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Fixed Prosthodontics I > L4: Introduction to periodontal tissues in health and disease- Link with Prosthodontics > Flashcards

L4: Introduction to periodontal tissues in health and disease- Link with Prosthodontics Flashcards

1
Q

What is the Periodontium?

A

Collective term describing tooth supporting tissues including:

  • the root cementum
  • periodontal ligament
  • alveolar bone
  • gingiva

These tissues develop and function as a unit, along with the formation of the tooth roots and tooth eruption

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2
Q

When do the first signs of tooth development appear?

A

First signs of tooth development around 6th week (thickening of the oral epithelium)

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3
Q

What is the tooth germ?

Where does it derive from?

A

The tooth germ is an aggregation of cells derived from the ectoderm of the first pharyngeal arch and the ectomesenchyme of the neural crest

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4
Q

Which are the three parts in which tooth germ is organized in?

A
  • Enamel organ: enamel and primary epithelial attachment
  • Dental papilla: pulp and dentin
  • Dental follicle: cementum, periodontal ligament, alveolar bone
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5
Q

What is gingiva?

A

The part of the oral mucosa covering the tooth-bearing part of the alveolar bone and the cervical neck of the tooth

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6
Q

Why is gingiva of major significance?

A

Major peripheral defense against microbial infections and mechanical trauma

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7
Q

What kind of function does gingiva have?

A

The gingiva has sensory function

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8
Q

What receptors is gingiva well innervated with?

A

it is well innervated with pain, touch and temperature receptors

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9
Q

What is gingiva anatomically divided into?

A

It is divided anatomically into attached, marginal and interdental components

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10
Q

What is attached gingiva demarcated by?

A

by gingival groove & mucogingival junction

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11
Q

Where is attached gingiva bound to?

A

Firm, resilient, tightly bound to the underlying periosteum of alveolar bone

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12
Q

What epithelium is attached gingiva covered by?

A

Covered by keratinized epithelium

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13
Q

Where is the width of attached gingiva greatest?

A

Width is greatest over buccal surface of maxillary incisors and narrows over buccal surface of mandibular premolars

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14
Q

Where is free gingiva attached to?

A

Delicately attached to the tooth surface

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15
Q

What does free gingiva cover?

A

It covers about 1-1.5 mm of tooth surface

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16
Q

What does free gingiva surround?

A

It surrounds the cervical part of the teeth and is separated from the teeth by a fine space called gingival sulcus

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17
Q

What is gingival sulcus?

A
  • Shallow crevice/space around the teeth bounded by the tooth on one side and the sulcular epithelium on the other side
  • The coronal extent of the gingival sulcus in the gingival margin
  • it is V shaped
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18
Q

What is gingival zenith?

A

The most apical point of the marginal gingival scallop is called the gingival zenith

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19
Q

What is the biological width?

A

Dimension of soft tissue which is attached to the portion of the tooth coronal to the crest of alveolar bone

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20
Q

What does the interdental papilla occupy?

A

Occupies the gingival embrasure, which is the inter proximal space beneath the area of tooth contact

  • Can be pyramidal or have a col shape
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21
Q

What is col?

A

Col is a valley like depression that connects a facial and lingual papilla

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22
Q

What does the shape of interdental papilla depend on?

A

The shape of the interdental gingiva depends on the contact point between the two adjacent teeth

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23
Q

What can the pigmentation be?

A
  • Exogenous
  • Endogenous
24
Q

What is GCF?

A
  • Serum transudate or inflammatory exudate
  • can be found in the crevice
25
Q

Where does GCF arise from?

A

Arises from the gingival plexus of blood vessels in the gingival corium, subjacent to the epithelium lining the dentogingival space

26
Q

What is GCF a mixture of?

A

Mixture of molecules originating from blood, host tissues and subgingival plaque

27
Q

What is Cementum?

A
  • Avascular mineralized tissue covering the root surface
  • It begins at the cervical portion of the tooth at the CEJ and continues to the apex
  • Less hard than dentin
  • Very permeable
28
Q

Which are the main functions of cementum?

A
  • anchorage -> medium for attachment to the collagen fibres of PDL
  • repair/resorption -> continuous deposition thus it repairs the damages
  • protection (fluoride) -> seal for open dentinal tubules
29
Q

What is the periodontal ligament?

A

Soft specialized connective tissue situated between the cementum and the bone socket wall

30
Q

Where does the periodontal ligament extend coronally up to?

A

It extends coronally up to the most apical part of the connective tissue of the gingiva

31
Q

Which is the width of the periodontal ligament?

A

Width 100-400 micron (decreases with age; thinnest portion around the middle third of the root)

32
Q

Which are the main functions of periodontal ligament?

