INDIAN DENTAL ACADEMYLeader in Continuing Dental Educationwww.indiandentalacademy.com
www.indiandentalacademy.com
Classification systemsIn the last 130 years, many classification system forperiodontal diseases have been used such asRamf...
In 1989 classification system was developed that included five types of periodontitis.(i) Adult periodontitis(ii) Early on...
The need to revise classification system for periodontaldiseases was emphasized during the 1996 World Workshop inPeriodont...
CHANGES IN THE CLASSIFICATION IN    PERIODONTAL DISEASES   Addition of a section on “ Gingival Diseases”   Replacement o...
   Replacement of “necrotizing ulcerative periodontitis    with “Necrotizing periodontal diseases”   Addition of a categ...
Classification of periodontal disease and condition (1999     international workshop for a classification of periodontal  ...
2.Gingival diseases modified by systemic factors   a) Associated with the endocrine system                1. Puberty assoi...
d) drug influenced gingival diseases1.     drug influenced gingival enlargements2.     drug influenced gingivitisa)     or...
b.      other1.     Gingival disease of fungal origina)      candida species infections1.     generalized gingival candidi...
b. Allergic reactions1)        Dental restorative materials     a)      Mercury     b)     Nickel,     c)     Acrylic     ...
6) Traumatic lesions (factitious, iatrogenic,accidental)      a)      Chemical injury      b)      Physical injury      c)...
II. Chronic Periodontitis       a) Localized       b) GeneralizedIII. Aggressive Periodontitis       a) Localized       b)...
B) Associated with genetic disorders1. Familial and cyclic Neutropenia2. Down syndrome3. Leukocyte adhesion deficiency syn...
V. Necrotising Periodontal Diseasesa) Necrotising ulcerative gingivitisb) Necrotising ulcerative periodontitisVI. Abscesse...
B. Mucogingival deformities and conditions around teeth1. gingival / soft tissue recession a. facial or lingual surfaces b...
C. Mucogingival deformities and conditions on edentulousridges1. vertictal and / or horizontal ridge deficiency2. lack of ...
1. GINGIVAL DISEASESDental plaque induced gingival diseases• Gingivitis that is associated with dental plaque formation is...
Gingivitis associated with dental plaque only• Plaque induced gingival disease is the result of an interaction between the...
Gingival Diseases Modified by Systemic Factors• Systemic factors contributing to gingivitis, such as  the endocrine change...
• Blood dyscrasias such as leukemia may alter immune  function by disturbing the normal balance of  immunologically compet...
Gingival Diseases Modified by medications:• Gingival diseases modified by medications are increasingly prevalent because o...
• The   development      and   severity     of   gingival enlargement in response to medications is patient- specific and ...
Gingival disease modified by Malnutrition• Gingival disease modified by malnutrition may  have clinical descriptions of br...
Non – Plaque Incduced Gingival LesionsGingival Disease of Specific Bacterial Origin• These disease are increasing in preva...
Gingival disease of Viral Origin• It may be caused by a variety of  deoxyribonucleic acid (DNA) and ribonucleic  acid (RNA...
Gingival Disease of Fungal Origin• It occurs most frequently on individuals who are  immunocompromised or in whom the norm...
• A generalized candidal infection may manifest as  white patches on the gingiva, tongue or oral mucous  membrane than can...
Gingival Disease of Genetic Origin• One of the most clinically evident conditions is  hereditary     gingival   fibromatos...
Gingival Manifestations of Systemic Conditions• It may appear as desqumative lesions, ulceration  of gingiva or both.• All...
Traumatic Lesions      Traumatic lesions may be factitial (produced by artificalmeans; unintentionally produced) as in the...
Foreign Body Reactions• Foreign      body   reactions    lead      to   localized  inflammatory conditions of the gingiva ...
CHRONIC PERIODONTITIS          It is a common plaque induced periodontal infection that is    major cause of tooth loss th...
