Perio Macro and Micro Structures Flashcards by Jon Misch

What articles are important when discussing the importance of KG width?

Lang and Loe 1972 (Need >2mm)

Stetler and Bissada 1987 (when sub G resto, >2mm better)

Wennstrom and Lindhe 1983 (when plaque control, doesnt matter)

Cortellini and Bissada 2018 (when plaque control, doesnt matter)

Kennedy and Dorfman 1980 (longitudinal split mouth - >2mm was protective against inflammation)

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How much of the population has stippling? What does it mean?

~40% Karring&Loe
if lost, early sign of inflammation
Green 1962
“ONLY LOST if inflammation goes beyond the FGM and in to the attached gingiva” - Orban (said in Green 1962)

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How much of the population has a free gingival groove?

~30% - Ainamo and Loe

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What is the width of the free gingival groove?

0.5 - 2mm
Bosshardt

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Width of attached facial gingiva

Bowers 1963
1-9mm
Most in incisors (Max>Mand)
Least in Canine and 1st premolars

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What is the width of lingual gingiva - what happens from primary to permanent teeth?

1-8mm
Decreases (lingual eruption of permanent teeth)
Voight 1978
Most in 1st and 2nd molars

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What study said we need 2mm kg?

Lang and Loe 1972
Stetler and Bissada 1987 (SubG Restoration)

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What study said we do NOT need 2mm KG?

Wennstrom & Lindhe 1983
Beagle dog study - removed attached gingiva and did FGG in 1/2
Oral hygiene
No difference in inflammation

Cortellini & Bissada 2018

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How is phenotype related to KT width and bone morphotype?

Cook et al. 2011 reported Thin biotype associated with 50% thinner buccal plate
as CEJ-Crest increased, KG decreased

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What are some protective/risk factors against recession?

Chambrone & Tatakis
Protective: KTW/GT
Risk: Lack of AG

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Describe the epithelium of Junctional, Sulcular, and Oral epithelium

Junctional/Sulcular are non-keratinized stratified squamous
Oral is Para-keratinized stratified squamous

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How many cell layers in Junctional, Sulcular, and Oral epithelium

Junction and sulcular: 2 - Basale and Suprabasale
Oral: 4 - Basale, Spinosum, Granulosum, Corneum

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Where are rete pegs present?

Junctional - only in inflammation
Sulcus - present
Oral - present

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How many cells thick are the Junctional, Sulcular, and Oral epithelium?

Junctional: 3-4 at apical, 15-20 coronal
Sulcus: Variable
Oral: 20-40

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Cell size of Junctional, Sulcular, and Oral epithelium

Junctional: Largest
Sulcular: Med
Oral: Smallest

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Intercellular space of Junctional, Sulcular, and Oral epithelium

Junctional: Widest
Sulcular: narrow
Oral: narrowest

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Cell Junctions and permeability of the Junctional, Sulcular, and Oral epithelium

Most abundant in all of them is Desmosomes
Oral epi has the most of them (> Junctional)

Junctional: Gap junctions (allows cell leakage (GCT and innate immunity)) Hemidesmosomes (attachment to enamel and basement membrane - RAPID TURNOVER

Sulcular: Desmosomes

Oral: Tight Junctions, Hemidesmosomes to basement membranes

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What is the clinical significance of Junctional, Sulcular, and Oral epithelium

Junctional: Barrier (attached to tooth) - Access of GCF and innate immune cells

Sulcular: more susceptible to breakdown - non-keratinized

Oral: mechanical/bacterial barrier

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Gargiulo 1961

Sulcus: 0.69mm
JE: 0.97mm (most variable)
CT: 1.07mm (most constant)

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What kinds of keratinization is there and what is the difference? Where are they present?

Ortho-Keratinized (no nuclei)
Pera-Keratinized (nuclei remnants)
Corneal layer has a range of these

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What is the cellular makeup of the oral epithelium?

90% Keratinocytes
10% non-keratinocytes (clear cells)

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What cells make up the % of the oral epi that is not keratinocytes? Where are they located?

4 types of clear cells

Merkel’s cells (basal)
Melanocytes (basal)
Langerhans cells (mostly suprabasal)
Inflammatory cells (variable)

What is a key histoloical feature of langerhans cells?

