PeriodontologyPeriodontology PeriodontologyPeriodontology PeriodontalPeriodontal tissuestissues ((supportivesupportive tissuestissues)) alveolaralveolar bonebone cementumcementum periodontalperiodontal ligamentligament gingivagingiva crown root Dentogingival junction Morphology Supportive tissues PeriodontalPeriodontal diseasesdiseases InflammationInflammation atat most!!!!most!!!! TheThe mostmost importantimportant ethiologicalethiological factorfactor?? DentalDental plaqueplaque!!!!!!!! BIOFILMBIOFILM DentalDental plaqueplaque == biofilmbiofilm ComunityComunity PrimitivePrimitive circulationcirculation More species Higher metabolic activity Higher resistance (S. sobrinus CHX 300x, AF 75x) better conditions to survive higher virulence BiofilmBiofilm AdherenceAdherence ColonisationColonisation MaturationMaturation CanCan itit bebe recognisedrecognised andand removedremoved easilyeasily?? OtheOthe aethiologicalaethiological factorsfactors CalcifiedCalcified deposit ondeposit on teethteeth,, plaqueplaque onon thethe surfacesurface OverhangsOverhangs,, crownscrowns,, denturesdentures GeneticGenetic factorsfactors –– gengen polymorphismpolymorphism ParodontopathiesParodontopathies GingivitisGingivitis PlaquePlaque associatedassociated gingivitisgingivitis Erythema No pain Easy bleeding Plaque on the tooth Chronic form Acute form Erythema Pain Easy bleeding Plaque on the tooth AcuteAcute necrotisansnecrotisans gingivitisgingivitis -- ANUGANUG NecrotizingNecrotizing ulcerativeulcerative gingivitisgingivitis AetiologyAetiology SpecialSpecial microbsmicrobs -- anaerobsanaerobs TheThe clinicalclinical picturepicture GingivalGingival inflammationinflammation andand destructiondestruction SevereSevere painpain,, bleedingbleeding gumsgums,, halitosishalitosis DiferentialDiferential diagnosisdiagnosis HerpeticHerpetic gingivostomatitisgingivostomatitis -- YoungYoung peoplepeople -- ProdromsProdroms -- PyrexyPyrexy -- LymphadenopathyLymphadenopathy -- LesionsLesions moremore widespreadwidespread andand diffusediffuse DiferentialDiferential diagnosisdiagnosis IfIf ANUGANUG doesdoes notnot tendtend toto recoverrecover in 10in 10 daysdays –– checkcheck thethe bloodblood picturepicture!! ! AtrophicAtrophic oror desquamativedesquamative gingivitisgingivitis symptomssymptoms ErythemaErythema on free gingivaon free gingiva –– lossloss ofof thethe epitheliumepithelium VarietyVariety ofof symptomssymptoms:: itchingitching,, tendernesstenderness ofof eatingeating,, burningburning.. HyperplasticHyperplastic gingivitisgingivitis HighHigh standardstandard ofof oraloral hygienehygiene mustmust bebe achievedachieved!! GingivectomyGingivectomy ((drugsdrugs inducedinduced)) ParodonthopatiesParodonthopaties PeriodontitisPeriodontitis ChronicChronic periodontitisperiodontitis.. AggressiveAggressive periodontitisperiodontitis.. PeriodontitisPeriodontitis as aas a manifestationmanifestation ofof systemicsystemic diseasedisease.. NecrotizingNecrotizing periodontalperiodontal diseasesdiseases.. AbscessesAbscesses ofof thethe periodontiumperiodontium.. PeriodontitisPeriodontitis associatedassociated withwith endodonticendodontic lesionslesions.. DevelopmentDevelopment oror acquiredacquired deformitiesdeformities andand conditionsconditions.. ParodonthopatiesParodonthopaties PeriodontitisPeriodontitis ChronicChronic periodontitisperiodontitis.. AggressiveAggressive periodontitisperiodontitis.. PeriodontitisPeriodontitis as aas a manifestationmanifestation ofof systemicsystemic diseasedisease.. NecrotizingNecrotizing