Essentials of Clinical Periodontology and Periodontics Shantipriya Reddy
INDEX
Page numbers followed by f, fc and t refer to figure, flowchart and table, respectively.
A
Abrasion 280, 536, 547
Absorbable barrier membrane
advantages of 398
disadvantages of 398
Acantholysis 547
Acanthosis nigricans 187
Acatalasia 123
Accordion technique 413f
Acellular cementum 30, 30f, 31, 31t, 547
Acid phosphatase 168
Acquired immunodeficiency syndrome 44, 127, 206, 266, 267, 293, 297, 547
Actinobacillus actinomycetemcomitans 38, 47, 73, 77, 107, 155, 219, 292, 515
Actinomyces 73
naeslundii 73
viscosus 69, 137
Addison's disease 44, 181, 547
Additive osseous surgery 548
Addy's classification 345
Adenosine monophosphate, cyclic 29
Adenoviruses 507
Adhesion molecules 96, 97, 105
Adrenal glands, disorders of 123
Aggregatibacter actinomycetemcomitans 71 73, 77, 137, 138t, 150, 155, 253, 260, 262t, 263, 289, 300, 303, 491
Agranulocytes 103, 207
Agranulocytosis, drug-induced 100
Albright syndrome 181
Aldehydes 501
Alexidine 345
Alkaline phosphatase 168
Alleles 548
Allergic reaction 45, 46
Allergy 44, 531
Allograft 401, 403, 548
Aluminum oxide 463
Alveolar
bone 26, 27, 38, 205, 215, 247, 464, 467, 548
composition of 27
functions of 26
nerve supply of 30t
normal anatomy of 240, 241f
parts of 26
structure 27f
types of 27t
crest fibers 22
defects 406
gingival fibers 18, 20
mucosa 10, 10t, 548
Alveolodental ligament 20
Amelogenin 4
American Academy of Periodontology 44, 172, 215, 219, 267, 365
American Dental Association 338, 365
Amino acid 119
Amlodipine 190
Amoxicillin 238, 268, 491
Amplification 513
Amylase 345
Anaerobic chamber techniques 301
Analyze laboratory tests 124
Androgen 242
Anemia 548
aplastic 122
pernicious 122, 122f
Angina 143
Angiomatosis, bacillary 273
Angles classification 280
Angular cheilitis 273, 548
Angular defects 247, 248, 549, 570
types of 248f
Angulation 330, 549
Ankylosis 29, 34, 549
Anterior nasal spine 539
Antibiotics 190, 345, 489, 549
local administration of 490, 493
systemic 207
administration of 490
therapy 262, 267
Antibody 105, 549
deficiency disorders 127
Anticalculus agents 347
classification of 85
Anticaries agents 342
Antigen 549
binding antigen antibody complex 105
Anti-infective therapy 469
Antimicrobial
agent 489, 549
classification of 344
therapy 307
Antisepsis 496
Antiseptics 549
Aphthae
major 210
minor 209
Aphthous stomatitis, recurrent 209, 273
Apical periodontitis, exacerbation of 273
Apically displaced flap 379, 382, 387, 414
Arachidonic acid metabolites
inhibition of 156
production of 156, 156fc
Arch, maxillary 539
Argon fluoride 514
Arterioles penetrating interdental bone 20f
Arteriosclerosis 126
Arthus reactions 105
Artificial crowns 86
Ascorbic acid 119
deficiency gingivitis 45
Asynchronous multiple burst model 255
Atherosclerosis 142, 144fc
Atrophy, functional 553
Augmentin 492
Aureomycin 217
Autoclave 499, 499f
components of 499
Autogenous bone grafting 402f
Autograft 401, 549
Autoregressive time series model 255
Autosomal dominant inheritance 187
Azidothymidine 274
Azithromycin 238
Azurophilic granules 100
B
B lymphocytes 101, 101f, 103
Bacteria 69, 72, 73, 138, 142, 167
accumulation of 69
identification of 300
role of 205
Bacterial
adherence 68
attachment 68, 69, 69f
balance 161
colonization 107, 138
enzymes 139
infections 203, 273
invasion 107, 138
role of 136
plaque 38, 45
proteases 169
smear 281
succession 549
toxins 139, 300
transmission, principles of 75
zone 206
Bacteriocin 138, 215, 220, 262
Bacteroides
capillus 73
forsythus 73, 77, 132, 255, 262, 268, 292, 300, 454
gingivalis 73
intermedius 73, 205, 217
