Chronic periodontitis is an inflammatory disease that causes the destruction of the tissues that support the teeth. It is caused by bacterial plaque accumulating at and below the gumline. The disease is characterized by pocket formation, attachment loss, and bone loss. It is usually slowly progressive and can range from mild to severe. Diagnosis involves measuring pocket depths, attachment levels, bleeding, and bone loss visible on radiographs. Risk factors include poor oral hygiene, smoking, diabetes, and genetic factors. Treatment aims to eliminate plaque and bacteria through nonsurgical methods like scaling and root planing or sometimes surgical procedures to reduce pocket depths and regenerate lost tissues.
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
AGGRESSIVE PERIODONTITIS
PRESENTER
DR. REBICCA RANJIT
DEPT. OF PERIODONTOLOGY & ORAL IMPLANTOLOGY
Why is there localisation of disease to 1st molars and incisors in LAP?
Often subjects present with attachment loss that does not fit the specific diagnostic criteria (AP or chronic periodontitis).
Schenkein et al. 1995: cigarette smoking was shown to be a risk factor for patients with generalized forms of AgP.
Smokers with GAP had more affected teeth and greater mean levels of attachment loss than patients with GAP who did not smoke.
IgG2 serum levels as well as antibody levels against A.a. are significantly depressed in subjects with GAP who smoked.
this ppt depicts pattern of bone destruction. its a very good slide show showing the process of bone formation, bone destruction and their patterns in periodontal diseases.
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
AGGRESSIVE PERIODONTITIS
PRESENTER
DR. REBICCA RANJIT
DEPT. OF PERIODONTOLOGY & ORAL IMPLANTOLOGY
Why is there localisation of disease to 1st molars and incisors in LAP?
Often subjects present with attachment loss that does not fit the specific diagnostic criteria (AP or chronic periodontitis).
Schenkein et al. 1995: cigarette smoking was shown to be a risk factor for patients with generalized forms of AgP.
Smokers with GAP had more affected teeth and greater mean levels of attachment loss than patients with GAP who did not smoke.
IgG2 serum levels as well as antibody levels against A.a. are significantly depressed in subjects with GAP who smoked.
this ppt depicts pattern of bone destruction. its a very good slide show showing the process of bone formation, bone destruction and their patterns in periodontal diseases.
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
Systemic Peridoontology, link between systemic health and periodontology, diabetes and periodontology, Pregnancy and Peridotology,Nutrition and periodontology
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
Systemic Peridoontology, link between systemic health and periodontology, diabetes and periodontology, Pregnancy and Peridotology,Nutrition and periodontology
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Dr. Eirini Georgiou from PerioExperts.
Periodontal disease refers to the periodontal tissues that surround, bind and support the teeth into their socket. These tissues are the gums, the jaw bone, the cementum of the root and the periodontal ligament. In healthy circumstances the gums are light pink, do not bleed and are firmly attached to the tooth, like a nice frame around a picture painting.
Periodontal disease can affect all people regardless age, but as age progresses the incidence of infection increases. It is estimated that in US 80% of people over 45 years old suffer from periodontal disease. Although periodontal disease is nowadays the main cause of tooth loss in adults, early diagnosis and preventive therapy, provide effective treatment.
Recently, periodontal disease is associated with the onset of cardiovascular problems, diabetes melitus, or premature birth and underweight babies, and morbid obesity. Therefore, the preservation and restoration of periodontal health is directly related to the conservation and restoration of general health.
At the end of this session, the student should be able to describe:
What is Periodontium and its role
Ecology of Dental Crevice and its role
Conditions that affect Periodontal tissue
Role of Microorganisms in Periodontal Disease
Complex relationship between Plaque and periodontal disease
For undergraduate dental students this presentation gives you the wide idea about the oral ulceration & it's causes. There causes also described though it's very easy for the reader to understand & planned how to approach the studying of ulcerations regarding the mouth. Here vesicular bullous lesions also described.
The periodontal examination should be systematic, starting in the molar region in either maxilla or mandible and proceeding around the arch. It is important to detect the earliest signs of gingival and periodontal disease.
Federación Odontológica del Perú
IX Jornada Anual
Auditorio del Colegio Odontológico del Perù
Conferencia: Abscesos Periodontales
Prof. Dr. Ricardo Benza Bedoya
Chronic periodontitis is an infectious disease resulting in inflammation with in supporting tissues of the teeth, progressive attachment loss and bone loss. With all emerging technologies, a successful diagnosis and treatment will only be achieved through open sharing of ideas, research findings and thorough testing .
Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. It is no more a separate entity, as earlier it had Aggressive periodontitis as a differential diagnosis. According to the New Classification from the 2017 World Workshop on Periodontal and Peri- Implant Disease and Conditions, it is now classified further into stages and grades under Periodontitis.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
EPIDEMIOLOGY OF PERIODONTAL DISEASES 1.pptxDrLasya
INTRODUCTION
• Gingival and periodontal diseases in their various forms have affected humans since the dawn of the history.
• Studies in paleopathology have indicated that destructive periodontal disease, as evidenced by bone loss, affected early humans in such diverse cultures as ancient Egypt and pre-columbian America.
• Epidemiologic studies identify risk factors for diseases and provide guidance for primary prevention, recommendations and identify where to intervene in disease process.
PERIODONTAL DISEASES
GINGIVITIS
• Inflammation of the gingival soft tissues with no loss of alveolar bone or apical migration of periodontal ligament along root surface.
• It may be characterized by edema, erythema, bleeding, and occasionally pain.
• Gingivitis is usually reversible with appropriate therapy.
PERIODONTITIS
• An inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or both.
• The clinical feature that distinguishes periodontitis from gingivitis is the Loss of clinical attachment
CLASSIFICATION OF PERIODONTAL DISEASES
CHRONIC PERIODONTITIS
• The most common form of periodontitis
• Most prevalent in adults but can occur in children
• Amount of destruction consistent with local factors
• Associated with a variable microbial pattern
• Associated with accumulations of plaque and calculus
• Slow to moderate rate of progression with possible periods of rapid progression
• Localized form: < 30% of sites involved
• Generalized form: > 30% of sites involved
• Slight: 1 to 2mm CAL (clinical attachment loss)
• Moderate: 3 to 4 mm CAL
• Severe: 5mm or greater CAL
AGGRESSIVE PERIODONTITIS
• Rapid attachment loss and bone destruction
• Amount of microbial deposits inconsistent with disease severity
• Familial aggregation of diseased individuals
• Generally diseased sites are infected with a specific bacteria (Actinobacillus actinomycetemcomitans)
• Abnormalities in phagocyte function
• Hyper-responsive macrophages, producing elevated PGE2 and IL1B
• Disease progression may be self-limiting
• It is of two types- localized and generalized
LOCALIZED AGGRESSIVE PERIODONTITIS
• Circumpubertal onset of disease
• Localized first molar/ incisor
• Interproximal attachment loss on at least two permanent teeth
• Robust serum antibody response to infecting agents
GENERALIZED AGGRESSIVE PERIODONTITIS
• Usually affecting persons under 30 years of age (however, may be older)
• Generalized interproximal attachment loss affecting at least three teeth other than first molars and incisors
• Pronounced episodic nature of destruction
• Poor antibody response to infecting agents
Periodontitis as a manifestation of Systemic disease
Hematologic disorders
A) Acquired neutropenia
B) Leukemias
Genetic disorders
A) Familial & cyclic neutropenia
B) Down’s syndrome
c) Papillon-Lefevre syndrome
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
3. CONTENTS
Introduction
History
Classification
Prevalence
Clinical features
Symptom
Disease distribution
Disease severity
Disease progression
Risk factors
Pathogenesis
Diagnosis
Clinical
Radiographic
Prognosis
Treatment
Non surgical
Surgical
Conclusion
References
3
PART I PART II
4. Introduction
It is inflammatory disease of supporting tissues of teeth caused by specific micro-
organism or group of specific micro-organisms resulting in progressive destruction of
periodontal ligament and alveolar bone with pocket formation, recession or both.
“As an infectious disease resulting in inflammation within the supporting tissues of the
teeth , progressive attachment loss and bone loss” (Flemmig TF 1999)
4
5. • Chronic – (Greek – Kronos means time) long lasting
• Chronic periodontitis, formerly known as “adult periodontitis” or “chronic
adult periodontitis” is the most prevalent form of periodontitis.
• Most commonly seen in adults.
• Age associated but not age relate.
5
6. History
• Fauchard recognized the relationship
between oral hygiene and the etiology
of periodontal disease
John W. Riggs (1811-85) - periodontitis or alveolar
pyorrhea was known as ‘Riggs disease’ and he have
been first individual to limit his practice to
periodontics.
