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Oral surgery > 20. Chronic periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention > Flashcards

20. Chronic periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention Flashcards

1
Q

Periodontitis defintion

A
  • Inflammatory process in periodontal space
  • Affects alveolar bone, soft tissues and lymphatics
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2
Q

Two main parts of periodontium

A
  • Periodontium periapicale(around root tip)
  • Periodontium marginale(Around alveolar ridge)
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3
Q

Periodontitis can be classified according to:

A
  • Aetiology
  • Type of inflammation
  • Location
  • Clinical course
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4
Q

Periodontitis classifications according to aetiology

A
  • Infectious
  • Trauma
  • Chronic
  • Chemotaxic
  • Allergic
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5
Q

Infectious organisms of Periodontitis

A
  • Micro-organisms from infected root canals or periodontal pockets
  • Aerobes
  • Anaerobes
  • Lactobacillus
  • Fusobacterium
  • Staphylococci
  • Streptococci
  • Actinomyces
  • Clostridium
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6
Q

Causes of infectious periodontitis

A
  • Untreated pulpitis
  • Improper treatment
  • Failure of root canal
  • Gangrenous roots
  • Periodontal defects
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7
Q

Types of trauma that cause periodontitis

A
  • Acute
  • Chronic
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8
Q

Acute trauma in periodontitis

A
  • Fracture of crown->
  • Disruption of vascular bundle
  • Influx of MO
  • Necrosis of pulp
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9
Q

Chronic trauma in periodontitis

A
  • Poorly designed restorations overload periodontium
  • Crowns
  • Bridges
  • Parafunction
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10
Q

Allergic causes of periodontitis

A
  • Allergy to dental materials
  • Hyperergic antigen antibody reactions
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11
Q

Chemotoxic causes of periodontitis

A
  • Irritating toxic drugs
  • Arsenic
  • Phenolic derivatives
  • Improper use of composite materials
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12
Q

Periodontitis classification according to location

A
  • Periapical
  • Total
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13
Q

Periodontitis classification according to type of inflammation

A
  1. Exudative
    * Serous
    * Purulent
  2. Proliferative
    * Granulomatous
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14
Q

Periodontitis classification according to Clinical course

A
  • Sharp
  • Chronic
  • Excacerbated
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15
Q

Chronis periodontitis classifications

A
  • Periodontitis periapicalis chronica granulomatosa diffuse(sin/cum fistulae)
  • Periodontitis periapicalis chronica granulomatosa localisata
  • Periodontitis periapicalis chronica fibrosa
  • Periodontitis chronica exacerba
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16
Q

The clinical course of periodontitis depends on:

A
  • Aetiology
  • Location and type of process
  • Microbial contamination
  • Virulence of microorganisms
  • Local and general immune status
  • Age
  • Contomitant diseases
17
Q

Important anamnestic data for diagnosis of periodontitis

A
  • Presence of pain
  • Socrates
  • Site
  • Onset
  • Character
  • Radiation
  • Associated symtoms
  • Time
  • Exacerbating factors
  • Severity
18
Q

Important criteria assessed during periodontitis examination

A
  • Adjacent teeth
  • Mucous membranes
  • Percussion of tooth-horiontal/vertical
  • Pressure on tooth(V/H)
  • Palpation(root tip/marginal gingiva)
19
Q

Characteristics of Chronic periodontitis

A
  • Can occur w/ low virulence mo and good immune status
  • Long course-months/years
  • Proliferation->Blood vessels+tissues
  • Fibrosis of connective tissue
20
Q

Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) characteristics

Chronic granulating periapical periodontitis

A
  • Chronic purulent proliferative process in bone
  • Bone resorption
  • No subjective complaints/pain
  • Fistula that may be located away from causative tooth
  • Acute exacerbations may occur- painful, edema and hyperaemia
21
Q

Diagnosis of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)

Chronic granulating periapical periodontitis

A
  • Periodic exacerbations
  • Presence of fistula
  • Blurred outline of bone on x-ray
22
Q

Treatment of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)

Chronic granulating periapical periodontitis

A
  • Endo
  • Tooth extraction
  • Resection of root tip
  • Hemisection
  • Anti-inflammatory treatment-osteotrophic drugs
23
Q

Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) differential diagnosis

Chronic granulating periapical periodontitis

A
  • Chronic osteomyelitis
  • Other chronic periodontitis
24
Q

Periodontitis periapicalis chronica granulomatosa localisata characteristics

Chronic periapical granulomatous localisaed periodontitis

A
  • Necrosis and bone destruction replaced by granulation tissue=>
  • Granulation tissue formation followed by fibrosis w/ proper treatment and optimal response=>
  • Becomes granuloma with inadequate treatment or poor response
25
Granulation tissue cells
* Well vascularised and rich in cells * Fibroblasts * Endothelial cells * Plasma cells * Mast cells
26
Granuloma characteristics
* Chronic inflammatory response- Granulation tissue rich in cells and blood vessels * Connective tissue capsule-> limits penetration of infection
27
Types of Granuloma according to their histology
* Common Granuloma/granuloma simplex * Epithelialising granuloma * Cystic granuloma/Granuloma cycsticum
28
Diagnosis of granuloma
* Ask about past pain * Exacerbations? * Mild pain on percussion * Round shadow around root radiographically
29
Differential diagnosis of Granuloma
* Diffuse granulating and fibrous periodontitis * Localised osteomyelitis * Radicular cyst
30
Treatment of granuloma
* Extraction * Endo * Surgical removal of granuloma * Hemisection of roots * Less common-reimplantation and autotransplantation of root
31
Periodontitis periapicalis chronica fibrosa characteristics
Following endo treatment * Granulation tissue replaced w/ fibrous tissue * Reduction in cells- w/exception of fibroblasts * Reduction in blood vessels * Fibrous tissue replaced w/ bone after some months ## Footnote Healing phase of acute and chronic periodontitis
32
Treatment of chronic periodontitis
* Extraction-Followed by removal /currettage of pathologically altered tissue/granuloma * Endo-rare * Surgical methods
33
Surgical methods of treatment of Chronic Periodontitis
* Apical osteotomy * Hemisection * Amputation * Reimplantation * Autotransplantation * Coronory radicular seperation

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