PeriodontoIogy Periodontology • Periodontal tissues > alveolar bone > cementum > periodontal ligament > gingiva Dentine Enamel Gingival sulcus Gingiva 0ral mucosa Periodontal liga™ent alveolar bone Morphology Supportive tissues Dentogingival junction Free gingiva Free gingival groove Attached gingiva Mucogingival junction Alveolar mucosa Gingival sulcus Suicular epithelium Cemento-enamel junction Periodontal diseases • Inflammation at most!!!! • The most important ethiological factor? g Dental plaque!!!! ^ BIOFILM Dental plaque = biofilm • Com u nity • Primitive circulation AF 75x) ( Well organized community of microbs Adherence Colonisation Maturation It can be removed mechanically only Biofilm Othe aethiological factors • Calcified deposit on teeth, plaque on the surface • Overhangs, crowns, dentures • Genetic factors - gen polymorphism Dental calculus Parodontopathies Gingivitis • Plaque associated gingivitis Chronic form Erythema No pain Easy bleeding Plaque on the tooth Acute form Erythema Pain Easy bleeding Plaque on the tooth Acute necrotisans gingivitis - ANUG • Necrotizing ulcerative gingivitis Aetiology Special microbs - anaerobs The clinical picture • Gingival inflammation and destruction I Severe pain, bleeding gums, halitosis Diferential diagnosis • Herpetic gingivostomatitis - Young people - Prodroms - Pyrexy - Lymphadenopathy - Lesions more widespread and diffuse Diferential diagnosis • If ANUG does not tend to recover in 10 days - check the blood picture! f Atrophic or desquamative gingivitis symptoms • Erythema on free gingiva - loss of the epithelium • Variety of symptoms: itching, tenderness of eating, burning. Hyperplastic gingivitis • High standard of oral hygiene must be achieved! • GingJVeCtOmy {r|mnciryj|^orh Parodonthopaties Periodontitis • 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. Parodonthopaties Periodontitis Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures • Recession Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures • Recession Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone Drifting and mobility Furcation exposures Recession Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures • Recession Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures • Recession Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures JUMPER »« .W'"H* O 13,.^ - Periodontitis • Gingivitis • Pocketing • Loss of alveolar bone • Drifting and mobility • Furcation exposures • Recession ■ Periodontitis • Chronic adult periodontitis • Agressive periodontitis • Early onset periodontitis Therapy • 1. Oral hygiene - professional, home care INDIVIDUAL Therapy • 1. Oral hygiene - professional, home care INDIVIDUAL Therapy • 1. Oral hygiene - professional, home care INDIVIDUAL Curettes Scaling, root planing Therapy • 2. Subgingival treatment - scaling root planing, curettage Therapy • 3. Periodontal surgery Gingivectomy, gingivoplastic Indications of gingivectomy > Hyperplasia gingivae (pseudopockets) >Supraalveolar periodontal pockets with the horizontal bone resorption > Bad configuration of the gingival margin or papilla. Gingivectomy Gingivoplastic Flap operations - principle Raising of the flap - removal of patological changed tissues, flap back. 1 1 1 1 1 1 \ 1 \ t \ 1 \ mm J 7 T Mucogingival surgery □Enlargement of attached gingiva - Frenulectomy - Vestibuloplastic □Plastic of recessus -Lateral flap -Bridge flap -Mucous or mesenchymal grafts