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Perio Midterm

Normal: Retrocuspid Papilla Gingival fibrous Nodules at MGJ slightly raised sessile nodule lingual to the Mand. cuspid
PDL or "Double Periosteum" (creates/resorbs both cementum & bone) soft CT between bone & tooth .4- 1.5mm space (4) Functions: SUPPORTIVE- suspends & maintains tooth in socket SENSORY- Pressure & Pain NUTRITIVE- nutrients to Cementum & Bone RESORPTIVE- 'remodel' the alveolar bone in response to pressure (Ortho)
Periodontium: Gingiva, PDL, Cementum, Alveolar Bone
Gingiva: Covers alveolar processes of jaw, cervical portions of teeth (4)Anatomical Areas: Free G., Gingival Sulcus, Interdental G., Attached G.
Interdental G. 1 facial/1 lingual papilla- prevents food from getting stuck
Gingival Sulcus Healthy: 1-3mm
Cementum (16-60microns) OMG Overlap 60%, Meet Margin 30%,Gap 10% 45-50% Organic + h20, 45-50% Inorganic mesechimal CT 45-50% Inorganic *more resistant to resorption than bone(good for Ortho, root remains) Anchors PDL fibers to tooth (Sharpey's) Protects Dentin (seals Tubules), Compensates for occlusal attrition (forms at apical area of root
Alveolar Bone or Process upper & lower jaw. surrounds & supports roots of teeth. Forms the Alveoli (sockets) NO teeth NO Alveolar Process
Cortical Bone: Compact, outside wall, max. &mand. Thicker in molar regions, NOT seen radiographically
Alveolar Crest Healthy: 1-2mm below CEJ, follow contours of CEJ
Cancellous Bone (Spongy) Interior, between cribiform plate(alv. bone proper) and the Cortical bone
Alveolar Bone Proper OR Cribiform Plate OR Lamina Dura thin, lines the socket aka Lamina Dura (radiographically)
Gingiva Innervation MAX: Superior Alvolar, Infraorbital, greater Palantine, Nasopalantine Nerves MAND: Mental, Buccal, Subligual Nerves
PDL & Teeth Innervation MAX: Superior Alveolar Nerves (Anterior, Middle, Posterior) MAND: Inferior Alveolar Nerve
Periodontium Vascular Supply (gingiva,PDL, Alveolar Bone) MAX: Anterior & Posterior Alveolar Arteries, Infraorbital, Greater Palantine Artery MAND:Inferior Alveolar Artery- buccal,facial,mental,sublingual Arteries
Teeth & Periodontal Tissues Blood Supply MAX: Superior Alveolar arteries MAND: Inferior Alveolar artery
Submandibular Lymph Nodes drains MOST of the periodontal tissues
Deep Cervical Lymph nodes Drains Palatal Gingiva of Maxilla
Submental Lymph Nodes Drains gingiva in Mand. Incisors
Jugodigastric node Drains gingiva in 3rd Molar area
Basal Lamina separates epithelium sheets from underlying CT (thin, tough sheet)
Keratinized Epi cells No Nuclei, tough
Non-keratinized Epi cells Nuclei, soft/flexible cushion, *Epi. tissues receive blood supply from CT
Desmosomes specialized cell junction-connects neighboring epi cells
Hemidesmosomes cell junction connecting epi cells to basal lamina
Periapical Cemental Dysplasia (NOT true Cementoma) PULP test for vitality to avoid unecessary RCT 1. Osteolitic-bone loss, replaced by ,appears as PA lesion 2. Cementoblastic-excessive cementoblastic activity, specule deposits(like matrix) 3. Mature- Excessive irregular cementum deposited Xray- well defined radiopacity w/ radiolucent border
Bundle bone Alveolar bone proper w/ Sharpey's fibers inserted
Interdental Septum indicator of bone health Perio Health: distance between CEJ & Interdental Septum (radiographically) .96mm->1.22mm (avg of 1.5mm) *Mand. Anterior 1.88->2.81mm Center is 'spongy' Trabeculae
Gingival Pocket (Pseudopocket) deepening of sulcus-solely from gingival enlargement(tissue swelling or increased collagen fibers in CT). JE remains coronal to CEJ, No PDL destruction
Periodontal Pocket Pathologic deepening of sulcus Suprabony-Horizontal bone loss Infrabony- Vertical bone loss (uneven) PDL & bone destroyed
Fenestrations 'window' bone denuded over root NOT including the marginal bone
Dehiscence bone denuded over root INCLUDING the marginal bone
Wolf's Law bone will adapt to load placed
Mobility Grade 1: up to 1mm Grade 2: more than 1mm grade 3: F,L,M,D horizontal & vertical displacement
Inactive/ Active Lesion or Periodontitis Inactive: little or no bleeding, minimal fluid and bacterial flora Active: More bleeding, Large amounts of fluids/exudates and bacteria
Biofilm Marginal: Facultative (4)Phases 1.adheres to glycoprotein pellicle 2. Initial colonization within 2dys w/ gram+ 3. Secondary Colonization- slime layer produced, bacteria multiply 4. Mature biofilm-Pedunculated,gram -,anaerobes *Must mature to cause perio damange
Epithelium attached biofilm *most detrimental, bacteria invades g.,CT,bone surface