melaninogenicus 73
Barrier membranes, classification of 397
Bartholin's duct 83
Basal lamina 16
Basic fibroblast growth factor 511
Basophils 103, 538
Bass method 339, 524
modified 340, 340f, 524
B-cells 101
Benzalkonium chloride 345, 489
Benzoyl-dl-arginine-naphthylamide test 132
Bergapten 510
Bicarbonate 162
Bifurcation ridges 287
Bioactive glass 404
Biofilm, structure of 66
Biointegration 549
Bio-medical waste
disposal of 503
management 503
Biopsy 281
Birth control pills 169
Bisbiguanides 345
Bismuth intoxication 127
Bisphosphonates 156
Bispyridines 345
Blade angulations 330f
Bleeding 45
acute 180
chronic 180
index, papillary 51, 53
points 369f
index 51, 53
time 538
Blood
dyscrasias 132
glucose 538
postprandial 124
urea nitrogen 538
vessels 23
Bokenkamp's grading 186
Bone 37, 403, 441
architecture of 539
crest of 462
defect 250
vertical 248f
destruction 243, 248
mechanism of 241
patterns of 240
formation, mechanism of 241
graft
classification of 401
material 401
placement 445f
height of 464
implant interface 461, 462
induction 400
interradicular 27
length of 464
lining socket 26
loss 55, 234, 240
amount of 539
degree of 284, 285
horizontal 247, 248, 248f, 281, 539, 557
pattern of 298
progressive 261f, 298
rate of 247
types of 539
vertical 281
metabolism 154
modulation of 156
regulation of 157
morphogenetic proteins 156
regeneration 396
resorption 138, 243fc, 244t, 490
inhibitors of 242
stimulation of 242t
shape 464
sialoprotein 32
substitutes 401
swaging 403
trabecular pattern of 539
width of 464
Bony defect, types of 284, 285
Borodontic probe 296
Borrelia vincentii 150
Bradykinin 104, 244
Branemark implant system 464
Breastfeeding 491
Bronchitis 132
Brown stain 92
Browne's tube 498
Brownian motion 255, 339
Brushing techniques 338, 339
Bruxism 91, 523, 550
treatment of 91
types of 91
Buccal incision placement 445f
Bulbous bone contours 247, 249, 250, 550
Bullous pemphigoid 223, 224f, 226, 550
Burning mouth syndrome 123
Burtonian line 128
Butt joint 31f
Buttressing bone formation 111, 550
C
Calcitonin 242
Calcium 84, 167
aluminates 463
channel blockers 190
compounds 361
deficiency 33
lactate 85
phosphate 463
ceramics 463
supplementation 156
Calculus 67f, 82, 85, 287, 294, 298, 307, 550
formation, theories of 85
pathogenic potential of 85
removal 331
surface index 59
Campylobacter 271
gracilis 74
rectus 73, 74, 253, 268, 300
Cancellous bone 27
interior portion of 26
Candida albicans 218, 510
Candidiasis 123, 203, 218, 273
acute 215, 218
chronic 218
Canine impaction 89f
Canker sores 209
Capnocytophaga 69, 73, 196, 215, 219, 253
sputigena 261, 263
Carbamazepine 491
Carbohydrates 167
Carbon 463
dioxide 514
silicon 463
Carcinoma 132, 200
Cardiovascular diseases 126, 142
Caries 281, 287
occlusal 539
Catalase reaction 138
Cell 17, 103
constituents, role of 137
damage 139
sheets, role of 507
signaling molecules 96, 97, 105
sources of 312f
types of 17
Cellular
cementum 30, 30f, 31, 31t, 550
composition 20
elements 166, 167
intrinsic fiber cementum 31
mixed stratified cementum 31
Cemental tear 46
Cementicles 23, 25, 34
Cementoblastoma 34
Cementoblasts 20, 21, 3032
Cementocytes 32
Cementodentinal junction 33
Cementoenamel junction 6, 9, 33, 54, 111, 236, 416, 529
configuration of 31f
detection of 533f
Cementoid 5, 32
Cementum 30, 31, 33, 34, 38, 215
advanced formation of 6f
anomalies 34
composition 32fc
continuous deposition of 38
early development of 4
formation, total absence of 34
intermediate 4, 31, 558
later development of 4
matrix 30
overlaps enamel 31f
primary 30, 547
secondary 30, 550
thickness of 32
types of 30
Centers for disease control 151, 273, 502
