Periodontology Etiology Pathogenesis Diagnosis Therapy prevention Periodontology  Periodontal tissues (supportive tissues)  alveolar bone  cementum  periodontal ligament  gingiva crown root Dentogingival junction Morphology Supportive tissues Periodontal diseases  Etiology Local factors Systemic factors Local factors  Dental plaque (biofilm)  Dental calculus  Bad fillings - Overhangs - No contact poing - Not polished (esp. Composite) fillings Local factors  Bad made crowns and prothesis  Mucosal disorders – frenum  Trauma (bad occlusion)- high fillings Systemic factors  Genetic disposition  Systemic diseases (diabetes, blood diseases, others) 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? Plaque detection  Special liquids  Tablets  Gels Dental calculus High insertion of labial frenum Periodontal diseases  Plaque associated  Plaque modulated 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 Acute necrotisans gingivitis - ANUG  Necrotizing ulcerative gingivitis Aetiology Special microbs - anaerobs The clinical picture  Gingival inflammation and destruction 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  Gingivitis  Pocketing  Loss of alveolar bone  Drifting and mobility  Furcation exposures  Recession Periodontitis  Gingivitis  Pocketing - incrfeasing depth of gingival sulcus  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 Diagnosis  History  Clinical examination - Level of oral hygiene - Periodontal status  Radiography Investigative instruments in periodontology  Periodontal probes - blunt (no damage of periodontal ligament) - calibrated (measurement of depth od sulcus or pocket) - Some with the ball at the end (tactile investigation – calculus) Investigation - indexes  Number characteristic of status of periodontal tissues – figures give us the orientation : PBI Index CPITN Index PBI – papilla bleeding index  0  1  2  3  4 No bleeding Point Line Triangl Drop Importance  Sume divided with number of investigated points - figure 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 WHO probe Slight pressure Around the teeth Wait 1 min CPITN  0 no bleeding  1 bleeding  2 dental calculus  3 periodontal pocket 3 – 5 mm  4periodontal pocker deeper than 5 mm CPITN (Comunity periodontal index of treatment needs) CPITN  0 -no therapy  1 bleeding – improve oral hygiene  2 dental calculus – professional oral hygiene, home care  3 periodontal pocket 3 – 5 mm complex periodontal therapy – more conservative  4periodontal pocker deeper than 5 mm – complex periodontal therapy including surgical 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 removal supragingival calculus only Sonic and ultrasonic scalers lenka.roubalikova@tiscali.cz 45 Air flow Currettes  Sharp spoons for subgingival treatment  Not pointed  Two sharp blades - universal  One sharp blade - special Universal and special currette Universal Working part and shaft 90° Cut also soft tissue Special Working part and shaft 70° Clean only root of the tooth Scaling, root planing  Action of the currette Therapy  Oral hygiene  Scaling – root planning  Surgery  Prosthetic treatment  Recall Therapy  2. Subgingival treatment – scaling root planing, curettage Therapy  3. Periodontal surgery Gingivectomy, gingivoplasty 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 Modified Widman flap Apical flap, replaced flap Papilla preservation technique Wedge excision Apical flap Replaced flap Mucogingival surgery  Enlargement of attached gingiva - Frenulectomy - Vestibuloplastic  Plastic of recessus -Lateral flap -Bridge flap -Mucous or mesenchymal grafts Graft Bone regeneration Tissue engineering…………..