Academic Department of Clinical Stomatology DACE ACADEMIC SECTION OF PERIODONTAL INTEGRAL CLINIC SUBJECT OF ADULT I Diagnostic Phase Diagnosis

of periodontal disease and other disorders of the periodontium Material Prepared by Dr. Lola I. N. Sueng LIMA - PERU 2007 Diagnosis of periodontal disease and other disorders of the periodontium Periodontium periodontal ANATOMY (Gr. peri "around"; odous "tooth"), dental bed, a functional system comprising the following tissues: the gingiva, periodontal ligament, the cementum and alveolar bone. The alveolar bone consists of two comp onents: the alveolar bone proper and the alveolar process. The alveolar bone pro per is continuing with the process and forms the thin alveolar bony plate locate d just outside the periodontal ligament (Figure 1). Three of the tissues of the periodontium: cement, periodontal ligament and alveolar bone proper, are compose d of cells contained in the dental follicle of the developing piece. The fourth component of the periodontium tissue, or gum, is not derived from dental follicl e. Crest of the interproximal papilla Interdental papilla buccal free gingiva Junctional epithelium Online or gingiva alveolar mucosa Mucogingival union cementum periodontal ligament cribriform plat e = alveolar bone spongy bone compact bone FIG. 1 Components of the periodontium Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 2 Diagnosis of periodontal disease and other disorders of the periodontium The main function of the periodontium is linking to the tooth with the jaw bone and to maintain the integrity of the surface of the masticatory mucosa in the or al cavity. The periodontium, also known as "attachment apparatus" or "supporting tissue of teeth," is a unit of biological and functional development suffers so me changes with age and also is subject to morphological and functional alterati ons and related changes alterations in the oral environment. Knowledge of the mo rphology and structural biology normal periodontal tissue is a prerequisite for understanding their pathological changes and treatment goals, ie the processes o f repair and regeneration of diseased tissues. The gum oral mucosa (mucous membrane some Ilama) is a continuation of the skin o f the lips and mucosa of the soft palate and pharynx. The oral mucosa consists o f: 1) masticatory mucosa, including the gums and lining of the hard palate, 2) s pecialized mucosa that lines the back of the tongue, and 3) creeping or remnant mucosa. The gingiva is the part of the masticatory mucosa covering the alveolar process and surrounding the cervical portion of the teeth. The gum reaches its f inal shape and texture along with the eruption of the teeth. On the crown, gum p ink coral ends at the free gingival margin scalloped outline. On the apical, is continuous with the alveolar mucosa (mucosa creeping), a darker red and loose, f

rom which the gum is separated by a line limiting usually easy to recognize, cal led a boundary line or union Mucogingival (LMG). On the palate, there is the LMG and the gum is part of the immobile keratinized palatal mucosa. We can distingu ish two parts in the gingiva: a) free or marginal gingiva (EL) 2) gum adhesive ( EA) or marginal free gingiva is coral pink and has a matte surface and firm cons istency; includes gingival tissue buccal and lingual or palatal, and the interde ntal papillae or gum. Buccal and lingual surfaces of the teeth, free gingiva ext ending from the gingival margin apical to the free gingival sulcus, which is at the limit cementoenamel (LCA). In clinical tests showed that the free gingival s ulcus is present in only 30-40% of adults. The free gingival groove is often mor e pronounced facial, occurs more frequently in the incisive and premolar regions of the mandible, and less frequently in regions maxillary molars and premolars. After the eruption of the teeth, free gingival margin is located on the enamel surface to approximately 0.5-2 mm in effect with respect to the limited coronary cementoenamel (Fig. 2a, 2b). Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 3 Diagnosis of periodontal disease and other disorders of the periodontium FIG. 2a The gum margin (margin) runs parallel to the boundary between the enamel and cement. Vestibular papillae are arranged so sharp on the point of contact.€ It is recognized in some areas a free gingival groove between the free gingiva a nd inserted (arrow). FIG. 2b shows radiographic interdental septa high, the ridge is in the original radiograph, approximately 1-2 mm apical to the CEJ line The shape of the interdental gingiva (interdental papilla) is determined by the relations of contact between the teeth, the width of the proximal tooth surfaces and the course of cementoenamel limit. In the anterior regions of the dentition , the interdental papilla has a pyramidal shape, while in the molar regions are more flattened papillae buccolingually. Because of the presence of the interdent al papillae, the free gingival margin scalloped follows a course more or less pr onounced across the teeth (Figure 3). FIG. 3 Form of interdental gingiva is determined by the contact area on the toot h surfaces (molar, premolar and incisive). Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 4 Diagnosis of periodontal disease and other disorders of the periodontium In regions premolars and molars, the teeth are proximal contact surfaces rather than contact points. As the interdental papilla is shaped according to the conto ur of the interdental contact, establishing a concave-col * - in these regions ( Figure 4). FIG. 4 col The region is covered by a thin epithelium queratinzado not. The gum adhesive, attached or inserted, is limited in regard coronary sulcus for free, or, if not present, by a horizontal plane located at the limit cementoena mel. The sticky gum extends apically to the mucogingival limit which is continuo us with the alveolar mucosa (creeping). The sticky gum texture is firm, pink cor

