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| 🇬🇧 | 🇬🇧 |
| What are the classification of Periodontal diseases | Gingival lesions Periodontal lesions Diagnosis, Prognosis and Treatment plan |
| The various diseases of the periodontium are collectively termed as | Periodontal diseases. |
| "tissues investing and supporting the teeth" | Periodontium |
| Periodontium is composed of 2 hard tissues: | Alveolar bone and cementum |
| 2 soft tissues of periodontium | Periodontal ligament and supporting gingiva |
| This type of gingiva is free or unattached | Marginal gingiva |
| Located between adjacent teeth | Interdental papillae |
| The most apical point of the marginal gingival scallop is called | Gingival zenith. |
| The most coronal portion of gingiva. well-adapted to tooth surface but not attached to it. | Marginal(free) gingiva |
| Firmly bound to the underlying tooth & alveolar bone. | Attached Gingiva |
| Portion of free gingiva located in inter-proximal space created by contact between two adjacent teeth. | Interdental gingiva (papilla) |
| The shape of interdental papilla depends on: | The presence or absence of a contact point between the adjacent teeth, the distance between the contact point & the osseous crest Presence or absence of some degree of recession. |
| Gingival Pocket- | Periodontal disease |
| There is a fluid secreted from gingival C.T into the sulcus through the thin sulcular wall termed as | Gingival fluid. |
| Components of sulcular fluid | 1. Cellular elements 2. Electrolytes 3.Organic compounds 4.Metabolic & bacterial products 5.Enzymes |
| Functions of Gingival (Crevicular) Fluid | ■ Its flow washes out irritants & prevent bacterial penetration. ■ Its plasma proteins improve epithelial adhesion to the teeth. ■ Has antibacterial effect upon many oral microorganisms. ■ Has defense mechanism by its immunoglobulin contents. ■ Essential growth factor for many microorganisms |
| Cells of the gingival epithelium | Keratinocytes |
| Non keratinocytes: | Melanocytes Langerhans cells Merkel cells |
| Keratinized stratified squamous epithelium arranged in 4 layers: | Stratum basale, Basal cell layer (The deepest) Stratum Spinosum, prickle cell laye Stratum granulosum, granular cell layer Stratum corneum, Keratinized cell layer |
| Lines the gingival sulcus facing the tooth extending from coronal limit of junctional epitht. the crest of gingival margin | Sulcular Epithelium |
| The tissue that joins the tooth on one side and to sulcular epith& C.T on the otherIt forms the base of the sulcus | Junctional Epithelium (Epithelial attachment) |
| The junctional epith. and the gingival fibers are considered a functional unit, referred to as the | Dentogingival unit. |
| Three zones in junctional epith. have been described | Apical, coronal and middle |
| Lamina propria consist of: | ■mainly Collagen fibers (60%) ■ Cells mainly fibroblasts(5%) ■Intercellular ground substance ■Blood vessels, lymphatic, Nerves |
| Primary gingival fibers: | Circular fibers: Dentogingival fibers: Alveologingival fibers: Dentoperiosteal fibers: Transseptal fibers: |
| Secondary Gingival Fibers | Semicircular fibers (SCF): from mesial surface of a tooth to distal surface of same tooth in a half circle Transgingival fibers (TGF): these fibers traversing from CEJ to free gingiva of adjacent tooth Intergingival fibers (IGF): extend along facial and lingual marginal gingiva from tooth to tooth. |
| Nerve supply of the gingiva | Maxillary and mandibular branches of trigeminal nerve. |
| The most important elements of PDL are the | Principal fibers type I collagen |
| Considered remnants of the Hertwig root sheath, which disintegrates during root development. | The epithelial rests of Malassez |
| Immune system cells: | Neutrophils,lymphocytes, macrophages, mast cells & cosinophils. |
| Functions of PDL | 1. Provision of a soft-tissue "casing" to protect the vessels & nerves from injury by mechanical forces 2. Transmission of occlusal forces to the bone 3. Attachment of the teeth to the bone 4. Maintenance of the gingival tissues in their proper relationship to the teeth 5. Resistance to the impact of occlusal forces (shock absorption |
| Functions of cementum | Provide anchorage, maintaining occlusal relationships |
| Occurs in Paget's disease | Hypercementosis |
| 2/3 inorganic matter mainly calcium + phosphate in the form of hydroxyapatite crystals 1/3 organic matrix mainly collagen type I | Extracellular matrix |
| Flattened cells, in a plane parallel to the gingival surface | Stratum granulosum |
| Associated with kratin formation 1 micrometer in diameter, round in shape and appear in the cytoplasm of the cell | Keratohyaline granules |
| Stratum cornea retains | Pyknotic nuclei |
| Sensory in nature- respond to touch | Tactile perceptors |
| The width of periodontal ligament is approximately | 0.25mm (range 0.2-0.4 mm) |
| Formative cells | Fibroblast osteoblasts cementoblasts |
| Resorptive cells | Fibroblasts osteoclasts cementoclasts |
| Epithelial cells | Remnants of hertwig epithelial root sheath |
| Immune system cells | Neutrophils, lymphocytes, macrophages, mast cells, eosinophils |
| Extend interproximally over the alveolar bone crest and are embedded in the cementum of adjacent teeth | Transseptal fibers |
| Extend obliquely from cementum just beneath junctional epithelium to alveolar crest; prevents extrusion of tooth | Alveolar crest group |
| Extend at right angles to the long axis of the tooth from cementum to alveolar bone; resists tipping forces; prevents lateral movements | Horizontal group |
| Dan out from cementum to tooth in furcation areas of multirooted teeth' resist tipping, torquing and luxation | Interradicular group |
| Elastin fibers : | Oxytalan and elaunin |
| Small collagen fibers associated with principal fibers | Indifferent fiber plexus |
| The palatal gingiva of maxilla drains to: | Deep cervical lymph nodes |
| Third molars and mandibular incisors drain to: | Submandibular lymph nodes |
| The third molars drain to the: | Jugulodigastric lymph nodes |
| The mandibular incisors drain to the: | Submental lymph nodes |
| Theory that states "displacement of the tooth is largely controlled by fluid movements with fibers have only a secondary role" | Visco elastic theory |
| Theory that states "PDL behaves like a thixotrophic material a collagenous gel and that fibers are only artefacts" | Thixotrophic theory |
| Often site of periapical granuloma which proliferates to produce a cyst common pathological lesion | Periodontal ligament in periapical area |