20. Chronic periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention Flashcards
Periodontitis defintion
- Inflammatory process in periodontal space
- Affects alveolar bone, soft tissues and lymphatics
Two main parts of periodontium
- Periodontium periapicale(around root tip)
- Periodontium marginale(Around alveolar ridge)
Periodontitis can be classified according to:
- Aetiology
- Type of inflammation
- Location
- Clinical course
Periodontitis classifications according to aetiology
- Infectious
- Trauma
- Chronic
- Chemotaxic
- Allergic
Infectious organisms of Periodontitis
- Micro-organisms from infected root canals or periodontal pockets
- Aerobes
- Anaerobes
- Lactobacillus
- Fusobacterium
- Staphylococci
- Streptococci
- Actinomyces
- Clostridium
Causes of infectious periodontitis
- Untreated pulpitis
- Improper treatment
- Failure of root canal
- Gangrenous roots
- Periodontal defects
Types of trauma that cause periodontitis
- Acute
- Chronic
Acute trauma in periodontitis
- Fracture of crown->
- Disruption of vascular bundle
- Influx of MO
- Necrosis of pulp
Chronic trauma in periodontitis
- Poorly designed restorations overload periodontium
- Crowns
- Bridges
- Parafunction
Allergic causes of periodontitis
- Allergy to dental materials
- Hyperergic antigen antibody reactions
Chemotoxic causes of periodontitis
- Irritating toxic drugs
- Arsenic
- Phenolic derivatives
- Improper use of composite materials
Periodontitis classification according to location
- Periapical
- Total
Periodontitis classification according to type of inflammation
- Exudative
* Serous
* Purulent - Proliferative
* Granulomatous
Periodontitis classification according to Clinical course
- Sharp
- Chronic
- Excacerbated
Chronis periodontitis classifications
- Periodontitis periapicalis chronica granulomatosa diffuse(sin/cum fistulae)
- Periodontitis periapicalis chronica granulomatosa localisata
- Periodontitis periapicalis chronica fibrosa
- Periodontitis chronica exacerba
The clinical course of periodontitis depends on:
- Aetiology
- Location and type of process
- Microbial contamination
- Virulence of microorganisms
- Local and general immune status
- Age
- Contomitant diseases
Important anamnestic data for diagnosis of periodontitis
- Presence of pain
- Socrates
- Site
- Onset
- Character
- Radiation
- Associated symtoms
- Time
- Exacerbating factors
- Severity
Important criteria assessed during periodontitis examination
- Adjacent teeth
- Mucous membranes
- Percussion of tooth-horiontal/vertical
- Pressure on tooth(V/H)
- Palpation(root tip/marginal gingiva)
Characteristics of Chronic periodontitis
- Can occur w/ low virulence mo and good immune status
- Long course-months/years
- Proliferation->Blood vessels+tissues
- Fibrosis of connective tissue
Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) characteristics
Chronic granulating periapical periodontitis
- 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
Diagnosis of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)
Chronic granulating periapical periodontitis
- Periodic exacerbations
- Presence of fistula
- Blurred outline of bone on x-ray
Treatment of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)
Chronic granulating periapical periodontitis
- Endo
- Tooth extraction
- Resection of root tip
- Hemisection
- Anti-inflammatory treatment-osteotrophic drugs
Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) differential diagnosis
Chronic granulating periapical periodontitis
- Chronic osteomyelitis
- Other chronic periodontitis
Periodontitis periapicalis chronica granulomatosa localisata characteristics
Chronic periapical granulomatous localisaed periodontitis
- 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
Granulation tissue cells
- Well vascularised and rich in cells
- Fibroblasts
- Endothelial cells
- Plasma cells
- Mast cells
Granuloma characteristics
- Chronic inflammatory response-
Granulation tissue rich in cells and blood vessels - Connective tissue capsule-> limits penetration of infection
Types of Granuloma according to their histology
- Common Granuloma/granuloma simplex
- Epithelialising granuloma
- Cystic granuloma/Granuloma cycsticum
Diagnosis of granuloma
- Ask about past pain
- Exacerbations?
- Mild pain on percussion
- Round shadow around root radiographically
Differential diagnosis of Granuloma
- Diffuse granulating and fibrous periodontitis
- Localised osteomyelitis
- Radicular cyst
Treatment of granuloma
- Extraction
- Endo
- Surgical removal of granuloma
- Hemisection of roots
- Less common-reimplantation and autotransplantation of root
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
Healing phase of acute and chronic periodontitis
Treatment of chronic periodontitis
- Extraction-Followed by removal /currettage of pathologically altered tissue/granuloma
- Endo-rare
- Surgical methods
Surgical methods of treatment of Chronic Periodontitis
- Apical osteotomy
- Hemisection
- Amputation
- Reimplantation
- Autotransplantation
- Coronory radicular seperation