al, and often shows a fine superficial punctate gives an appearance of orange pe el. This point, however, is only present in approximately 40% of adults (Figure 5). This type of mucosa firmly adheres to the alveolar bone and the underlying c ement through connective tissue fibers and, therefore, is comparatively still. U nlike the latter, the alveolar mucosa is relatively mobile with respect to the u nderlying tissue. In a darker red, the alveolar mucosa (AM) is located near the junction apical Mucogingival loosely linked to the tissues lining. The mucogingi val junction remains unchanged throughout adulthood. FIG. 5 gingiva, is limited, in respect coronary the free gingival groove (GG), e xtends to the edge apically Mucogingival (arrows) which is continuous with the a lveolar mucosa (creeping) (AM). Note the characteristic dots (orange peel aspect ) Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 5 Diagnosis of periodontal disease and other disorders of the periodontium The width of attached gingiva varies in different parts of the mouth, as can be observed wide variability in different patients in a given area (Figure 6). In g eneral, higher in the incisor region (3.5 - 4.5 mm in the maxilla and 3.3 - 3.9 mm in the mandible) and lowest in the posterior segments. The minimum width appe ars in the area of the first premolar (1.9 mm in the maxilla and 1.8 mm in the m andible). In the mandible, the lingual gingiva is particularly narrow in the are a of the incisors and wide in molar region (Figure 7). FIG. 6 Variability of the width of attached gingiva: Three patients of approxima tely the same age are in the same place (front lobby) gingival widths ranging fr om 1 to 10 mm FIG. 7 Distribution of the average width of attached gingiva in the maxilla (buc cal) and mandibular (buccal and lingual) The gingiva may present different degrees of melanin pigmentation, this can occu r in diffuse, dark purple spots or irregular shaped, brown more or less clear. I t is present in all individuals, often in insufficient quantities to be detected clinically, is absent or very Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 6 Diagnosis of periodontal disease and other disorders of the periodontium individuals decreased in albinos and accented in black-skinned individuals (Figu re 8a, 8b). FIG.8 The attached gingiva of this young man is clearly dotted white and shows a brown pigmentation of variable intensity. FIG. 8b Intense pigmentation, irregular distribution, a black male 22 years. The anterior teeth showed a slight retraction of the papillary vertices Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 7 Diagnosis of periodontal disease and other disorders of the periodontium