6
9. AAP 1999
• Chronic periodontitis
Generalised
Localised
• Aggressive periodontitis-
Generalised
Localised
• Periodontitis as a manifestation of systemic diseases
9
10. Change in terminology……….?
(Wiebe et al 2000)
Age-dependent nature of the adult periodontitis designation was felt to be somewhat
arbitrary as similar bone loss patterns can also be seen in adolescents and even in the
primary dentition of children.
Another difficulty lay in the fact that the age at which a patient presents for treatment does
not necessarily reflect the age at which the disease began.
“Chronic” periodontitis refers to progression of the disease over time without treatment
and does not suggest that the disease is “untreatable
10
11. Prevalence
• NAHNES III (1988 – 1994) depends upon threshold chosen
eg. 1mm – 99%, 7mm – 7%
But for 3mm – 53.1%
Gupta(1962) Sample-800,
Russell’s Index, Bombay
Age 11 to 30 years- 90%PD
Age 30 years plus- 100% PD
11
12. Clinical features
• Supra and subgingival plaque accumulation (frequently associated with calculus)
• Gingival inflammation
• Pocket formation
• Loss of periodontal attachment
• Occasional suppuration
• Poor oral hygiene – gingiva is typically may be slightly to moderately swollen12
13. • Color- pale red to magenta
• Consistency – soft or firm
• Surface topography – loss of stippling
• Blunted or rolled gingival margin
• Flattened or cratered papillae.
• Furcation
• Tooth mobility
13
14. Attachment loss with and without deep PD
Pocket depths are variable, and both horizontal and vertical bone loss can be found
14
15. • Furcation involvement in the molars
are common in advance cases of
chronic periodontitis.
• Tooth mobility often appears in
advanced cases when bone loss has
been considerable.
15
16. SYMPTOMS
Bleeding gums during brushing or eating
Increasing spacing between their teeth
Loose teeth
Usually painless, but sometimes localized dull pain radiating deep into the jaw
Sensitivity due to exposed roots
Food impaction
Halitosis
Gingival tenderness or itching
16
17. DISEASE DISTRIBUTION
• Chronic periodontitis is considered a site-specific disease.
• The clinical sign of Chronic periodontitis , namely inflammation pocket
formation, attachment loss, and bone loss are considered to be due to the
direct, site specific effect of subginigival plaque accumulation.
• It may occur on one surface and other may be free of symptom.
17
18. In addition to being site specific, chronic periodontitis may be described as
being localized when few sites demonstrate attachment and bone loss or generalized
when many sites around the mouth are affected.
18
19. Disease Severity
• Slight (mild) periodontitis: Periodontal destruction is generally
considered slight when no more than 1 to 2 mm of clinical
attachment loss has occurred.
• Moderate periodontitis: Periodontal destruction is generally considered
moderate when 3 to 4 mm of clinical attachment loss has
occurred.
• Severe periodontitis: Periodontal destruction is considered severe when 5
mm or more of clinical attachment loss has occurred.
19
21. Disease Progression
• The rate of disease progression is usually slow but may be modified by
systemic and/or environmental and behavioral factors.
• Chronic periodontitis does not progress at an equal rate in all affected sites
throughout the mouth.
• Rapidly progressive lesions occur most frequently in interproximal areas' and
are usually associated with areas of greater plaque accumulation and
inaccessibility to plaque control measures (e.g., furcation areas, overhanging
margins, sites of malposed teeth, or areas of food impaction).
21
23. • Several models have been proposed to describe the rate of disease
progression.
• In these models, progression is measured by determining the amount of
attachment loss during a given period, as follows-
1. The Continuous Model.( SOCRANSKY et al 1984)
2. The Random Model or Episodic Burst Model.
3. The Asynchronous, Multiple-Burst Model. 23
25. RISK FACTORS
Risk - is the probability that an individual will get a specific disease in a given
period. The risk of developing the disease will vary from individual to
individual.
Risk factor - is a characteristic, an aspect of behavior, or an environmental
exposure that is associated with destructive periodontitis
25
26. RISK FACTORS FOR DISEASE
• Prior History of Periodontitis
• Local Factors
• Systemic Factors
• Environmental and Behavioral Factors
• Genetic Factors
26
27. Prior History Of Periodontitis
Although not a true risk factor for disease but rather a disease predictor, a
prior history of periodontitis puts patients at greater risk for developing further
loss of attachment and bone, given a challenge from bacterial plaque
accumulation.
