Yellow Cortical Bone: Thoughts?
I recently did a surgical exposure of the alveolar ridge of this 57 year old healthy male with no medical complications. During regenerative periodontal surgery his cortical bone was found to be yellow. When questioned if he was ever treated for acne he said in his 20’s he was on tetracycline for about 2 years. This appears to be a case where tetracycline staining of bone may last a lifetime. Any thoughts?
![]tetracycline stain](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/12/tetracycline-stain-comp-e1356697283323.jpg)
![]Tetracycline stain grafted](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/12/tetracycline-stain-grafted-e1356697354437.jpg)When questioned if he was ever treated for acne he said in his 20’s he was on tetracycline for about 2 years. This appears to be a case where tetracycline staining of bone may last a lifetime.
23 Comments on Yellow Cortical Bone: Thoughts?
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CRS
12/28/2012
Yep that sure looks like it, tetracycline gets incorporated into the bone, see it a lot in third molars. The bone tends to be harder. Usually of no clinical consequence.
sb oms
12/29/2012
i see this a lot. the bone still has normal vascularity and healing potential.
i'm still amazed that with all the turnover and remodeling of alveolar bone, the color stays. i'd be interested to know the mechanism involved here, if anyone knows.
Alex
12/29/2012
I agree it tetracycline.
Robert J. Miller
12/30/2012
I agree with the posters regarding the consequences of tetracyline use. However, this is a rather intense LOCAL phenomenon. If this is from oral medication, we would tend to see a more diffuse and generalized reaction. Given the periodontal defect on the tooth you obviously extracted, was this a consequence of localized placement of minocycline (Arrestin) in the course of earlier periodontal treatment?
RJM
greg steiner
12/31/2012
Dr. Miller
The potential that this is a local phenomenon as a result of Arrestin is a great thought that I have not considered and I thank you for thinking outside of the box on this one. I will check with the patient next week and report back to determine if he recalls having localized antibiotic therapy. However the tooth was not extracted. You are seeing Regen Biocement Putty mixed with Osseoconduct BTCP granules which was covered with an inverted periosteal graft for regenerating the periodontal defect. Greg Steiner Steiner Laboratories
DrT
1/1/2013
I would love to see some pictures of your inverted periosteal graft. Also since this appears to be a straight forward 3 wall IBD why not keep things simple and place an osseous graft and suture flaps with primary closure? Going eons back to the articles by Pritchard, we know that regeneration in 3 wall IBD's is highly predictable without the use of any of our newer fancy bioactive materials or membranes. KISS
Thank you.
DrT
greg steiner
1/1/2013
DrT
The photos were not descriptive of the perio lesion. It was a class two buccal furcation with loss of the buccal wall on the distal root creating a distal two wall defect.
Greg Steiner Steiner Laboratories
Periodrill
1/1/2013
This is a great case to discuss when and how to graft( I think the tetracycline issue is obvious). When I look at the photographs the defect looks like more of a 2/3 wall combined defect. What is everyone's opinion on best approach? Graft alone? Graft & membrane? Or the most predictable but not regenerative option of osseous recontouring? Any radiographs available of this case?
greg steiner
1/2/2013
Hello Periodrill
As you have stated there are many ways to treat periodontal disease but my goal is to make the patient whole again and the only way to do that is regenerative surgery. Occlusive membranes are limited in their regenerative capacity and I think this is because while unwanted cells are blocked their signaling molecules are not and they do not provide any regenerative cells. The periosteum is a biologically active barrier to unwanted cells but also comes with the addition of regenerative cells that have the potential to regenerate periodontal ligament and bone. In addition why should I pay for a membrane when the patients walks in with a better one? Greg Steiner Steiner Laboratories
Baker k. Vinci
1/2/2013
The question is not about grafting . This type of staining is quite common and is not likely a result of your patient taking the antibiotic in his 20's. This was one of the most common questions in the second year standardized test exam in dental school. This drug had to be ingested while the patient was in his mother's uterus. I see this 2-3 times a month. BV
greg steiner
1/2/2013
BV If this is not tetracycline staining and you see it regularly then what is the etiology? Greg Steiner Steiner Laboratories
Baker k. Vinci
1/2/2013
Greg, you misunderstood me, or maybe I wasn't clear. I believe it is tetracycline, I just used the term antibiotic in stead. Meckels cartlige developes in the first trimester. The scientific suggestion is; the drug is taken by the mother during the first three months of pregnancy. Bv
DrT
1/2/2013
Thanks for the clarification. As I re-examine your picture I can now visualize what the defect looks like. Do you have any pictures of the inverted periosteal graft?
Thank you.
DrT
greg steiner
1/2/2013
DrT for photos and information you can Google "inverted periosteal graft". Greg Steiner Steiner Laboratories
DrT
1/2/2013
Excellent, excellent documentation on your site. Do you by any chance have any videos as I would love to see, in motion, precisely how you dissect the periostium coronally and then invert it coronally. In any event, thank you for sharing this information with me/us.
DrT
greg steiner
1/3/2013
DrT
We are in the process of making videos of our other surgeries but we do not have anything in the pipeline for the IPG. I do have a detailed how to case I can email you if you contact me through our web site. Greg Steiner
R Knepper
1/3/2013
Also, consider Vitamin D as a cause of yellow bone. I have seen this with patients taking Vitamin D suppliments.
greg steiner
1/3/2013
R Knepper
Thank you for the suggestion. I will ask the pateint if he has a history of Vitamin D intake and let you know. Greg Steiner Steiner Laboratories
John Kong
1/4/2013
The 'yellow' bone should not be of any clinical significance to the outcome of your periodontal surgery.
Joseph CHOUKROUN
1/6/2013
Branemark said in 1985: "when I see a yellow bone, I cancel the transplant ! " .
Please check the cholesterol, specially LDL cholesterol. With high fat diet,and high LDL, the percentage of fat in the bone increases.
CRS
1/7/2013
This appears to be hard cortical bone not medullary fat as seen in the maxillary tuberosity. Perhaps that is what Branemark may be referring too . The mandibular cortex does not have fat. This just looks like plain old tetracycline staining either systemic or Arrestin. Pretty picture and interesting perio grafting good post!
greg steiner
1/9/2013
This patient was seen for a post op and questioned if he had ever taken vitamin D or had localized application of antibiotics into the periodontal lesion and he reported he had not. The conclusion is that the color imparted to his bone is a result of long term tetracycline ingestion for acne. An interesting thought is if his bone had accumulated this amount of tetracycline why did this not protect him from the development of periodontal disease. As the disease progressed the tetracycline would have been released. When I told him that his body would always be easy to identify as the one with the yellow skeleton he found little humor in this observation. Greg Steiner Steiner Laboratories
Mike crowley
2/22/2013
Never seen it that yellow but a spectrum of green/yellow is a -cycline.
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