Surgical Anatomy Lecture Flashcards
Periodontitis
Inflammation
• Characterized by loss of clinical attachment
– Destruction of PDL and bone
Principal Gingival Fiber Groups
Dentogingival • Circular • Dentoperiosteal • Alveologingival • Transeptal
Layers of epithelium
– Stratum corneum
– Stratum granulosum
– Stratum spinosum
– Stratum basale
Sulcular Epithelium
Non-keratinized – Gingival crest to junctional epithelium – More permeable to bacteria – 3 Layers: stratum basale, stratum spinosum, superficial layer
Junctional epithelium
– Non-keratinized – 2 cell layers • Stratum basale • Stratum spinosum – Large intercellular spaces – High renewal rate – First barrier to cell bacterial penetration
Biologic Width
• Junctional epithelium – 0.97mm • Connective tissue – 1.07mm • Total biologic width – 2.04mm
Biologic Complex
Biologic width plus
– Includes sulcus depth of
.69mm
Connective Tissue Layers
Papillary layer
• Reticular layer
Connective Tissue Composition
– 60% Collagen – Ground substance • proteoglycans, glycosaminoglycans, glycoproteins – Cells • fibroblasts, lymphocytes, PMNs, plasma cells
Cementum Types
– Acellular- coronal 2/3 – Acellular extrinsic fiber cementum provides predominant support for tooth • Apical 1/3 is cellular
Goals of Periodontitis Tx
Health
Comfort
Function
Esthetics
Types of periods tx
Non Surgical
Surgical
Non surgical therapy
ScRp
Surgical Perio Therapy types
Pocket Elimination Regeneration Implants Functional Crown Lengthening Ridge Preservation
Masticatory Mucosa
Gingival
Palatal
Alveolar Mucosa
Buccal
Floor of the Mouth
Inferior Tongue
Specialized Mucosa
Dorsum of tongue
Histology of Masticatory Mucosa
Ortho/parakeratinized
Prominent Rete Ridges
Alveolar Mucosa
Floor of the mouth, bucal, vestibules
Non Keratinized
Indistinct rete Ridges
Specialized Mucosa
Papillae
Tast buds
on dorm of tongue
Attached Gingiva in Facial
Variable range 1-9mm Max -widest in ant, narrowest in posterior Man widest in anterior, narrowest in canine/premolar
Lingual attached gingiva
1-8 mm
narrowest in anterior, wider posteriorly
(man)
Papillae
Interdental Tissue
Gingival Col
Connects facial and lingual papillae
Keratinized Tissue Thickness
Free Gingiva 1.56 mm
Attached Gingiva…1.25mm
Overall 1.41 mm
Thin Biotype
Thinner gingival tissues
more ovoid tooth form
propensity of tissues for recession
Thick Biotype
Thick gingival tissues
more square shaped form
Main artery for periods blood flow
Ext Carotid
Branches of Ext Carotid
Maxillary Artery
Facial Artery
Lingual Artery
Maxillary Artery
Inferior Alveolar
Descending Palatine
PSA
Infraorbital
Facial Artery Branch
Submental
Lingual Artery Branches
Sublingual
Deep Lingual
Max Vasculature
Post Superior Alveolar ArteryInfraorbital
Greater Palatine
Naso Palatine
Posterior Superior Alveolar Artery
Supplies Max Bone, Teeth, and facial Soft tissues
Infraorbital Artery
Supplies ant mucosa
Greater palatine Artery
Supplies palatal Soft Tissue
Poses a sig risk in palatal per surgical procedures
Nasopalatine Artery
Emerges from incisive canal at max midline
anastomoses with greater palatine artery
May present obstacle to flap reflection
Man Vasculature
Inferior alveolar artery
mental artery
Facial mucosa from submental
lingual mucosa from sublingual
IA artery
Supplies Man bone, dental arteries, and soft tissue in mandible
Mental artery
Cont of IA artery
exits mental foramen
can have ant loop
Facial Artery Sig
Position should be counted for prior to flap reflection, or block harvest
Submental artery
Supplies surrounding facial muscles
floor of mouth
skin in submental area
Sublingual artery
Suppliestongue
lingual of ant mandible
Blood supply to gingiva and mucosa
Anastamoses from
PDL
Bone
Periosteum
Periodontal Innervation
Trigeminal Nerve
Max innervation
V2
V2 branches
•Zygomatic •Pterygopalatine •Greater palatine •Posterior superior alveolar •Infraorbital –Middle superior alveolar –Anterior superior alveolar •Nasopalatine
Man innervation
V3
V3 Branches
–Inferior alveolar
–Lingual
–Long buccal
–Mental
Lingual Nerve
Ant 2/3 of tongue (sensory)
Buccinator
–Origin: Outer surface of the alveolar process of maxilla and mandible
–Insertion: Fibers of the orbicularis oris
Mylohyoid
–Origin: Midline raphe
–Insertion: Forms ridge of mandible
Genioglossus
–Origin: Genial tubercles
–Insertion: Tongue
Mentalis
–Origin: Mandibular symphysis
–Insertion: Connective tissue of chin
Mailla
2nd larges bone of the face •Four processes A.Palatine B.Zygomatic C.Alveolar D.Frontal
Maxillary tuberosity
–Size and thickness are important
–Length will influence flap design for distal wedge
Palatal Tubercles
•Prevalence –56% •Location –57% directly lateral to Greater Palatine Foramen •Factors –Male > Female –Dentate > Edentulous –Young > Old
Max Sinus
•33x33x23mm
•Total volume
–15 cc
Maxillary sinus septae
–28% 1 or more septa
–3.5mm average height
•Anterior nasal spine
–Possible source of autogenousbone for grafting
•Palatine vault
- High: 17mm
- Average: 12mm
- Shallow: 7mm
Man Ramus
–Site of autogenousbone grafts
–Limitations: Proximity may prevent adequate room for access, distal wedge procedures
Ext Oblique Ridge
–Attachment for buccinator, source of autogenousbone
–Limitations: If prominent may make crown lengthening challenging
•Mental foramen
–Point of exit for mental nerve
–Apical to second premolar 63% of the time
•Mandibular symphysis
–Thickness critical for harvesting autogenousbone
–Thin symphysiscontraindicated for harvesting
•Lingula
–Entrance of IAN
–Target for IAN block
•Submandibular fossa
–Location of submandibular gland
–Prominence of mylohyoidridge may hinder flap reflection
•Supporting Bone
–Dense outer layer of bone into which periosteumand PDL attach
Non-supporting bone
(Trabecular or medullary)
–Inner layer, less dense and more vascular
