A periodontal pocket is a pathologically deepened gingival sulcus caused by an inflammatory response to oral infection. It is characterized by the apical migration of junctional epithelium along the root surface. Periodontal pockets can be classified based on their morphology, the surfaces and structures involved, and the nature of the soft tissue wall. The pathogenesis of pocket formation involves the destruction of collagen fibers by collagenases and other enzymes released during the host inflammatory response to bacterial plaque accumulation. This results in the apical migration and proliferation of junctional epithelium along the root, forming a periodontal pocket. Histopathologically, the soft tissue wall shows edema, inflammation and ulceration while the root surface undergoes structural and chemical changes with
This document provides classifications for various conditions affecting the periodontium, including:
- Gingival diseases such as dental plaque-induced and non-plaque induced gingivitis.
- Periodontitis, which is further classified into necrotizing periodontitis, periodontitis as a manifestation of systemic diseases, and other forms.
- Other conditions like periodontal abscesses, endo-peridontal lesions, mucogingival deformities, traumatic occlusal forces, and teeth/prosthesis factors.
It also defines terms like peri-implant mucositis and peri-implantitis, and discusses factors associated with soft and hard tissue deficiencies around dental
This document discusses the classification, pathogenesis, histopathology, and progression of periodontal pockets. Periodontal pockets are classified as suprabony or intrabony based on their location relative to the alveolar bone. Theories on the pathogenesis suggest pockets form due to bacterial invasion, inflammation, or proliferation of the junctional epithelium leading to destruction of connective tissue and loss of attachment. Histopathology shows the soft tissue wall undergoes degenerative changes while the root surface develops structural and chemical alterations. Pockets progress in an episodic manner with periods of exacerbation and quiescence. Understanding the etiology and progression of pockets is important for providing successful treatment and monitoring response to therapy.
This document defines and classifies periodontal pockets, describing their pathogenesis and histopathological features. It discusses gingival pockets, periodontal pockets (which can be suprabonny or infrabonny), and pseudo pockets. The key stages in pocket formation are outlined, from bacterial plaque initiation to colonization by anaerobic bacteria and collagen destruction. Clinical and histological characteristics of pocket walls and contents are also summarized.
This document discusses the historical background and various methods of root biomodification, which involves chemically or mechanically modifying the root surface to promote periodontal regeneration. It describes how citric acid, tetracycline, fibronectin, and EDTA work to demineralize and detoxify the root surface in order to remove the smear layer and expose collagen fibers, making the surface more biocompatible and conducive to new attachment of periodontal tissues. Register and Burdick's 1975 technique using citric acid application for 2-3 minutes is outlined, along with modifications by Miller. The mechanisms and benefits of different agents are explained.
The document discusses periodontal pockets, which are a characteristic feature of periodontitis. It defines a periodontal pocket as a pathologically deepened gingival sulcus and classifies pockets as either gingival, suprabonny, or intrabony based on their location relative to the alveolar bone. The document outlines several theories on the pathogenesis of periodontal pockets, including the destruction of gingival fibers, changes in the cementum, stimulation of the junctional epithelium by inflammation, destruction of the junctional epithelium by infection or trauma, and bacterial invasion at the base of the sulcus.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
The document discusses attached gingiva, defining it as the portion of gingiva that extends from the base of the gingival crevice to the mucogingival junction. It describes the width and thickness of attached gingiva, noting it varies between 1-9mm wide and has an average thickness of 1.25mm. Microscopically, attached gingiva has a keratinized, cellular epithelium and dense connective tissue. It functions to act as a buffer zone, bear trauma and forces from occlusion, and prevent attachment loss and recession.
This document provides classifications for various conditions affecting the periodontium, including:
- Gingival diseases such as dental plaque-induced and non-plaque induced gingivitis.
- Periodontitis, which is further classified into necrotizing periodontitis, periodontitis as a manifestation of systemic diseases, and other forms.
- Other conditions like periodontal abscesses, endo-peridontal lesions, mucogingival deformities, traumatic occlusal forces, and teeth/prosthesis factors.
It also defines terms like peri-implant mucositis and peri-implantitis, and discusses factors associated with soft and hard tissue deficiencies around dental
This document discusses the classification, pathogenesis, histopathology, and progression of periodontal pockets. Periodontal pockets are classified as suprabony or intrabony based on their location relative to the alveolar bone. Theories on the pathogenesis suggest pockets form due to bacterial invasion, inflammation, or proliferation of the junctional epithelium leading to destruction of connective tissue and loss of attachment. Histopathology shows the soft tissue wall undergoes degenerative changes while the root surface develops structural and chemical alterations. Pockets progress in an episodic manner with periods of exacerbation and quiescence. Understanding the etiology and progression of pockets is important for providing successful treatment and monitoring response to therapy.
This document defines and classifies periodontal pockets, describing their pathogenesis and histopathological features. It discusses gingival pockets, periodontal pockets (which can be suprabonny or infrabonny), and pseudo pockets. The key stages in pocket formation are outlined, from bacterial plaque initiation to colonization by anaerobic bacteria and collagen destruction. Clinical and histological characteristics of pocket walls and contents are also summarized.
This document discusses the historical background and various methods of root biomodification, which involves chemically or mechanically modifying the root surface to promote periodontal regeneration. It describes how citric acid, tetracycline, fibronectin, and EDTA work to demineralize and detoxify the root surface in order to remove the smear layer and expose collagen fibers, making the surface more biocompatible and conducive to new attachment of periodontal tissues. Register and Burdick's 1975 technique using citric acid application for 2-3 minutes is outlined, along with modifications by Miller. The mechanisms and benefits of different agents are explained.
