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Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims LESSON TITLE Module # | Online Lecture CY ✦ Additional Know...

Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims LESSON TITLE Module # | Online Lecture CY ✦ Additional Knowledge: TOPIC ​ Insert Here ​ Sublesson ○​ Text ​ Subtext ​ Important Info mentioned by Prof SUB TOPIC ​ Sublesson AF ○​ Text ​ Subtext TERMS Insert Photo Title Insert Photo Title ​ Sublesson ○​ Text TITLE ​ Subtext PICTURE DESCRIPTION TABLE TITLE 0  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims INTRODUCTION TO ORAL MUCOSA PERIODONTICS ​ soft tissue that lines the interior of the mouth Module #1 | Onsite Lecture 3 ZONES OF THE ORAL MUCOSA PERIODONTOLOGY ​ PERI - “around/surrounding” ​ ODONT - “tooth” ​ LOGOS/ LOGY - “study/science” Masticatory covering of the hard ​ The knowledge of the different tissues surrounding the Mucosa palate & gingiva tooth ​ It can be interchangeable to periodontics, but the thin line between the two is that the -ics of periodontics is the technique, or the study or science of periodontal treatment dorsum of the tongue, and it is called TISSUES OF PERIODONTIUM Specialized specialized because of Mucosa the presence of taste buds ​ GINGIVA - covers the alveolar bone ​ PERIODONTAL LIGAMENTS - attach the cementum to the alveolar bone ​ CEMENTUM - root is covered by cementum ​ ALVEOLAR BONE - surround each root of the tooth Goodluck! - AFCY | 1  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims vestibule, alveolar It is described as the part of the mucosa, lip & cheek gingiva that connects the mucosa, floor of the facial, buccal or labial gingiva Lining mouth, frenum Mucosa to the lingual gingiva. (oral mucous membrane lining the remainder of the oral cavity)​ NOTE! GINGIVA ​ marginal gingiva years ago was called unattached gingiva, but recent studies showed microscopic attachments (epithelial and connective) to the tooth, not the alveolar ​ Covers the alveolar bone bone ​ Healthy normal gingiva is coral pink ​ In prostho, you try to simulate interdental grooves, ​ Gingiva is up to CEJ of each tooth fistonning to make it appear natural, vertical 3 PARTS OF GINGIVA scalloped form, following the OTHER PARTS OF THE GINGIVA marginal edge or proximal Marginal gingiva edge, covers CEJ, attached to ​ GINGIVAL GROOVE - horizontal shallow groove, that separate tooth the marginal gingiva and attached gingiva, ​ MUCOGINGIVAL JUNCTION - imaginary line that separates firmly adherent to alveolar attached gingiva(pink) and alveolar mucosa (red due to Attached gingiva bone, beneath marginal gingiva capillaries) ​ VESTIBULAR FORNIX - In a much deeper portion of the alveolar mucosa, some sort of canal. Lowest part of the The pink area or u shape area, vestibule next to the mandible or the highest part next to the Interdental gingiva located interproximal/ maxillae. interdental between two teeth. ​ INTERDENTAL PAPILLA - pointed part of marginal gingiva at interdental space found underneath the contact area Goodluck! - AFCY | 2  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims ​ INTERDENTAL GROOVES - A shallow vertical groove in between two adjacent teeth. IIn wax pattern of complete denture you should try to simulate the interdental groove called fistune ​ ATTACHED GINGIVA - coral pink in color ​ ALVEOLAR MUCOSA - darker or red in color ○​ The col has various shapes according to the location if the contact area (for anterior or incisors the faciolingual dimension are narrow then the col is narrow and thin, for premolar are the contact are is wider to incisors and the col is wider, the col is widest in the molars since the buccolingual width is wider so that the contact area is wider) NOTE! ​ COL ○​ part of the interdental gingiva, middle portion ​ Col is important because when you do scalings, and root ○​ Valley-like depression, in between 2 interdental planing non surgically in the proximal area, You have to gingiva keep in mind the morphology, and anatomy so you will not ○​ In other books, saddle-like be lacerating the gingiva ○​ It has depression because it follows the shape of contact area Goodluck! - AFCY | 3  