2: Normal Periodontium Flashcards
What are the three components to periodontal attachment?
1.PDL 2.Cementum 3.Alveolar Bone
What is the FUNDAMENTAL difference between an implant and a natural tooth concerning attachment?
Implant has NO PDL REGROWTH
Gingival Sulcus Space: Histologic ___mm; Average: ____mm Clincial _____mm
Histo: 0-6mm….Avg: 1.8mm….Clinical 0-3mm
KG= ___ to ____
GM to MGJ
AG = ___ to ____ minus ____
AG = GM to MGJ minus PD (sulcus)
AG = ____ minus ____
AG = KG minus PD (sulcus)
Rank molars, premolars, and incisors in MOST to LEAST gingival width…
Incisors > Molars > Premolars
What type of gingiva? Occupies embrasure, “Col”± Keratinization, Pyramidal, Contact point, Susceptible
Interdental Gingiva (Papilla)
Where does Periodisease usual start? Why?
Interdental Gingiva (Papilla)—Hardest area to brush/maintain
What is the minimal amount of acceptable keritinized tissue?
2mm
What are the three types of gingival epithelium?
1.Oral/Outer Epi 2.Crevicular (sulcular) epi 3.Junctional Epit
Which type of gingival epithelium contains the rete ridges? What type of appearance do these make?
outer/oral gingival epi…orange peel/stipling
Oral/Outer Gingival Epithelium: type of keratinization
Keratinized or ParaKeratinized
Oral/Outer Gingival Epithelium: How thick?
0.2-0.3 mm
Oral/Outer Gingival Epithelium: levels of keratinization…Palate _____ and Cheek ____
Palate=most….Cheek=least
What are the 4 cell types of the Oral/Outer Gingival Epithelium and how often do they turnover?
1.Keratinocytes 2.Nonkeratinocytes 2.Melanocytes (pigment) 3.Langerhan’s Cells(immune) 4.Merkel Cells(nerve)….Turnover=10-12 days
Sulcular Gingival Epithelium: Similar to ______
Oral/Outer Gingival Epithelium
Sulcular Gingival Epithelium: Resistant to ______
fluid flow
Sulcular Gingival Epithelium: keratinized/nonkeratinaized?, thin and without ______.
Nonkeratinized…without rete ridges
Sulcular Gingival Epithelium: has the potential to ______ with consistent flossing.
keratinize
Sulcular Gingival Epithelium: Extends from the ____ to the coronal limit of ____.
GM….JE
Junctional Epithelium: Keratinized/NonKeratinized?
NonKeratinized
Junctional Epithelium: ____ cells thick
2-30 cells thick (WOW thats thin as shit!)
Junctional Epithelium: ____mm in length
0.25-1.35mm in length (wow!)
Junctional Epithelium: What is used to attach tooth/implant to connective tissue?
HemiDesmosOmes
Junctional Epithelium: What is the cell turnover here?
1-6 days
Junctional Epithelium: Do hemiDesmosOmes interact with implants?
YES! the connect both tooth and implant to connective tissue
Junctional Epithelium: ATTACHMENT-To tooth or implant (3 layers…one major, 2 minor)
Internal Basal Lamina (Lamina Densa, Lamina Lucida)
Junctional Epithelium: ATTACHMENT- to connective tissue
External Basal Lamina
What are the 3 components of Gingival Connective Tissue?
1.Papillary (rete ridges into the epithelium) 2.Reticular (adjacent to the periosteum) 3.Gound Substance(fills space between fibers and cells
Gingival Connective Tissue: Collagen Types ___ & ___
I & III
Gingival Connective Tissue: Collagen Fibers = ___%
60%
Gingival Connective Tissue: Fibroblasts= ___%
5%
Gingival Connective Tissue: Vessels, Nerves, Matrix= ___%
35%
What is the main theme of the types of cells found in the Gingival Connective tissue?
LOTS of immune cells! Fibroblasts, Mast cells, Macrophages, Plasma cells, Lymphocytes, Neutrophils
Gingival Fibers: ______ – support & contour to free gingiva
Circular
Gingival Fibers: ________ - support of the gingiva
Dentogingival*
Gingival Fibers: ________ - anchors tooth to bone
Dentoperiosteal*
Gingival Fibers: ________– attaches gingiva to alveolar bone
Alveologingival
Gingival Fibers: ________ - Keep teeth in alignment and protects bone Continuously reform as bone and fibers are destroyed
Transseptal fibers
Where are the three places I will find the Gingival Blood Supply?
1.PDL 2. Alveolar Bone 3.Surface of Periostium
Healthy gingiva can be described as “_____” pink.
“coral”
Healthy Gingiva -Contour…Anterior = ______; Posterior= ______
Anterior = pyramidal; posterior = flattened
Alveolar Mucosa: Keratinized/Nonkeratinized?…… texture-_____, shiny surface….Color-_____.
NonKeratinized…..smooth…..reddish
What is composed of collagen fibers and has an hour glass shape?
PDL
What is the approx width of PDL?
0.2 mm
Where is the PDL the narrowest, making the Hour Glass shape?
mid-root
What are the 5 PDL Fiber groups?
1.Alveolar Crest 2.Horizontal 3.Oblique 4.Apical 5.Interradicular
What are the 5 pieces to the periodontium? Which 3 are *Specific to Periodontal Attachment?
1.Gingiva Mucosa 2.Alveolar Mucosa *3.PDL *4.Cementum *5. Alveolar Bone
DOES the MGJ ever change?
NO, that line is permanent!
What is the ‘formula’ to for Keratinized Tissue?
KG=GM to MGJ
Stippling only occurs on the _______ gingiva.
Attached
The degree of ________ and prominence of stippling are related
keratinization
Stippling occurs at the sites of fusion of the epithelial ridges (_______).
rete ridges
PDL Principal Fiber Groups: resists lateral movement
Alveolar Crest Fibers
PDL Principal Fiber Groups: opposes lateral forces
horizontal fibers
PDL Principal Fiber Groups: absorbs occlusal forces
Oblique Fibers
PDL Principal Fiber Groups: resists tipping of the tooth
Apical Fibers
PDL Principal Fiber Groups: resists forces of luxation (pulling out) and tipping
Interradicular Fibers
What is the largest PDL fiber group?
Oblique Fibers
PDL: Principal fibers insert into ________ (tooth) and _______ (bone).
Cementum (tooth)–>Alveolar Bone (bone)
_______ fibers - terminal portion of principal fibers that insert into cementum and alveolar bone.
Sharpey’s
What is the physiologic zone of gingival tissue coronal to the alveolar bone crest and is composed of the epithelial attachment and the gingival connective tissue attachment?
BIOLOGICAL WIDTH
What is the range for biological width NECESSARY!?!? KNOW FOR REST OF LIFE!!!
2-3mm needed!
How do you compute biological width?
Jxnal Epi + Connective Tissue= Bio Width
What is the formula for finding CAL?
ClinicialAttachmentLoss= PocketDepth (mm) + CEJ to GingivalMargin(mm)
CEJ to GM may be: (+) Positive if ______ to CEJ (-) Negative if _____ to CEJ.
apical…. coronal
CAL= Sum of ____ to ____ plus ____
CAL= Sum of GingvalMargin to CementoEnamelJxn plus ProbeDepth