The document discusses periodontal pockets, which are a characteristic feature of periodontitis. It defines a periodontal pocket as a pathologically deepened gingival sulcus and classifies pockets as either gingival, suprabonny, or intrabony based on their location relative to the alveolar bone. The document outlines several theories on the pathogenesis of periodontal pockets, including the destruction of gingival fibers, changes in the cementum, stimulation of the junctional epithelium by inflammation, destruction of the junctional epithelium by infection or trauma, and bacterial invasion at the base of the sulcus.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
The document discusses attached gingiva, defining it as the portion of gingiva that extends from the base of the gingival crevice to the mucogingival junction. It describes the width and thickness of attached gingiva, noting it varies between 1-9mm wide and has an average thickness of 1.25mm. Microscopically, attached gingiva has a keratinized, cellular epithelium and dense connective tissue. It functions to act as a buffer zone, bear trauma and forces from occlusion, and prevent attachment loss and recession.
Periodontal pockets can be classified in several ways, including by their relationship to the alveolar crest (suprabony or intrabony), the number of tooth surfaces involved (simple, compound, or complex), and the number of remaining osseous walls in intrabony pockets. Periodontal abscesses are acute or chronic localized purulent infections that develop from preexisting periodontal pockets. They are typically treated first by establishing drainage through the pocket or incision, along with antibiotics in some cases. Further treatment involves scaling and root planing or surgery to address the underlying chronic periodontitis.
The periodontal pocket is a key feature of periodontal disease that results from the deepening of the gingival sulcus. Pockets can be classified as gingival, suprabony, or intrabony depending on their location relative to the alveolar bone. The document describes the signs, symptoms, clinical features, and histopathological changes that occur as the gingival sulcus transforms into a periodontal pocket through collagen destruction and epithelial downgrowth along the root surface. Bacteria can invade the soft tissue wall and contribute to further inflammatory changes in the pocket.
This document discusses biological width, which refers to the dimensions of soft tissue attached to the tooth coronal to the alveolar bone crest. It defines biological width as the connective tissue attachment (1.07mm on average) plus the epithelial attachment (0.97mm on average), totaling 2.04mm. It discusses factors that can lead to biological width violation like subgingival restoration margins and its signs. Methods to evaluate and correct biological width violations like bone sounding, surgical crown lengthening, and forced tooth eruption are also described. The importance of respecting biological width is emphasized in restorative and implant dentistry.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
pathogens in periodontal microbiology. the red complex bacteria described in detail. recent updates regarding proteases and virulence factors of all pathogens.
This document discusses various techniques for non-surgical periodontal therapy, focusing on root planing. It defines root planing as the removal of plaque, calculus, and contaminated cementum and dentin from root surfaces. It discusses the rationale for root planing, including the removal of diseased cementum that may contain toxins. It evaluates different root planing instruments like curettes and ultrasonic scalers. While some studies found root smoothness and cementum removal were unnecessary, most support root planing to remove toxins and prepare the surface for new attachment. The document analyzes debates around techniques and their role in resolving inflammation and facilitating healing.
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
This document discusses different types of necrotizing ulcerative periodontitis including non-AIDS type and AIDS-associated type. It also discusses refractory periodontitis caused by abnormal host response, resistant bacteria, failure to remove plaque, and smoking. Microbial complexes associated with refractory periodontitis include Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Treatment involves antimicrobial therapy and local drug delivery. The document also discusses periodontitis caused by systemic diseases that impair neutrophil function such as Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, and Down syndrome.
This document discusses furcation involvement, including classifications, diagnosis, treatment options, and prognosis. It notes that furcation involvement indicates advanced periodontitis and poorer prognosis. Treatment depends on the grade of involvement and may include nonsurgical therapy like scaling and root planing, surgical approaches like furcation plasty, regenerative techniques like GTR, or extraction. Prognosis is best for grade I and II furcations treated nonsurgically or with furcation plasty, and poorer for grade III and IV furcations. Long-term success requires eliminating plaque, establishing anatomy to facilitate cleaning, and preventing further attachment loss.
- Trauma from occlusion occurs when occlusal forces exceed the adaptive capacity of the periodontium, causing injury. It can be acute or chronic.
- The magnitude, direction, duration, and frequency of forces impact the periodontium's ability to adapt. Excessive pressure or tension can damage tissues.
- Primary trauma from occlusion is caused by changes in occlusal forces, while secondary trauma occurs when reduced bone support impairs the tissues' resistance to normal forces.
- The periodontium responds to trauma in three stages - injury, repair through new tissue formation, and adaptive remodeling to better withstand forces. Trauma can cause reversible damage if forces are reduced, or lead to irreversible injury if
This document discusses biological width, which refers to the dimension of soft tissue attached to the tooth above the alveolar bone crest. It includes the junctional epithelium and connective tissue attachment. The total biological width in healthy tissue is about 2.04mm. Violation of the biological width due to factors like poor oral hygiene, defective restorations, or over-contouring can lead to inflammation and bone loss. Diagnosis involves probing measurements and radiographs. Biological width can be restored through surgical crown lengthening or orthodontic extrusion procedures.
Pathologic tooth migration (PTM) refers to tooth displacement resulting from a disturbance in factors that maintain normal tooth position. PTM is common in periodontal patients, with prevalence studies finding rates of 30-55%. The primary factor in PTM is periodontal bone loss resulting from periodontal disease. Other factors include occlusal changes from tooth loss, soft tissue pressures, oral habits, and periapical or gingival inflammation. Treatment involves periodontal therapy, sometimes with adjunctive orthodontics or prosthodontics, while prevention focuses on periodontal disease control and management of predisposing occlusal and habit factors.