27
31. ROLE OF MICROBES
• Dental plaque is composed primarily of bacteria. One gram of plaque (wet weight)
contains approximately 1011 bacteria.
• In a periodontal pocket,
Healthy crevice - 103 bacteria.
Deep pocket - 108 bacteria.
• Nonbacterial microorganisms that are found in plaque include Mycoplasma species,
yeasts, protozoa, and viruses. 31
32. Significance Of Microbial Community
These include:
(a) A broader habitat range for growth.
(b) An increased metabolic diversity and efficiency.
(c) An enhanced resistance to environmental stress, antimicrobial agents and the
host defenses.
Shapiro (1998), Marsh & Bowden (2000).
32
34. World Workshop in Periodontology consensus
report 1996
Designated as A .A comitans , P. gingivalis & B. forsythus as
periodontal pathogens.
34
35. ROLE OF VIRUSES
• More recently, viruses including cytomegalo , Epstein Barr, Papilloma and
herpes simplex have been proposed to play a role in the etiology of
periodontal diseases, possibly by changing the host response to the local
subgingival microbiota.
(Contreras & Slots 2000).
35
36. ROLE OF FUNGI
• Hannula J, Dogan B, Slots (2001) showed geographical differences in the
subgingival distribution of C. albicans serotypes and genotypes and suggested
geographic clustering of C. albicans clones in Subgingival samples of Chronic
Periodontitis patients.
36
37. Systemic and environmental risk factors
Uncontrolled diabetes mellitus (types I and II)
Smoking
Emotional stress
Oral hygiene habit
Environmental factor and Nutrition
Osteoporosis
HIV
37
39. DIABETES
• Diabetes mellitus is a disease of metabolic dysregulation.
• About 37-40million Indians have diabetes and is expected to double
by 2025. India is having maximum number of diabetic patients.
39
40. Microvascular changes
Hyperglycemia
Glycosylation of
basement membrane
proteins
Thickening of
basement membrane
Altered structural
and physical
properties of BM
Disruption of
collagen fibers in
BM, swelling of
endothelium
Impedes oxygen diffusion,
metabolic waste elimination,
PMN migration diffusion of
serum factor including antibodies
Susceptible to
infection
Brownlee et al 1994
40
42. SMOKING
• Undoubtedly one of the main and most prevalent, risk factors for
chronic periodontitis, risk calculations suggesting 40% of the cases of
chronic periodontitis may be attributable to smoking.
• It has been estimated that there are 1.1 billlion are smokers worldwide
and 182 million (16.6%) of them live in India.
42
43. • The International Classification of Disease (ICD-10) has
recognized that “Tobacco Dependence” is a disease .
• The negative effect of cigarette smoking on the
Periodontium is Cumulative and Dose dependent. (Sreedhar,
Shobha P 2006)
43
44. MECHANISM
Vascular alterations
Altered neutrophil function
Decreased IgG production
Decreased lymphocyte proliferation
Increased prevalence of periopathogens
Altered fibroblast attachment and function
Difficulty in eliminating pathogens by mechanical therapy
Negative local effects on cytokine and growth factor products 44
47. NUTRITION
Vitamin C or ascorbic acid is essential for the formation of collagen and intercellular
material, bone and teeth.
Anti oxidant that reduces free radicals that cause DNA damage to immune cells.
↓ phagocytic function of neutrophils and macrophages
↓ antibody response
↓ cytotoxic T-cell activity
47
48. AGE
Both the prevalence and severity of periodontal disease increases with age.
(Burt 1994, Papapanou 1994, 1998).
• Lindhe (1991, 1992) – minimal loss of attachment in aging subjects enrolled
in preventive programs throughout their lives.
Intake of medications,
Decreased immune function, and
Altered nutritional status interaction
48
49. GENDER
• United States national surveys..
• Abdellatif et al (1987) have shown that males have poorer oral hygiene…
• Gender differences in prevalence and severity of chronic periodontitis are
related to preventive practices rather than any genetic factor.
49
50. RACE
• In USA – prevalence, severity and extent of chronic periodontitis is more in
Black, intermediate in Mexican African and least in Whites.
CAL
• Whites – more on facial aspect and associated with gingival recession.
• Blacks – interproximal areas
50
51. OSTEOPOROSIS
• It is a disease characterized by low bone mass and deterioration of bone
structure that causes bone fragility and increases the risk of fracture.
