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Hello everyone... I am Dr. Shravanthi, periodontist by profession. Please take a tour of my website periowiki.com. Periowiki is my initiative to help people learn about periodontology in detail. See you there.
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Radiographic aids in periodontal disease diagnosis part I
This document discusses the use of radiographs in diagnosing periodontal disease. It provides a brief history of using radiographs in dentistry and periodontics. Radiographs can reveal bone loss and destruction patterns but not current soft tissue changes. Standardized techniques are needed for accurate assessment over time. Early periodontitis may show fuzziness of the lamina dura or widening of the periodontal ligament space. More advanced disease appears as severe bone loss, fingerlike projections into the bone, or interdental bone craters. However, radiographs have limitations in depicting the full extent and morphology of bone defects.
Alveolar bone
The alveolar process forms the tooth sockets and supports the teeth. It consists of external cortical plates and internal cancellous trabeculae. Osteoblasts, osteocytes, and osteoclasts maintain the alveolar bone through remodeling. The alveolar bone develops with tooth eruption and is resorbed after tooth loss. It undergoes constant remodeling to withstand forces while maintaining form. The document provides detailed descriptions of the anatomical structures and cellular processes that comprise and maintain the alveolar bone.
Smoking effects on the periodontium
Smoking has various negative effects on the immune system's response to periodontal disease. It reduces the phagocytic activity and respiratory burst of neutrophils, impairs their migration and apoptosis. Smokers have increased T cell levels but reduced IgG2 and B cell antibody production. Natural killer cell activity and numbers are also lower in smokers. Regarding cytokines, smokers have higher TNF-alpha but lower IL-1 levels in gingival crevicular fluid. Overall, smoking causes both quantitative and qualitative defects in immune cells that compromise periodontal defense mechanisms.
Technological advances in dental implant surgery
This document discusses recent technological advances in dental implant surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM) technology and computer-guided implant surgery techniques. It describes computerized tomography (CT) imaging and how CT data can be used for virtual surgical planning and fabrication of surgical guides. The document compares computer-guided implant surgery (CGIS), which uses static surgical guides, to computer-navigated implant surgery (CNIS), which allows for intraoperative modification of the surgical plan. Both techniques aim to increase the accuracy and predictability of dental implant placement.
Aggressive periodontitis
The document discusses aggressive periodontitis, specifically localized aggressive periodontitis (LAP). It provides:
1) A historical background on LAP, formerly known as localized juvenile periodontitis, describing its identification and classification over time.
2) Key diagnostic criteria for LAP including an early age of onset typically around puberty, involvement of first molars and incisors, and a rapid rate of attachment loss and bone destruction.
3) Typical clinical characteristics of LAP such as minimal visible inflammation despite deep pockets and bone loss out of proportion to plaque levels. Radiographs often show vertical bone loss around first molars and incisors. Prevalence is typically below 1% with some studies finding higher rates in black males
Splinting
The document discusses splinting, including its history, definitions, aims, principles, indications, classifications, advantages, and disadvantages. Some key points:
- Splinting aims to immobilize and stabilize loose or mobile teeth by redistributing forces across multiple teeth.
- It has been used since ancient Egypt to stabilize teeth and fractures. Modern classifications include temporary, provisional, and permanent splints made of various materials.
- Indications include reducing tooth mobility from trauma, occlusal adjustment, or periodontal disease. Contraindications include active periodontal inflammation.
- Advantages are stabilizing teeth and tissues, but disadvantages include increased risk of decay and difficulties with oral hygiene.
Guided tissue regeneration
Guided tissue regeneration (GTR) aims to regenerate lost periodontal tissues by using barrier membranes to selectively prevent the migration of epithelial and gingival connective tissue cells to the root surface, allowing periodontal ligament cells to repopulate the area. The document discusses the history and development of GTR, the biological basis and concept behind using barrier membranes, characteristics of ideal GTR membranes, indications and contraindications for GTR, and outcomes from studies applying GTR in treating periodontal defects.
Furcation the problem and its management
The document discusses furcation involvement, which occurs when periodontal disease causes attachment loss that affects the bifurcation or trifurcation of multi-rooted teeth. It presents Glickman's classification of furcation defects into four grades based on the extent of bone loss and visibility of the furcation opening. Grade I is the earliest stage where only soft tissues are affected. Grade IV is the most advanced where bone is destroyed between roots, making the furcation opening visible. The classification schemes of Karthikeyan et al. (2015) and Pilloni and Rojas (2018) are also presented, which provide additional assessment criteria for furcation defects.
