Histological response to non surgical therapy

Question 1

What happens when you carry non-surgical therapy to microbiological changes and cellular events?

Answer 1

Microbiological changes = major disruption to the biofilm leading to conversion from anaerobic to aerobic flora

Cellular changes = acute inflammatory response seen and initiation of resolution of this inflammation

Question 2

What does plaque removal do to the microflora?

Answer 2

Reduction in the total number of organisms.

Change from anaerobic to aerobic flora.
Proportion of gram negative bacteria is reduced.
The microflora becomes gram +
and aerobic.

The competition of flora changes from that associated with disease to one associated with health.

Question 3

What happens to the periodontitis 24-48h after removing plaque and one month after?

Answer 3

24-48h:
- Inflammation begins to subside
- Reduction in GCF
- Reduction in number of neutrophils in pocket
- Fibroblasts and endothelial cells go to area and proliferate into the inflamed area
- Reduction in swelling and redness of gingiva

one months after:
- no inflammation, get gingival recession
- no gingival connective tissue placed
- reattachment of the pocket to tooth root surface
- mature gingival cells and few inflammatory cells

Question 4

How does the formation of the long JE occur?

Answer 4

Seen in healing of the pocket epithelium.
Due to reattachment of the epithelium to the clean root surface brought about by hemi-desmosomes.

Question 5

What are the limitations of healing by the long junctional epithelium?

Answer 5

• Absence of regeneration / new attachment
• Poor aesthetics
• Limited effects on tooth support
• Sensitivity

Question 6

What are the clinical responses seen following instrumentation?

Answer 6

Reduction in redness due to less inflammation and increased collagen production.
Reduction in swelling due to resolution of inflammation.
Reduction in BOP due to reduced blood flow.
Reduction in probing depth due to shrinkage of tissues, reformation of the fibrous gingival cuff and increased gingival recession.

Question 7

Summarise the 7 main changes to the periodontium seen histologically after instrumentation

Answer 7

Reduction in quantity of micro-organisms

Conversion of anaerobic flora to aerobic flora

Initial acute inflammatory response followed by initiation of inflammation resolution

Reduction in gingival vasodilation and swelling

Migration of gingival fibroblasts into area and gingival collagen fibre bundles reform

Healing of sulcular epithelium leading to formation of long junctional epithelium

Limited bone remodelling, no regeneration of crestal bone height