Periodontal Disease and Regeneration Flashcards
peri
around
odont
tooth
What four tissues make up the periodontium?
- gingiva
- PDL
- cementum
- bone
What is supracrestal attachment or biological width?
where the gum attaches to the tooth at the CEJ
What should the sulcus depth be
connective tissue ~ 1.0 mm
junctional epithelium ~ 1.0 mm
biological width = 2.0 mm
The connective tissue attaches ___ to the CEJ
apical
What are the fibers that help attach the gum to the tooth?
- DGF - dentogingival fibers
- CF - circumfrential fibers
- TF - trans-septal fibers
- DPF - dentoperiosteal fibers
What are the 6 PDL fibers?
- ACF - alveolar crest
- HF - horizontal
- OF - oblique
- APF - apical
- ABP
- RC - inter-radicular
What are the three different terms for bone depending on what field you are studying in?
- alveolar bone proper - gross anatomy
- bundle bone - histology
- lamina dura - radiographic anatomy
What is the disease spectrum?
*not everyone who has gingivitis will develop periodontitis, it depends how the body responds to certiain bacteria
What are the 4 main factors which lead to periodontitis?
- local risk factors and environment
- bacteria
- time
- host immune response and genetics
What is gingivitis?
An inflammatory lesion resulting from interactions between the plaque biofilm and the host’s immune response, which remains contained within the gingiva and does not extend into the periodontal attachment.
Inflammation is contained in the gingiva and does not extend past the mucogingival junction and is reversible by reducing the levels of plaque at and apical to the gingival margin.
What is periodontitis?
Chronic *multifactorial inflammatory disease associated with dysbiotic plaque biofilms characterized by progressive destruction of the tooth-supporting apparatus. Primary features include loss of periodontal tissue support manifested through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding.
Compare and contrast health, gingivitis and periodontitis.
What is the normal probing pocket depth?
1-3 mm
How do you calculate clinical attachment loss?
CAL = probing depth + recession
If you have a 4mm pocket, does that mean you have abnormal pocket depths?
CAL = 4 mm - 4 mm = 0
*not an abnormal pocket depth and might not have periodontal disease
If you have 4 mm probing depth and 2 mm gingival recession, does this person have periodontal disease?
Yes. Patient has lost 6mm of bone
CAL = 4 + 2 = 6 mm
What are the 4 consequences of untreated disease?
- further attachment loss
- periodontal abscess
- tooth mobility and altered position
- tooth loss
Describe the fate of a pocket
- reduce bacteria
- reduce inflammation
- pocket becomes inactive
- reduction in probing depth
- recession
- long junctional epithelium formation
Inactive pockets heal with a
long junctional epithelium
What happens if the long junctional epithelium has a chance to re-open?
- pocket reformed
- depends on OH levels and host response
True or false: Inactive pockets can be maintained for long periods with little CAL if frequent maintenance and excellent OH on patients part
True
What type of environment does a bacteria love in deep pockets?
warm, dark, damp, oxygen free
What does altering pocket depth via SURGICAL REDUCTION result in?
- healthy sulcus with or without gain in attachment
- recession of gingiva exposing the attachment loss caused by previous bout of disease
What does altering pocket depth via PERIODONTAL REGENERATION result in?
- improved gingival attachment
- restoration of bone height, with re-formation of periodontal ligament fibers and cementum
What are the three ways of altering a pocket depth?
- surgical reduction
- periodontal regeneration
- tooth extraction
Compare and contrast the three methods of pocket reduction
Which method of pocket reduction offers an ideal result?
periodontal regeneration
True or False: The goal of periodontal regeneration is to create a long junctional epithelium.
False
Long junctional epithelium is not a true attachment, it is just a tightening after removal of bacteria
What is repair?
healing of a wound that does not fully restore the architecture or the function of the long junctional epithelium
What is reattachment?
reattachment of the gingiva to areas from which it was mechanically removed
What is new attachment?
occurs when newly generated fibers are embedded in new cementum on a portion of the root that was uncovered by disease
What is regeneration?
reproduction or reconstruction of the lost or injured part in such a way that the architecture and function is completely restored
What is resorption?
loss or blunting of some portion of a root, sometimes idiopathic, also associated with orthodontics, inflammation, trauma, endocrine disorders and neoplasia
What is ankylosis?
fusion of the tooth and alveolar bone
Periodontal regeneration must consider what 4 environmental factors?
- coordinated formation from
- bone
- PDL
- cementum - role of bacterial contamination during healing
- faster moving epithelium vs bone, PDL, cementum (growth)
- functional environment (i.e., tongues)
How many mm/day does bone and epithelium move?
- epithelium = 0.5 mm/day
- bone = 0.05 mm/day **slower
