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PERIO I > intro > Flashcards

intro Flashcards

1
Q

Reasons for Adult Tooth Loss

A
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2
Q

occurance rate of perio dx

A
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3
Q

“F”s in Periodontics

A

Failure to diagnosis
Failure to treat
Failure to refer
Failure to establish an appropriate maintenance schedule
Failure to accept treatment (patient)

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4
Q

phases of tx plans

A
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5
Q

Court Dictated Role of general dentists

A

Diagnose periodontal disease

Inform the patient of clinical findings

Refer patient to a Periodontist, or treat themselves

Treat to the current standard of care

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6
Q

Gingivitis

A

“Gingivitis is the inflammation of the gingival tissues without loss of connective tissue attachment.”

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7
Q

Periodontitis

A

“Periodontitis is the inflammation of
the gingival tissues with apical
migration of junctional epithelium
with concomitant loss of connective
tissue attachment and bone.

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8
Q

Probing Depth

A

“Probing depth is the distance from the soft tissue margin to the tip of the periodontal probe.”

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9
Q

Pockets are classified as:

A

Shallow (1-3mm); Moderate (4-6mm); Severe (≥ 7mm)

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10
Q

Clinical Attachment Level

A

“Clinical attachment level (CAL) is the distance from the cementoenamel junction (CEJ) to the tip of the periodontal probe during normal
probing.”

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11
Q

Chronic Periodontitis forms (1999)
mild, moderate, severe CAL
localized vs generalized?

A

Mild (Incipient): 1-2 mm CAL (Clinical Attachment Loss)
Moderate: 3-4 mm CAL
Severe: ≥ 5mm CAL

Localized: less than 30% teeth involved
Generalized: more than 30% teeth involved

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12
Q

Aggressive Periodontitis

A

Not classified as mild/moderate/severe
Assumed all aggressive cases are severe due to the high rate of destruction and/or the young age of onset

Localized: 1st molars and incisors (first to erupt)
Generalized: 1st molars, incisors, and ≥ 3 other
teeth

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13
Q

Periodontal Diseases and Conditions classes (2017)

A

Periodontal Health, Gingival Diseases and Conditions

Periodontitis

Other Conditions Affecting the Periodontium

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14
Q

Peri-Implant Diseases and Conditions

A

Peri-Implant Health
Peri-Implant Mucositis
Peri-Implantitis
Peri-Implant Soft and Hard Tissue Deficiencies

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15
Q

Periodontal Health, Gingival Diseases and Conditions

A

Periodontal Health and Gingival Health
Gingivitis: Dental Biofilm-Induced
Gingivitis Diseases: Non-Dental Biofilm-Induced

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16
Q

types of Periodontitis

A

Necrotizing Periodontal Diseases

Periodontitis

Periodontitis as a Manifestation of Systemic Disease

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17
Q

Other Conditions Affecting the Periodontium

A

Systemic Diseases or Conditions Affecting the Periodontium

Periodontal Abscesses and Endodontic-Periodontal Lesions

Mucogingival Deformities and Conditions

Traumatic Occlusal Forces

Tooth and Prosthesis Related Factors

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18
Q

Classification of Periodontitis

A

use staging and grading

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19
Q

STAGING periodontitis

A
  • Based upon
  • Severity of the case
  • Complexity of the case
    management
  • Consider
  • CAL
  • Amount and % of bone loss
  • PD
  • Presence/extent of ridge
    defects
  • Furcation involvement
  • Tooth mobility
  • Tooth loss due to periodontitis
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20
Q

grading periodontitis

A
  • Consider biologic features
  • Rate of disease progression
  • Risk of further advancement
  • Potential threats to general
    health (eg. smoking, diabetes)
  • Grade A, B, C
  • A: low risk of progression
  • B: moderate risk
  • C: high risk
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21
Q

periodontitis stages chart

A
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22
Q

periodontitis grades chart

A
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23
Q

Peri-Implant Health

A

absence of inflammation
No BOP
Bone loss ≤ 2mm

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24
Q

Peri-Implant Mucositis

A

Signs of inflammation
BOP and/or SOP
Increased PD
Bone loss ≤ 2mm

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25
Q

Peri-Implantitis

A

Signs of inflammation
BOP and/or SOP
Increased PD (≥ 6mm)
Progressive Bone loss ≥ 3mm

