Local Factors Flashcards
Friskopp 1980
calculus does not directly causes periodontal disease, but it protects and host bacteria, obstructing adequate oral hygiene
Allen 1965
sterile calculus may be encapsulated in connective tissue without causing abscess formation or even marked inflammation
Steralized calculus put in flaps of guinnie pigs
Will all plaque turn in to calculus? Why or why not?
Not all plaque will become calcified, it depends on the binding of calcium ions to carbohydrate protein complexes of the organic matrix and precipitation of crystalline calcium phosphate salts. (Jepsen 2011)
How many “types” of calculus are there? What are they?
According to Jepsen 2011: 2 types - Supragingival and Subgingival
Describe Supragingival Calculus
(Jepsen 2011)
6 characteristics
Color - White/yellow
Position - Coronal to gingival margin
Location - Usually near salivary ducts - facial surface of molars
Mineral Content - 37% - saliva is major contributor
Crystal type - Octacalciumphosphate (external) Hydroxyapatite (Internal)
Formation - Heterotypic nucleation/growth/and calcification
Describe Subgingival Calculus
(Jepsen 2011)
6 characteristics
Color - Brown/Green
Position - Apical to gingival margin from CEJ to pocket base
Location - variable - lingual/interproximals
Mineral content - 58% - GCF major contributor
Crystal type - whitelockite (WHT)
Formation - Heterotopic nucleation/growth - Homogenous calcification
How is calculus attached to the tooth?
According to Zander 1953 there are 4 modes of attachment
RISP
Resorption
Irregularities
Secondary Cuticle
Penetration
1 - secondary cuticle
2 - microscopic irregularities
3 - areas of resorption
4 - microbial penetration
Describe Secondary Cuticle attachment of calculus
There can be a thin cuticle of epithelial attachment that remains attached to cementum after apical migration - calculus can form on this and be easily detached
Describe Microscopic Irregularities attachment of calculus
Adhered by irregularities left from detached Sharpey’s Fibers (MOST COMMON FORM OF ATTACHMENT)
Describe calculus attachment by areas of resorption
Areas where the cementum has resorbed create potential areas of mechanical attachment
Describe calculus attachment by microbial penetration
DESPUTED BY Canis et al 1979
Microbes present on calculus penetrate cementum and lay calculus
What are some tooth related factors that impact periodontal health?
Accessory/lateral canals
Root proximity
Root concavities
Root trunk
Bifurcation ridges
Furcation entrance
Cemental tears
Verticle root fractures
Cervical enamel projections
Enamel pearls
Palatoradicular grooves
Crowding
Helpless teeth
Impacted third molars
How do lateral canals form?
According to Gutman 1978
believed to form by a failure of the HERS where odontoblasts do not differentiate and fail to form dentin
How can lateral canals impact periodontal health and vic versa?
According to Armitage 1999
Canals exposed to periodontal disease can cause “idopathic pulpitis”
Infected canals exposed to periodontium can lead to accelerated periodontal disease progression by spreading endodontic pathogens
What is the prevalence of lateral canals?
According to Gutmann 1978
Average 28.4% in the furcations
Mandibular > Maxillary
(prevalence of about 25-30%)
What is a bifurcation ridge?
A dentin ridge that is covered by a layer of cementum extending from buccal to lingual furca in mandibular molars
What is the prevalence of bifurcation ridges?
Everett 1958 (Mt. Everest) REMEMBER EVERETT
1st Molar - 73%
Hou and Tsai 1997
1st Molar - 73%
2nd Molar - 67.9%
What is a cemental tear?
a root SURFACE fracture that usually involves only cementum, but can involve dentin in rare cases. - commonly associated with periodontal abscess
What are the predisposing factors for a cemental tear?
Lin 2011
Collected from multicenters
Male Gender (3:1)
Age >60
Pocket >6mm
Vital teeth
Position - Incisors (Max and Mand)
Mod-Sev attrition (TFO)
What is a cervico enamel projection?
anatomical anomaly in which there is projection of the enamel tissue on the cervical area of the tooth, pass the CEJ level, extending towards or even into the furcation area.
How do we grade CEPs?
Master and Hoskins 1964
Grade 0 - no CEP
Grade 1 - slight extension of CEP toward furcation
Grade 2 - CEP approximating the furcation
Grade 3 - CEP extends into furcation
Prevalence of Cervico-Enamel Projections
Hou & Tsai 1987
Most prevalent in Mandibular 1st molar (74%)
Second is Max 1st (62%)
Mandible > Grade III
Maxilla > Grade II
SUBJECTS ALL HAD PERIO DISEASE! Thats why so high
Bissada 1973
Max 1: 8%
Max 2: 15%
Mand 1: 3%
Mand 2: 9%
What effect does crowding have on perio?
Ainamo 1972
increased PI, Calculus, GI, and CAL in misaligned anterior teeth in max and mand.
Makes the patient more likely to retain plaque and calculus than a patient with aligned teeth. The area becomes more difficult to clean and maintain.
What is an enamel pearl? How do they effect perio?
ectopic deposit of enamel believed to come from HERS cells that did not detach from the dentin matrix and differentiate into ameloblasts mainly in furcation area.
Allow plaque retention and prevents attachment of CT
How do you determine between cemental tear and root fracture
Fracture - single narrow deep probing
Fracture - non-vital
X-ray - hard to see fracture
Pain - no pain in cemental tear - fracture pain on release
How can furcation entrance effect periodontal treatment?
