Oral Biology 5670

• Bone growth and development• Bone biology• Educational objectives

– Exposure to basic concepts of bone biology– Correlation of basic bone biology to clinical

treatment– Special considerations / implications of bone

biology to dentistry

Clinical Correlates of Bone Growth and Development

• Facial skeletal development

• Maxillary development

• Mandibular development

Clinical Correlates of Bone Growth and Development

• Effect of congenital anonalies on facial growth and development

• Effect of surgical correction of congenital anomalies on facial growth and development

• Tooth development and retention influence on alveolar bone levels

Clincal Correlates of Bone Growth and Development

• Orthodontic tooth movement

• Bone healing following tooth extraction

• Bone response to alloplastic materials

• Bone healing in approximation of dental implants

Clinical Correlates of Bone Growth and Development

• Bone grafting to treat dentoalveolar defects

• Bone grafting to treat discontinuity defects

• Fracture healing

Cellular Growth

• Hypertrophy

• Hyperplasia

• Secretion of extracellular material

• Interstitial growth

Embryologic Type of Bone

• Endochondral

• Intramembranous

Functional Matrix Theory of Growth

• “Growth of the face occurs as a response to the functional need and is mediated by the soft tissue in which the bone is embedded”

• Soft tissues grow, bone and cartilage react

Growth Control

• Bone is the determinant of its own growth

• Cartilage is the determinant of bone growth

• Soft tissue matrix is the determinant of growth

Orthodontic Tooth Movement

• Bone apposition and resorption

• Effects on the pulp

• Effects on the PDL

• Effects on the tooth root

Effects of Periosteum

• Provision of undifferentiated mesechymal cells

• Envelope to limit/regulate bone apposition

Introduction10 y.o. female 12/98

• CC:– Noticed swelling in

face on left side for two weeks

• HPI:– Facial swelling

– Left lower lip “tingles”

– No pain or change in bite

Examination

• Left lower facial swelling, without thrill/bruit

• Lower vestibular swelling, L>R

• No abnormal tooth mobility

• Teeth 19-28 vital with EPT

• CN II-XII grossly intact

Assessment

• Problem list:– Multilocular

radiolucent lesion

– Teeth vital without resorption, displacement, or mobility

– Apparent cortical expansion

• Diff. Dx:– Central Giant Cell

Lesion

– Ameloblastomic Fibroodontoma

– Ameloblastoma

Treatment Plan

• Impressions for splint fabrication• Screening labs Ca, alk phos, PTH

– All WNL

• CT of mandible:– Multilocular radiolucents, from infer border to

encompass tooth roots superiorly

– Buccal and lingual cortices intact, although expansion present

• Incisional bx