Lecture 9 Flashcards
OSTEOPETROSIS
DEFECT IN THE FORMATION OF OSTEOCLASTS - BONES HARDEN AND BECOME MORE DENSE
OSTEOMALACIA
SOFTENING OF THE BONE CAUSED BY DEFECTIVE BONE MINERALIZATION SECONDARY TO INADEQUATE AMOUNTS OF AVAILABLE PHOSPHORUS AND CALCIUM
OSTEOPOROSIS
BONES BECOME FRAGILE AND MORE LIKELY TO FRACTURE
BONE LOSES DENSITY WHICH MEASURES THE AMOUNT OF CALCIUM AND MINERALS IN THE BONE
50% OF ALL WOMEN AND 25% OF ALL MEN AGES 50+ WILL FRACTURE A BONE B/C OF OSTEOPOROSIS (MAINLY SEEN IN CAUCASIAN AND ASIAN WOMEN)
RISK FACTORS OF OSTEOPOROSIS
- ) AGEING
- ) BEING SMALL AND THIN
- ) FAMILY HISTORY (GENETIC INVOLVEMENT)
- ) CERTAIN MEDICATIONS
- ) MOST COMMONLY IN OLDER WOMEN
**GWAMS
OSTEOPOROSIS TREATMENT
BISPHOSPHONATES
PROMOTE PRESERVATION OF BONE DENSITY BY INHIBITING RESORPTION BY OSTEOCLASTS
PRENYLATION - ADDITION OF A HYDROPHOBIC MOLECULE TO A PROTEIN NEEDED TO ACTIVATE OSTEOCLASTS - ACCOMPLISHED BY THE ENZYME FPP
OR… BISPHOSPHONATE FORMS A COMPLEX W/ HAP AND THIS IS A TOXIC SUBSTANCE IN ENDOCYTIZED BY THE OSTEOCLASTS
NITROGEN-CONTAINING BISPHOSPHONATES
INHIBIT FPP AND BLOCK INTRACELLULAR SIGNAL CONDUCTION
GTP BINDING PROTEINS - NECESSARY FOR OSTEOCLAST ACTIVATION AFTER BEING PRENYLATED
1.) RHO
2.) RAC
3.) CDC42
BISPHOSPHONATES USED FOR
ORAL ADMIN. - STABILIZING BONE LOSS BY OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN
IV ADMIN. - STABILIZING METASTATIC CANCER (BREAST/PROSTATE), TREATMENT OF BONE RESORPTION DEFECTS OF MULTIPLE MYELOMA AND SEVERE HYPERCALCEMIA
SIDE EFFECTS OF BISPHOSPHONATES
PAINFUL EXPOSURE OF MAX/MAN BONE (CORRELATION ESTABLISHED BETWEEN BISPHOSPHONATE USE AND OSTEONECROSIS OF THE JAW ->BRONJ OR MRONJ)
BRONJ/MRONJ RISK FACTORS
- ) DENTAL XO
- ) SX BONE MANIPULATION
- ) TRAUMA FROM DENTURES
- ) ORAL INFECTION
- ) POOR ORAL HEALTH
DSTOP
THEORIES FOR BRONJ/MRONJ
- ) CESSATION OF BONE REMODELING/TURNOVER - OSTEOCLAST/BLAST ACTIVITY IMBALANCE
- ) INHIBITION OF CAPILLARY NEOANGIOGENESIS => ENDOTHELIAL CELL PROLIFERATION INHIBITED IN THE JAW CAUSES A LOSS IN BLOOD VESSELS AND AVASCULAR CONDITION => NECROSIS
DENOSUMAB - MONOCLONAL ANTIBODY
ALTERNATIVE TREATMENT FOR OSTEOPOROSIS
BLOCKS RANKL AND PREVENTS OSTEOCLAST ACTIVATION => OSTEONECROSIS OF THE JAW
EARLY PREVENTATIVE MEASURES OF OSTEONECROSIS OF THE JAW
DENTAL EVALUATION XO OF TEETH DENTAL TREATMENT PLAN RESTORATIVE DENTISTRY GOAL SETTING PROPHYLAXIS PERIODONTAL HEALTH STATUS
MANAGEMENT OF DENTAL CARE DURING OSTEONECROSIS OF THE JAW
ROUTINE RESTORATIVE CARE
AVOID DENTAL XO
EXTENSIVELY CARIOUS TEETH SHOULD BE CONSIDERED FOR ENDODONTIC THERAPY
ELIMINATE SHARP EDGES OF BONE THAT TRAUMATIZE SOFT TISSUE
SOFT VINYL APPLIANCES TO COVER EXPOSED NECROTIC BONE
REEVALUATE PROSTHETIC APPLIANCES
ATRAUMATIC SRP/PROPHYLAXIS
TREATMENT OF ODONTOGENIC INFECTIONS AGGRESIVELY
POST NATAL GROWTH
1.) APPOSITIONAL GROWTH/REMODELING - WIDENING
2.) INTERSTITIAL BONE GROWTH - LENGTHENING
3.) SUTURAL GROWTH - APPOSITIONAL GROWTH OCCURS HERE AND PERIOSTEAL ACTIVITY DUE TO THE PRESSURE OF THE GROWING BRAIN
4.) SURFACE APPOSITION/REMODELING RESORPTION
CRANIAL VAULT = IM GROWTH (COMPLETED @ 8 Y.O.)