Epithelial structures supporting Junctional epithelium. Epithelial attachment. S ulcus The marginal gingiva is attached to the tooth surface because the junction al epithelium forms and renews the epithelial (Listgarten Schroeder, 1977). The junctional epithelium junctional epithelium is about 2 mm in height and in a rin g around the neck of the tooth. Apical direction, is composed of only a few cell layers, and in a coronal direction, ie in the vicinity of the sulcus, approxima tely 15-30 cell layers, and its width at this location (sulcus floor) of approxi mately 0, 15 mm. The epithelium is formed by only two layers, the basal (mitotic ally active) and suprabasal (daughter cells). Remain undifferentiated and non-ke ratinized. Basal cells are attached to the tissue through hemidesmosomes and bas al lamina outside (v. epithelial). The junctional epithelium is not healthy tiss ue interdigitating with the neighbor. The renewal fee (turn over) of the junctio nal epithelium is 4-6 days, ie very high (6-12 days = oral epithelium; Skougaard , 1965, 1970) (Figure 9a, 9b). The epithelial attachment epithelial attachment is the product and part of the j unctional epithelium and consists of an inner basal yameen (LBI) and hemidesmoso mes. Allows epithelial attachment between the gum and the tooth surface, irrespe ctive of whether it is on the enamel, cementum or dentine. The basal lamina and hemidesmosomes of the epithelial attachment are similar to those of the bonding surface epithelial-connective tissue (Figure 10). The cells attached to the toot h surface also migrate in a coronal direction, so that its attachment should be released and settle hemidesmosomales continuously. Between the basal lamina and the tooth surface is usually found a dental cuticle of 0.5 to 1 micron, which is possibly a product of the junctional epithelium cells. Sulcus The gingival sulcus or groove is a small channel of about 0.5 mm deep, wh ere the soil formed by the junctional epithelial cells located more coronally, a nd he continuously exfoliated epithelial cells. The sulcus IADO limited by the t ooth and the other with the sulcular oral epithelium (Lange and Schroeder, 1971) . Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 8 Diagnosis of periodontal disease and other disorders of the periodontium 1. 2. 3. 4. Junctional epithelium oral epithelium of gingival sulcus Sulcus Connective tissu e FIG. The 9th The spindle-shaped cells of junctional epithelium (a) are oriented parallel to the surface of the tooth. On the floor of the sulcus (4) (100 '150 μ m) are removed cells from the basal layer of junctional epithelium, 1.5 - 2 mm i n length FIG. 9b apical portion of the junctional epithelium junctional epithelium cement oenamel ends at the edge. Cuboidal basal cells (B) migrate to the sulcus (red ar rows) and when it reaches the surface of the tooth, the mechanism of adhesion fo rm above. Immediately below the junctional epithelium are located early dento-gi ngival fibers. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 9

Diagnosis of periodontal disease and other disorders of the periodontium FIG. 10 internal Basal lamina and hemidesmosomes Each cell of the junctional epi thelium is located on the surface of the tooth form hemidesmosomes (HD) with the help of which adheres to the internal basal lamina (IBL) and to which is attach ed to the tooth surface. The long arrows indicate the intercellular space betwee n three cells of the junctional epithelium. The internal basal lamina is composed of two layers: the lamina lucida (LL) and lamina densa (LD) The distance between the floor of the sulcus and the alveolar bone is known as b iological space. The biological width consists of two areas, one of epithelial a dhesion and other connective insertion. These two areas form a biological closur e around the neck of the tooth and act as a barrier to the penetration of microo rganisms and their products. Gargiulo, Wentz and Orban in 1961, described the di mensions and relationships of the tissues of the union dentogingval, they quanti fied the dimensions doing autopsies in humans. Their results showed that on aver age the depth of the sulcus (sulcus) is 0.69 mm, the junctional epithelium of 0. 97 mm and the insertion connective supracrestal 1.07 mm (Figure 11). FIG. 11 biological space: includes epithelial connective = 0.97 mm = 1.07 mm Ins ertion Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 10 Diagnosis of periodontal disease and other disorders of the periodontium Structures tissue attachment gingival attachment apparatus attachment structures allow tissue union between the teeth and alveoli, between your teeth and gums a nd between teeth. These structures include: - You do fibrous gingival - periodon tal ligament. - Cement-radicular alveolar bone gingival fiber bundles appear in the region supralveolar bundles of collagen fibers that intersect in different d irections. These beams transmitted to the gum firmly on the form, fixing the too th below the junctional epithelium, and secure it against shearing forces, furth er stabilize the position of each of the teeth and keeping them well aligned. Th e beams periost - gum can also be considered in a broad sense, as part of the gi ngival fibers and their function is to determine the gum "inserted" to the alveo lar process (Figure 12a, 12b). FIG. 12th A. B. gingival fibers C. periodontal fibers Alveolar bone Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 11 Diagnosis of periodontal disease and other disorders of the periodontium FIG. Route 12b of the gingival fiber bundles. 1. Dentogingival - Coronal - Horiz ontal - Apical 2. Alveologingival 3. Interpapillary 4. Transgingival 5. Circular - Quadrant 6. Dentoperiostal 7. Transseptal 8. Periostiogingival 9. Intercircul ar 10. Intergingival The functions of the gingival fibers are: 1. 2. 3. 4. 5. 6. 7. Dentogingival .gingival provides support. Gingival alveolar gingiva .- insertion to the bone. I