AGGRESSIVE PERIODONTITIS• Aggressive periodontitis is much less common than chronic  periodontitis and affects a narrower ...
Both forms of aggressive periodontitis share the  following common features.• Expect for the presence of periodontitis pat...
Some of the important secondary features of both forms of   aggressive periodontitis are• Amount of microbial deposits are...
Specific features of localized and generalized               aggressive periodontitis.Localized Aggressive Periodontitis• ...
Generalized Aggressive Periodontitis• Usually affecting individuals less than 30 years but patients may be older• Poor ser...
Periodontitis as a manifestation of systemic diseases       There are two general catogories of systemic  disease that hav...
NECROTIZING PERIODONTAL DISEASE• Necrotizing periodontal infections include  necrotizing ulcerative gingivtis (NUG) and  n...
NECROTIZING ULCERATIVE GINGIVITIS       The two most significant criteria used for the diagnosis  of NUG are      1. Prese...
It is a heterogenous film composed of fibrin, bacteria,sloughed epithelial cells and other debris. It can be easilyremoved...
• In children from underdeveloped countries, NUG appears  to be associated with malnutrition or the debilitating and  immu...
Necrotizing Ulcerative Periodontitis• Compared to NUG, NUP always involves  considerable loss of periodontal attachment an...
• In some patients with NUP there were exposure and sequestration of alveolar bone.• Severe immuno suppression from other ...
ABSCESSES OF PERIODONTIUM  An abscess is a circumscribed collection of pus.  Factors that predispose to abscess formation ...
Periodontitis Associated with Endodontic Leisions• Infections of periapical tissues caused by the pulpal  death (i.e endod...
Developmental or Acquired Deformities and Conditions• There are many developmental or acquired deformities and conditions ...
Localized tooth related factors that modify or  predispose to plaque induced periodontal  diseases.• Tooth related factors...
Mucogingival Deformities and conditions around Teeth        Mucogingival deformities refer to a group of congenital,develo...
Mucogingival     Deformities     and     Conditions   on Edentulous Ridges.There are:• Vertical and/or horizontal ridge de...
Occlusal Trauma:Damage to periodontal tissues can occur during avariety of conditions involving occlusal loads andforces t...
www.indiandentalacademy.com
www.indiandentalacademy.com
Upcoming SlideShare
Loading in...5
×

Classification of periodontal diseases /certified fixed orthodontic courses by Indian dental academy

2,782

Published on

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable

Published in: Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,782
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Classification of periodontal diseases /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMYLeader in Continuing Dental Educationwww.indiandentalacademy.com
  2. 2. www.indiandentalacademy.com
  3. 3. Classification systemsIn the last 130 years, many classification system forperiodontal diseases have been used such asRamfjord and Ash 1979Page and Schroeder 1982Vogel and Cattabriga 1986Suzuki 1988.Grant, Stern, and Listgarten, 1988European workshop on Periodontology 1993World workshop in Clinical Periodontics 1989Genco 1990Ranney 1993 www.indiandentalacademy.com
  4. 4. In 1989 classification system was developed that included five types of periodontitis.(i) Adult periodontitis(ii) Early onset periodontitis(iii) Periodontitis associated with systemic disease(iv) Necrotizing ulcerative periodontitis(v) Refractory periodontitis The main drawbacks of this classification were(i) Considerable overlap in disease categories(ii) Absence of a gingival disease component(iii) Inappropriate emphasis on age of onset of disease and rates of progression(iv) Inadequate or unclear classification criteria www.indiandentalacademy.com
  5. 5. The need to revise classification system for periodontaldiseases was emphasized during the 1996 World Workshop inPeriodontics. In 1997 the American academy of periodontologyresponded to this and formed a committee to plan and organize aninternational workshop to revise the classification system forperiodontal diseases. On October 30 – November 2, 1999, the InternationalWorkshop for a classification of Periodontal Diseases and conditionswas held and a new classification was agreed upon. www.indiandentalacademy.com