Width of attached gingiva and its significance Hudson Jonathan
This document discusses the width of attached gingiva and its significance. It begins by defining the different parts of the gingiva and describing the microscopic and macroscopic features of attached gingiva. It then discusses the normal width of attached gingiva in different regions of the mouth, how it is measured, and what constitutes an inadequate width. The document also covers the indications for increasing the width of attached gingiva, its significance around implants, and methods for measuring and augmenting the width.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The document discusses the microbiology of dental plaque and periodontal infections. It notes that after birth, infants acquire oral bacteria that establish a mature microbiota in the mouth within two weeks. Dental plaque is a biofilm that forms on teeth and consists of over 500 microbial species living in an extracellular matrix. Key points include that plaque maturation involves an ecological shift from primarily aerobic bacteria to anaerobic species over time. The microbial composition of plaque can influence the transition from periodontal health to disease if pathogens overgrow due to changes in the local environment.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
This document defines and outlines common iatrogenic (treatment-caused) factors that can contribute to periodontal disease. It discusses 10 main factors: overhanging or subgingival restoration margins, poor restoration contours, materials and procedures, partial denture design, malocclusion, orthodontic therapy, impacted tooth extractions, habits like toothbrushing, chemical injuries, radiation therapy, and laser use complications. Each factor is described in terms of how it can disrupt plaque control and the periodontal environment, leading to issues like gingivitis, recession, and bone loss. Prevention methods are also outlined.
This document provides an overview of desquamative gingivitis (DG), a clinical sign characterized by redness and scaling of the gingiva. It discusses the various diseases that can present as DG, including lichen planus, pemphigus, pemphigoid, linear IgA disease, and lupus erythematosus. It outlines the diagnostic process and significance of DG, noting that the associated disorders can impact oral health and require systemic treatment with corticosteroids or immunosuppressants, increasing risk of complications. Proper diagnosis of the underlying condition is important for effective management of DG lesions and systemic disease.
This document discusses the history and techniques of free gingival grafts (FGG), a periodontal plastic surgery procedure used to widen attached gingiva. It describes the classic FGG technique which involves preparing the recipient site, obtaining a partial-thickness graft from the palate donor site, suturing the graft into place, and protecting the donor site. Variant techniques like the accordion, strip, and combination methods are also outlined. The healing process of FGG grafts is explained, noting revascularization begins after 2-3 days and integration is largely complete by 10-17 days, though thicker grafts may take longer. FGG procedures aim to enhance plaque removal, improve tooth stability, and provide tissue
Periodontal pockets can form when the gingival sulcus deepens through movement of the gingival margin or displacement of the gingival attachment. Pockets are classified based on their morphology, relationship to crestal bone, number of tooth surfaces involved, and nature of the soft tissue wall. The pathogenesis of pockets involves inflammatory changes that lead to degradation of collagen fibers and destruction of connective tissue and bone. Clinically, pockets present with signs like bleeding and suppuration. Microscopic examination reveals areas of bacterial accumulation, leukocyte emergence and interaction, and epithelial desquamation. Pockets contain debris, microorganisms, and inflammatory products. Probing is used to detect and measure pocket depth.
This document discusses periodontal pockets, including their definition, classification, formation, clinical features, histopathology, pathogenesis, and healing process. It defines a periodontal pocket as a pathologically deepened gingival sulcus due to migration of the junctional epithelium. Periodontal pockets are classified based on their morphology, number of tooth surfaces involved, and relation to the alveolar bone crest. The formation of pockets depends on host response, anatomical factors, local irritants like plaque and calculus. Successful treatment and healing of pockets involves removing irritants and providing a compatible surface for regeneration of periodontal tissues.
Periodontal pockets can be classified in several ways, including by their relationship to the alveolar crest (suprabony or intrabony), the number of tooth surfaces involved (simple, compound, or complex), and the number of remaining osseous walls in intrabony pockets. Periodontal abscesses are acute or chronic localized purulent infections that develop from preexisting periodontal pockets. They are typically treated first by establishing drainage through the pocket or incision, along with antibiotics in some cases. Further treatment involves scaling and root planing or surgery to address the underlying chronic periodontitis.
The periodontal pocket is a key feature of periodontal disease that results from the deepening of the gingival sulcus. Pockets can be classified as gingival, suprabony, or intrabony depending on their location relative to the alveolar bone. The document describes the signs, symptoms, clinical features, and histopathological changes that occur as the gingival sulcus transforms into a periodontal pocket through collagen destruction and epithelial downgrowth along the root surface. Bacteria can invade the soft tissue wall and contribute to further inflammatory changes in the pocket.
This document discusses biological width, which refers to the dimensions of soft tissue attached to the tooth coronal to the alveolar bone crest. It defines biological width as the connective tissue attachment (1.07mm on average) plus the epithelial attachment (0.97mm on average), totaling 2.04mm. It discusses factors that can lead to biological width violation like subgingival restoration margins and its signs. Methods to evaluate and correct biological width violations like bone sounding, surgical crown lengthening, and forced tooth eruption are also described. The importance of respecting biological width is emphasized in restorative and implant dentistry.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
pathogens in periodontal microbiology. the red complex bacteria described in detail. recent updates regarding proteases and virulence factors of all pathogens.
This document discusses various techniques for non-surgical periodontal therapy, focusing on root planing. It defines root planing as the removal of plaque, calculus, and contaminated cementum and dentin from root surfaces. It discusses the rationale for root planing, including the removal of diseased cementum that may contain toxins. It evaluates different root planing instruments like curettes and ultrasonic scalers. While some studies found root smoothness and cementum removal were unnecessary, most support root planing to remove toxins and prepare the surface for new attachment. The document analyzes debates around techniques and their role in resolving inflammation and facilitating healing.
