is a heritage osseous disease,
characterized for the bones are extremely
fragile with a defect in osseous matrix.
Etiology Heritage is transmitted as an autosomal dominant trait. A
defect of biosynthesis of type I collagen causes
osteoblasts to fail to form bone in adequate amounts
Osteogenesis
Imperfecta
Clinical feature
Osteogenesis Imperfecta
•Appears follows a family patron
•bones are very thin and lack the
usual cortex of compact bone but
development of epiphyseal
cartilages is unimpaired so that
bone can grow to their normal
length but may be so distorted by
multiple fractures.
•In severe cases, die at birth or
soon after.
•The sclera of the eyes may appear
blue because it allows see the
pigment layer through it.
•Deafness and dentinogenesis
imperfecta.
•May appear dental fracture. and
jaws fracture during extraction is
uncommon
Radiography: Dental roots are short and decrease of the radiopacity of
dentin. The bones are poor and this cortical defect
Osteogenesis Imperfecta
Management: Oral hygiene, prevention of trauma, taken care during extraction.
Osteopetrosis Is a rare genetic osseous disease in which the
bone become solidified, dense and with excessive
growth, but its brittle
Etiology: It is follows a autosomal recessive trait that is very severe and
other follows autosomal dominant trait that is less severe
Osteopetrosis
Clinical feature
•Begin at infancy, but is notable at second
decade of life .
•Great head and short height
•Spontaneous fractures for poor
elasticity.
•Optic atrophy and deafness for stenosis
of cranial channel.
•Anemia, leucopenia, and
trombocithopenia for loss marrow
•The dental eruption is retarded, and
malocclusion
•Osteomyelitis a recognized complication. Radiography:
Osseous sclerosis, with decrease of
medullar space.
Management
•Oral hygiene. Avoid extraction.Antibiotic prevention
•Bone marrow transplantation
Achondroplasia It’s a common type of genetic bone disorders,
associated to failure of normal cartilage
proliferation in the epiphyses and base of the
skull
Aetiology: Heritage, follow a autosomal dominant trait.
Clinical feature
Achondroplasia
•Is a type of genetic dwarfism.
•Very short height.
•Limbs are very short in relation to the
trunk, while the head, which is normal in
size , appears disproportionately large.
•The middle third of the face is retrusive for
a defective growth of the base of the skull
•Concave profile
•Malocclusion, with mandible is often
protrusive. For disparity of the jaws growth
•Dental dimorphisms and decrease of
dental formulae. Radiography Poor growth of base of the skull
Management: Oral hygiene
Orthodontic treatment or maybe
orthognatic treatment
Cleidocranial dysplasia It’s a rare familiar disorder with
dental and osseous disorders
Etiology: Heritage, its follow a autosomal dominant trait
Cleidocranial dysplasia
Clinical feature •Familiar patron.
•Short height
•Partial or complete absence of
clavicles, allows the patients to bring
the shoulders together in front of the
chest.
•Delayed eruption of the permanent
teeth, may remain embedded in the
jaw and may have associated
dentigerous cysts.
•Alteration of dental formulae.
Radiography:
Seen the several included teeth and
the absence of clavicles.
Treatment.
Oral hygiene. Eruption control .Orthodontic and surgical manage.
Rickets It’s a general disease associated to deficiency of
vitamin D. and may be called according to appears
time: rickets if appears in infancy and osteomalasie in
the adult
Etiology: The vitamin D is essential for calcium, and phosphorus metabolism,
its deficiency may associated to poor ingestion of vitamin, for
absorption defects, chronic kidney diseases, poor sun exposition.
This produces a deficiency of the bone calcification with inadequate
mineralization of matrix.
Rickets Clinical feature
•The main defect are broadening of the
growing ends of bone and prominent
costochondral junctions,
•Wide fontanelles, bossing of frontal
and parietal eminences. And thinning
of the back of the skull.
•Hypocalcification of the dentin in
severe case.
• Delayed eruption,
•Is not very susceptible to caries.
•In adults is seen an extreme fragile of
bone with fracture tendency.
•Radiography: the wide, thick
epiphysis and deformities. Included
teeth.
Management: 1)adequate diet. 2)Administration of 200-3000 iu daily, and
3)orthopedic treatment is needed.
Osteitis Deformans Its a chronic osseous disease that
cause bone distortion and
weakening, particularly in elderly
Etiology
Unknown
intranuclear inclusion compatible with a
paramyxo or others virus have been demonstrated in both osteoclasts and
osteoblasts
Genetic
Vascular disorders a result of gen activate
for eruptive virus in male
Osteitis Deformans Clinical feature
•Appears in male more frequently to female, after 40
years.
