Alveolar Bone in

Health
Prepared By: Dr. Dhiren

Dhanani

CONTENTS
Introduction
Classification
Composition
Development of the alveolar bone
Structure of the alveolar bone
Radiogrphic features
Cell types in bone

 Matrix components
Bone formation
Bone resorption
Osseous topography
Bone resorption and formation-coupling
Implant-bone interface

INTRODUCTION
Bone is a mineralized connective tissue. It is unique

in body in that it exists both as a tissue and as an

organ. An example for Organ is maxilla and mandible.
Each of the bony organs that are collectively called
Skeleton, which is primarily composed of a tissue i.e
called bone. Therefore the bony skeleton is
constructed from the same basic building material
which is called bone mass.

 The structural organization and composition of bone

reflects the activity of the cells involved in the

formation of the organic matrix.

ALVEOLAR BONE:
The part of the maxilla or mandible that supports and
protects the teeth is known as alveolar bone.

Functions - mineralised supporting tissue

- gives attachment to muscles
- provide a framework for bone marrow
- act as a reservoir for ions (especially calcium).
- most important biological properties of bone is
its "plasticity', allows
it to remodel according to the functional
demands placed upon it

CLASSIFICATION:

 DEVELOPMENTALLY,
Endochondral bone where the bone is preceded by
a cartilaginous model which is eventually replaced by
bone.

Intramembranous bone

where the bone forms

directly within a vascular fibrous membrane.

HISTOLOGICALLY,

according to its density,

mature bone can be divided into;

Compact (cortical) bone

Cancellous (spongy) bone

COMPOSITION:
DEVELOPMENT
Alveolar bone is dependent on the presence of teeth for its
development and maintenance.

 At the late bell stage, bony septa and bony bridge start to
form, and separate the individual tooth germs from another,
keeping individual tooth germs in clearly outlined bony
compartment.

At this stage, the dental follicle surrounds each tooth germ,

which is located between a tooth germ and its bony

compartment. Even prior to root formation, the tooth germs
within bony compartments show continued bodily
movement in various directions to adjust to the growing
jaws. This movement causes minor remodeling of bony
compartment through bone resorption and deposition of new
bone.

The major changes in the alveolar processes begin to occur

with the development of the roots of teeth and tooth

eruption. As the roots of teeth develop, the alveolar
processes increase in height.

At the same time, some cells in the dental follicle also

differentiate into osteoblasts and form the alveolar bone

proper. The formation of the alveolar bone proper is closely
related to the formation of the periodontal ligament and
cementum during root formation and tooth eruption.

 Thus, the size and shape of the individual developing tooth

roots determine the overall structure of the alveolar bone

proper. On the other hand, the rest of bony structures in the
alveolar process are achieved by periosteal bone formation.

STRUCTURE OF ALVEOLAR BONE

The maxilla and mandible of the adult human can be

subdivided into two portions:
(a) The alveolar process that involves in housing the roots
of erupted teeth
(b) The basal body that does not involve in housing the
roots.

As a result of its functional adaptation, two parts of the

alveolar process can be distinguished.

Alveolar bone proper

Supporting alveolar bone

- cortical plate, which consists of compact bone and

forms outer and inner plates of alveolar processes.
- spongy bone, which fills area between these plates
and alveolar bone
proper, also known as cancellous
bone.

CORTICAL PLATES:

Thinner in maxilla
Thickest

in premolar & molar regions of lower jaw

especially on buccal side. In mandidle- dense..

In maxilla-perforated-blood & lymph vessels pass. Anterior

region-supporting bone is thin, no cancellous bone. Cortical

bone is fused with alveolar bone proper.

SPONGY BONE:

Type 1: The interdental and interradicular trabeculae are

regular and horizontal in a ladder like arrangement.

Type

2: Shows irregularly arranged numerous delicate

interdental and interradicular trabeculae

INTERDENTAL SEPTA:

consists of cancellous bone bordered by the socket wall

cribriform plates of approx. teeth and facial and lingual
cortical plates.

