Dev.+&+Acquired+Deformities

Arlene and Natalie

=**Developmental and Acquired Deformities**=

Localized tooth related factors that predispose to plaque-induced gingival diseases and periodontitis
 What this type of gingival disease would look like clinically sometimes a furcation will not be visible clinically.  What this type of gingival disease would look like radiographically



 Specific organism assoicated with the gingival disease Gam negative bacteria and spirochetes.

 How would you diagnosis this- what would your differential diagnosis be? This would be diagnosed clinically while using the furcations probe and also radiographically.

Mucogingival deformities and conditions around teeth
 What this type of gingival disease would look like clinically A significant departure from the normal shape of the gingival and alveolar mucosa. Loss of attached gingival around the tooth, localized clefting. Can be caused from recession usually from intraoral piercings.

 What this type of gingival disease would look like radiographically Will not see radiographically

 Specific organism assoicated with the gingival disease Gram negative bacteria

 How would you diagnosis this- what would your differential diagnosis be? This could be diagnosed by clinically identifying the mucogingival defect and seeing what can be a causative factor such a frenum attachment and asking the patient if they had an intra oral piercing in that specific area. A differential diagnosis would be mucogingival defect, traumatic lesion from fingernail scratching.

Usually require corrective surgery to restore form and function before the prosthetic replacement of missing teeth or implant placement. Adequate vestibular depth and a wider zone of attached gingival in ridge areas is necessary for proper placement and retention of removable prostheses.
 * Mucogingival deformities and conditions on edentulous ridges:**
 * 1) What it would look like clinically- narrow zone of attached gingival on ridges where dentures would be placed. Shallow vestibules.
 * 2) What it would look like radiographically- You wouldn’t see anything radiographically.
 * 3) How you would diagnosis it- ridges may be accompanied by shallow vestibules and narrow zone of attached gingival accompanying ridges.
 * 4) Specific organism associated with the gingival disease- none.

Refers to tissue injury produced by occlusal forces, not to the occlusal forces themselves. Forces that exceed the adaptive capacity of the periodontium produce injury called trauma from occlusion. Diagnosing it requires periodontal findings that suggest the presence of trauma from occlusion include excessive tooth mobility, particularly in teeth showing radiographic evidence of a widened PDL; vertical or angular bone destruction; intrabony pockets; and pathologic migration, especially of the anterior teeth.
 * Occlusal trauma:**
 * Evidence supports that occlusal therapy will positively influence the outcome of both nonsurgical and surgical therapy for patients with moderate to sever periodontitis; it is usually deferred until inflammation is controlled and reevaluation determines that any residual mobility is the result of adverse tooth loading rather than decreased support.
 * Occlusal therapy consists of adjusting the occlusion until the bite is equilibrated. The goal is to establish a stable, nontraumatic occlusion. Not correcting a malocclusion can result in tissue necrosis, orofacial pain and TMD.

Acute trauma from occlusion- results from an abrupt occlusal impact, such as biting on a hard object in your food.
 * 1) What it would look like clinically- gingival would appear normal around injured tooth.
 * 2) What it would look like radiographically- periodontal abscess may or may not be present. Cementum tears may be present. PDL space may be widened.
 * 3) How you would diagnosis it? Is the periodontal tissue damaged, ask questions in relation to what they are experiencing, test the tooth with percussion and test for mobility.
 * 4) Specific organism associated with the gingival disease- none.

Chronic trauma from occlusion- gradual changes in occlusion produced by tooth wear, drifting movement, extrusion of teeth, combined with parafunctional habits such as bruxism and clenching.
 * 1) What it would look like clinically- gingival would appear normal.
 * 2) What it would look like radiographically- periodontally injury would be apparent; widened PDL space.
 * 3) How you would diagnosis it? Check bite with articulating paper, ask pt if they clench or grind their teeth, evaluate bite and check for teeth that are extruded or drifting and check for occlusal wear.
 * 4) Specific organism associated with the gingival disease- none.

Primary Trauma for occlusion- is the etiologic factor in periodontal destruction, example is previously healthy periodontium has periodontal injury after insertion of a “high filling.”
 * 1) What it would look like clinically- gingival would appear normal.
 * 2) What it would look like radiographically- normal periodontium with normal height of bone or periodontal injury would be apparent; widened PDL space.
 * 3) How you would diagnosis it? Check bite with articulating paper; ask pt if their restoration is feeling “high.”
 * 4) Specific organism associated with the gingival disease- none.

Secondary Trauma for occlusion- adaptive capacity of tissues to withstand occlusal forces is impaired by bone loss due to marginal inflammation.
 * 1) What it would look like clinically- Recession may or may not be present. Tooth may be mobile.
 * 2) What it would look like radiographically- normal periodontium with reduced height of bone or marginal periodontitis with reduced height of bone; widened PDL space.
 * 3) How you would diagnosis it? Periodontal probing and mobility assessments, check the patients bite with articulating paper. Look at radiographs.
 * 4) Specific organism associated with the gingival disease- none.

Influence of trauma from occlusion on progression of marginal periodontitis- trauma from occlusion occurs in the supporting tissues and does not affect the gingival.
 * 1) What it would look like clinically- Tooth may be mobile.
 * 2) What it would look like radiographically- normal periodontium with reduced height of bone or marginal periodontitis with reduced height of bone; widened PDL space. Thickening of lamina dura. A narrowing and vertical destruction of the interdental septum. Radiolucency and condensation of the alveolar bone. Root resporption.

3. How you would diagnosis it? Periodontal probing and mobility assessments, check the patients bite with articulating paper. Look at radiographs. 4. Specific organism associated with the gingival disease- none.
 * Cartilage-like material sometimes develops in the PDL space as an aftermath of the trauma. Buttressing bone formation occur when bone is resorbed by excessive occlusal forces, the body attempts to reinforce the thinned bony trabeculae with new bone; important feature of the reparative process associated with trauma from occlusion.
 * The injurious force must be relieved for repair to occur. Escape from or adaptation to excessive occlusal force, periodontal damage persists and worsens.