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ImportantValues to
remember in
Periodontology
Dr Aishwarya Pandey
MDS, IMS, BHU
https://www.linkedin.com/in/dr-aishwarya-pandey-63095b1aa
https://instagram.com/conundrums_of_life?igshid=OGQ5ZDc2ODk2Z
A==
• Ideal depth of gingival sulcus= 0 mm
• Histologic depth of gingival sulcus=1.8 mm (as
determined by histologic sections of gingival sulcus)
• Clinical probing depth = 2-3 mm (the estimation of the
distance of apical penetration by a periodontal probe
with as measured from gingival margin)
Clinical probing depth
Values important from clinical perspective
• Clinical attachment level
Recession +
Overgrowth -
• Critical probing depth
• This concept was given by Lindhe et al, 1982.
• The critical probing depth represents a baseline probing-depth
value above which the outcome of a therapy will result in
attachment gain and below which the outcome of therapy will
result in clinical attachment loss.
• The critical probing depth for nonsurgical therapy (scaling
and root planing) is 3 mm (2.9 mm).
• For the access flap therapy, the critical probing depth is 5.4
mm.
• This, means that flap surgery is indicated predominantly with a
probing depth of 5.4 mm, while between 2.9 mm and 5.4 mm,
nonsurgical therapy is to be preferred.
• Biologic width = 2 mm (the physiologic dimension of the
junctional epithelium and connective tissue attachment)
*peri-implant biologic width= 4 to 4.5 mm
• Infringement on the biologic width by the placement of a
margin of a restoration within its zone may result in gingival
inflammation, pocket formation, and alveolar bone loss.
• So, it is recommended that there be at least 3 mm between
the gingival margin and bone crest.
• This allows for adequate biologic width when the restoration is
placed 0.5 mm within the gingival sulcus.
Greater than 3 mm of soft tissue
between the bone and gingival
margin, with adequate attached
gingiva, allows crown lengthening by
gingivectomy
With less than 3 mm of soft tissue
between the bone and gingival margin,
or less-than-adequate attached gingiva, a
flap procedure and osseous
recontouring are required for crown
lengthening.
Crown Lengthening
• Restoration Margin Placement
• Rule 1: If the sulcus probes 1.5 mm or less, place the
restoration margin no more than 0.5 mm below the
gingival tissue crest. (Most common)
• Rule 2: If the sulcus probes more than 1.5 mm, place the
margin no more than half the depth of the sulcus below
the tissue crest.
• Rule 3: If a sulcus greater than 2 mm is found,
gingivectomy to be performed to lengthen the teeth and
create a 1.5-mm sulcus. Then the patient can be treated
using rule 1.
• Surgical Blades
• The #12D blade = to engage narrow, restricted areas with
both pushing and pulling cutting motions. (*has cutting
edges on both the sides, beak shaped)
• The #15 blade = for thinning the flaps and is also used for
general purposes.
• The #15C blade= for making the initial, scalloping-type
incision. (narrower version of the #15 blade)
• Gracey curettes
1. Gracey #1-2 and #3-4 Anterior teeth
2. Gracey #5-6 Anterior teeth and
premolars
3. Gracey #7-8 and #9-10 Posterior teeth,
facial and lingual
4. Gracey #11-12 Posterior teeth,
mesial
5.
Gracey #13-14
Posterior teeth,
distal
Blade angulation.
(A) 0 degrees: correct angulation for blade insertion.
(B) 45 to 90 degrees: correct angulation for scaling and root planing.
(C) Less than 45 degrees: incorrect angulation for scaling and root planing.
(D) More than 90 degrees: incorrect angulation for scaling and root planing,
but correct angulation for gingival curettage.
• Important frequencies
• Electrosurgery =1.5 to 7.5 million cycles per second
(megahertz).
• Sonic =2000 to 6500 cycles per second (Hertz)
• Ultrasonic =18,000 to 50,000 cycles per second (Hertz)
• Piezoelectric primary ultrasonic frequency 24-36 kHz
secondary sound frequency 30-6- Hz
• The objective of sharpening is to restore the fine, thin, linear
cutting edge of the instrument.
• India and Arkansas oilstones are examples of natural
abrasive stones. Carborundum, ruby, and ceramic stones are
synthetically produced.