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26
Q

New Vocabulary for:
perio biotype
excessive occ force
bio width
chronic/aggressive periodontitis

A
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27
Q

components of periodontium

A

Gingiva
PDL
Cementum
Alveolar Process

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28
Q

types of gingiva

A
  • Marginal Gingiva
  • Gingival Sulcus
  • Attached Gingiva
  • Interdental Gingiva
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29
Q

microscopic portions gingiva

A
  • Gingival Epithelium
  • Gingival Connective Tissue
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30
Q

Marginal Gingiva

A

Unattached or free
Sulcus epithelium adjacent to tooth
About 1 mm in depth
Up to 3 mm still considered normal

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31
Q

Free gingival groove

A

In 50% of cases, marginal gingiva is demarcated from
the attached gingiva by a free gingival groove

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32
Q

Gingival sulcus

A

Not attached to enamel or cementum
Bounded apically by the free gingival groove (50%
incidence) on the oral epithelium (if present)

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33
Q

If attachment loss occurs a sulcus is referred to as :

A

periodontal pocket

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34
Q

calculating attatched gingiva

A
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35
Q

attatched gingiva border

A

Bordered apically by the mucogingival junction
Bound to underlying periosteum of alveolar bone

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36
Q

attatched gingiva texture

A

firm, resilient

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37
Q

variable width attatched gingiva

A

vaires man and max

38
Q

Interdental Gingiva

A

It occupies the embrasure
The interproximal space beneath the area of tooth
contact (Col)
Pyramidal or col shaped

39
Q

Gingival Epithelium

|cellular/acellular? acts as? to protect? allows for?

A
  • Predominately cellular in nature
  • As a mechanical/chemical/water/microbial barrier
  • To protect the deep structures while allowing for a
    selective interchange with the oral environment.
40
Q

Gingival Connective Tissue

composed of mainly?
AKA? layers?
fibers arranged as?

A
  • Composed primarily of collagen fibers and
    ground substances
  • Also known as “lamina propria”. It consists of
    a papillary layer and a reticular layer.
  • The gingival fibers are arranged in 3 groups
41
Q

layers of gingival epithelium

A
42
Q

ginigval epithelium areas

A
  • Oral Epithelium
  • Sulcular epithelium (~1 mm)
  • Junctional Epithelium (~ 1mm)
43
Q

oral epithelium

A
  • Keratinized stratified squamous epithelium
  • Turnover of 30 days
  • Stratum corneum
  • Stratum granulosum
  • Stratum spinosum
  • Stratum basale
44
Q

sulcular epthelium
length?
attatched?
histo?
lacks what layers? unique cell found?

A
  • Sulcular epithelium (~1 mm) * Unattached to enamel
  • Non-keratinized stratified squamous epithelium
  • Lacks stratum corneum and granulosum; Langerhans cells
45
Q
  • Junctional Epithelium
    size?
    histo?
    TO rate?
    attachment?
A
  • Junctional Epithelium (~ 1mm)
  • Non-keratinized stratified squamous epithelium
  • High turnover rate (7-10 days)
  • Attachment to the tooth surface via hemidesmosomes and non-collagenous proteins (proteoglycans & glysosaminoglycans)
46
Q

Sulcular epithelium
Importance

A

it is a semi-permeable membrane against
bacterial products passing into underlying tissue

47
Q

Development of Gingival Sulcus

A
48
Q

Gingival Connective
Tissue composition

A
  • 60% collagen fibers, 5% fibroblasts, 35% matrix, vessels and nerves.
  • The gingival fibers are oriented with functions
49
Q

orientation of gingival fibers purposes

A
  • To brace the marginal gingiva against tooth
  • To provide rigidity,
  • To unite the marginal gingiva with the cementum and adjacent attached gingiva
50
Q

gingival fiber groups

A
51
Q

what contributes to bio width

A

Fibers that are in close proximity to the alveolar crest contribute to the connective tissue attachment component of the
“Biologic Width”.