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Radiographic aids in periodontal disease diagnosis part I
This document discusses the use of radiographs in diagnosing periodontal disease. It provides a brief history of using radiographs in dentistry and periodontics. Radiographs can reveal bone loss and destruction patterns but not current soft tissue changes. Standardized techniques are needed for accurate assessment over time. Early periodontitis may show fuzziness of the lamina dura or widening of the periodontal ligament space. More advanced disease appears as severe bone loss, fingerlike projections into the bone, or interdental bone craters. However, radiographs have limitations in depicting the full extent and morphology of bone defects.
Alveolar bone
The alveolar process forms the tooth sockets and supports the teeth. It consists of external cortical plates and internal cancellous trabeculae. Osteoblasts, osteocytes, and osteoclasts maintain the alveolar bone through remodeling. The alveolar bone develops with tooth eruption and is resorbed after tooth loss. It undergoes constant remodeling to withstand forces while maintaining form. The document provides detailed descriptions of the anatomical structures and cellular processes that comprise and maintain the alveolar bone.
Smoking effects on the periodontium
Smoking has various negative effects on the immune system's response to periodontal disease. It reduces the phagocytic activity and respiratory burst of neutrophils, impairs their migration and apoptosis. Smokers have increased T cell levels but reduced IgG2 and B cell antibody production. Natural killer cell activity and numbers are also lower in smokers. Regarding cytokines, smokers have higher TNF-alpha but lower IL-1 levels in gingival crevicular fluid. Overall, smoking causes both quantitative and qualitative defects in immune cells that compromise periodontal defense mechanisms.
Technological advances in dental implant surgery
This document discusses recent technological advances in dental implant surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM) technology and computer-guided implant surgery techniques. It describes computerized tomography (CT) imaging and how CT data can be used for virtual surgical planning and fabrication of surgical guides. The document compares computer-guided implant surgery (CGIS), which uses static surgical guides, to computer-navigated implant surgery (CNIS), which allows for intraoperative modification of the surgical plan. Both techniques aim to increase the accuracy and predictability of dental implant placement.
Aggressive periodontitis
The document discusses aggressive periodontitis, specifically localized aggressive periodontitis (LAP). It provides:
1) A historical background on LAP, formerly known as localized juvenile periodontitis, describing its identification and classification over time.
2) Key diagnostic criteria for LAP including an early age of onset typically around puberty, involvement of first molars and incisors, and a rapid rate of attachment loss and bone destruction.
3) Typical clinical characteristics of LAP such as minimal visible inflammation despite deep pockets and bone loss out of proportion to plaque levels. Radiographs often show vertical bone loss around first molars and incisors. Prevalence is typically below 1% with some studies finding higher rates in black males
Splinting
The document discusses splinting, including its history, definitions, aims, principles, indications, classifications, advantages, and disadvantages. Some key points:
- Splinting aims to immobilize and stabilize loose or mobile teeth by redistributing forces across multiple teeth.
- It has been used since ancient Egypt to stabilize teeth and fractures. Modern classifications include temporary, provisional, and permanent splints made of various materials.
- Indications include reducing tooth mobility from trauma, occlusal adjustment, or periodontal disease. Contraindications include active periodontal inflammation.
- Advantages are stabilizing teeth and tissues, but disadvantages include increased risk of decay and difficulties with oral hygiene.
Guided tissue regeneration
Guided tissue regeneration (GTR) aims to regenerate lost periodontal tissues by using barrier membranes to selectively prevent the migration of epithelial and gingival connective tissue cells to the root surface, allowing periodontal ligament cells to repopulate the area. The document discusses the history and development of GTR, the biological basis and concept behind using barrier membranes, characteristics of ideal GTR membranes, indications and contraindications for GTR, and outcomes from studies applying GTR in treating periodontal defects.
Furcation the problem and its management
The document discusses furcation involvement, which occurs when periodontal disease causes attachment loss that affects the bifurcation or trifurcation of multi-rooted teeth. It presents Glickman's classification of furcation defects into four grades based on the extent of bone loss and visibility of the furcation opening. Grade I is the earliest stage where only soft tissues are affected. Grade IV is the most advanced where bone is destroyed between roots, making the furcation opening visible. The classification schemes of Karthikeyan et al. (2015) and Pilloni and Rojas (2018) are also presented, which provide additional assessment criteria for furcation defects.
