Clinical Features and Pathogenesis of Periodontal Disease

Question 1

Connective tissue attachment loss with subsequent alveolar and supporting bone destruction
Chronic and aggressive forms of periodontitis
NOTE: Chronic typical regular perio
Aggressive is rapidly progressive

Answer 1

Periodontitis

Question 2

Histopathogenesis of Perio

Answer 2

1. Inflammatory/immune events occur in the periodontal tissues
   - Microscopic changes in the lamina propria and epithelium
   - Development of periodontal disease

Question 3

Histopathogenesis of Perio

Drawing!

Answer 3

1. Inflammatory/immune events occur in the periodontal tissues
   - Microscopic changes in the lamina propria and epithelium
   - Development of periodontal disease

Page and Schroeder’s Lesions

1. Initial
   - 2-4 days, subclinical gingivitis
2. Early
   - 4-7 days, acute inflammation
3. Established
   - Chronic gingivitis
4. Advanced
   Perio

Question 4

plas·ma cell

Answer 4

a fully differentiated B cell that produces a single type of antibody.

Question 5

Pocket: a _____ deepened gingival sulcus occurring between the ___ surface and the gingiva

Answer 5

pathologically

root

Question 6

Periodontal Pocket:
Increased depth of periodontal pocket makes ideal area for ___ growth
Difficult to maintain

Answer 6

bacterial

Question 7

Two types of periodontal pockets
–depends on the pattern of bone loss??
1.
2.

Answer 7

Suprabony- more common w/ horizontal bone loss

Infrabony- more common w/ vertical bone loss

Question 8

Cemental changes: Areas where fibers are not attached into cementum undergo changes…. surface is ___. We are shooting to remove some util smooth not glassy.

Old Theory:
Easily absorbs endotoxins and bacteria and their by-products
Called “___ ____”
Root plane until “glassy smooth”

Answer 8

Rough

necrotic cementum

Question 9

Prior to ____ , the theory was that total removal of necrotic cementum was necessary to arrest disease

Clinicians would strive for a glassy smooth surface, using excessive cementum removal

1987: documented that extensive root planing may not be necessary, as toxins were found to be very superficial, and not deeply embedded in cementum

Today: happy medium– remove calculus and biofilm, and strive for a smooth enough surface to avoid new attachment of biofilm and calculus

Answer 9

1987

Question 10

Bone Resorbing Factors:
Inflammatory process causes bone destruction
As the ____ _____ destroys and replaces more collagen in the lamina propria the alveolar crest is approached

Answer 10

inflammatory infiltrate

Question 11

5 Bone Resorbing Factors

Answer 11

1. Prostaglandins (released by PMNs and macrophages)
   PGE2 destroys bone
   PGs activate resting osteoclasts which destroy bone
   PGs are also produced in bone and have a direct resorptive effect on bone
2. Endotoxins destroy bone
   released by gram-negative bacteria
3. B –cells (release cytokines like IL-1)

4. Cytokines destroy bone
released by macrophages, T-cells 
interleukin-1 (IL-1)
also stimulates PGE2
Cytokines and PGs stimulate collagenase

5. MMPs: collagen destruction

Question 12

Patterns of Bone Loss :
The pattern of bone loss depends on the route of the inflammatory infiltrate from the gingiva into the bone via __ ___

Route of tissue destruction:

2 Patterns of bone loss
horizontal
vertical/angular

Answer 12

blood vessels

Gingiva -> bone-> PDL (principle fibers)

Question 13

penetration of the inflammatory infiltrate into the marrow spaces and on the bone surfaces is associated with a loss of the ___ between bone formation and ____*****

Answer 13

equilibrium

resorption

Question 14

Horizontal Bone Loss:

Answer 14

Bone is lost equally on the surfaces of two adjacent teeth with the interproximal bone level remaining flat and the deepest portion of the pocket is located coronal to the alveolar crest

Related to a suprabony pocket (when pocket is probed, the tip end of the probe is located coronal to crest of bone)
Usually equals suprabony pocket

Question 15

Inflammation travels directly from the gingiva into the periodontal ligament= PDL SPACE
Interproximal bone level is not flat and even as in horizontal bone loss
Bone loss is more rapid on one side of the tooth than the other
Base of the deepest portion of the bony defect is apical to the alveolar bone crest creating an infrabony defect
related to an infrabony pocket (when pocket is probed, the tip end of the probe is apical to the crest of bone as seen on the radiograph)

Answer 15

Vertical Bone Loss

Question 16

Vertical Bone Destruction:

Vertical defects (infrabony) are classified on the basis of the number of \_\_\_ \_\_\_ present
May have one, two, or three walls

Can generally be seen on radiographs, but can be obscured by bony plates
__ ___ is the only way to determine configuration

Answer 16

osseous walls

Surgical exposure

Question 17

**Typically vertical bone destruction seen on radiograph but the only way we can determine the configuration or shape of bony defectis by ____ _____

Answer 17

SURGICAL EXPOSURE

Question 18

3 bony walls remaining with the tooth forming the fourth wall
A three-wall defect that wraps around the tooth and involves two or more adjacent root surfaces is referred to as a ____ defect

Answer 18

circumferential

Question 19

Two bony walls remaining

___ crater is most common angular bony defect

Answer 19

Interdental

Question 20

One bony wall remaining

Usually occurs ____

Answer 20

interdentally

Question 21

Factors Relating to Pattern of Bone Loss:

Bone destruction occurs roughly ___ away from the plaque mass itself-supracrestal attached tissues

Remember supracrestal attached tissues: you will usually have about 2mm between the base of the sulcus and the alveolar crest

Width and thickness of ____ _____ primarily determines the pattern of bone loss

Answer 21

2mm

interdental bone