[Music] all right so now let's look at the bone so when we have a client who has a healthy mouth or even when we have a client who has inflammation of just the gums alone so gingivitis their bone would be intact what i want you to gather from this is that in health and even in gingivitis the bone level is intact and to be very specific the bone always starts or it's right at the crust of the bone rather is located just two millimeters below the ceja or two millimeters apical apical means below below the cej so this is normal okay so in health we see bone like this in the gingivitis which is just inflammation of the gum the bone is not affected we see that the bone is just two millimeters apical or below the cej one thing i did not mention in the previous video is that we know that gingivitis is reversible so if someone has gum disease and their gums are inflamed if they visit a hygienist regularly and if they brush and floss and take care of their health then it is reversible the gums can return back to health but unfortunately with periodontitis when the periodontium is inflamed we can see that there is bone loss so instead of the bone being over here the bone has resorbed and in this case this is quite severe severe periodontitis is what we're looking at here because the bone has resolved significantly so much that the tooth can eventually fall off there's nothing the bone is supposed to be there to hold on to support the tooth and in this case we don't see that so here we would see mobility the teeth will start to um shift a little and we can become mobile and lose and the reason for that is because the bone has been resorbed so that's statement over here bone destruction may eventually lead to tooth loss is absolutely true so when someone is losing bone when there is bone loss there are two patterns that can happen one is horizontal bone loss and horizontal bone loss basically means that when we're looking at the bone in between the the teeth it is a straight line for the most part right it's horizontal bone loss and when you can draw a straight imaginary line like so that means it's horizontal bone loss so typically normal bone would be right over here two millimeters below the cej however when someone has bone loss it goes below the normal ideal level so with the horizontal bone loss if we look over here instead of it being a nice peak where we would see the alveolar crust which would crust up and have a nice peak we see a little bit of fuzziness like so and a straight line can be drawn through this is the most common type of bone loss that we see now sometimes someone could have vertical bone loss and vertical bone loss is when you can draw a diagonal line like so so it's not a straight line parallel it's a diagonal line and this is the less common type for bone loss this is also more severe if someone has vertical bone loss their bone loss would progress even further so it's a rapid progression we don't like to see vertical bone loss it's not a good thing to see it's more severe and so if you look here at this picture you can see that there is vertical bone loss where the bone loss is diagonal now let's look at how this happens so someone has horizontal bone loss which is like this what happens is when you get inflammation so when the gum starts to get inflamed the inflammation goes a certain way so it goes into the connective tissues remember this is the epithelial tissue this is the connective tissue which is in between so the connective tissue gets inflamed and then the bone gets inflamed and then the pdl gets infected and that's how we're getting horizontal bone loss it's going this way and that's why i can see a straight line over here when the inflammation goes this way and the bone is reserved this way we see horizontal bone loss but when we're looking at the vertical bone lossy inflammation is going a different way and if you look here it's going through the connective tissue which is this light pink tissue over here the inflammation is spreading this way and then the key difference is that it's hitting the periodontal ligament space and then going to the bone so that's why it's it's a different pathway and that's why you get vertical bone loss now why why is it that it's a different pathway well the reason is because the paradigm to ligament fibers are weak from before why could it be weak from before well perhaps this person is grinding or clenching and anytime you put your have occlusal trauma anytime you're grinding and clenching the periodontal ligament fibers becomes weak and when it becomes weak the inflammation likes to go this way because it's already weak the periodontal ligament fibers are already weak so it would go this way and then back the bone that way so this is the more harmful the worse the we don't like to see vertical bone loss because it progresses this way and because the periodontal ligament fibers are already weak