Periodontics | Classifications | INBDE, ADAT
TLDRIn this comprehensive video, Ryan delves into the intricate world of periodontics, exploring various classification systems pivotal for dental professionals. He begins with the Miller Classification System, detailing tooth mobility levels from normal to severe. The discussion then shifts to furcation involvement, highlighting its predisposition factors and the Hamp and Glickman classifications for severity assessment. Ryan also touches on alveolar bone loss, explaining horizontal and vertical bone loss differences and the importance of bone height measurement. The video further covers Miller Classification for recession, emphasizing the likelihood of regaining route coverage. Gingivitis and its indicators, the three C's, are also examined, before moving on to the classification of periodontal diseases by severity, distribution, and type. Ryan concludes with a look at necrotizing diseases, their characteristics, and the comprehensive classification of periodontitis. This video serves as an invaluable resource for understanding periodontal health and disease, making it a must-watch for dental students and practitioners preparing for board exams.
Takeaways
- 🦷 The Miller Classification System is used for tooth mobility, with Class 0 being normal physiologic mobility and Class 3 indicating severe mobility with potential vertical displacement.
- 🌱 Furcation involvement refers to bone loss at the branching point of a tooth root, which can be exacerbated by a short root trunk, generally short roots, narrow inter-radicular dimension, and cervical enamel projection.
- 📏 Hamp and Glickman classifications measure the severity of furcation involvement, with Hamp Class 0 indicating no involvement and Class 3 indicating a through-and-through lesion, while Glickman Class 4 adds a clinically visible through-and-through lesion.
- 📐 Alveolar bone loss can be horizontal, where the bone crest sinks down but remains parallel to the CEJ line, or vertical/angular, which is characterized by the number of bony walls remaining and the formation of angles.
- 🕳️ Four types of bony defects are identified: four-wall (extraction socket), three-wall (trough), two-wall (crater), and one-wall defects, each described by the number of bone walls remaining adjacent to the tooth.
- 📉 Miller Classification for recession measures the severity of gingival recession, with Class 1 being the least severe and Class 4 indicating severe recession with little likelihood of achieving root coverage.
- 🔍 Gingivitis is characterized by inflammation of the gingival tissues, identified by changes in color, contour, and consistency, and is caused by microbial plaque.
- 💊 Certain medications, such as calcium channel blockers, dilantin, cyclosporine, and oral contraceptives, can modify gingival diseases, potentially leading to gingival enlargement.
- ⏳ Periodontal disease is classified by severity (slight, moderate, severe), distribution (number of affected sites), and type (chronic or aggressive), with chronic periodontitis being more common and associated with older patients and slower progression.
- 🚨 Necrotizing periodontal diseases are acute conditions characterized by a pseudo-membrane on the gingiva, foul breath, blunted papilla, and sometimes fever.
- 📝 For board exams, it's crucial to understand and differentiate between the various classification systems for tooth mobility, furcation involvement, alveolar bone loss, gingival recession, and periodontal diseases.
Q & A
What is the Miller classification system used for in periodontics?
-The Miller classification system is used to categorize tooth mobility in periodontics. It ranges from class zero, which indicates normal physiologic mobility, to class three, which is for teeth with severe mobility greater than one millimeter of buccal lingual displacement.
What is the significance of furcation involvement in periodontics?
-Furcation involvement refers to the area of bone loss at the bifurcation or trifurcation of a tooth root. It is significant because it can predispose a tooth to further bone loss and periodontal issues, especially if the root trunk is short, the roots are generally short, the distance between roots is narrow, or there is a cervical enamel projection.
How is the Hamp classification used to assess furcation involvement?
-The Hamp classification is used to classify the severity of furcation involvement in teeth with furcations. It ranges from class zero, indicating no furcation involvement, to class three, which is a through-and-through furcation involvement where a probe can pass through the furcation area.
What is the Glickman classification in the context of periodontal disease?
-The Glickman classification is another method of assessing the severity of furcation involvement. It includes class one, which indicates pocket formation into the furcation area, and class three and four, which are similar to the Hamp classification, representing through-and-through furcation lesions.
How is alveolar bone loss typically measured?
-Alveolar bone loss is typically measured using bite wings radiography, which allows for the assessment of horizontal or vertical bone loss. The normal distance from the cemento-enamel junction (CEJ) to the alveolar crest is about two millimeters, and the crest should be parallel to a line connecting the CEJs of adjacent teeth.
What are the different types of bony defects associated with periodontal disease?
-The different types of bony defects include four-wall defects (circumferential defects), three-wall defects (trough), two-wall defects (crater), and one-wall defects (horizontal defect). These defects are classified based on the number of remaining bony walls adjacent to the tooth or teeth.
What is the Miller classification system for recession?
-The Miller classification system for recession measures the severity of gingival recession. It ranges from class one, where recession does not extend to the mucogingival junction, to class four, where severe recession extends beyond the mucogingival junction with significant interdental bone or soft tissue loss.
How is gingivitis characterized and measured?
-Gingivitis is characterized by the inflammation of the gingival tissues and can be measured by the three C's: color (redness due to increased blood flow), contour (swelling due to edema), and consistency (change in texture, such as fibrosis or loss of stippling).
What are some systemic factors that can modify gingival diseases?
-Systemic factors that can modify gingival diseases include endocrine changes (puberty, pregnancy, diabetes), blood disorders (leukemia), medications (calcium channel blockers, dilantin, cyclosporine), oral contraceptives, and malnutrition (vitamin C deficiency or scurvy).