Central giant cell granuloma 199201
Cerebrovascular diseases 142
Cervical
enamel projections 286, 287, 440
root resorption 46
Cetylpyridinium chloride 134, 345, 489
Chairside kits 304
Charter's method 341, 341f
Charter's technique 524
Chediak-Higashi syndrome 44, 46, 100, 122, 215, 216, 221, 268, 269
Chemical
curettage 363
injury 46, 203
irritation 91
methods 500
plaque control 344
Chemiluminescence 133
Chemosurgery 368, 373
Chemotactic inhibition factors 220, 262
Chemotaxis 98, 551
cellular activation 97
inhibitor 138
Chemotherapeutic agent 274, 489, 551
Chin-cup technique 329
Chlorhexidine 345, 494, 501
gluconate 346
stains 92
Chlorophyll 510
Chloroxylenol 501
Chlortetracycline 217
Chondroitin sulfatase 172
Christmas disease 531
Chromium-doped yttrium scandium gallium garnet 514
Chronic obstructive pulmonary disease 143, 147
Cicatricial pemphigoid 45
Ciprofloxacin 492
Citroxain 85
Clark's vestibuloplasty 434f
Clavulanate potassium 268
Cleft palate 132
Clindamycin 238, 492
hydrochloride 268
Clostridium tetany 498
Clot stabilization 399
Cohen syndrome 46
Cold
sores 209, 217
sterilization 500
Colitis, severe 491
Collagen 22, 397
fibers 17, 21
Collagenase 138, 172, 220, 262, 303
Color coded
complexes, types of 74t
microbial complex 75f
Combined periodontic-endodontic lesions 46
Communication, pathways of 450
Community periodontal index 60
Complete blood count 538
Computer aided design 507
Connective tissue 17f, 67, 139t, 180, 531
atrophy of 38
attachment 462
cells 20
degradation of 138
harvesting of 428f
pedicle flap 435f
technique 412
Contact hypersensitivity 203
Contraceptive pill 491
Conventional periodontal probes, types of 296
Coronal cementum 552
Cotton test 522
Cowden syndrome 187
Cresols 501
Crevicular
fluid 163
biochemistry of 124
generation of 164f
incision 378
Cribriform plate 27
Crohn's disease 44
Cross syndrome 187, 193
Cross-arch fulcrum 329
Crown fracture 536, 539
Crystal growth, inhibitors of 85
Cumine scaler 542
Cumulative interceptive supportive therapy 469
Cuneiform defect 554
Curettes
principles of 331
types of 318f
Cyclosporine 45, 190, 192
therapy 192f
Cyst 464, 552
Cysteine 131
Cytokines 96, 97, 105, 107, 243, 552
activation of 138
role of 140
Cytolysis 97
Cytomegalovirus 209
infection 273
Cytotoxin 138
D
Deep subgingival carious lesion 433
Dehydration 132
Demineralized freeze-dried bone
allograft 403, 444
graft 401f
Dental
abscesses 132
calculus 82, 552
care, frequency of 294
caries 123
endoscope 320
epidemiology 552
floss 343, 525
types of 343
fluorosis 93
implant 460, 461, 552
instruments 502
classification 502t
materials 86, 87, 486
mirror 326, 327
plaque 65, 68, 70f, 552
composition of 68
development of 68
growth 69, 70f
maturation of 70f
types of 66
pulp 451
restorations 46
restorative materials 46
splint 553
stain 553
structures 152
tape 321
Dentogingival fibers 18, 20
Dentomycin 494
Dentoperiosteal fibers 18, 20
Deoxyribonucleic acid 207, 507
Dermatan sulfate 32
Dermatitis herpetiformis 223, 226
Dermatoses 223
Desmosome 553
composition of 14, 14f
Desquamative gingivitis 223
Diabetes 44, 123, 123t, 131, 292, 294
chemical induced 123
drug-induced 123
gestational 123
mellitus 44, 100, 123, 125f, 131, 132, 143, 145, 215, 216, 253, 292
oral manifestations of 123
types of 123
Diarrhea 491
Digoxin 491
Dimethyl sulfide 132
Diphosphates metal salts 347
Diphosphonate 85
Distal wedge technique 356f
Donor tissue, excision of 424
Double papilla flap 419, 420f
Down syndrome 44, 46, 100, 215, 216, 221, 268, 269, 269f, 288, 553
Doxycycline 268, 491, 494
sub-antimicrobial dose of 154, 156
Drug allergy 203
Dry mucosa 132
Dyes 501
