Perio Macro and Micro Structures Flashcards
What articles are important when discussing the importance of KG width?
Lang and Loe 1972 (Need >2mm)
Stetler and Bissada 1987 (when sub G resto, >2mm better)
Wennstrom and Lindhe 1983 (when plaque control, doesnt matter)
Cortellini and Bissada 2018 (when plaque control, doesnt matter)
Kennedy and Dorfman 1980 (longitudinal split mouth - >2mm was protective against inflammation)
How much of the population has stippling? What does it mean?
~40% Karring&Loe
if lost, early sign of inflammation
Green 1962
“ONLY LOST if inflammation goes beyond the FGM and in to the attached gingiva” - Orban (said in Green 1962)
How much of the population has a free gingival groove?
~30% - Ainamo and Loe
What is the width of the free gingival groove?
0.5 - 2mm
Bosshardt
Width of attached facial gingiva
Bowers 1963
1-9mm
Most in incisors (Max>Mand)
Least in Canine and 1st premolars
What is the width of lingual gingiva - what happens from primary to permanent teeth?
1-8mm
Decreases (lingual eruption of permanent teeth)
Voight 1978
Most in 1st and 2nd molars
What study said we need 2mm kg?
Lang and Loe 1972
Stetler and Bissada 1987 (SubG Restoration)
What study said we do NOT need 2mm KG?
Wennstrom & Lindhe 1983
Beagle dog study - removed attached gingiva and did FGG in 1/2
Oral hygiene
No difference in inflammation
Cortellini & Bissada 2018
How is phenotype related to KT width and bone morphotype?
Cook et al. 2011 reported Thin biotype associated with 50% thinner buccal plate
as CEJ-Crest increased, KG decreased
What are some protective/risk factors against recession?
Chambrone & Tatakis
Protective: KTW/GT
Risk: Lack of AG
Describe the epithelium of Junctional, Sulcular, and Oral epithelium
Junctional/Sulcular are non-keratinized stratified squamous
Oral is Para-keratinized stratified squamous
How many cell layers in Junctional, Sulcular, and Oral epithelium
Junction and sulcular: 2 - Basale and Suprabasale
Oral: 4 - Basale, Spinosum, Granulosum, Corneum
Where are rete pegs present?
Junctional - only in inflammation
Sulcus - present
Oral - present
How many cells thick are the Junctional, Sulcular, and Oral epithelium?
Junctional: 3-4 at apical, 15-20 coronal
Sulcus: Variable
Oral: 20-40
Cell size of Junctional, Sulcular, and Oral epithelium
Junctional: Largest
Sulcular: Med
Oral: Smallest
Intercellular space of Junctional, Sulcular, and Oral epithelium
Junctional: Widest
Sulcular: narrow
Oral: narrowest
Cell Junctions and permeability of the Junctional, Sulcular, and Oral epithelium
Most abundant in all of them is Desmosomes
Oral epi has the most of them (> Junctional)
Junctional: Gap junctions (allows cell leakage (GCT and innate immunity)) Hemidesmosomes (attachment to enamel and basement membrane - RAPID TURNOVER
Sulcular: Desmosomes
Oral: Tight Junctions, Hemidesmosomes to basement membranes
What is the clinical significance of Junctional, Sulcular, and Oral epithelium
Junctional: Barrier (attached to tooth) - Access of GCF and innate immune cells
Sulcular: more susceptible to breakdown - non-keratinized
Oral: mechanical/bacterial barrier
Gargiulo 1961
Sulcus: 0.69mm
JE: 0.97mm (most variable)
CT: 1.07mm (most constant)
What kinds of keratinization is there and what is the difference? Where are they present?
Ortho-Keratinized (no nuclei)
Pera-Keratinized (nuclei remnants)
Corneal layer has a range of these
What is the cellular makeup of the oral epithelium?
90% Keratinocytes
10% non-keratinocytes (clear cells)
What cells make up the % of the oral epi that is not keratinocytes? Where are they located?
4 types of clear cells
Merkel’s cells (basal)
Melanocytes (basal)
Langerhans cells (mostly suprabasal)
Inflammatory cells (variable)
What is a key histoloical feature of langerhans cells?
