crown
Dentine
Enamel Gingival sulcus
Gingiva Oral mucosa
peno
donta! ligament
alveolar bone
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Comunity
Primitive circulation
More species
Higher metabolic activity
Higher resistance
(S. sobrinus CHX 300x, AF 75x)
nit
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better conditions to survive higher virulence
Microorganisms worth noting in periodontology
Porphyromonas gingivalis Obligate anaerobe associated with chronic periodontitis and aggressive periodontitis.
Prevotella intermedia Found in chronic periodontitis, localized aggressive periodontitis, (juvenile periodontitis), necrotizing periodontal disease, and areas of severe gingival inflammation without attachment loss.
Prevotella nigrescens New, possibly more virulent.
Fusobacterium Obligate anaerobes. Originally thought to be principal pathogens in necrotizing periodontal disease. Remain a significant periodontal pathogen.
Borrelia vincenti (refringens) Large oral spirochaete; probably only a co-pathogen.
Actinobacillus actinomycetemcomitans Microaerophilic, capnophilic, Gram -ve rod. Particular pathogen in juvenile periodontitis and rapidly progressive periodontitis.
Actinomyces israelii Filamentous organism; major cause of actinomycosis. A persistent rare infection which occurs predominantly in the mouth and jaws and the female reproductive tract. Implicated in root caries.
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Treatment
Chlorhexidin mouthwash
Systemic antimicrobials in severe cases (metronidazol 3x 200 mg, penicilin 250 mg 4x
enne
Gingivoplasty in some cases
Atrophie or desquamative gingivitis
symptoms
Erythema on free gingiva — loss of the epithelium
Variety of symptoms: itching, tenderness of eating, burning.         i-----------------------------
A	L    >^V *4- -d   ^^V   II   ^^V  ^"WW T"		
	Letioiogy		
■  Xerostomia ■  Mouth breathing	&«/		
■ Mucocutaneous disorders (lichen planus, pemphigoid)			
■ Othe factors (postmenopausal women, stress)			
			
Parodonthopaties
n nodontitis
Chronic periodontitis.
Aggressive periodontitis.
Periodontitis as a manifestation of systemic disease.
Necrotizing periodontal diseases.
Abscesses of the periodontium.
Periodontitis associated with endodontic lesions.
Development or acquired deformities and conditions.
Periodontal surge
>  Curretage (closed)
>  Gingivectomy, gingivoplastic, frenulectomy, vestibuloplastic (Mucogingival surgery)
> Flap operations — open curretage. Elimination of inflammationy achievment of better conditions f or oral hygiene, bone and tissue regeneration.
Periodontal surge
Elimination of periodontal pockets (2 -3mm without bleeding - BOP 0)
Better gingival configuration
Better conditions of oral hygiene
Periodontal tissue regeneration (esp. bone regeneration)
Peri		Lodo	ntal	Is
i ĺ i	\fter the 1- - 8 weel nformati	initial on	phase!	
				
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Gingivectomy, gingivoplastic
Indications of gingivectomy
Supraalveolar periodontal pockets with th~ horizontal bone resorption
- Bad configuration of the gingival margin or papilla fol. ANUG or extraction.
□ Membranes -  Resorbable
Non-resorbable
□ In combination with bone, alloplastic minera — tricalciumphoshat, hydroxylapatit), bone morphogenetic protein, growth factors — tissue
LSI
Mucogingival surgery
□ Enlargement of attached gingiva - Frenulectomy
-  Vestibuloplastic
□ Plastic of recessus
-Lateral flap
-Bridge flap
-Mucous or mesenchymal grafts