CRANIAL BASE = EC GROWTH (COMPLETED = ANT @ 10 Y.O., POST. @ 20 Y.O.)
WOLFF’S LAW
BONE IN HEALTHY INDIVIDUALS ADAPTS TO LOADS UNDER WHICH THEY ARE PLACED
MECHANICAL STRESS APPLIED TO BONE INCREASES OSTEOBLAST ACTIVITY AND REMOVAL OF MECHANICAL STRESS DECREASES OSTEOBLAST ACTIVITY
BONE RESPONSES TO STRESS
MECHANOTRANSDUCTION - MEDIATES REMODELING OF BONE IN RESPONSE TO STRESS
STEPS = MECHANO- AND BIOCHEMICAL-COUPLING, SIGNAL TRANSMISSION, AND CELL RESPONSE
SPECIFIC EFFECTS DEPEND ON - DURATION, MAGNITUDE, AND RATE OF LOADING
DURING MECHANICAL LOADING - FLUID FLOWS AWAY FROM AREAS OF HIGH COMPRESSION
OSTEOCYTES = MOST ABUNDANT AND SENSITIVE TO FLUID FLOW (W/IN LACUNAE AND THERE ARE CHANNELS THAT ALLOW COMMUNICATION BETWEEN OSTEOCLASTS)
SIGNAL CELLS THROUGH HAVERSIAN CANNALS OR OTHER SIGNALS (INITIATE INITIAL STEPS IN RESPONSE TO PRESSURE)
OSTEOPROGENITOR CELLS = CAN DIFFERENTIATE INTO OSTEOCYTES/BLASTS DEPENDING ON LOADING CONDITION
POST-NATAL GROWTH OF MAN/MAX
MAXILLA FOLLOWS NEURAL GROWTH PATTERNS
MANDIBLE FOLLOWS SOMATIC GROWTH PATTERNS
GROWTH OF THE FACE
UPPER NASOMAXILLARY COMPLEX = COMPLETED @ 16-18 Y.O. (MAXILLA = IM GROWTH)
MANDIBLE = 20-25 Y.O. (MIXED IM EC)
GROWTH CENTER
LOCATION OF INDIVIDUAL GROWTH (CONTROLS BONE GROWTH)
EPIPHYSEAL PLATES
GROWTH SITES
SITE AT WHICH GROWTH OCCURS (MANDIBULAR CONDYLE AND MAXILLARY TUBEROSITY)
CORTICAL DRIFT
COMBINATION OF PERIOSTEAL BONE DEPOSITION AND ENDOSTEAL RESORPTION - RESULTS IN GROWTH MOVEMENT TOWARDS DEPOSITION SURFACE
DISPLACEMENT
MOVEMENT OF WHOLE BONE AS A UNIT AWAY FROM A CERTAIN POSITION/PLACE
1˚ DISPLACEMENT - OCCURS IN CONJUNCTION W/ BONE’S OWN GROWTH
*W/IN MAXILLA OCCURS IN MAXILLARY TUBEROSITY
*W/IN MANDIBLE THERE IS LARGE VARIABILITY IN GROWTH POST-NATALLY - GROWS ANTERIORLY AND INFERIORLY (EXPANDING V PRINCIPLE)
2˚ DISPLACEMENT - CAUSED BY AN ENLARGEMENT OF ADJACENT OR REMOTE BONES OR SOFT TISSUE BUT NOT OF BONE ITSELF
MANDIBULAR GROWTH AT BIRTH
SHELL-LIKE BONE BODY - CONTAINS SOCKETS OF 2 INCISORS, CANINE, AND 2 DECIDUOUS TEETH
LARGE MANDIBULAR CANAL RUNE NEAR LOWER BORDER OF THE BONE (CONTAINS INFERIOR ALVEOLAR NERVE, ARTERY AND VEIN - CONTINUOUS W/ MENTAL FORAMEN AND MANDIBULAR FORAMEN)
