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Perio I > 1. The Normal Periodontium > Flashcards

1. The Normal Periodontium Flashcards

1
Q

Clinical periodontal exam:
• Insert measuring instrument between the gum and tooth
◦ Instrument stops where you have the ____ (where the most coronal aspect begins)

A

connective tissue attachment

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2
Q

Gingival epithelium

____ epithelium
____ epithelium
____ epithelium

A

oral
sulcular
junctional

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3
Q

Epithelium-function

  • ____
  • Dependence on the ____ tissues
  • Clinical implications

The epithelium has a dependence on the connective tissues, which has clinical implications:
i.e. ____ - trying to put epithelialized tissue when it’s lacking

Epithelium takes its characteristics from the underlying ____ tissue - AKA, the ____ of the tissue is from the connective tissue

A 
protective
connective
free gingiva graft
connective
phenotype
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4
Q

Connective tissues

\_\_\_\_ components 
Fibers
\_\_\_\_ substance 
Blood vessels
\_\_\_\_
A

cellular
ground
nerves

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5
Q

Connective tissues - function

  • ____
  • Resorptive - means that it ____ over
  • ____ - gives some bulk and ____
  • Nutritive - nutrition for cells and ____
  • ____ - awareness of ____
A 
Formative
turns
supportive
structure
vessels
sensory
sensation
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6
Q

RETE PEGS

Rete pegs:
Projections from ____ into the ____ tissue

A

epithelium

connective

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7
Q

Epithelial-connective tissue interface

  • Rete pegs
  • Straight

Rete pegs - usually at the epithelial-connective tissue interface
• Tend to be ____
• Quite distinct in terms of their ____

A

straight

shape

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8
Q

Periodontium

  • ____
  • ____
  • ____
  • ____

The orientated cell and fiber attachment system is the structure and the form of the periodontium.

A

gingiva
PDL
cementum
alveolar bone

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9
Q

The tissues are described in terms of

____ - redness
Contour
Texture - various ____
____ - underlying structure of the tissues

A

color
indentations
consistency

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10
Q

Connective tissues-fiber

  • ____
  • Elastic
  • ____
  • Reticular

These are all within the connective tissue fiber matrix

A

collagen

oxytalan

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11
Q

Gingiva

\_\_\_\_ margin 
Marginal gingiva
\_\_\_\_ gingiva? 
Attached gingiva 
\_\_\_\_ junction 
Gingival groove

Free gingiva contains a question mark because: historically this existed, but more recently, it has been ____ as to whether there really is a free gingiva.

A

gingival
free
mucogingival
questioned

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12
Q

Thickness of ____ gingiva varies considerably between individuals

If have very small amount of attached gingiva, may be more susceptible to ____ (only 1 or 2 mm here)

If have large amount gingiva (5-7mm), resistant to ____

A

attached
recession
recession

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13
Q

GINGIVA

____ gingiva has varying thickness in different areas on same person - due to normal ____ variation.

A

attached

anatomic

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14
Q

MGJ

Mucogingival junction = Junction between ____ and ____

A

gingiva

mucosa

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15
Q

MELANIN- COLOR INFLUENCE

Images depict the influence of ____ in color of gingiva
There are normal variations in melanin concentration in different areas
• These variations are ____

A

gingiva

normal

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16
Q

INTERDENTAL PAPILLAE

Interdental papillae here is more blunted and flattened

Again, gingiva takes the form of the ____ area.

A

interdental

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17
Q

Interdental Papilla

Interdental papilla here is less of a ‘col’ and more of a ____

A

peak

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18
Q

In the middle area (col), it is ____
◦ Buccal and lingual aspects are ____
but on the middle it is non-keratinized

In this slide, can see variations in the width of the col in different areas
• Has some significance clinically:
◦ As look from buccal to the lingual in the incisor, get an idea of the relationship between the buccal and the lingual –> as get to the interdental area, it is a ____ area.
◦ As look from buccal to the lingual in the molar, there is a wider area that is inaccessible to viewing
‣ The interdental area is more distant and more interproximal
‣ This larger surface area can contribute to ____ because:
• These areas are more inaccessible and at greater distance from buccal and lingual papilla and thus plaque can accumulate here
◦ Contributes to more disease - could be gingivitis initially, and more periodontitis more long term
• Patients can get more plaque stuck between larger ____ than thinner anterior teeth

A 
non-keratinized
keratinized
wider
plaque
molars
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19
Q

