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Classic Lit - Fall 2022 > Anatomy_Janet_09112022 > Flashcards

Anatomy_Janet_09112022 Flashcards

1
Q

Prevalence of free gingival groove? most common Location?

A

only in 30% of adults (Ainamo and Loe)

Facial of mandibular incisors and premolars (0.5- 2 mm)

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2
Q

How to distinguish free from attached gingiva (AG)? Does the width of AG increases with age? Why?

A

Methods to distinguish Free from AG:

  • Visual exam (color difference)
  • Schiller Iodine test (mucosa contains glycogen)
  • Roll technique

Yes, AG width increases with age due to continuous teeth eruption with the MGJ remaining constant (Ainamo and Talari)

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3
Q

Methods to detect attached gingiva? Does AG change with age?

A
  • Visual
  • Roll technique
  • Schiller Iodine test (Detects glycogen)

AG increases with age due to continous eruption of teeth + MGJ remains constant (Ainamo & Talari)

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4
Q

Stippling cause, prevalence and clinical signficance

A

Cause: external reflection of epith. rete invading into CT (Karring and Loe)

Present only in 40% of adults –> indicates health

its loss –> early sign of inflammation (it’s presence always means health, while it’s absence does not necessarily mean disease)

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5
Q

Average AG width on facial and lingual aspects?

A

Facial:

Bowers: 1-9 mm

  • Narrowest → canines and premolars (prominent teeth)
  • Widest → incisors (maxillary > mandibular)

Lingual:

Voight:

  • Narrowest → incisors and canines
  • Widest → 1st and 2nd molars
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6
Q

What are the techniques to measure gingival thickness?

A
  • Autopsy
  • Caliper (intrasurgical)
  • CBCT (with lip retraction)
  • Transging. probing
  • Ultrasound
  • Probe visbility
  1. Kan et al. 2010 → thin (≤ 1mm) or thick (1 < mm)
  2. Rasperini color coded probe →Color coded probe is used to identify 4 gingival biotypes: thin, medium, thick and very thick.
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7
Q

What is the significance of KG/AG around teeth?

A
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8
Q

What are the components of Periodontal biotype according to the 2017 WW? % of thick vs. thin biotypes?

A
  1. Gingival Biotype: GT (gingival thickness) + KTW (keratinized tissue width)
  2. Bone Morphotype (BM)
  3. Tooth Dimension

Based on thickness: Thick biotype = 51.9%, Thin = 42.3%

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9
Q

Impact of thickness on gingival health?

A

Claffey and Shanley 1986:
Measured CAL changes after NSx therapy at shallow (≤ 3.5 mm) buccal sites to assess whether thickness and BOP affect those changes.

  • Thin (≤ 1.5 mm) + non-bleeding sites → SS CALoss after SRP (-0.3)
  • Thick (≥ 2 mm) + non-bleeding sites → less CALoss
  • All bleeding sites → CAL gain
  • CAL loss associated with non-Sx therapy seen in shallow sites post therapy is associated with areas with thin gingival thickness.
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10
Q

Is there an association between ging. thickness and labial plate thickness?

A

Cook et al. 2011:

60 Px, CBCT + impression + clinical exam of maxillary anterior teeth

→ thin biotype associated with thin labial plate thickness, narrow KT, greater distance from CEJ-crest and probe visibility

Frost 2015: Probe visibility was associated with thinner measurements of gingival thickness and showed a tendency to be associated with a thinner buccal plate.

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11
Q

Impact of AG width on Recession?

A

Chambrone and Tatakis 2016:

  • Absence of AG → Increased risk for Rec
  • Presence of KT or larger GT → decrease risk of increased REC depth or develop new REC
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12
Q

Characteristics of Interdental Ging. “Col”

A

McHugh 1971:

Non-kerati. squamous epith (5+ layers thick), considered Interprox JE, not present if adj. tooth is missing or not contacting

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13
Q

Difference betw. junctional, sulcular and oral epith?

A
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14
Q

Clinical significance of Junctional, sulcular and oral epith.

A
  • Junctional epith
  • Barrier due to its attachment to the tooth
  • Allows access of GCF, inflammatory cells
  • Rapid turnover (Basal layer)
  • Sulcular epith
  • More susceptible to bacterial insult due to non- keratinization
  • Noted decrease in bacteria, inflammation, mitotic activity assoc. of keratinization of sulcular epithelium (Caffesse et al. 1980) (double check)
  • Infiltrate typically T-, B-, plasma cells, lymphocyte
  • Oral epith → mechanical barrier against bacteria
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15
Q

Biologic Width (supracrestal tissue attachment): dimensions and signficance

A

Invasion of the supracrestal tissue attachment results in inflammation, loss of supporting periodontal tissues, and apical shift of junctional epithelium and connective tissue attachment.

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16
Q

Layers of gingival/oral epith

A
  1. Basal Layer (stratum basale or stratum)
  2. Prickle cell layer (stratum spinosum)
  3. Granular cell layer (stratum granulosum)
  4. Keratinized cell layer (stratum corneum)

Additional categorization:

Ortho-keratinized → cell nuclei are not present
Para-keratinized → cell nuclei remnants are present

Keratinocytes comprise 90% of the oral epithelium while 10% are categorized as non-keratinocytes (“clear cells” due to cell appear clear around nuclei compared to keratinocyte

17
Q

Non keratinocytes of oral epithelium?

A
  • Melanocytes: basal layer, melanin synthesis
  • Langerhans cells: suprabasal_,_ APC, dendritic like cells and contains bierbeck granules
  • Merkel’s cells: basal, tactile sensory cells
  • Inflammatory cells: different layers, lymphocytes
18
Q

Basement membrane layers?