  6. 6. CHANGES IN THE CLASSIFICATION IN PERIODONTAL DISEASES Addition of a section on “ Gingival Diseases” Replacement of “adult periodontitis” with “chronic periodontitis” Replacement of “early onset periodontitis” with “aggressive periodontitis” Elimination of a separate disease category for “refractory periodontitis” www.indiandentalacademy.com
  7. 7.  Replacement of “necrotizing ulcerative periodontitis with “Necrotizing periodontal diseases” Addition of a category on “Periodontal abscess” Addition of a category on “Periodontic endodontic lesions” Addition of a category on “Development or acquired deformities and conditions” www.indiandentalacademy.com
  8. 8. Classification of periodontal disease and condition (1999 international workshop for a classification of periodontal disease and conditions)The new classification (1999) is as follows:1.GINGIVAL DISEASESa) Dental plaque induced gingival disease.(Can occur without attachment loss or on a periodontium with attachment loss that is not progressing)1.Gingivitis associated with dental plaque only:a) Without other local contributing factorsb) With local contributing factors (See VIII A) www.indiandentalacademy.com
  9. 9. 2.Gingival diseases modified by systemic factors a) Associated with the endocrine system 1. Puberty assoicated gingivitis 2. Menstrual cycle associated gigivitis 3. Pregnancy assoicated a) gingivitis b) pyogenic granuloma 1. Diabetes mellitus assoicated gingivitis c) assoicated with blood dyscrasias1. leukemia assoicated gingivitis2. Other3. Gingival diseases modified by medications www.indiandentalacademy.com
  10. 10. d) drug influenced gingival diseases1. drug influenced gingival enlargements2. drug influenced gingivitisa) oral contraceptive assoicated gingivitisb) other4.Gingival diseases modified by malnutritiona) ascorbic acid deficiency gingivitisb) otherB. Nonplaque induced Gingival lesions1. Gingival disease of specific bacterial origina. Nesseria gonorrhea assoicated lesionsb. Treponema pallidum associated lesionsc. Streptococcal species assoicated lesionsd. Others2. Gingival disease of viral origina) herpes virus infection3. primary herpetic gingivostomatitis4. recurrent oral herpes5. www.indiandentalacademy.com varicella zoster infections
  11. 11. b. other1. Gingival disease of fungal origina) candida species infections1. generalized gingival candidiasisb. linear gingival erythemac. histoplasmosisd. other4. Gingival lesions of genetic origina. hereditary gingival fibromatosisb. other5. Gingival manifestations of systemic conditionsa. mucocutaneous disorders1. lichen planus2. pemphigoid3. pemphigus vulgaris4. erythema multiforme5) Lupus erythematosus6) Drug-induced7) Other www.indiandentalacademy.com
  12. 12. b. Allergic reactions1) Dental restorative materials a) Mercury b) Nickel, c) Acrylic d) Other 2) Reactions attributable to a) Toothpaste’s /dentifrice’s b) Mouth rinses / mouth washes c) Chewing gum additives d) Foods and additives 3) Other www.indiandentalacademy.com
  13. 13. 6) Traumatic lesions (factitious, iatrogenic,accidental) a) Chemical injury b) Physical injury c) Thermal injury 7) Foreign body reactions 8) Not otherwise specified (NOS) www.indiandentalacademy.com
  14. 14. II. Chronic Periodontitis a) Localized b) GeneralizedIII. Aggressive Periodontitis a) Localized b) GeneralizedIV. Periodontitis as a manifestation of systemic diseases.A) Associated with hematological. disorders. 1) Acquired neutropenia 2) Leukemias 3) Other www.indiandentalacademy.com
  15. 15. B) Associated with genetic disorders1. Familial and cyclic Neutropenia2. Down syndrome3. Leukocyte adhesion deficiency syndromes4. Papillon - Lefevre syndrome5. Chediak – Higashi syndrome6. Histiocytosis syndrome7. Glycogen storage disease8. Infantile genetic agranulocytosis9. Cohen syndrome10. Ehlers – Danlos syndrome (Types IV and VIII)11. Hypophosphatasia12. Other www.indiandentalacademy.com
  16. 16. V. Necrotising Periodontal Diseasesa) Necrotising ulcerative gingivitisb) Necrotising ulcerative periodontitisVI. Abscesses of the periodontiuma) Gingival abscessb) Periodontal abscessc) Periocoronal abscessVII Periodontitis assoicated with endodontic lesionsA. Combined periodontal endodontic lesionsVIII. Developmental or Acquired Deformities and conditionsA. Localized tooth related factors that modify or predispose to plaqueinduced gingival disease / periodontitis1. Tooth anatomic factors2. Dental restorations / appliances3. Root fractures4. Cervical root resorption and cemental tears www.indiandentalacademy.com