The mesiodistal angulation of the crest of the interdental

septum usually parallels a line drawn between CEJ of the

approximating teeth.

Distance between crest of the alveolar bone and CEJ in

young adults is 0.75-1.49mm (avg.1.08mm). This distance
increases with age to an average of 2.81mm.

The

interdental and interradicular septa contain the

perforating canals of Zuckerkandl and Hirschfeld which
house interdental or interradicular arteries, veins, lymph
vessels and nerves.

BUNDLE BONE (LAMINA DURA) AND

CRIBRIFORM PLATE:

Bundle bone is the part of alveolar bone, into which the

fiber bundles of the PDL insert. The ABP appears as an
opaque line called LAMINA DURA.

Embedded within this bone are the extrinsic collagen fiber

bundles of PDL.

 Lining of alveolar bone is fairly smooth in youngsters but

with age, the socket lining become rougher.

It is referred to as cribriform plate because of perforation

through which the blood vessels, lymphatics and nerves of

PDL pass.

HAVERSIAN SYSTEM

Bone is deposited in layers, or lamellae, each lamella

being about 5m thick.

4 and 20 concentric lamellae within each Haversian

system.

The longitudinally running Haversian canals are

connected by a series of horizontal ones (interconnecting
canals).

Three distinct types of layering are recognized:

1) Circumferential lamellae enclose the entire adult
bone, forming its outer perimeter.

2) Concentric lamellae make up the bulk of compact

bone and form the basic metabolic unit of bone, the osteon.
3) Interstitial lamellae are interspersed between adjacent
concentric lamellae and fill the spaces between them .

Bone Marrow:
In the embryo and newborn, the cavities of
all bones are occupied by red hematopoietic
marrow. The red marrow gradually undergoes
a physiologic change to the fatty or yellow
inactive type of marrow.
In the adult, the marrow of the jaw is
normally of the latter type, and red marrow is
found only in the ribs, sternum, vertebrae,
skull, and humerus.

Periosteum:
The tissue covering the outer surface of bone
is termed periosteum.
The periosteum consists of:

An inner layer composed of osteoblasts

surrounded by osteoprogenitor cells, which

have the potential to differentiate into
osteoblasts,

An outer layer rich in blood vessels and

nerves and composed of collagen fibers and

fibroblasts.

Endosteum:
The tissue lining the internal bone cavities is
called endosteum.
The endosteum consists of:

An inner layer is the osteogenic layer and

An outer is the fibrous layer.

RADIOLOGIC FEATURES
Lamina dura:

 Tooth sockets are bounded by a thin radiopaque layer of

dense bone called, lamina dura ("hard layer").

It

is caused by the fact that the x-ray beam passes

tangentially through many times the thickness of the thin
bony wall, which results in its observed attenuation.

Alveolar crest:

The gingival margin of the alveolar process that extends

between the teeth is apparent on radiographs as a radiopaque

line, the alveolar crest.

The level of this bony crest not more than 1.5 mm from the
CEJ of the adjacent teeth is considered normal.

Radiographs

can demonstrate only the position of the crest;

determining the significance of its level is primarily a clinical
problem.

Cancellous bone:

 The cancellous bone (also called trabe.cular bone, or spon-giosa)

lies between the cortical plates in both jaws.

It is composed of thin radiopaque plates and rods (trabec-ulae)

surrounding many small radiolucent pockets of marrow.

CELL TYPES IN BONE:

Osteoblasts
These are specialized fibroblast -like cells of
mesenchymal origin.

Cuboidal or slightly elongated , uninucleated cells.

