Perio Board Review Textbook

Gingiva

Tissues that cover the cervical portions of the teeth and the alveolar processes of the jaws.

Periodontal Ligament (PDL)

The fibers that surround the root of the tooth.

Cementum

The thin layer of mineralized tissue that covers the root of the tooth.

Alveolar Bone

the bone that surrounds the roots of the teeth

Free Gingiva

unattached portion of the gingiva that surrounds the tooth in the region of the CEJ; unattached gingiva

Gingival Sulcus

the space between the tooth and the free gingiva

Interdental Gingiva

Gingiva that fills the interdental embrasure between two adjacent teeth apical to the contact area

Attached Gingiva

Continuous with the free gingiva and is part of the gingiva that is firm, dense, and tightly bound to the cementum on the cervical third of the root or to the periosteum of alveolar bone

incisor and molar regions

attached gingiva is widest in the _______:

Mandible: 3.3-3.9 mm

Maxilla: 3.5-4.5 mm

premolar regions

attached gingiva is narrowest in the ______:

Mandible: 1.8 mm

Maxilla: 1.9 mm

palatal surfaces

WIDTH OF ATTACHED GINGIVA IS NOT CALCULATED ON

Gingival Margin

The coronal-most portion of the gingiva follows the contours of the teeth, creating a scalloped outline.

Mucogingival Junction

The scalloped linear area denoting the approximation or separation of the attached gingiva to the loosely attached and moveable alveolar mucosa.

epithelium

underlying connective tissue

Gingiva consists of

Dentogingival (DG) fibers

Alveologingival (AG) fibers

Dentoperiosteal Fibers

Circular (C) fibers

Transseptal Fibers

what are the principle fiber groups of connective tissue?

Dentogingival (DG) Fibers

principal fiber group that extends from the cementum into the gingiva; function is to support the gingiva

Alveologingival (AG) Fibers

principal fiber group that extends from the periosteum of alveolar crest into attached gingiva; function is to attach gingiva to bone.

Dentoperiosteal Fibers

principal fiber group that anchors tooth to bone and protects periodontal ligament.

Circular (C ) Fibers

principal fiber group that encircle the entire tooth to the alveolar crest, functioning to support the free gingiva

Transseptal Fibers

principal fiber group that extends from the cementum of one tooth to the cementum of the adjacent tooth; functions to maintain relationship between teeth in the arch.

Periosteo Gingival (PG) Fibers

Interpapillary Fibers

Transgingival Fibers

Inter Circular Fibers

Semicircular Fibers

Intergingival Fibers

what are the secondary gingival fiber groups of connective tissue

Periosteo Gingival (PG) Fibers

Secondary fiber group that extends from the periosteum of alveolar bone into connective tissue; function to attach gingiva to bone

Interpapillary Fibers

Secondary fiber group that is found in papillae coronal to transseptal fibers; function is to support papillary gingiva

Transgingival Fibers

Secondary fiber group that extends horizontally between teeth from cementum near CEJ; functions to support marginal gingiva

Inter Circular Fibers

Secondary fiber group that encircles several teeth; function is to maintain dental arch form

Semicircular Fibers

Secondary fiber group that run from the mesial surface to the distal surface of teeth; function is to support free gingiva

Intergingival Fibers

Secondary fiber group that extends mesiodistally along entire dental arch; function is to support attached gingiva and link adjacent teeth in the dental arch.

Keratin

Tough Fibrous structural protein that occurs in the outer layer of the skin and the oral epithelium

Kerainized or parakeratinized

Gingiva is

Free Gingiva

Gingiva that attaches to the tooth via junctional epithelium (not directly attached to the tooth)

Attached gingiva

Gingiva that attaches to the cementum and bone via connective tissue

mucosa and col

non-keratinized structures

Gingival Col

Valley-like depression of tissue between the buccal and lingual interdental papilla.

Alveolar Bone Proper

Thin layer of bone lining the socket that surrounds the root of the tooth; where fibers of the PDL insert

Alveoli

Tooth sockets lined by the cribriform plate.

Lamina dura

forms walls of the tooth socket.