•Affecting mainly to sacrum, spine, skull, femora and
pelvis.
•May be widespread and is usually symmetrical. But
sometimes affected a single bone.
•Enlarged head, thickening of long bones, which bend
under stress.
•Tenderness or aching pain that may be severe
•The vault of the skull is more often affected than the
facial skeleton.
•The maxilla is more affected to mandible.
•Narrowing of foramina can produce cranial nerve
defects, like to deafness, blindness , cephalea
•The alveolar process becomes severally and grossly
enlarged, allow to periodical denture
substitution.Malocclusion.
•Hypercementosis which may attempt to extraction,
•Severe bleeding and osteomyelitis for the ischaemia of
the bone
•Histology: mosaic patterns of bone.
Radiography:
Lower density of the bone, and a characteristic aspect called cotton-
wool appearance. Hypercementosis.
Osteitis Deformans
Management:
•Oral hygiene. Calcitonins .Bisphosphonates .calcitonins
Osteomielitis is an inflammatory process of medullar
spaces and bone for several causes
Classifications:
1.Acute Suppurative Osteomielitis
2.Chronic Suppurative Osteomielitis
3. Focal Chronic Sclerosing Osteomyelitis
4.Difusse Chronic Sclerosing Osteomielitis
5.Osteomyelitis with Proliferative Periostitis (Garre Osteomyelitis)
Osteomielitis
Acute and chronic
suppurative osteomielitis
as an infection of the medullary
portion of bone that includes the
production of pus
Etiology an extension of a dentoalveolar
infection ,
a complication of a fractura,
to infections from extraction
sockets,
Rare cases are related to
bloodborne pathogens
Clinical feature •Patients will variably present with some or
all of the signs of inflammation, including
swelling, limited motion, erythema, and
warmth of the overlying tissues.
•Most will have pain.
•Most will be afebrile and have a normal
white cell count unless the infection is
severe. In such cases, a leukocytosis with
a slight left shift toward immature
neutrophils is seen.
•The chronic type ,the symptom are less
evident
•The mandible is affected much more than
is the maxilla
•will create an ischemic neuropathy,
causing lip paresthesias.
Acute and chronic
suppurative osteomielitis
X ray
Acute and chronic
suppurative osteomielitis
in acute ,the x ray findings are
poor , only the causal agent. In
chronic an irregular radiolucent
pattern with ragged borders
develops Some radiographs will
show a portion of bone
separated from the parent bone.
This has been termed a
sequestrum, and the radiolucent
band separating it from the
parent bone an involucrum
Treatment:
•Remove the infection source.
•all necrotic tissue should also be
debrided and tissue samples taken
for Gram staining, aerobic culture,
and anaerobic culture before
antibiotics are administered
•soft diet
•systematic irrigations with
antiseptics or antibiotics
•antibiotic therapy
•Hyperbaric oxygenation
Acute and chronic
suppurative osteomielitis
Chronic Sclerosing
Osteomielitis
This form is less symptomatic , with
two forms. The focal associated to
few teeth and diffuse widespread by
jaws with large evolution.
Etiology: caused by one of the Actinomyces species in a
mutualism with E corrodens. Microorganism with low virulence in
high resistant organism Clinical feature:
•more in female ,in mandible
and in blacks .
have painless period ,
associated to sharp pain
period
•no suppurate and not
drainage
•tender to palpation.
•the focal form is associated
with first or second molars
and its asymptomatic
generally
Chronic Sclerosing
Osteomielitis
x ray:
radiopaque areas with irregular
margins , can give cotton-wool
appearance. focal shows
radiopaque areas associate to
tooth affected
focal
diffuse
Treatment. •Oral hygiene
•Avoid dental extraction
•In the focal case follow up
•In the diffuse if it is symptomatic
the same care that suppurative
form
Osteomyelitis with
Proliferative Periostitis
(Garre osteomyelitis)
It is variant of a chronic osteomyelitis
found in young individuals because of
their high resistance, increased local
blood supply, and greater bone
regenerative capabilities
Clinical feature:
•It presents most often in a child or
teenager associated with an apical
infection in a mandibular posterior
tooth
•Appears in mandible, It does not
seem to occur in the maxilla
•The expansion is bone hard and not
usually painful or tender to
palpation. There is no pus, drainage,
or erythema
X ray . it is the deposition of
extracortical new bone outside an
existing intact cortex(“onion skin”
effect).widening of the cortical bone
Treatment:
To remove of the source of
infection and antibiotic therapy
Osteomyelitis with
Proliferative Periostitis
(Garre osteomyelitis)
Bibliographical References