A
  • supportive
  • sensory/proprioception
  • formative o protective
  • regeneration/wound healing
  • nutritive
33
Q

What is the alveolar bone?

A
  • The specialized bone structure that contains the sockets of the teeth and supports the teeth
  • Develops from the dental follicle
34
Q

What does the alveolar bone consist of?

A
  • Alveolar process/supporting alveolar bone (maxilla and mandible)
  • Alveolar bone proper (bundle bone and Sharpey’s fibers)
35
Q

Which are the main functions of the Alveolar bone?

A
  • Anchorage
  • Protection and support for teeth
  • Bone synthesis
  • Absorbs and distributes forces (e.g. occlusal pressure generated from tooth contacts or ortho movement)
36
Q

What is the alveolar process continuous with?

A

Alveolar process is continuous with basal bone of maxilla and mandible

37
Q

Cortical bone:

A
  • similar to cortical/compact bone anywhere else in the body
  • extends both on the lingual/palatal and buccal side
  • thicker in mandible vs. maxilla
  • cortical bone generally greater in the lingual/palatal vs. buccal side
  • hierarchical structure, where the fundamental units are represented by osteons (Harversian system)
38
Q

Cancellous bone:

A
  • similar to cancellous/spongy bone anywhere else in the body
  • honeycomb structure
  • Network of thin highly connected trabecular containing bone marrow
39
Q

Alveolar bone proper/bundle bone:

A
  • Continuation of the cortical plate, it lines the tooth socket
  • Surrounds the root of the teeth
  • It gives attachment to the principal fibers of PDL
  • It is a specialized type of compact bone composed of bundle bone and Haversian bone
  • Called bundle bone as numerous bundles of Sharpey’s fibers pass into it from the PDL
40
Q

What is a periodontal disease?

A

It is a chronic multifactorial inflammatory disease

  • initiated by bacterial microorganisms and
  • characterized by a severe chronic inflammation that leads to progressive destruction of the tooth supporting apparatus, tooth loss and eventually to masticatory dysfunction
41
Q

What is necessary to cause periodontitis?

A

A pathogenic biofilm is necessary but not sufficient to cause periodontitis

42
Q

What percentage is the inflammatory-immune response estimated to account for, regarding the risk of periodontal tissue damage?

A

The inflammatory-immune response is estimated to account for almost 80% of the risk of periodontal tissue damage

43
Q

What is Plaque Induced Gingivitis?

A

Inflammation of the gums due to plaque accumulation

44
Q

Which are the clinical characteristics of Plaque Induced Gingivitis?

A
  • Erythema
  • Edema
  • Tenderness
  • Enlargement
  • Swelling
  • Redness
45
Q

What happens upon probing in the situation of Plaque Induced Gingivitis?

A

Bleeding on probing

46
Q

Which are the clinical observations of Plaque Induced Gingivitis?

A
  • Bleeding on probing
  • No bone loss
  • REVERSIBLE
47
Q

What is Periodontitis caused by?

A

Supra and sub gingival plaque/calculus accumulation

48
Q

Which are the clinical characteristics of Periodontitis?

A

erythema, edema, tenderness, enlargement, swelling, redness, suppuration, tooth mobility, gum recession, halitosis

49
Q

Which are the clinical observations of Periodontitis?

A
  • Bleeding on probing
  • Loss of periodontal attachment
  • IRREVERSIBLE
50
Q

What can periodontal disease be classified as?

A
  • Gingival pocket
  • Periodontal pocket
51
Q

What is gingival pocket formed by?

A

formed by gingival enlargement without destruction of the underlying tissues.

52
Q

Why does the sulcus deepen?

A

The sulcus deepens because of the increased bulk of the gingiva

53
Q

What does the periodontal pocket occur with?

A

it occurs with destruction of supporting periodontal tissues

54
Q

What can periodontal pocket be?

A
  • supra bony (supracrestal) -> horizontal bone loss and pocket base coronal to the crest of the alveolar bone
  • intrabony -> vertical bone loss and pocket base below the crest of the alveolar bone
55
Q

What can invasion of biologic width lead to?

A
  • Can lead to gingival inflammation
  • Can lead to pocket formation
  • Can lead to loss of clinical attachment (loss of bone and gum)
56
Q

How does an active periodontal disease affect the flow of GCF?

A

Increased flow rate when there is active periodontal disease

57
Q

How does GCF flow affect prosthodontic procedures?

A
  • Will affect moisture control which is important when trying to restore a tooth or when cementing any fixed prosthesis.
  • Nearly all cements are hydrophobic and should be used only when there is good moisture control

Fixed Prosthodontics I (12 decks)

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