nterpapillary .- provides support to the interdental gingiva. Transgingival .- e nsures alignment of teeth in the arch. Circular .- keeps the shape and position of the free gingival margin. Dentoperiostal.Transeptal .- maintains the relation ship of adjacent teeth, protects the interproximal bone. 8. Periostiogingival .insertion of the gingiva to the bone. 9. Intercircular .- stabilizes the teeth in the arch. 10. Intergingival .- provides support and contour of the gingiva. Periodontal ligament periodontal ligament (PDL) is situated between the root sur face and alveolar bone and is composed of fibers of connective tissue cells, ves sels, nerves, and substance. The basic element of the fiber bundles of collagen are fibriIlas thickness of 40-70 nm, which are arranged in parallel, forming col lagen fibers. In turn, the meeting of many of these fibers causes the collagen f iber bundles (Sharpey fibers), which are inserted first, in the alveolar bone an d, secondly, in the root cementum (Feneis, 1952) ( Figure 13). Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 12 Diagnosis of periodontal disease and other disorders of the periodontium FIG. 13 Trajectory of fibrous periodontal 11. Crest 12. Horizontal 13. Oblique 1 4. Interradicular 15. Apical the do The periodontal ligament space is shaped like an hourglass and is narrower towar ds the middle of the root. The periodontal ligament width is approximately 0.25 mm + 50%. The presence of a periodontal ligament is essential for tooth mobility . Tooth mobility is determined largely by the width, height and quality of perio dontal ligament. Cementum Cementum is a specialized calcified tissue covering the root surfaces a nd, sometimes, small portions of the tooth crowns. It has many features in commo n with bone tissue, but a) has no blood vessels or nodes, 2) has no innervation, and 3) do not experience physiological resorption and remodeling, but is charac terized by a continuous deposition throughout life. The cement meets different f unctions. Root insertion provides the periodontal ligament fibers and contribute s to the repair process after injury to the root surface. There are two kinds of cement: 1) primary or acellular cementum is formed in conjunction with root for mation and eruption; (Figure 14a). 2) secondary or cellular cement that is forme d after the eruption and in response to functional needs. It is located in the a pical third and part of the furcation area (Figure 14b). Small ponds are usually seen in cement up to 80 μm in depth (which are recesses for bacteria during the formation of the bags). Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 13 Diagnosis of periodontal disease and other disorders of the periodontium FIG. Cement 14th root (CR) or acellular primary,€that is in contact with the roo t dentin. FIG. Cement 14b secondary or cellular cementum is deposited on the primary funct

ional throughout the duration of the tooth. Apparatus supporting alveolar process bone. The alveolar bone alveolar processes of maxilla and mandible are dependent on tooth structures that develop during t heir training and atrophy rash and once they disappear. There are three structur es in the alveolar process: - The alveolar bone proper - spongy bone - external compact bone. The outer compact bone overlying the alveolar process and the entr y level of the alveoli (edge or ridge) is transformed into the cribriform plate, or alveolar bone proper. The bone that forms the alveolar wall is about 0.1 - 0 .4 mm thick and shows numerous small holes through which and out of the periodon tal space and lymphatic vessels and nerve fibers (Volkmann canals). The spongy b one is between the compact bone and the alveolar bone, the marrow spaces of canc ellous bone generally contain fat (Figure 15a, 15b, 15c). Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 14 Diagnosis of periodontal disease and other disorders of the periodontium FIG. January 15. Synonym alveolar bone alveolar anatomy • Wall • Synonym cribrif orm plate imaging • Print hard 2. 3 spongy bone. Compact bone FIG. Cross section 15b of the upper alveolar process at half of the dental roots . Note that the bone around the root surfaces is considerably thicker than in ve stibular Palatine. The walls of the alveoli are lined by compact bone (arrows) t hat is connected primarily with proximal cancellous bone. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 15 Diagnosis of periodontal disease and other disorders of the periodontium FIG.15c Transverse sections of the alveolar process below the level of the coron ary roots thirds (1) and apical (2). Compact bone lining the walls of the alveol i is usually continued with the compact bone or cortical bone on the lingual (L) and vestibular (B) (arrows). Note how the buccal and lingual bone of the alveol ar process thickness varies from region to region. In incisive and premolar regi ons, the vestibular cortical bone yameen is considerably thinner than the lingua l. In the molar region, the bone is thicker than lingual buccal. In the buccal surface of the jaw bone coverage is sometimes lacking in the coron al portion of the roots, forming the so-called dehiscence (a). If there is any b one in the coronary portion of such areas, the defect is called fenestration (b) (Figure 16). FIG. 16 dehiscence was observed (a) and fenestration (b) Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 16 Diagnosis of periodontal disease and other disorders of the periodontium Vascularization of the periodontal periodontal tissues, including periodontal li gament, have a rich blood supply, even in the absence of pathology, which is due

