3- clinical forms of periodontal disease

What is a periodontal pocket?

Gingival groove deepened by pathological process

Sulcus, when it deepens due to the apical migration of JE, with attachment loss

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, lateral proliferation of basal cells on JE

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

Due to pathological process- destruction of periodontal tissues- lose and exfoliates teeth

Suprabony vs infrabony

Bottom of pocket is coronal to underlying alveolar bone

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

What is always a predecessor of periodontitis?

Gingivitis but not all gingivitis progresses to periodontitis

Describe the bone loss process (4)

1. Osteoclastic stimulation by the plaque

2. Bone destruction by the plaque

3. Gingival cells release products that induce osteoclast differentiation

4. Gingival cells release products that destroy bone by direct chemical action + constructive phase

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

Research shows 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, crestal 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

Explain the radius of action/circular blow of destruction

Limited distance around a tooth within which plaque can cause bone resorption

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 determines type of bone loss

Horizontal- Bone height is reduced evenly, bone margin stays straight (perpendicular) to the tooth surface- perio pocket will be suprabony

Vertical- Bone loss is uneven, creating an angular defect usually when interdental septum more than 1.5-2.5mm thick- infrabony

What 4 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?

Bone profile is oblique to the root profile, leaves an undercut pocket

Depends on the number of bone walls-

- 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

3. Periodontitis as manifestations of Systemic Diseases

What are risk factors of periodontitis (5)?

Prior history

Local factors- anything that facilitates accumulation/prevents removal of plaque- hygiene, overcrowded teeth, uncleanable resto

Systemic factors- influences effectiveness of host response like diabetes

Environmental and behavioural factors- smoking, stress

Genetic- polymorphism in genes encoding interleukin 1a, 1b

Localised vs generalised periodontitis

When less than 30% of sites show attachment and bone loss

30% or more show attachment and bone loss

Clinical features of necrotising periodontitis?

Necrosis + ulceration of coronal part of interdental papilla and gingival margin

Painful, bright red, suppurative margin- bleeds easy

Recession, severe mobility

Conventional pockets missing due to destruction of marginal epithelium and ct

Related to an AIDS or HIV+ diagnosis

4 etiological factors of necrotising periodontitis?

Microbial flora- hiv patients, spirochete aggregate fusiforms, Candida albicans, herpes virus

Immunosuppressed

Stress

Malnutrition