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
This document discusses different types of necrotizing ulcerative periodontitis including non-AIDS type and AIDS-associated type. It also discusses refractory periodontitis caused by abnormal host response, resistant bacteria, failure to remove plaque, and smoking. Microbial complexes associated with refractory periodontitis include Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Treatment involves antimicrobial therapy and local drug delivery. The document also discusses periodontitis caused by systemic diseases that impair neutrophil function such as Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, and Down syndrome.
This document discusses furcation involvement, including classifications, diagnosis, treatment options, and prognosis. It notes that furcation involvement indicates advanced periodontitis and poorer prognosis. Treatment depends on the grade of involvement and may include nonsurgical therapy like scaling and root planing, surgical approaches like furcation plasty, regenerative techniques like GTR, or extraction. Prognosis is best for grade I and II furcations treated nonsurgically or with furcation plasty, and poorer for grade III and IV furcations. Long-term success requires eliminating plaque, establishing anatomy to facilitate cleaning, and preventing further attachment loss.
- Trauma from occlusion occurs when occlusal forces exceed the adaptive capacity of the periodontium, causing injury. It can be acute or chronic.
- The magnitude, direction, duration, and frequency of forces impact the periodontium's ability to adapt. Excessive pressure or tension can damage tissues.
- Primary trauma from occlusion is caused by changes in occlusal forces, while secondary trauma occurs when reduced bone support impairs the tissues' resistance to normal forces.
- The periodontium responds to trauma in three stages - injury, repair through new tissue formation, and adaptive remodeling to better withstand forces. Trauma can cause reversible damage if forces are reduced, or lead to irreversible injury if
This document discusses biological width, which refers to the dimension of soft tissue attached to the tooth above the alveolar bone crest. It includes the junctional epithelium and connective tissue attachment. The total biological width in healthy tissue is about 2.04mm. Violation of the biological width due to factors like poor oral hygiene, defective restorations, or over-contouring can lead to inflammation and bone loss. Diagnosis involves probing measurements and radiographs. Biological width can be restored through surgical crown lengthening or orthodontic extrusion procedures.
Pathologic tooth migration (PTM) refers to tooth displacement resulting from a disturbance in factors that maintain normal tooth position. PTM is common in periodontal patients, with prevalence studies finding rates of 30-55%. The primary factor in PTM is periodontal bone loss resulting from periodontal disease. Other factors include occlusal changes from tooth loss, soft tissue pressures, oral habits, and periapical or gingival inflammation. Treatment involves periodontal therapy, sometimes with adjunctive orthodontics or prosthodontics, while prevention focuses on periodontal disease control and management of predisposing occlusal and habit factors.
Width of attached gingiva and its significance Hudson Jonathan
This document discusses the width of attached gingiva and its significance. It begins by defining the different parts of the gingiva and describing the microscopic and macroscopic features of attached gingiva. It then discusses the normal width of attached gingiva in different regions of the mouth, how it is measured, and what constitutes an inadequate width. The document also covers the indications for increasing the width of attached gingiva, its significance around implants, and methods for measuring and augmenting the width.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The document discusses the microbiology of dental plaque and periodontal infections. It notes that after birth, infants acquire oral bacteria that establish a mature microbiota in the mouth within two weeks. Dental plaque is a biofilm that forms on teeth and consists of over 500 microbial species living in an extracellular matrix. Key points include that plaque maturation involves an ecological shift from primarily aerobic bacteria to anaerobic species over time. The microbial composition of plaque can influence the transition from periodontal health to disease if pathogens overgrow due to changes in the local environment.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
This document defines and outlines common iatrogenic (treatment-caused) factors that can contribute to periodontal disease. It discusses 10 main factors: overhanging or subgingival restoration margins, poor restoration contours, materials and procedures, partial denture design, malocclusion, orthodontic therapy, impacted tooth extractions, habits like toothbrushing, chemical injuries, radiation therapy, and laser use complications. Each factor is described in terms of how it can disrupt plaque control and the periodontal environment, leading to issues like gingivitis, recession, and bone loss. Prevention methods are also outlined.
This document provides an overview of desquamative gingivitis (DG), a clinical sign characterized by redness and scaling of the gingiva. It discusses the various diseases that can present as DG, including lichen planus, pemphigus, pemphigoid, linear IgA disease, and lupus erythematosus. It outlines the diagnostic process and significance of DG, noting that the associated disorders can impact oral health and require systemic treatment with corticosteroids or immunosuppressants, increasing risk of complications. Proper diagnosis of the underlying condition is important for effective management of DG lesions and systemic disease.
This document discusses the history and techniques of free gingival grafts (FGG), a periodontal plastic surgery procedure used to widen attached gingiva. It describes the classic FGG technique which involves preparing the recipient site, obtaining a partial-thickness graft from the palate donor site, suturing the graft into place, and protecting the donor site. Variant techniques like the accordion, strip, and combination methods are also outlined. The healing process of FGG grafts is explained, noting revascularization begins after 2-3 days and integration is largely complete by 10-17 days, though thicker grafts may take longer. FGG procedures aim to enhance plaque removal, improve tooth stability, and provide tissue
Periodontal pockets can form when the gingival sulcus deepens through movement of the gingival margin or displacement of the gingival attachment. Pockets are classified based on their morphology, relationship to crestal bone, number of tooth surfaces involved, and nature of the soft tissue wall. The pathogenesis of pockets involves inflammatory changes that lead to degradation of collagen fibers and destruction of connective tissue and bone. Clinically, pockets present with signs like bleeding and suppuration. Microscopic examination reveals areas of bacterial accumulation, leukocyte emergence and interaction, and epithelial desquamation. Pockets contain debris, microorganisms, and inflammatory products. Probing is used to detect and measure pocket depth.