Dysplasia, cleidocranial 34
E
Edema 126f
Edentulous maxilla 464
Ehlers-Danlos syndrome 44, 46, 215, 216, 220
Eikenella corrodens 73, 253, 300
Elastase 345
Elasticity, loss of 38
Elastin fibers 17, 18, 20, 21
Electrocoagulation 372, 553
Electrodesiccation 372, 553
Electrofulguration 372, 553
Electrolytes 166, 167
Electrosurgery 321f, 368, 372, 554
healing after 372
Enamel
hypoplasia 93
matrix
derivative 156, 400, 506
proteins 400
pearls 34, 287
projections 34
Endocrine
disorders 123
system 143
Endodontic
lesion 46, 47
primary 452, 453
periodontal lesions 452, 554
stabilizer 463
therapy 443
treatment 281
Endoperio lesion 454f
classification of 453t
prognosis of 455
Endosseous implant surgery 465
Endosteal hollow-basket implant system 464
Endosteum 28
Endothelial
adhesion molecule 97
cells 98
Endotoxicity 138
Endotoxin 137139, 168, 220, 262, 554
Environmental plaque hypothesis 71
Enzyme 139, 162, 166, 168, 345
inhibitors 166, 168
linked immunosorbent assay 273, 274, 302
reduction technique 301
release of 139
role of 137
Eosinophils 103, 538
Epidermal nevus 187
Epidermolysis bullosa acquisita 223, 226
Epithelial
adaptation 554
attachment, concept of 15f
cell 20, 96, 98, 138, 167
desquamated 84
migration, prevention of 397
Epithelium 17f, 180, 531
connective tissue interface 16
keratinized 11
nonkeratinized 11, 13f
orthokeratinized 13f
outer 12, 561
Epstein-Barr virus 73, 209
Erbium-doped yttrium aluminum garnet 514
Erosion 280, 536, 554
Eruption gingivitis 215
Erythema multiforme 46, 203, 209, 223
Erythematous candidiasis 273
Erythroblastosis fetalis 93
Erythromycin 190, 345
Erythrosine 68
dye 346
Estrogen 242
Ethyl cellulose 397
Ethylene
oxide 501
sterilizer 501f
vinyl acetate system 320
Eubacterium 215
nodatum 74, 150
European Workshop on Periodontology 44
Excessive gingival
display 47, 407
pigmentation 407
Excisional new attachment procedure 365f
Exopolysaccharides 66
Exotoxins 138
role of 137
Extracellular
fluid 29
matrix derivatives 400
Extraoral fulcrums 543f
Extrinsic stain 91, 92
F
Facial
cementoenamel junction 11
incisions 383f
margin 53
papilla 10, 357f
distal 52
Familial neutropenia
benign 120
severe 120
Fanconi's anemia 122
Fasting blood glucose 124
Felodipine 190
Fenestration operation 415
Fever 132, 266
Fiberoptics 514
Fibers 17, 22
contact dentin surface 5f
horizontal 22
interradicular 22
principal group of 17f
secondary group of 18f
semicircular 18, 20
Fibroblasts 17, 20, 21, 30, 98, 139
growth factor 400
Fibroma 199, 200, 555
Fibronectin 32, 555
Fibro-osseous
disease 464
integration 462, 555
Fibrosis 107, 138
Fibrotic
enlargement, drug-induced 190
gingival enlargement 189, 528f
Fibrous dysplasia 201
Fimbriae 138, 555
Finger rest 328, 543, 555
Finger-on-finger fulcrum 329
Flap 555
after surgery, placement of 377
closure of 465
coronal displacement of 423f
coronally positioned 419, 421f
coronally repositioned 419, 422f
design of 377, 465
full thickness 376, 555
incisions 382f
mucosal 376
non-displaced 377, 561
palatal 386f, 387, 389f
partial thickness 376t, 562
reflection of 380f, 445f
semilunar 423f
surgery 376
healing after 390
techniques 379
thickness of 376
types of 377f
Flavobacterium 92
Flezer's index 58
Fluoride 84, 345
Focal dermal hypoplasia 187
Follicular cells 5f
Fones technique 341
Food
debris 66t
impaction 86, 87, 555
Foot diseases 203
Formaldehyde 501
Free connective tissue
autograft 408
graft 426f
Free soft-tissue autograft 408, 409f411f, 413f
Fremitus 537, 555
test 111, 536, 536f
Frenectomy 430, 555
procedure 431f, 432f
Frenotomy 430, 555
Frenum 555
removal of 430
Fungal
diseases 203
lesions 273
origin, gingival diseases of 46