The average hand instrument is 0.75mm in diameter.
Bower et al. 1979
81% of 1st molars have <1mm
58% are <0.75mm (85% of buccal max molars)
How do hopeless teeth impact periodontal health?
Devore 1988
Retained hopeless teeth has no effect on proximal perio
Machtei 1989
If not maintained, hopeless teeth will effect the adjacent tooth’s perio condition
Machtei and Hirsch 2007
Hopeless teeth that are retained and maintained did not affect adjacent teeth
How do hopeless teeth impact periodontal health?
Devore 1988
Retained hopeless teeth has no effect on proximal perio
Machtei 1989
Retaining hopeless teeth effects adjacent teeth (when not cleaned)
Machtei and Hirsch 2007
Hopeless teeth that are retained and maintained did not affect adjacent teeth
Moskow and Canut 1990
Cervical Pearl prevalence is 2.6% (reviewed 9 articles) Russians are rich (pearls)
What age should 3rd molars be removed?
Kugelberg 1990 (retrospective)
Residual PD
25 or younger - 25%
26 or older - 52%
Beneficial effect on perio of D of 2nd molar
Sammartino 2009
Bone graft w/wo membrane showed sig reduction in PD and CAL gain. Efficient in preventing second molar defect.
What are palatoradicular groves?
cause by an invagination of the inner enamel epithelium and HERS during the tooth development,
Classification for Palatoradicular grooves?
Goon 1991
Mild - gentle depressions of the coronal enamel which terminate at or
immediately after crossing the CEJ
Moderate - extend some distance apically along the root surface in the
form of a shallow or fissured defect
What are palatoradicular groves?
Cause by an invagination of the inner enamel epithelium and HERS during the tooth development.
A funnel for bacteria that is difficult to clean.
Post common on Maxillary lateral incisor
Classification for Palatoradicular grooves?
Goon 1991
Mild - gentle depressions of the coronal enamel which terminate at or
immediately after crossing the CEJ
Moderate - extend some distance apically along the root surface in the
form of a shallow or fissured defect
Complex - deep invagination that involves the entire length of the root or that separate an accessory root from the main rot trunk
Prevalence of Palatoradicular grooves:
Kogon 1986**
Central and Lateral combined prevalence of 4.6%
5.6% of laterals
58% are >5mm***
Everett and Kramer said 2%
Where are the most common areas to find root concavities?
Bower 1979b
1st molars
Max - MB 94%
Mand - M 100%
Booker and Loughlin 1985
Max 1st PM - M 100% D 40%
How deep are root concavities on max and mand molars?
Bower 1979b
1st molars
Max - MB 94% (0.3) - 31% (0.1) - 17% (0.1)
Mand - M 100% (0.7mm) D 99% (0.5mm)
How deep are root concavities on Max 1st PM?
Booker and Loughlin 1985
Max 1st PM - M 100% D 40%
Single rooted - 0.35mm
2 rooted - 0.44mm
Ochsenbein Root Trunk Classification
Mandibular molars (2 roots)
2mm - short
3mm - med
4mm - long
Maxillary molars (3 roots)
3mm - short
4mm - med
5mm - long
How do we determine severity of root proximity?
Vermylen 2005a
Type 1: 0.5 - 0.8mm (cancellous + cortical + CT)
Type 2: 0.3 - 0.5mm (cortical + CT)
Type 3: <0.3mm (only CT)
Heins and Wieder 1986
> 0.5mm - cancellous bone
<0.5mm - no cancellous, only lamina dura
<0.3mm - only PDL
What portion of the tooth can be effected by root proximity? Apical/Mid/Crest?
The crest is what can be effected by close root proximity
How does crown margin effect perio?
Newcomb et al 1974
Strong correlation between gingival inflammation and approximation to base of the crevice.
How big does an overhang have to be to impact boneloss?
Jeffcoat and Howell 1980
If it extends more than 20% of the interproximal space it will effect bone
Classification of overhangs
Jeffcoat and Howell 1980
Small <20%
Med 20-50%
Large >51%
M and L associated with bone loss
Classification of overhangs
Jeffcoat and Howell 1980
Small <20%
Med 20-50%
Large >51%
M and L associated with bone loss
Classification of open contacts
Hancock 1980
Tight - resistance to floss
Loose - minimal resistance
Open - no resistance
No association between PD and Contact Type
Association between Contact Type + Food Impaction
Association between Food Impaction + Contact Type
Is open contact an issue for perio?
Hancock 1980
Only if there is food impaction associated with the open contact.
Joseph 1996
Maxillary 1st Premolars
M furcation: 7.9mm
D Furcation: 7.6mm
Miller-McEntire 2014
An Evidenced-Based Scoring Index to Determine the Periodontal Prognosis on Molars
15yr survival based on Molars Score:
Score 1-3: 96%-98%
Score 4-6: 90%-95%
Score 7-10: 67%-86%
How does Miller-McEntire grade molars?
Age (<40 = 0, >40 = 1)
Number of Fucations (1=1, 2=2, 3=3)
Smoking Status (No=0, Yes=4
PD (>5=0, 5-7=1, 8-10=2, >10=3)
Mobility (0=0, 1=1, 2=2, 3=3)
Molar Type (Mand=0, Max1st=1, Max2nd=2)
