Preclinical
periodontology
Periodontology
 Periodontal tissues
 alveolar bone
 cementum
 periodontal ligament
 gingiva
Morfology
 Periodontal tissues
Of epithelium origin
- Gingiva-
Attachement
Of mesenchymal origin
- Periodontal ligaments
- Bone
- Cementum
Supportive tissues
 Alveolar bone
 Cementum
– insertion of periodontal ligaments
crown
root
Dentogingival junction
Morphology
Supportive
tissues
Dentogingival junction
 Attachement - epithelium
Two layers:
- Stratum basale
- Stratum suprabasale
Cementum
On the root surface
Approx 50% inorganic
material
Insertion of collagen
fibers
Alveolar bone
Compact bone – lamina dura
Spongise
Periodontal ligament
 In periodontal space
(width 0,4 – 1,5 mm) 20 – 35 %.
Interfibrilar substance with cells, nerves, blood
vessels
Periodontal ligaments
 Supraalveolar ligaments
In various directions.
 Intraalveolar ligaments (Sharpey´s fibers)
- Horizontal
- Oblique
- Apical
- Crestal
- Interradicular
Paeriodontal diseases -
classification
 Inflammation – gingivitis
 Inflammation of deeper structures –
periodontitis
 Non inflammatory diseases
- gingival recessions
Aethiology
 Local factors
Dental biofilm
Dental calculus
Iatrogenic diseases
Mucogingival disorders (frenulum breve)
Trauma a traumatizace
Dental plaque = biofilm
 Comunity
 Primitive circulation
More species
Higher metabolic activity
Higher resistance
(S. sobrinus CHX 300x, AF 75x)
better conditions to survive
higher virulence
Biofilm
 Adherence
 Colonisation
 Maturation
Can it be recognised and removed
easily?
Aethiology
 Systemic factors
Genetic predispositions
Systemic diseases (diabetes mellitus,
leukaemia,HIV infection)
Side effects of drugs (cyklosporin A,
imunosupresivs, cytostatika, calcium blockers)
Physiologic factors (pregnancy, climacterium, etc).
Periodontal diseases
 Inflammation at most!!!!
 The most important ethiological factor?
Dental plaque!!!!
BIOFILM
Diagnosis
 History
 Clinical examination
 Imaging methods (radiography)
Diagnosis and treatment plan
Patient´s history
 Contemporary troubles
 Oral history
 Hygienic habits
 Professional and social situation
 Smoking
 Family history
Patient´s history
 Diseases:
Hypertension
Cardiovascular diseases
Diabetes
Allergy
Rheumatism
… Others
 Farmakotherapy
Clinical examination
 Examination of oral hygiene
 Screening examination
 Complex check
 Special examination
 Status of oral hygiene
 Mucogingival diseases
 Imaging methods - radiogram
Inspection, probing
Examination of depth of gingival sulcus
(periodontal pocket)
in 4 points – mesiobuccally,buccally,
distobuccally, orally
Or in 6 points
Also mesioorally and distoorally
Pressure – 0,25 N (gentle probing)
Periodontal probes
 WHO probe
 Wiliams probe
 Nabers probe (for furcation)
Visualisation of dental plaque
 Sonda
 Barviva
 Tablety
Plaque
Plaque induced inflammation
Detection of dental plaque
 Special dyes
 E.g. Tri Plague ID gel
 Blue- old plaque (48hours), red – fresh plaque, light blue – high
risk (pH 4,5 – 5,5)
Indexes
 K vyšetření orálního zdraví (ve vztahu ke kazu a
onemocněním parodontu)
 Ke kontrolám terapeutických opatření
U všech zubů nebo u 16,21,24,36,41,44.
Skóre se dělí počtem vyšetřených míst
Gravimetrické a planimetrické testy
Indexes – special figures
 Level of oral hygiene
 Stage of inflammation
 Treatment needs …
Plaque-index (Quigley, Hein)
 0: No plaque
 1:isolated regions
 2: line of plaque alogn the gingival border
 3: plaque in cervical third of the crown
 4: plaque in the midle third of the crown
 5: plaque in coronal third of the crown
Approximal Plaque-Index
(API)(Lange)
 Yes (1) or no (0)
 API = (sum of positive findings/ sum of
investigated approximal spaces) x 10
(multiplied by 10).
Plaque-Index (API)(Lange)
 API 25 % optimal OH
 API 25–39 % good OH
 API 40–69 % wores OH
 API 70–100 % insufficient OH
PBI (papilla bleeding) index
 0
 1
 2
 3
 4
No bleeding
Point
Line
Triangle
Drop
Measurement and assesment
 Sume or sume divided by number of
investigated papillas
1 2
3 2
3 1
2 2
1 0
0 2
2 3
12 14
1 1
2 2
0 4
0 3
3 4
2 3
1 0
9 17
52:28= 1,8
52/28
CPITN
(Comunity periodontal
index of treatment needs)
Měření hloubky parodontálních chobotů
Depth of periodontal pockets
Furcations
 Klasifikace I. – III.
Gingival recessions
 Classification
1
2
3
4
Radiographic investigation
Treatment plan
Initial phase
Oral hygiene– professsional and home care
Extractions, fillings RCT.
Subgingival treatment
Surgical treatment
Prosthetic treatment
Parodontopathies
Gingivitis
 Plaque associated gingivitis
Erythema
No pain
Easy bleeding
Plaque on the tooth
Chronic form
Acute form
Erythema
Pain
Easy bleeding
Plaque on the
tooth
Parodontopathies
Gingivitis
 Plaque modulates gingivitis
Changes on gingiva worsen by dental plaque
The clinical picture
 Gingival inflammation and destruction
 ANUG
Severe pain, bleeding gums, halitosis
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!
 Gingivectomy (drugs induced)
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.
Periodontitis
 Inflammation in deeper structures of
periodontium
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
 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
Scalers – sharp pointed instruments
for removal of supragingival calculus
Curretes
Universal
Special (Gracey)
Grace
Edge
Shank
Scaling, root planing
 Gracey curretes, cleaning of the root surface
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 fol. ANUG or extraction.
Gingivectomy
Gingivoplastic
Internal gingivectomy
External gingivectomy
Intrasulcular
Marginal
Paramarginal
Papilar
Paramedial
Medial
Closed curretage
Flap operation
Ressective
Regenerative
Apical flap
Replaced flap
Mucogingival surgery
 Enlargement of attached gingiva
- Frenulectomy
- Vestibuloplastic
 Plastic of recessus
-Lateral flap
-Bridge flap
-Mucous or mesenchymal grafts