Project 1
1.Emphysema
2.Tuberculosis
3.COPD
Emphysema: The fragile walls and elastic fibres of the alveoli are destroyed by this lung condition. When you exhale, small airways constrict, obstructing the passage of air from your lungs.
Emphysema is a lung condition caused by damage to the alveolar walls of your lungs. It's possible for an obstruction (blockage) to form, trapping air in your lungs. Your chest may look larger or barrel-chested if you have too much air trapped in your lungs. Your bloodstream receives less oxygen when there are fewer alveoli.
At the end of the bronchial tubes (airways), which are located deep inside your lungs, are clusters called alveoli, which are tiny, fragile air sacs with thin walls. An average set of lungs has 300 million alveoli. Air enters your lungs through your bronchial tubes and moves through the alveoli as you breathe in (inhale). As soon as air enters, the alveoli expand, take in oxygen, and send oxygen to your blood. Your alveoli contract as you exhale, expelling carbon dioxide from your body.
Chronic bronchitis.In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.
It is difficult to stop smoking. It could take several tries to successfully stop. Speak with your healthcare practitioner when you're ready to stop smoking. They can assist you in creating a plan to stop smoking. Joining support groups is another smart move. You can talk about your thoughts and experiences in support groups with people who can relate.
Describe the gross anatomy of the organ involved
Describe the microscopic and macroscopic structure of the organ involved with relevant labelled diagram
Describe the blood supply and nerve supply of the organ involved with suitable diagram
Blood supply
The lungs' pulmonary and systemic circuits are two parallel blood supplies. The heart generates the pulmonary circuit, which transports deoxygenated blood to the lung for gas exchange. Additionally, this circuit returns oxygenated blood to the heart so that it can be transported once more throughout the body. Blood that cannot be supplied by simple diffusion is transported from the heart to the lung parenchyma via the systemic circuit. This circuit's venous branch also returns deoxygenated blood to the heart for processing.
Arterial supply
The pulmonary arteries carry deoxygenated blood from the right ventricle to the lungs. To provide a conduit to each lung, the pulmonary trunk splits in two beyond the superior vena cava, giving rise to these blood arteries. Additionally, each pulmonary artery divides into superior and inferior branches during a second division. Greater than the ipsilateral superior artery is the inferior right pulmonary artery. Before supplying the middle and inferior lobes, it travels between the intermediate bronchus and the superior pulmonary vein. It transmits a recurrent branch to the superior lobe in addition to supplying these lobes with blood.
As it supplies the superior lobe of that lung, the right superior pulmonary artery splits in two. The left pulmonary artery enters the left oblique fissure at the bifurcation location by crossing the aortic arch. This vessel might be divided in different ways after that. The left pulmonary artery's initial division is the biggest of all the others. It is in charge of supplying the left superior lobe's anterior bronchopulmonary portion. There are more branches coming from this vessel, but they are arborized in a very different way than their counterparts on the right. Within the oblique fissure, the left pulmonary artery also emits a lingular branch that supplies the lingula. There are many other branches arising from the left pulmonary artery that extends throughout the left lung to supply the rest of the organ.
The bronchial arteries give oxygenated blood to the organ and its supporting structures at high pressures, whereas the pulmonary arteries deliver low-pressured deoxygenated blood to the lungs. Most people have two vessels on their left side and one on their right. Along with the posterior intercostal artery, the right bronchial artery emerges from the intercostobronchial trunk. The vessels serve as a vasa nervorum for the vagus nerve to supply the middle third of the oesophagus and other structures, as well as a vasa vasorum (to the pulmonary vessels and aorta).
The bronchial arteries on the left are straight branches of the thoracic aorta. A portion of the aortic arch is supplied by the superior left bronchial artery, and the bronchi and connective tissue of the hilum are supplied by the inferior left bronchial artery.
Venous drainage
The pulmonary venous circulation is created by the distal coalescence of the capillary networks within the alveolar walls. Segmental veins are formed by the union of several intra-segmental vessels within each bronchopulmonary segment. Inter-segmental vasculature, also known as segmental vessels, combine to create bigger solitary veins in each lobe. As a result, the left side possesses two lobar veins while the right side has three. Only 2 lobar veins join to generate the pulmonary veins because the superior and intermediate lobar veins ultimately fuse. The oxygenated blood is returned to the left atrium by means of these low-pressure arteries. The remainder of the body receives it after that.