This document discusses periodontal pockets, including their definition, classification, formation, clinical features, histopathology, pathogenesis, and healing process. It defines a periodontal pocket as a pathologically deepened gingival sulcus due to migration of the junctional epithelium. Periodontal pockets are classified based on their morphology, number of tooth surfaces involved, and relation to the alveolar bone crest. The formation of pockets depends on host response, anatomical factors, local irritants like plaque and calculus. Successful treatment and healing of pockets involves removing irritants and providing a compatible surface for regeneration of periodontal tissues.
The periodontal pocket is a pathologically deepened gingival sulcus that is a key sign of periodontal disease. Pockets can be classified based on their morphology, relationship to crestal bone, number of tooth surfaces involved, soft tissue walls, and disease activity. The pathogenesis involves bacterial plaque that leads to inflammation, collagen loss, and detachment of the junctional epithelium from the tooth, forming a pocket. Pockets contain debris and can promote further attachment and bone loss if left untreated. Treatment involves non-surgical approaches like scaling and root planing or surgical procedures to reduce pocket depth.
This document discusses periodontal pockets, including their classification, clinical features, pathogenesis, and histopathology. Periodontal pockets are pathologically deepened gingival sulci that can form through coronal movement of the gingival margin, apical displacement of the gingival attachment, or a combination. They are classified based on their morphology (gingival vs periodontal) and number of tooth surfaces involved (simple, compound, complex). Periodontal pockets develop due to bacterial plaque initiating an inflammatory response and host tissue destruction through the action of leukocytes and enzymes. Histologically, the soft tissue wall shows inflammation and the junctional epithelium is shortened.
This document discusses periodontal pockets, including their classification, clinical features, pathogenesis, and histopathology. Periodontal pockets are pathologically deepened gingival sulci that are a key feature of periodontal disease. They can form via gingival enlargement or destruction of supporting tissues. Histologically, the soft tissue wall shows edema, inflammation and sometimes fibrosis or ulceration. Bacteria may accumulate in the pocket and invade tissues. The pocket represents an area of ongoing healing and destruction in response to the bacterial challenge.
Gingivitis is defined as the inflammation of gingival tissue.Gingival inflammation has two components: the acute
inflammatory component, with vasodilation, edema, and
polymorphonuclear infiltration, and the chronic inflammatory
component, with B and T lymphocytes and capillary
proliferation forming a granulomatous response.
The document defines and classifies periodontal pockets. Key points:
- Periodontal pockets are pathologically deepened gingival sulci with destruction of supporting tissues.
- They are classified as suprabony, infrabony, or furcation pockets based on their location relative to alveolar bone.
- Periodontal pockets contain plaque, microorganisms, inflammatory cells and products that drive the pathogenesis of periodontitis through host immune response and tissue destruction.
- Probing depth measures pocket depth while attachment loss measures loss of supporting tissues from their original position. Pocket depth does not always correlate with severity of bone loss.
This document provides an overview of periodontal pockets, including:
- Definitions and classifications of periodontal pockets as gingival, periodontal, suprabony, or intrabony pockets.
- Clinical features such as signs of inflammation, bleeding, mobility, and symptoms like pain, sensitivity, and loose teeth.
- Pathogenesis involving the inflammatory response to bacteria, cytokine production, collagen degradation, and pocket formation through destruction of tissues.
- Histopathology showing features like edema, infiltration of leukocytes, epithelial proliferation and degeneration, and bacterial invasion along the pocket walls.
This document provides an overview of the anatomy and surgical procedures related to the maxillary sinus. It begins with the development, anatomy, functions, relations, and applied anatomy of the maxillary sinus. It then discusses diseases that can involve the sinus, including sinusitis, infections, tumors, and oroantral fistulas. Finally, it reviews surgical procedures such as Caldwell-Luc operation, functional endoscopic sinus surgery, sinus lifts, and treatments for maxillary sinus fractures and displaced teeth. In summary, the document is a comprehensive review of the maxillary sinus from an anatomical and surgical perspective.
This document discusses the rationale for endodontic therapy and periradicular healing. It begins by explaining that the rationale for endodontic therapy is to completely debride and seal the root canal system through non-surgical or surgical means. This achieves a fluid-tight seal and removes the source of infection, allowing periradicular tissues to heal. Several theories are discussed relating to the spread of infection and zones of reaction in periradicular tissues. Complete elimination of irritants from the root canal through treatment is necessary for periradicular healing to occur over several months. Factors like technical quality of the root filling and ability to clean the entire root canal influence healing outcomes.
Understanding of etiology and pathogensis of periodontal pocket will help to treat periodontal pocket successfully. Here I have descried the entire process with diagrams.
Periodontal pockets form due to a pathological deepening of the gingival sulcus caused by the apical migration of the junctional epithelium and destruction of underlying periodontal tissues. Plaque accumulation leads to an inflammatory response, detachment of the junctional epithelium, and migration along the root surface. This establishes an open communication between the pocket and connective tissue, allowing bacterial invasion and continued bone resorption and pocket deepening. Histopathology shows extensive proliferation of the lateral pocket epithelium, an inflamed and infiltrated connective tissue, and numerous neutrophils.
The document discusses ulcerative, vesicular, and bullous lesions. It provides classifications of oral ulcers according to etiology and occurrence. Specific conditions discussed in detail include pemphigus vulgaris and bullous pemphigoid. Pemphigus vulgaris is an autoimmune disease causing intra-epithelial blistering, while bullous pemphigoid features sub-epithelial blistering. Both can cause oral and skin lesions. Diagnosis involves history, clinical examination, biopsy, and immunofluorescence testing.
