PP7 Chronic Periodontitis

• –Inflammation within the supporting tissues of the periodontium
• –Progressive and irreversible destruction of the periodontal ligament and supporting bone
• –Most frequent form of periodontitis
• –Mostly commonly seen in adults over 35–Initiated by plaque biofilm but host response plays a major role in tissue destruction

slow to moderate

Pain

presence or severity

estimate of the extent of destruction of the supporting structures of the tooth

• Loss of alveolar bone support +–
• Periodontal pockets and/or gingival recession +–
• Furcation involvement with multirooted teeth +/-
• Tooth mobility

–loss of 1 to 2 mm

–loss of 3 to 4 mm

–loss of 5 mm or greater

Depression on the Mesial of the maxillary molars

3-5mm

13mm

16mm

12mm

Gingivitis

• Slight chronic periodontitis
• – pocket depth 4mm
• – progression of gingival inflammation into deeper periodontal structures and alveolar crest with slight bone loss less than 15%

• Moderate chronic or aggressive periodontitis – pocket depth 6mm
• – increased destruction with noticeable loss of bone (16 TO 30%) may be accompanied by increased mobility.
• There may be furcation involvement in multirooted teeth

• Advanced chronic or aggressive periodontitis – pocket depth greater than 7mm
• – major loss of alveolar bone support greater than 30%, usually accompanied by increased tooth mobility.
• Furcation involvement is likely

• REFRACTORY PERIODONTITIS
• Multiple sites that continue to show attachment loss after appropriate therapy –

without destruction

• with destruction
• apical migration

Has less blood and more fibers

Discoloration caused by engorgement of vessels(vasodilation), flaccidity by destruction of gingival fibers and surrounding tissues, shiny surface by edema and pitting by edema and destruction of tissue

increased vascularity and ulceration of pocket wall

ulceration of the inner pocket wall exposing connective tissue and nerves

slow to moderate

new signs and symptoms of periodontitis that reappear after treatment because the disease was not treated adequately and/or the patient did not practice adequate self care