• Angle between sharpening stone and face of the blade=
100-110° (angle between the face of the blade and the lateral surface of
any curette is 70 to 80 °)
Instrument sharpening
• Dental Implant considerations
• Implant should be placed buccolingually so there is at least 2 mm
of bone circumferentially around it
• Distance between implant and natural tooth= 1.5 mm
• Inter-implant distance=3 mm
• Violation of biologic width around an implant can lead to bone
loss. Improperly spaced implants invariably lead to chronic
inflammation and periimplantitis.
• Implants that are placed too close to each other or to natural
teeth can be difficult to restore.
• Implant placed at an excessive distance from an adjacent tooth or
implant may require prosthetic compensation in the form of
mesial or distal cantilevers, which can predispose the implant to
biologic (i.e., bone loss) and mechanical (i.e., screw loosening,
screw fracture, and implant fracture) complications and
difficulties with hygiene.
• Apicocoronally, the implant should be placed so the platform is
about 3 mm apical to the gingival margin of the anticipated
restoration
• Implant platform is placed too far coronally= there will not be
sufficient room to develop a natural-looking emergence
profile; unaesthetic appearance; exposure of implant collar
• At or above the level of the gingival margin= metal collar or
implant exposure can occur.
• Too far apical= a long transmucosal abutment will be necessary
to restore the implant.This can lead to a deep pocket and
difficult hygiene access for the patient and clinician.
• Wavelength of Lasers commonly employed (nm)
The wavelengths of light used for LLLT (low level laser therapy) = 600–1070
nm
(It is referred to as “low level” because the density of light energy is low
compared with other lasers; promote wound healing by reducing inflammation,
enhancing epithelialization, fibroblast proliferation, and matrix synthesis, as
well as neovascularization)
*Exposure of bone to temperatures ≥47°C =cellular damage and osseous
resorption.
≥60°C = tissue necrosis
Stages of Gingivitis
Values important from disease perspective
• Radius of Action
• Garant and Cho suggested that locally produced bone
resorption factors may need to be present in the proximity
of the bone surface to exert their action.
• Page and Schroeder, postulated a range of effectivenessof
about 1.5 mm to 2.5 mm in which bacterial biofilm can
induce loss of bone.
• Chronic periodontitis
• Localized form: 30% of teeth involved
• Generalized form: >30% of teeth involved
• Mild: 1 to 2 mm clinical attachment loss (CAL)
• Moderate: 3 to 4 mm CAL
• Severe: ≥5 mm CAL
• Healing after Gingivectomy
A. Connective tissue components
• The initial response = formation of a protective surface blood
clot. (occurs within minutes)
• The clot is then replaced by granulation tissue in next few hours.
• In 24 hours= an increase occurs in new connective tissue cells,
which are mainly angioblasts beneath the surface layer of
inflammation and necrotic tissue.
• By the third day, numerous young fibroblasts are located in the
area.
• Vasodilation and vascularity begin to decrease after the fourth
day of healing, and they appear to be almost normal by the 16th
day.
• Complete repair of the connective tissue = 7 weeks
B. Epithelial components
• 12 to 24 hours= epithelial cells at the margins of the wound begin
to migrate over the granulation tissue, thereby separating it from
the contaminated surface layer of the clot. (The epithelial cells
advance by a tumbling action, with the cells becoming fixed to
the substrate by hemidesmosomes )
• Epithelial activity at the margins reaches a peak after 24 to 36
hours.
• After 5 to 14 days= completion surface epithelialization
• Complete epithelial repair takes about 1 month.
• 24 hours= a thick connection between the flap and the
tooth or bone surface is established by a blood clot
• 1- 3 days after flap surgery= the space between the flap
and the tooth or bone is thinner. Epithelial cells migrate
over the border of the flap, and contact the tooth at this
time.
• One week after surgery= an epithelial attachment to
the root has been established by means of
hemidesmosomes and a basal lamina. The blood clot is
replaced by granulation tissue derived from the gingival
connective tissue, the bone marrow, and the periodontal
ligament.
• Two weeks after surgery= collagen fibers begin to
appear parallel to the tooth surface.