The bronchial veins drain the hila, but the pulmonary veins drain the lung parenchyma. The bronchial vein receives tributaries from both shallow and deep bronchial veins. There is only one bronchial vein per hilum. Before joining to produce the deep bronchial veins, the intra-bronchial venous plexuses travel next to the bronchi in the hilum. It has been observed that they either empty into the pulmonary vein or the left atrium.
The principal tributaries of the superficial bronchial veins are the subpleural venous channels. These veins are supplied by the extrapulmonary bronchi, hilar lymph nodes, and vasa vasorum of the pulmonary vasculature. The brachiocephalic, accessory hemiazygos, and left superior intercostal veins on the left, and the azygos vein on the right, get blood from the superficial bronchial veins.
Lymphatic drainage
The subpleural plexus refers to the lymphatic veins that drain the lungs and begin below the pleura. This set of vessels is further separated into superficial and deep groups, the latter of which includes the bronchi as well as the pulmonary artery and vein. At the hilum, where they drain to the ipsilateral bronchopulmonary lymph nodes, all the superficial lymphatic arteries converge.
The superficial and deep lymphatic pathways are connected on the periphery. When lung disease obstructs the lymphatics, the communication veins have the ability to dilate in order to reroute the flow of lymphatic fluid from one system to another. The inferior tracheobronchial nodes have historically served as the lymphatic fluid drain for the inferior lobes of the lungs. Superior tracheobronchial nodes, on the other hand, discharge lymphatic fluid from the top lobes.
COPD
Chronic Obstructive Pulmonary Disease, or COPD. Airways get clogged as a result of lung inflammation, which is its defining feature.
COPD is a catch-all term for a number of lung disorders that worsen with time. Emphysema and chronic bronchitis can potentially lead to COPD. A COPD diagnosis indicates that you may have signs of both of these lung-damaging conditions or just one of them. As COPD worsens over time, breathing becomes more difficult.
If you’re having any of the signs or symptoms of COPD, don't wait for your next appointment to call your provider. Report these symptoms promptly, even if you don't feel sick. Don't wait for symptoms to become so severe that you need to seek emergency care. If you notice your symptoms early, your provider might change your treatment or medications to relieve your symptoms.
COPD results in persistent and progressive respiratory symptoms, such as coughing up phlegm and having trouble breathing.
Vital points
>3.23 million people died from chronic obstructive pulmonary disease (COPD), the third most common cause of mortality in the world in 2019.
>In low- and middle-income nations, COPD fatalities in people under 70 years of age account for about 90% of all mortality (LMIC).
>To stop the progression of symptoms and lessen flare-ups, early diagnosis and treatment are necessary, including help for quitting smoking.
>Important COPD risk factors include occupational exposure to dust, gases, and chemicals, indoor air pollution, and tobacco smoke exposure.
>Long-term exposure to toxic chemicals and particles mixed with individual factors, such as childhood lung development-influencing events and genetics, cause COPD.
Causes:
Prolonged exposure to particulate matter
Smoke from cigarettes
persistent bronchitis
Emphysema
Symptoms:
Having trouble breathing
Cough
mucus formation
Wheezing
Not enough energy
>Shortness of breath, especially during physical activities
>Wheezing
>chest constriction
>a persistent cough that may discharge clear, white, yellow, or greenish mucus (sputum)
>Frequent respiratory infections
>Not enough energy
>Unwanted loss of weight (in later stages)
>ankles, feet, or legs swelling
Therapy:
Oxygen administration
lung surgery
Transplanting lungs
Lifestyle adjustments, such as giving up smoking
Bronchodilators to be inhaled
6.Corticosteroids
Antibiotics and viral medications
Prevention:
One should refrain from smoking.
You should stay away from polluted locations.
Frequent exercise
Consume healthily
Vaccine
How your lungs are affected?
Two substantial tubes carry air into your lungs from your windpipe (trachea) (bronchi). Like the branches of a tree, these tubes within your lungs repeatedly split into smaller tubes called bronchioles, which then terminate in collections of tiny air sacs (alveoli).
