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??????????