periodontalperiodontal diseasesdiseases.. AbscessesAbscesses ofof thethe periodontiumperiodontium.. PeriodontitisPeriodontitis associatedassociated withwith endodonticendodontic lesionslesions.. DevelopmentDevelopment oror acquiredacquired deformitiesdeformities andand conditionsconditions.. PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession PeriodontitisPeriodontitis GingivitisGingivitis PocketingPocketing LossLoss ofof alveolaralveolar bonebone DriftingDrifting andand mobilitymobility FurcationFurcation exposuresexposures RecessionRecession IndexesIndexes PBIPBI –– papillapapilla bleedingbleeding indexindex 00 11 22 33 44 No bleeding Point Strip Triangle Drop CPITN (Comunity periodontal index of treatment needs)WHO probe 0 – no changes 1 – bleeding (oral hygiene) 2- dental calculus (removal of dental calculus, oral hygiene) 3 –periodontal pocket 3,5 – 5,5 mm (subgingival treatment) 4 – periodontal pocket more than 6 mm subgingival treatment, periodontal surgery. PlakPlak PlakemPlakem indukovaný zindukovaný záánněětt MMěřěřeneníí a výpoa výpoččet indexu,et indexu, jeho významjeho význam 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 TherapyTherapy 1. Oral1. Oral hygienehygiene -- professionalprofessional, home care, home care INDIVIDUALINDIVIDUAL TherapyTherapy 1. Oral1. Oral hygienehygiene -- professionalprofessional, home care, home care INDIVIDUALINDIVIDUAL TherapyTherapy 1. Oral1. Oral hygienehygiene -- professionalprofessional, home care, home care INDIVIDUALINDIVIDUAL Professional oralProfessional oral hygienehygiene VisualisationVisualisation ofof dentaldental biofilmbiofilm CalculusCalculus removalremoval –– scalersscalers ((handhand instrumentsinstruments)) PowerPower drivendriven instrumentsinstruments ((sonicsonic,, ultrasonicultrasonic)) PolishingPolishing AirAir flowflow ScalersScalers forfor thethe supragingivalsupragingival treatmenttreatment SharpSharp pointedpointed instrumentsinstruments SickleSickle-- scalerscaler ClawClaw-- scalerscaler ScraperScraper ––scalerscaler DoubleDouble angleangle scalerscaler CurrettesCurrettes SharpSharp spoonsspoons,, forfor subgingivalsubgingival treatmenttreatment ScalingScaling,, rootroot planingplaning TherapyTherapy 2.2. SubgingivalSubgingival treatmenttreatment –– scalingscaling rootroot planingplaning,, curettagecurettage TherapyTherapy 3.3. PeriodontalPeriodontal surgerysurgery GingivectomyGingivectomy,, gingivoplasticgingivoplastic IndicationsIndications ofof gingivectomygingivectomy HyperplasiaHyperplasia gingivaegingivae ((pseudopocketspseudopockets)) SupraalveolarSupraalveolar periodontalperiodontal pocketspockets withwith thethe horizontalhorizontal bonebone resorptionresorption -- BadBad configurationconfiguration ofof thethe gingivalgingival marginmargin oror papillapapilla folfol. ANUG. ANUG oror extractionextraction.. Gingivectomy Gingivoplastic Internal gingivectomy External gingivectomy Intrasulcular Marginal Paramarginal Papilar Paramedial Medial Closed curretage FlapFlap operationoperation ModifiedModified WidmanWidman flapflap ApicalApical flapflap,, replacedreplaced flapflap PapillaPapilla preservationpreservation techniquetechnique WedgeWedge excisionexcision Apical flap Replaced flap MucogingivalMucogingival surgerysurgery EnlargementEnlargement ofof attachedattached gingivagingiva -- FrenulectomyFrenulectomy -- VestibuloplasticVestibuloplastic PlasticPlastic ofof recessusrecessus --LateralLateral flapflap --BridgeBridge flapflap --MucousMucous oror mesenchymalmesenchymal graftsgrafts