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44 Cards in this Set

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Periodontal Formation
Dental Follicle is?
consist of?
Oral Mucosa is?
- Tooth supporting structures
-cementum, PDL, Alveolar Bone

-gingiva
ginigva
located?
Fxn?
parts?
Margin, attached, interdental

-protect against microbial and mechanical damage

-Free margin(coronal)
-Attached ginigva: attached to tooth
-Mucoginigval jxn: where ginigva meets rest of oral epithelium
Ginigiva
epithelium?
cell types?
-stratfied squamous epithelium
-keratinocytes, langerhands, melanocytes, merkel
gingiva sulcular epithelium
physical charactersitics?
-thin epithelium
-non keratinized strat. squamous
Jxnal epithelium:
forms when?
formed from?
forms?
-as tooth erupts
-fusion of reduced enamel epithelium with oral epithelium
-colar around tooth
Jxnal Epithelium Function
-Defense: PMNs, T-cells, B-cells
-Filtration
-Cell polarization
--Differentiation
-Migration
-Adhesion
Jxnal vs. Oral Epithelium
Cell turnover
Cell size
Intercellular spaces
Keratinization
-Jxnal higher
-Jxnal Larger
-Jxnal wider
-Jxnal non keratinized
Connective Tissue of Ginigiva
consists of?
collagen fibers
-collagen, reticular, elastic
fibroblast
vessels
Nerves
Matrix(35%)
2 layers: papillary and reticular
Ginigva connective tissue fibers?
Circular fibers:everywhere
Transspetal Fiber: inteprroximal
Dentoginigval fibers : bucall/lingualy
Dentoperiosteal fibers: same as DGF but different curvature
ginigvitis:
inflamamtion of ginigval tissues
gingivitis
where?
inidcated by?
reversible?
signs of inflammation
-ginigiva/soft tissue
-usually presence of plaque but can be non assoicated as well
-yes
-Pain, heat, swelling, redness
ginigivits:
effect of vasculature

infiltrated by
can be seen only?
present after?
-vasodilation-->vascular proliferation

-infiltration by PMNs-->lymphocytes-->plasma cells

-histologically
-4 days no brushing
supporting structures
Periodontal ligament
Bone Cmenetum
Periodontal Ligament
is?
cells?
consist of as well?
thickness?
-specialized connective tissue

-fibroblasts
-osteolbasts
-immune cells: macrophages, neutrophils, lymphocytes, mast cells, eosinophils
-cementoblasts
-osteoclasts
-epithelial rests of Malassez

Extracellular matrix(70 % water)

-.4-.1 mm
Peridontal Ligament Fxns?
key role in?
1. Physical: anchors teeth to bone, rpotects from mechanical force
2. Formative: undifferentiated precursor cells
-PDL cells migrate to cementum and help rebuild
-also help bone formation
-renew itself as well
3. Sensory
4. Nutritive

regeneration
Peridontal Ligaments?
-Principle Fibers
-Transseptal(most coronal)
-Alveolar crest(apical)
-Horizontal(more apical)
-Oblique(more apical,oriented slightly coronal)
-Apical
-interraddicular(between roots)
Alveolar Process
-Buccal lingual coritcal plates
-trabecular bone
-alveolar bone
Alveolar Process
fxn?
Components?
-support tooth
-force distribution

-70% inorganic
-20-25% organic
-Cells: osteoblasts, osteocytes, osteoclasts

-Contain blood and lymph veseels
Bone remodeling
-preosteoclasts-->active osteoclasts(bone resporption)-->mononuclear cells(resorption-->reversal)-->pre-osteoblasts-->osteoblast(bone formation)-->osteocytes(mature osteoblasts, send signals to each other through trapped bone, minarealization)
Normal bone level?
1.5-2mm below CEJ
Tooth extraction
-blood clot formation
-inflamamtory resposne(48-72 hrs)
-matrix formation remodeling
-eventually dissappear then refill area with bone,
-many times sckt doesn't entirely fill thus alter esthetics, so use bone from other areas to use as a scaffold(which will eventually be resorbed)
tooth Loss
Height and width of bone decreases?
40-60 in first 3 years

