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Periodontium consist of
- G PAC
- Gingiva
- Periodontal ligament
- Alveolar bone
- Cementum
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what kind of epi is gingiva made of?
keratinized oral epithelium
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what type of epi is the sulcus composed of?
non-keratinized sulcular epi
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what type of epi is the JE made of
non-keratinized junctional epithelium
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what are gingival fibers composed of?
collagen connective tissues.
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Primary Gingival Fiber Groups
Dentogingival
Alveologingival
Dentoperiosteal
Circular
Transeptal
- Dentogingival - cementum -> free gingiva & attached gingiva (support)
- Alveologingival - Periosteum of bone -> attached gingiva (attach. gingiva to bone)
- Dentoperiosteal - cemetum at CEJ -> alveolar crest (anchors teeth)
- Circular - surrounds coronal portion of alveolar crest (supports free gingiva)
- Transeptal - interdental space to cementum (maintains associations with other teeth)
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cementum -> free gingiva & attached gingiva (support)
Dentogingival
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Periosteum of bone -> attached gingiva (attach. gingiva to bone)
Alveologingival
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cemetum at CEJ -> alveolar crest (anchors teeth)
Dentoperiosteal
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surrounds coronal portion of alveolar crest (supports free gingiva)
Circular
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interdental space to cementum (maintains associations with other teeth)
Transeptal
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function of secondary gingival fiber: intercircular
sustains dental arch.
distal, facial, and lingual of one tooth to adjacent tooth and mesial of next adjacent tooth
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secondary gingival fiber group: semicircular, connections and function
connection: mesial to distal of same tooth
supports free gingiva
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bone surrounding root that is lined by cribriform plate
alveolar bone proper
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bone comprised of cortical plates on the facial and lingual aspects of a tooth
compact bone
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bone which fills in bone between the cortical bone and the alveolar bone
cancellous bone
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means of attachment to perio ligament
bundle bone
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first bone lost in periodontal disease
alveolar crest bone
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two nonpathogenic bone modifications that can occur
dehiscence : bone resorption in absense of disease. can occur on facial surfaces of teeth with labially inclined teeth.
fenstration: openings or windows into the bone
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openings or windows into the bone
fenstration
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bone resorption in the absence of disease, can occur on the facial surfaces of teeth with labially inclined teeth
dehiscence
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first periodontal ligament to be lost in periodontal disease are
alveolar crest fibers
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Periodontal Fibers and Their Functions:
Alveolar Crest
Horizontal
Oblique
Apical
Interradicular
Transeptal
- Alveolar Crest; cementum to alveolar crest bone; opposes lateral forces
- Horizontal; cementum to alveolar bone horizontally; resist tilting and rotation
- Oblique; occlusal aspect apically to alveolar bone; main mode of attachment
- Apical; apically fr cementum to alveolar bone; resist extrusion
- Transeptal; cementum to cementum of adjacent tooth
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perio fiber which connects cementum to alveolar crest bone
Alveolar crest fibers
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function of alveolar crest fibrs
opposes lateral forces
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perio fiber which connects cementum to alveolar bone horizontally
horizontal
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function of horizontal perio fibers
resist tilting and rotation..
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function of oblique perio fiber
main mode of attachment, counter vertical mastication forces
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a tooth's main mode of attachment (perio fiber)
oblique fibers
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function of apical perio fibers
resist extrusion
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suprabony pockets are involved with
horizontal bone loss, located coronal to alveolar crest bone
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infrabony pockets are
apical to alveolar crest bone and may be horizontal or vertical bone loss
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one-walled defect has how many walls left standing?
just one wall.
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drugs which cause gingival hyperplasia
- Phenytoin (seizure)
- cyclosporins (anti-rejection drugs)
- nifedipine or verapamil (calcium-channel blockers)
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pemphigoid
blisters. body attacks fibrous attachment of skin and underlying connect tissues.