Furcation 439, 555
anatomy of 439, 441
defects 298, 481
fornix 439
invasion 555
involvement 247, 249, 281, 287, 433, 439, 539, 555
classification of 534
Furocoumarins 510
Fusobacterium 215
nucleatum 66, 73, 74, 78, 150, 268, 300
Fusospirochetes 206
G
Gallium aluminum arsenide 514
Gantrez copolymer 347
Gas liquid chromatography 300, 301
Gastroesophageal reflux disorder 132
Gastrointestinal tract 119, 131
diseases of 132
Gauze strip 525
Gene therapy 507
Genetic
disorders 46
factors 256, 285
marker 556
Genial tubercles 539
Gingiva 8, 9f, 10, 19, 20f, 38, 45, 101, 126f, 127f, 152, 180, 205, 214, 216f, 441, 556
anatomic landmarks of 9f
attached 9, 10, 52, 205, 412, 530, 531f, 549
benign tumors of 199, 199t
color of 526f
consistency of 181
contour of 527f
defense mechanisms of 161
interdental 4, 9, 10, 186, 558
keratinized 46
lower 183f
lymphatic drainage of 19t
malignant tumors of 200, 200t
marginal 9, 52, 559
normal 4f, 9f, 12t, 231f, 527
color of 525
papillary 52
position of 181
size of 181, 527f
traumatic lesions of 203
unattached 9
Gingival
abscess 46, 186, 188, 203, 556
treatment of 188
augmentation 408, 415
bleeding 121, 177, 180, 530f
index 51, 53, 177
significance of 177
blood vessels, vasoconstriction of 152
bone count index 55
candidiasis, generalized 46
connective tissue 15
contour 183, 371f
crescent formation 111
crevice, anatomy of 162
crevicular fluid 96, 151, 165, 166t, 167t, 556
collection of 165f
composition of 166
curettage 363, 363f, 556
cyst 199, 200
depigmentation 407, 432
disease 44, 45, 45t, 126, 288
classification of 215
dental plaque induced 44, 288
desquamative 45
epidemiology of 49
plaque induced 288
types of 45
enlargement 45, 47, 121, 126f, 185, 186,186t, 192f, 197, 215, 556
classification of 185
degree of 186
diffuse 186, 187t
idiopathic 190
localized 127f
tumor like 194
types of 527
epithelium 12, 96
erythema
linear 46, 272, 273
marginal 272f
excess 47
extension operation 407
fibers 462
fibromatosis 193
idiopathic 186, 193
fluid 169, 170
flow 169
volume of 166
hyperplasia 556
phenytoin-induced 190
index 51, 52
infections, acute 203
inflammation 51, 52, 165t, 172, 241, 243fc, 307, 308, 529
lesions 46, 216
acute 203
nonplaque-induced 45, 288
manifestations 46
margin 205
massage 344
overgrowth 190t, 216
drug-associated 192t
periodontal index 59
pigmentation 181t
pocket 556
recession 88, 111, 181, 182, 182f, 183, 183f, 472, 529f, 556
classification of 181
localized 218
redness 45
response, types of 263fc
status 280
sulcus 9, 229, 231f, 556
depth 462
significance of 163
tissues 220, 288, 370f
strip of 371f
tumor 186, 199
vasculature, significance of 163
Gingivectomy 307, 367, 368, 368f371f, 372, 373, 556
contraindications of 368
indications of 367
surgical 368
types of 368
Gingivitis 4345, 89, 123, 126, 126f, 136, 151, 173, 174, 176, 180, 216, 288, 557
acute 176, 528, 547
artefacta 218
childhood 43
chronic 43, 73, 176, 177f, 528, 551
desquamative 207, 223, 224f, 225t, 553
diffuse 553
drug-influenced 45
factitious 218
generalized 555, 556
histopathology of 215
leukemia-associated 45
linear 272
localized 559
marginal 559
menstrual cycle-associated 45
necrotizing 45
oral contraceptive-associated 45
papillary 177f, 562
plaque induced 215
preexisting 205
pregnancy associated 73
puberty 45, 216
recurrent 176, 566
stages of 173t
subclinical 568
types of 176
Gingivogenic factors, actual positions of 182f
Gingivoplasty 207, 367, 368, 372, 557
Gingivostomatitis
acute herpetic 203, 207, 209, 216
herpetic 45, 216f
menopausal 126
primary 208
herpetic 45, 206, 206t, 208f, 565
Glandular fever 203
Glickman's classification 441f
Glickman's concept 113, 114
