Clinical Cases in Periodontics

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Case Studies The British Society of Periodontology invites its members to view clinical cases sent in by other members. The requirements for the case report are as follows; The report should include information about the clinical condition before treatment, treatment undertaken and the outcome of treatment. The report must be submitted in electronic format. Each report should be restricted to 4 pages of A4 and can contain an unlimited number of clinical photographs or radiographs but the total document must not exceed the 4 page maximum.

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It is the responsibility of the author to ensure that they have obtained appropriate signed consent from the patient. If the BSP decide to publish a case report, it will remain the responsibility of the author to ensure that they have fully complied with all data protection and consent rules. Various mandibular movements and muscles involved in the movement.

Gingivitis and periodontitis - causes, symptoms, diagnosis, treatment, pathology

The examination of various muscles involved in mandibular movement can be done by activation of these muscles. For example masseter can be activated by clenching the teeth. Any pain associated with a specific mandibular movement should be noted. Palpation of Masseter and Temporalis.

In the hard tissue examination the teeth are examined. Before we record the dental and periodontal findings, we must follow a tooth notation system. Following is a brief description of three most commonly followed tooth notation systems,. In Adolph Zigmondy of Vienna introduced the symbolic system for permanent dentition. He then modified it for the primary dentition in The symbolic system is now commonly referred to as the Palmer notation system or Zigmondy system.

Palmer notation System. ADA officially recommended the Universal system in In this notation system for the permanent dentition the maxillary teeth are numbered through 1 to 16 beginning with upper right third molar.

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The mandibular teeth are numbered through 17 to 32 beginning with lower left third molar. The universal system notation for primary dentition utilises upper case alphabets.

Universal notation system. In this system, each quadrant is assigned a number. The maxillary right quadrant is assigned the number 1, the maxillary left quadrant is assigned the number 2, the mandibular left quadrant is assigned the number 3, and the mandibular right quadrant is assigned the number 4.

Clinical Cases in Periodontics

The teeth within each quadrant are assigned a number from 1 through 8 with 1 being the central incisor and 8 being the third molar. In the present case history discussion we are following the FDI tooth notation system.

Type of dentition should be mentioned here. Total number of teeth present in oral cavity are mentioned here. Although any system can be used but name of the notation system should be clearly mentioned. All the teeth should be examined with the help of an explorer and carious teeth should be mentioned. Any kind of restoration should be examined and all the teeth with restorations should be mentioned here. Patients with staining of teeth should be asked about any habit like tobacco chewing etc. Some patients regularly use chlorhexidine mouthwash. In these cases, although the patient may be having a good oral hygiene but black stains on teeth because of chlorhexidine are usually seen.

Wasting disease of the teeth is a broad term mainly used to describe the attrition, abrasion, and erosion of the teeth. In wasting disease of the teeth, the enamel is wear off, if the disease not controlled in its initial stage, it may involved the dentine and some time whole teeth get involved. The most systematic classification of tooth wasting diseases has been given by Grippo 4 who defined four categories of tooth wear:. Key points to remember,. Food impaction is the forceful wedging of food into the periodontium.

There are two type of food impaction,. Horizontal lateral food impaction: It is seen in gingival inflammation in areas with enlarged gingival embrasure. Because of inflammation the embrasure is enlarged and lateral pressure from lips, cheeks, and tongue causes lateral food impaction. Class I : Occlusal wear. Class II : Loss of proximal contact. Class III : Extrusion beyond the occlusal plane. Class IV : Congenital morphological abnormality. Class V : Improperly constructed restorations. Periodontal findings may include.

Normal proximal contacts do not allow any food impaction in between the teeth.

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The interdental papilla fills the space upto tooth contact in normal conditions. However due to periodontal disease there is loss of interdental soft tissue and bone levels. Due to this, the position of interdental papilla recedes from its normal position. Nordland and Tarnow have given classification of interdental papillary hight.

Classification of papillary height:. According to Nordland and Tarnow :.

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The embrasure space is not filled. The gingival papilla has receded extensively or it is completely lost. Interdental Aid Used for embrasure spaces. Pathologic tooth migration is tooth displacement that results when the balance among factors that maintain physiologic tooth position is disturbed by periodontal disease 6.

It may present as extrusion, facial flaring, rotation, diastema, and drifting of affected teeth but most patients with pathologic tooth migration appear to have combined forms with the most common being facial flaring and diastema. The position of a tooth depends upon balance n the health of the periodontium as well as other factors such as occlusion, pressure of the lips, cheeks, tongue and oral habits. Posterior bite collapse is one of the reasons for pathological tooth migration. Increased occlusal load on anterior teeth and reduced periodontal support in case of secondary trauma from occlusion together cause pathological migration of affected teeth.

In case of reduced periodontal support, forces from tongue lips and cheek put forces on teeth which are sufficient to cause pathological tooth migration. In intra-oral soft tissue examination, the first step is the examination of oral mucosa and associated structures.

These include tongue, l ips, buccal mucosa, floor of the mouth, frenum, soft palate, hard palate and the v estibule. Any abnormality associated with these structures should be noted and described in detail. As demonstrated in the diagram, the gingiva has different parts like free gingival margin, free gingiva, free gingival groove, attached gingiva, mucogingival junction and alveolar mucosa.

Gingival margin is knife edge in healthy gingiva. In periodontal health and absence of periodontal pocket formation the gingival groove is 0. Diagrammatic representation of parts of gingiva. Attached gingiva is non-movable gingiva as the name indicates. It also prevents free gingiva from being pulled away from the tooth when tension is applied to the alveolar mucosa.

It is lined by keratinized stratified squamous epithelium. Width of attached gingiva is generally greatest in the………………………………………………. It is also called epithelial attachment and the distance between the base of the attachment and the crest of the alveolar bone is approximately 1. This distance is maintained in disease when the epithelium moves along the root surface and bone loss occurs. The interdental gingiva is the portion of the gingiva that fills the area between two adjacent teeth apical to beneath the contact area.

The col is a valleylike depression in the portion of the interdental gingiva that lies directly apical to the contact area of two adjacent teeth. Mucogingival junction is the junction of attached gingiva and alveolar mucosa.

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Alveolar mucosa is movable and is continuous with vestibule. It can be distinguished easily from the attached gingiva by its dark red color and smooth, shiny surface. Identification of width of attached gingiva:. In this method first the pocket depth or the sulcus depth is measured, and then the total width of gingiva is measured, i. Subtracting the two measurements gives us the width of attached gingiva.

By doing so junction of immovable attached gingiva and movable alveolar mucosa can be identified Tension test. It can also be identified by rolling the alveolar mucosa over the attached gingiva with a blunt instrument Roll test. Here, the movable alveolar mucosa accumulates ahead of the instrument till mucogingival junction when pushed coronally. Histochemically iodine solution………………………………….

One should know the exact probing technique to avoid any false readings during periodontal examination. Probing is the act of walking the tip of a probe along the junctional epithelium within the sulcus or pocket for the purpose of assessing the health status of the periodontal tissues. Walking of periodontal probe:. The walking stroke is the movement of a calibrated probe around the perimeter of the base of a sulcus or pocket. A calibrated probe is walked around the circumference of the tooth. Purpose is to record the periodontal pocket depth around the tooth surface.

It is important to note that the junctional epithelial attachment is not uniform around the tooth surface.