  17. 17. B. Mucogingival deformities and conditions around teeth1. gingival / soft tissue recession a. facial or lingual surfaces b. interproximal (papillary)2. lack of keratinized gingiva3. decreased vestibular depth4. aberrant frenum / muscle position5. gingival excess a. pseudopocket b. inconsistent gingival margin c. excessive gingival display d. gingival enlargement (see section I, parts A3 and B4)1abnormal color www.indiandentalacademy.com
  18. 18. C. Mucogingival deformities and conditions on edentulousridges1. vertictal and / or horizontal ridge deficiency2. lack of gingiva / keratinized tissue3. gingiva / soft tissue enlargement4. aberrant frenum / muscle position5. decreased vestibular depth6. abnormal colorD. Occlusal trauma1. Primary occlusal trauma2. Secondary occlusal trauma www.indiandentalacademy.com
  19. 19. 1. GINGIVAL DISEASESDental plaque induced gingival diseases• Gingivitis that is associated with dental plaque formation is the most common form of the gingival disease.• It has been proved that plaque induced gingivitis may occurs on a periodontium with no attachment loss or on a periodontium with previous attachment loss that is stable and not progressing. www.indiandentalacademy.com
  20. 20. Gingivitis associated with dental plaque only• Plaque induced gingival disease is the result of an interaction between the microorganism found in the dental plaque biofilm and the tissues and inflammatory cell of host.• The plaque host interaction can be altered by the effects of local factors, systemic factors or both, medications and malnutrition that can influence the severity and duration of the response. www.indiandentalacademy.com
  21. 21. Gingival Diseases Modified by Systemic Factors• Systemic factors contributing to gingivitis, such as the endocrine changes associated with puberty, menstrual cycle, pregnancy and diabetes may be exacerbated because of the alterations in the gingival inflammatory response to plaque.• This is caused by the effects of the systemic conditions on the cellular and immunological functions of the host.• These changes are most apparent during pregnancy, when the prevalence and severity of gingival inflammation may increase even in the presence of low levels of plaque. www.indiandentalacademy.com
  22. 22. • Blood dyscrasias such as leukemia may alter immune function by disturbing the normal balance of immunologically competent white cells supplying periodontium.• Gingival enlargement and bleeding are common findings and may be associated with, swollen, spongy gingival tissues caused by excessive infiltration of blood cells. www.indiandentalacademy.com
  23. 23. Gingival Diseases Modified by medications:• Gingival diseases modified by medications are increasingly prevalent because of the increased use of anticonvulsant drugs, known to induce gingival enlargement.• Such as phenotoin, immunosuppressive drugs such as cyclosporine A, and calcium channel blockers such as nifedipine, verapamil, diltiazem and sodium valproate. www.indiandentalacademy.com
  24. 24. • The development and severity of gingival enlargement in response to medications is patient- specific and may be influenced by uncontrolled plaque accumulations.• The increased use of oral contraceptives by pre- menoposal woman has been associated with a higher incidence of gingival inflammation and development of gingival enlargement. www.indiandentalacademy.com
  25. 25. Gingival disease modified by Malnutrition• Gingival disease modified by malnutrition may have clinical descriptions of bright red, swollen and bleeding gingiva associated with severe ascorbic acid deficiency or scurvy.• Nutritional deficiencies are known to affect immune function a may have an impact on the hosts ability to protect itself against some of the detrimental effects of celluar products such as oxygen radicals. www.indiandentalacademy.com
  26. 26. Non – Plaque Incduced Gingival LesionsGingival Disease of Specific Bacterial Origin• These disease are increasing in prevalance especially as a result of sexually transmitted disease such as gonorrhea and to a lesser degree syphillis.• Oral lesions may be secondary to systemic infections or may occur through direct infection.• Streptococcal gingivitis or gingivo stomatitis is a rare condition that may present as an acute condition with fever, malaise and pain associated with acutely inflammed diffuse red, and swollen gingiva with increased bleeding and occasional gingival abscess formation.• The gingival infections usually are preceded by tonsillitis and have been associated with group A β hemolytic steptococcal infections. www.indiandentalacademy.com