Gingival sulcus

  • Borders
  • ____
A

depth

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20
Q

SULCI-TISSUE TYPES

In relation to the variations in gingival sulcus, there are tissue types.
Some people have a thinner periodontium while others have a thicker periodontium
• In different people, perhaps you have different thickness of ____

Phenotypically, people are different in terms of tissue type whether thick or thin
◦ Clinical significance:
‣ Thinner periodontium is perhaps more susceptible to ____ and ____ breakdown

A

sulcus
inflammation
periodontal

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21
Q

Thicker gingiva provides better conditions for ____ and ____ (blood flow; stable position of the gingival margin)

A

treatment

wound healing

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22
Q

HISTOLOGICAL SULCUS

Histological sulcus is present in microscope and in diagrams.

The attachment is an ____ - not an actual attachment with fibers.

A

adhesion

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23
Q

3 TYPES OF EPITHELIA

  • ____ Epithelium
  • ____ epithelium
  • ____ epithelium
  • Unique features of the gingival epithelium has clinical implications in relation to the ____ of periodontal disease, as well as ____ of the periodontium.
A

oral
oral sulcular
junctional

etiology
development

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24
Q

JUNCTIONAL EPITHELIUM

____ epithelium: the ____ cells are moving in ‘that’ direction - proceeded to move pointer upwards and to the right. Assuming he meant in the direction of the arrows.

A

dynamic

cuboidal

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25
Q

Sulcus-Junctional Epithelium

____ is associated with early changes of inflammation and gingivitis

Underlying connective tissue
• Contains
\_\_\_\_
• ICT = Infiltrated/
Inflammed connective tissue
A

ICT

collagen

26
Q

Connective tissue

  • ____ substance
  • Water
  • ____
  • Proteoglycans
  • ____
A

ground
glycoproteins
hyaluronic acid

27
Q

GINGIVAL CUFF

Historically, thought that junctional epithelium ____ like a glue until get to free gingiva area then becomes almost ____ and a little bit loose - this is known as the ____
• Present in a ____ situation

A

adheres
detached
gingival cuff

healthy

28
Q

Connective tissue

  • Gingival fibers
    Gingival fibers are ____ fibers which are extending from the tooth into the gingiva (indicated by red

Fibers between the adjacent teeth are called the ____ fibers

____ fibers are shown as dots as they are going around the tooth

Group of fibers going from the tooth into the ____.

A

collagen
trans-septal
sulcular
alveolar bone

29
Q

Periodontal ligament

  • Principal fibers - Principle fibers are going in a ____ and ____ direction
  • Alveolar
  • ____
  • Oblique
  • ____
  • ____

^fiber structure of periodontal ligament •Periodontal ligament is one part of the ____

A 
horizontal
oblique
horizontal
apical
interradicular

periodontium

30
Q

PDL-INTERRADICULAR FIBERS

  • Periodontal ligament has ____ fibers
  • – All of these groups attach from the ____ through the ____
A

interadicular
cementum
alveolus

31
Q

Periodontal ligament

  • ____ fibers
    Histological stain where can see fibers going into the bone
A

sharpey’s

32
Q

PDL cells

\_\_\_\_
Cementoblasts
\_\_\_\_
Cell rests of Malassez 
\_\_\_\_ 
Macrophages
\_\_\_\_
Osteocytes 
\_\_\_\_
A 
fibroblasts
osteoblasts
vascular and neural elements
cementocytes
undifferentiated cells
33
Q

Fibroblasts: form ____

Cementoblasts: form ____

Osteoblasts: form ____

Epithelial cell rests of Mallasez: Groups of ____l cells that function for tooth formation
•After periodontium has developed, the epithelial cell rests of Mallasez are ____ groups of epithelial cells
Note: in regard to the cell rests of Mallasez, he said: “they travel from tooth formation in the dental papilla.” Was hard to understand and this sentence was unclear.

Vascular and neural elements: supply ____ and ____ aspects

Macrophages: did not say anything about these.

Cementocytes: precursors of the ____
Note: this was questioned by a student because we learned that the ‘blast’ precedes the ‘cyte,’ particularly in osteocytes and osteoblasts. Dr. Wang clarified the correct definition of osteocyte which is below. Still seems to be unclear whether the cementocyte precedes the cementoblast or vice versa.

