Post on 24-Dec-2015
Periodontics
Periodontitis
Periodontist• Dentist specializes in
treating tissues around the tooth.
• Peri = around
• Dont = tooth
Periodontal tissues (Periodontium)
• Gingiva
• Sulcus
• Epithelial attachment
• Bone (alveolar)
• Lamina dura
• PDL
• Periodontal ligament
• Sharpey’s fibers
• Cementum
• Surrounds the root
Periodontitis
Signs / symptoms • Swollen gums
• Shiny gums
• Red gums
• Bleeding
• Plaque
• Calculus
• Recession
• Maloclussion
Periodontitis
Causes• Poor oral hygiene
• Plaque
• Calculus
• Poor diet
• Lack of sleep
• Genetics
• Medications / drugs
• Stress
• Bruxism
Periodontal stages
Stage I• Gingivitis
• Inflammation of the gingiva.
• Not true perio
• Must have pockets!
Stage II• Early perio
• Pocket formation
• 4 -5 mm
• No mobility
Periodontal stages
Stage III• Moderate perio
• 4 – 6 mm pockets
• Recession
• Bone loss
• Mobility
Periodontal stages
Stage IV• Advanced perio
• 6+ mm pockets
• Mod – severe recession
• Severe bone loss
• Furcation involvement
• Mod- severe mobility
Refractory periodontitis
ANUG• Acute
• Necrotizing
• Ulcerative
• Gingivitis
• Aka
• Vincent’s Disease
• “trench mouth”
Really bad perio…• Additional
signs/symptoms
• PAIN
• Dead tissue
• Sores
• Metallic taste
• ‘Death Breath’
Mobility
Movement of the tooth within the socket.• Scale of 0 – 4
• 0 = normal
• 1 = slight
• 2 = moderate
• 3 = severe
Diagnosis
Extraoral exam• Skin, lips, TMJ
Intraoral exam• Color
• Size
• Texture
• Consistency
• Of all tissues
Radiographs• X-rays
• Vertical BWX
• Pano
• Indicate
• Bone loss
• Vertical
• Horizontal
• Diseased tissue
• abscesses
Radiographs
Periodontal probing
Measures the sulcus / pocket depth.• Instrument?
• Periodontal probe
• 0 – 3 mm = healthy
• 6 readings / measurements around the tooth.
Anterior teeth• F, MF, DF
• L, ML, DL
Posterior teeth• B, MB, DB
• L, ML, DL
Periodontal probing
Treatment
Full Mouth Debridement• Too much calculus to
probe.
Root Planing• Smoothing root
surface
• Calculus
• Dead cementum
Gingival curettage• Scraping the gums
• Remove dead / diseased gingival tissue.
Treatment
Prophylaxis• Fine scale and
polishing.
• Remove • Calculus
• Sub-gingival
• Supra-gingival
• Stain• Extrinsic
• Soft depostis• Plaque
• stain
Surgical Treatment
Flap surgery• Used to gain access to
the bone.
• Allows other procedures to be completed.
Alveoplasty• Reshaping the
alveolar bone
Ostectomy• Bone removal
Additive osseous surgery.• Bone graft.
Surgical Treatment
Gingivectomy• Surgical removal of
the gums
Gingivoplasty• Reshaping /
recontouring the gums
• Scallop
Mucogingival Surgery
Frenectomy• Removal of the frenum
and attachment to bone.
• Tongue tied
• Anklyoglossia
Gingival grafting• Tissue is taken from
one site and place on another.
• Palate
Periodontal instruments
Periodontal probe• Measures the sulcus
Ultrasonic scaler• Used with hand
scaling to remove gross calculus
Scaler• Removes gross
calculus
• supragingival
Curette• Root planing
• Curettage
• Sub-gingival calculus Pocket marker
• Marks tissue for incision
Periosteal elevator• Separates tissue from
bone
Periodontal instruments
Rongeurs• Cut / trim bone
Periodontal knives• Cut / incise tissue
• Orban
• Kirkland
• Bard parker and #15 blade.
Electrosurgery machines.• Uses electric current
to incise tissue.
Lasers• Many different uses in
periodontics.
Periodontal dressing
“Band-aid” for the gums after perio treatment• Protects tissue w/
chewing
• Support for mobile teeth
• Holds ‘flaps’ in place
• Stay on about 1 week
Please reference pics in your textbook on pgs. 525, 526, 527
Conclusion
Understanding signs and symptoms of perio is a very important part of your job.
Being able to explain different treatments and procedures to your patients increases your value to your dentist.
Any questions??????????