Glickman's index 57
Glossitis 122
Glossodynia 122, 123
Glossopyrosis 122
Glucose tolerance test 124
Glutaraldehyde 501
Glutathione 131
Glycation end products, formation of 124fc
Glycogen storage disease 46
Glycoproteins 22, 162
Glycosaminoglycan 557
Golgi apparatus 14
Goltz-Gorlin syndrome 187
Gomphosis 20
Gonads 126
Gottlieb concept 15
Gracey curettes 318, 319t, 332, 557
Graft 400, 557
healing of 414, 414f
immobilization of 412
Granules
membrane coating 162
tertiary 100
Granulocyte 103
macrophage colony stimulating factor 98, 244
monocyte colony stimulating factor 244f
Granuloma pyogenicum 186, 196
Granulomatosis, orofacial 223
Granulomatous disease 122, 186, 198, 198t, 528
Growth factor 400
insulin like 124, 400
H
Haemophilus influenzae 148
Hairy leukoplakia 272, 273
Halimeters 132, 133f
Halitophobia 131
Halitosis 130, 280, 557
classification of 130
diagnosis of 132
pathologic 131
physiologic 131
Halogens 501
Hard tissue 280
Haversian systems 29
Healing 107, 138, 467
sockets 403
Health 73
Heart disease
congenital 127
coronary 143, 144
ischemic 145
Heat 497
Helicobacter pylori 510
Hematocrit 538
Hematological disorders 46, 120
Hemidesmosome 557
Hemisection 444, 557
Hemiseptal defect 248, 250, 481
Hemiseptum 557
Hemoglobin 538
Hemophilia 531
Hemorrhage 360
Hemorrhagic disorders 538
Heparan sulfate 32
Heparin 244
Hepatic disease 491
Hereditary gingival fibromatosis 46
Herpangina 203
Herpes
labialis 208f, 217
simplex virus 207, 209, 215
varicella 203
virus 73, 209
infections 45
Herpetiform aphthae 210
Hertwig's root 5
sheath of 4f, 34
Heterograft 400, 570
Hexetidine 345
Hexosamine 167
Hexuronic acid 167
Highly active antiretroviral therapy 274
Histamine 97, 104, 105
Histiocytosis syndrome 46
Histoplasmosis 45, 46
Homeostasis 557
Homograft 401, 548
Hopewell-Smith, hyaline layer of 4, 31
Hormone replacement therapy 156
Host
bacterial interaction 206
enzymes 300
modulation 154
therapy 154
status, role of 256f
Hot air oven 498, 498f
Howship's lacunae 28
Human
cytomegalovirus 73
herpes virus 209
immunodeficiency virus 179, 267, 293, 294
infection 253, 271273, 273t, 292
treatment of 274
periodontal diseases 155
Humoral immune systems 104f
Hunton probe 296
Hyaluronic acid 32
Hyaluronidase 139, 168, 172
Hydrogen
peroxide 345, 509
sulphide 132
Hydrolytic enzymes 557
Hydroxyapatite 83, 84, 463
coating 463
crystal 5, 403f
Hydroxyproline 167
Hypercementosis 34, 557
Hyperfunction 557
Hyperkeratosis 218
Hyperkeratotic skin lesions 269
Hyperpigmentation, melanotic 273
Hyperplasia 527
Hyperplastic
candidiasis 273
gingival enlargement, idiopathic 193f
Hypersensitivity 558
delayed 105
reactions 105, 491
Hyperthyroidism 123
Hypertrichosis 193
Hypertrophy 527
Hypophosphatasia 34, 46, 215, 216, 221, 268270, 288
Hypopituitarism 34
Hypoprothrombinemia 531
Hypothiocyanate 345
Hypothyroidism 33, 190
I
Iatrogenic origin, pathways of 450
Idiopathic neutropenia, chronic 120
Immunity
acquired 95, 96, 106f
cell mediated 106, 162, 550
innate 95, 96, 319f
nonspecific 95
Immunoglobulin 105, 138, 167, 558
functions of 105, 107t
types of 107, 107t
Implant 39
biological considerations of 461
classification of 463
failure 468
innovations systems 464
placement of 308, 465, 466f
surgery 461, 468
systems, classification of 464
therapy 464
Incision 377
facial view of 381f
horizontal 377, 378, 378f
interdental 378
vertical 377, 378, 379f
Infantile genetic agranulocytosis 46
Infection, types of 75
Inflammation, spread of 241
Inflammatory cells 16, 17, 102, 103t
Infrabony
defects 250
pockets 236, 236t, 237fc, 533, 533f
Insulin 491
Intercircular fibers 18, 20
Interdental bleeding index 51, 53