not only to the high degree of cellular metabolism and fibrous tissue, but also the mechanical function of the periodontium: occlusal overload not only act on the fibrous apparatus of the periodontal ligament and alveolar process, but also the tissue fluid causing their movement within the periodontal cleft (distribut ion Hydraulic pressure, damping). The most important vessels until you reach the alveolar ridge and periodontal are: - The anterior and posterior alveolar arter y, infraorbital artery and the maxillary palatine arteries - arteries mandibular , sublingual arteries, the arteries barbels, the lingual arteries and arteries v estibular in the mandible (Figure 17). The lymph vessels and nerves are basicall y the way of blood vessels. FIG. 17 Ways of vasculature 1. Periodontal 2. Alveolar 3. Mucogingival supraperi osteal Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 17 Diagnosis of periodontal disease and other disorders of the periodontium PERIODONTAL EPIDEMIOLOGICAL INDICES Gingival Index (Löe and Silness, 1963) (Löe 1967) determines the severity and lo cation of gingival inflammation by assessment of capillary fragility. It evaluat es all existing teeth, each piece takes 04 areas: o By mouth: distal, middle, an d mesial. o palatal or lingual: middle portion. Procedure: a. Dry with an air je t b. marginal gingiva€Probe the gingival crevice with the periodontal probe. Car ry the probe to the bottom of the slot or bag, walk in the lateral from mesial t o distal or vice versa. c. Record data on clinical history, according to the fol lowing criteria. Grade 0 = normal gingiva Grade 1 = mild inflammation. o Slight change in color or slight edema of the gingival bleeding on probing or No Grade 2 = mild inflammation. or tissue can see shiny and smooth or moderate redness an d swelling or bleeding on probing Grade 3 = severe inflammation. or edema and / or marked redness or ulceration or spontaneous bleeding Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 18 Diagnosis of periodontal disease and other disorders of the periodontium RETENTION INDEX (Bjorby and Löe, 1967) determines the degree of retention of the tooth surfaces adjacent to the gingival margin as bright spots for the accumula tion of plaque in the sulcus. It evaluates all teeth present. Procedure a) Explo re the marginal edge of the restorations and / or tooth surfaces around the peri meter Cervical browser. b) Place each tooth the largest value found turned down due to the following criteria Grade 0: o There are no cavities or no calcified p laque or no imperfect margins supragingival dental restorations in the vicinity of the gum. Grade 1: o Caries supragingival supragingival or calcified plaque or imperfect margins supragingival dental restorations. Grade 2: o subgingival car ies or calcified plaque or subgingival margins subgingival dental restorations i mperfect Grade 3 or above and extensive subgingival caries or Abundance of subgi ngival calcified plaque above or very inadequate or marginal adaptation of denta l restorations supragingival, subgingival or both Grade 1: calcified plaque supragingival Grade 1: Restoration overflowing supragingival

Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 19 Diagnosis of periodontal disease and other disorders of the periodontium Grade 2: Restoration overflowing subgingival Grade 2: subgingival calcified plaque Grade 3: supra and subgingival calcified plaque TOOTH MOBILITY INDEX (Miller) determines the degree of mobility or displacement of the tooth in its socket Procedure: a. Use non-active end of two instruments w ith pen making modified. b. Place one end in the palatal or lingual side and one on the buccal. Use ring and middle fingers as a fulcrum on neighboring teeth or edentulous areas c. Observe a reference point on the incisal edge or occlusal s urface of the test piece, apply a lateral force in the buccolingual direction an d by comparison with a point of reference for the next room or excess (if toothl ess) calculate the distance moves the piece tested. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 20 Diagnosis of periodontal disease and other disorders of the periodontium d. Run this procedure on each of these parts in the order of 18-48 and record th e grade on the following criteria Grade 0: no measurable but perceptible Mobilit y (Mobility physiological) Grade 1 Grade 2 perceptible Mobility: Mobility teeth up to 1 mm only horizontally Grade 3: tooth mobility greater than 1 mm in any di rection, horizontal, vertical or rotation in the socket. Mobility Grade 3 SIMPLIFIED ORAL HYGIENE INDEX (Greene and Vermillion 1964) quantitatively determ ine the hard and soft deposits on the tooth surfaces. • It is obtained by evalua ting the buccal surfaces of the teeth 16, 11, 26 and 31, and lingual surfaces of the teeth 36 and 46. • To consider measurable, these pieces must be at the leve l of occlusion. • In case of absence, or partial eruption coronary destruction o f parts 11 or 31, take the pieces 21 or 41 respectively and in the absence or pr esence of coronary destruction of parts 16, 26, 36 or 46, use the pieces 17, 27, 37 or 47 respectively. In the absence of the latter tooth put a line in the box . • For the index must be present in the mouth at least two of the songs listed, otherwise it is used in evaluating all components present in the mouth. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 21 Diagnosis of periodontal disease and other disorders of the periodontium • The simplified oral hygiene index consists of the indices of soft plaque and cal cified plaque (calculus).€The index value is obtained by adding the values of so ft plaque index plus the rate of calcified plaque. Soft plaque index: Procedure: a. Ringworm of the teeth with revealing substance (tablet or liquid) b. Record the value of each surface using the following crite ria: Grade 0: Absence of plaque on the tooth surface Grade 1: Presence of staine d plaque that does not cover beyond the cervical third of the tooth surface. Gra de 2: Presence of stained plaque that covers all or part of the cervical third a

nd the middle third. Grade 3: Presence of stained plaque that covers the cervica l third of the three thirds of the total or partial tooth surface. c. Get the pl aque index, averaging the sum of the values for each observed surface. Index of calcified plaque (calculus): Procedure: a. Place the tip of an explorer No. 17 perpendicular to the tooth surface, walk along the length of the tooth. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 22 Diagnosis of periodontal disease and other disorders of the periodontium b. Determine the value, the presence of calcified plaque on the following criter ia: Grade 0: Absence of calculation Grade 1: supragingival calculus covering not more than one third cervical. Grade 2: supragingival calculus covering the cerv ical and middle third, or subgingival calculus discontinuous. Grade 3: supraging ival calculus covering more than two thirds from the cervical area or subgiginva l continuous band calculation. c. Get the index calculation, averaging the sum o f the values of each surface observed. CONTENTS furcation (Hamp) Determines the destruction of the periodontal ligament and / or furcation bone horizontally in the tooth multirooted. For the inspecti on of the furcation probe Naber use. The areas assessed are: vestibular area hal f or upper and lower molars or lingual half zone or area of lower molars mesial and distal proximal upper molar Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 23 Diagnosis of periodontal disease and other disorders of the periodontium Record the value of each piece using the following criteria: Class I: Visualizat ion furcation or access to less than 3 mm. Class II: Entering the furcation part of 3 mm or more but not total passage. Class III: direct passage through the fu rcation. Class I furcation Class II furcation Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 24 Diagnosis of periodontal disease and other disorders of the periodontium Class III furcation REGISTRATION CONTROL BOARD (O'Leary, Drake and Naylor 1972) indicates the percen tage of the total stained areas of tooth surfaces present. This index is applied at baseline and throughout treatment to determine the ability to control mechan ical plaque before and after oral hygiene instruction and is obtained by applyin g the following formula: Number of stained surfaces X 100 = Total Surface Each t ooth was considered present consists of four surfaces. The record to determine t he rate of O'Leary is done by checking the stained surface on the following diag ram. Ahem. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 25

