Intro Flashcards
biologic width (dentogingival jxn)
~2 mm
what does the dentogingival jxn comprise of?
- junctional epithelium (epithelial attachment) = 1 mm
2. connective tissue attachement = 1 mm
what happens if crown margin encroaches on biologic width?
will need crown lengthening with flaps and osseous resection
plaque induced gingivitis
plaque induced only
how is plaque induced gingivitis modified?
by systemic factors (e.g. horomones) or medications/nutrition
chronic periodontitis
relatively slow progression, many local factors (plaque and plaque retention)
aggressive periodontitis
- systemically healthy patient
- rapid bone loss
- familial aggregation
localized aggressive periodontitis
- adolescent African American male
2. 1st molar/incisor distribution
the severity of localized aggressive periodontitis is not consistent with what?
- local factors
- PMN (neutrophil) chemotaxis defect
- robust serum antibody response
generalized aggressive periodontitis typically affects who?
young adults (under 30) and is episodic
examples of periodontitis as a manifestation of systemic disease
- cyclic neutropenia and other PMN defects
- Down’s syndrome
- Papillon-Lefevre syndrome
what may be significant modifiers of any periodontal disease entitiy?
- diabetes
2. smoking
what was necrotizing periodontal disease was previously classified as what?
- acute necrotizing ulcerative gingivitis (ANUG)
2. periodontitis (NUP)
acute periodontal abscess may result in what?
the most rapid destruction of alveolar bone
other periodontal entities
- periodontitis associated with endodontic lesions
- developmental or acquired deformities (tooth morphology changes, mucogingival deformities/recession)
- periodontal occlusal trauma
immune cells in gingival and periodontal diseases
- neutrophils
- lymphocytes
- macrophages
- plasma cells
what is the 1st line of defense immune cells?
neutrophils
initial lesion and acute episodes of gingival and periodontal diseases are caused by what?
loss of collagen
early lesion of gingival and periodontal diseases are caused by what?
- lymphocytes
2. macrophages
examples of lymphocytes
- cell mediated immunity/cytokines (IL-1, TNFα)
role of macrophages
process antigens
role of plasma cells
produce immunoglobins
which immune cells caues an established lesion?
plasma cells
periodontal pathogens are generally what?
- gram negative anaerobic
2. frequently motile
what type of bacterial forms microbial complexes (biofilm)?
specific gram negative periodontal pathogens
what are putative (suspected) genera of periodontal pathogens?
- Aggregatibacter - Aa (formaly Actinobacillus)
- Bacteroides
- Campylobacter
- Eikenella
- Fusobacterium nucleatum
- Prevotella intermedia
- Porphyromonas gingivitis (Pi)
- Peptostreptococcus
- Treponema denticola
- Eubacteria
- Tannerella forsythia
what type of periodontal pathogens are associated with early plaque and periodontal health?
gram + rods and cocci
what is the most pathogenic in chronic periodontitis?
red complex
red complex in chronic periodontitis
- P. gingivalis
- T. denticola
- T. forsythia
what are some proven major risk factors for periodontal disease other than plaque and age?
- diabetes
2. smoking
possible risk indicators (not conclusive) for periodontal disease?
- age
- male gender
- race
- socio-economic status
- stress
- alcoholism
- IL-1 polymorphism
- osteoporosis/osteopenia
- obesity
periodontal disease may be a risk for what?
- certain pathogens cardiovascular disease
- non-bleeding type (non-hemorrhagic) strokes
- low birth-weight pre-term babies (if mother has perio disease)
- chronic obstructive pulmonary disease
- control of diabetes
- osteopenia
- obesity
treatment order of periodontal disease
- manage acute and urgent problems
- dental disease control
- evaluate response to initial therapy
- periodontal and pre-prosthetic surgery
- reconstruction (cast restorations)
- periodontal maintenance
dental disease control includes what?
- control inflammation
- remove plaque retentive factors (calculus, defective restorations)
- caries control
- pulpal disease treatment
- strategic extractions
T/F: abx should be prescribed for patients with chronic perio disease
false
first option of abx used to manage aggressive periodontitis
metronidazole + amoxicillin
which abx should be used to manage aggresive periodontitis if patient is allergic to amoxicillin?
ciprofloxacin + metronidazole
abx to manage acute perio disease (perio abscess)
amoxicillin
abx to manage acute perio disease (perio abscess) if patient is allergic to amoxicillin, metronidizole
clindamycin
management of ANUG/NUP (including NUP found in HIV positive patients)
- ultrasonic debribement
- use of chlorhexidine (Peridex) disinfectant/antiseptic rinses
- if fever, l
abx to manage ANUG/NUP pts with fever, lymphadenopathy, severe pain
metronidazole (effective against anaerobes)
sustained release local delivery agents
at isolated sites perio-reeval or maintenance: chlorhexidine or minocycline
root planing
involves some cementum removal, which may have residual calculus
scaling
calculus removal (calculus retains plaque)
limitations for periodontal surgery including crown lengthening
- external oblique line
- pterygomandibular raphe
- mylohyoid ridge
- shallow vestibule
perils for periodontal surgery including crown lengthening of maxillary palatal flaps, second molars
greater (anterior) palatine artery
perils for periodontal surgery including crown lengthening of mandibular lingual flaps or wedge distal to second molars
- lingual n.
2. lateral pharyngeal space
perils for periodontal surgery including crown lengthening of mandibular buccal first/second premolar
mental artery and n.
examples of periodontal surgery
- resective
- conservative
- regenerative
- mucogingival
examples of resective (pocket elimination) periodontal surgeries
- gingivectomy
- apically positioned flaps
- osseous surgery
- root resections
examples of conservative (for access to roots) periodontal surgeries
- flap curettage
- modified Widman flap
- ENAP (excisional new attachment procedure)
- open flap debridement
examples of regenerative (new bone, cementum, PDL) periodontal surgeries
- bone grafts
- growth factors
- guided tissue regeneration
- root treatment
examples of mucogingival periodontal surgeries
- free gingival graft
- pedicle graft
- subepithelial connective tissue graft
- acellular dermal matrix
what are the different types of bone grafts?
- allograft (FDBA and DFDBA)
- autograft (osteogenesis, osteoinduction and osteoconduction)
- heterografts (xenografts)
- synthetic materials (alloplastic)
what is the most utilized graft material?
mineralized freeze dried bone allograft (FDBA)
intraoral autograft
- osseous coagulum
- tuberosity
- healing extraction site
extraoral autograft
iliac crest
examples of heterografts (xenografts)
- anorganic bovine bone
- horse bone
- porcine (pig) bone
synthetic materials (alloplastic)
- bioactive glass
- hydroxyapatite
- tricalcium phosphate
T/F: alloplastic materials are osteoconductive (regeneration)
false, NOT
guided tissue regeneration (periodontal regeneration)
collagen membrane (bovine/porcine) barrier membrane excluding gingival epithelium and gingival CT
what does guided tissue regeneration (periodontal regeneration) promote?
multi-potential mysenchymal (progenitor) cells to migrate from the PDL and bone to differentiate into osteoblasts, cementoblasts and fibroblasts
growth factors (biologics) to gingival and periodontal diseases
- PDGF
- bone morphogenetic proteins (BMP-2,7)
- fibroblast GF
- vascular endothelial GF (VEGF)
- enamel matrix derivative (EMD, Emdogain)
root treatment (root conditioning)
- citric acid
- tetracycline hydrochloride
- EDTA
