Differentiating Periodontal Disease, Pockets and patterns of Bone loss Flashcards
Is periodontal disease the same as periodontitis?
NO
Explanation: Periodontal diseases are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults
What is periodontal disease?
- Bacterial infection of the periodontium
- includes gingival diseases and diseases of supporting structures
What are the two basic categories of periodontal disease?
- Gingivitis
- Periodontitis
What is the clinical picture of heath within the periodontium?
Pink
Firm
No bleeding
What does a healthy Sulcus look like?
- JE coronal to CEJ
- Supragingival fibers intact
- Alveolar bone intact
- Periodontal ligament intact
- Bone 2-3mm apical to base of JE
What is gingivitis?
- Bacterial infection confined to gingiva
- characterized by clincial changes-3cs
What are the microscopic changes in gingivitis ?
- Subclinical gingivitis
- Clinical gingivitis
What is the clinical picture of gingivitis ?
- Red
- Swollen
- Bleedling likely
What is the clinical picture of gingival pocket in gingivitis?
- JE at CEJ
- Supragingival fiber destruction: epithelial ridges and gingival fibers
- Alveolar bone intact
- PDL intact
Gingivitis leads to _____ in the epithelial cells?
- Hemidesmosomes of JE still attached to enamel coronal to or at CEJ
- Supragingival fiber destruction (reversible if infection controlled)
- JE extends epithelial ridges into CT
- Presence of a gingival pocket
What is a Gingival Pocket (Pseudopocket or false pocket)
- Deepening of gingival sulcus soley from gingival enlargement
- Coronal migration of the gingival margin more than 3mm
- No apical migration of JE
- Alveolar bone and PDL intact
What is acute gingivitis ?
Fuid in tissue resulting in swelling
What is chronic gingivitis?
Repair attempt lays down excess collagen resulting in fibrosis
What is periodontitis?
- Bacterial infection of all parts of the periodontium
- Extension of inflammation into attachment apparatus: PDL and Alveolar bone
- Development of periodontal pockets
- Body response to bacterial invasion causes marked changes
- Irreversible permanent destruction
- visible alternations in gingival tissue
- Bleeding and suppuration
What are the marked changes, when the body responses to bacterial invasion?
Connective Tissue
Junctional epithelium
What is the clinical picture for periodontitits?
Pink or Purplish
Swollen or fibrotic
Bleeding
What is the histological view for a periodontal pocket, when in periodontitis stage?
- JE on cementum
- Supragingival fiber destruction
- Alveolar Bone desruction
- Periodontal ligament destruction
What are the characterisitics of periodontitis ?
- Severe degeneration of connective tissue and gingival fibers
- Detachment of gingival fibers from tooth
- Coronal portion of JE separates from tooth surface forming a periodontal pocket
- Apical to JE Collagen fibers are also destroyed as inflammation sets in
- Destruction of periodontal ligament fiber group facilitates apical migration of JE onto cementum
- Epithelium attached on cementum: prevents reinsertion of periodontal ligament fibers on cementum
- Results in permanent loss of fiber attachement
- JE and sulcular epithelium extend ridges into CT
- Permanent destruction of alveolar bone and PDL
- Cementum exposed to plaque biofilm (more poreous)
- Regenerstion of transseptal fibers continue
- intact band separates inflammation from remaining bone
What is the periodontal pocket ?
(Deepend Gingival Sulcus)
* Apical migration of JE- (JE elongates)
* Destruction of PDL fibers
* Destruction of alveolar bone
What are the two different periodontal pocket?
Suprabony Pocket and Infrabony pocket
What is the difference between both periodontal pockets?
difference lies in the relationship of the JE- based on the pocket to the alveolar crest
Define suprabony (supracrestal) pocket?
- Base of pocket is coronal to underlying crest of alveolar bone
- Horizontal bone loss
Define infrabony (subcrestal) pocket ?
- Base of pocket is apical to the adjacent crest of alveolar bone: (within cratered out area of bone, along root surface)
- Vertical bone loss
Pcoket formation and loss of clinical connective tissue attachment = destruction of alveolar bone, what is the cause?
Bacteria
What is Persistence of Inflammation?
- As the inflammatory infiltrate destroys collagen it approches bone
What does bone loss involve?
- inflammatory cells including PMNS and macrophages
- Osteoclasts
- Prostaglandins, endotoxins and cytokines
What are the Bone resorbing factors?
- neutrophils and macrophages (release cytokines, prostaglandins, collagenase)
- Bacterial endotoxins (release lipopolysaccharides)
- PGE2 and LPS (activates osteoclasts for bones resorption)
What are the causes of Bone destruction ?
- Extension of inflammation from gingiva into supporting periodontal tissues (mark for transition)
- Local and systemic factors
- Trauma from occlusion
What are the local and systemic factors for bone destruction ?
- Regulate physiologic equilibrium of bone
- Bone loss may be magnified when systemic condition upset this balance.
