2. The Diseased Periodontium Flashcards
Classification of Periodontal Diseases and Conditions*
▪ Gingival Diseases
• Plaque-Induced Gingival Diseases
• Non-Plaque-Induced Gingival Lesions
▪ Chronic Periodontitis
▪ Aggressive Periodontitis
▪ Periodontitis as a Manifestation of Systemic Disease
▪ Necrotizing Periodontal Diseases
▪ Abscesses of the Periodontium
▪ Periodontitis Associated with Endodontic Lesions
▪ Developmental/Acquired Deformities and Conditions
*____ for the Classification of Periodontal Diseases
1999 International World Workshop
Classification of Periodontal Diseases and Conditions
▪ Gingival Diseases
• ____-Induced Gingival Diseases
▪ ____ Periodontitis
▪ ____ Periodontitis
plaque
chronic
aggressive
Plaque-Induced Periodontal Diseases
Gingivitis - ____ of the gingiva
Periodontitis - inflammation and destruction of the ____
Attachment apparatus: ____ & ____ and ____
inflammation
attachment apparatus
cementum
alveolar bone
PDL
Structure of the Periodontium
Can only see ____ histologically
PDL
Plaque-Induced Gingivitis
Mild > Moderate > Severe
Moderate > fair amount of ____
Severe > ____, ____ bleeding
____ classification
edema
edematous
spontaneous
subjective
Plaque-Induced Periodontitis
Severity can be based on: ____ levels (measurement you make with periodontal probe), look at extent of ____ relative to length of root (<25% is mild, 25-50% is moderate, >50% is advanced)
Need ____ in order to make classification
____ vary from individual to individual, and from anterior to posterior teeth
attachment
bone loss
PA radiographs
roots
Page and Schroeder Lesions
Defined four phases of disease: ____, ____ and ____; and then an ____ lesion: periodontitis
initial
early
established
advanced
Page and Schroeder Histologic Stages of Gingivitis and Periodontitis
Initial Lesion (Clinical Health)
- Slightly ____ vascular permeability and vasodilation.
- ____ flows out of the sulcus.
- Migration of leukocytes, primarily PMNs, in relatively ____ numbers through the gingival connective tissue, across the junctional epithelium and into the sulcus.
Early Lesion (Early Gingivitis)
- Increased vascular permeability, vasodilation and ____ flow.
- ____ numbers of infiltrating leukocytes (mainly PMNs and lymphocytes.
- Degeneration of ____.
- Collagen ____, resulting in collagen depleted areas of the connective tissue.
- Proliferation of the ____ and ____ epithelium into collagen-depleted areas.
No one has inflammation-____ periodontium > neutrophils migrate into JE into the gingival sulcus > low-level inflammatory reaction that cannot be seen clinically, but can be seen histologically
elevated
GCF
small
GCG large fibroblasts degradation junctional sulcular
free
Page and Schroeder Histologic Stages of Gingivitis and Periodontitis
Established Lesion (Established Gingivitis)
- ____ inflammatory cell infiltrate (PMNs, plasma cells, lymphocytes).
- Accumulation of inflammatory cells in ____ tissue.
- Elevated release of ____ and the ____ contents from PMNs.
- Significant collagen depletion and epithelial proliferation.
- Formation of ____ epithelium containing large numbers of PMNs.
Advanced Lesion (Periodontitis)
- Predominance of PMNs in the ____ epithelium and pocket.
- Dense inflammatory infiltrate in connective tissues that is made of predominantly ____ cells.
- Apical migration of the ____ epithelium to preserve an intact epithelial barrier.
- Continued collagen breakdown resulting in large areas of collagen depleted connective tissue.
- ____ resorption of bone.
Established = ____ from of periodontitis
dense connective matrix metalloproteinases (MMPs) lysosomal contents pocket
pocket plasma junctional osteoclastic severe
Page and Schroeder Lesions
Initial lesion > Early lesion > Established Lesion > Advanced Lesion
No radiographic evidence of ____!
alveolar bone loss
Healthy Periodontium
Lines represent the ____ bundles of the gingival CT
principal fiber
Healthy Periodontium
The measurement from the gingival margin to the most coronal aspect of the ____ is equal to the ____ depth.
- Histologically, the mean gingival sulcus depth is ____ mm.
- Clinically, the gingival sulcus depth ranges from ____ to ____ mm in health.
____ > presence of pathology; gingival sulcus is normal
JE gingival sulcus 0.6 1 3
Healthy Periodontium
Epithelial Attachment of Gingiva (mean of ____ mm)
Connective Tissue Attachment of Gingiva (mean of ____ mm)
Biologic Width = Epithelial Attachment + Connective Tissue Attachment = mean of ____ mm
CT only serve purpose of attaching ____ to the teeth
JE ends at the ____
1.0
1.0
2.0
soft tissues
CEJ
Health Periodontium
Histology:
- Intact junctional epithelium without ____.
- Intact connective tissue attachment of the gingiva to cementum via ____.
- Alveolar bone crest positioned approximately ____ mm apical to the
cementoenamel junction.
- Sparse number of neutrophils transmigrating from the vascular plexus through the junctional epithelium into the sulcus.
Clinical Findings:
- Gingiva is ____ (can be ____).
- Clearly defined ____ junction.
- Gingiva is ____.
- ____ gingival margins.
- Gingiva is ____.
- Probing depths of ____ to ____ mm without bleeding on probing
Radiographic Findings:
- Clearly defined alveolar bone crests positioned approximately ____ mm apical to the cementoenamel junction.
- Clearly defined ____.
- Absence of ____ defects.
- Intact ____ bone.
____ = spaces bt multi-rooted teeth are filled with defined bone
rete ridges
gingival fiber bundles
2
coral pink pigmented mucogingival firm 1 3
2
lamina dura
infrabony
furcal
infurct
Periodontal Probing of the Healthy Periodontium
The histologic sulcus has a mean depth of ____ mm while clinically, probing depths range from ____ to ____ mm due to penetration of the junctional epithelium (up to ____ of its length).
We do not have sufficient ____ sensation to stop at the mean depth of gingival sulci; that’s why the depths are ____ than what they actually are
0.6
1
3
50%
tactile
deeper
