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44 Cards in this Set
- Front
- Back
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Periodontal Formation
Dental Follicle is? consist of? Oral Mucosa is? |
- Tooth supporting structures
-cementum, PDL, Alveolar Bone -gingiva |
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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 |
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Ginigiva
epithelium? cell types? |
-stratfied squamous epithelium
-keratinocytes, langerhands, melanocytes, merkel |
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gingiva sulcular epithelium
physical charactersitics? |
-thin epithelium
-non keratinized strat. squamous |
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Jxnal epithelium:
forms when? formed from? forms? |
-as tooth erupts
-fusion of reduced enamel epithelium with oral epithelium -colar around tooth |
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Jxnal Epithelium Function
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-Defense: PMNs, T-cells, B-cells
-Filtration -Cell polarization --Differentiation -Migration -Adhesion |
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Jxnal vs. Oral Epithelium
Cell turnover Cell size Intercellular spaces Keratinization |
-Jxnal higher
-Jxnal Larger -Jxnal wider -Jxnal non keratinized |
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Connective Tissue of Ginigiva
consists of? |
collagen fibers
-collagen, reticular, elastic fibroblast vessels Nerves Matrix(35%) 2 layers: papillary and reticular |
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Ginigva connective tissue fibers?
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Circular fibers:everywhere
Transspetal Fiber: inteprroximal Dentoginigval fibers : bucall/lingualy Dentoperiosteal fibers: same as DGF but different curvature |
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ginigvitis:
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inflamamtion of ginigval tissues
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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 |
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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 |
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supporting structures
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Periodontal ligament
Bone Cmenetum |
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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 |
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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 |
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Peridontal Ligaments?
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-Principle Fibers
-Transseptal(most coronal) -Alveolar crest(apical) -Horizontal(more apical) -Oblique(more apical,oriented slightly coronal) -Apical -interraddicular(between roots) |
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Alveolar Process
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-Buccal lingual coritcal plates
-trabecular bone -alveolar bone |
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Alveolar Process
fxn? Components? |
-support tooth
-force distribution -70% inorganic -20-25% organic -Cells: osteoblasts, osteocytes, osteoclasts -Contain blood and lymph veseels |
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Bone remodeling
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-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)
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Normal bone level?
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1.5-2mm below CEJ
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Tooth extraction
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-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) |
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tooth Loss
Height and width of bone decreases? |
40-60 in first 3 years
.25-.5% annually |
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Cementum
is? origin? similar to? cellular? |
-avascular bone-like mineralized tissue
dental follicle after the disintegration of hertwig's epithelial root sheath -bone, acelluar |
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Cementum fxn?
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anchors PDL fibers(sharpeys)
maintain occlusal relationship repair -cellular intrinsic fiber: rep |
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types of cementum
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-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 |
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CEJ types
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Overlap 60%
meet butt: 30% grap: 10% |
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Cementum vs Bone
Vascularity collagen? |
-no for cementum
-bone has 12, cementum has 8, both have 1,3,5 |
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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 |
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Goal of Perio treatment
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-preserve dention in stte of health, comfort and fxn
-prevent disease -arrest progression -regain lost periodntium -maintain newly regained tissues |
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After iintial scazling and celaning need to wait because?
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-allow connective tissue to heal
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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 |
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Problem with periodntal surgery?
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-most procedureds are repair/healing but can never fully recover/restore original structure
-cannot reform only repair what we have lost |
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Tradiitonal periodontal approaches:
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-non surgical
-surgical Long jxnal epithelium |
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Development vs. wound healing
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jxnal epithelium: REE+ OEE, Oral epithelium
Fibroblast, Cementoblast, Osteoblasts: dental follicle in development Fibroblast: PDL Cementoblast: PDL progeniators Osteoblast:PDL bone |
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Ideal treatment?
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regeneration: reproduction/reconstruction of a lost or injured part
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Peridontal regenraiton
only reliable method? Clincally? |
-histology: new cementum, PDL, bone
Clinically: probe, xray, re-entry evaluation |
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What needs to happen to renerate Piodontal tissues?
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Cell, Scaffold,Signal molecules, Blood supply
Need to make sure JE doesn't fill in |
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Types of Regeneration
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-guided tissue regeneration
-bone grafts -growth/differentiation factors -tissue engineering |
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guided tissue regeneration cell origin?
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1. Oral ginigval epithelium: coronal part of gum
2. Ginigval connective tissue: gingiva on the insde of Oral epithelium 3. Bone 4. PDL |
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guided tissue regenration occurs how?
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-exclusion of epithelial cells from the root sruface via barrier membrane
-only wroks in spoecific cases |
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Growth/Differentiatons Factors?
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-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 |
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Growth Factor PDGF BB
Gem 21s |
-rhPlatelet Derived growth factor-->stimulate proliferation
-B-TCP scaffold -increases attachment level and bone growth |
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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 |
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Development vs. Regeneration
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development:
periondtal fomration moves downward regenreation: peridontal formation moves upward |
