Periodontal And Periapical Diseases

1. Periodontal And Periapical Diseases

2. Periodontal Disease

3. Usefulness of Radiographs • Amount of bone present • Condition of alveolar crest • Bone loss in furcation areas • Width of periodontal ligament • Local factors: calculus, overhanging restorations • Crown/root ratio

4. Limitations of Radiographs • No indication of morphology of bony defects • No indication of successful management • No indication of hard/soft tissue relationship, i.e., depth of pockets

5. Normal Alveolar Crest • 1.0-1.5 mm apical to cemento-enamel junction • Parallel to line joining the CEJ of adjoining teeth • Smooth • Continuation of lamina dura, has the same radiopacity

9. Evidence of Early Periodontitis • Localized erosion of crest of bone • Blunting of crest- anterior teeth • Loss of sharp angle between lamina dura and crest • Widening of PDL near crest

12. Local Factors • Calculus • Overhanging restorations • Poor restoration contours

13. Calculus

14. Overhanging Restoration

15. Buccal VS Lingual Bone Loss

18. Direction Of Bone Loss Horizontal Bone Loss: Crest of bone is parallel to CEJ line between adjoining teeth. The remaining bone is still horizontal but may be positioned apically.

20. Direction Of Bone Loss Vertical bone loss Crest of remaining bone is not parallel to the CEJ line between adjoining teeth (displays an oblique angulation to the CEJ line )

23. Bone Loss In Bifurcation/trifurcation Areas

26. Bitewing Radiographs Most Reliable For Crestal Bone Evaluation

29. Generalized Periodontal Disease

30. Juvenile Periodontitis(Early-onset Periodontitis, Rapidly Progressing Periodontitis) • Occurs in healthy individuals between puberty and age 25 • Amount of bone loss is not consistent with local factors and oral Hygiene habits. Rate of bone loss is 3-4 times faster than in typical periodontitis

31. Juvenile Periodontitis(cont.) • Typically affects crestal bone of first molars and incisors. Eventually affects greater # of teeth. • Bone loss is progressive and frequently bilaterally symmetrical. Many teeth show vertical bone loss. • Host neutrophil dysfunction has been demonstrated by several investigators.

34. Papillon-Lefevre Syndrome • Autosomal recessive trait • Hyperkeratosis of palms and soles • Occasional keratosis of other skin surfaces • Calcification in falx cerebri • Severe destruction of alveolar bone involving all deciduous and perm. teeth • Exfoliation of teeth

40. Langerhans’ Cell Histiocytosis (Histiocytosis X) • Complex of three diseases: • Eosinophilic granuloma (usually solitary) • Hand-Schuller-Christian disease (chronic) • Letterer-Siwe disease (acute) • Due to abnormal proliferation of Langerhans’ cells or their precursors

41. Eosinophilic Granuloma of Bone • Most common in children and young adults • Usually single radiolucency • Skull, mandible, vertebra and long bones commonly involved • Painful, mobile teeth and gingival lesions

42. Hand-Schuller-Christian Disease • Most cases reported in children under 10 years. Has been reported in older individuals • Skeletal and soft tissues may be involved • Classic triad of symptoms: • “punched out” destructive bone lesions • unilateral or bilateral exophthalmos • diabetes insipidus • Complete triad occurs in 25% of patients

43. Hand-Schuller-Christian (Cont.) • Oral manifestations include: • loose teeth • exfoliated teeth • gingivitis • loss of alveolar bone / advanced periodontitis • Sharply outlined multiple radiolucent lesions in skull, jaws and other bones

44. Letterer-Siwe Disease • Acute, disseminated form of disease • Usually occurs before age 3. Most patients die • Involves several bones and organs • Skin rash • Intermittent fever, enlargement of liver and spleen, lymphadenopathy common • Destructive radiolucencies in jaws • Loosening and premature loss of teeth

45. Hand-Schuller-Christian Disease

46. Hand-Schuller-Christian Disease

47. Skull lesions of Histiocytosis X

48. Other Diseases Influencing Course Of Periodontal Disease • Diabetes mellitus • Leukemia

49. Leukemia

50. Leukemia