Preclinical periodontology Periodontology * Is a branch of dentistry that is focused on periodontal tissues * • Parodont – periodontium (supportive tissues) q Alveolar bone qCementum – insertion of the periodontal ligaments qPeriodontal fibres qGingiva qAttachement (epithelium junction) • • o periodontal tissues periodontal tissues2 E:\LRd\d\publikace odr.2009\IMG_2466.JPG Stippling Free gingiva Attached gingiva Gingivodental junction * Attachement • -Stratum basale -Stratum suprabasale Cementum * 8 jmoobr2a M:\Zalohapc\abstraktaakt\obr.9.tif Covers the root surface 50% inorganic material Insertion of collagen fibres Sharpey´s fibres Alveolar bone C:\Users\Elite\Desktop\hajkrtg.jpg Compact bone thin layer – lamina dura Spongis Periodontal membrane * * Tissues in periodontal space (width 0,4 – 1,5 mm) - 20 – 35 %. Fibres,interfibrillar substance, nervs, blood vessels. Periodontal fibres * Supraalveolar •Lig. circulare * Intraalveol (Sharpey´s fibres) -Horizontal -Oblique -Apical -Crestal -Interradicular Periodontal diseases * Gingivitis (inflamation limited on gingiva only) * Periodontitis (inflammation of deeper parts of periodontal tissues) * Non inflammatory diseases • Aethiology * External factors (local) •Dental biofilm •Dental calculus •Iatrogenic factors (badly made fillings • overhangs, missing contact point, badly • made prosthetic treatment) •Mucogingival disorders (high insertion of frenum) •Trauma, traumatization * • Aethiology * Internal factors (systemic) * Genetics * Systemic diseaes (diabetes mellitus, leukaemia,HIV infekction…) * Systemic medication (cyclosporin A, immunisupresive medicaments, calcium blockers and others * Hormonal dysbalance (e.g.pregnancy) • Diagnosis * Patients history * Clinical examination * Radiographic examination (OPG) * * •Diagnosis and treatment plan • History * Chief complaint * Dental history * Oral hygiene attitudes * Professional and social status * Smoking * Periodontitis in family * Systemic diseases Clinical examination * Inspection * Probing of the depth of periodontal sulcus – if deeper than 3 mm –periodontal pocket * Observation of bleeding or pus * Periodontal probes * WHO probe * * Wiliams probe * * Nabers probe (furcation) • Probes sonda WHO Williams Nabers Probing Depth of periodontal pocket Indexes Visualization of the biofilm (plaque) * Probes * * Dyes * * Tablets * DSC_0237 Plaque Visualisation of the biofilm * Tablets, special liquids, gels * * detekce plaku.jpg image from GC_Tri_Plaque_ID_Gelčesky-2.bmp Plaque induced inflammation bleeding * DSC_0238 Bleeding of gingiva is a sign of inflammation – inflammation of gingiva is a sign of insufficient oral hygiene Measurement, expression and importance of PBI * pbi 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 martina PBI 0 PBI 1 PBI 2 PBI 3 PBI 4 CPITN (Comunity periodontal index of treatment needs) vzplnovacitabulka vyplnovacitabulka2 sonda 0 – normal finding 1 – bleeding 2 – dental calculus (sub or supragingival) 3- periodontal pocket 3,5 – 5,5 mm 4 – periodontal pocket deeper than 5,5 mm * CPI – periodontal status * TN – treatment needs •TN – treatment needs •0 – healthy tissues: no treatment •1 – bleeding on probing: improvement of oral hygiene •2 – dental caculus: profesional hygiene needed •3 – complex periodontal therapy – can be conservative •4- complex periodontal therapy – surgical therapy can be needed • • • Furcations * Classification C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\furkace.tif Gingival recesions * Classification * * C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\recesy.tif 1 2 3 4 rtg2 rtg1 Rtg vyšetření v parodontologii Treatment plan * * Initial phase. Oral hygiene (motivation of the patient, individual plan of oral hygiene removal of biofilm and supragingival calculus). * * * Conservative treatment - subgingival treatment: scaling and root planing * * oobr calculus driftingandmobility hyperplastica Initial phase * 1. Oral hygiene – home and professional obr obr [USEMAP] * obr obr obr [USEMAP] * obr obr [USEMAP] zk -Hand scalers : sharp pointed instruments of various design - -Ultrasound scalers Supragingival treatment [USEMAP] ozk2 ozk3 ozl1 [USEMAP] Subgingival treatment * The treatment inside the periodontal pocket -Dental biofilm and calculus removal (subgingivally) -Ingrowth epithelium removal -Necrotic cementum removal -Smoothening of the root surface • Scaling and root planing [USEMAP] Principles of subgingival treatment * Currets are used subg1 subg2 [USEMAP] [USEMAP] kyrety1 Universal currete – the angle of the working part and the shank is 90°, two blades Treatment of surfece the root and soft tissues Special (Gracey) currete – the angle between the working part and the shank is 70° Only one blade is sharp Treatment of the root surface only Topic specifity [USEMAP] [USEMAP] [USEMAP] [USEMAP] Scalers * Sharp pointed instruments for supragingival treatment * • [USEMAP] Curretes * * * Sharp spoons for subgingival treatment [USEMAP] Periodontal surgery [USEMAP] C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\hyperplnifedipin.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\hyperplcyklosporin.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\hyperplcyklosporinA1.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\hyperplasienifedipin.tif Cyclosporin A Blokátory kalciových kanálů Phenytoin Niphedipin [USEMAP] C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\principgingivektomie.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\principgingivoplastiky.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\pohydantoinatech.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\poanug.tif Gingivectomy Gingivoplasty [USEMAP] C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\rezy.tif Internal gingivectomy External gingivectomy C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\vertikalnirezy.tif Intrasulcular Marginal Paramarginal Papilar Paramedial Medial [USEMAP] C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\Widman.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\apikal.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\apikal2.tif Flap operations [USEMAP] Bone defect operations * C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\bonrpockets1.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\bonepockets2.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\kostnichobot.tif [USEMAP] C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\frenulektomie1.tif C:\Documents and Settings\Lenka\Dokumenty\kurzyapredn\parasliz\frenulektomie2.tif Frenulectomy [USEMAP] lroubalikova@gmail.com * ciscionova01 cisconova03 [USEMAP] lroubalikova@gmail.com ciscionova01 cisconova04 cisconova kontrola [USEMAP]