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Alveolar bone in health and

disease

Presented by:
Snehi Kumar
JR-1 2
CONTENTS :
DEFINITON
BRANCHIAL ARCHES
DEVELOPMENT OF MANDIBLE
DEVELOPMENT OF MAXILLA
INTRODUCTION
DEVELPOMENT OF ALVEOLAR PROCESS
STRUCTURE OF ALVEOLAR PROCESS
Alveolar bone proper
Supporting bone
Interdental septum
Socket wall
Bone marrow
Periosteum and Endosteum

COMPOSITION
BONE CELLS
-Osteoblast
-Osteocyte
-Osteoclast
MECHANISM OF BONE FORMATION
MECHANISM OF BONE RESORPTION
CLINICAL CONSIDERATION
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 ALVEOLAR PROCESS
The alveolar process is that portion of the maxilla and the mandible that forms
and supports the tooth sockets (alveoli) . However there is no boundary
between the alveolar process and the basal bone of the jaws.

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The formation as well as continued preservation of the alveolar bone is
dependent on continued presence of
teeth.

Its morphologic characteristics being related to :

Size of teeth
Shape of teeth
Events occurring during tooth eruption
Inclination of erupted teeth 5
Normal bone contour conforms to the prominence
of the roots.
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 DEVELOPMENT

Stomodeum formation

Laterally bounded by a pair of branchial or pharyngeal

arches

Sheet of mesoderm sandwiched between ectoderm and

endoderm.

Ectodermal pouch and cleft divide into 6 thicknings

The first branchial arch forms other processes - the

maxillary process and mandibular process.

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Branchial arches

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 Development of the mandible
Intramembranous development

Develops indirectly from the Meckles cartilage which has

a close relationship with the Trigeminal
nerve(mandibular division).

Meckles cartilage extends as a solid hyaline cartilage on

both sides.

Lingual branch
Mandibular division of
Inferior alveolar
trigeminal nerve divides into
incisive mental

The intramembranous ossification starts at the 7th week both :

Anteriorly
Posteriorly
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10
 Anteriorly
Posteriorly
plate
plate plate
plate plate
plate plate
Lateral Medial
Medial Lateral Medial
Medial

Trough is formed Gutter is formed

Soon converted into a canal as bone is formed.

By rapid spread of ossification posteriorly into mesenchyme of first arch the
RAMUS is formed and the point of divergence being marked by lingula.
By the end of the 10th week – the rudimentary mandible is formed.
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Spread of mandibular ossification away
from Meckel’s cartilage at the lingula.
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The further growth of the mandible is governed by the
SECONDARY CARTILAGE :
CONDYLAR PROCESS
CORONOID PROCESS
SYMPHYSEAL PROCESS 13
 DEVELOPMENT OF THE MAXILLA
The center of ossification is the mesenchyme of the maxillary process of the first arch,from
where the maxilla starts to develop.

The center of ossification is associated closely with the cartilage of nasal capsule , no arch
catilage exists in the process.

The centre of ossification develops between the branches of antero superior dental nerve
(branch of the inferior orbital nerve )

Posteriorly Ossification spreads Superiorly

Inferiorly

Lateral alveolar plate Medial alveolar plate

(And anteriorly upto the incisor region)

Secondary cartilage: zygomatic or malar process contributing to zygomatic process..
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 INTRODUCTION
Together with the root cementum and periodontal membrane the
alveolar bone forms the “attatchment apparatus”

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 The alveolar process develops in conjugation with the
development and eruption of the teeth .

The alveolar process consist of the bone which is

formed by
*cells from dental follicle(alveolar bone proper)

At 8 weeks in utero alveolar bone forms a horse shoe

shaped groove which contains the tooth germs.

Gradually bone develops between the roots and soon

a crypt is formed.

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 Initially embryonic type of bone is formed which is
gradually replaced by mature lamellar bone.
At the end of second month of fetal life the maxilla
as well as the mandible from a groove known as the
dental groove.

The alveolar process at the time of birth are known

as gum pads.

