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23 Periodontology > 1 - Anatomy of the Periodontium > Flashcards

1 - Anatomy of the Periodontium Flashcards

1
Q

what is part of the normal periodontium

A
  1. gingiva
  2. tooth supporting structures
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2
Q

what are tooth supporting structures

A
  1. PDL
  2. cementum
    3 alveolar process
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3
Q

what landmarks can you see at a cross section from B-L

A

sulcus, sulcular epithelium, junctional epithelium, cementum

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4
Q

what determines the color of gingiva

A

blood flow, physiologic pigmentation (melanin)

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5
Q

consistency of gingiva

A

firm with stippling sometimes

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6
Q

contour of gingiva

A

inderdental papillae fill interprox w/ no recession

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7
Q

three regions of gingiva

A
  1. oral or outer epithelium
  2. sulcular epithelium
  3. junctional epithelium
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8
Q

what has no nuclei in stratum corneum, distinct stratum granulosum

A

orthokeratinized outer epi

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9
Q

what has nuclei stratum corneum

A

parakeratinised outer epithelium

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10
Q

whawt region of gingiva is non-keratinized

A

sulcular and junctional

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11
Q

describe outer wall of sulcus

A
  1. has free gingival groove in 50% of patients
  2. keratinized
  3. unattached/free
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12
Q

width of keratinized gingiva

A

distance from gingival margin to MGJ (but varies w/ location in mouth

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13
Q

with of KG in maxilla

A

anterior > molar > premolar

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14
Q

width of keratinized gingiva in facial mandible

A

anterior > molar > premolar

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15
Q

width of keratinized gingiva in lingual mandible

A

molar > premolar > incisor

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16
Q

why important to know width of keratinized gingiva?

A

we want to know where is it vulnerable for patients to get gingival recession. often occurs where keratinized gingiva is thinnest. nothing protecting underlying bone resulting in bone loss

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17
Q

what is is. keratinized gingiva bound tightly to tooth and bone to be protective against recession

A

attached gingiva

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18
Q

what extends from base of sulcus to MGJ

A

attached gingiva

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19
Q

what thype of epithelium is attached gingiva

A

ortho or parakeratinized

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20
Q

what is the width of attached gingiva

A

width of KG - probing depth = width of attached gingiva

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21
Q

is stippling present in attached gingiva

A

depends on patient

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22
Q

how to determine the width of attached gingiva

A
  1. probe
  2. measure w/ KG
  3. attached gingiva = KG - PD
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23
Q

what is the differentce between KG and AG

A

attached = use perio probe, all is keratinized

not all keratnized is attached

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24
Q

the coronal extent of ____ is mucogingival junction

A

alveolar mucosa

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25
Q

what type of epithelium is alveolar mucosa

A

non-keratinized epi

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26
Q

is alveolr mucosa bound to bone

A

no,; mobile

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27
Q

what is more red in color due to lack of keratinization and visibility of underlying BC

A

alveolar mucosa

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28
Q

what is a Line that demarcates the keratinized gingiva from the
alveolar mucosa

A

mucogingival juncition

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29
Q

what is an absence of attached gingiva (0 mm)

A

mucogingival defect

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30
Q

what happens when a probe penetrates to or beyong MGJ

A

mucogingival defect

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31
Q

what happens when probing depth >/= width of keratinized gingiva

A

MGJ

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32
Q

what are surgical corrections for mucogingival defects

A
  1. CT graft
  2. free gingival graft
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33
Q

what is a combination of GINGIVAL phenotype and BONE morphotype

A

periodontal phenotypes

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34
Q

what are the periodontal phenotypes

A
  1. thin-scalloped
  2. thick-flat
  3. thick-scalloped
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35
Q

what periodontal phenotype is most likely to be risk of gingival reession

A

thin-scalloped

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36
Q

what periodontal phenotype is more likely to have more excessive gingival display, gummy smile

A

thick-flat

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37
Q

what shape dependent on the buccal lingual width of teeth

A

col: inderdental gingiva

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38
Q

shape of col on molars and premolar vs. anterior teeth

A

molars and premolar: saddle shaped
anterior: pyramidal shaped

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39
Q

depression between two interdental peaks

A

Col

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40
Q

where does periodontal disease start

A

where the toothbrush doesnt reach - interprodimal gingiva (col)

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41
Q

why does disease typically start at interproximal gingiva (col)

A
  1. col is non-keratinized
  2. more permeable
  3. less resistant to bacterial ingress
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42
Q

what is the predominate cell in epithelium

A

keratinocyte

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43
Q

what produces pigmentation (melanin)