The document discusses acute appendicitis. It describes the anatomy of the appendix and explains that appendicitis is usually caused by obstruction of the appendix lumen by a fecalith. The clinical features of appendicitis include pain that initially starts around the umbilicus and later localizes to the right lower quadrant, along with nausea, vomiting, fever and tenderness at McBurney's point. Diagnosis is often made through ultrasound or CT scan. Treatment involves surgical removal of the appendix (appendicectomy) through an open or laparoscopic approach.
The document discusses gingival crevicular fluid (GCF), including its formation, composition, and methods of collection. GCF is a serum-like exudate that bathes the gingival sulcus. It forms as a result of increased capillary filtration and exudation during inflammation. GCF contains components from the blood as well as products of local tissue destruction and bone loss. Common techniques to collect GCF include use of filter paper strips, microcapillary tubes, gingival washing, and plastic strips. Analysis of GCF composition can provide diagnostic information about periodontal disease status.
Liver hydatid disease is caused by the larva of the dog tapeworm Echinococcus granulosus. Humans can become infected by ingesting the tapeworm's eggs from contact with infected dog feces. The larva travels to the liver where it forms a hydatid cyst. Symptoms are usually mild until complications occur. Diagnosis involves serological tests and imaging such as ultrasound or CT scan which can identify cyst characteristics. Treatment options include medication, minimally invasive techniques such as PAIR, or surgery depending on cyst location and size.
Liver hydatid disease is caused by the larva of the dog tapeworm Echinococcus granulosus. Humans can become infected by ingesting parasite eggs from dog feces. Ultrasound is the primary diagnostic tool, showing cysts that may contain daughter cysts. Treatment options include surgery, chemotherapy with albendazole, and minimally invasive techniques like PAIR which involve puncturing and draining the cysts.
This document provides an overview of gingival diseases and their management. It begins with an introduction to gingiva and gingivitis. It then classifies and describes the characteristics, course, and components of gingival inflammation. It discusses experimental gingivitis and the characteristics of plaque-induced gingivitis. It also covers the prevalence, distribution, and stages of gingival inflammation from initial to established lesions. The document provides detail on the histological changes that occur at each stage of gingival inflammation.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
3. Definition
Periodontal pocket:
• Apical migration of junctional epithelium down root surface &
transformation of (JE) into pocket epithelium (Glauser 1982)
• Is histopathology change in the soft tissue and possibly the
underlying bony tissues, reflecting an inflammatory response to oral
infection. (Rose 2000)
•
Is pathologically deepened gingival sulcus.
(Carranza 12ed 2016)
• Is pathologically deepened gingival sulcus which is formed due
to increase in original sulcular depth and apical migration of
junctional epithelium.
(Shalu Bathla textbook 2017)
3 M.E.AlmaQaleh
5. Depending on morphology
Depending on surfaces involved
Depending on the nature of soft-tissue wall
Depending on lateral wall of pocket
Depending on disease activity
5 M.E.AlmaQaleh
7. Gingiva pocket Periodontal pocket
Pseudo pocket Absolut or true pocket
Seen in gingivitis Seen in periodontitis
Formed by gingival
enlargement without
destruction of underlying
periodontal tissueof
Occurs with destruction of the
supporting periodontal tissues
cause loosening of the teeth
Depending on morphology
7 M.E.AlmaQaleh
8. Suprabony pocket Infrabony pocket
I. Base of pocket is coronal to the level of
alveolar bone.
II. Horizontal pattern of bone
destruction.
III. On facial and lingual surfaces , pdl fibers
beneath pocket follow their normal
oblique course.
IV. Transeptal fibers are arranged
horizontally.
I. Base of pocket is apical to crest of
alveolar bone.
II. Vertical (angular) pattern of bone
destruction.
III. They follow angular pattern.
IV. Transeptal fibers are arranged obliquely
Depending on morphology
8 M.E.AlmaQaleh
14. Symptoms
a. Localized pain or a sensation of pressure in the gingiva after eating.
b. A foul taste in localized areas.
c. A tendency to suck material from the interproximalspaces.
d. Radiating pain “deep in the bone”.
e. A “gnawing’ feeling or feeling of itching in the gums.
f. Urge to dig with pointed instrument into the gingiva.
g. Food “sticks between the teeth”.
h. Sensitivity to heat and cold.
14 M.E.AlmaQaleh
15. Signs
Parameters signs cause
Color bluish-red Circulatory stagnation
Surface
Texture
Smooth, Shiny
pits on pressure
Atrophy of epithelume&edema
Edema & degeneration
consistency Flaccid Destruction of gingival
fibers
Bleeding Gently probing bleeding 1-Increased vascularity
2-thining & degeneration of epithelium
3-proximity of engorged vessels
Pain Generally painful Ulceration of inner surface
of pocket
Pus Expressed by gentle pressure Supportive inflammation of
inner wall15 M.E.AlmaQaleh
18. periodontal probe
• Carful examination of gingival margin along each tooth
surface gives exact location and extent of periodontal
pocket.
• G.V BLACK use of very thin flat explorers to
determine the depth of pockets (1924)
• Periodontal probe and its use was first
described by F.V. Simoton of the University
OfCalifornia, San Francisco in
(1925)
• The Latin word probo means “to test.
18 M.E.AlmaQaleh
19. • Carful examination of gingival margin along each tooth surface gives exact
location and extent of periodontal pocket.
periodontal probe
WALKING
19 M.E.AlmaQaleh
20. periodontal probe
1- Pocket depth:distance between base of pocket& gingival margin.
2-Level of attachment:distance between base of pocket and fixed point (CEJ)2-3mm
20 M.E.AlmaQaleh
21. Florida probe
Clark and Yang trained operators and
performing the ‘double pass’ method, the
measurements taken with Florida probe
system shows more accuracy than those
obtained with conventional probing.