A

At the Interface between the epithelium and the underlying connective tissue

Consists of Type IV collagen, proteoglycans and laminin (most in lamina lucida and most abundant non collagenous prot. in BM.

19
Q

Connective tissue components?

A

2 layers → papillary: loose, betw. epith rete pegs) and reticular: thick and contimuous with periosteum

  • Fibers (65%): Collagen type I (major) and type III + elastin fibers (minor)
  • Cells: Fibroblasts that produce the following CT fibers:

1- Collagen Fibers (predominant)

2- Reticulin fibers (present at the CT interfaces, primarily type III collagen)

3- Oxytalan fibers (scarce but more numerous in PDL, unknown function but theory for sensory function and/or nutrition support to PDL)

4- Elastic fibers (blood vessels stretch, recoil)

20
Q

ECM: composition and function

A

Composition: GAGs, proteoglycans and proteins

Functions:

  • Scaffold for anchorage and support of cells, transportation (nutrients, metabolites, water, etc.)
  • Binding of growth factors/hormones,
  • Regulation of cell growth/differentiation, mediates cell adhesion/signaling through integrins and/or proteoglycans.
21
Q

Types of GAGs?

A
22
Q

Clinical relevance of ginigval CT

A

Karring et al. 1975:

7 monkeys, harvesting ging. and mucosal CT then is is transplanted to alveolar mucosa.

  • sites with ging. CT submerged → developed KM
  • sites with mucosal CT submerged → No KM
23
Q

Types of ging. collagen fibers

A
  • *1. Circular (CF):** Maintains contour and position of the free gingival margin
  • *2. Dento-gingival (DGF):** Provides gingival support
  • *3. Dento-periosteal (DPF):** Protects the PDL, provides anchorage for tooth to bone
  • *4. Alveolo-gingival (AGF):** Attaches gingiva to bone
  • *5. Transseptal (TF):** Protects underlying interproximal bone, maintains the interproximal spacing connecting adjacent teeth
24
Q

PDL : composition and fibers types?

A

PDL consists primarily of collagen (type I 80%, type III 20%) with a width of around 0.25mm (range = 0.2-0.4mm)

divided into the following 5 categories:

25
Q

Cementum?

A

Does not contain vascularity or innervation, but contains collagen (type I 90%, type III 5%).

26
Q

Types of relationships of Cementum to Enamel at CEJ

A

OMG rule:

Overlapping 60%

Meeting (as a butt joint) 30%

Gap (exposing dentin) 10%.

“OMG” =Overlap, Meet, Gap 60, 30, 10

27
Q

Is complete removal of diseased cementum required to achieve health?

A

Nyman 1988:

In vivo, split mouth study (Reverse bevel incision with or without exposed cementum removal) demonstrated that complete removal of “diseased exposed cementum” was not required in non-surgical or surgical tx to achieve health

This study also confirmed the findings of Moore & Wilson 1986 → 99% of endotoxin can be removed from root surface via gentle cleaning (39% by 1 min. washing + 60% by 1 min. brushing with a rotating brush)

28
Q

Location of thinnest and thickest root cementum

A

Zander and Hurzeler 1958:

233 single rooted teeth from 11-76 YO patients → histologyThe cementum layer thickens with age

  • Cementum thickness increases with age
  • Cementum is thickest at the root apex, and is thinnest at the CEJ
29
Q

Is cementum deposition contimuous throughout life

A

(Kerr 1961)

Cementum deposition can be considered a continuous process, from 20–70-year-old will observe 3- fold increase with thickest at apical, changes are impacted by inflammation, occlusal trauma, ortho movements, pathology

30
Q

Relationship between Perio disease activity and crestal lamina dura

A

Rams et al. 1994

51 patients examined at BL and at 36 months (3 months maintenance program)

crestal LD was examined at interproximal sites

  • Absence of crestal LD → high sensitivity (high NPV) and low specificity for disease recurrence/activity
  • Presence of crestal LD → high specificity (high PPV) and low sensitivity for periodontal stability
  • The presence of radiographic crestal lamina dura showed a positive association with clinical periodontal stability (high positive predictive value) and negatively associated with periodontitis recurrence for the 36- month study period.
  • Absence of lamina dura does NOT indicate increased risk of breaking down (low PPV), but the presence of a lamina dura means there is a high probability the sites is stable.
  • No firm relationship was found between absence of crestal lamina dura and future periodontitis progression
31
Q

Periosteum layers?

A

“periosteum” and is about 10-12 cells thick. (Rhodin 1974) There are 2 layers:

  • Outer fibrous layer: dense, vascular, consists of collagen and nerves
  • Inner cambium layer: loosely arranged, consists of connective tissue and osteogenic cells.
32
Q

Most common fenestrations and dehisences locations?

A

Rupprecht 2001:

  • Fenestrations → Max. 1st molars (58% of fenestrations in maxilla)
  • Dehisences → Mand. canines (67% of dehisences in the mandible)

Larato 1970:

  • Anteriors (both Max and Mand) have more fenestrations/dehiscences than posteriors
  • Most associated teeth for those defects: Max 1st molars, canines (max and mand)
  • Defects are associate with prominent roots
  • No relation between defect presence and age of skull
33
Q

3 sources of blood supply to the gingiva?

A

Blood vessels from:

  • Supraperiosteal arteries
  • PDL
  • Alveolar bone (inter-radicular arteries)

Classic Lit - Fall 2022 (16 decks)

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