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Three States of Periodontium (Microscopic Picture of Periodontitis : (JE:…
Three States of Periodontium
Healthy
Junctional Epithelium: JE coronal to CEJ tight intercellular junctions
Connective Tissue: Supragingival fiber bundles provide support to gingiva and CEj
PDL fibers: attach root to the bone of the tooth socket
Alveolar Bone: supports and protects roots of tooth
Gingivitis Def: a bacterial infection that is confined to the gingiva, tissue damage that occurs results in reversible destruction to the tissues of the periodontium
JE: JE at the CEJ; widened intercellular junctions; epithelial extensions into CT
CT is damaged
PDL fibers are intact
Alveolar bone is intact
Periodonttitis Def: infection of all parts of the periodontium including the gingiva, PDL, bone, and cementum; tissue damage during periodontitis is irreversible
JE: apical to CEJ widened intercellular junctions; epithelial extentions into CT
CT: destruction of supragingival fiber bundles
PDL fibers: destruction of PDL fibers, exposure of cementum to pocket environment
Alveolar bone: destruction of bone, eventual tooth loss
Characteristics of Gingivitis:
Acute or Chronic
Tissue Enlargement: swelling (acute) or fibrosis (chronic)
reversible tissue damage
Duration of gingivitis
Clinical Picture:
Color: red or reddish-blue, blood flow increases in CT causing enlargement of blood vessels, if congested then bluish color
Gingival margin: swollen, loses knife edge, may cover some of the crown due to swelling
Interdental papillae: bulbous swollen
upon gentle probing
sulcus may be greater then 3mm probe depth b/c of swelling tissue, no apical migration
Microscopic picture of Gingivitis:
Junctional Epithelium: hemidesmosomes attach to enamel coronal to CEJ
Epithelial-Connective tissue junction: JE extends epithelial ridges down into connective tissue; only occur b/c destruction of gingival fibers creates space for growing epithelium
Gingival fibers: damage to supragingival fiber bundles
Alveolar bone: no destruction
PDL: no destruction
Cementum: no destruction
Characteristics of Periodontitis:
Characterized by: 1. apical migration of the junctional epithelium 2. loss of connective tissue attachment 3. loss of alveolar bone
Tissue damage is permanent
tissue destruction is intermittent with extended periods of inactivity
Clinical Picture of Perio:
Color: edematous tissue= bluish or purplish, red w/ smooth shiny appearance; fibrotic tissue=light pink w/ a leathery consistency
Gingival margin: swollen or fibrotic, no close knife edged adaption, recession may be present
Interdental papillae: may not fill embrasure space
bleeding: often bleeding upon probing & suppuration may happen
4mm or greater pocket present; JE is attached to root
Microscopic Picture of Periodontitis :
JE: located on cementum, JE detaches from tooth surface and moves further apically, extracellular matrix & the attached collagen fibers at apical edge are destroyed
Epithelial-connective tissue junction: both push epithelial ridges into connective tissue
Gingival Connective tissue: changes are severe, collagen destruction in the inflamed area is almost complete; transseptal bundles regenerated continuously across the crest of bone
Alveolar bone: permanent destruction
PDL Fibers: permanent destruction
Cementum: cementum within the periodontal pocket is exposed to dental plaque biofilm
Pulp: studies show inflammation, edematous pulp, pulpal necrosis, vascular congestion & dentin demineralization
Changes in Alveolar Bone Height in Disease
Horizontal Bone Loss
most common pattern of bone loss
fairly even, overall reduction in the height of the alveolar bone
margin if the alveolar crest remains more or less perpendicular to the long axis of the tooth
Pathway of inflammation in horizontal bone loss:
within the gingival connective tissue along the connective tissue sheaths surronding the blood vessels
into alveolar bone
into periodontal ligament space
This is the path of least resistence, PDL fibers act as a barrier so the inflammation spreads into the alveolar bone then the PDL
Vertical Bone Loss
less common, aka angular boneless
resorption progresses more rapidly in the bone next to the root surface, leaves a trench next to root surface
uneven reduction in the height of the alveolar bone
Pathway of inflammation in Vertical Bone Loss:
within the gingival connective tissue
directly into the periodontal ligament
into the alveolar bone
Happens whenever the crestal periodontal ligament fibers are weakened so they aren't a good barrier
Bony Defects in Periodontal Disease
Infrabony Defects: bone resorption occurs in an uneven oblique direction, primarily affects one tooth
Osseous Craters: bowl-shaped defect in the interdental alveolar bone w/bone loss nearly equal on the roots of two adjacent teeth. affects two adjacent root surfaces
Bone loss in Furcation areas: periodontal infection invades the area between and around the roots, maybe hidden by gingival tissue or visible in mouth
Pocket Formation:
Gingival Pockets: deepening of the gingival sulcus as a result of swelling or enlargement of the gingival tissue
Increasing probe depths are do to: 1. detachment of the coronal portion of the JE from the tooth 2. increased tissue size due to swelling of the tissue
Periodontal pockets: pathologic deepening of the gingival sulcus
occurs as a result of- 1. apical migration of JE 2. destruction of the periodontal ligament fibers 3. destruction of alveolar bone
Apical migration- movement of the cells of the JE from their normal position- coronal to the CEJ- to a postion apical to the CEJ
Types of Periodontal Pockets:
Suprabony Pocket: horizontal boneloss, the JE os locates coronal to the crest of the alveolar bone
Infrabony Pocket: vertical boneloss, the JE will be apical to the crest of the alveolar bone, the base of the pocket will be within the cratered- out area of the root surface