Interdental papilla, early necrosis of 272f
Interleukins 146, 244, 511, 558
International Workshop Classification of Periodontal Diseases 216
Interproximal bone, flattening of 395
Intracellular pathway 191fc
Intraoral
autograft 402
cancellous bone marrow chips 402
finger rests 543f, 544f
fulcrum, modified 329
periapical radiographs, advantages of 539
Intrauterine growth retardation 146fc
Ionizing radiations 500
J
Jar technique 301
Jaw deviation 280
Junctional epithelium 6, 11, 15, 136, 173, 233fc, 462, 558
apical migration of 231f
development of 6, 6f
Juvenile periodontitis 47, 107, 216, 559
generalized 73, 107, 258, 262
localized 43, 73, 100, 107, 137, 258
K
Kanamycin 345
Kaposi's sarcoma 200, 271273
Keratinization 14, 96
Keratinocyte 139
damage of 139
proliferation 139
Keratinosome 162
Ketoconazole 274
Keyes technique 494
Kirkland knife 321f
Klebsiella 271
Knots, types of 352
Knuckle-rest technique 329
Krypton chloride 514
Kypophosphatasia 44
L
Lactic
acid 167
dehydrogenase 169
Lactoferrin 96
Lactoperoxidase 162, 345
Lamina dura 27, 298, 559
continuation of 539
Laminar airflow system 334
Langer's technique 426, 427f
Langerhans cells 12, 16, 161, 162
Laser 513, 515
advantages of 515
assisted new attachment procedure 515
curettage 365
delivery system 514
device components 514
disadvantages of 515
gingivectomy 368, 373
safety 515
systems, classification of 514
therapy 515
tissue interaction 514
Latex agglutination 302
test, principle of 302f
Lazy leukocyte syndrome 44, 122
Lead intoxication 128
Leptotrichia 215
Leukemia 44, 46, 121, 121f, 186, 197, 207, 528, 559
acute 121, 221
chronic 121, 198
inhibitory factor 29
subacute 221
Leukemic gingival enlargement 197f
Leukocyte 16, 84, 167
adhesion deficiency 44, 215, 221, 268, 270
syndrome 46
Leukoplakia 90f, 199, 200, 559
Leukotoxin 138, 220, 262
Leukotrienes 140, 243, 244
Lichen planus 45, 46, 123, 559
Linear gingival erythema, treatment of 274
Lingual incision placement 445f
Lipase 345
Lipids 84, 167
Lipopolysaccharide 78, 99, 137, 139, 144, 151, 155, 559
Lipoteichoic acid 69
Lipoxins 156
Liver
cirrhosis of 132
disease 531
failure 131
insufficiency 131
Local drug delivery systems 492
Lower anterior teeth, lingual surface of 92f
Lung abscess 131
Lupus erythematosus 46, 223
Lymph nodes 280, 280f
Lymphadenopathy, localized 266
Lymphatic
drainage 19, 24, 30
vessels 25
Lymphocytes 12, 16, 101, 103, 538
alterations 138
Lymphokine 559
Lysosomal storage diseases 187
Lysozyme 96, 162, 168
M
Macroglossia 464
Macrophages 17, 20, 22, 96, 98
colony stimulating factor 244f
functions of 101
Magnesium 84
Malaise 266
Malassez, epithelial cell rests of 5, 20, 21
Malnutrition 216, 559
Malocclusion 88, 111
Mammalian proteases 168
Mandibular
arch 539
canal 464, 539
incisors 249f
molars 388, 390f
teeth, gingival status of 280t
Marginal gingivitis
chronic 218
generalized 556
localized 559
Marginal line calculus index 59
Mast cells 17, 20, 22, 98
Masticatory mucosa 3, 8, 412, 559
Matrix 69
degradation of 29
disruption agents 85
early deposition of 5f
metalloproteinases 78, 136, 140
excessive production of 154, 155
inhibition of 156
Maxillary teeth, gingival status of 280t
McCall's festoons, formation of 111
Measles 203
Median palatal sutures 539
Melanocytes 16
Melanoma, malignant 200
Menopause 132
Menstruation 132
Mental foramen 539
Mercury 46
intoxication 128
Merkel cells 12, 16
Mesial facial papillae 53
Metallic salts 345, 501
Metalloproteinases 560
tissue inhibitor of 569
Metronidazole 268, 345, 491, 494
Microbial sampling method 301f
Microbiological tests 237
Migration, pathologic 114f, 280, 562