Attached gingiva and procedures for gingival augmentation
The document discusses attached gingiva and procedures for gingival augmentation. It defines attached gingiva and explains its clinical significance as a barrier against microbes and irritants. The width and thickness of attached gingiva can be measured using various methods and are influenced by factors like age, tooth position, and frenal attachments. Adequate attached gingiva is important for periodontal health and limiting recession, though its width alone does not prevent recession. In restorative dentistry, at least 2mm of attached gingiva is recommended when crowns are placed close to or below the gingival margin to avoid inflammation and recession.
Role of iatrogenic factors in the etiology of periodontal disease
The document discusses various dental procedures that can potentially cause iatrogenic injury to periodontal structures, including restorations, endodontic therapy, prosthetics, orthodontics, surgery, implants, and periodontal treatment. It provides definitions of iatrogenic factors and reviews the history. For restorations specifically, it examines how cavity preparation, violation of biologic width, overhanging margins, subgingival margins, contours can negatively impact the periodontium. Studies have demonstrated links between overhangs and increased pocket depth and bone loss. Contours that limit access for oral hygiene or retain plaque and irritants can also increase inflammation.
Classification of diseases and conditions affecting the periodontium
The document discusses the historical development of classification systems for periodontal diseases from the 1870s to present. It describes the three dominant paradigms that influenced classification: the clinical characteristics paradigm from 1870-1920 which based classifications on observable symptoms; the classical pathology paradigm from 1920-1970 which considered the pathological changes; and the current infection/host response paradigm since 1970 which considers the roles of infection and the body's response. It provides details on influential classification systems under each paradigm.
The gingiva
The document discusses the anatomy and histology of the gingiva. It describes the different types of gingiva - marginal, attached, and interdental gingiva - and their clinical and microscopic features. Microscopically, the gingiva consists of stratified squamous epithelium and connective tissue. The gingival epithelium undergoes proliferation and differentiation, including keratinization in some areas. Keratin proteins and other proteins important for epithelial maturation are also discussed.
Reactive oxygen species and anti-oxidants
This document discusses reactive oxygen species (ROS) and antioxidants. It begins with a brief history of the discovery of oxygen, free radicals, and their role in biology. ROS are classified and sources both endogenous and exogenous are described. The document outlines the origins and formation of ROS, as well as their beneficial roles in physiological functions and microbial destruction. However, excessive ROS can also cause tissue damage through lipid peroxidation and DNA damage. The body's antioxidant defense systems and how ROS levels impact periodontal health are examined. The conclusion discusses measuring ROS and antioxidants.
Periodontal connective tissue
The document discusses the development, composition, and function of the four main tissues that make up the periodontium - gingiva, periodontal ligament, cementum, and alveolar bone. It describes how each tissue develops during tooth formation and eruption. It also provides details on the biochemical components of the normal connective tissues in the periodontium, including the cells, fibers, and ground substance present in the gingiva, periodontal ligament, cementum and alveolar bone. The document concludes by discussing how diseases can affect the periodontal connective tissues.
Molecular mediators in periodontal pathology
This document provides an overview of inflammatory mediators involved in the pathogenesis of periodontitis. It begins by introducing inflammation and how acute inflammation can become chronic. It then classifies inflammatory mediators as exogenous (bacterial products) or endogenous (produced internally). Key endogenous mediators discussed include cytokines like tumor necrosis factor (TNF)-α, colony stimulating factors, and interferons. The document explains the roles of these mediators in periodontal tissue destruction and bone resorption.
Local anesthesia
Local anesthesia involves the loss of sensation, especially pain, in one part of the body through the use of local anesthetic drugs. The document discusses the historical background of local anesthesia beginning in the 1880s with cocaine. It defines local anesthesia and related terms and outlines the ideal properties of local anesthetic drugs. The document describes the composition of local anesthetic solutions, classifications of drugs, and their mechanism of action in blocking nerve conduction. It explores theories of pain and the pain pathway, which local anesthetics are able to interrupt.
General microbiology
This document provides an overview of general microbiology. It discusses the history of microbiology, including early pioneers like Hooke, van Leeuwenhoek, Pasteur, and Koch. It also covers the basic classification of microorganisms into domains, including bacteria, archaea, protists, fungi and viruses. Specific sections are dedicated to bacteria, including their structures, growth patterns, shapes, and gram-positive and gram-negative examples. The document aims to introduce the key topics within general microbiology.
Collagen & its disorders
Collagen is the most abundant protein in mammals and provides structural integrity to tissues. There are over 30 types of collagen that can be classified based on structure and function. Collagen forms fibrils, networks, membranes, and other structures essential for tissue morphology and function. Disorders of collagen synthesis and structure can lead to a variety of associated pathologies.