Osteocytes: Located next to the ____ - osteocytes are ____ that have been incorporated into the bone matrix

Undifferentiated cells: Cells which don’t have particular characteristics but have potential to form various things - thus they are ____
• Periodontal progenitor cells
• When stimulated in the appropriate environment - can form a ____ (periodontium = cementum, ligament, and bone - oriented in cell/fiber attachment way)

A

collagen
epithelial
residual

blood
sensory

cementoblasts

bone
osteoblasts

stem cells
periodontium

34
Q

Osteoprogenitor cells are the stem cells of bone and form ____

Osteoprogenitor cells are derived from ____ cells. They form a population of stem cells that can differentiate into the more specialized bone-forming cells (i.e. osteoblasts and osteocytes).

Osteocytes are inactive ____ trapped in mineralized bone
When osteoblasts have completed a burst of ____ activity, most return to an inactive state, becoming ____ and ____-shaped and closely applied to the now-____ bone surface. Some osteoblasts, however, become surrounded by mineralizing bone matrix and lie within small cavities (____) in the bone. When this happens, the cell is called an ‘osteocyte’.

A

osteoblasts
primitive mesenchymal

osteoblasts
osteoid-producing
flattened
spindle
inactive
lacunae
35
Q

Periodontal ligament
clinical considerations

  • ____
  • Excessive forces
  • ____
  • Destruction
A

thickness

accidental exfoliation

36
Q

Excessive forces can result in remodeling of periodontium
◦ Tooth can get more ____ as the ligament adapts
◦ The ligament adapts, remodels, and gets ____ with displacing forces
◦ Types of forces that are used professionally to do this = ____
‣ Orthodontists move the teeth with controlled forces:
• Use remodeling ability of periodontium and once it away from the displacing force, the ligament heals and goes back to a normal ligament width

Accidental exfoliation -
Example: If tooth is knocked out, then re-implanted into the socket and given a temporary stabilization - the ligament heals.
• It heals because the periodontal ligament is a ____ structure, thus if you can maintain the vitality of the cells - then stand a good chance of getting periodontal ligament reformation in situations of accidental exfoliation
◦ In endodontics, they are extracting and reimplanting teeth and trying to get the ligament to reform and trying to retain the cell vitality
◦ If stabilize teeth for longer period of time - do not get ligament reformed, but rather get bony union between the tooth and the root (=____)

Destruction of the ligament - determines how much repair one is able to get
◦ Ligament can get destroyed by periodontal disease = ____
◦ Look at root surface and consider in terms of managing it from a maintenance or reattachment point of view
◦ Destruction can also be ____ - using ____ for example, one can sometimes be removing
part of the periodontal fibers

A

loose
wider
orthodontic wires

cellular
ankylosis

periodontitis
mechanical
curettes

37
Q

Cementum

  • Location: ____, ____
  • Cellularity: ____, ____
  • Fiber presence, ____, ____
A

radicular
coronal

cellular
acellular

fibrillar
afibrillar

38
Q

Apical Cementum

Histology image showing apical area of the tooth
Cementum is different in the different areas around the ____
-Dr. Max Listgarten did important work on cementum formation.

A

root

39
Q

ALVEOLAR BONE

Crest of the bone follows the ____ and then rounds off ____

A

CEJ

interdentally

40
Q

ALVEOLAR BONE

____ has been raised.
As part of procedure, flap was raised, and thus able to see normal bone anatomy and its three dimensional structure.

A

Flap

41
Q

ALVEOLAR BONE

Alveolar bone is sometimes a little more ____ - why it is called the ____ bone sometimes
•Some of the cells that are here may be the ____

A

spongey
cancellous
stem cells

42
Q

The Periodontium

Anatomical structure together with gingival component
- This is normal ____ (we will discuss changes that occur with this with periodontal disease)

A

periodontium

43
Q

You can see the bone crest being parallel to the CEJ. This is a normal situation. If you look at the bone morphology you can see lines. This represent formation of bone, layer of bone that are being deposited, bone formation (bone matrix). This ____, in small increment overtime is seen when grinding your teeth. The periodontium is a dynamic structure, the tooth ____ to compensate for the occlusion wear, you get this successive small and incremental bone deposition. As you wear teeth away teeth go back to occlusion by new bone being deposited on the crest. This is the normal situation. What is shown histologically is what one has stain with. There are fibers that dont show because this is a cell stain to show the cellular and alveolar component