• A direct association between skeletal and mandibular osteopenia and
destructive periodontal disease as measured by loss of interproximal
alveolar bone in postmenopausal women has been reported.
(Wactawski-Wende and coworkers 1996)
51
52. • Studies in animal models indicate that osteoporosis does not initiate
periodontitis, there is evidence that the reduced bone mass seen in
osteoporosis may aggravate periodontal disease progression
(Krook 1975, Aufdemorte 1993).
• Both osteoporosis and periodontal diseases are bone resorptive
diseases……hypothesized that osteoporosis could be a risk factor for the
progression of chronic periodontal disease.
52
53. HIV
AIDS epidemics in US suggests HIV positive patients
especially those with AIDS and low count of T
Lymphocytes(CD4 <200 cells/ml) were at increased risk
of chronic periodontitis.
Recent – HIV infection alone does not increases the risk
for periodontitis.
(Smith et al 1995) 53
54. GENETICS
• Multifactorial disease………………..?
• Twin studies – it has familial component but transmission of bacteria among
family members and due to common environmental factors it is difficult to
interpret.
• Polymorphism in genes encoding for IL-1alpha and beta is associated with
aggressive form of chronic periodontitis in Northen America.
(Korman1998)
54
64. Clinical diagnosis
• Clinical parameters, such as pocket probing depths, bleeding on probing
(BOP) and suppuration (Badersten et al. 1985) or micro- biological
parameters using dark-field microscopy (Listgarten & Levin 1981, Listgarten
& Schifter 1982) with or without adjunctive culturing techniques (Rosling et
al. 1984) as indicator tests for disease "activity".
64
65. DISEASE ACTIVITY
Consistent with the view of periodontitis as a highly localized infection of the
periodontium, disease activity is perceived as the condition under which
periodontal attachment loss increases abruptly at discrete sites over a relatively
short period of time in a small percentage of sites (Socransky et al 1984).
65
67. Probing pocket depth– walking of probe.
G.V.Black was first to describe systematic use of probe to explore periodontal
pocket.
Periodontal probing is done on all surfaces of every tooth in the dentition.
During probing, a thin periodontal probe should be used with gentle pressure
and it should be ‘‘walked’’ around the entire circumference of each tooth.
67
68. • Increased probing depth and loss of clinical attachment are pathognomonic
for periodontitis.
• Therefore, pocket probing is a crucial and mandatory procedure in
diagnosing periodontitis and evaluating periodontal therapy.
• Reduction of pocket depth and gain of clinical attachment are the major
clinical outcome measurements used to determine success of treatment.
68
69. • Although recent increases in probing depth and clinical attachment loss are
evidence of disease activity in the recent past, but not necessarily of on
going disease, they are highly indicative of diseased pockets, active lesions,
and further loss of attachment.
69
70. Clinical attachment loss
• Clinical attachment loss is the distance from the cemento-enamel junction to
the apical extent of the pocket and represents the best clinical measure of
disease severity in terms of loss of support for the teeth.
• Clinical attachment level greater than 1 mm should be considered in
establishment of periodontitis.
• Ramfjord et al. proposed that loss of attachment was considered the best
measure of disease progression.
70
71. • Gingival recession is recorded during periodontal probing as the
distance of the free gingival margin to the cemento-enamel junction .
• Miller’s classification is widely accepted classification to determine the
gingival recession:
• Class I: Recession that does not extend to the mucogingival junction
and is not associated with loss of bone or gingival tissue in the
interdental area;
• Class II: Recession that extends to the mucogingival junction and is
not associated with loss of bone or soft tissue in the interdental area;
• Class III: Recession that extends to or beyond the mucogingival
junction with loss of bone or soft tissue in the interdental area; and
• Class IV :Recession extending to or beyond the mucogingival
junction with severe loss of inter- dental bone and/or soft tissue
and/or severe tooth malposition.
71
72. BLEEDING ON PROBING
• Gingival bleeding has universally been considered an
indicator of gingival inflammation and by some investigation,
an indicator of disease activity (Polson 1985).
• Although bleeding on probing alone …………may serve as
an excellent predictor for future loss of attachment.
• Lack of bleeding on probing does appear to serve as an
excellent indicator of periodontal health.
72
73. • Lang NP and Joss A et al (1986) reported Bleeding on probing is A
predictor for the progression of periodontal disease.