A

melanocyte

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44
Q

what are dentritic cells (antigen presenting cells) important in immune response

A

Langerhans cells

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45
Q

what extends from oral epi to junctional epi

A

sulcular eip

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46
Q

what is 1-2 mm in depth (in health), non-keratinized, and semi-permeable

A

sulcular epi

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47
Q

what forms attachment between gingival and tooth

A

junctional epi

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48
Q

what is the confluence of oral epi and REE at tooth eruption

A

junctional epi

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49
Q

what are the 2 strata of junctional epi

A
  1. external basal lamina
  2. internal basal lamina
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50
Q

what basal lamina of JE faces CT

A

external basal lamina

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51
Q

what basal lamina of JE attaches to tooth thru hemidesmosomal attachment

A

internal basal lamina

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52
Q

JE is coronal to or at level of CEJ when

A

prior to disease

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53
Q

what are the functions of JE

A
  1. attachment to tooth
  2. permeable barrier against bacteria
  3. signal transduction
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54
Q

what allows diffusion of fluid and inflammatory cells to sulcus as host defense mech

A

permeable barrier against bacteria of JE

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55
Q

what allows hemidesmosomes to regulate gene expression, cell differentiation, an dproliferation of JE

A

signal transcution

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56
Q

what is the cell turnover rate of JE

A

rapid 1-6 days

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57
Q

what composes gingival CT lamina propria

A

collagen fibers (type1), fibroblasts, vessles, nerves, matrix, and inflammatory cells

reticular and papillary layer

58
Q

what are 3 groups of collagen fibers

A
  1. gingivodental
  2. circular
  3. transseptal
59
Q

what collagen fiber:

Embedded into cementum of the tooth
Fan out coronally and apically
Extend to facial and lingual alveolar bone

A

gingivodental

60
Q

what collargen fiber: encircle tooth

61
Q

what collagen fiber:

Extend between approximating teeth
Sometimes classified as principal fibers of the
Periodontal Ligament

A

transseptal

62
Q

what is the function of gingival collagen fibers

A

Gingival fibers brace and
strengthen the gingiva

63
Q

what does CAL stand for

A

clinical attachment loss

64
Q

what occurs when there is loss of atachment in periodontitis

A
  1. Connective tissue fibers are lost
  2. Apical migration of junctional epithelium
  3. Pocket formation
65
Q

what is supracrestal tissue attachment

A

apico-coronal dimensions of JE and supracrestal CT attachment

(JE + CT)

66
Q

what is the old term for supracrestal tissue attachment

A

biologic width

67
Q

length of supracrestal tissue attachemtn

68
Q

Allow ___ between ___ to allow for “Supracrestal Attached Tissues” and sulcus depth.

A

3-4 mm; crown margin and bone crest

69
Q

what is fluid that seeps from vessels in the gingival CT and flows outward into the sulcur

A

gingival crevicular fluid

70
Q

does gingival crevicular fluid flow increase with increasing inflammation

71
Q

what do you think happens if you put a crown very close to bone

A

inflammation, recession, pain complaints by pt

72
Q

function of gingival crevicular fluid

A
  1. cleanse material from sulcus
  2. improves adhesion of epi to tooth
  3. contains antibodies
  4. contains leukocytes
73
Q

what is the CT that surrounds the root and connects it to alveolar bone

74
Q

the PDL is continuous with ___ of the gingival CT

A

gingival collagen fibers

75
Q

what are the terminal ends of principal PDL fibers which insert into cementum and bone

A

Sharpey’s fibers

76
Q

what type of bone lines the socket wall is is adjacent to PDL that contains the greatest number of Sharpey’s fibers inserting into it

A

bundle bone

77
Q

what are the 6 groups of principal collagen fibers of PDL

A
  1. transseptal
  2. alveolar crest
  3. horizontal
  4. oblique
  5. apical
  6. interradicular
78
Q

what PDL fiber extends interproximally from tooth to adjacent tooth

A

transseptal

79
Q

what PDL fiber extends from cementum just beneath the JE to alveolar crest

A

alveolar crest

80
Q

what PDL fiber resists extrusion and lateral forces

A

alveolar crest

81
Q

what PDL fiber extends at right angles from cementum to alveolar bone

A

horizontal fibers

82
Q

what is the largest PDL collagen fiber gorup

83
Q

what PDL fiber extends from cementum in a coronal direction obliquely to bone

84
Q

what PDL fiber obtains the bear brunt of vertical masticatory forces

85
Q

what PDL fiber is in the furcation area of multi-rooted teeth

A

interradicular

86
Q

principle fibers of PDL are composed mainly of what

A

collagen type I

87
Q

what are the connective tissue cells in PDL

A

fibroblasts (primary cell), cementoblasts, osteoblasts

88
Q

what are the epithelial cells of PDL

A

epithelial cells of Malassez and remnants of HERS

89
Q

remnants of HERS can result in what?

