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CH. 8 PERIODONTITIS & OTHER PERIODONTAL DISEASES (PATHOGENESIS OF THE…
CH. 8 PERIODONTITIS & OTHER PERIODONTAL DISEASES
Periodontitis -
clinical attachment loss with subsequent bone loss.
Technically, I don't have periodontitis because I don't have bone loss
HISTOPATHOGENESIS OF PERIODONTITIS
Initiation of Inflammatory Periodontal Disease
If gingivitis does not resolve the inflammatory reaction spreads into the gingival connective tissue attachment, alveolar and supporting bone, and the principal fibers.
Page and Schroeder classified gingivitis and periodontitis according to histopathology from animal and some human adolescent specimens.
Advanced Lesion (Plasma Cell/Antibody Dominated)
A characteristic of periodontitis
The apical and lateral migration of the juntional or pocket epithelium permits extension of subgingival plaque on the root surface.
The base of my second molars migrates due my extractions.
The lymphocytic infiltrate in the subjacent connective tissues is primarily B cells.
Stages of Pathogenesis of Periodontal Disease
Initial -
2 to 4 days
Early -
4 to 7 days
Established -
2 to 3 weeks
Advanced -
Undetermined
PATHOGENESIS OF THE PERIODONTITIS LESION
Sequence of Events in Pocket Formation
The Periodontal Pocket
As the inflammation infiltrate progresses from the coronal gingival connective tissue subjacent to the junctional epithelium in the underlying connective tissue, an extensive amount of collagen is destroyed.
The junctional epithelium migrates apically only as a result of the destruction of the gingival collagen.
Root Surface
The surface of the cementum is rough because of the detachment of the previously inserting connective tissue.
Extensive root planing may not be warranted because the endotoxins were found to be very superficial and not embedded deeply into the cementum. They are weakly adherent to the cementum.
Gracey's should be enough.
Bone Resorbing Factors
The process of
bone loss
involves the inflammatory cells including PMNs and macrophages.
Relationship of Bone Loss and Pocket Formation
The degree of bone loss is not necessarily correlated with the depth of periodontal pockets.
Radiographically extensive bone loss can be associated with shallow pocket depths and vice versa.
I have 5 mm pockets but my chart says I have no bone loss.
Different substances involved in bone resorption include
(1)
prostaglandins,
(2)
endotoxins,
(3)
cytokines, and
(4)
B cells.
Prostaglandins activate resting osteoclasts, increase the number of osteoclasts, increase the number of macrophages, and inhibit bone collagen formation.
Site Specificity
Pocket formation and bone loss do not occur in all areas of the dentition at the same time.
this is why we walk the probe around the whole tooth
Pattern of Bone Loss
Vertical/Angular bone loss
- occurs when the inflammation travels directly from the gingiva into the periodontal ligament and then the bone
The base or the deepest portion of the bony defect is apical to the alveolar bone crest , creating an
infrabony defect
Three-wall bony defect, Two-wall bony defect, One-wall bony defect.
Horizontal bone loss
- when bone resorption occurs from its outer aspect buccal and lingual walls
Factors Related to Pattern of Bone Loss
The width and thickness of the interdental septum primarily determines if the pattern of bone destruction is horizontal or vertical.
CLASSIFICATION OF PERIODONTITIS AND OTHER CONDITIONS
Chronic periodontitis -
formally "adult periodonditis
Localized
≤ 30% of the sites are affected
Generalized
> 30% of the sites are affected
aggressive periodontitis -
formally "early-onset periodontitis"
-
Other than the periodontitis, the patients are clinically healthy,
-
Rapid attachment loss,
-
Familial disposition,
-
Inflammatory infiltrate in the tissues is predominately plasma cella
TREATMENT OF PERIODONTITIS
4-8 week reevaluation
Oral hygiene & SRP
Patient's with aggressive periodontitis will need a antibiotic.
Peri-implant disease
- a collective term for soft-tissue inflammation surrounding an implant