• They reported that pockets with a probing depth of > 5 mm had a
significantly higher incidence of BOP.
• They conclude that BOP is a limited but yet useful prognostic indicator in
clinical diagnosis for patients in periodontal maintenance phase.
73
74. SUPPURATION
• Gingival suppuration : weak predictor of active periodontal destruction, but
better than bleeding.
• Suppuration upon probing is associated with probing attachment loss.(Anita
Bmjersten 1985)
Journal of Clinical Periodontology 1985: 12: 432-4074
75. • A strong association with the risk of disease progression was reported by
Armitage et al (1994).
• The sites with suppuration at baseline (25% of the total sites) were at a
threefold higher risk of further bone loss during the following 6 months.
75J Periodontol.1994 Feb;65
76. SUBGINGIVAL TEMPERATURE
• Elevated temperature is one of 4 cardinal inflammatory signs.
• Subgingival temperature is thought to directly reflect the subgingival
inflammatory state (Hoithius et al. 1981)
• In a study by Fedi and Killoy (1992), the temperature of pockets more than
5mm deep with bleeding on probing was 1.00C to 1.80C higher than that of
pockets less than 3mm deep without bleeding.
76
77. • Haffajee et al used this probe to asses its predictability in identifying loss of
attachment, concluding that sites with a red (higher) temperature indication
had more than twice the risk for future attachment loss than did those with a
green indication.
• Subgingival temperature like other signs of inflammation has good specifity
but poor sensitivity when considered as marker for progressive periodontitis
77
78. MOBILITY
• Tooth mobility is a clinical expression of periodontitis.
• Many attempts have been made to develop mechanical or electronic
devices for the precise measurement of tooth mobility.
• Mobility is graded clinically by holding the tooth firmly between the
handles of two metallic instruments or with one metallic instrument
and one.
• An effort then is made to move it in all directions. Abnormal mobility
most often occurs facio-lingually.
78
79. Mobility is graded according to the ease and extent of tooth movement as
follows:
• Normal mobility
• Grade I: Slightly more than normal.
• Grade II: Moderately more than normal.
• Grade III: Severe mobility faciolingually and/or mesiodistally, combined
with vertical displacement
79
80. • Device to check mobility – Periotest
Ranges:
-8 to +9 : Clinically firm tooth
10-19 : Palpable mobility
20-29: Visible mobility
30-50 : Mobility in response to lip & tongue
movements
80
81. FURCATION
• It is important to document furcation involvement because
teeth with periodontal pockets in furcation have been shown
to have increased loss of attachment and a poorer prognosis
following periodontal therapy than teeth without furcation
involvement. (McGuire MK, J Periodontol 1996)
• Furcation can be probed with naber’s probe to determine
extension of pockets into areas between roots.
81
82. Pathological tooth migration
82
Pathological tooth migration is a characteristic sign of
an advanced form of chronic periodontitis.
Microbial plaque-induced periodontal infection is
considered to be the most common causative factor.
Kim et al., In 2012.
He observed that no single factor is associated with
PTM, but the primary factor is periodontal bone loss.
83. Radio graphical Diagnosis
Widening of PDL space
Loss of corticated interdental crestal margin
Localised or generalized loss of alveolar supporting bone.
Blunting of the alveolar crest due to beginning of bone resorption
Bone loss may be either horizontal or vertical.
83
85. • Numerous cross sectional and longitudinal epidemiologic studies have used
radiographs as the principal method of determining the presence or absence
of periodontal destruction.
• The primary criterion for bone loss in these studies was the distance from
the cementoenamel junction (CEJ) to the alveolar crest, The threshold
distance of bone loss has varied from 1 mm to 3 mm, although most of the
studies have used > 2 mm as the criterion for bone loss.
85
87. 87
Quantitative.
Highly sensitive method capable of analyzing a single periodontal site in health as well as disease.
Reproducible.
Highly specific.
Simple to perform.
A rapid, one or two stage procedure.
Non-invasive.
Versatile in terms of sample handling, storage and transport.
Amendable to chairside use.
Economical.