They are pink ,firm and are covered by a dense layer

of fibrous periosteum.
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Formation of alveolar bone
Bone development around erupting
tooth

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 The alveolar process consists of the following :

Seen as lamina dura in

Haversian bone radiographs.
Compact bone Has series of openings
Cortical bone
(Alveolar bone
(external plate)
proper) for neurovascular
Compacted bone lamellae bundles hence known
as cribriform plate.

Portion of jaw
Acts as supporting Cancellous located apically,
alveolar bone and is bone/Trabecular Basal bone
bone unrelated to teeth.
enclosed by a compact
border between the
interdental septum.

 Bone marrow
 Periosteum
 Endosteum
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Parts of alveolar bone

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 ALVEOLAR BONE PROPER

The alveolar bone proper consists of

thin lamella of bone
1. That surrounds the root of the tooth
2. Gives attachment to principle fibers of
periodontal ligament
The compact bone which lines the
tooth socket and in radiographs it
appears as “Lamina dura.”
The layer of bone into which the
principal fibre are inserted is
sometimes called “Bundle bone”.
Alveolar bone or the bundle bone has
a varying width.

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 Alveolar process with periodontal
ligament and cementum is
responsible for the attachment
between the tooth and the skeleton.
Alveolar bone proper as a result of
altered functional demands undergo
adaptive changes.
The alveolar bone which forms the
inner wall of the socket is perforated
by many openings that carry
branches of the inter alveolar nerves
and blood vessels into the Allignment of bony
periodontal ligament and is
therefore called the “cribriform trabeculae
plate”.
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 Histopathological features :

The alveolar bone includes

circumferential lamella and
contains sharpey’s fibre which
extend into periodontal
ligament .
Histology of alveolar bone proper

Lamellar bone at a site

contains osteons each of which
harbours blood vessels located
in haversian canals.

The space between the

different osteons is filled with so
called interstitial lamellae . 24
 Compact bone is perforated by
numerous Volkman canals through
which

Lymphatics
Blood vessels

Nerves

pass from alveolar bone to the

periodontal ligament.

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In maxilla the outer cortical plate is perforated by many small
openings through which blood and lymph vessels pass.

In lower jaw the cortical bone of alveolar process is dense in the region of anterior
teeth.The supporting bone is usually very thin,no spongy bone is found here and the
cortical plate is fused with the alveolar bone proper.

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 Cortical Plates

The cortical plates form the

outer and inner plates of the
alveolar process.

The cortical plates are

continuous with the compact layer
of maxillary and mandibular body.

They are generally much thinner

in the maxilla than in the
mandible.

They are thickest in the

premolar and molar regions of the
jaw,Specially on the buccal side.

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 Interdental Septum
The interdental septum consist of
cancellous supporting bone
enclosed within a compact border.

The interdental and interadicular

septa contains the perforating
canals of Zuckerkandl and
Hirschfeld (nutrient canal)which
house the:
•interdental and interadicular
arteries
•veins
•lymph vessels
•nerves 28
 Socket Wall

The socket wall consist of dense

lamellated bone,some of which is
arranged in haversian system and
bundle bone.

It is characterized by thin lamellae

arranged in layers parallel to the root
with intervening oppositional line.

Bundle bone is localized within

alveolar bone proper.Some sharpey’s
fibres are completely calcified but
most contain an uncalcified outer
layer .

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 30
• The red marrow gradually undergo a physiologic change to a fatty or yellow inactive
type of marrow
• In the embryo ,the cavities of all bones are occupied by a red hematopoietic marrow
Bone Marrow
 Periosteum
It is a tough sheath of dense
irregular connective tissue.

It surrounds the bone surface

whenever it is not covered by
articular cartilage.