How is periodontal disease classified in terms of severity, distribution, and type?
-Periodontal disease is classified by severity as slight, moderate, or severe based on the amount of clinical attachment loss. Distribution is determined by the percentage of sites affected by the disease (less than 30% or greater than or equal to 30%). The type of periodontal disease can be chronic, which is more common and typically affects older patients with slower progressive bone destruction, or aggressive, which is less common and tends to affect younger patients with rapid tissue destruction.
What are the characteristics of necrotizing periodontal diseases?
-Necrotizing periodontal diseases are characterized by the presence of a pseudomembrane on the gingiva, foul breath, blunted papilla, and sometimes systemic symptoms such as fever. These diseases include acute necrotizing ulcerative gingivitis and acute necrotizing ulcerative periodontitis.
Outlines
📚 Introduction to Periodontics Classification Systems
Ryan introduces various classification systems used in periodontics. The Miller classification system is highlighted for tooth mobility, with class zero indicating normal physiologic mobility, class one for slightly more mobility, class two for moderate increase, and class three for severe mobility, which may include vertical depression. The concept of furcation involvement is also discussed, along with factors that predispose teeth to this condition. The Hamp and Glickman classifications are mentioned for assessing furcation involvement severity.
🦴 Alveolar Bone Loss and Defects
The paragraph delves into alveolar bone loss, explaining the normal radiographic distance from the cemento-enamel junction (CEJ) to the alveolar crest. It contrasts horizontal bone loss, where the bone crest sinks down evenly, with vertical or angular bone loss, which forms an angle and is classified by the number of bony walls remaining. Four types of bony defects are described: four-wall (circumferential), three-wall (trough), two-wall (crater), and one-wall defects, each associated with different levels of bone loss and its implications for treatment.
🦷 Miller Classification for Recession and Gingival Diseases
Ryan discusses the Miller classification system for gingival recession, detailing four classes based on the severity of recession and the potential for root coverage restoration. Class one has minimal recession not extending to the mucogingival junction, class two reaches or exceeds this junction without interdental loss, class three involves recession with interdental bone or soft tissue loss, and class four is severe, making root coverage unlikely. The paragraph also touches on plaque-induced and non-plaque-induced gingival diseases, and the modifying factors that can exacerbate these conditions.
📈 Classification of Periodontal Disease
The classification of periodontal disease is explained according to severity (slight, moderate, severe), distribution (localized or generalized), and type (chronic or aggressive). Chronic periodontitis is more common and typically affects older patients with systemic factors like smoking and diabetes, while aggressive periodontitis affects younger patients and presents differently. Necrotizing diseases, characterized by a pseudo-membrane, foul breath, blunted papilla, and potential fever, are also mentioned as a unique type of periodontal disease.
🏥 Clinical Diagnosis of Periodontitis
Ryan concludes with how to integrate the distribution, severity, and type of periodontal disease to make a clinical diagnosis. An example is given where a patient with greater than or equal to 30% of sites having 3-4 millimeters of clinical attachment loss, presenting in an older patient with long-term tissue destruction and substantial plaque and calculus, would be classified with generalized moderate chronic periodontitis.
Mindmap
Keywords
💡Periodontics
💡Miller Classification System
💡Furcation
💡Hamp Classification
💡Glickman Classification
💡Alveolar Bone Loss
💡Infrabony Defects
💡Gingivitis
💡Periodontal Disease
💡Clinical Attachment Loss (CAL)
💡Necrotizing Periodontal Disease
Highlights
Miller classification system is used for tooth mobility, with class zero indicating normal physiologic mobility.
Class one mobility in the Miller system signifies slightly more than normal tooth movement.
Class two mobility is characterized by moderate movement, less than or equal to one millimeter of displacement.
Class three mobility involves severe tooth movement greater than one millimeter, potentially with vertical depression.
Furcation involvement is the area of bone loss at the branching point of a tooth root, which can be exacerbated by a short root trunk.
Hamp classification measures the severity of furcation involvement, with class zero indicating no involvement.
Class one Hamp classification is characterized by horizontal furcation involvement of less than three millimeters.
Glickman classification is another method to assess furcation involvement, with class one indicating pocket formation into the furcation area.
Alveolar bone loss can be measured radiographically, with normal distance from the CEJ to the alveolar crest being about two millimeters.
Horizontal bone loss is characterized by even bone loss while vertical or angular bone loss forms an angle between the bone and CEJ lines.
Four-wall defects, also known as circumferential defects, are similar to extraction sockets with all four walls of bone present.
Miller classification for recession measures the severity of gingival recession, with class one indicating recession not extending to the mucogingival junction.
Gingivitis involves inflammation of the gingival tissues, characterized by changes in color, contour, and consistency.
Plaque-induced gingival diseases are the most common, resulting from the interaction between plaque bacteria and the host's inflammatory cells.
Drug-induced gingival enlargement can occur with certain medications like calcium channel blockers, dilantin, and cyclosporine.
Hereditary gingival fibromatosis is a non-plaque induced gingival disease characterized by firm, non-hemorrhagic gingiva.
Periodontal disease is classified by severity (slight, moderate, severe), distribution, and type (chronic or aggressive).
Necrotizing diseases of periodontium are characterized by a pseudo-membrane on the gingiva, bad breath, blunted papilla, and sometimes fever.
Generalized moderate chronic periodontitis is diagnosed when over 30% of sites have 3-4mm clinical attachment loss, with tissue destruction over time.
Transcripts
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