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CHAPTER 8: PERIODONTITIS AND OTHER PERIODONTAL CONDITIONS (PATHOGENESIS OF…
CHAPTER 8: PERIODONTITIS AND OTHER PERIODONTAL CONDITIONS
HISTOPATHOGENESIS OF PERIODONTITIS
Classification, 1976 by Page and Schroeder
STAGES
: Initial, Early, Established, & Advanced
1. INTIAL
- 2-4 DAYS
PMNs
no signs of gingivitis, increased GCF
2. EARLY
- 4-7 DAYS
T-Cells
clinical signs of gingivitis
3. ESTABLISHED
- 2-3 WKS
B-cells, plasma cells
chronic gingivitis
4. ADVANCED
- UNDETERMINED
Alveolar bone loss, perio. pocket form., B-cells
Periodontitis
ADVANCED LESIONS
Perio pocket formation occurs/ w the clinical connective tissue attachment loss to the root surface & the apical migration of the apical aspect of the JE along the root surface = alveolar & supporting bone loss
apical & lateral migration of the JE permits extension of SubG plaque on the root surfaces
PATHOGENESIS OF THE PERIODONTITIS LESION
pocket= a pathologically deepened gingival sulcus
apical & lateral migration of the JE continues & as this epithelium separates from the root surfaces, a periodontal pocket is formed
Classification of Pockets
Periodontal pockets: 2. Suprabony
conn. tissue attach. loss & bone loss
coronal to the alveolar crest, hortizontal bone loss
hortizontal bone loss- occurs frm its outer aspect buccal & lingual walls, bone lost equally on the surfaces of 2 adjacent teethw/ interproximal bone level remaining flat
3. Infrabony
conn. tissue attach. loss and bone loss
apical to the alveolar crest, vertical or angular bone loss
vertical bone loss-occurs when the inflamm. travels directly frm the gingiva into the perio. ligament & then the bone, the interproximal bone level is NOT flat & even. Bone loss occurs at different rates around the tooth & is more rapid on one side of the tooth than the other
defects are classified according to the number of osseous wall surrounding the pocket= 4 bony interproximal walls surrounding the tooth, M/F/D/L
1. Three-wall bony defect
2. Two-wall bony defect
3. One-wall bony defect
1. Gingival (pseudo-pocket)
no clinical conn. tissue attach. loss & no bone loss
at the CEJ
cementum that no longer have gingival or perio. ligament fibers attached is rough bc of the detachment of the previously inserting conn. tissue
BONE RESORBING
inflamm. cause the resorption of alveolar & supporting bone
bone loss involves the inflamm. cells ( PMN & macrophages)
release of PGE2 from macrophages or PMNs
substances involved in bone resorption
1. prostaglandins
2. endotoxins
3. cytokines
4. B cells
SITE SPECIFICITY- FEAT. OF PERIO. DISEASES, POCKETS & BONE LOSS DOES NOT OCCUR IN ALL AREAS OF DENTITION
RELATIONSHIP OF BONE LOSS & POCKET FORM- level of bone corresponds to previous perio. destruction& changes in the soft tissue of the pocket wall reflect the present inflamm. condition, the degree of bone loss is not necessarily correlated w/ the depth of perio. pockets
CLASS. OF PERIODONTITIS & OTHER COND.
1. CHRONIC
- subdivided as localized & generalized
disease severity is divided into 3 groups; CAL: slight (1-2mm), moderate (3-4mm), & severe (above 5mm)
2. AGGRESSIVE
COMMON FEATURES (OF LOCAL. & GENERAL.)- 1. rapid attach. loss & bone destruction 2. familial disposition 3. inflammatory infiltrate in the tissue is predominately plasma cells
A. LOCALIZED- circumpubertal onset, serum antibody response, localized 1st molar/incisor presentation w/ interproximal attach. loss on at least 2 perm. teeth, one of which is a 1st molar, & involving no more than 2 teeth other than 1st molars & incisors
B. GENERALIZED- under 30 yrs old, but can be older, pronounced episodic nature of the destruction of attach. & bone, poor antibody response, & generalized interproximal attach. loss & bone destruction affecting @ least 3 perm. teeth other than 1st molar & incisors
LAP bacteria= A.A, P. intermedia, Eikenella corrodens, Campylobacter rectus & Capnocytophaga species
AgP= strong genetic or heredity component, children w/ GAgP are more prone to ear, skin, & upper resp.tract infect.
PERI-IMPLANT DISEASES