What is the alveolar bone height within a health and ginigivitis PT?
- Crest of alveolar bone located 2mm apical to CEJ.
- Between 1-3mm
What is the alveolar bone height within a periodontitis PT?
- morphologic features are altered
- Bone height reduced
- Destruction results in crest of alveolar bone locatied more than 2mm apical to CEJ
- Progessive disease results in lack of alveolar support
What are the patterns of bone loss?
- Varies among individual teeth and om different surfaces of the same tooth
- Depends on the pathway of inflammation as it spreads from gingiva into alveolar bone
The Route of inflammation takes from the gingiva to underlying supporting structures will determine what?
- Types of pockets
- Pattern of bone loss
How does horizontal bone loss occur?
- Spreads into CT, bone and PDL space
- Follows path of least resistance
- Periodontal fiber bundles are protective barrier (last to be involved)
How does vertical bone loss occur?
- Spreads into CT, PDL space and bone
- occurs when crestal PDL fibers bundles are compromised (occlusal trauma)
How do you determine bone loss?
- Width and thickness of interdental septum determines types of bone loss (vertical or horizontal)
Bone destruction typically does not occur within ____of plaque mass at base pocket
2mm
How to determine wide crestal septum bone loss?
Greater than 2mm
- vertical loss
- Molars
How to determine narrow crestal septum bone loss?
Less than 2mm
- Horizontal loss
- Mandibular anterior teeth
What changes based on pathway of inflammation?
- Interdental Septum width
- Transseptal fibers
What is the pathway for wide crestal septum?
- Gingiva
- PDL
- Bone
What is the pathway for narrow crestal septum?
- Gingiva
- Bone
- PDL
What are the two types of bone loss?
- Horizontal bone loss (MOST COMMON)
- Vertical or Angular Bone Loss
What is Horizontal bone loss?
- Bone reduced in height and equally on surfaces of two adjacent teeth
- Interproximal bone levels remian flat
What is the types of pockets does horizontal bone loss produces?
- Suprabony pockets
- Deepest portion of pocket is coronal to alveolar crest
When horizontal bone lost is deepest portion is coronal to alveolar crest what is this called?
Suprabony defect
What is vertical bone loss?
- occurs in an oblique direction
- uneven reduction in height of alveolar bone
- bone loss occurs at different rates
- more rapid in bone next to root surface
What is name of the deepest portion of defect that is apical to alveolar crest?
Infrabony defect
Test Question
When results from inflammation traveling directly from?
Gingiva to PDL and then to BONE
Where does vertical or angular bone loss occur mostly?
- most occur interproximally
- Can also occur on facial lingual or palatal aspects
What is osseous walls ?
bone surrounding the teeth
What is osseous walls in health?
4 bony walls surround a tooth
What is osseous walls in periodontitis?
One or more wall is destroyed
What is a infrabony defects
- Classified based on the number of osseous walls surrounding the pocket or defect.
- Three, two, one-wall bony defect
What defect is the middle picture ?
Two wall boney defect
What defect is the first picture?
Three wall boney defect
What defect is the third picture?
one wall boney defect/ hemiseptum
What is Hemiseptum?
- one-wall defect
- Remaining wall is a proximal wall
What is interdental crater/osseous crater?
- Defect with the facial and lingual wall remaining
- most common angular bony defect
- interdental area collects plaque
- difficult to clean
What is anatomic features affecting bone loss patterns ?
- thickness,width and angulation of interdental septa
- Thickness of facial and lingual bone
- Alignment of teeth
- Root anatomy
- Root position within alveolar process
- Proximilty with other tooth surfaces
- Presence of fenestrations and dehiscences or both
What is attachment loss?
- Destruction of CT fibers and bone supporting teeth
- Spreads laterally and vertically
- Irregular pattern
True or False
A pocket on different root surfaces of same tooth can have different depths?
True
What is episodic nature of periodontitits?
- Intermittent tissue destruction
- Destruction progressess at different rates
What encourages episodic nature of periodontitits?
- Lifestyle can encourage episodes periocharts used to see active destruction
What is disease site?
- Area of tissue destruction
- single or multiple surfaces
- inactive disease site
- active disease site
- Disease activity requires assessment at regular intervals
what is inactive disease site ?
- Stable site
- Attachment level of JE remains same over time
what is active disease site ?
Continued apical migration of JE over time
What is the CAL?
- Measurement is most reliable method to document loss of attachment
- requires successive measurments over time
- provides a measure of progression over time
- used to classify disease severity
What are the measurement for slight , moderate and severe?
Slight- 1-2mm
Moderate- 3-4mm
Severe More than 5mm
Documenting the periodontal condition ?
- Determine correct Classification
- Describe Severity (slight, moderate, severe, use clinical measurements)
- Describe Extent (localized or generalized)
What is periodontal pocket?
- Area of tissue destruction left by disease process
- Presence does not indicate active disease
- majority of pockets in most adults with periodontitis are inactive disease sites
