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

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

Bacterial and inflammatory byproducts may exit readily

through the apical foramen to cause periapical pathosis

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

Patent accessory and lateral canals may serve as a

potential pathway for the spread of bacterial

byproducts

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

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

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

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 Post-op 2 yr follow-up

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 DiseaseThe 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.

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Thank you for attention