Limitations
Lack of tactile sensitivity.
21 M.E.AlmaQaleh
22. FP Handpiece tip as it enters the sulcus Handpiece tip with constant force in
use (tip at bottom of sulcus) and sleeve
properly positioned at the top of the
gingival margin allowing the computer
to measure the difference.
22 M.E.AlmaQaleh
24. Gingival Temperature Kung et al (1990)
diagnostic devices for measuring early inflammatory changes in gingival
tissue.
Subgingival temperature at diseased sites is increased as compared to
normal healthy sites
Possible explanation for ↑ temperature with increasing
Haffajee et al. (1992): found that elevated subgingival
site temperature is related to attachment loss in shallow pockets
24 M.E.AlmaQaleh
25. X-Ray
• By using gutta-percha & insertion it in the pocket then
use x-ray.
A-Conventional Radiography.
25 M.E.AlmaQaleh
26. B-Digital radiography
Capturing radiographic image using a sensor
The first direct digital imaging system, RadioVisioGraphy
(RVG), was invented by Dr. Frances Mouyens.
This technique facilitates both quantitative and
qualitative visualization of even minor density changes
in the bone
26 M.E.AlmaQaleh
28. 28
Depending on disease activity September 7, 2017
Source: University of California - San Diego
Combination of squid ink with light and ultrasound, a team led
by engineers has developed a new dental imaging method to
examine a patient's gums that is noninvasive, more
comprehensive and more accurate than the state of the art.
The squid ink component: melanin nanoparticles
M.E.AlmaQaleh
29. 29
The method:
oral rinse
melanin
nanoparticles get
trapped in the
pockets
squid ink heats up
and quickly swells
detecting by
ultrasound
creating pressure
differences in the
pockets
M.E.AlmaQaleh
31. Theories of pathogenesis:
1- Hermann Becks theory(1929): defect in sulcus.
2-Skillen theory (1930):pathological destruction of
epithelial by infection or trauma
3- Wilkinson theory (1935): proliferation of the
lateral wall epithelium rather than the base epithelium of
the sulcus
4-Box theory(1941): invasion of bacteria at the base
of the sulcus Or absorption of bacterial toxins
31 M.E.AlmaQaleh
32. 5- Fish theory ( 1946): destruction of gingival fiber.
6- Gottlieb theory (1948): the initial change in
pocket formation occurs in cementum.
7- Aisenberg theory (1948):stimulation of epithelial
attachment by inflammation rather than destruction
of gingival fibers
8- J Nuckolls (1950): inflammation is the initial
change in formation p.pocket.
Theories of pathogenesis:
32 M.E.AlmaQaleh
33. Pathogenesis
• The first event in pocket formation is the inflammation of
gingiva in response to bacterial challenge.
• Healthy gingiva associated with (coccoid cells and straight
rods).
• Diseased gingiva associated with (spirochetes & motile
rods).
• The microbiota of diseased sites cannot be used as a
predictor of future attachment or bone loss, because their
presence alone is not sufficient for disease to start or
progress. 33 M.E.AlmaQaleh
34. • Early concepts assumed that, after the initial bacterial
attack, periodontal tissue destruction continued to be
linked to bacterial action. Recently, it was established that
the host's immunoinflammatory response to the initial and
persistent bacterial attack unleashes mechanisms that
lead to collagen and bone destruction.
• The mechanisms of formation of p.pocket are related to
various cytokines which are produced normally by cells in
non-infiamed tissue and others by cells that are involved
in the inflammatory process, such as leukocytes (PMNs),
monocytes, and other cells which lead to collagen & bone
loss.
Pathogenesis
34 M.E.AlmaQaleh
35. i. Collagenases & matrix metalloproteinase degrade collagen & other matrix
macromolecules to small peptide.
i. Fibroblasts phagocytize collagen fibers by extending cytoplasmic processes
to the ligament-cementum interface and degrading the inserted collagen
fibrils and the fibrils of the cementum matrix
Con..:
Tow mechanisms of losing collagen:
35 M.E.AlmaQaleh
36. 1-As a consequence of the loss of collagen, the
apical cells of the junctional epithelium proliferate
along the root and extend fingerlike projections
2-The coronal portion of the junctional epithelium
detaches from the root as the apical portion
migrates, thereby resulting in its apical shift and this
as result of:
A-increasing the PMNs in the coronal portion of
the junctional epithelium (60% or more).
B-Physical force exerted by rapidly growing
bacteria .
c-Exudate associated with the advancing
bacteria .
Inflammation changes that form P.Pocket
36 M.E.AlmaQaleh
37. 3- Bacteria VS immunosystem:
1-In normal conditions neutrophils emigrate from the vessels of the gingival
plexus through the junctional epithelium into the gingival sulcus and oral
cavity (the transmigrating cells leave no trace of their passage and cause no
damage).
Neutrophils are the primary and first line of defense around the teeth &
the epithelial barrier is the second.
2-In presence of bacteria the substance produced by it chemotactically attract
neutrophils also chemotactic agent is produced by intact junctional
epithelium.
Con..:
37 M.E.AlmaQaleh
38. 3- Extension of plaque subgingivally causes an
increase in the number of transmigrating
neutrophils due to the increased concentration
of chemotactic factors & other inflammation
induced substances produced by bacteria which
cause vasculitis.
4- Neutrphils pass through the junctional
epithelium form a thick layer that covers the
surface of the subgingival plaque(neutrophils
are viable partly, but not completely functional)
to limit further extension and spread of bacteria
by phagocytosis and killing.
