chronic periodontitis l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Chronic Periodontitis PowerPoint Presentation
Download Presentation
Chronic Periodontitis

Loading in 2 Seconds...

play fullscreen
1 / 33

Chronic Periodontitis - PowerPoint PPT Presentation


  • 369 Views
  • Uploaded on

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Chronic Periodontitis' - blue


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
chronic periodontitis

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • In Slide Show, click on the right mouse button
  • Select “Meeting Minder”
  • Select the “Action Items” tab
  • Type in action items as they come up
  • Click OK to dismiss this box
  • This will automatically create an Action Item slide at the end of your presentation with your points entered.

Chronic Periodontitis

Localized

Generalized

learning outcomes
Learning Outcomes
  • Describe the development of a periodontal pocket.
  • Relate clinical characteristics to the histopathologic changes for chronic periodontitis.
  • Compare the gingival pocket with the periodontal pocket.
  • Determine the severity of PD activity using clinical data.
common characteristics
Common Characteristics
  • Onset - any age; most common in adults
  • Plaque initiates condition
  • Subgingival calculus common finding
  • Slow-mod progression; periods of rapid progression possible
  • Modified by local factors/systemic factors/stress/smoking
extent severity
Extent & Severity
  • Extent:
    • Localized: 30% of sites affected
    • Generalized > 30% of sites affected
  • Severity:entire dentition or individual teeth/site
    • Slight = 1-2 mm CAL
    • Moderate = 3-4 mm CAL
    • Severe =  5 mm CAL
clinical characteristics
Clinical Characteristics
  • Deep red to bluish-red tissues
  • Thickened marginal gingiva
  • Blunted/cratered papilla
  • Bleeding and/or suppuration
  • Plaque/calculus deposits
clinical characteristics6
Clinical Characteristics
  • Variable pocket depths
  • Horizontal/vertical bone loss
  • Tooth mobility
pathogenesis pocket formation
Pathogenesis – Pocket Formation
  • Bacterial challenge initiates initial lesion of gingivitis
  • With disease progression & change in microorganisms  development of periodontitis
pocket formation
Pocket Formation
  • Cellular & fluid inflammatory exudate  degenerates CT
  • Gingival fibers destroyed
  • Collagen fibers apical to JE destroyed  infiltration of inflammatory cells & edema
  • Apical migration of junctional epithelium along root
  • Coronal portion of JE detaches
pocket formation9
Pocket Formation
  • Continued extension of JE requires healthy epithelial cells!
  • Necrotic JE slows down pocket formation
  • Pocket base degeneration less severe than lateral
pocket formation10
Pocket Formation
  • Continue inflammation:
    • Coronal extension of gingival margin
    • JE migrates apically & separates from root
    • Lateral pocket wall proliferates & extends into CT
    • Leukocytes & edema
      • Infiltrate lining epithelium
      • Varying degrees of degeneration & necrosis
continuous cycle
Continuous Cycle!
  • Plaque  gingival inflammation  pocket formation  more plaque
histopathology
Histopathology
  • Connective Tissue:
    • Edematous
    • Dense infiltrate:
      • Plasma cells (80%)
      • Lymphocytes, PMNs
    • Blood vessels proliferate, dilate & are engorged
    • Varying degrees of degeneration in addition to newly formed capillaries, fibroblasts, collagen fibers in some areas
histopathology14
Histopathology
  • Periodontal pocket:
    • Lateral wall shows most severe degeneration
    • Epithelial proliferation & degeneration
    • Rete pegs protrude deep within CT
    • Dense infiltrate of leukocytes & fluid found in rete pegs & epithelium
    • Degeneration & necrosis of epithelium leads to ulceration of lateral wall, exposure of CT, suppuration
clinical histopathologic features
Clinical :

Pocket wall bluish-red

Smooth, shiny surface

Pitting on pressure

Histopathology:

Vasodilation & vasostagnation

Epithelial proliferation, edema

Edema & degeneration of epithelium

Clinical & Histopathologic Features
clinical histopathologic features16
Clinical:

Pocket wall may be pink & firm

Bleeding with probing

Pain with instrumentation

Histopathology:

Fibrotic changes dominate

 blood flow, degenerated, thin epithelium

Ulceration of pocket epithelium

Clinical & Histopathologic Features
clinical histopathologic features17
Clinical :

Exudate

Flaccid tissues

Histopathology:

Accumulation of inflammatory products

Destruction of gingival fibers

Clinical & Histopathologic Features
root surface wall
Root Surface Wall
  • Periodontal disease affects root surface:
    • Perpetuates disease
    • Decay, sensitivity
    • Complicates treatment
  • Embedded collagen fibers degenerate  cementum exposed to environment
  • Bacteria penetrate unprotected root
root surface wall19
Root Surface Wall
  • Necrotic areas of cementum form; clinically soft
  • Act as reservoir for bacteria
  • Root planing may remove necrotic areas  firmer surface
classification of pockets
Classification of Pockets
  • Gingival:
    • Coronal migration of gingival margin
  • Periodontal:
    • Apical migration of epithelial attachment
      • Suprabony:
        • Base of pocket coronal to height of alveolar crest
      • Infrabony:
        • Base of pocket apical to height of alveolar crest
        • Characterized by angular bony defects
periodontal pocket
Periodontal Pocket
  • Suprabony pocket
inflammatory pathway
Inflammatory Pathway
  • Stages I-III – inflammation degrades gingival fibers
    • Spreads via blood vessels:
  • Interproximal:
    • Loose CT  transseptal fibers  marrow spaces of cancellous bone  periodontal ligament  suprabony pockets & horizontal bone loss transseptal fibers transverse horizontally
inflammatory pathway23
Inflammatory Pathway
  • Interproximal:
    • Loose CT  periodontal ligament  bone  infrabony pockets & vertical bone loss  transseptal fibers transverse in oblique direction
inflammatory pathway24
Inflammatory Pathway
  • Facial & Lingual:
    • Loose CT  along periosteum  marrow spaces of cancellous bone  supporting bone destroyed first  alvoelar bone proper  periodontal ligament  suprabony pocket & horizontal bone loss
inflammatory pathway25
Inflammatory Pathway
  • Facial& Lingual:
    • Loose CT  periodontal ligament  destruction of periodontal ligament fibers  infrabony pockets & vertical or angular bone loss
periodontal pathogens
Periodontal Pathogens
  • Gram negative organisms dominate
  • P.g., P.i., A.a. may infiltrate:
    • Intercellular spaces of the epithelium
    • Between deeper epithelial cells
    • Basement lamina
periodontal pathogens28
Periodontal Pathogens
  • Pathogens include:
    • Nonmotile rods:
      • Facultative:
        • A.a., E.c.
      • Anaerobic:
        • P. g., P. i., B.f., F.n.
    • Motile rods:
      • Facultative:
        • C.r.
    • Spirochetes:
      • Anaerobic, motile:
        • Treponema denticola
periodontal disease activity
Periodontal Disease Activity
  • Bursts of activity followed by periodsof quiescence characterized by:
    • Reduced inflammatory response
    • Little to no bone loss & CT loss
  • Accumulation of Gram negative organisms leads to:
    • Bone & attachment loss
    • Bleeding, exudate
    • May last days, weeks, months
periodontal disease activity30
Periodontal Disease Activity
  • Period of activity followed by period of remission:
    • Accumulation of Gram positive bacteria
    • Condition somewhat stabilized
  • Periodontal destruction is site specific
  • PD affects few teeth at one time, or some surfaces of given teeth
overall prognosis
Overall Prognosis
  • Dependent on:
    • Client compliance
    • Systemic involvement
    • Severity of condition
    • # of remaining teeth
prognosis of individual teeth
Prognosis of Individual Teeth
  • Dependent on:
    • Attachment levels, bone height
    • Status of adjacent teeth
    • Type of pockets: suprabony, infrabony
    • Furcation involvement
    • Root resorption