• One month after surgery= a fully epithelialized gingival
crevice with a well-defined epithelial attachment is
present.
Thank you!

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Important values to remember in periodontology.pptx

  • 1. ImportantValues to remember in Periodontology Dr Aishwarya Pandey MDS, IMS, BHU https://www.linkedin.com/in/dr-aishwarya-pandey-63095b1aa https://instagram.com/conundrums_of_life?igshid=OGQ5ZDc2ODk2Z A==
  • 2. • Ideal depth of gingival sulcus= 0 mm • Histologic depth of gingival sulcus=1.8 mm (as determined by histologic sections of gingival sulcus) • Clinical probing depth = 2-3 mm (the estimation of the distance of apical penetration by a periodontal probe with as measured from gingival margin) Clinical probing depth Values important from clinical perspective
  • 5. • Critical probing depth • This concept was given by Lindhe et al, 1982. • The critical probing depth represents a baseline probing-depth value above which the outcome of a therapy will result in attachment gain and below which the outcome of therapy will result in clinical attachment loss. • The critical probing depth for nonsurgical therapy (scaling and root planing) is 3 mm (2.9 mm). • For the access flap therapy, the critical probing depth is 5.4 mm. • This, means that flap surgery is indicated predominantly with a probing depth of 5.4 mm, while between 2.9 mm and 5.4 mm, nonsurgical therapy is to be preferred.
  • 6.
  • 7. • Biologic width = 2 mm (the physiologic dimension of the junctional epithelium and connective tissue attachment) *peri-implant biologic width= 4 to 4.5 mm
  • 8. • Infringement on the biologic width by the placement of a margin of a restoration within its zone may result in gingival inflammation, pocket formation, and alveolar bone loss. • So, it is recommended that there be at least 3 mm between the gingival margin and bone crest. • This allows for adequate biologic width when the restoration is placed 0.5 mm within the gingival sulcus.
  • 9. Greater than 3 mm of soft tissue between the bone and gingival margin, with adequate attached gingiva, allows crown lengthening by gingivectomy With less than 3 mm of soft tissue between the bone and gingival margin, or less-than-adequate attached gingiva, a flap procedure and osseous recontouring are required for crown lengthening. Crown Lengthening
  • 10. • Restoration Margin Placement • Rule 1: If the sulcus probes 1.5 mm or less, place the restoration margin no more than 0.5 mm below the gingival tissue crest. (Most common) • Rule 2: If the sulcus probes more than 1.5 mm, place the margin no more than half the depth of the sulcus below the tissue crest. • Rule 3: If a sulcus greater than 2 mm is found, gingivectomy to be performed to lengthen the teeth and create a 1.5-mm sulcus. Then the patient can be treated using rule 1.
  • 11. • Surgical Blades • The #12D blade = to engage narrow, restricted areas with both pushing and pulling cutting motions. (*has cutting edges on both the sides, beak shaped) • The #15 blade = for thinning the flaps and is also used for general purposes. • The #15C blade= for making the initial, scalloping-type incision. (narrower version of the #15 blade)
  • 12. • Gracey curettes 1. Gracey #1-2 and #3-4 Anterior teeth 2. Gracey #5-6 Anterior teeth and premolars 3. Gracey #7-8 and #9-10 Posterior teeth, facial and lingual 4. Gracey #11-12 Posterior teeth, mesial 5. Gracey #13-14 Posterior teeth, distal
  • 13. Blade angulation. (A) 0 degrees: correct angulation for blade insertion. (B) 45 to 90 degrees: correct angulation for scaling and root planing. (C) Less than 45 degrees: incorrect angulation for scaling and root planing. (D) More than 90 degrees: incorrect angulation for scaling and root planing, but correct angulation for gingival curettage.