The periosteum contains bone

forming cells .
Functions :
i. Allow the bone to grow in
thickness
ii. Assists in fracture repair
iii. Helps to nourish bone tissue
Endosteum

It is a membrane that contains bone forming cells

and lines the medullary cavity. 31
 COMPOSITION of Alveolar Bone :

65% Inorganic

35% Organic COLLAGEN 88-89%

The organic material is NON-COLLAGEN 11-12%

primarily type I collagen
which lies in the ground GLYCOPROTEINS 6.5-10%
substance.Glycoprotein are
proteins with small amount of PROTEOGLYCANS 0.8%
monossacharides,
disaccharides, and SIALOPROTEINS 0.35%
polysaccharides or oligo
-saccharides and LIPIDS 0.4%
proteoglycans are sulfated and
non-sulfated
glycosoaminoglycan with a 32
 The inorganic material almost exclusively consist
of calcium and inorganic orthophosphate in the form
of hydroxyapatite crystals .
The crystals are deposited in between the
molecules of collagen as well as in the non-
collagen,organic material that makes up the ground
substance of bone.
The exact mechanism by which hydroxyapatite
crystals are deposited in the bone matrix produced
by osteoblasts is still unknown ,however certain
enzymes like Alkaline Phosphatase , ATP ase and
Pyrophosphatase have been shown to participate
in this process .

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 STRUCTURAL CHANGES

The internal structure of bone is adapted to mechanical stress.

Its changes continues during growth and alteration of functional

stress.

In jaws ,structural changes are correlated to the

Growth

Eruption

Movement

Wear

Loss of teeth
All these process are made possible only by a coordination of destructive
and formative activities ,these are brought about by :
OSTEOBLAST OSTEOCLAST
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 Cells :
OSTEOBLASTS
Osteoblasts are mononuclear -plump,cuboidal cells or
slightly flattened cells ,that are primarily responsible for bone
production.
Although they are post mitotic cells both preosteoblast and
osteoblast can undergo mitosis during prenatal development
and occasionally during post natal growth.

Both have high level of alkaline phosphatase on the outer

surface of plasma membrane.

This enzyme is used experimentally as a cytochemicalmarker

to distinguish preosteoblast from fibroblast.
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 Osteoblasts exhibit abundant and well
developed protein synthetic organelles.
-At light microscope the golgi
complex characteristically appear as a
clear , paranuclear area that can be
defined easily following cytochemical
reaction .
For golgi-resistant enzyme the collagen
type I molecule is formed and assembled,
as in fibroblasts and odontoblasts within
the spherical and cylindrical distention of
the golgi complex.

Apart from that it consists of rough

endoplasmic reticulum,mitochondria,
nucleoli,and many secretory vesicles and
vacuoles. 36
Their function is synthesis of:

Collagen Non-collagen

Mainly osteoid

I. Type –I and TYPE –V collagen

II. Proteoglycans
III.Several non collagen protein

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The typical elongated ,electron dense, collagen –containing secretory granules
release their content primarily along the surface of the cell apposed to forming
bone,these molecules assemble extracellularly as fibrils to form the osteoid layer.
Irrespective of this aspect non-collagenous protein also are released mainly along
the surface of osteoblast apposed to osteoid and diffuse from the surface towards
the mineralization front where they participate in regulating mineral deposition.
Near the mineralization front ,mineralization foci can be seen within osteoid and
certain non collagenous proteins, such as bone sialoproteins and osteopontin
accumulating within them .

Osteoblast secrete several bone morphogenic protein (BMP) superfamily

including :-
BMP-2,
BMP-7 and
Transforming growth factor(TGF)
in addition to ;
Insulin –like growth factor (IGF-I)
Platelet derived growth factor(PDGF)
Fibroblastic growth factor(FGF)
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 Although the timings of secretion and complex
interaction of these growth factors remain to be
clarified;the combination of IGF-I,TGF-β and PDGF,
and fibroblastic growth factor (FGF) exists .

For instance these combinations ,may be used to

speed healing and bone growth after periodontal
surgery or to prevent periodontal disease by the early
treatment of periodontal pocket.

Similarly ,they may be used to enhance osseous

integration after placement of dental implants.

