An alternative reaction

Sir, I am writing to bring attention to the case of a 47-year-old male smoker initially diagnosed with aggressive periodontitis. The patient presented with what was deemed to be approximately 70% generalised horizontal bone loss affecting his remaining teeth (Fig. 1). Upon looking at the radiograph closely, particularly at the lower jaw, there does not appear to be loss of bone height per se in the mandible, just a loss of bone surrounding the teeth, making the teeth appear extruded – see height of bone above inferior dental canal and anterior mandible. In light of this and other similar observations, could tooth extrusion be an alternative reaction of the periodontium to the effects of dental neglect, smoking and other patient factors?

Figure 1

Orthopantogram showing 70% generalised horizontal bone loss