The walls of the air sacs are extremely thin and filled with microscopic blood veins (capillaries). These blood arteries allow the oxygen in the air you breathe to enter your bloodstream. Carbon dioxide, a gas that is a waste product of metabolism, is also exhaled at the same time.
To force air out of your body, your lungs rely on the bronchial tubes' and air sacs' inherent suppleness.
Causes of airway obstruction
Causes of airway obstruction include:
Describe the common disorders in association with the organ
Pleural Effusion
Emphysema
Lung Cancer
Pulmonary Embolism
Pulmonary Edema
Chronic Obstructive Pulmonary Disease
Bronchitis
Pneumothorax
Pneumonia
Asthma
COVID-19
Enumerate the various diagnostic techniques and investigations used in diagnosis of the disorder
Spirometry
Bronchodilator reversibility test
Blood tests
Genetic testing
Chest X-ray or CT scan
Sputum examination
Electrocardiogram (ECG or EKG)
Spirometry:
Spirometry is the most used and reliable approach for identifying COPD. The pulmonary function test, or PFT, is another name for it. This quick, painless test evaluates lung capacity and function.
You will exhale as forcefully as you can into a tube that is attached to the spirometer, a little machine, to conduct this test. The forced vital capacity refers to the total amount of air that leaves your lungs each breath
The FEV1 is the proportion of the FVC that is driven out in the first second. Forced expiratory volume is referred to as FEV. Peak expiratory flow rate refers to the fastest rate at which you can empty your lungs (PEFR).
The results of a spirometry test assist in identifying the type and severity of your lung disease. The outcomes are immediately interpretable.
The most accurate test is one that can identify COPD even before serious symptoms manifest. It can also help your doctor track the progression of COPD and monitor the effectiveness of treatment.
Precautions
Spirometry is not advised for someone who has recently undergone heart surgery or had a heart attack because it needs you to exhale strongly.
Prior to testing, it's crucial to be fully healed from any severe illnesses or ailments. You might have a little breathlessness and lightheadedness just after the test, even if you generally have good health.
Describe the management and treatment plan utilized in the disorder
Describe the surgical management of the disorder & Q.5. Self study on recent advances in the field
Risk factors for COPD include:
Exposure to tobacco smoke.The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
People with asthma.Asthma, a chronic inflammatory airway disease, may be a risk factor for developing COPD. The combination of asthma and smoking increases the risk of COPD even more.
Occupational exposure to dusts and chemicals.Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
Exposure to fumes from burning fuel.In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.
The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.
Complications
COPD can cause many complications, including:
Respiratory infections.People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue.
Heart problems.For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack
Lung cancer.People with COPD have a higher risk of developing lung cancer.
High blood pressure in lung arteries.COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).
Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to the development of depression.
Prevention/ Management
Unlike some diseases, COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now.
If you're a longtime smoker, these simple statements may not seem so simple, especially if you've tried quitting — once, twice or many times before. But keep trying to quit. It's critical to find a tobacco cessation program that can help you quit for good. It's your best chance for reducing damage to your lungs.
Occupational exposure to chemical fumes and dusts is another risk factor for COPD. If you work with these types of lung irritants, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment.
Here are some steps you can take to help prevent complications associated with COPD:
Quit smoking to help reduce your risk of heart disease and lung cancer.
Get an annual flu vaccination and regular vaccination against pneumococcal pneumonia to reduce your risk of or prevent some infections.
Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.
Surgical procedures for the treatment of COPD
Only very advanced cases of COPD are thought to demand surgical interventions. The volume of the lungs can be decreased via a variety of methods to facilitate breathing. Lung transplantation may be an option in really severe COPD cases.
Emphysema of the lungs can develop as a result of advanced chronic obstructive pulmonary disease (COPD). The walls of the lungs' air sacs (alveoli) are destroyed in this process, resulting in bigger air sacs that occasionally burst. The lungs' volume rises as a result of this "hyperinflation" of the air sacs. Less oxygen enters the blood as the lung's healthy area shrinks. The breathing muscles also need to exert more effort. As a result, people are less fit, have more frequent sputum coughs, and are more easily out of breath.
Under certain conditions, an operation or minor surgical procedure may be an option if the symptoms are no longer properly managed by alternative treatments. In general, this kind of therapy isn't applied very frequently.