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims walls composed of tooth surface (enamel or cementum depending of the location of the sulcus) and the soft tissue wall of the sulcus is the sulcular epithelium. important landmark that starts at the base of the sulcus to the Junctional epithelium most apical part of the gingival epithelium. Attached to the tooth surface. EPITHELIUM NOTE! ​ lining of the tissues, most exterior part of any tissues, ​ Marginal gingiva is also attached to the tooth surface Underneath is connective tissues through the junctional epithelium and connective tissues of the gingiva called epithelial attachments and connective tissue attachments while attached gingiva is PARTS OF GINGIVAL EPITHELIUM attached to the bone located in the oral cavity, ​ Connective tissue lies beneath the epithelial layer of the Oral epithelium clinically visible gingiva. It is also attached to the tooth surface ​ Sulcus will become deeper when microscopic attachments gets removed, and that will be the start of the periodontal Located in the gingival sulcus, issues even without carious lesions which is the vertical space, Sulcular epithelium described as a v shape or oval triangle space between the enamel and gingiva, that has 2 Goodluck! - AFCY | 4  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims GINGIVAL SULCUS COMPONENTS OF THE PERIODONTIUM ​ The sulcus pockets are always viewed proximally in periodontics. ​ A. NORMAL GINGIVAL SULCUS ○​ Base of the sulcus is made up of your junctional epithelium ​ B. INTERNAL BASAL LAMINA ○​ Junctional epithelium is attached to the tooth surface by means of an internal basal lamina and hemidesmosomes ​ C. APICAL EXTENT OF THE JUNCTIONAL EPITHELIUM ​ PERIODONTAL LIGAMENT - connective tissues or fibrous connective tissues that connects the cementum layer to the alveolar bone ​ In the junctional epithelium the presence of epithelial attachment is important in periodontics. Beneath that is part of the connective tissue of the gingiva BIOLOGICAL WIDTH ​ Epithelial and connective tissue attachments to the tooth surface is called the biologic width. ​ Biologic width measures 2.04 mm or 2 mm (junctional epithelial attachment is 0.97 mm and connective tissue attachment is 1.07mm). Goodluck! - AFCY | 5  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims ​ SUPRACRESTAL TISSUE ATTACHMENT (STA) - The new name ​ INTERDENTAL PAPILLA (terminal ends/extensions of for the biologic width the marginal gingiva located in between two teeth)- pointed appearance ​ INTERDENTAL GINGIVA - must occupy or fill up the interdental space, interproximal space, the embrasure. ​ GINGIVAL SULCUS -From the base to the gingival margin it should measure 0-3 mm (measurement of a healthy sulcus if it exceeds there is already inflammation and attachment loss) ○​ If it measures 3.5 or 4 mm, it means there is already an inflammation or attachment loss. ○​ periodontal probe is used and it should touch the base of the gingival sulcus and the tip of the gingival margin is the reference point ​ BLEEDING - no bleeding BLACK TRIANGLE FEATURES OF A HEALTHY GINGIVA ​ COLOR - coral pink ​ CONTOUR - scalloped marginal gingiva ​ CONSISTENCY - firm and resilient when palpated ​ TEXTURE- stippling (orange peel- it has pores like appearance) it is not smooth or rough. Stippling is more numerous in the labial surfaces anteriorly then reduce in numbers while going posteriorly and it is absent lingually only labially/buccally Goodluck! - AFCY | 6  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims ​ BLACK TRIANGLE - the space in which the interdental GINGIVA OF A BLACK PERSON papilla is starting to recede. ​ Occurs in older people (undergo normal physiologic recession or abrasions, 40s, 50s, or 60s) ​ Having black triangle at age 20 is very alarming, it is caused by a gingival recession which should be addressed as soon as possible. Because it will lead to periodontal disease. (caused by food impaction) ​ Receding of gingiva because there is attachment destruction or attachment loss in supracrestal tissue attachments (STA) ​ This appearance of Gingiva can be considered PALATAL GINGIVA (LINGUAL GINGIVA) healthy because this is a gingiva of a black person. ​ Atypical in color (gingiva is pinkish) ​ Black people have so much melanin thickness. (giving them black skin and gingiva) ​ But there are black people with pinkish gingiva also. RADIOGRAPH OF ALVEOLAR CREST ​ Attached gingiva and oral mucosa lining the hard palate are hard to delineate (even if you palpate, they are both rigid and firmly attached to the palatal bone) Goodluck! - AFCY | 7  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims ​ Supracrestal attachment is made up of epithelial attachment and connective tissue attachment ​ APPEARANCE- Conical shaped radiographically ​ In radiograph, the tip of alveolar crest is not visible - indicative of bone resorption FEATURES OF AN INFLAMED/ DISEASED GINGIVA ​ RADIOPAQUE STRUCTURES ○​ Gingiva ○​ Periodontal Gingiva ​ COLOR - Reddish ○​ Attachment ​ CONTOUR - rounded and enlarge, blunted, less ​ If there is diastema, no contact area, and no pronounced scalloping of gingiva if may gingivitis, interdental papillae, but there is Interdental gingiva more flattened area but not really plot that leads to black triangle ​ CONSISTENCY - Spongy (has the presence of fluid inside) ​ TEXTURE - Smooth and shiny ​ INTERDENTAL PAPILLAE - blunted GINGIVAL FIBERS ​ GINGIVAL SULCUS - should remain 0-3 mm but the measurement could result to more than 3mm due to swelling but not due to attachment loss ​ BLEEDING - 98% percent the gingiva bleeds when there is inflammation. MODERATE TO HEAVY GINGIVITIS ​ Sulcus cannot be seen, the gingiva is blunt, swollen marginal and attached gingiva. Cannot see the stippling Goodluck! - AFCY | 8  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims GINGIVAL HYPERPLASIA ​ check the medical history of the patient, it will not happen just because of the food impaction or calcular deposits. This is a side effect of drugs/maintenance drugs. Not practicing oral hygiene. ​ May also be caused by medication the patient, due to maintenance leading to fibrous overgrowth of the gingiva, that need proper oral hygiene MARGINAL GINGIVITIS ​ the inflammation is mostly located in gingival margin ​ Reddish and no interdental gingiva, cratered gingival margin, already a periodontitis, much of the gingiva and attachments has been destroyed, even the pdl and alveolar mucosa. STILLMAN’S CLEFT Goodluck! - AFCY | 9  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims ​ McCALL FESTOON - is near the marginal gingiva, has a collar like fibrous thickening, the color is much much lighter than attached gingiva. ○​ Gingival recession - CEJ is the ideal position, 1mm (gingival margin) but if it moves apically it exposed CEJ and cementum. DIFFERENT MEASUREMENTS OF ATTACHED GINGIVA ​ If there is stillman’s cleft, we try to probe the sulcus area, plaque can be retrieved and deposited, and give 1-2 weeks and it will become healthy and will be back to its original healthy appearance. Not unless there is periodontal disease ​ Position the probe in Mucogingival Junction up to gingival groove that is attached gingival width. McCALL FESTOON ​ Healthiest attached gingiva is 8mm (middle part of the root, vertical) ​ 2nd photo - width is 4mm lesser attached gingiva ​ 3rd photo- 0mm, no attached gingiva, alveolar mucosa color NOTE! ​ Gingiva can also be affected by orthodontic movement, has gingival recession, not patient fault, too much force and movement, alveolar bone will also resorb, Goodluck! - AFCY | 10  Periodontics Lecture by Dr. Fe Calingo 2nd Semester S.Y. 2024-2025 Prelims DIFFERENT TYPES OF POCKET ​ A. Base of the sulcus is near the CEJ area - regular normal healthy ​ B. Base of the pocket grows apically not coronally if coronal pseudo pocket yon kaya meron 3mm ​ C. The attachment was loss that is why it moved apically ​ A. Healthy sulcus - 0-3mm and the gingiva is healthy 2 TYPES OF PERIODONTAL POCKETS ​ B. Sulcus that is below 3mm ​ C. pseudo pocket the base of the pocket is ○​ 3mm or more is called pocket or periodontal pocket, coronally to the alveolar crest Suprabony pocket not sulcus ○​ PSEUDO POCKET - not true pocket, can see the base of the sulcus is still in the CEJ. located apical to the alveolar crest, It is the highest point of Infrabony/ intrabony pocket alveolar crest Goodluck! - AFCY | 11