Cortical (compact) bone

Outer wall of bone of the mandible and maxilla on the facial and lingual aspects

Cancellous (Spongy) Bone

Lattice like bone between the cortical bone and the alveolar bone proper, surrounded by marrow

Alveolar Process

Bone of the upper or lower jaw that surrounds and supports the roots of the teeth.

2--3 mm apical to CEJ

Crest of the alveolar process follows the CEJ at a

Tooth migration

Bone apposition

Resorption

Alveolar process is in a CONSTANT state of remodeling accommodating physiologic

Dehiscence

Loss of alveolar bone on one aspect of the tooth, typically facial, that leaves the area of the root covered by soft tissue only. – occurs mostly in pt with labially inclined roots

Three Features:

Gingival recession

Alveolar bone loss

Root Exposure

Fenestration

A "window" of bone loss bordered by alveolar bone on its coronal aspect

Osteoblasts

Bone builders/bone forming cells

Osteoclasts

Bone consumers/bone destroying cells

Extracellular Matrix

Collagen fibers and gel-like substance that forms the major component of the alveolar bone. - allows rigidness of the alveolar bone by allowing the bone matrix to undergo mineralization by deposition of minerals (calcium and phosphate)

Blood vessel and nerve innervation

the alveolar bone has

Periodontal Ligament (PDL)

Layer of soft connective tissue that covers the root of the tooth and attaches it to the bone of the tooth socket. Supports the tooth in the socket and absorbs mechanical loads placed on the tooth - protecting the tooth in the socket.

Fibroblasts (mainly)

Cementoblasts

Osteoblasts

Cells of PDL include:

Physical – suspends/maintains tooth in the socket, and transmits occlusal forces to bone.

Formative – participates in formation and resorption of cementum and bone, and remodeling of PDL

Nutritive – supplies nutrients to the cementum, bone, and gingiva via blood vessels

Sensory – contains sensory nerve fibers which transmit tactile, pressure, and pain sensations.

what are the functions of the PDL?

.05-.25 mm

Thickness of PDL Space is

collagen fiber bundles

The PDL connects the root cementum to the alveolar bone via

Alveolar crest fibers

Horizontal fibers

Oblique fibers (Main support)

Apical fibers

Interradicular fibers (present in furcation areas of multirooted teeth)

5 principle PDL Fiber Bundle Groups include

Sharpeys Fibers

ends of the PDL fibers that are embedded in the cementum and alveolar bone

Cementum

Thin layer of hard, mineralized connective tissue that covers the surface of the tooth formed by cementoblasts

Softer than dentin or enamel -- **Attaches PDL to the tooth, AND provides a seal for dentinal tubules

20-50 um

at the CEJ, how think is cementum

50-2000 um

at the apex, how thick is cementum

PDL

cementum does NOT Contain blood, nerves, or lymphatic vessels – receives nutrients from

Overlap of cementum on enamel (60-65%)

Meet between cementum and enamel (30%)

Gap between cementum and enamel (5-10%)

Three Types of relationship possible at Cementoenamel Junction:

Extrinsic – sharpey's fibers

Intrinsic – formed by cementoblasts, create cementum matrix

Collagen fibers in cementum are from extrinsic and intrinsic sources:

Acellular Cementum

Cementum that forms DURING tooth eruption, and covers cervical ⅔ of root; is devoid of cells, function is tooth support.

Acellular Afibrillar Cementum

acellular cementum located near CEJ that contains no fibers or cementocytes.

Acellular extrinsic fibers

acellular cementum that is located on the coronal third of the root, containing sharpey's fibers.

Cellular Cementum

Cementum that forms AFTER tooth eruption in the apical ⅓ of the root; contains cementocytes, and function is continuous deposition of cementum.

Cellular Mixed Stratified Cementum

cellular cementum located in areas of resorption, containing intrinsic fibers and cementocytes.

Intermediate cementum

cellular cementum located near junction of cementum and dentin, containing no fibers but remnants of cementocytes

Biofilm

Complex microbial community, containing a diverse array of many types of microbial species embedded in protective matrix that adheres to a living or nonliving surface.

Oral Biofilm

Accumulations of microbes on the surface of teeth or other solid oral structures, not easily removed by rinsing

Quorum Sensing

Communication between bacteria organized in a biofilm, has potential to influence gene expression and community structure.