Diagnosis of periodontal disease and other disorders of the periodontium Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 26 Diagnosis of periodontal disease and other disorders of the periodontium PERIODONTOGRAMA INSTRUCTIONS FOR FILLING THE FORM OF PERIODONTAL I. GENERAL To t he diagram of periodontal tab need the following colors (pencils or pens): black , red, blue and green. Abbreviations used: MG: UCA Gingival Margin: Union Cement Adamantina PS: Depth probing SS: Bleeding on probing PL: Board NIC: Clinical At tachment Level II. Structures SPECIFIC tooth colored or black: missing teeth, cr owns fractured or undermined by caries or outlined in black: impacted teeth and / or unerupted III. STEPS TO REGISTER IN THE LOCKERS EACH TOOTH ASSOCIATED six measures were re corded for each tooth, three on the buccal and 3 in the palatal or lingual to th e MG, PS and IAS in the corresponding boxes. MG: It is the distance from the UCA to MG. When the MG is apical to the UAC registers a positive integer. When the GM is coronal to the AAU is recorded an integer with negative sign. PS: It is th e mark depth in millimeter periodontal probe from the MG to the base of the peri odontal pocket or crevice.€PL: If the soft plaque and / or calcification are pre sent marked with a blue dot ( ) on the whole number of the PS in the correspondi ng area (mesial, middle, or distal). NIC: It is the distance from the UCA to the base of the periodontal pocket or crevice. This can be directly calculated by t he arithmetic sum of MG and PS. SS: It is marked with a red dot (°) the presence of bleeding on probing, the number of the NIC in the area correspondienete (mes ial, middle, or distal) Note: Records of MG, PS and IAS is done with colored pen cil black Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 27 Diagnosis of periodontal disease and other disorders of the periodontium Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 28 Diagnosis of periodontal disease and other disorders of the periodontium COLORED SHEET OF PERIODONTAL Consider 2 mm away from line to line. Traces oo blu e MG in relation to the UCA ( ) Color red PS ≥ 4 mm, vertically along the surfac e of the tooth (│) Place a green asterisk between the box of MG with the corresp onding component, when the gingiva or ≤ 2 mm is inserted. (*) Fucación defects a re marked in red in the furcal area corresponding with the following schedule: C lass I = Class II = Δ Λ Class III = ▲ Mobility must be signed in blue pencil dra wing of the occlusal surface of tooth. The presence of drainage is indicated by a red circle with a red dot in the center (Θ) and recorded at the apex of the pi ece. The presence of caries or restoration margin on periodontal important conto ured are marked with a vertical zigzag red line on the heart surface (Σ) The dia stema or inadequate interproximal contacts are marked with a vertical zigzag blu e line, which is placed on the contact area (Σ) or

 

or or or or or Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 29 Diagnosis of periodontal disease and other disorders of the periodontium View of completed and plotted a periodontograma (maxilla) Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 30 Diagnosis of periodontal disease and other disorders of the periodontium C A IFICATION OF PERIODONTA DI EA E I. Gum disease A. Disease-induced gingival plaque * 1. Gingivitis associated with dental plaque only or no taxpayer or any other factor contributing to local factors (root fra cture, dental anatomy, overhanging restorations, orthodontic appliances, carious lesions, etc. 2. Gingival diseases modified by systemic factors or Associated w ith the endocrine system - gingivitis associated with puberty - Gingivitis assoc iated with the menstrual cycle - Associated with Pregnancy • Gingivitis • Pyogen ic Granuloma - Gingivitis associated with diabetes mellitus with blood dyscrasia or Associate - Gingivitis associated with leukemia - Other 3. gingival diseases modified by medications or influenced gingival diseases Drug - drug-influenced gingival enlargement phenytoin, calcium antagonist and cyclosporin A - Gingiviti s • Gingivitis influenced by drugs related to contraception • Other 4. gingival diseases modified by malnutrition B. Deficiencies of ascorbic acid-induced gingi val lesions plate 1. Diseases gingival bacterial origin specific or injuries ass ociated with Neisseria gonorrhoeae, or Treponema pallidum-associated lesions or lesions associated with streptococcal species or others 2. gingival diseases or viral infections herpes virus - hepética Gingivostomatitis primary - recurrent o ral Herpes - Varicella Infections zoster Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 31 Diagnosis of periodontal disease and other disorders of the periodontium o Other 3. Gingival diseases or fungal infections by Candida species or linear g ingival erythema Histoplasmosis or Other 4. Gingival lesions genetic or heredita ry gingival fibromatosis or Other 5. Gingival manifestations of systemic conditi ons or disorders mucocutaneous - ichen Planus - Pemphigoid - Pemphigus vulgaris - Erythema multiforme - upus erythematosus - Drug-Induced - Other or allergic reactions - dental restorative material • Mercury • Nickel • Acrylic • Other - R eactions attributed to • toothpaste • Mouthwashes • gum additives • Food Additiv es - Other 6. Injury (artificial, iatrogenic, accidental) or chemical attack or physical or thermal aggression 7.€Foreign body reactions 8. * Unspecified can oc cur in a periodontium with no attachment loss or on a periodontium with no progr