Biofilm Levels Distance from bone:Never<.5mm or>2.7mm less than 3mm is bone destruction Healthy: 100-1000, 75%-80% gram+, non-motile, mostly Cocci Gingivitis: 1,000-100,000, Equal gram-& gram+ Periodontitis:100,000-100,000,000 more Gram- anaerobes,motile,asaccralytic small % are perio pathogens
Endotoxins harmful proteins Gram - have Lipopolysaccharides (cell walls)
Etiology of Gingivitis & Periodontitis Tooth Anatomy, Nutrition, Malocclusion, Medication i.e. Dilatin, Hormones/birthControl, xerostomia, Faulty dentistry, Disease i.e. diabetes, HIV
1st changes/clinical signs of Gingivitis 1st- increase in crevicular fluid MOST DETECTABLE- Bleeding
PDL cells CT cells, Fibroblasts(collagen), Osteoblasts, osteoclasts, Cementoblasts -Epi Rest cells (Malassez)remnants of Hertwig's root sheath -Defense cells -Neurovascular Cells
6 Principal fibers *Apical:fully formed tooth resists vert.force*Interradicular:multirootvertical/lateral*Horizontal: 10-15% of coronal root *Oblique: 2/3 of fibers,80-85% of root *Transseptal:1st affected by disease/inflammation, under col*Alveolar Crest:counterbalance
Fremetus Vibrations when occluding +slight ++barely visible +++clearly visible
Periodontal Disease Bacteria AA:parent->child,aggressive perio (25%chronic) *Fusobacterium nucleatum: early stage gingivitis, subg plaque in perio w/ severe attach loss *Porphyromonas g-grows in JE, perio, destroy bone *Bacteroides forsythus-subg plaque,Deep pockets, aggressive pe
PMN (Neutrophils) Acute, Anaerobic glycolysis=acidity leaves axial stream->pavementing Lysosomes- can kill/digest bacteria after phagocytosis
Hyperemia 10X more blood increased permeability
Edema fluid (Exudate BEFORE Cellular Phase) Leukocytes & Plasma proteins leak from capillaries into tissue at injury/infection site, Activates Lymphatic system, Dilutes toxins
Macrophages (in tissue) Monocytes (in blood) not as many but live longer, no memory phagocytosis
B cells->plama cells->Antibodies Antibodies:Neutralize bacteria, Coat bacteria for easier phagocytosis, Activate complement system
Cytokines (Produced by various cells) powerful protein mediators: recruits cells, increase permeability, can cause tissue destruction in chronic cases
Prostaglandins (mainly PMNs and Macrophages produce) powerful inflammatory mediators, trigger osteoclast activity-> Destroys Bone, Promotes overproduction of MMP
MMP (Matrix Metalloproteinases) produced by various cells 12+ enzymes, collagen destruction
Complement System proteins that facilitate phagocytosis, and puncture cell membranes
Gram + Thick Single Cell Wall, Purple
Gram - Double cell Wall, doesn't stain purple
Biofilm formation 1. Initial Colonization, 2dys mainly Gram+ 2. Secondary Colonization: Slime layer (protects, adheres), bacteria multiplies 3. Mature- complex mushroom microcolonies, extremely resistant antibiotics/microbials- Mechanical Removal!
Exotoxins harmful proteins i.e. leukotoxins (AA), hydrogen sulfide, ammonia
Furcation Class I: curvature felt w/probe, penetrates<1mm II: penetrates, but not completely through, III: Completely through IV: same as III but visible because of recession
Oxytalin and Eulanin immature elastin, parallel to root surface, regulates vascular flow
COL: depression just apical to contact area- VERY susceptible to infection
Epi Cells (rests of Malasssez) PDL latticework, diminish w/ age, close to cementum side of PDL,remneants of Hertwig's root sheath, cluster or interlacing strands, more in apical and cervical area
Primary, Acellular Cementum more in coronal half of root, mostly calcified Sharpeys fibers
Secondary, Cellular Cementum More apical root portion, Increases w/ age in apical and furcations
Physiologic Mesial Migration age 40, 5mm loss in Q length from 3rd Molar to midline
Vascular Proliferation capillaries from Endothelia cells (BV) feed/bring fibroblasts, fragile, Granulation tissue forming
Fibroblastic Proliferation 'Star' shaped then elongates, creates collagen, Granulation tissue forms
Dark Field Microscopy detects basic type and mobility-NOT specific or exact amount
Calculus Ca, Phosphorus, carbonate, Sodium, Magnesium, Potassium...S
Saccrolytic Asaccrolytic loves Carbs= caries loves proteins (more dangerous by products)
Unattached Plaque Gram -, free floating, susceptible to Phag.
Tooth attached plaque gingival margin almost to JE, Gram+, Caries
Virulence Colonize, Invade, Damage
Vasodilation 2nd, Kinin System, caused by histamines from Mast cells (basophils)---fragile
Created by: michelleleigh33