5-Increasing growth rate of bacteria, swamps
the neutrophil system and permits tissue
destruction to occur (First defense line is
broken).
Con..:
38 M.E.AlmaQaleh
39. 6-Aggressive growth and action of bacteria cause increasing
number of neutrophils that transmigrate through the
junctional
epithelium and pocket epithelium causes open communication
between the pocket and connective tissue by disrupting the
epithelial barrier(2nd defense line is broken) .
Ulceration of this sort is the second major event in pocket
formation.
7- After the epithelial barrier is breached:
I. The chemotactic agents released by it is stopped & as a
result the neutrophils have no guidance systems to direct
them from the vessels through tissues and into the pocket
they remain in the connective tissue moving randomly.
II. Bacterial substances, and bacteria may enter the connective
tissue
Con..:
39 M.E.AlmaQaleh
40. 8-The neutrophils encounter substances within the C.T rather
than outside & neutrophils become completely activated and
undertake phagocytosis, release lysosomal enzymes,
collagenases and other substances (PGE2) that cause
extensive tissue damage.
9-As soon as the bacterial substances have entered the
connective tissue many systems other than the neutrophils
are activated like macrophages lymphocytes and
complement system.
10-When the epithelial barrier is re-established the
chemotactic gradient is formed again and the destructive
process subsides. If this barrier is not re-established, tissue
destruction continues and alveolar bone is resorbed. A
periodontal pocket is now established.
Con..:
40 M.E.AlmaQaleh
41. Inflammatory changes in the the C.T of gingival
sulcus
Collagenase &
MMPs
Activate Fibroblasts for
phagocytizing collagen
Gingival Collagen Fiber Destruction
apical cells of the junctional epithelium
proliferate along the root
coronal portion of the junctional
epithelium detaches from the root
Intraepithelial cleft & pocket progression
Summary of
pathogenesis
41 M.E.AlmaQaleh
43. 1-The connective tissue is edematous and
densely infiltrated with plasma
cells(80%) ,lymphocytes, and PMNs.
2-Blood vessels are increased in number,
dilated and engorged in sub-epithelial
connective tissue layer.
3-Single or multiple necrotic foci are present
in the connective tissue.
Soft-Tissue wall
43 M.E.AlmaQaleh
44. 4-Proliferation of endothelial cells with newly formed capillaries ,fibroblasts,
and collagen fibers
.
5-The junctional epithelium at the base of the pocket is usually much shorter
than that of a normal sulcus.
Con..:
44 M.E.AlmaQaleh
45. 6-Changes occur along lateral wall of the
p.pocket:
I.The epithelium along the lateral wall of the pocket
presents striking proliferative and degenerative
changes.
II.The epithelium is infiltrated with leukocytes and
other inflammatory cells.
III. Degeneration and necrosis of the epithelium
leading toulceration of the epithelium and exposure
of the underlying connective tissue.
IV.Bacterial invasion along the lateral and apical areas
of the pocket. Some bacteria traverse the basement
lamina and invade the subepithelial connective
tissue.
45 M.E.AlmaQaleh
46. Bacterial Invasion
-Bacterial invasion of the apical and lateral
areas of the pocket wall has been described in
human chronic periodontitis: Filaments, rods,
and coccoid organisms with predominant
gram-negative cell walls have been found in
intercellular spaces of the epithelium.
-Hillmann and colleagues have reported the
presence of Porphyromonas gingivalis and
Prevotella intermedia in the gingiva of
aggressive periodontitis cases. A.ctinobacillus
actinomycetemcomitans has also been found
in the tissues
46 M.E.AlmaQaleh
47. Changes in the Root Surface Wall
Structural
Changes Chemical
changes
Cytotoxic
47 M.E.AlmaQaleh
48. 1-Collagenous remnants of Sharpey fibers in the cementum undergo
degeneration thereby creating an environment favorable to the penetration
of bacteria
2-Viable bacteria have been found in the roots of 87% of periodontally
diseased non-carious teeth.
3-Bacterial penetration into the cementum can be found as deep as the
cementodentinal junction & it may also enter the dentinal tubules.
4-Formation of areas of increased mineralization due to exchanging of
minerals and organic components at the cementumsaliva interface after
exposure to the oral cavity.
Structural Changes
48 M.E.AlmaQaleh
49. 5-Formation of Areas of
demineralization often
related to root caries.
6-Pathologic granules :
Collagen degeneration /
Incompletely mineralized
collagen fibrils
Structural Changes
49 M.E.AlmaQaleh
50. • Mineral content change
1-Bacterial penetration : Cemento-dentinal Junction
2-Endotoxins
Chemical Changes
Cytotoxic Changes
50 M.E.AlmaQaleh
51. • 1- debris
• 2-principally containing micro-organisms and their products, (like
enzymes, endotoxins and othermetabolic products)
• 3-dental plaque
• 4-gingival fluid,
• 5-foodremnants,
• 6-salivary mucin,
• 7-desquamated epithelial cells and
Pocket Content
51 M.E.AlmaQaleh
53. • 1. Cementum covered by calculus,.
• 2. Attached plaque, which covers
calculus and which extends apically from it
to a variable degree (typically 100 to 500
µm).
• 3. The zone of unattached plaque that
surrounds attached plaque and extends
apically to it.
Surface Morphology of Tooth Wall
53 M.E.AlmaQaleh
54. 4.The zone of attachment of the
junctional epithelium to the tooth. The
extension of this zone, which in normal
sulci is more than 500 µm, is usually
reduced in periodontal pockets to less
than 100 µm.
5.A zone of semi-destroyed connective
tissue fibers may be apical to the
junctional epithelium
Surface Morphology of Tooth Wall
54 M.E.AlmaQaleh