Applied Anatomy Flashcards
What is passive eruption?
Once a tooth reaches the occlusal plane, the gingiva starts to recess, so the free gingival groove reaches the CEJ
If a patient has deep pockets, does that mean they have poor gingival health?
Not necessarily. If a patient had altered passive eruption, their pockets can be deep and their gingival health still good
In healthy gingiva, what structure does a perio probe reach?
It penetrates to the free gingival groove
In diseased gingiva, what structure does a perio probe reach?
It penetrates past the junctional epithelium into the CT
What is the diagnosis of periodontitis based on?
Attachment loss (not recession)
Does recession mean a patient has periodontitis?
No
It can involve recession, but in order for it to be periodontitis, it has to follow specific steps
What are the steps of periodontitis?
Plaque induced
Inflammatory in origin
Leading to bone loss
Finally attachment loss
Periodontitis happens when?
Junctional epithelium migrates apically down the root surface and thickens
At what rate does periodontitis occur?
Very slowly
~1mm every 5 years
What are of gingiva is most prominent to periodontal disease? Why?
Col
Because it is non keratinized, and located just below a contact point
What is the most important place to probe correctly in posterior teeth?
Contact area
How does one properly probe the interproximals of posterior teeth?
Find interproximal contact
Use the contact as a guide to insert the probe
Open the angulation of the probe by 10 degrees
Why is it so important to properly probe?
Improper probing can cause up to a 2 mm discrepancy, which is a huge difference between health and disease
What was the original thinking of gingival width and recession?
If keratinized tissue got to be less than 2 mm, it predisposes it to recession
What is the current thinking of gingival width and recession?
Gingival health can be maintained independent of its dimensions
Narrow gingiva has the same resistance to attachment loss as wide gingiva
So not everyone necessarily gets a graft
What are some consequences of thin gingiva phenotype?
Increased recession
More vulnerable to trauma
More inflammation
Less favorable treatment outcome
When would you recommend gingival grafts?
When recession causes symptoms (pain, caries, esthetic concerns)
Subgingival restorations on someone with the thin gingiva phenotype
Pre-ortho treatment (final tooth position will be buccal)
What is the epithelial mesenchymal interaction?
The characteristics of the gingiva are genetically determined, rather than being the result of functional adaptation to environmental stimuli
What is the clinical translation to the epithelial mesenchymal interaction?
Connective tissue determines epithelial characteristics
What does keratinized gingiva correspond to?
Thick, fibrous CT
What does nonkeratinized gingiva correspond to?
Thin, elastic CT
What is the modern grafting procedure?
Connective-tissue graft
-Remove CT from the palate (or donor tissue) and stuff in in the desired area like a pita pit
What is the minimum biological width? What happens if it is any less?
The minimum distance between the CEJ and alveolar ridge is 2mm (therefore, distance from crown margin to alveolar crest has to be 2mm - otherwise have to do crown lengthening)
IF the gingiva loses that 2mm, it will have bone recession to try and achieve it, but it doesn’t know when to stop
What happens if crown margins are at the CEJ?
No issues
Guided bone regeneration
After an extraction, you pack the socket withe bone or bone substitute to the get the socket you want - this preserves the ridge for an implant
Collagen membrane
Prevents the epithelium form coming down to migrate
This gives the PDL time to regenerate
What is the point of a barrier membrane?
It excludes the epithelium to create a tent that provides an area for bone regeneration
