ALVEOLAR

BONE
LEARNING OBJECTIVES
At the end of the class, you should be able to-

• Define alveolar process

• Describe the development of alveolar bone
• Enumerate the cells of the alveolar bone and their functions
• List the composition of the bone matrix
• Explain the process of bone remodelling
• Define fenestration and dehiscence
• Describe the vascular supply of alveolar bone
CONTENTS

• Definition • Bone marrow

• Development of alveolar process • Periosteum and endosteum
• Parts of the alveolar process • Interdental septum
• Osseous topography
• Cells of the alveolar bone
• Fenestration and dehiscence
• Intercellular matrix • Ostectomy and osteoplasty – Clinical
• Bone remodeling applications
• Socket wall • Blood supply of alveolar bone
 DEFINITION
• The alveolar process is the portion of the maxilla
and mandible that forms and supports the tooth
sockets (alveoli)- Carranza

• Constitutes the attachment apparatus of the teeth

• Distribute and resorb forces generated by mastication
and other tooth contacts
 DEVELOPMENT OF ALVEOLAR PROCESS
• Forms when the tooth erupts to provide the osseous attachment to the forming
periodontal ligament
• Disappears gradually when tooth is lost
n t b o n y
d e p e n de
Tooth t u r es
s t r u c
Alveolar Bone

Cells from dental Cells

follicle- independent of
ALVEOLAR tooth
BONE PROPER development
 Alveolar bone The succedaneous
When deciduous Alveolar bone and
develops around permanent tooth
tooth is shed- its basal bone- derived
each tooth follicle moves into place
alveolar bone is from neural crest
during and develops its
resorbed ectomesenchyme
odontogenesis own dental follicle
 Mandibular Maxillary basal
basal bone bone
begins begins at the
mineralization at exit of
the exit of infraorbital
mental nerve nerve from
from mental infraorbital
foramen foramen
 Just before
Enzymes- help to
mineralization-
Vesicles- contain jumpstart the
osteoblasts start
enzymes nucleation of HA
producing matrix
crystals
vesicles

Through bone
As the crystals grow
deposition, remodeling,
and develop – they
secretion of collagen
form coalescing bone
fibres- mature lamellar
nodules
bone
 Mineral deposition at Mineralized areas
Early fetal life small foci in the increase in size,
INTRAMEMBRANO mesenchymal matrix fuse , become
US OSSIFICATION surrounding tooth resorbed and
buds remodelled

Continuous mass of
bone is formed
around the erupted
teeth
PARTS OF THE ALVEOLAR PROCESS

CORTICAL BONE

ALVEOLAR BONE PROPER

SUPPORTING ALVEOLAR BONE

BASAL BONE
 Cancellous portion of
alveolar bone -trabeculae
that enclose irregularly More cancellous bone exists
shaped marrow spaces lined in maxilla than mandible in
by thin ,flat endosteal cells adult human.

Cancellous bone- found

predominantly in the
interradicular and interdental
spaces and in limited
amounts facially or lingually
except in palate
 CELLS OF THE ALVEOLAR BONE
Osteoblasts- bone growth by apposition of an organic
matrix

Osteocytes - extend processes into canaliculi that

radiate from the lacunae
Canaliculi- anastomosing system- brings oxygen and
nutrients to the osteocytes through blood and removes
waste products
Osteons(Haversian systems)- internal mechanisms that
bring vascular supply to thick bones (outer cortical
plates and alveolar bone proper)

Osteoclasts- cells that resorb bone

COMPOSITION -INTERCELLULAR MATRIX
INORGANIC MATRIX(two
ORGANIC MATRIX(one third)
thirds)
• Calcium • Type I collagen (90%)
• Phosphate • Noncollagenous proteins
• Hydroxyl • Osteocalcin
• Carbonate • Osteonectin
• Citrate • Bone morphogenetic protein
• Sodium • Phosphoproteins
• Mg • Proteoglycan
• Fluorine • Osteopontin
• Bone sialoprotein
• Cytokines, chemokines ,
growth factors
CLASSIFICATION OF ALVEOLAR
BONE:

KEVITTS CLASSIFICATION

HYPOCALCEMIC NORMAL HYPERCALCEMIC

 RADIOGRAPHIC APPEARANCE

Type 1 Type 2
 COMPACT

MATURE

CANCELLOUS
HISTOLOGICALLY

IMMATURE WOVEN BONE

 FUNCTIONS OF ALVEOLAR BONE
Houses the roots of teeth

Anchors the roots of teeth to the alveoli, which is achieved by the insertion of Sharpey’s
fibers into the alveolar bone proper

Helps to move the teeth for better occlusion

Absorbs and distribute occlusal forces

Supplies vessels to PDL

Houses & protect developing permanent teeth while supporting primary teeth

Organizes eruption of primary and permanent teeth

Questions session
 • The alveolar bone is constantly changing its internal organization but
retains the same form from childhood through adult life- HOW???

Bone
deposition by
osteoblasts

Bone
resorption by
osteoclasts
BONE REMODELLING?
Resorption followed by formation

Involves coordination of activities of osteoblasts and osteoclasts

Major pathway of bony changes in shape, resistance to forces, repair

of wounds and calcium and phosphate homeostasis in the body

Both cortical and cancellous bone constantly undergo remodelling

PHASES OF BONE REMODELLING
BONE MODELLING AND REMODELLING
REGULATION OF BONE REMODELLING
Regulation of bone remodeling is a complex process involving
hormones and local factors in an autocrine and paracrine manner
on the generation and activity of differentiated bone cells

Bone- 99% of body’s Ca ions – major source for Ca release when

Ca blood levels decrease

Monitored by the parathyroid gland

A decrease in blood Ca – mediated by receptors on the chief cells

of parathyroid glands- release parathyroid hormone(PTH)
 Osteoblasts
Interdependency COUPLING

Osteoclast

Coupling process ensures that the amount of bone removed is equivalent to the amount of bone laid
down during the subsequent bone formation phase
 BONE RESORPTION AND
MECHANISMS OF OSTEOCLAST ACTIVITY

Osteoclasts originate
When osteoclasts are The activity of
from hematopoetic
active- ruffled border- osteoclasts and
tissue and are formed
Howship’s lacunae morphology of ruffled
by the fusion of hydrolytic enzymes-
and osteoclasts mononuclear cells of
border can be modified
digest organic portion and regulated by PTH
asynchronous of bone and calcitonin
populations
• Another mechanism of bone resorption – creation of an acidic
environment on the bone surface – dissolution of mineral component of
bone

Ten
99 4 )
1
Cate(
Attachment of Creation of Degradation of Sequestering
osteoclasts to sealed acidic matrix to of mineral
the mineralized environment amino acids by ions and
surface of bone which enzymes amino acids
demineralizes
within the
bone and
exposes osteoclast
organic matrix
 SOCKET WALL
• Consists of dense, lamellated bone some of which is
arranged between Haversian systems and bundle bone

• BUNDLE BONE- bone adjacent to PDL that contains great

no. of Sharpey’s fibres

• Some fibres are completely calcified but most contain an

uncalcified central core within a calcified outer layer

• Characterized by thin lamellae arranged in layers parallel to

the root with intervening appositional lines

• Localized within alveolar bone proper

 Sharpey’s fibers enter the bundle bone at right angles or obliquely.
 These are mineralised at the periphery and non mineralised at the
core
 Most of the sharpey’s fibers are seen at the alveolar crest region of
cribriform plate.
 At cervical region of Interdental septa, where bone is compact,
sharpey’s fibers entering the bone in mesiodistal plane become
continuous with similar fibers from roots of adjacent teeth -
TRANS ALVEOLAR FIBERS
 Alveolar fibers are less numerous , less mature and are of larger
diameter
 BONE MARROW
• In the embryo and newborn- red hematopoetic marrow
• Red marrow- undergoes physiologic change to the fatty
or yellow inactive type of marrow