Acquired Pellicle

primary colonizers, film composed of salivary glycoproteins and antibodies absorbed to the surface of the tooth. Forms within minutes, and promotes bacterial adhesion, and protects enamel from acidic activity. (dominated by gram-positive cocci - streptococcus sanguis is MOST present)

Secondary Colonization

Growth and maturation phase of plaque, in which bacteria multiple and form mini colonies to form a matrix that increases mass and thickness from the growth of the attached bacteria.

Fusobacterium nucleatum

Functions as a bridge between primary and secondary colonizers, allowing shift from gram positive cocci to gram negative bacteria and spirochetes.

Supragingival Plaque

Plaque that is predominantly gram positive cocci and short rods, with aerobic bacteria.

Subgingival Plaque

Plaque that is predominantly gram negative, anaerobic bacteria that may be tooth attached, epithelium attached, or unattached.

Aerobe

Organism that requires an aerobic or oxygenated environment to survive.

Anaerobe

Microorganism that can exist and grow only in the partial or complete absence of oxygen.

Gram positive

Aerobic

Non-motile

Cocci, Rods

in health, what bacteria are present?

Gram negative

Anaerobic

Motile

Rods, Spirochetes

in disease, what bacteria are present?

Host Response

The way that an individual's body responds to an infection

Innate Immunity

Immunity present at birth, NOT ANTIGEN SPECIFIC - exposure results in no immunologic memory

Adaptive Immunity

Immunity that develops throughout life, ANTIGEN SPECIFIC - provide lifelong immunity to infectious agent

Neutrophils

1st cells to respond, play a vital role in combating bacteria in plaque biofilms

Macrophages

2nd cell to respond to infection, often most numerous cells in chronic infection

Bacterial Accumulation - Initial Lesion

Stage of development within pathogenesis of periodontal disease that develops within 2-4 days after biofilm accumulation, in which no clinical changes are present, but an acute inflammation response is present:

Junctional epithelium and coronal connective tissue affected

Vasodilation of capillaries, increased migration of neutrophils into junctional epithelium and gingival sulcus

T-Lymphocytes predominate

Increase in gingival crevicular flow

Early gingivitis - early lesion

Stage of development within pathogenesis of periodontal disease that develops within 4-7 days, in which clinical signs of gingivitis are present such as erythema and edema.

Established Gingivitis – Established Lesion

Stage of development within pathogenesis of periodontal disease that develops within 2-3 weeks, in which clinical signs of gingivitis are present such as erythema and edema, and EXTENSIVE collagen destruction occurs and pocket develops.

Periodontitis – Advanced Lesion

Stage of development within pathogenesis of periodontal disease that BONE LOSS occurs, and pocket epithelium migrates forming PERIODONTAL POCKET, with BOP, destruction of PDL, and alveolar bone loss are present causing irreversible damage.

Gingival description (color, contour, consistency, texture)

Probing depths:

Bleeding on probing

Suppuration/exudate presence

Clinical attachment loss

Tooth mobility

Furcation involvement

Before any therapy is performed, assessment of patients current periodontal status is mandatory including evaluation of:

Periodontal probing

Distance from the gingival margin to the base of the pocket, measured on 6 specific sites on each tooth.

junctional epithelium

In health probe will penetrate into

connective tissue attachment

In periodontal pockets, the probe will penetrate into

1-3 mm

The normal sulcus depth is

Clinical Attachment Loss

best measure to assess periodontal stability, recording the distance from the cementoenamel junction to the depth of periodontal probe penetration.

subtract

when calculation CAL:

If the gingival margin is coronal, ______the amount of gingival tissues laying on enamel

Add

when calculation CAL:

If the gingival margin is apical (recession), _____ the amount of recession to the probing depth.

Inflammation of periodontal ligament

Loss of periodontal support

Trauma from occlusion

Causes of Mobility include

Class I Mobility

Classification of mobility in which there is barely distinguishable tooth movement.

Class II Mobility

Classification of mobility in which there is less than 1 mm movement in any direction.

Class III Mobility

Classification of mobility in which there is MORE than 1 mm of displacement in any direction, OR vertical displacement (tooth is depressed in socket)

Class I Furcation

Class of furcation in which there is pocket formation into the flute but intact interradicular bone.