Coast Dental Blog
Fast Facts - Perio Edition Episode 21
Fast Facts: Perio Edition “Alveolar Bone Crest”
A Message for Coast Dental Hygienists and Doctors:
Happy Monday Coast Dental Family!
This episode is an extremely important one because it helps us as clinicians determine how to measure bone levels. The particular aspect I find important is to follow the CEJ of the teeth to help determine what is normal or appropriate contour of the bone level and what is abnormal due to disease.
In my clinical experiences, I have often found teeth, specifically the most distal molars be they 2nd or 3rd molars that have drifted or tilted mesially. When they tilt, that changes the expectations for normal bone level health. If this concept is confusing and you need help, just reach out and I will be happy to talk you through it.
Andrew Johnston, RDH, BSBM
Director of Hygiene Coast Dental
[Andrew Johnston, RDH]
Welcome back, everyone. You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello and welcome to Fast Facts: Perio Edition. You guys, we are still on the anatomy train and we are talking about bone and this is a very particularly important episode because I know when we start talking about bone, start talking about the morphology, as well as, of course, the composition of bone, that it is imperative for us as clinicians to understand this morphology.
Specifically, what we're looking at is the shape of the alveolar bone crest and how it's influenced. For most of us we're utilizing dental radiographs to evaluate or approximate what that bone level looks like. So know that when we're looking at the shape of that bony crest, we're looking at several influential factors, things like what is the width of the interdental space? Do we have a closed contact? Do we have a diastema or do we have a completely open contact? Because that is of course going to change the shape of our alveolar bony crest. We're also looking at things like the stage of eruption. Is the tooth still moving into occlusion? Is the tooth super erupted at this point? And those things we know can certainly bend or adjust the shape of our alveolar bony crest.
We also look at things like the position of teeth within the arch. And of course, as we see teeth that have mesial drifting or tipping, all of those entities as well as crowding can adjust the observation of the shape of the bony crest and finally the shape of the cementoenamel junction and primarily when we look at comparing bone in a state of health, really it is that contour of the CEJ that will essentially determine for us if that alveolar bone crest is relatively flat like we see in the posterior or more pointed or convex in the anteriors.
We know, of course, that the typical observation of the bony crest itself should follow an imaginary parallel line that connects the CEJ's of adjacent teeth and we are looking at the bone itself approximating about two millimeters apical from the biologic width in an ideal situation. Now, from a composition standpoint, the alveolar process itself really is a dense collagenous fiber and it's important for us to understand that. These collagen fibers provide that ground substance or that ground matrix. And then we have inorganic salts of bone, primarily calcium and phosphate, that permit the remineralization or mineralization itself of the bone.
Within the bone itself we will also see cells present within the alveolar and supporting bone, things like osteoblasts, which we know have the opportunity to synthesize bone. Osteocytes, which are osteoblasts. And these osteoblasts are embedded in a lacunae or a little cocoon as bone is being laid down and then, of course, osteoclasts and osteoclasts are the cells responsible for the resorption of bone.
That's it. That's all I know about morphology and the composition of bone. Stay tuned as we continue the conversation around anatomy of the periodontium. Have a great week you guys!
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!