Classifying periodontal disease

Question 1

List the determinants of clinical periodontal health

Answer 1

Microbiological determinants:
• Supragingival plaque composition
• Subgingival biofilm composition

Host determinants:
Local predisposing factors
• Periodontal pockets
• Dental restorations
• Root anatomy
• Tooth position and crowding

Systemic modifying factors
• Host immune function
• Systemic health
• Genetics

Environmental determinants:
• Smoking
• Medications
• Stress
• Nutrition

Question 2

How does diabetes and smoking impact periodonttiis

Answer 2

Diabetes
• Level of glycemic control in diabetes influences the grading of periodontitis

Smoking:
• Level of tobacco use influences the grade of periodontitis in classification of periodontitis

Question 3

List the conditions under peri-implant diseases

Answer 3

Peri- implant health

Peri- implant mucositis

Peri- implantitis

Peri- implant soft and hard tissue deficiencies

Question 4

Describe peri- implant health

Answer 4

• No inflammation
• No bleeding
• Health, even with reduced bone health

Question 5

Describe peri- implant mucositis

Answer 5

• Erythema
• Inflammation
• Bleeding on gentle probing and/or
• Suppuration may be present
• Increase in probing depths due to swelling

Question 6

Describe causes of peri- implant mucositis

Answer 6

• Biofilm accumulation
• Host response to bacterial challenge
• Smoking and diabetes mellitus may modify condition

Question 7

Describe peri- implantitis and its histological characteristics

Answer 7

• Inflammation of mucosa
• Bleeding on probing and/or suppuration
• Increased probing depths and/or recession
• Rate of progression of bone loss may vary between patients

Histological Characteristics
• Lesions extend apical of the junctional epithelium
• Contain large numbers plasma cells, macrophages and neutrophils

Question 8

Describe the management of peri- implantitis

Answer 8

Anti-infective treatment strategies are successful at decreasing inflammation and suppressing bone loss progression

Question 9

Describe what causes peri- implant soft and hard tissue deficiencies

Answer 9

Healing process following tooth loss leads to reduced alveolar process/ridge which represents deficiencies in hard and soft tissues
• Loss of periodontal support
• Endodontic infections
• Thin buccal bone plates
• Trauma during extraction
• Medications
• Systemic diseases
• Pressure from removable prosthesis