  27. 27. Gingival disease of Viral Origin• It may be caused by a variety of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) viruses, the most common being the herpes viruses.• Lesions are frequently related to reactivation of latent viruses especially as a result of reduced immune function. www.indiandentalacademy.com
  28. 28. Gingival Disease of Fungal Origin• It occurs most frequently on individuals who are immunocompromised or in whom the normal oral flora has been disturbed by long term use of broad spectrum antibiotics.• The most common oral fungal infection is candidiasis caused by infection with candida albicans which also can be seen under prosthetic devices the individuals using topical steriods and in individuals with decreased salivary flow increased salivary glucose, or decreased salivary pH. www.indiandentalacademy.com
  29. 29. • A generalized candidal infection may manifest as white patches on the gingiva, tongue or oral mucous membrane than can be removed with a gauze leaving a red, bleeding surface.• In HIV infected individuals candidal infection may present as erythema of attached gingiva and has been referred to as linear gingival erythema or HIV associated gingivitis. www.indiandentalacademy.com
  30. 30. Gingival Disease of Genetic Origin• One of the most clinically evident conditions is hereditary gingival fibromatosis that exhibits autosomal dominant or (rarely) autosomal recessive modes of inheritance.• The gingival enlargement may completely cover the teeth, delay eruption and present as an isolated finding or be associated with several more generalized syndromes. www.indiandentalacademy.com
  31. 31. Gingival Manifestations of Systemic Conditions• It may appear as desqumative lesions, ulceration of gingiva or both.• Allergic reactions that manifest with gingival changes are uncommon but have been observed in association with several restorative materials, tooth pastes, mouth washes, chewing gum and foods. www.indiandentalacademy.com
  32. 32. Traumatic Lesions Traumatic lesions may be factitial (produced by artificalmeans; unintentionally produced) as in the case of tooth brushtrauma resulting in gingival ulceration, recession or both;iatrogenic (trauma to the gingiva induced by the dentist orhealth professional) as in the case of preventive or restorativecare that may lead to traumatic injury of the gingiva; oraccidental as in the case of damage to the gingiva throughminor burns from hot food and drinks. www.indiandentalacademy.com
  33. 33. Foreign Body Reactions• Foreign body reactions lead to localized inflammatory conditions of the gingiva and are caused by the introduction of foreign material into the gingival connective tissues through breaks in epithelium• Eg. Introduction of amalgam into gingiva during the placement of restoration or an extraction of a tooth leaving an amalgam tatoo or the introduction of abrasives during polishing procedures. www.indiandentalacademy.com
  34. 34. CHRONIC PERIODONTITIS It is a common plaque induced periodontal infection that is major cause of tooth loss throughout the world. Its important clinical features are• Most prevalent in adults but can occur in children and adolescents.• Amount of destruction is consistent with the presence of local factors.• Associated with a variable microbial pattern• Slow to moderate rate of progression but may have periods of rapid progression.• Can be associated with local predisposing factors.• May be modified by or associated with systemic disease• Can be modified by or factors other than systemic disease such as cigarette smoking and emotional stress. www.indiandentalacademy.com
  35. 35. AGGRESSIVE PERIODONTITIS• Aggressive periodontitis is much less common than chronic periodontitis and affects a narrower range of younger patients.• It occurs in localized and generalized forms and the two forms differ in many respects with regard to their etiology and pathogenesis.• LAP and GAP were once called localized and generalized juvenile periodontitis respectively.• However these terms were replaced with LAP and GAP terminology because they do not depend on questionable age based classification criteria. www.indiandentalacademy.com