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essive loss of support. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 32 Diagnosis of periodontal disease and other disorders of the periodontium II. Chronic Periodontitis o o ocalized Generalized III. Aggressive Periodontitis o o ocalized Generalized IV. Periodontitis as a Manifestation of ystemic Diseases or Associated with hematological disorders - neutropenia syndrome - eukemia - O ther genetic disorders Neutropenia Associated with Down yndrome Family cyclical deficiency syndrome leukocyte adhesion in Papillon- efevre syndrome Chediak-Hig ashi syndrome histocitiosis glycogen storage disease child Agranulocytosis Cohen syndrome gene Ehlers-Danlos (type IV and VIII) hypophosphatasemia other unspeci fied o o V. Necrotizing Periodontal Diseases oo necrotizing ulcerative gingivitis necrotizing ulcerative periodontitis VI. Periodontal abscess ooo abscess gingival abscess periodontal abscess pericoronal VII. Periodontitis associated with endodontic lesions or combined endo-periodontal lesions Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 33 Diagnosis of periodontal disease and other disorders of the periodontium VIII. Conditions and developed or acquired deformities or localized dental factors that modify or predispose to periodontitis and plaqu e-induced gingival diseases - tooth anatomical factors - Restorations and braces - Root fractures - cervical root resorption mucogingival deformities around the teeth - gingival recession - oss of gum queratinzada - vestibular Fund reduced - Position inadequate muscle / braces - Excess gingival • Pseudo inconsistent b ag • • Excessive gingival margin gingival appearance • gingival enlargement - mu cogingival deformities color Abnormalities in edentulous ridges - horizontal rid ge deficiency and / or vertical - oss of gum tissue / keratinized - Enlarged gi ngival tissue / soft - Position inadequate muscle / braces - reduced vestibular Fund - Abnormalities color occlusal trauma - primary occlusal trauma - secondary occlusal trauma or or

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or Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 34 Diagnosis of periodontal disease and other disorders of the periodontium Clinical and radiographic features GINGIVITI or may be soft or calcified plaque or redness and swelling of the gingival tissue or absence of tooth mobility or probing depth of 3 mm to about bleeding on probing (for provocation) or no gingi val recession or not clinical evidence support or loss of gingival margin to the limit amelo cemento-enamel or cementum or normal Radiographic examination PERIODONTITI : A EVERITY PERIODONTITI Mild or minimal bone loss or clinical s igns of inflammation or gingival margin at the cementum-enamel junction limit or probing depth of 4-6 mm or commitment not fork or Radiological alveolar ridges are no more than 2 mm apical to the AC or mild bone resorption (effacement of t he interproximal crest) or clinical attachment level (clinical support lost) = 1 -2 mm moderate periodontitis: o oss of bone support or clinical signs of inflam mation or probing depth of 5 to 6 mm (varies with the position of the gingival m argin) or Probable tooth mobility or fork can be no compromise or radiography us ually shows bone resorption begins to be horizontal or vertical or resorption fi nd clinical attachment level (clinical support lost) = 3-4 mm severe periodontit is: o oss of bone can be horizontal or vertical or clinical signs of inflammati on or probing depth greater than 6 mm or ≥ Insertion loss is the probing depth o r commitment or fork II or III clinical attachment level (clinical support lost ) ≥ 5 mm Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 35 Diagnosis of periodontal disease and other disorders of the periodontium PERIODONTITI : ACCORDING TO YOUR AREA ED:> 30% of sites affected OCATED: ≤ 30% of sites affected GENERA IZ

REFERENCE 1. Carranza, F.A. I. Clinical Periodontology Glickman. 7ma. Edition. Editorial Interamericana. Mexico. 1993. 2. Donayre, F. Col. and Procedures Manua l in Clinical Periodontology. chool of tomatology, Universidad Peruana Cayetan o Heredia. ima-Peru, 1993. 3. Armitage, G. Classification of periodontal diseas es.€Ann of Periodontol. 1999. 4 (1) :1-6. 4. indhe, J. Clinical Periodontology. 2nd. Edition. Editorial Médica Panamericana. Argentina. 1992. 5. Rateitschak, K laus & Edith. Atlas of Periodontology. 2nd. Edition. alvat Editores. pain. 6. Carranza - Newman. Clinical Periodontology. 8th. Edition. Editorial Interamerica na. Mexico. 1998. Universidad Peruana Cayetano Heredia - Faculty of Dentistry "Roberto Beltrán Nei ra" 36

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