A
  1. lateral periodontal cysts
  2. PA cysts
  3. cementicles
90
Q

what are the cellular elements of PDL

A
  1. immune cells
  2. neurovascular cells
91
Q

what are the immune cells of PDL

A
  1. neutrophils
  2. lymphocytes
  3. macrophages
  4. mast cells
  5. eosinophils
92
Q

what are the functions of PDL

A
  1. soft tissue casing to protect vessels and nerves
  2. transmission of occlusal forces to bone
  3. attachment of teeth to bone
  4. SHOCK ABSORPTION
  5. progenitor cells
  6. nutritional and sensory functions
93
Q

what broad category of cells aid with formation/resorption of bone, cementum

A

progenitor cells

94
Q

what are the progenitor cells

A

fibroblasts, cementoblasts, osteoblasts

95
Q

fusion of root to bone is called what

96
Q

what is the shape of PDL

A

hour glass

97
Q

PDL [increses or decreases] with loss of function

98
Q

PDL [increases of decreases] with increased forces

A

INCREASES (e.g. occlusal trauma)

99
Q

average width of PDL

100
Q

what are the types of cementum

A

acellular (primary) and cellular (secondary)

101
Q

what are the two sources of collagen fibers in cementum

A
  1. extrinsic (Sharpey’s fibers from PDL)
  2. intrinsic (produced by cementoblasts within cementum)
102
Q

what are the incremental lines in cementum

A

periods of rest in cementum formation

103
Q

what is the inorganic content of cementum

A

45-50% HAP

104
Q

what cementum is first formed? when?

A

acellular/primary cementum prior to complete eruption of tooth

105
Q

what covers cervical 1/3rd of root

A

acellular/primary cementum

106
Q

what cementum contains many Sharpey’s fibers

A

acellular primary cementum

107
Q

when is cellular/secondary cementun formed

A

after tooth reaches occlusal plane

108
Q

what contains cementocytes in lacunae

A

cellular/secondary cementum

109
Q

where is cellular/secondary cementum thinnest? thickest?

A

thinnest = coronal half
thickest = apical third

110
Q

what cementum increases in thickness with age

A

celular (secondary) cementum

111
Q

which cementum has fewer sharpey’s fibers

A

cellular (secondary) cementum

112
Q

what are the type of CEJs from most common to least common

A

cementum overlaps enamel -> butt joint -> cementum does not meet enamel

113
Q

what is the clinical significance of the CEJ

A

can result in dentinal hypersensitivity especially when cementum does not meet enamel

114
Q

what is the portion of maxilla and mandible which supports the tooth sockets

A

alveolar process

115
Q

what disappears after tooth is loss

A

alveolar process

116
Q

what does alveolar process consist of

A
  1. alveolar bone proper
  2. cancellous trabeculae
  3. cortical bone plate
117
Q

in tooth socket wall, what contains bundle bone

A

alveolar bone proper

118
Q

in tooth socket wall, what contains perforations for blood vessels entering PDL

A

cribiform plate

119
Q

in tooth socket wall, what is the dense cortical bone surrounding the socket and is a radiographic term

A

lamina dura

120
Q

T/F: alveolar process CANNOT resorb after tooth extraction

A

FALSE. can resorb

121
Q

what is the loss of bone overlying the root surface that does not involve the crestal bone

A

fenestration

122
Q

what is it called when portion of root surface is exposed, and crestal bone is not intact

A

dehiscence (entire portion not window)

123
Q

dehiscence predisposes to what

A

gingival recession

124
Q

what are the cells of the alveolar process

A
  1. osteoblasts
  2. osteoclasts
  3. osteocytes
  4. osteoid
125
Q

what produces organic matrix of bone

A

osteoblasts

126
Q

what are bone resorptive cells

A

osteoclasts

127
Q

what cells of alveolar process are found in lacunae

A

osteocytes

128
Q

what cells of alveolar process are non-mineralized bone matrix

129
Q

gingival blood supply comes from what sources

A
  1. vessels from PDL
  2. supraperiosteal arterioles from alveolar process
  3. arterioles from interdental septa
130
Q

what are the effects of aging on perodontium

A
  1. gingival recession
  2. root surface caries
  3. alveolar bone
  4. wound healing after surgery
  5. periodontitis
131
Q

what is a cumulative effect over many years of inflammation and toothbrush trauma

A

gingival recession

132
Q

does gingival recession occur during passive eruption

133
Q

is gingival recession an inevitable physiologic process of aging

134
Q

what is at increased risk due to recession and xerostomia related to medications

A

root surface caries

135
Q

what is the exposure of teeth via apical migration of gingiva (recession)

A

passive eruption

136
Q

what part of periodontium is affected with osteoporosis

A

alveolar bone

137
Q

how is wound healing after surgery affected in regards to aging on the periodontium

138
Q

is periodontitis more prevalent with increased age?

A

yes due to increased exposure compared to younger people

139
Q

periodontitis is due to cumulative epxosure to what

140
Q

is periodontitis due to increased risk for disease

141
Q

what is each #

A
  1. free/marginal gingiva
  2. free gingival groove
  3. keratinized gingiva
  4. attached gingiva
  5. mucogingival junction
  6. alveolar mucosa
  7. papilla
142
Q

what is each letter

A

A = free gingival groove
B = sulcus
C = sulcular epi
D = oral epi
E = junctional epi
F = cementum

23 Periodontology (13 decks)

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