.25-.5% annually
Cementum
is?
origin?
similar to?
cellular?
-avascular bone-like mineralized tissue

dental follicle after the disintegration of hertwig's epithelial root sheath

-bone, acelluar
Cementum fxn?
anchors PDL fibers(sharpeys)

maintain occlusal relationship

repair

-cellular intrinsic fiber: rep
types of cementum
-acellular extrinsic fibers: 2/3 of root-anchorage, cells from PDL

-cellular mixed intrinsic and extrinisc fibers: apical 1/3 of root and furcations, adaptation and repair

-cellular intrinsic fiber: repair
-acellular afibrillar: cementum enamel jxn, no cells n
CEJ types
Overlap 60%
meet butt: 30%
grap: 10%
Cementum vs Bone
Vascularity
collagen?
-no for cementum

-bone has 12, cementum has 8, both have 1,3,5
Periodontitis
is?
caused by?
results in?
-inflammation disease of supporting tissues of the teeth
-caused by specific microorganisms
-results in progressive destruction of the periodontium
Goal of Perio treatment
-preserve dention in stte of health, comfort and fxn

-prevent disease
-arrest progression
-regain lost periodntium
-maintain newly regained tissues
After iintial scazling and celaning need to wait because?
-allow connective tissue to heal
Goal of scaling and root planing:
heals?
-remove biofilm
-remove calculus
-remove contaminated cementum
-heals via long jxn epithelium which regenrates quicker than connectivue, tissue, it will grow into a clean root surface into sulcus
Problem with periodntal surgery?
-most procedureds are repair/healing but can never fully recover/restore original structure

-cannot reform only repair what we have lost
Tradiitonal periodontal approaches:
-non surgical
-surgical
Long jxnal epithelium
Development vs. wound healing
jxnal epithelium: REE+ OEE, Oral epithelium

Fibroblast, Cementoblast, Osteoblasts: dental follicle in development

Fibroblast: PDL
Cementoblast: PDL progeniators
Osteoblast:PDL bone
Ideal treatment?
regeneration: reproduction/reconstruction of a lost or injured part
Peridontal regenraiton
only reliable method?
Clincally?
-histology: new cementum, PDL, bone

Clinically: probe, xray, re-entry evaluation
What needs to happen to renerate Piodontal tissues?
Cell, Scaffold,Signal molecules, Blood supply

Need to make sure JE doesn't fill in
Types of Regeneration
-guided tissue regeneration
-bone grafts
-growth/differentiation factors
-tissue engineering
guided tissue regeneration cell origin?
1. Oral ginigval epithelium: coronal part of gum
2. Ginigval connective tissue: gingiva on the insde of Oral epithelium
3. Bone
4. PDL
guided tissue regenration occurs how?
-exclusion of epithelial cells from the root sruface via barrier membrane

-only wroks in spoecific cases
Growth/Differentiatons Factors?
-Extracellular matrix proteins: enamel amtrix proteins

-Growth factors:
-insulin-like growth factor
-platelet-derived growth factor(BMP used for bone implant regeneration)
-cell proliferation, cell activity, cehmotaxis
Growth Factor PDGF BB
Gem 21s
-rhPlatelet Derived growth factor-->stimulate proliferation

-B-TCP scaffold

-increases attachment level and bone growth
Enamel Matrix Proteins
called?
evidence of?
concept?
example?
-emdogain
-new cmeentum, new bone with inserting connective tissue fibers
-Concept: enamel amtrix proteins involved in cementogenesis
-amelogenin
Development vs. Regeneration
development:
periondtal fomration moves downward
regenreation:
peridontal formation moves upward