52
Q

bio width

A

2.04 mm total
0.97mm junctional epithelium
1.07mm connective tissue attachment

53
Q

bio width AKA

A

Supracrestal Tissue Attachment

54
Q

GCF

can be? main route? can serve as?

A

Can be represented as either a transudate (healthy) or an exudate (inflamed) from the gingival connective tissue and blood vessels.
* The main route: basement membrane -> JE intercellular space-> sulcus
* The biochemical factors (cytokines, enzymes, antibodies, etc.) in the GCF could potentially serve as diagnostic or prognostic biomarkers.

55
Q

GCF functions

A
  • Improve adhesion of the epithelium to the tooth through plasma proteins
  • Possesses antimicrobial properties

cleanse sulcus

56
Q

Stippling of attatched gingiva

A
  • Represents the microscopic depressions and elevations created by the connective tissue projections within the gingival tissue
  • Is a form of adaptive specialization or reinforcement for function
  • ~ 40% of population
57
Q

Mesenchymal-Epithelial
Interaction

A

The gene of the underlying connective tissue
determines the covering epithelium

58
Q

PDL

A

A complex vascular and highly cellular connective tissue that surrounds the tooth root and connecting to the alveolar bone
* Periodontal fibers
* Cellular elements
* Ground substances

59
Q

PDL Fibers

A
  • Contains Collagen I, III and IV
  • Sharpey’s fibers: the terminal portions of the collagen fibers embedded in the root cementum and the bundle bone
60
Q

PDL fiber groups

A
  • Alveolar crest
  • Horizontal
  • Oblique
  • Apical
  • Interradicular
61
Q
  • Alveolar crest PDL group
A
  • Alveolar crest* Cementum → crest alveolar bone
  • Prevents extrusion and lateral movements
62
Q
  • Horizontal PDL group
A
  • Horizontal* Cementum → alveolar bone at 90º
  • Opposes lateral forces
63
Q
  • Oblique PDL group
A
  • Oblique *Largest group
  • Cementum → alveolar bone coronal direction
  • Resists vertical masticatory forces
64
Q
  • Apical PDL group
A
  • Apical* Cementum → apical alveolar bone
  • Resists tipping
65
Q
  • Interradicular PDL group
A
  • Interradicular* Cementum → furcation bone
  • Resist luxation and tipping
66
Q

PDL Cells

A
67
Q

PDL functions

A

physical, formative/remodeling, nutritional and sensory

68
Q

PDL Physical functions
* Contains?
* Absorbs? transmits?
* mechanism?
* Maintains?

A
  • Contain blood vessels & nerves
  • Absorbs occlusal forces and transmits occlusal force to the bone
  • Suspensory mechanism attaching the teeth to the bone
  • Maintains gingival tissue in the relationship to the teeth
69
Q
  • PDL Formative and remodeling functions
A
  • Cells could respond to occlusal force and participate in the formation and resorption of cementum/bone/collagens
70
Q

PDL Nutritional and sensory functions
supplies nutrients to?
transmits what sensations? through what CN?

A
  • Supplies nutrients to cementum/bone/gingiva
  • Transmits pressure and pain via trigeminal pathways
71
Q

PDL Space

normal width? affected by? adaptions?

A

The normal width of PDL is approximately 0.2 mm
* Occlusal functions can affect PDL space
* Within physiologic limits, PDL accommodates increased force with an increased width, thickened fiber bundles, and
increased numbers of Sharpey’s fibers.
* When the force exceeds the adaptive capacity -> trauma from occlusion.

72
Q

Cementum

A
  • A specialized mineralized tissue
  • Inorganic content (45-50%) is mainly hydroxyapatite, < bone/dentin/enamel
  • Organic matrix (50-55%) is mainly composed of type I and type III collagen
73
Q

cementum contains no/grows by?

