Periodontology
Periodontology
 Periodontal tissues
 alveolar bone
 cementum
 periodontal ligament
 gingiva
crown
root
Dentogingival junction
Morphology
Supportive
tissues
Periodontal diseases
 Inflammation at most!!!!
 The most important ethiological factor?
Dental plaque!!!!
BIOFILM
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?
Othe aethiological factors
 Calcified deposit on teeth, plaque on the surface
 Overhangs, crowns, dentures
 Genetic factors – gen polymorphism
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
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!
!
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.
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
 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
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 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