Robert Gougaloff
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Robert Gougaloff, DMD

Information Pages:
Implant Dentistry
Laser Dentistry

 

Resource Pages:
Articles & White Papers
Slide and Photo Center
Videos

 

Info Links:

Osseointegration
History of Dental Implants
Titanium
Cylindrical (Rootform) Implants
Blade Implants
Subperiosteal Implant
Implant Fixture
(Prosthetic) Abutment
Implant Crown
Bone Resorption

Bone Grafting
      Autografts
      Allografts
      Alloplasts
      Xenografts
      Bio-engineered Grafts
      Cellular Graft Material

      Sinus Augmentation
      Sinus Lift
      Onlay Graft
      Socket Preservation
      Ridge Split
      Particulate Graft

Atrophic Mandible
An x-ray of a severely resorbed (atrophic) mandible. This mandible is very prone to spontaneous fractures
Resorbed Mandible 1a
Above we can see a lower jaw with teeth. The bone height is 38mm and the red circles represent the mental foramen, where one of the sensory nerves exits from the bone
Bone, despite its rigid nature, is not a permanent, immutable tissue. It is in fact a very dynamic and living tissue that maintains its structure via an equilibrium of opposing activities: Bone Regeneration and Bone Resorption. Both activities are constantly ongoing in living bone. This process of bone regeneration and bone resorption in equilibrium is also called Bone Remodeling.

Bone consists of three distinct entities:

The Organic Matrix is mainly composed (90%) of type I collagen. The remaining 10% is composed of non-collagenous components and sediment.

The Inorganic Matrix is often also called the "mineralized matrix" contains about 99% of the body's calcium, 85% of all the phosphorous and between 40 and 60% of the sodium and magnesium. The mineral crystals of the inorganic matrix can be classified as apatite, as it is mainly composed of carbonates and amorphous combinations of phosphate and calcium.

The Cells consist of Osteoblasts, Osteocytes and Osteoclasts. Osteoblasts secrete the bone matrix in form of an insoluble organic substrate, mainly composed of type I collagen. This substrate will then rapidly mineralize by means of the deposition of calcium phosphate crystal. So, in essence, these cells are the "bone builders". The Osteocytes are actually osteoblasts, which get entrapped in very matrix they secrete. They are relatively inactive cells, which are thought to have more of a regulatory function to other cells. Finally, the Osteoclasts are large macrophages, which resorb or destroy bone matrix. All of these cells are necessary for proper bone maintenance.

Bone maintains its structure and volume through mechanical stimuli. The skeletal bone is maintained through us walking in gravity. Our jaw bones are maintained by chewing on our teeth. Once this mechanical stimulus is gone (i.e. the teeth are gone), the body "thinks" that the calcium is no longer needed there and the resorption process starts. Dentures don't count in terms of delivering enough mechanical stimulus to the bone to prevent bone resorption. They are not "bone-anchored" devices. Dental implants are the only devices that can prevent further bone resorption.

This bone resorption can be rather dramatic as shown in the sequence of images below. These images show how a real mandible or lower jaw can resorb once the teeth are taken out.

Resorbed Mandible 1b
This is the same jaw from the side. Here we measured the bone height to be 39mm. Also note the position of the mental foramen.
Resorbed Mandible 2a
Resorbed Mandible 2b
Here we have a jaw without teeth. Notice that the bone height has diminished from 38mm to now only 24mm. Also, note that the mental foramen is getting closer to the top of the ridge
This is again the same jaw from the side. Here the bone height is reduced to 22mm. Note the position of the mental foramen
Resorbed Mandible 3a
Resorbed Mandible 3b
This is the condition after many years of denture wearing. Notice that the bone height is only 16mm and that the mental foramina are sitting on top of the ridge. This is what causes the denture pain in those areas. The exiting nerve is being compressed
Here we have the side view again. The side of the mandible resorbs usually at a faster pace. You can see that the bone height is only 12mm here. Also note the mental foramen on top of the ridge.

Bone Resorption

Contact Info:

Phone: 310.374.5616
Fax:     310.424.7101

E-mail:
rgougaloff@gmail.com

Professional Links:

Redondo Beach Dental Group
LA Implants
Robert Gougaloff 's Blog
Academy of Osseointegration
AAID
Academy of Laser Dentistry
USA Laser Biotech, Inc

North American Association for Laser Therapy
World Association for Laser Therapy

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Robert Gougaloff, DMD
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