Bierbeck granuals (tennis racket)
What is the basal cell attached to? How
Basement membrane - Hemidesmosomes
How many layers are in the basement membrane and what are they?
3
Lamina Lucida
Lamina Densa
Sublamina Lucida (Kobayashi, 1976)
What is the most superfical layer of the BM made of and why is it named the way it is?
Lamina Lucida
Electron lucent
Lamanin, nidrogens, dystroglycans
What is the most inferior layer of the BM made of and why is it named the way it is/How is it connected to the CT layer?
Lamina Densa
Electron dense
Anchoring Fibrils (COL VII)
What is the BM composed of?
50% Type IV Collagen
Lamanin (most abundant non-collagen protein)
Proteoglycans
What is the CT composted of?
aka Lamina Propria
60-65% fibers (Collagen type I>Collagen type III)
35% ECM/vessels
5% cells (65% fibroblasts)
How many layers is the CT and what are they?
2
Papillary (loose - CT papilla between rete pegs)
Reticular (dense - continuous with periosteum)
What are the most abundant GAGs in the periodontium?
Epithelium: Heparan sulfate (60%)
CT: Dermatan Sulfate (60%)
Cementum/Bone: Chondroitin Sulfate (94%)
What other GAGs are there? Are they in the periodontium at all?
Hyaluronic Acid (in CT/synovial fluid)
Keratan sulfate (Cornea/bone/cartilage)
Where is Chondroitin Sulfate found in the body?
Cartilage/Bone/Heart valve/Cementum
Where is Dermatan Sulfate found in the body?
Gingival CT/skin/vessels/heart valves/lung/tendons
Where is Heparan Sulfate found in the boyd?
Basement Membrane!
cell surface component
Where is Hyaluronic Acid found in the body?
Synovial fluid
ECM
Skin
Articular cartilage
What are the gingival fiber groups?
5 groups
Trans-septal
Circular
Dento-Gingival
Dento-Alveolar
Alveolo-gingival
What are the principle fiber groups of the PDL?
Alveolar crest fibers
Horizontal fibers
Oblique fibers
Apical fibers
Interradicular fibers
What cells does the PDL contain?
Mesenchymal cells that can differentiate into fibroblasts, osteoblasts, or cementoblasts
What are the functions of the PDL?
PDL Never Stops Forming Self
Protective
Nutritive
Supportive
Formative
Sensory
How thick is the PDL?
0.2-0.4mm Carranzza
What is the primary collagens of CT, PDL, and Cementum?
Col I and III
Cementum: 90% I
PDL : 80% I
CT: 70% I
What are the different types of cementum? CITATION?
Schroeder 1986
Acellular Afibrillar
Acellular Extrinsic-fiber
Cellular Intrinsic-fiber
Cellular Mixed
Where are the different cementums present? How thick are they?
AAF: Coronal to PDL fibers: 1-15microns
AEFC: Coronal-Mid third: 30-230microns
CIFC: Apical third: variable
CMC: Apical 1/2-1/3/Furcation: 100-1000microns
What is the first cementum produced?
AAC
What cementum is produced to repair itself?
CIFC - resorption lacunae and GTR
What fibers act in adapting to occlusal forces?
CIFC and CMC
How is cementum oriented with enamel?
OMG rule
Overlapping: 60%
Meeting: 30%
Gap: 10%
How is cementum deposition characterized and what does it respond to? CITATION
Kerr 1961
Continuous throughout life
3fold increase from 20-70
Thickest at apex
Responds to inflammation, occlusion, ortho movement, pathology
What are the different names for the bone surrounding a tooth?
Bundle bone
Cribriform bone
Lamina dura
What are the layers of the periosteum?
Fibrous (outer/dense)
Osteogenic (loose CT/Inner)
Where are the most common places for fenestration/dehisence? CITATION
Ruperecht et al. 2001
Maxillary 1st Molar: 58% of Fenestrations
Mandibular Canine: 67% of Dehisences
How does blood flow in the periodontium
Kleinheinz 2005
Primarily posterior
Secondarily inferior
What are the main lymph nodes that the oral cavity drains to?
What drains to each?
Submental (mand anteriors)
Submandibular (Max Facial/Mand Posteriors)
Jugulodigastric (3rd molars)
Deep cervical (Max Palatal)
