Classification of Diseases and

Conditions Affecting the

Periodontium (Part 2)

drg Ervi Gani

DEVELOPMENTAL OR ACQUIRED
DEFORMITIES AND CONDITIONS
 3 mechanisms local
factors can increase
periodontal disease

*Pathogenicity: the ability of the dental plaque biofilm to

cause periodontal disease
 Localized Tooth-Related Factors That
Modify or Predispose to Plaque-Induced
Gingival Diseases or Periodontitis

Tooth
anatomic Root fracture
factors

Cervical root
Dental resorption
restoration or and
appliances cemental
tears
 TOOTH ANATOMIC
1
Malformation of
tooth Tooth location
development

Malaligned teeth
Proximal rootCervical Enamel Projections and
grooves Enamel Pearls

Palatogingival
grooves
Open contacts loss alveolar bone
food impaction
 Untreated tooth decay
Another example of local contributing
factors
Tooth decay defects in tooth
structure (dental cavities) act as
protected environments for bacteria
that cause gingivitis and periodontitis
to live and grow undistrubed.
 Dental Restorations or
Appliances
2 Dental Restoration
Appliances
3 4
 Local factor that increase plaque
pathogenicity

Plaque retention
rough and
irregular calculus
surface
alteration of
tooth contour
Dental Calculus

Mineralized bacterial plaque, covered on its external

surface by nonmineralized living bacterial plaque
mineralization of plaque can begin from 48 hours up
to 2 weeks after plaque formation
 Composition of dental
calculus
Inorganic Organic
70-90% 1030%

Calcium phosphate , Derived from plaque,

calcium carbonate and dead epithelial cells and
magnesium phosphate dead white blood cells

= Inorganic portion of
bone
Local factor that can cause direct
damage to the periodontium

Occlus
al Direct
force damage to
Faulty the
restorati
on and periodontiu
applianc
es m
Food
Patient
Impacti
on habit
 Direct damage from
occlusal forces
* Trauma From Occlusion

* Parafuctional occlusal forces

 Enlarged, funnel shaped sign
periodontal ligament space Radiographic
Alveolar bone resorptiom
Tooth mobility symptoms
Sensitivity to pressue and
Migration of teeth Clinical sign
Direct damage to the periodontium
caused by heavy occlusal forces Definition
from the teeth alveolar bone
resorption
Trauma From Occlusion
1
 Types of occlusal trauma
Primary trauma Secondary trauma
from occlusion fom occlusion
Excessive occlusal Normal occlusal
forces on a healthy force on an
periodontium unhealthy
Placement of high periodontium
restoration or previously
insertion of a fixed weakened by
bridge or partial periodontitis
denture > force Rapid bone loss and
on abutment teeth pocket formation
Reversible if the
trauma is removed
 Type of
force

Functional Parafunctional
occlusal force Occlual force

Clenching
forceful closure
Normal force Tooth-tooth mx n md
during the act of contact when not
chewing in act of eating Bruxism
forceful
grinding
 2 Food Impaction

Forcing food (pieces of tough meat) between

teeth during chewing, trapping the food in
the interdental areas

Stripping of gingival tissue (periodontal breakdown)

Alteration of gingiva contour in interdental area
difficult in palque control
 3 Patient Habits
Tongue Thrusting application of forceful
pressure against anterior teeth with the tongue
exerts excessive lateral pressure against the teeth
traumatic to periodontium

Mouth breathing inhaling and exhaling air

primarily through the mouth rather than nose dry
out the gingival tissue in the anterior region
inflammation of gingiva

Improper use of toothpick and other interdental

aids
 Faulty restorations and
4 appliances

Faulty crown design

The edge of crown (margin) placed
below gingival margin and too near the
alveolar bone closer than 2 mm to
crest of alveolar bone resorption
Faulty removable
prosthesis
A damaged or poorly fitting removable
prosthesis can impinge on gingival
tissue + plaque accumulation
progress of periodontittis
 Mucogingival Deformities and
Conditions around Teeth
Mucogingival deformity is a generic term used to
describe the mucogingival junction and its
relationship to the gingiva, alveolar mucosa, and
frenula muscle attachments

Defects in the morphology, position, and/or

amount of gingiva mucogingival surgery

Esthetic reasons, function, or to facilitate oral

hygiene.
A, Mucogingival defect
depicted by recession.
B, Defects extend into
alveolar mucosa and
lacks keratinized gingiva.
 Mucogingival Deformities and
Conditions of Edentulous Ridges
Lack of stable keratinized gingiva between
the vestibular fornices and the floor of the
mouth before prosthodontic
reconstruction require soft tissue
grafting and vestibular deepening

Alveolar bone defects in edentulous ridges

before placement of implants and
prosthesis require corrective surgery to
restore form and function
A, Mucogingival ridge defect from floor of mouth to
vestibular fornix. B, Partial thickness flap with
vestibular deepening. C, Placement of free gingival graft.
D, Reestablishment of vestibular depth and keratinized
 References
1. Newman MG, Takei HH, Klokkevold PR,
Carranza MA. Carranzas clinical
periodontology. Ed 11th. Philadelphia:
Elsevier Saunders, 2012
2. Foundations of periodontics for dental
hygenist. Ed 2nd. Philadelphia:Wolters
Kluwer, 2003
3. Perry DA, Beemsterboer PL, Essex G.
Periodontology for dental hygenist. Ed
4th.
 Answer
1. A
2. B
3. B
4. D
5. C
6. D