THE IDEAL DIAGNOSTIC TEST SHOULD BE
88. Chairside periodontal test kits can be categorized as
88
Microbiological test
kits
Biochemical test kits Genetic kits
89. Various chair side kits
PERIOSCAN
(Perioscan requires a plaque sample to detect the presence
of enzymes capable of degrading N-benzoyl-DL-arginine-
2-naphthylamide (BANA) from relatively few anaerobic
periodontal pathogens)
89
90. • POCKET- WATCH (Periodontal Tissue Monitor System)
The Pocket Watch detects elevated levels (>1200IU) of Aspartate
Aminotransferase (AST) in GCF and is used as an objective, biochemical test
for diagnosing & monitoring the disease activity, to determine when to treat,
and also to evaluate the treatment effectiveness.
• PERIOCHECK
This system (Pro Dentec Bates ville) detects the presence of neutral proteinases
such as collagenase in GCF
90
91. • PROGNOSTIK [Dentsply]
It detects the presence of serine proteinase and elastase in
GCF samples.
• PERIOGARD [Colgate]
It detects the presence of Aspartate Aminotransferase in GCF
sample.
• EVALUSITE
This chair side immunoassay detects periodontal pathogens
such as Aa commitans , P gingivalis , P intermedia .
91
92. • CRP LATEX KIT
C- Reactive Protein (CRP) latex slide test (Serology kit) is
used for the qualitative and semi-quantitative measurement
of C-reactive protein (CRP) in human serum.
• Topas- I (Toxicity Pre Screening Assay)
• Introduced to detect two markers of infection:
Increased levels of bacterial toxins.
Increased levels of human inflammatory proteins &
bacterial proteins
92
93. • PERIODONTAL SUSCEPTIBILITY
TEST, IL GENETICS INC.
WALTHAM.MASS
Detects the presence of a specific form of 2 IL
genes; Allele 2 at IL1A+4845 & IL1B+3954.
Test also used to correlate the IL-1 production
with other clinical parameters; BOP, Bone &
attachment loss and tooth & implant loss.
93
94. • BIOLISE
Recently a software has been made Biolise [SLT-Lab instruments, Craitsheim,
Germany] which is used to detect the elastase activity in GCF.
[Hermann et al 2001].
• GLUCOMETER
It is used for Blood glucose measurements using gingival crevicular blood.
94
95. PROGNOSIS
• Slight-to-moderate periodontitis, the prognosis is generally good, provided
the inflammation can be controlled through good oral hygiene and the
removal of local plaque-retentive factors .
• In patients with more severe periodontitis, as evidenced by furcation
involvement and increasing clinical mobility, or in patients who are
noncompliant with oral hygiene practices, the prognosis may be downgraded
to fair to poor.
95
96. TREATMENT PLANNING
96
Treatment for periodontitis generally falls into two
categories:
1) Procedures designed to halt the progression of disease.
2) Procedures designed to regenerate structures destroyed
by disease.
Pihlstrom BL, Committee of the American Academy of Periodontology. J Periodontol 1997: 68
98. Successful periodontal therapy is dependent on anti-
infective procedures aimed at eliminating pathogenic
organisms found in dental plaque associated with the
tooth surface and within other niches in the oral
cavity.
98
Slots J. Subgingival microflora and periodontal disease. J Clin Periodontol 1979: 6: 351–382
99. • Since periodontal disease is a plaque-induced infection and most patients are
not skilled in mechanical plaque removal, professional cleaning is almost
universally indicated to sustain long-term stability of the periodontium .
• Anti-infective therapy includes both mechanical and chemotherapeutic
approaches to minimize or eliminate microbial biofilm (bacterial plaque), the
primary etiology of gingivitis and periodontitis..
99
101. • Mechanical therapy consists of debridement of the roots by the meticulous
use of hand or power-driven scalers to remove plaque, endotoxin, calculus
and other plaque-retentive local factors.
• The term mechanical therapy refers to both supra-gingival and sub-gingival
scaling as well as root planing.
101
102. • The term periodontal debridement was suggested by Smart et al. to describe
the light overlapping strokes used for instrumenting the root with a sonic or
ultrasonic scaler.
• The endpoint of all periodontal debridement is to produce a root that is
biologically acceptable for a healthy attachment.
102
103. • Numerous studies since the 1950’s have indicated that manual instrument
tation in general takes from 20% to 50% longer to achieve the same clinical
end-points than that of sonic and/or ultrasonic scalers (Badersten A et al
1981).
• When manual instrumentation or sonic/ultra- sonic scalers are used for the
treatment of the sub- gingival pockets, profound shifts in the composition
of the microbial flora are observed (Bollen CML et al 1998)
103
104. • Mechanical therapy is usually the first mode of treatment recommended for
most periodontal infections (Cobb CM.1996)
• The American Academy of Periodontology 1996 World Workshop
consensus report states that ultrasonic and sonic instrumentation have
shown similar clinical effects as manual scaling and root planing.
