffled/ Striated border
Clear zone
Sequence of events; MORPHOLOGY :
40 to 100 microns in diameter
Removal of mineral/inorganic Matrix
15 to 20 closely packed nuclei
Degradation of org. matrix
Variable in shape
BONE LINING CELLS :
Similar to osteocytes – i.e., osteoblasts that do not get embedded
in newly formed bone ,gets adhered to the outer surface of the bone
…..when bone formation halts.
Bone modeling and remodelling ….( does both
same???)
In the haversian canals, closest to the surface,
osteoclasts differentiate and resorb the haversian
lamellae and part of circumferential lamellae which is
replaced by proliferating loose connective tissue.
This area of resorption is called the cutting cone or
the resorption tunnel.
Light micrograph of bone turnover. A, Cutting cone in cross section.
Large multinucleated osteoclasts resorb an old osteon. B, Filling cone in
cross section. Uninucleated osteoblasts ring the partially formed osteon .
Bone remodeling
REMODELING involves the removal of discrete packets of old bone ,replacement of
these packets with newly synthesised protenaceous matrix and subsequent
mineralization of the matrixto form new bone . ( fernandez –tresguerres –hernandez
et.al 2006 )
Remodeling of bone
Bone multicellular unit(BMU):
local groups of osteoblasts and osteoclasts involved in bone remodelling is called bone multicellular
units (BMU).
- each unit is organized into "cutting cone" of osteoclasts reabsorbing bone followed by trail of
osteoblasts reforming the bone to fill defect
Osteoclast recruitment
Resorption
Osteoblast recruitment
Origination
Osteiod formation
Mineralization
Mineral maturation
Quiescence:
osteoblasts become resting bone lining cells on the newly formed bone surface
If OPG+RANKL=inhibit osteoclast genesis
Osteoblast OPG
RANKL
RANK
RANK
RANKL
+RANK
Osteoclast progenitor cell
Mature osteoclast
RANKL+RAaNK
Bone resorption
BONE COUPLING:
New bone formation occurs at bone resorption sites in each cycle of bone remodeling to maintain the microarchitecture required for bone's
mechanical properties. This is achieved through different levels of cellular communication. In bone matrix, TGF-β1, and probably IGF-1, act as
the primary coupling factors and are released in response to osteoclastic bone resorption. These factors induce the migration of osteoblastic cells so
that the new bone formation is spatiotemporally coupled with resorption through this mode of matricellular signaling. Negishi-Koga et al now
reveal that Sema4D secreted from osteoclasts regulates osteoblast differentiation; Sema4D activates downstream of RhoA by binding to Plexin-B.
RhoA also mediates the actions of both TGF-β1 and IGF-1. Thus, the matricellular signaling of TGF-β1 and IGF-1 is integrated with Sema4D–
Plexin-B1–mediated osteoclast-osteoblast communication through RhoA. RANK-RANKL mediates communication to induce differentiation of
osteoclast progenitors. Osteoclastic production of Sema4D is stimulated by increased osteoblastic RANKL. Sema4D then inhibits osteoblast
differentiation to balance the supply of osteoclasts and osteoblasts, thus functioning in a negative-feedback loop.
Factors regulating Bone Formation
1. Platlet derived growth factor
2. Heparin binding growth factor
3. Insulin like growth factor
4. Transforming growth factor
5. Bone morphogenic protein
Factors regulating Bone Resorption
1. IL 1
2. IL 6
3. TNF & Lymphotoxins
4. Gamma interferon
5. Colony stimulating factors
6. Prostaglandin & other Arachidonic Acid metabolites
Regulation of Bone by systemic hormones
1. Parathyroid hormone
2. 1,25 Dihydroxy vit D3
3. Calcitonin
4. Estrogen
AT MICROSCOPIC LEVEL :
4 types of bones are seen ….
Plays main role
in healing Composite
Phase I bone/
Woven bone bone
It forms very quickly
(30-60mm/day)
And resorbs very quickly
Phase II bone/
lamellar bone/
Mature load Bundle bone
Forms very slowly
(0.6-1mm/day)
bearing bone
AGE CHANGES :
I. Periodontitis
II. Periodontal abscess
III. Food impaction
IV. Overhanging restoration
V. Adjacent tooth extraction
VI. Ill-fitting prosthesis
BONE DISTRUCTION CAUSED BY EXTENTION OF
GINGIVAL INFLAMMATION :
Horizontal bone loss
Most common pattern of bone loss in periodontal
disease.