MENTAL FORAMEN IS BELOW THE SOCKET OF THE 1ST DECIDUOUS MOLAR
ANGLE = OBTUSE 175˚
CONDYLOID PROCESS NEARLY IN LINE W/ BODY, CORONOID PROCESS = LARGE IN SIZE
MANDIBULAR GROWTH AT CHILDHOOD
BONE SEGMENTS BECOME JOINED AT THE SYMPHASIS
BODY LENGTH - BECOMES ELONGATED BEHIND THE MENTAL FORAMEN (TO ACCOMODATE ADDITIONAL TEETH)
BODY DEPTH - INCREASES W/ INCREASED GROWTH OF ALVEOLAR PORTION - ENABLES THE JAW TO W/STAND MASTICATORY MUSCLE ONCTRACTIONS
ANGLE - 140˚ AT 4TH YEAR
MANDIBULAR GROWTH AT ADULTHOOD
RAMUS ALMOST VERTICAL (110˚-120˚)
MOVES POSTERIORLY BY A COMBINATION OF RESORPTION AND DEPOSITION
RESORPTION ON ANTERIOR AND DEPOSITION ON POSTERIOR
CAUSES A DRIFT POSTERIORLY
DEPOSITION EXCEEDS RESORPTION
AFTER THIS STAGE- ANGLE INCREASES DUE TO OSTEONECROSIS
CONTRIBUTION OF ALVEOLAR PROCESS
DEVELOPS IN RESPONSE TO PRESENCE OF TOOTH BUDS
AS TEETH ERUPT THE ALVEOLAR PROCESS DEVELOPS AND INCREASES IN HEIGHT
IF TEETH ABSENT IT WILL FAIL TO DEVELOP
TOOTH DEVELOPMENT
- ) THICKENING (LAMINA PHASE) - 1ST SIGNS OF TOOTH DEVELOPMENT
- ) BUD - INVAGINATION OF THE EPITHELIUM INTO THE MESENCHYME
- ) CAP - MESENCHYME CONDENSATION
- ) BELL - AMELOBLASTS AND ODONTOBLASTS FORM BETWEEN EPITHELIUM AND MESENCHYME
- ) ERUPTED TOOTH - ~5 DAYS PAST-NATAL
AGE CHANGES IN THE MANDIBLE
BONE REDUCED IN SIZE - TOOTH LOSS => ALVEOLAR PROCESS RESORPTION
RAMUS @ 140˚ W/ NECK OF CONDYLE BENT BACKWARDS
CHANGES IN MENTAL FORAMEN LOCATION
BIRTH - @ LOWER BORDER
ADULT - MIDWAY
ELDERLY - NEAR THE UPPER BORDER
BONE DEPOSITION RESULTS
EXTERIOR SURFACE OF MANDIBLE
POSTERIOR BORDER OF RAMUS
ANTERIOR BORDER OF CORONOID PROCESS
CHIN REGION
BONE RESORPTION RESULTS
INNER SURFACE OF MANDIBULE
ANTERIOR BORDER OF RAMUS
POSTERIOR BORDER OF CORONOID PROCESS
RESULT OF BONE DEPOSITION AND RESORPTION
INCREASES TRANSERVE DIMENSION
ADJUSTS THICKNESS OF RAMUS
DISPLACEMENT OF CORONOID PROCESS
MODELING OF THE LOWER FACE
BISPHOSPHONATE EXAMPLES
ALENDRONATE, RISEDRONATE, IBANDRONATE, ZOLEDRONIC ACID
OSTEOPENIA
STRESS SHIELDING OR A REDUCTION IN BONE DENSITY (CAN OCCUR AS A RESULT OF A PROSTHESIS)