A
  • Contains no blood or lymph vessels, no nerves,
    and grows by continuing deposition
74
Q

cementum greatest growth rate/thickest area

A
  • The highest rate of formation is in the apical regions
  • The greatest thickness is in apical third and the furcation areas
75
Q

Forms of Cementum

A
  • Two main types of cementum
  • Acellular (primary)* Found in coronal portion of root
  • Cellular (secondary)* Found in apical portion of root
76
Q

sources of cementum collagen fibers

A

Two major sources of collagen fibers
* Sharpey’s fiber* extrinsic - from fibroblasts
* Fibers that belong to cementum matrix * Intrinsic - from cementoblasts

77
Q

Functions of Cementum

A
  • Attaches the principal PDL fibers to the root (main function)
  • Contributes to the process of repair after damage to the root surfaces
  • Adjusts the tooth position to new requirements* It compensates for tooth eruption
  • Protects dental pulp/dentin
78
Q

potentail CEJ forms

A
79
Q

Exposed Cementum issues

A
  • Rough surface texture facilitates plaque adherence
  • Porosities facilitate attachment of calculus
  • Porosities facilitate absorption of bacterial enzymes
    (i.e. endotoxin)
  • Smear layer inhibits attachment of connective tissue
80
Q

Alveolar Process

A
  • The portion of the maxilla and mandible that forms and supports the tooth sockets.
  • A tooth dependent structure: It forms when the tooth erupts and disappears gradually after tooth extraction
  • Contains blood or lymph vessels, and attachment of PDL fibers (Sharpey’s fibers)
  • Nerves are not in the bone but in the periosteum
  • Vascular pathways from gingiva into supporting alveolar bone
81
Q

alveolar process shape
depends on?
anterior vs posterior?
distance from CEJ in health?

A
  • Depends on interdental distance, tooth contours, root contours
  • Anterior: Scalloped
  • Posterior: Flattened Scallop
  • Distance from CEJ in health
  • 1 to 1.5 mm
  • 1.5-2 mm in adult (taking into account the biologic width concept)
82
Q

alveolar process components

A
  • External plate: cortical bone
  • Inner socket wall: thin cortical
    bone
  • Alveolar bone proper
  • Bundle bone
  • Lamina dura:radiographic term
  • Spongy bone: cancellous
    trabeculae
    *Basal bone is located apically but unrelated to the teeth.
83
Q

Cancellous bone

A

found predominately in the interdental & interradicular areas (less in facially/lingually)
* In adult humans, more cancellous bone in the maxilla than in the mandible.
* Usually in the mandible, there is thicker cortical bone and less cancellous bone.

84
Q

cancellous bone vs cortical bone for implants

A

cortical bone will produce more heat in preparation which can kill osteocytes=failure

85
Q

F/L cortical plates

A
  • Thin facial and lingual cortical plates overlying root surfaces
  • Lack of cancellous bone (so no progenitor cells) overlying many facial root surfaces
86
Q

fibrosis of marrow spaces in adults

A
  • Increased fibrosis and lipid cell
    content in marrow spaces (results
    in a decrease in progenitor cells)
    in adults > 40 years old
87
Q
  • Dehiscence:
A
  • Dehiscence: lack of bone on
    the facial/lingual of the tooth
    but with interproximal bone
88
Q
  • Fenestration
A
  • Fenestration: lack of bone
    on the facial/lingual of the
    tooth resembling a “window”
89
Q
  • Predisposing factors to Dehiscences & Fenestrations
A

prominent root contours, malposition and roots with labial protrusion in combination of thin bony plate

90
Q

Periosteum
how can it bind bone?

A
  • The periosteum is a fibrous sheath that lines the outer surface of bone.
  • Bundles of periosteal collagen fibers penetrate the bone, binding the periosteum to the bone.
91
Q

periosteum layers

A
  • Composed of two layers:
    Fibrous layer: a dense, fibrous, vascular layer
    Osteogenic layer: a loose connective tissue inner layer, containing osteoprogenitor cells.

PERIO I (13 decks)

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