  36. 36. Both forms of aggressive periodontitis share the following common features.• Expect for the presence of periodontitis patients are otherwise clinically healthy• Rapid attachment loss and bone destruction• Familial aggregation www.indiandentalacademy.com
  37. 37. Some of the important secondary features of both forms of aggressive periodontitis are• Amount of microbial deposits are inconsistent with the severity of periodontal tissue destruction.• Increased proportions of Actinobacillus actino – mycetemcomitans and in some populations, Porphyromonas gingivalis may increased.• Phagocyte abnormalities• Hyper responsive macrophage phenotype, including increased levels of prostaglandin E2 and inter leukin – 1 β• Progression of attachment loss and bone loss may be self arresting www.indiandentalacademy.com
  38. 38. Specific features of localized and generalized aggressive periodontitis.Localized Aggressive Periodontitis• Circum Pubertal onset• Robust serum antibody to infecting agents• Localized first molar / incisor presentation with interproximal attachment loss on at least two permanent teeth one of which is a first molar and involving no more than two teeth other than first molars and incisors. www.indiandentalacademy.com
  39. 39. Generalized Aggressive Periodontitis• Usually affecting individuals less than 30 years but patients may be older• Poor serum antibody response to infecting agents• Pronounced episodic nature of the destruction of attachment and alveolar bone• Generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors. www.indiandentalacademy.com
  40. 40. Periodontitis as a manifestation of systemic diseases There are two general catogories of systemic disease that have periodontitis as a frequent manifestation1. Certain hematologic disorders (eg acquired neutropenia, leukemia) and2. Some genetic disease (eg. Familial / cyclic neutropenia, down syndrome, leucocyte adhesion deficiency syndromes, papillon lefevre syndrome). www.indiandentalacademy.com
  41. 41. NECROTIZING PERIODONTAL DISEASE• Necrotizing periodontal infections include necrotizing ulcerative gingivtis (NUG) and necrotizing ulcerative periodontitis (NUP).• In both the condition there is a rapid onset of pain associated with development of necrotic and ulcerative lesions of marginal gingiva, particularly involving interproximal sites. www.indiandentalacademy.com
  42. 42. NECROTIZING ULCERATIVE GINGIVITIS The two most significant criteria used for the diagnosis of NUG are 1. Presence of interproximal necrosis and ulceration 2. A histroy of rapid onset of gingival soreness and pain.• The interproximal necrosis and ulceration take the form of eroded crater like depressions of one or more interproximal gingival papillae sometimes referred to as having “ Punched Out” appearance.• Marked halitosis is present in most patients with NUG.• Some patients have a pseudomembrane covering the ulcerated areas of the gingiva. www.indiandentalacademy.com
  43. 43. It is a heterogenous film composed of fibrin, bacteria,sloughed epithelial cells and other debris. It can be easilyremoved or wiped of by frictional forces of eating and istherefore frequently absent. NUG are occasionally associatedwith lymphadenopathy, increased salivation, fever, malaviseand anorexia. Predisposing factors for NUG in adult patients fromNorth America and Europe include. 1. Emotional stress 2. Heavy cigarette somking 3. Lack of sleep 4. Poor dietary habits 5. Immunosuppression. www.indiandentalacademy.com
  44. 44. • In children from underdeveloped countries, NUG appears to be associated with malnutrition or the debilitating and immunosuppressive effects of viral or parasitic infection.• The common features of all the predisposing factors of NUG is that they decrease host resistance to periodontal infections.• In every immunosuppressed children, NUG is believed to be the first stage of noma or cancrum oris, a severe necrotic infection that caused massive destruction of the tissues of the oral cavity and the face. www.indiandentalacademy.com
  45. 45. Necrotizing Ulcerative Periodontitis• Compared to NUG, NUP always involves considerable loss of periodontal attachment and alveolar bone.• The term necrotizing ulcerative periodontitis did not appear in classification systems for periodontal disease until the later 1980s at the peak of the AIDS epidemic.• It was added to the classification systems primarily because of the increasing appearance of a rapidly destructive and intensely painful form of periodontitiswww.indiandentalacademy.com in HIV infected patients.
