Bacterial/Cellular Features Advanced Lesion

Plaque biofilm grows laterally and apically along the root surface Chronic inflammation from intense bacterial infection PMNs and macrophages produce cytokines that destroy gingival connective tissue and periodontal ligament fibres Macrophages produce lots of cytokines, PGE and MMPs that destroy connective tissue and alveolar bone MMPs destroy the extracellular matrix of the gingiva collagen fibres and periodontal ligament PGE destroy the bone by stimulating osteoclasts to resorb the crest of the alveolar bone Chronic inflammation causes irreversible damage to the periodontium and tissues causing the condition periodontitis