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pemphigus vulgaris
desmosomes and positive Nikolsky's sign. (pressure of finger near bull causes extension of bulla)
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bacteria involved with chronic perio
Porphyromonas gingivalis
- P. intermedia
- Bacteroides forsythus
- Actinobacillus actinomycetemcomitans
- Fusobacterium nucleatum
- Eikenella corrodens
- Campylobacter rectus
- Treponema spp
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Classification of Perio Disease:
I. Gingivitis
II. Slight chronic perio
III Mod chronic Perio
IV: advanced chronic perio
V: aggressive perio
- I: gingivitis: 1-3 mm
- II: slight chronic perio: 4-5 mm
- III: mod chronic perio: 5-7 mm
- IV: advanced chronic perio: >7 mm
- V: aggressive perio: possibly lose 1 mm/year
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Heavy plaque accumulation is not present with what type of perio?
Juvenile
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Why are down syndrome pts prone to perio?
because they have P. gingivalis
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Papillion-Levfevre syndrome
- genetic disorder
- charac: hyperkeratosis of palms and soles
affects primary dentition with perio
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Periodontal abscesses occur on vital or non vital teeth?
VITAL
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tooth vibration as teeth occlude
fremitus
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Furcation Classification
I
II
III
IV
- I. just a notch
- II. enters but does not go through
- III goes through but gingival margin hides furcation
- IV furca fully exposed
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Tooth Mobility classifcation
+
I
II
III
- + very slight mobility
- I. 1 mm
- II. 2 mm
- III. 3 mm or compressible
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actisite
cord impregnated with tetracycline that must be removed 7-10 days after therapeutic treatment. higher concentration than systemic tetracycline
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Atridox
slowly releases doxycycline for about 1 week. administered subgingivaly for 21 days.
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Periostat
doxycycline
suppresses increased levels of tissue-destroying collagenase enzymes produced by bacteria.
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surgery which rapidly eliminates excessive tissues
Excisional surgery
(gingivectomy, gingivoplasty: reshapes gingival tissues)
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bone grafts:
autografts
allografts
xenografts
alloplast
- autografts: fr pt
- allografts: cadaver bone
- xenograft: cow or pig
- alloplast: synthetic bone
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surgery which involves the removal of half the tooth, both crown and root.
root hemisection
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root resection is the
removal of one root from a multirooted tooth with the crown still intact.
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direct anchorage of an implant by the formation of bony tissue aronud it without growth of fibrous tissue at the bone-implant interface
osseointegration
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dental implants are made from what metal?
titanium
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implants which are screw-shaped, cylindrical, or blade implants that serve as an anchor for a crown or a bridge.
Endosseous
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implants custom-fabricated to fit over the bone and the under periosteum. fit whole arches or unilateral.
Subperiosteal
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"staple implant"
Transosteal
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infection around an implant due to a change in the microbial growth
peri-implantitis
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when should sutures typicall be removed after periodontal surgery?
7-14 days.
epi heals at day 7, osseous heal and recounter take place in 4-6 months
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when does osseous healing and recountouring take place?
4-6 months
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the preferred type of toothbrushing method to be used with periodontal pack is
Charter's method (place bristles of brush at a 45 degree angle to the occlusal surface)
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healing process when the edges of the wound are close together as a clot forms to act like a scaffolding.
First intention healing
(clot is replaced by granulation tissue as capillaries migrate into the wound site. Fibroblasts produce collagen fibers, healing the wound in about 2 weeks)
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healing when the edges of the wound are not within close proximity. the wound heals from the base and outer borders inward one cell layer at a time.
second intention healing
(ex: donor site from the palate for a free gingival graft)
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digoxin
cardiac glycoside that increases heart contractions
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cyclosporin
causes gingival hyperplasia
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lidocaine
treats dysrhythmias
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a good drug for juvenile periodontal disease, so long as all teeth have formed
tetracycline
longer half-life in gingival crevicular fluid
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drug used for NUG, pericoronitis, periaplica and perdontal abscesses
penicillin
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drug to treat oral candidiasis
Diflucan
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Drug to treat lichen planus
Decadron
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Drug to treat primary herpes
Zovirax
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lesion that when rubbed with a 2x2 sloughs off leaving a red inflamed area
desquamative gingivitis
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gingivitis due to a lack of vitamin C and affects connective tissues
Scorbutic gingivitis
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average distance of alveolar crestal bone to cementoenamel junction (CEJ) is
1.5-2.0 mm
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