Bierbeck granuals (tennis racket)

What is the basal cell attached to? How

Basement membrane - Hemidesmosomes

How many layers are in the basement membrane and what are they?

3 Lamina Lucida Lamina Densa Sublamina Lucida (Kobayashi, 1976)

What is the most superfical layer of the BM made of and why is it named the way it is?

Lamina Lucida Electron lucent Lamanin, nidrogens, dystroglycans

What is the most inferior layer of the BM made of and why is it named the way it is/How is it connected to the CT layer?

Lamina Densa Electron dense Anchoring Fibrils (COL VII)

What is the BM composed of?

50% Type IV Collagen Lamanin (most abundant non-collagen protein) Proteoglycans

What is the CT composted of?

aka Lamina Propria 60-65% fibers (Collagen type I>Collagen type III) 35% ECM/vessels 5% cells (65% fibroblasts)

How many layers is the CT and what are they?

2 Papillary (loose - CT papilla between rete pegs) Reticular (dense - continuous with periosteum)

What are the most abundant GAGs in the periodontium?

Epithelium: Heparan sulfate (60%) CT: Dermatan Sulfate (60%) Cementum/Bone: Chondroitin Sulfate (94%)

What other GAGs are there? Are they in the periodontium at all?

Hyaluronic Acid (in CT/synovial fluid) Keratan sulfate (Cornea/bone/cartilage)

Where is Chondroitin Sulfate found in the body?

Cartilage/Bone/Heart valve/Cementum

Where is Dermatan Sulfate found in the body?

Gingival CT/skin/vessels/heart valves/lung/tendons

Where is Heparan Sulfate found in the boyd?

Basement Membrane! cell surface component

Where is Hyaluronic Acid found in the body?

Synovial fluid ECM Skin Articular cartilage

What are the gingival fiber groups?

5 groups Trans-septal Circular Dento-Gingival Dento-Alveolar Alveolo-gingival

What are the principle fiber groups of the PDL?

Alveolar crest fibers Horizontal fibers Oblique fibers Apical fibers Interradicular fibers

What cells does the PDL contain?

Mesenchymal cells that can differentiate into fibroblasts, osteoblasts, or cementoblasts

What are the functions of the PDL?

PDL Never Stops Forming Self Protective Nutritive Supportive Formative Sensory

How thick is the PDL?

0.2-0.4mm Carranzza

What is the primary collagens of CT, PDL, and Cementum?

Col I and III Cementum: 90% I PDL : 80% I CT: 70% I

What are the different types of cementum? CITATION?

Schroeder 1986 Acellular Afibrillar Acellular Extrinsic-fiber Cellular Intrinsic-fiber Cellular Mixed

Where are the different cementums present? How thick are they?

AAF: Coronal to PDL fibers: 1-15microns AEFC: Coronal-Mid third: 30-230microns CIFC: Apical third: variable CMC: Apical 1/2-1/3/Furcation: 100-1000microns

What is the first cementum produced?

AAC

What cementum is produced to repair itself?

CIFC - resorption lacunae and GTR

What fibers act in adapting to occlusal forces?

CIFC and CMC

How is cementum oriented with enamel?

OMG rule Overlapping: 60% Meeting: 30% Gap: 10%

How is cementum deposition characterized and what does it respond to? CITATION

Kerr 1961 Continuous throughout life 3fold increase from 20-70 Thickest at apex Responds to inflammation, occlusion, ortho movement, pathology

What are the different names for the bone surrounding a tooth?

Bundle bone Cribriform bone Lamina dura

What are the layers of the periosteum?

Fibrous (outer/dense) Osteogenic (loose CT/Inner)

Where are the most common places for fenestration/dehisence? CITATION

Ruperecht et al. 2001 Maxillary 1st Molar: 58% of Fenestrations Mandibular Canine: 67% of Dehisences

How does blood flow in the periodontium

Kleinheinz 2005 Primarily posterior Secondarily inferior

What are the main lymph nodes that the oral cavity drains to? What drains to each?

Submental (mand anteriors) Submandibular (Max Facial/Mand Posteriors) Jugulodigastric (3rd molars) Deep cervical (Max Palatal)