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 OSTEOCYTES
As osteoblast form ,some become entrapped within the matrix
they secrete ,whether mineralized or non-mineralised ,these cells
are then called osteocytes.The number of osteoblast that become
osteocytes are present per unit volume .

As a general rule ,embryonic bone and repair bone have more

osteocytes than does a lamellar bone .

After bone formation ,osteocytes become reduced in size , space

in the matrix occupied by osteocytes is called “osteocytic
lacunae”.Narrow extentions of these lacunae form enclosed
channels or cannaculi that house radiating osteocytic process
through these channels.
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 OSTEOCLASTS
Compared with all other bone cells and their precursors ,the
multinucleated osteoclast is a much larger cell,because of
their size.Osteoclast can be identified easily under the light
microscope, they often are seen in cluster.

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 Typically osteoclast are found against
the bone surface ,occupying hollowed
–out depression called
HOWSHIPS LACUNAE,
that they have created .

Scanning electron microscopy of

bone resorbing surface show

The howships lacunae reflecting

the activity and the mobility of
osteoclast during active resorption
under the electron
microscope,multinucleated osteoclast
exibit a unique set of morphological
characteristics.
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 The cell organelles consist of many nuclei each of which is
surrounded by multiple golgi complexes ,mitochondria ,
numerous vesicular structures situated between the golgi complex
and resorption surface .

For years osteoclast have been known to be rich in lysosomal

structures.Enzymes are synthesized in the rough endoplasmic
reticulum later transported to the golgi complexes and then move
to the ruffled border.

An electron dense,interfacial matrix layer (lamina limitans)often

is observed between the sealing zone and calcified tissue surface .

Several mechanism bind the osteoclast to surface,among these

the concentration of osteopontin on the bone surface (lamina
limitans) may facilitate osteoclast adhesion and formation of the
sealing zone .
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 Adjacent to the tissue surface ,the multinucleated osteoclast
cell membrane is thrown into a myriad of deep folds that form
a “ruffled border”.
At the periphery of this border ,the plasma membrane is
opposed closely to the bone surface and the adjacent cytoplasm
devoid of cell organelles and is enriched in
Actin
Vinculin
Talin
Fibrillar contractile protein

This clear or sealing zone not

only attaches the cell to the
mineralized surface but also
isolates a microenvironment
between them and the
bone surface . 45
ACTIN is a globular, roughly 42-kDAprotein found in all 
eukaryotic cells where it may be present at concentrations of over
100 µm.
Actin is the mononumeric subunit of two types of filaments in
cells: microfibril, a major component of the cytoskeleton, and thin
filaments, part of the contractile apparatus in muscle cells. Thus,
actin participates in many important cellular processes
including muscle contraction, cell motility, cell division
and cytokinesis, vesicle and organelle movement, cell signaling,
and the establishment and maintenance of cell junctions and cell
shape. 

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VINCULIN is a cytoskeletal protein associated with cell-cell and
cell-matrix junctions, where it is thought to function as one of
several interacting proteins involved in anchoring F-actin to the
membrane. Binding alternately to talin or α-actinin, vinculin's
shape and, as a consequence, its binding properties are changed.
The vinculin gene occurs as a single copy and what appears to be
no close relative to take over functions in its absence.

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TALIN is a high-molecular-weight cytoskeletal protein
concentrated at regions of cell-substratum contact and,
in lymphocytes, at cell-cell contacts.Talin is a
ubiquitous cytosolic protein that is found in high concentrations
in focal adhesions. It is capable of linking integrins to the actin
cytoskeleton either directly or indirectly by interacting
with vinculin and alpha-actinin.

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Mechanism of bone formation
I. Membranous bone formation

II. Endochondral bone formation

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 As the osteoblasts secrete the organic matrix of bone ,it is at first
devoid of mineral salts and at this stage it stains pink in routine
hematoxyline and eosin and is called osteoid tissue ,as this material
is produced, some of the osteoblasts become embedded in it and
form the osteocytes.

Near the mineralization front ,mineralization foci can be seen

within osteoid and certain non collagenous proteins,such as bone
sialoproteins and osteopontin accumulating within them .

