Transcript 04. anatomical and histological structure of periodontal mortise

Anatomical and histological structure and
function of periodontal mortise ages of children.
Etiology and pathogenesis periodontits.
Classification. Symptoms, diagnosis and
diferentdiagnosis of periodontitis in children.
Lecturer: Dr. Katrin Duda
Periodontium is disposed in space, limited from one
side the cortical plate of small hole, and from other —
by cement of root. Child's dentistry must know the
features of periodontium of the unformed tooth, in
what periodontium stretches from the neck of tooth to
part of root of, which was formed, where meets with
the area of growth and is in touch with mash of root
channel.
Periodontium
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As the tooth develops and the root is formed, 3 main
avenues for communication are created:
1. Apical Foramen
2. Lateral and Accessory Canals
3. Dentinal Tubules
Apical Foramen

It is the principal and the most direct route of
communication between the pulp and periodontium
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Bacterial and inflammatory byproducts may exit readily
through the apical foramen to cause periapical pathosis
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The apex may also serve as a portal of entry of
inflammatory byproducts from deep periodontal pockets
to the pulp
Apical Foramen
Lateral and Accessory Canals

These may be present anywhere along the root
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Patent accessory and lateral canals may serve as a
potential pathway for the spread of bacterial
byproducts
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30-40% of all teeth have lateral or accessory
canals and the majority of them are found in the
apical third of the root
Lateral Canals
Dentinal Tubules
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Scanning electron micrograph of open dentinal tubules
Dentin Tubules

The tubules may be denuded of their cementum
coverage as a result of perio disease, surgical
procedures or developmentally when the
cementum and enamel do not meet at the CEJ thus
leaving areas of exposed dentin. Patients
experiencing cervical dentin hypersensitivity are
examples of such a phenomenon
Endodontic Disease and the
Periodontium
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When the pulp becomes inflamed or
necrotic, inflammatory byproducts may
leach out through the apex, lateral and
accessory canals as well as the dentinal
tubules to trigger an inflammatory vascular
response in the periodontium
Periodontal Disease and the Pulp

The effect of periodontal inflammation on the pulp is
controversial and conflicting studies exist:

It has been suggested that periodontal disease has no effect on
the pulp, at least until it involves the apex
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On the other hand, some studies suggest that the effect of
perio disease on the pulp is degenerative in nature including
an increase in calcifications, fibrosis and collagen resorption
in the pulp. It has been reported that pulpal changes resulting
from periodontal disease are more likely to occur when the
apical foramen is involved
Differential Diagnosis of
Endo/Perio Lesions
Primary Endodontic Disease

For diagnostic purposes, it is imperative to trace the
sinus tract by inserting a gutta-percha cone and
exposing one or more radiographs to determine the
origin of the lesion

The sinus tract of endodontic origin is readily probed
down to the tooth apex, where no increased probing
depth would otherwise exist around the tooth
Primary Endodontic Disease

Typically, endodontic lesions resorb bone apically
and laterally and destroy the attachment apparatus
adjacent to a nonvital tooth

It is possible for an acute exacerbation of a chronic
periapical lesion on a tooth with a necrotic pulp to
drain through the PDL into the gingival sulcus. This
clinical presentation mimics the presence of a
periodontal abscess, or a deep periodontal pocket
Primary Endodontic Disease
Pre-op #16
follow-up
Post-op
2 yr
Primary Endodontic Disease
Pre-op #17: periapical and furcal RL + a deep narrow perio defect
Classification of periodontitis
on etiology :
- infectious,
- traumatic,
- medical;
for localizations:
- apical,
- marginal;
Classification of periodontitis
on clinical motion:
-sharp,
-chronic
-in the stage of sharpening;
On pathomorphological changes in fabrics:
- serenity
- festering,
- fibrosis,
- granulematous,
- granulating.
Primary Periodontal Disease

Pre-op: alveolar bone loss + a periapical lesion, a deep narrow
pocket was traced on the mesial aspect of the root, the tooth
tested vital
Primary Periodontal Disease
The tooth was extracted. Note the deep mesial
radicular developmental groove
The features of periodontitis of
baby teeth.
Frequent all meet chronic forms of periodontitu in the
stage of sharpening in temporal teeth, however much it
eliminates development of sharp forms of disease.
General symptomatic of sharp apical periodontitis for
children characterized active motion of inflammatory
process in periodontium, rapid passing of the limited
process to diffuse. The stage of inflammation usually
did not last and passes to festering.
A prognosis at diagnostics of
periodontitu of temporal teeth depends
and from as rezorbtion of root: even,
uneven, mainly in the area of bifurcation
of root. Yes, if at even rezorbtion of root
the border of conservative treatment is
rarefaction of 2/3 lengths, at bifurcation extraction of tooth are shown regardless
of the state of root.
Periodontitis
Clinic of periodontitis of temporal
teeth
Сhronic motion of periodontitis or his sharpening is most widespread
In temporal teeth. Chronic periodontitis of infectious origin in temporal
teeth can develop as a chronic process without the previous stage of
sharp inflammation. It relates with the аanatomic-morphological
features of temporal teeth, in particular with absence for the children of
stability of structure of periodontitu, and also with the features of
functioning of the immune system for the children of junior age.
Chronic granulating periodontitis appeared in temporal teeth far more
frequent comparatively with other forms of chronic inflammation.
Periodontitis
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Thank you for attention