• In adults-
• Yellow marrow- predominant
• Red marrow- ribs, sternum, vertebrae, skull and
humerus
• foci of red marrow in jaws with resorption of bony
trabeculae- maxillary tuberosity, maxillary and
mandibular molar and premolar area, mandibular
symphysis, ramus
 PERIOSTEUM AND ENDOSTEUM

• The tissue covering the outer surface of bone-

periosteum
• Tissue lining the internal bone cavities - endosteum

PERIOSTEUM ENDOSTEUM

Outer layer- rich

in blood vessels Inner layer-
Inner layer - Outer layer-
and nerves, osteogenic
osteoblasts fibrous
collagen fibres
and fibroblasts
INTERDENTAL SEPTUM

• Consists of cancellous bone bordered by socket wall

cribriform plates (lamina dura or alveolar bone proper) of
approximating teeth and facial and lingual cortical plates

• Narrow interdental space- septum consists of only

cribriform plate
• If roots are too close together-
irregular “window” can appear in the
bone between adjacent roots

• The mesiodistal and faciolingual

dimensions and shape of the
interdental septum are governed by :

• Size and convexity of crowns of

two approximating teeth
• Position of teeth in the jaw and
their degree of eruption
 OSSEOUS TOPOGRAPHY
• The bone contour – prominence of the
roots with intervening vertical depressions
that taper toward the margin
• Alveolar bone anatomy varies among
patients
• Height and thickness of the facial and
lingual bony plates are affected by:
Teeth alignment
Angulation of root to the bone
Occlusal forces
• On teeth in labial version- margin
of labial bone is located farther • On teeth in lingual version-
apically that on teeth in proper facial bony plate is thicker
alignment than normal
• Bone margin is thinned to a knife • Margin is blunt , rounded and
edge and presents an accentuated horizontal rather than arcuate
arc in the direction of apex
FENESTRATION AND DEHISCENCE

• FENESTRATIONS- Isolated areas in which

the root is denuded of bone and the root
surface is covered only by periosteum and
overlying gingiva; marginal bone is intact

• DEHISCENCE - when the denuded areas

extend through marginal bone, the defect is
called dehiscence
 Fenestration and
Occur often on facial bone More common on anterior
dehiscence occur in 20%
than on lingual bone teeth than posterior
of teeth

Predisposing factors -
prominent root contours, Fenestration and
malposition, labial dehiscence- complicate
Frequently bilateral
protrusion of root outcome of periodontal
combined with a thin surgery
bony plate
 OSTEOPLASTY OSTECTOMY
Reshaping of the alveolar process to achieve a more The excision of portion of bone to correct or reduce
physiologic form without removal of alveolar bone proper deformities in the marginal and interproximal bone ( removal
(not removing Supporting bone) of bone that is attached to tooth)

CLINICAL APPLICATIONS CLINICAL APPLICATIONS

• Buccal or lingual bony ledges, tori • Elimination of shallow or moderate craters

• Shallow or moderate intrabony defects associated with • Intrabony pocket not amenable to reattachment procedure
tilted molars • Horizontal alveolar bone loss with irregular marginal bone
• Shallow buccal or lingual crater level
• Flat interproximal areas
• Elimination of deep interproximal defects to achieve a
physiologic contour
• Incipient furcation invasions
• Improvement of alveolar contours for flap adaptation
CONDITION INVOLVING LOSS OF ALVEOLAR BONE

Adjacent tooth
extraction

Functional
Periodontitis
forces

Systemic
Age changes
factors

Overhanging Trauma from

restorations occlusion
 VASCULAR SUPPLY TO THE ALVEOLAR BONE

• The vascular supply to bone enters the interdental septa

through nutrient canals together with veins, nerves and
lymphatics by superior and inferior alveolar arteries

• Dental arterioles send tributaries through the PDL

• Some small branches enter the marrow spaces of the bone

through perforations in the cribriform plate

• Small vessels that emanate from the facial and lingual

compact bone also enter the marrow and spongy bone
 SUMMARIZE

• Definition
• Development
• Parts and Composition
• Its functions
• Remodelling and its mechanism
• Regulations of bone remodeling
• Fenestration and dehiscence
• Conditions involved
• Blood supply
THANK YOU