Antimicrobials general considerations
This document provides an overview of antimicrobial agents (AMAs), including a brief history, classifications, characteristics of ideal antibiotics, factors to consider when choosing an AMA, indications, contraindications, problems associated with AMA use, and mechanisms of antibiotic resistance. It covers topics such as the distinction between bacteriostatic and bactericidal mechanisms, advantages and disadvantages of each, and common causes of AMA treatment failure.
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In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
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Attached gingiva and procedures for gingival augmentation
The document discusses attached gingiva and procedures for gingival augmentation. It defines attached gingiva and explains its clinical significance as a barrier against microbes and irritants. The width and thickness of attached gingiva can be measured using various methods and are influenced by factors like age, tooth position, and frenal attachments. Adequate attached gingiva is important for periodontal health and limiting recession, though its width alone does not prevent recession. In restorative dentistry, at least 2mm of attached gingiva is recommended when crowns are placed close to or below the gingival margin to avoid inflammation and recession.
Role of iatrogenic factors in the etiology of periodontal disease
The document discusses various dental procedures that can potentially cause iatrogenic injury to periodontal structures, including restorations, endodontic therapy, prosthetics, orthodontics, surgery, implants, and periodontal treatment. It provides definitions of iatrogenic factors and reviews the history. For restorations specifically, it examines how cavity preparation, violation of biologic width, overhanging margins, subgingival margins, contours can negatively impact the periodontium. Studies have demonstrated links between overhangs and increased pocket depth and bone loss. Contours that limit access for oral hygiene or retain plaque and irritants can also increase inflammation.
Classification of diseases and conditions affecting the periodontium
The document discusses the historical development of classification systems for periodontal diseases from the 1870s to present. It describes the three dominant paradigms that influenced classification: the clinical characteristics paradigm from 1870-1920 which based classifications on observable symptoms; the classical pathology paradigm from 1920-1970 which considered the pathological changes; and the current infection/host response paradigm since 1970 which considers the roles of infection and the body's response. It provides details on influential classification systems under each paradigm.
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The document discusses the anatomy and histology of the gingiva. It describes the different types of gingiva - marginal, attached, and interdental gingiva - and their clinical and microscopic features. Microscopically, the gingiva consists of stratified squamous epithelium and connective tissue. The gingival epithelium undergoes proliferation and differentiation, including keratinization in some areas. Keratin proteins and other proteins important for epithelial maturation are also discussed.
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This document discusses reactive oxygen species (ROS) and antioxidants. It begins with a brief history of the discovery of oxygen, free radicals, and their role in biology. ROS are classified and sources both endogenous and exogenous are described. The document outlines the origins and formation of ROS, as well as their beneficial roles in physiological functions and microbial destruction. However, excessive ROS can also cause tissue damage through lipid peroxidation and DNA damage. The body's antioxidant defense systems and how ROS levels impact periodontal health are examined. The conclusion discusses measuring ROS and antioxidants.
Periodontal connective tissue
The document discusses the development, composition, and function of the four main tissues that make up the periodontium - gingiva, periodontal ligament, cementum, and alveolar bone. It describes how each tissue develops during tooth formation and eruption. It also provides details on the biochemical components of the normal connective tissues in the periodontium, including the cells, fibers, and ground substance present in the gingiva, periodontal ligament, cementum and alveolar bone. The document concludes by discussing how diseases can affect the periodontal connective tissues.
Molecular mediators in periodontal pathology
This document provides an overview of inflammatory mediators involved in the pathogenesis of periodontitis. It begins by introducing inflammation and how acute inflammation can become chronic. It then classifies inflammatory mediators as exogenous (bacterial products) or endogenous (produced internally). Key endogenous mediators discussed include cytokines like tumor necrosis factor (TNF)-α, colony stimulating factors, and interferons. The document explains the roles of these mediators in periodontal tissue destruction and bone resorption.
Local anesthesia
Local anesthesia involves the loss of sensation, especially pain, in one part of the body through the use of local anesthetic drugs. The document discusses the historical background of local anesthesia beginning in the 1880s with cocaine. It defines local anesthesia and related terms and outlines the ideal properties of local anesthetic drugs. The document describes the composition of local anesthetic solutions, classifications of drugs, and their mechanism of action in blocking nerve conduction. It explores theories of pain and the pain pathway, which local anesthetics are able to interrupt.
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