Contain a cytoplasm rich in synthetic and

secretory organelles as rough ER, Golgi apparatus,

secretory granules and microtubules

Secretes- Osteoid

 unmineralized bone matrix

thickness 5-10 before reaching a level of
maturity conducive to mineralisation.
consists of type 1 collagen fibres, more or
less parellel to bone.
There is a lag phase of about 10 days
before the deeper layer of osteoid has
matured sufficiently to undergo
mineralisation

Functions of osteoblasts
Secretion
control
bone

of
osteoid
and
of mineralization of

Production of paracrine and

autocrine factors

 Production of proteases, which

are
involved
degradation

in

matrix

Osteoblasts control the process of

mineralization at three levels:
primary calcification, by production of an

extracellular organelle called the matrix

vesicle

secondary calcification, by modifying the

matrix through the release of different
enzymes

by regulating the amount of ions available

for mineral deposition in the matrix

Osteocytes

- Entrapped' osteoblasts.
- Decreased quantity of secretory organelles
- Smaller size with large nucleus
- Formative and resorptive activity of these cells may vary
under certain metabolic requirements-OSTEOCYTIC
OSTEOLYSIS

Numerous cell processes from the osteocytes run in the

canaliculi in all directions.

About 25000 osteocytes per cubic millimetre of bone

Detect stress induced in

mechanoreceptors of bone.

bone-regarded

as

the

Bone lining cells

cover most but not all quiescent
bone surfaces
decreased protein secretion

 relative paucity of organelles

Quiescent surfaces are known to be a
primary
site
of
mineral
ion
exchange between blood and adult
bone.

OSTEOPROGENITOR CELLS:

 The cells that eventually give rise to osteoblasts are

termed osteoprogenitor cells.

Reside

in the layer of cells beneath the osteoblast

layer in the periosteal region, in the periodontal
ligament, or in the marrow spaces.

fibroblast-like cells, with an elongated nucleus and

few organelles

life cycle-up to about eight cell divisions

Friedenstein (1973) divided osteoprogenitor
cells into;

 Determined osteogenic precursor cells are

present in bone marrow, in the endosteum and in

the periosteum thet cover the surfaces of the bone.
These cells possess an intrinsic capacity to
proliferate and differentiate into osteoblasts.

Inducible osteogenic precursor cells

represent mesenchymal cells present in the other

organs and tissues (eg; muscles) that may become
bone forming cells when exposed to specific stimuli.

Osteoclasts
They are derived from haemopoietic cells of the

monocyte/ macrophage lineage by fusion of

mononuclear
precursors,
giving
rise
to
multinucleated cells.

Osteoclasts

are the cells responsible for bone

resorption

Howships lacunae : bony concavities

 Osteoclasts may be up to 100 um in diameter and

have on average 10-20 nuclei.

The lifespan of osteoclasts is thought to be about

10-14 days.

MATRIX COMPONENTS

 The

bone matrix is formed from a scaffold of

interwoven collagen fibers within and between which
small, uniform, plate-like crystals of carbonated
hydroxyapatite (Ca10[PO4]6[OH]2) are deposited.

Other

proteins, including proteoglycans, acidic

glycosylated and non-glycosylated proteins associate with
and regulate the formation of collagen fibrils and
mineral crystals, or provide continuity between matrix
components and between the matrix and cellular
components.

Small amounts of carbohydrate and lipid contribute to

the organic matrix-comprises 1/3 rd of matrix.

Calcium

and phosphate in the form of poorly

crystalline, carbonated apatite, also described as dahllite,
predominates the inorganic phase.

COLLAGEN
Collagen comprises the major ~8090% organic component.

Type I collagen (>95%) is the principal collagen

Type V (<5%) collagen
In addition,type

I, III ,V and XII collagens are also

present.

The

collagen fibrils in bone are stabilized by

intermolecular cross-linking involving lysines and
modified lysines that form pyridinium ring structures
(pyridinolines) - high tensile strength

 In

rapidly forming (woven) bone that is produced

during early development and in repair sites, the fibers
are extensively interwoven, leaving a substantial volume
of inter-fibrillar space that is largely occupied by mineral
crystals and associated acidic proteins.

NONCOLLAGENOUS PROTEINS
Using dissociative extraction procedures, most of the major
noncollagenous proteins from mineralized bone have been
isolated and characterized.

Some

of these proteins, typically osteocalcin and bone

sialoprotein, are essentially unique to mineralized tissues,
whereas others, such as osteonectin/ SPARC and osteopontin
have a more general distribution.