Bone is reduced in height but margin remain almost
perpendicular to tooth surface not necessarily equal
degree around same tooth
Bone deformities
Careful probing & surgical exposure required to
determine exact dimension of the defect
Vertical / Angular bone defect
.
These defects are classified on bases of No. of osseous walls
present :
walls remain intact.
Three wall
defect Combined defect
Two wall
defect
No.of walls in the apical portion of the
defect is greater than its
One wall occlusal portion .
defect
Crater:
Concavities in the crest
of interdental bone
Most common osseous
Defect -35.2 %
Most common in
Mandible – 62%
Bulbous bone contour (Exostosis) :
Bony enlargements caused by
adaptation to function or
buttressing bone formation
etc.
More frequently found in
maxilla.
Reverse Architecture
-Maxilla
Ledges :
Plateau like bone margins caused by resorption of
thickened bony plates .
Bone Destruction caused by Trauma from
Occlusion
Def:” when occlusal forces exceeds the adaptive capacity of the tissue , tissue
injury results k/a Trauma from occlusion
Vitamin D or calciferol - absorption of calcium from the gastrointestinal tract and the
maintenance of the calcium phosphorous balance.
Therefore, when you have Vitamin D deficiency you will develop rickets (in children) or
osteopenia (in adults).
The issue, is that if you have too much of Vitamin D (Vitamin D excess) then at that
time it will work on the nuclear receptors in the osteoblasts and promote bone
resorption. – they bind to vitd receptor on osteoblasts and stimuates the
expression of RANK-L - which in turn induces osteoclastogenesis
Therefore, both deficiency and excess of Vitamin D can cause osteopenia and bone
resorption.
Taylor et al suggested that poorer glycemic control leads to both an increased risk for
alveolar bone loss and more severe progression.
Bone quality is also reduced as a result of advanced glycation end products, which
eventually results in fractures.
Hyperparathyroidism :
Oral changes include malocclusion and tooth mobility, radiographic evidence of alveolar
osteoporosis with closely meshed trabeculae, widening of the lamina dura, and
radiolucent cyst like spaces.
Bone cysts become filled with fibrous tissue with abundant hemosiderin- laden
macrophages and giant cells. They have been called brown tumors, although they are
not really tumors but reparative giant cell granulomas.
In leukemia , the presence of infiltrate in marrow spaces and the periodontal ligament
results in osteoporosis of alveolar bone with destruction of the supporting bone and
disappearance of periodontal fibers. (the malignant T-lymphocytes produced an osteoclast-activating-factor-like
substance that caused osteoclast proliferation and hypercalcemia.)
In Sickle cell anemia generalized osteoporosis of the jaws, with a peculiar stepladder
alignment of the trabeculae of interdental septa and pallor and yellowish discoloration of
oral mucosa.
Pagets disease :
In pagets disease - Osteoclasts and osteoclast
precursors contain paramyxoviral transcripts and
appear hyperresponsive to 1,25-(OH)2D3 and
RANK ligand (RANKL).
Osteoclasts in Paget's disease are increased both in
number and size
BONE REGENERATION :
Osteogenesis is the ability of the graft to produce new bone, and this process is dependent on
the presence of live bone cells in the graft.
Osteoconduction is the physical property of the graft to serve as a scaffold for viable bone
healing. Osteoconduction allows for the ingrowth of neovasculature and the infiltration of
osteogenic precursor cells into the graft site.
Osteoinduction is the ability of graft material to induce stem cells to differentiate into mature
bone cells. This process is typically associated with the presence of bone growth factors within the
graft material or as a supplement to the bone graft.
BONE GRAFTS :
Is there any relation between bisphosponates
and
osteoradionecrosis of jaw ??????
References:
Dr.Narendra dev
(HOD &Prof)
Dr.S.V.Madhuri
(ASSO. Prof)
Presented by Dr.B.Lahari
Dr.s.Gnana sekar, (ASSIS.Prof)
GDC ,VJD.