Perio Midterm
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| show | slightly raised sessile nodule lingual to the Mand. cuspid
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| show | 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)
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| show | Gingiva, PDL, Cementum, Alveolar Bone
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| Gingiva: | show 🗑
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| Interdental G. | show 🗑
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| Gingival Sulcus | show 🗑
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| Cementum (16-60microns) OMG Overlap 60%, Meet Margin 30%,Gap 10% 45-50% Organic + h20, 45-50% Inorganic | show 🗑
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| show | upper & lower jaw. surrounds & supports roots of teeth. Forms the Alveoli (sockets) NO teeth NO Alveolar Process
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| Cortical Bone: | show 🗑
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| show | Healthy: 1-2mm below CEJ, follow contours of CEJ
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| Cancellous Bone (Spongy) | show 🗑
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| Alveolar Bone Proper OR Cribiform Plate OR Lamina Dura | show 🗑
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| show | MAX: Superior Alvolar, Infraorbital, greater Palantine, Nasopalantine Nerves MAND: Mental, Buccal, Subligual Nerves
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| show | MAX: Superior Alveolar Nerves (Anterior, Middle, Posterior) MAND: Inferior Alveolar Nerve
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| Periodontium Vascular Supply (gingiva,PDL, Alveolar Bone) | show 🗑
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| Teeth & Periodontal Tissues Blood Supply | show 🗑
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| show | drains MOST of the periodontal tissues
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| show | Drains Palatal Gingiva of Maxilla
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| Submental Lymph Nodes | show 🗑
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| Jugodigastric node | show 🗑
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| show | separates epithelium sheets from underlying CT (thin, tough sheet)
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| show | No Nuclei, tough
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| show | Nuclei, soft/flexible cushion,
*Epi. tissues receive blood supply from CT
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| Desmosomes | show 🗑
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| Hemidesmosomes | show 🗑
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| show | 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
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| show | Alveolar bone proper w/ Sharpey's fibers inserted
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| Interdental Septum | show 🗑
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| show | deepening of sulcus-solely from gingival enlargement(tissue swelling or increased collagen fibers in CT). JE remains coronal to CEJ, No PDL destruction
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| show | Pathologic deepening of sulcus
Suprabony-Horizontal bone loss
Infrabony- Vertical bone loss (uneven)
PDL & bone destroyed
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| show | 'window' bone denuded over root NOT including the marginal bone
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| show | bone denuded over root INCLUDING the marginal bone
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| Wolf's Law | show 🗑
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| Mobility | show 🗑
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| show | Inactive: little or no bleeding, minimal fluid and bacterial flora
Active: More bleeding, Large amounts of fluids/exudates and bacteria
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| show | (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
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| Epithelium attached biofilm | show 🗑
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| show | 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
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| show | harmful proteins
Gram - have Lipopolysaccharides (cell walls)
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| Etiology of Gingivitis & Periodontitis | show 🗑
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| show | 1st- increase in crevicular fluid
MOST DETECTABLE- Bleeding
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| show | CT cells, Fibroblasts(collagen), Osteoblasts, osteoclasts, Cementoblasts
-Epi Rest cells (Malassez)remnants of Hertwig's root sheath
-Defense cells
-Neurovascular Cells
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| 6 Principal fibers | show 🗑
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| Fremetus | show 🗑
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| show | 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
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| PMN (Neutrophils) | show 🗑
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| Hyperemia | show 🗑
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| Edema fluid (Exudate BEFORE Cellular Phase) | show 🗑
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| show | not as many but live longer, no memory
phagocytosis
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| B cells->plama cells->Antibodies | show 🗑
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| Cytokines (Produced by various cells) | show 🗑
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| show | powerful inflammatory mediators, trigger osteoclast activity-> Destroys Bone, Promotes overproduction of MMP
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| MMP (Matrix Metalloproteinases) produced by various cells | show 🗑
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| show | proteins that facilitate phagocytosis, and puncture cell membranes
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| show | Thick Single Cell Wall, Purple
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| Gram - | show 🗑
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| Biofilm formation | show 🗑
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| show | harmful proteins i.e. leukotoxins (AA), hydrogen sulfide, ammonia
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| show | 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
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| Oxytalin and Eulanin | show 🗑
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| COL: | show 🗑
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| Epi Cells | show 🗑
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| show | more in coronal half of root, mostly calcified Sharpeys fibers
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| show | More apical root portion, Increases w/ age in apical and furcations
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| Physiologic Mesial Migration | show 🗑
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| show | capillaries from Endothelia cells (BV) feed/bring fibroblasts, fragile, Granulation tissue forming
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| Fibroblastic Proliferation | show 🗑
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| Dark Field Microscopy | show 🗑
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| show | Ca, Phosphorus, carbonate, Sodium, Magnesium, Potassium...S
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| show | loves Carbs= caries
loves proteins (more dangerous by products)
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| Unattached Plaque | show 🗑
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| show | gingival margin almost to JE, Gram+, Caries
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| Virulence | show 🗑
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| show | 2nd, Kinin System, caused by histamines from Mast cells (basophils)---fragile
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| ARESTIN | show 🗑
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