Lung volume reduction
The hyperinflated areas of the lungs are removed or have their size decreased in this sort of treatment. As a result, the initial volume of the lungs is smaller overall. However, the healthy parts of the lungs have more room, which makes it simpler for them to oxygenate the blood. The purpose of this treatment is to improve overall breathing, lessen shortness of breath, and lessen stress on the breathing muscles.
There are two types of lung volume reduction treatment:
Surgery: Either a major cut in the chest is made to expose the rib cage or multiple minor apertures are used (keyhole surgery). In order to improve breathing, the surgeon eliminates inflated lung tissue.
Surgery: Either a major cut in the chest is made to expose the rib cage or multiple minor apertures are used (keyhole surgery). In order to improve breathing, the surgeon eliminates inflated lung tissue.
Only those with severe COPD who can afford them should undergo these procedures.
haven’t smoked for several months,
don’t have any other serious medical conditions,
aren’t extremely underweight, and
have already tried out all of the other treatment options.
Depending on variables like the type of pulmonary emphysema, different procedures will be better suited for various individuals.
How well does treatment for lung volume reduction work?
COPD patients may benefit from medication that reduces lung volume, but there are also certain dangers involved. Every process has advantages and disadvantages. Nowadays, bronchoscopy is a more common operation than surgery, although less study has been done on them.
Surgery The likelihood of surviving longer may be increased by lung volume reduction surgery. After five years, the following results were observed in the largest trial on this therapy:
Additionally, those who underwent the procedure had improved quality of life, were physically fitter, and experienced fewer episodes of breathing problems. Additionally, they were less likely to require hospitalisation if their symptoms suddenly got severe (exacerbation).
However, there were drawbacks to the surgery as well: more patients in the surgery group passed away in the first year following the procedure (due to consequences of the operation). The surgery carries dangers like inflammations and issues with wound healing, much like any operations. These negative effects, however, weren't sufficiently examined in the studies.
Bronchoscopic procedures:
Bronchoscopic procedures using valves or coils can improve your physical fitness and quality of life. Coils were also found to reduce the likelihood of breathing difficulties. It’s not clear whether this treatment can help people to live longer. The studies so far have lasted one year at most. That's too short to be able to answer this question.
One disadvantage of this treatment is that people's breathing sometimes suddenly gets worse afterwards. This can be caused by the endoscope that is inserted into the bronchi (air tubes in the lungs). It can lead to a collapsed lung (pneumothorax) too. People often cough up a bit of blood after the procedure, and the treatment is associated with the usual surgery-related risks. If coils are used, there is a greater risk of pneumonia.
Less is known about the pros and cons of procedures that use steam, foam and stents because there’s a lack of research on these approaches.
Bullectomy
This treatment is similar to lung volume reduction. It specifically gets rid of large air-filled spaces (known as bullae). Bullectomy is considered as a treatment option if individual air pockets take up more than a third of a lung and put pressure on nearby tissue. Like other treatments mentioned above, bullectomy is a minimally invasive procedure. In other words, it is done through small cuts in the chest area (keyhole surgery).
Transplants
Lung transplants are only considered for people who have advanced pulmonary emphysema, and only if they have already tried out all other treatment options. Due to a lack of donor lungs, this treatment isn't always possible. People who receive new lungs can usually breathe a lot better and their quality of life improves.
Transplants are associated with special risks because they involve major surgery and the body’s immune system might attack the new organ afterwards. To lower the risk of the body rejecting the organ, people have to take medication to suppress their immune system for the rest of their lives. But this medication sometimes has serious side effects.
Lung transplants are only considered as a treatment option if someone is very likely to die of COPD in the next few years – and if they don’t have any other serious illnesses. They have to stop smoking quite a long time before having the transplant, and they have to be prepared to actively take part in rehabilitation activities and exercises. Because people over the age of 65 are more likely to have other serious illnesses, most patients who have a lung transplant are younger.
Sources:
Bundesärztekammer. Richtlinie gemäß § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG für die Wartelistenführung und Organvermittlung zur Lungentransplantation.
Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Deutsche Atemwegsliga, Österreichische Gesellschaft für Pneumologie (ÖGP). S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). AWMF-Registernr.: 020-006. January 24, 2018.
Institute for Quality and Efficiency in Health Care (IQWIG, Germany). Procedure for lung volume reduction in severe lung emphysema: Final report; Commission N14-04. February 07, 2017. (IQWiG Reports; Volume 487).
