Lecture 3 Flashcards
what is the sulcus?
marginal gingiva
what is the healthy gingival sulcus?
a potential space
where does the perio probe penetrate to in health?
free gingival groove
where does the perio probe penetrate to in disease?
past junctional epithelium into connective tissue
when does periodontitis increase?
in inflammation due to swelling and probing error
what is the diagnosis of periodontitis based on?
attachment loss, not probe depths
when does periodontitis occur?
when junctional epithelium migrates apically down root surface
what is necessary for pocket formation?
viable junctional epithelium
what is cal?
pocket depth+gingival recession
what does the shape of interdental papilla depend on?
the contact relationships between adjacent teeth
width of approximal tooth surfaces
course of CEJ
col- concavity seen in contact areas of premolar and molar region
how is the probe angulation in posterior teeth determined?
position and dimensions of the contact area determine probe angulations in posterior teeth
correct probe angulation and position
find interproximal contact
use contact as guide to insert probe
open angulation by 10 degrees
what were the initial theories on gingival width and recession?
width of keratinized tissue <2mm predisposes too recession
narrow gingiva cannot protect from friction
cannot buffer against muscle pull
facilitates subgingival plaque formation since mobile tissue causes pocket to open, facilitates food impaction, impedes oral hygiene
what is the theory on gingival width and recession now?
gingival health can be maintained independent of its dimensions
narrow gingiva has same resistance to attachment loss as wide gingiva
what are two phenotypes of gingival tissue?
scalloped- thin
flat- thick
what is different between thin and thick phenotype?
increased recession
more vulnerable to trauma
more inflammation
less favorable treatment outcome
when would you recommend gingival grafts?
when recession causes symptoms- caries, esthetic concerns, progressive recession, sensitivity
subgingival restoration margins on thin biotype
preorthodontic therapy- final tooth position will be buccal
is tissue differentiation in the adult organism influenced by environmental or genetic factors?
the characteristics of the gingiva are genetically determined rather than being the result of functional adaptation to environmental stimuli
what were the early clinical theories on tissue differentiation?
gingiva will become keratinized in response to friction
what are the clinical theories now on tissue differentiation?
connective tissue determines epithelial characteristics
what were the early grafting procedures
free gingival grafts
coronally advanced flaps
what are the grafting procedures now?
connective tissue grafts
what is the rationale behind early grafting procedures?
keratinized epithelium converted to firm attached gingiva
epithelium directs new epithelium
what is the rationale behind grafting procedures now?
connective tissue determines epithelial prototype
what is necrosis of junctional epithelium?
junctional epithelial cells die, so no pocketing
bone exposed
what is biologic width?
soft tissue attachment to tooth has two parts-
fibrous tissue
junctional epithelium
what is the biologic width of connective tissue attachment?
1.06 to 1.08 mm
what is the biologic width of connective tissue attachment?
1.4mm
what is the distance from cej to alveolar crest?
3mm so distance from crown margins to alveolar crest has to be 3mm
what do you do if the distance from crown margins is under 3mm?
crown lengthening
how does the mouth heal after extraction?
clot formation wound cleansing- PMNs, monocytes, macrophages migrate into wound new vasculature, mesenchyma cells (from pdl) form granulation tissue provisional connective tissue immature bone forms bundle bone (socket proper) is resorbed wound filled with woven bone bone maturation
why is socket preservation important?
for preserving bone morphology
what is the principle of guided tissue regeneration?
epithelium grows faster than bone or connective tissue
epithelial exclusion will allow selective growth of these cells
