3- clinical forms of periodontal disease

What is a periodontal pocket?

Gingival groove deepened by pathological process

What can cause deepening of the gingival sulcus?(3)

Coronal movement of gingival margin

Apical displacement of gingival attachment

Combination of both

What is the gingival sulcus, healthy sulcus measurements?

Healthy- 0.5mm deep, 2mm on probing

Gingival sulcus- space between neck of tooth and gingival tissue

Gingival vs pseudo vs periodontal pockets

Due to inflammation- gingival enlargement, no insertion or periodontal loss

Due to edematous swelling- causes increase in groove depth- coronal migration

Gingival groove deepened by pathological process- destruction of periodontal tissues- loss ends and exfoliates teeth

Suprabony vs infrabony

Bottom of pocket is coronal to underlying alveolar bone

Type 1- Bottom of bone apical to level of adjacent alveolar bone, type 2- lateral pocket wall lies bateen tooth surface and alveolar bone

Sulcus vs pocket

Gingival sulcus- space between the neck of the tooth and the gingival tissue

Sulcus, when it deepens due to the apical migration of JE, with attachment loss- periodontal pocket.

What is always a predecessor of periodontitis?

Gingivitis but not all gingivitis progresses to periodontitis

Describe the bone loss process

Osteoclastic stimulation by the plaque

Bone destruction by the plaque

Release from gingival cells of products that induce osteoclast differentiation.

Release of gingival cells from products that destroy bone by direct chemical action

What are the rates of progress of periodontitis (Loe et al)?

Rapid- 0.1-1mm attachment loss in 1 yr

Moderate- 0.05-0.5

Minimal/No- 0.05-0.09mm

Nowadays they suggest that periodontitis develops more in outbreaks- patient may be stable for a while, they’ll have an outbreak and spreads rapidly then stops

What anatomical features can effect the bone destructive pattern in periodontal disease? (7)

Interdental septa- thickness, width, crystal angulation

Thickness of facial and lingual alveolar plates

Presence of fenestrations and dehiscences

Alignment of the teeth

Root and root trunk anatomy

Root position within the alveolar process

Proximity with another tooth surface

Describe the circular blow of destruction and the radius of action

There’s a limited distance within which bacterial plaque can cause bone resorption around a tooth

The effective radius is about 1.5–2.5 mm

Beyond 2.5 mm plaque generally does not cause bone destruction.

Horizontal and vertical resorption pattern?(interadicular)

Interdental septum determined type of bone loss

Horizontal- reduced bone height but bone margin remains perpendicular to tooth surface- perio pocket will be suprabony

Vertical- thickness of interproximal septum more than 1.5-2.5mm- infrabony

What infraosseous bone resorption patterns can occur?

Angular defects

Circumferential defects- cicrcular wall of destruction

Bone craters- if 2 circular defects connect next to each other

Hemiseptal defect- bone crater loses one of its outer walls

Describe the angular defects that can occur?

The bone profile is oblique to the root profile, leaving an undercut pocket

in the bone along the root. Depending on the number of bone walls we talk about

- Defect of 3 walls- worst prognosis

- Defect of 2 walls

- Defect of 1 wall- can clean and put in bone graft

3 furcation grades?

1- probe penetrates up to 3mm deep

2- beyond 3mm but not permeable

3- permeable furca

What are the 3 distinguished subgroups of periodontitis and peri-implant diseases?

1. Necrotizing Periodontal Diseases,

2. Periodontitis and

3. Periodontitis as manifestations of Systemic Diseases.

Describe the grades and stages o f periodontitis (classification) - NEED TO LEARN TABLE

FOR EXAM

What are risk factors of periodontitis (5)?

Prior history

Local factors- anything that facilitates plaque accumulation or prevents its removal

Systemic factors- anything that influences effectiveness of host response, rate of destruction- like diabetes

Environmental and behavioural factors- smoking, stress…

Genetic