Van Agteren JE, Carson KV, Tiong LU, Smith BJ. Lung volume reduction surgery for diffuse emphysema. Cochrane Database Syst Rev 2016; (10): CD001001.
Part 2
Bone matrix, which includes both organic and inorganic components, makes up bones. Osteoblasts lay down the collagen, commonly referred to as osteoid, that makes up bone matrix. Inorganic salts like calcium and phosphate and the compounds that the osteoblasts release during the mineralization process harden osteoid.
An osteon is the basic microscopic component of bone (or Haversian system). Osteons are essentially cylinder-shaped structures that can be several millimetres long and have a diameter of 0.2 mm.
A central canal is surrounded by lamellae of compact bone tissue that make up each osteon. The bone's blood vessels are located in the Haversian canal. The cement line designates an osteon's edge. Osteons can be organised into lamellar or woven bone
Osteon: A photo taken through a microscope that shows the anatomy of compact bone with a detailed view of an osteon.
Blood supply to the long bones comes from these three main sources:
Nutrient artery system
Metaphyseal-epiphyseal system
Periosteal system
The external carotid, internal carotid, and vertebrobasilar circulations all supply tributaries of a complicated artery network that supplies the cranial nerves with blood. Many times, each of these areas contributes to the circulatory supply of a specific cranial nerve along its path.
The major systemic arteries branch into the high-pressure nutrition artery system. It moves into the medullary canal after entering the cortex via the nutrient foramen. The inner 2/3 of the bone in the Haversian system are supplied by arterioles, which further branch out into ascending and descending branches.
The periarticular plexus, which is located surrounding the joint region of a long bone, is the source of the metaphyseal-epiphyseal arteries. The outer third of the bone is supplied by the low-pressure periosteal artery system, which is connected by the Haversian and Volkmann canals. The osteon structure of the cortex includes these channels.
Our bones become weaker as we age. A variety of calcium-rich foods, including dairy products, broccoli, and specific seafood, are advised to maintain them robust. A lifetime of movement is supported by your skeletal system with the aid of weight-bearing exercise.
The outer third of the bone is supplied by the low-pressure periosteal artery system, which is connected by the Haversian and Volkmann canals. The osteon structure of the cortex includes these channels.
Elaborate on bone remodeling and new bone formation
Osteoclast cells in cell remodelling.
Osteoblast cells helps in bone formation.
To sustain mechanical forces, growth, and reparative processes, bones are formed. Bone is continuously resorbed by osteoclasts and replaced by osteoblasts during the process of bone remodelling.
> As mechanosensors, osteoocytes guide osteoclasts in where to remove bone and osteoblasts in when and where to add new bone.
>There are four stages to the remodelling of bones. First comes the activation phase, which entails the osteoclast detecting a remodelling signal as a result of changes in physical stresses sensed by the osteocytes or damage to the bone matrix as a result of osteocyte apoptosis.
>The bone matrix is broken down by osteoclasts during the second phase, which is called resorption. The undigested, demineralized collagen matrix in the lacunae is removed by mononuclear cells during the reverse phase, which also prepares the bone surface for new bone formation.
> Osteoblastic bone development is the final stage. Bone resorption is prevented and stimulated by mechanical stimulation. Conditions of rest prevent bone growth. When an equal amount of resorbed bone has been rebuilt, the remodelling cycle is complete. The majority of the time, remodelling happens at random, although it can sometimes happen in damaged places.
Growing cartilage is gradually replaced by bone to generate long bones during the process known as endochondral ossification. The physis and epiphysis of the bone are the two primary places where this process takes place. Additionally, the cuboidal carpal and tarsal bones are undergoing the same process. Mesenchymal progenitor cells that differentiate into chondrocytes play a role in the development of endochondral bone. The cartilaginous template is laid down by chondrocytes, which is later mineralized and replaced by bone. The physis contains chondrocytes that can be separated into several zones or layers. The resting or reserve zone is located in the distalmost zone (furthest from the metaphysis). The proliferative zone, where chondrocyte division takes place, is located just next to this zone. The development of the flat bones of the skull, mandible, maxilla, and clavicles is followed by the differentiation of mesenchymal progenitor cells directly into osteoblasts.