These proteins are released from bone by demineralization,

reflecting the predominant association with the mineral
phase. Other proteins are present in bone in specifically
modified forms.

 Certain proteins derived from blood and tissue fluids are

concentrated in bone include albumin, 2HS-glycoprotein,

immunoglobulins and matrix gla protein.

Some Noncollagenous proteins in bone

matrix

PHYSIOLOGIC REMODELLING OF
ALVEOLAR BONE:

 Complete remodeling of the alveolar bone occurs when the

primary dentition is replaced by succedaneous teeth. The

alveolar bone associated with the primary tooth is
completely resorbed together with the roots of the tooth
while new alveolar bone is formed to support the newly
erupted tooth.

The ability of the alveolar bone to remodel rapidly also

facilitates positional adaptation of teeth in response to
functional forces and in the physiological drift of teeth that
occurs with the development of jaw bones.

Formation

of alveolar bone is a prerequisite for the

regeneration of tissues lost through periodontal disease and
for osseointegration of implants used in restorative dentistry.
Bone remodeling involves the co-ordination of activities of
cells from two distinct lineages, the osteoblasts and the
osteoclasts, which form and resorb the mineralized
connective tissues of bone, respectively

CALCIUM HOMEOSTASIS

Decreased
blood Ca++

PTH

Osteoblasts

IL-1, IL-6
LIF

Monocytes migrates
to bone area
Bone resorption

Inhibits PTH
released

Normal blood Ca++

Ca++ ions

BONE FORMATION
Formation of bone, which appears to be linked with bone

resorption to maintain bone mass, involves the proliferation

and differentiation of stromal stem cells along an osteogenic
pathway that leads to the formation of osteoblasts.

 The formation of a collagen substratum appears to trigger

the differentiation of pre-osteoblastic cells into osteoblasts
through interactions with the 21 receptor.

Expression

of developmentally regulated genes and

transcription factors appear to be the most useful for
defining the early stages of osteodifferentiation.

Many

of the developmental genes, including homeobox

genes such as hoxa-2, hoxd-13 and hoxa-13, dlx5, msx-1 and
msx-2, are common to various forms of organogenesis.

BONE RESORPTION:

Resorption of mineralized tissues requires the

recruitment of a specialized cell, the osteoclast, which

is produced by the monocyte/macrophage lineage of
hematopoietic cells that are derived from bone
marrow.

 Tencate, described the sequence of events in

the resorptive process is as follows:
-

Attacment of osteoclats to the mineralized surface of

bone.

Creation of a sealed acidic environment through the

action of the
proton pump, which demineralizes
bone and exposes the organic
matrix.

- Degradation of exposed organic matrix to its constituent

amino acids by
the action of released enzymes, such as
acid phosphatase and cathepsin B.

- Sequestering of mineral ions and amino acids within the

osteoclast.

BLOOD SUPPLY

It

receives from inferior and superior alveolar

arteries for mandible and maxilla, respectively and
reaches PDL from three sources; apical vessels,
penetrating vessels from the alveolar bone and
anastomosing vessels from gingiva.

INTERNAL RECONSTRUCTION OF
BONE:

During

the growth of maxilla and the mandible, bone

deposited on the outer surfaces of the cortical plates.

 In the mandible, with its thick, compact cortical plates,

bone is deposited in the shape of basic or circumferential

lamellae. When the lamellae reach certain thickness, they are
replaced from inside by haversian bone. This reconstruction
is correlated to the functional and nutritional demands of the
bone.

In the haversian canals, closest to the surface osteoclasts

differentiate and resorb the haversian lamellae and the part
of circumferential lamellae.

The

resorbed bone is replaced by proliferating loose

connective tissue. This area of resorption is sometimes
called the cutting cone or the resorption tunnel

After a time the resorption ceases and the new bone is

opposed onto the old. The scalloped outline of houships

lacunae thet turn their convexity toward the old bone
remains visible as a darkly stained cementing line, a

reversal line.