  • 14. • Important frequencies • Electrosurgery =1.5 to 7.5 million cycles per second (megahertz). • Sonic =2000 to 6500 cycles per second (Hertz) • Ultrasonic =18,000 to 50,000 cycles per second (Hertz) • Piezoelectric primary ultrasonic frequency 24-36 kHz secondary sound frequency 30-6- Hz
  • 15. • The objective of sharpening is to restore the fine, thin, linear cutting edge of the instrument. • India and Arkansas oilstones are examples of natural abrasive stones. Carborundum, ruby, and ceramic stones are synthetically produced. • Angle between sharpening stone and face of the blade= 100-110° (angle between the face of the blade and the lateral surface of any curette is 70 to 80 °) Instrument sharpening
  • 16. • Dental Implant considerations • Implant should be placed buccolingually so there is at least 2 mm of bone circumferentially around it • Distance between implant and natural tooth= 1.5 mm • Inter-implant distance=3 mm • Violation of biologic width around an implant can lead to bone loss. Improperly spaced implants invariably lead to chronic inflammation and periimplantitis. • Implants that are placed too close to each other or to natural teeth can be difficult to restore. • Implant placed at an excessive distance from an adjacent tooth or implant may require prosthetic compensation in the form of mesial or distal cantilevers, which can predispose the implant to biologic (i.e., bone loss) and mechanical (i.e., screw loosening, screw fracture, and implant fracture) complications and difficulties with hygiene.
  • 17. • Apicocoronally, the implant should be placed so the platform is about 3 mm apical to the gingival margin of the anticipated restoration • Implant platform is placed too far coronally= there will not be sufficient room to develop a natural-looking emergence profile; unaesthetic appearance; exposure of implant collar • At or above the level of the gingival margin= metal collar or implant exposure can occur. • Too far apical= a long transmucosal abutment will be necessary to restore the implant.This can lead to a deep pocket and difficult hygiene access for the patient and clinician.
  • 18. • Wavelength of Lasers commonly employed (nm) The wavelengths of light used for LLLT (low level laser therapy) = 600–1070 nm (It is referred to as “low level” because the density of light energy is low compared with other lasers; promote wound healing by reducing inflammation, enhancing epithelialization, fibroblast proliferation, and matrix synthesis, as well as neovascularization) *Exposure of bone to temperatures ≥47°C =cellular damage and osseous resorption. ≥60°C = tissue necrosis
  • 19. Stages of Gingivitis Values important from disease perspective
  • 20. • Radius of Action • Garant and Cho suggested that locally produced bone resorption factors may need to be present in the proximity of the bone surface to exert their action. • Page and Schroeder, postulated a range of effectivenessof about 1.5 mm to 2.5 mm in which bacterial biofilm can induce loss of bone.
  • 21. • Chronic periodontitis • Localized form: 30% of teeth involved • Generalized form: >30% of teeth involved • Mild: 1 to 2 mm clinical attachment loss (CAL) • Moderate: 3 to 4 mm CAL • Severe: ≥5 mm CAL
  • 22. • Healing after Gingivectomy A. Connective tissue components • The initial response = formation of a protective surface blood clot. (occurs within minutes) • The clot is then replaced by granulation tissue in next few hours. • In 24 hours= an increase occurs in new connective tissue cells, which are mainly angioblasts beneath the surface layer of inflammation and necrotic tissue. • By the third day, numerous young fibroblasts are located in the area. • Vasodilation and vascularity begin to decrease after the fourth day of healing, and they appear to be almost normal by the 16th day. • Complete repair of the connective tissue = 7 weeks
  • 23. B. Epithelial components • 12 to 24 hours= epithelial cells at the margins of the wound begin to migrate over the granulation tissue, thereby separating it from the contaminated surface layer of the clot. (The epithelial cells advance by a tumbling action, with the cells becoming fixed to the substrate by hemidesmosomes ) • Epithelial activity at the margins reaches a peak after 24 to 36 hours. • After 5 to 14 days= completion surface epithelialization • Complete epithelial repair takes about 1 month.
  • 24. • 24 hours= a thick connection between the flap and the tooth or bone surface is established by a blood clot • 1- 3 days after flap surgery= the space between the flap and the tooth or bone is thinner. Epithelial cells migrate over the border of the flap, and contact the tooth at this time. • One week after surgery= an epithelial attachment to the root has been established by means of hemidesmosomes and a basal lamina. The blood clot is replaced by granulation tissue derived from the gingival connective tissue, the bone marrow, and the periodontal ligament. • Two weeks after surgery= collagen fibers begin to appear parallel to the tooth surface. • One month after surgery= a fully epithelialized gingival crevice with a well-defined epithelial attachment is present.