The steps in intramembranous ossification are:
Ossification center formation
Calcification
Trabeculae formation
Periosteum development
Bone implant – an overview
Ø Biological principles and biomechanical considerations of implants, miniplates and miniscrew implants
Ø Distance and Contact Osteogenesis
Ø Bone Density
Ø Biological compatibility of materials
Ø Effect of surface topography on osseointegration
Ø Occlusal Considerations for Implant-Supported Prostheses
Ø Biocompatibility of Mesoporous Materials
Biocompatibility, Surface Engineering, and Delivery of Drugs, Genetic
The correct material choice for an orthopaedic implant depends on its intended use. Orthopedic implants frequently use ceramics, polymers, and metallic alloys. Different physical, chemical, and biological characteristics of these materials allow them to be used in various applications.
Postoperative Complications
Mobile Implant.
The absence of bone-implant integration requires the urgent removal of the implant because infection and more bone loss could follow. The implant may occasionally migrate within tissue cavities, or it may be eaten or aspirated.
With the counter-torque ratchet approach, an abutment or an engaging extraction tool is inserted into the implant and reverse torque is applied to the implant in a counterclockwise direction. This method is typically fairly non-traumatic.
To encourage ectopic bone growth, demineralized bone matrix can be injected into muscle or soft tissue. When transplanted into rats with normal vitamin D levels, demineralized allogeneic bone matrix from vitamin D-deficient rats is less successful in inducing bone formation than matrix from control animals. It was speculated that the lack of a mitogen in the vitamin D-deficient matrix may be the reason for the decreased induction of osteoblasts.
Conventional Extraction Methods: To avoid the possibility of breaking the buccal or lingual plate, this technique should only be used with minimal luxation and conventional forceps and elevators. Before grafting or reimplantation, all soft tissue around the implant site should be removed after removal.
Enumerate the indications and contraindications for the bone implant
Indications and contraindications for bone surgery in periodontology and implant dentistry
The extraction of teeth following trauma results in a loss of substance, creating functional and esthetic consequences that are significant during oral rehabilitations.
bone resorption may have four main causes:
Pathologic (eg, periodontal diseases, cysts)
Surgical (eg, extraction of impacted cuspids, apicoectomy)
Congenital (eg, micrognathy, oligodontia, palatal clefts)
Physiologic (eg, tooth loss, age, pneumatization of the maxillary sinus)
The most common causes of bone material loss are aggressive periodontitis and post-extraction injuries brought on by using a detachable prosthesis that is not properly fitted. The effects of these bone diseases are illustrated by the subsequent clinical case.
In this radiographic example, a 40-year-old woman with severe chronic periodontitis who was otherwise healthy and whose condition had been stabilised for two years had undergone traditional periodontal therapy (i.e., initial nonsurgical treatment, periodontal surgery, and replacement of tooth 16 with a conventional fixed bridge).
She has received routine maintenance every four months for the previous 15 years. After 15 years, the periodontal condition was acceptable. But on the distal of tooth 15, where occlusal stress was also evident, bone loss developed.
The maintenance care was strengthened after an occlusal adjustment was finished. After two years (1997), the patient went back for follow-up care with a fixed prosthesis that was noticeably mobile. The radiograph revealed irreversible bone loss, necessitating tooth extraction number 15. After healing, there will unavoidably be a three-dimensional vertical and horizontal loss of material.
Conditions that can be healed depend on three things:
Defect size: The critical size of the bone defect, which is unique to the kind of bone, determines the healing quality. A defect that is too large to mend correctly will result in substance loss.
Number of walls: The behaviour of the soft tissues above is influenced by the number of bony walls. If there are only one or two bone walls left, the unsupported soft tissues will fall into the defect. Defect type: A close infrabony defect will mend more quickly than an open defect because it can be filled mechanically. The presence of an open lesion implies the requirement for bone surgery. A bone block graft, a bone filler, or a membrane with or without bone chips must be used to restore the lost substance. It is now possible to execute osteotomies, osteoplasties, and the separation of the soft and hard tissues to rectify these substance losses with the use of potent ultrasonic devices and their wide range of tips mountable on a handpiece.
As with any oral surgery, bone surgical techniques (eg, manual, mechanical, or ultrasonic) present indications and contraindications.