  46. 46. • In some patients with NUP there were exposure and sequestration of alveolar bone.• Severe immuno suppression from other sources such as cancer chemotherapy and advanced protein energy malnutrition also can lead to the development of NUP. www.indiandentalacademy.com
  47. 47. ABSCESSES OF PERIODONTIUM An abscess is a circumscribed collection of pus. Factors that predispose to abscess formation are1. Deep periodontal pockets.2. Incomplete removal of sublingival calculus during scaling and root planing3. Occlusion of the pocket orifice by foreign bodies4. Administration of antibiotics to patients with periodontitis in the absence of mechanical therapy www.indiandentalacademy.com
  48. 48. Periodontitis Associated with Endodontic Leisions• Infections of periapical tissues caused by the pulpal death (i.e endodontic lesions) can often locally join with separate infections emenating from periodontal pockets.• This coalescence of endodontic and periodontal infections has termed combined periodontal– endodontic lesions. www.indiandentalacademy.com
  49. 49. Developmental or Acquired Deformities and Conditions• There are many developmental or acquired deformities and conditions of periodontal tissues that technically are not disease.• They are included in most classifications of periodonatl disease because they may be important modifiers of susceptibility to periodontal infections or can dramatically influence treatment outcomes. www.indiandentalacademy.com
  50. 50. Localized tooth related factors that modify or predispose to plaque induced periodontal diseases.• Tooth related factors that can be associated with an increased risk for development of plaque induced periodontal disease include, cervical enamel projections, enamel pearls, furcation anatomy, tooth position, root proximity and anamalous grooves in roots.• Defect in dental restorations such as poor contours and marginal discrepancies can increase the risk of periodontal infections. www.indiandentalacademy.com
  51. 51. Mucogingival Deformities and conditions around Teeth Mucogingival deformities refer to a group of congenital,developmental, or acquired defects in the normal relation betweenkeratinized gingival tissues and nonkeratinized alveolar mucous. Thesedeformities are1. Gingival/soft tissue recession - Facial or lingual surfaces - Inter proximal (papillary)2. Lack of keratinzed gingiva3. Decreased vestibular depth4. Aberrant frenum/muscle position5. Gingival excess - Pseuodpockets - Inconsistent gingival margin - Excessive gingival display - Gingival enlargement6. Abnormal colourwww.indiandentalacademy.com
  52. 52. Mucogingival Deformities and Conditions on Edentulous Ridges.There are:• Vertical and/or horizontal ridge deficiency• Lack of gingival /keratinized tissue• Gingival / soft tissue enlargement• Aberrant frenum /muscle position• Decreased vestibular depth• Abnormal color. www.indiandentalacademy.com
  53. 53. Occlusal Trauma:Damage to periodontal tissues can occur during avariety of conditions involving occlusal loads andforces that exceed the capacity of the periodontium towith stand them eg: Primary occlusal trauma Secondary occlusal trauma www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com

×