In addition to structured matrix protein ,osteoblasts secrete a

variety of cytokines that help regulate cell metabolism

A key factor in the rate of bone cell development is the elaboration

of number of growth factors by osteoblast ,their precursor or both.
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 Bone resorption
Bone resorption at any site is a chemotactic phenomenon i.e it is initiated by the
release of some soluble factors that attracts monocytes to the target site.

During bone resorption three process occur :-

Transport of
soluble products
Degradation of to the
Decalcification
matrix extracellular fluid
or the blood
vascular system

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 DECALCIFICATION
Since calcified matrix is resistant to protease of all kinds bone
must be decalcified ,this is achieved at the ruffled border of
osteoclast by the secretion of organic acid (citric and lactic
acid),which chelate bone and by H+ which increases the solubility of
hydroxy apatite.

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 DEGRADATION OF MATRIX

After this decalcification process pieces of matrix are released by

the activity of cathepsin B1 and collagenase enzyme.
Collagenase is secreted as a proenzyme that is activated by specific
neutral protease .
Collagenolytic activity takes place outside the osteoclast and
occurs at a specific site on tropocollagen (collagen)molecule .The
site is one-third of the distance from the carboxyl end of the
molecule .
The broken fragments of collagen are further decalcified and
collagenolysis occur outside the osteoclast ,only calcium phosphate
can be identified within these cells.

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 TRANSPORTATION OF SOLUBLE
PRODUCT

After the degradation of the matrix the breakdown

products of bone must be transported to the extracellular
fluid and to the blood vascular system.

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FACTORS AFFECTING BONE FORMATION
The hormones most important in bone metabolism are :
a) Parathyroid hormone (PTH)
b) 1,25,dihydroxyvitamin D
c) Calcitonin
d) Estrogen
e) Glucocorticoids

The action of parathyroid hormone and vitamins are biphasic enhancing bone
resorption at high concentration ,but supporting bone formation at lower
concentration .
Calcitonin +estrogen inhibit resorption where as the glucocorticoids inhibit
formation .
The hormones effecting bone most likely work primarily through altering the
secretion of the cytokines .The osteoblast and lining cells also have anabolic
function and participate in matrix degradation through the production of
interlukin -6. 55
 Bone remodelling
Bone remodelling takes place by mainly 3 processes:
Osteogenesis
Osteoinduction
Osteoconduction

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 CLINICAL
CONSIDERATIONS
ORTHODONTIC ASPECT

Bone although the

hardest substance is
biologically a highly
plastic tissue.

Bone is resorbed on the

side of pressure and
opposed on the side of
tension.
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Effect of pressure and
tension on bone .

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 PERIODONTAL ASPECT

Bone resorption is almost universal.

Occur in episodic spurts both in horizontal and vertical types.

Endotoxins released by gram negative bacteria of the plaque leads to an

increase in cAMP which increase the osteoclastic activities.

Further more a peptide called osteoclast activating factor has been

demonstrated in the lymphocytes near the periodontal pocket .

This substance is capable of increasing cAMP and osteoclastic activity and

reducing osteoblastic activity at the target site.

The greater number of cells and the reduced volume of calcified intercellular
substance render this immature bone more radiolucent than mature bone.

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 References
ORBANS ORAL HISTOLOGY & EMBROYOLOGY-11EDITION
AVERY ORAL DEVELOPMENT & HISTOLOGY-3EDITION
CARRANZA-9&10 EDITION
LINDHE-4&5 EDITION
JOURNAL 2000 PERIODONTOLOGY
A.R.TEN CATES book OF ORAL HISTOLOGY
S.L.BHALAJHI ,TEXTBOOK OF ORTHODONTICS
THEORY AND PRACTICE OF HISTOLOGICAL TECHNIQUES
– J.D.BANCROFT & M.GAMBLE
K.B.BERKOVITZ-ORAL ANATOMY & EMBROYOLOGY

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THANKYOU
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