 This is in contrast to those cementing lines that correspond

to a rest period in an otherwise continous process of bone
apposition. They are called resting lines.

Resting and reversal lines are found between layers of bone

of varying age.

During these changes, compact bone may be replaced by

spongy bone or spongy bone may change into compact bone.

This type of internal reconstruction of bone can be observed
in physiologic mesial drift or in orthodontic mesial or distal
movement of teeth.

BONE RESORPTION-FORMATION;
COUPLING:

 Many

of the factors that result in bone resorption are

known to have no direct effect on osteoclasts, but act
indirectly through osteoblasts.

Most of the receptors to bioactive molecules that cause

bone resorption are present on osteoblasts [e.g. receptors to

PTH and PTHrP). Indeed, the main receptor found in
osteoclasts is related to calcitonin.

Reversal lines mark the position where bone activity

changes from resorption to deposition. Such lines are darkly
stained and irregular in outline, being composed of a series
of concavities that were once the sites of the resorptive
Howship's lacunae. They may be seen to contain the
enzyme acid phosphatase.

On account of collagen degradation occurring during bone

resorption, analysis of its special cross links retained in

urine (pyridinoline fragments) is used clinically as a marker
to indicate rates of bone remodelling.

 There are several mechanisms whereby

osteoblasts
resorption:

might

promote

bone

1) By the local release of substances such as cytokines

and growth factors (e.g. macrophage colony-stimulating
factor, osteoprotegerin and interleukins), osteoblasts
could stimulate the production of osteoclasts
2) By releasing enzymes (such as MMPs) to degrade the
unmineralised osteoid layer covering forming bone,
osteoblasts could help expose mineralised matrix on
which osteoclasts could attach and commence resorption.
3) By bioactive molecules present within bone (e.g.
cytokines, BMPs. TC.F-|3) that could be activated as a
result of osteoclastic bone resorption and subsequently
have an effect on remodelling.

Osseous Topography

 The bone contour normally conforms to the

prominence of the roots, with intervening
vertical depressions that taper towards the
margin.

The height and thickness of facial and

lingual bony plates are affected by the

alignment of the teeth, by the angulation of
the root to bone, and by occlusal forces.

THE IMPLANT - BONE

INTERFACE
The relationship between endosseous implants and bone
consistas of one of the two mechanism:

1) Osseointegration: when the bone is in intimate but not

not ultrastructural cntact with implant or,
2) Fibrosseous integration, in which soft tissues such as
fibers and/or cells, are interposed between the two surfaces.

 Osseointegration concept proposed by Branemark et al

called functional ankylosis by Schroeder states that there
is an absence of connective tissue or any non-bony tissue in
the interface between the implant and the bone

After implant insertion;

First, woven bone is quickly

formed in the gap between the implant and bone.

Second, after several months, this is progressively replaced

by lamellar bone under the load stimulation.

Third, a steady state is reached after about

1 years.
Often for oral implants, occlusal load is allowed as soon as
2-3 months, while mostly woven bone is present.

Bone has a limited elasticity, with an elasticity modulus of about;

- 10 GPa/m2 for the cortex and

- 1-5 GPa/m2 for cancellous bone.

If an implant that is 4mm diameter and 10mm long, the minimal

width of the jaw bone needs to be 6-7mm, and the minimal height
should be 10mm (12mm for posterior mandible- for safety of
mandibular nerve)

This dimension is desired to maintain at least 1.0 to 1.5mm of

bone around all surfaces of the implant after preparation and
placement.

CONCLUSION
Alveolar

bone, which has interdependence with the

dentition, has a specialized function in the support of the
teeth. While there are architectural specifications for
alveolar bone that relate to its functional role, the basic
cellular and matrix components are consistent with oyher
bone tissues. Similarly the cellular activities involved in
the formation and remodelling of the alveolar bone and
the factors that infulencethese cellular processes are
common to bone tissues generally. However, specific
features, such as the rate of remodelling, may be unique
to alveolar bone and may be important for its
adaptability.