A

linear deposition

erupt

44
Q

Cellular stain (Left). Can see the orientation of the cell with fibroblast with the cementum. Can se the alignment of the cells in relation to the fibers (fiber stain on right) and the orientation and the attachment of the fibers to the CEJ area. Have Transseptal fibers in the fiber stain (right). Again You can see new bone formation due to ____. Can see junctional epithelium with some rete pegs as a result of inflammation in the tissue. This is the normal situation. You can see the marrow space as well

A

eruption

45
Q

This is a periodontal bone. This is a ____ ended instrument to measure the space between the gum and the tooth. This is a particular marking system hear (3,5,7,8,9,10mm) This is a ____ marking system named after the head of perio in Toronto. The prob you will be using are calibrated in ____. Every 5mm you have a marking to make it more straight forward for reading

A

blunt
William’s
mm

46
Q

The technique, the long axis of the probe ____ to the long axis of the tooth then into the sulcus until it stops

A

parallel

47
Q

See different probing system but usually the prob finishes at the ____. The attachment is a ____ and not a ____ attachment. The probe stops at the end of the epithelium. This is the normal structure

A

CEJ
cellular
fiber

48
Q

When having periodontitis you have pocket formation. And loss of alveolar bone. Probe goes ____ depth wise. The probe is the measuring device. See inflammation in the connective tissue

A

deeper

49
Q

When one measure you go around various point around the tooth. These are the ____ area and these location points are next to the contact area on the mesial distal and middle area.

The contact area require specific identitifaction and location. why do you measure at several point around the tooth structure?

To see how the inflammation has spread around the circumference of the root called the ____ nature of periodontal diseases. It is not ____ around the tooth and varies in the different part around the tooth with different points where you measure difference and variability

A

contact
site specific
uniform

50
Q

The pocket depth is the distance from the ____ to the position of the ____. You have loss of attachment from the CEJ to the en the probe

A

gingival margin

loss of attachment (LA)

51
Q

It is important to account for the ____ in relation to the loss of attachment Here you see no loss of attachment

5mm pocket depth. The distance from CEJ to gingival margin is ____ and you have ____ of loss of attachment

Here 5mm pocket and you have ____ of gingiva and you have ____ of loss of attachment at that site. Attachment loss means periodontitis

A

5mm

1mm
4mm

recession
7mm

52
Q

Histopathology of Periodontitis

Change in:

  • ____
  • ____
  • ____
A

bone
cementum
PDL

53
Q

Can see loss of attachment with ___. This is called ___ epithelium and with inflamed connective tissue (ICT).

The is the histopathology of periodontitis

A

rete pegs

pocket

54
Q

Can see the probe and as a result there is bleeding on probing after pocket probing, not ___ type of probing

A

gingivitis

55
Q

BOP

  • ___
    If you can quantitate the bleeding on probing on a quantitative basis you can be more accurate and sensitive on the presence of bleeding.
A

indices

56
Q

Histopathologic progression of Periodontitis

  • ___ and ___ classification
  • Lesions: initial, early, established, advanced

This is classic method of ___. This is the one that will be emphasized the most in the histopathology that you learn

A

page
shcroeder
progression

57
Q

Spread of Inflammation

  • Stages of inflammation
  • ___ pathways
  • ___ through periodontium
  • ___ versus ___ progression
  • Altered pathway from ___ factor effect
  • Accelerated progression after surgery in ___ dentitions
A 
traditional
pervasive
acute
chronic
codestructive
plaque-infected
58
Q

Spread of Inflammation

In traditional pathways: inflammation go straight through the ___.

The spread of infection throughout the periodontium (he wrote a paper on this)

Acute ___ of disease activity (Socransky)

First person to be the author of your textbook was ___. At that time he said that if you have periodontitis and trauma from ___ you alter the spread of inflammation. Instead of going through the bone it spreads in the ___ and you have ___ pockets forming

Nyman (periodontist from Sweden) When he performed surgery, patient having plaque infection seem that there was greater ___ of disease compared to when the disease was only by itself. When doing surgery you should be carful that the infection and inflammation is well ___ or you will have accelerated progression of detachment loss

A 
bone
burst
Glickman
occlusion
PDL
infabony

spread
controlled

59
Q

Osteoclastic bone resorption

The main ways that gingivitis cans spread to periodontitis. You have ___ bone ___

A

osteoclasts

resorption

60
Q

Look through the pathway to periodontal disease!

A

YAY

Perio I (10 decks)

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