104
105. • According to recent systematic reviews (Tunkel et al. 2002, van der Weijden
& Timmerman 2002, Hallmon & Rees 2003), there is no major difference in
the efficacy of debridement techniques using hand or power-driven
instruments in terms of pocket reduction and gain in clinical attachment.
• While Tunkel et al. (2002) concluded, based on their systematic review, that
the use of ultrasonic/sonic devices requires less treatment time than manual
instrumentation,
105
106. • The traditional modality as an initial periodontal treatment phase has been to
perform scaling and root planing by jaw quadrant (Q-SRP) at a series of
appointments (Badersten et al. 1984).
• More recently, Quirynen et al. (1995) advocated the benefit of performing
full- mouth SRP within 24h in order to prevent re-infection of the treated
sites from the remaining untreated periodontal pockets.
106
108. Chemotherapeutic approaches include topical
application of antiseptics or sustained-release local
drug delivery agents that are designed to prevent
plaque accumulation and to disinfect the root
surfaces and adjacent periodontal tissues.
108
109. Rationale for adjunctive topical or systemic
antimicrobial agents
Mechanical therapy alone may not effectively control infection, particularly in deep
pockets.
Poor plaque control increases the rate of reinfection of the pocket
Root surface, tongue, tonsils and within other niches in the oral mucosa harbor
pathogenic bacteria that recolonize the periodontal pocket and can act as sources for
reinfection
Actinobacillus actinomycetemcomitans and other tissue-invasive organisms are not easily
irradicated without concomitant antibiotic therapy
109
110. • Vandekerckhove et al. were among the first to report a new innovative
treatment for periodontal infections using a partial-mouth disinfection
protocol that consisted of a thorough supragingival and subgingival
chlorhexidine application (rinses, irrigation and tongue brush) followed by
four quadrants of scaling and root planing within 24 hours.
110
111. • Antimicrobial products such as mouthrinses containing essential oils,
triclosan or chlorhexidine are also useful adjuncts to brushing and flossing in
gingivitis and periodontitis patients and can reduce plaque accumulation and
gingivitis by 0–75% .
111
112. • In disease sites that are more difficult to control, local drug delivery devices
such as chlorhexidine chips (PerioChipTM) or 10% doxycycline gel (Atri-
doxTM) may be placed directly adjacent to the infected site.
• By placing an antibiotic or antiseptic in direct contact with the root surface,
pathogenic organisms that were not accessible to mechanical removal by
hand or power-driven instruments can be reduced or eliminated.
112
113. • Radvar et al. and Kinane et al. compared three types of local delivery
devices, tetracycline fiber, metronidazole gel, and minocycline gel in
combination with scaling and root planing, to scaling and root planing alone.
All treatments improved attachment levels over the 6-month testing period,
but there were no significant differences between treatment.
113
114. • Another new nonsurgical approach includes using a systemic
subantimicrobial dose of doxycycline (PeriostatA) that targets tissue
breakdown by blocking bacterial and host-derived enzymes associated with
loss of alveolar bone and connective tissue .
• Ashley has reported in a summary of several studies that as an adjunct to
either scaling or root planing or supra-gingival scaling and dental prophylaxis,
subantimicrobial doses of doxycycline were shown to reduce collagenase
levels in both gingival crevicular fluid and gingival biopsies.
114
116. • Nonsurgical therapy is performed prior to surgical treatment for periodontitis.
Surgery is indicated where nonsurgical methods fail.
• Advantages of periodontal surgery :
Improved visualization of the root surface
More accurate determination of prognosis
Improved pocket reduction or elimination
Improved regeneration of lost periodontal structures
An improved environment for restorative dentistry
Improved access for oral hygiene and supportive periodontal treatment
116
117. • Pocket elimination procedures gave the greatest probing depth
reduction.
• Pocket elimination was defined as gingivectomy or a flap
procedure with or without osseous re-contouring.
117
119. CONCLUSION
• Chronic periodontitis an infectious disease resulting in
inflammation with in supporting tissues of the teeth,
progressive attachment loss and bone loss”. With all
emerging technologies, a successful diagnosis and
treatment will only be achieved through open sharing of
ideas, research findings and thorough testing .
119
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121