chapter 16 periodontics

periodontics

periodontology

one of the ADA-recognized specialties and is the field of dentistry that deals with the treatment of diseases of the tissues around the teeth

periodontium

serves as an attachment apparatus and is composed of four major tissues

gingival

fibrous, epithelial tissue surrounding a tooth

attached

the portion that is firm, dense, stippled, and bound to the underlying periosteum, tooth, and bone

keratinized

hard

mucogingival

where the gingiva and mucous membrane unite, is indicated by the color changes from pink gingiva to red mucosa

marginal

the portion that is unattached to underlying tissues and helps to form the sides of the gingival cervice

sulcus

groove

papillary

the part of the marginal gingiva that occupies the interproximal spaces

interdental papilla

normally this tissue is triangular that fills the tooth embrasure area

periodontal ligaments

bundles of fibers that support and retain the tooth in the alveolar socket

alveolar crest fibers

located at the cementoenamel junction; assists with the retention of the tooth in its socket and protects the deeper fibers

horizontal fibers

attached along the upper side of the root; assists in the control of lateral movement

oblique fibers

connects the majority of the root in the alveolar socket; assists with the tooths resistance to axil forces

apical fibers

arranged in bundles and attaches the apex of the tooth to the alveolar bone; assists with prevention of tipping and dislocation and also protects the nerve and blood supply to the tooth

interradicular fibers

also arranged in bundles and located in the furcations of multiple rooted teeth

cementum

outer hard, rough surface covering of the root section of the tooth that permits the fiber attachment for tooth retention

alveolar bone process

compact bone that forms the tooth socket

cribriform

sieve-like plate to form and line the tooth socket

lamina dura

lining, thin layer

plaque

plate or buildup

calculus

plate or buildup

pellicle

teeth acquire an adhering biofilm

erythema

the gingiva is red and appears inflamed

edema

the tissue is overgrown from excessive number of tissue cells

hyperplasia

excessive number of tissue cells

hypertophy

excessive cellular growth

loss of stippling

spotting

pocket formation

gingiva is unattached, recession occurs, and the root may be observed

alveolar bone loss with exudate

passing out of pus

mobility

the tooth seems loose and moves under pressure because of loss of attachment

dental plaque involvement

tissues react to irritants

dental plaque with systemic factors included

pregnancy, hormone, medication, or malnutrition may modify and intensify the disease course of action

nondental plaque tensions

these are of specific bacterial, viral, fungal, or genetic origin, such as gonorrhea, herpes, HIV, and candida infections

allergies

the patient may be allergic to dental restorative materials and have reactions to food, additives, and so forth

traumatic lesions, injury

the patient may have been subjected to an external force or have been injured in some way

chronic periodontitis

previously termed adult periodontitis, this is the most common type of slowly progressive periodontal disease

aggressive periodontitis

rapidly progressive disease

refractory periodontitis

the periodontitis progresses in spite of excellent patient compliance and provision of periodontal therapy

desquamative

shedding, or scaling off

periodontitis as manifested of systemic disease

periontal inflammatory reactions occur as a result of diseases and genetic disorders

Necrotizing periodontal diseases

rapid gingival tissue destruction with bacterial invasion of connective tissue may be a manifestation of systemic disease, such as HIV infection

NUG

with foul odor and a loss of interdental papilla

NUP

with bone pain and rapid bone loss

abscesses of the periodontium

abscesses are classified according to location, such as gingival, periodontal, and pericoronal

periodontitis associated with endodontic lesions

this simple classification was added to distinguish between periodontitis and periodontitis with endodontic inflammation involvement

Developmental or acquired deformities and condition

deformities appear around teeth, edentulous ridges, and from trauma

medical history

questions regarding diabetes, pregnancy, smoking.. etc

dental history

chief complaint, past dental records and radiographs, complete assessment of restoration condition, tooth position, mobility

extraoral structure assessment

exam of oral mucosa, muscles of mastication, lips, floor of mouth, tongue, palate, salivary glands, and the oropharynx area

periodontal probing depth

charting and recording findings of probe depths

assessing intraoral findings

exam for tori palatinus or tori mandibularis growths abnormal frenum placement and size, and furcation involvement

prophylaxis

scaling, root planning, and polishing of teeth

index

measurement of conditions to a standard

periodontal probe

a round or flat bladed hand instrument marked in millimeter increments

prophylaxis debridement

removing supragingival plaque, calculus, stain, and irritants through tooth crown and tooth surface scaling and root planing

tooth and surface polishing

polishing surfaces to remove accumulated extrinsic

extrinsic

outer

endotoxins

absorbed pathogens

selective polishing

term applied to the polishing of chosen tooth sites or areas

prohylaxis

term applied to the combination of debridement and tooth polishing

patient education

customized instruction in oral hygiene

antimicrobial therapy

against small life

occlusal adjustment

selective grinding of occlusal cusps to eliminate premature contract

tooth stabilization

splinting, wire ligation, or bonding of teeth to lessen tooth mobility

occlusal guards

custom formed acrylic nightguard to protect from tooth grinding

mucogingival excision

used to correct defects in shape position or amount of gingiva

gingivectomy

excision of pocket tissue areas

gingivoplasty

instrumental or laser surgical contour of gingival tissue to remove excessive tissue or pellical edges

periodontal flap surgery

a loosened section of tissue is separated from the adjacent tissues to enable elimination of deposits and contouring of alveolar bone

envelop flap

no vertical incision with the mucoperiosteal flap retracted from a horizontal incision line

mucoperiosteal

mucosal tissue flap, including the periosteum

partial thickness flap

surgical flap, including mucosa and connective tissue but no periosteum

pedicle flap

tissue flap with lateral incisions

positioned flap

flap that is moved to a new position apically, laterally, or coronally

repositioned flap

surgical flap replaced into its original position

sliding flap

pedicle flap resituated to a new position

osseous surgery

tissue surgery with alteration in bony support of the teeth

re-entry

second-stage surgical procedure to enhance or improve conditions from a previous surgical procedure

vestibuloplasty

surgical alteration of the gingival mucous membrane in the vestibule of the mouth

ENAP (excisional new attachment procedure)

removal of chronically inflamed soft tissue to permit formation of new tissue attachment

guided tissue regeneration

placement of a semipermeable membrane beneath the flap to prevent ingrowth of epithelium between the flap and the defect

bone grafts

involve transplants to restore bone from periodontal disease

allograft

human bone graft from someone other than the patient

autograft

bone graft from another site in the same patient

xenograft

graft taken from another species, such as cow or big bone

allogenic

addition of synthetic material to repair or build up bone

osseointegration

union of bone and device

endosteal

implants of various designs placed within the bone

subperiosteal

implant placement beneath the periosteum and onto the bone

transosteal

implant placement through the bone

endodontic

the implant is set within the apex of the root

crown lengthening

removal of excessive gingival covering tooth enamel in the sulcus area

soft tissue graft

periodontal flap coverage of exposed root areas or repair of pocket damage

pocket reduction

eliminate collection area from pocket position; may include bone grafts

ridge augmentation

bone graft inserts to reshape to the natural contour of gingival and alveolar bone

sinus augmentation

raising the floor of the sinus cavity and building bone replacement may be necessary for placement of maxillary implants in cosmetic surgery

combination procedures

union of more than one procedure to achieve cosmetic effect

periodontal probe

used to measure the depth of the periodontal pocket by determining the amount of gingival tissue attachment

explorer

instrument with a longer, tapered, thin wire tip to determine calculus formation