Miller's classification 416t, 417f, 530
Miller's index 57
Minerals, glycoprotein pellicle 162
Minocycline 491, 494
Mirror test 522
Mitogen 560
Moist heat sterilization 498
Molars
maxillary 388, 389f, 443
surgery, distal 388, 389f, 390f
Monocytes 98, 103, 560
Mouth
breathing 89, 90f, 131, 132, 522
diseases 203
floor of 280
Mucinase 345
Mucocutaneous lesions 46
Mucogingival
deformities 47, 560
junction 3
line 3
surgery 406, 407, 560
Mucoperiosteal flap 376
Mucosa 561
Mucous membrane pemphigoid 223, 225, 561
Multiple periodontal abscess 124f
Multisystem granuloma 198
Murray-Puretic-Drescher syndrome 187, 193
Muscle
hypertonicity 111
position 47
tenderness 477
Mycoplasma 263
Myocardial infarction 143
N
Nanotechnology, generation of 516
Nasal
fossa 539
infections 132
septum 539
Nasopalatine foramen 539
National Health Survey 54
National Institute for Dental and Craniofacial Research Criteria 317t
Nausea 491
Navy plaque index, modified 52, 57
N-benzoyl-dl-arginine-2-naphthylamide test 303
Neisseria 73
gonorrhoeae 45
Nerve innervation 19, 23, 24, 30
Neurosis 89
occlusal 91
Neutropenia 44, 215, 216, 221, 268, 270
acquired 46
chronic benign 120
cyclic 46, 100, 120, 288
Neutrophil 98, 103, 139, 538, 561
abnormality 44
chemotaxis 99, 99f
disorders 100
functions of 98
phagocytic action of 231f
N-formyl-methionyl-leucyl-phenylalanine 220
Nickel 46
Nicotine 152
Nifedipine 190, 192
Nikolsky's sign 224
Nitric oxide synthase inhibitors 156
Non-Hodgkin's lymphoma 272, 273
Noninflammatory gingival enlargement 189, 190t
Non-nucleoside reverse transcriptase inhibitors 274
Non-steroidal anti-inflammatory drugs 157, 247, 268, 310, 492, 492fc
Nuclear medicine bone scan 299
Nucleic acid technology 300
Nucleoside reverse transcriptase inhibitors 274
Nutritional deficiency 206, 217
Nyman's index 57
O
Occlusal therapy 29, 47, 307, 469, 477, 561
Occlusion, intraoral evaluation of 477
Octacalcium phosphate 83, 84
Octenidine 345
Odland body 161, 162
Opposite arch fulcrum 329
Opsonin 561
Oral
candidiasis 272, 561
epithelium 561
basal cells of 6
hairy leukoplakia 273
herpes, recurrent 45
hygiene methods 279
hyperpigmentation 273
implantology 461
irrigation devices 344
leukocytes, reduced activity of 152
lichen planus 223, 225
malodour
measurement of 132
pathogenesis of 131, 131fc
mucosa 38, 220, 561
part of 8
pathologic alteration of 464
pathologic lesions 132
prophylaxis 170
sulcular epithelium 14
ulceration 198
severe 209
Orange stain 92
Organ system 143
Oropharyngeal lesions 209
Orthodontics 482
application of 481
forces 482fc
procedures, timing of 481
role of 479
therapy 87, 87f, 481
tooth movement 26, 115
use of 480
Orthopantomograph 298, 539
Osseointegration 461, 462, 562
Osseous defects, diagnosis of 247
Osseous surgery
basic rules of 395
types of 393
Ostectomy 393, 562
Osteoblasts 20, 21, 28
Osteoclast 20, 21, 28
activating factor 562
formation 245f
inhibition of 245f
Osteoconduction 401, 562
Osteocytes 28
Osteogenesis 562
Osteoid 28
Osteoinduction 401, 562
Osteoma 201
Osteomyelitis 273
Osteonectin 32
Osteoplasty 393, 562
Osteopontin 32
Osteoporosis 38, 292, 293, 294
Osteoprotegerin 242, 245f
Osteosarcoma 201
Osteotomy procedure 466f
Oxygen 509
dependent killing mechanisms 100
Oxytalan fibers 17, 18, 20, 21
P
Paget's disease 33, 34, 201, 311
Pain 45, 360
types of 454
Palatal mucosa 412
Palate 216f, 280
Palm
down technique 329
up technique 329
Pancreatic diseases 123
Papilla 382f
lingual 10
management of 377
preservation flap 377, 378, 380f, 381f, 382f
reflection of 381f
Papilloma 199, 200
Papillon-Lefevre syndrome 44, 46, 100, 215, 220, 268, 269, 269f, 288, 562
Paradontosis 259
Parafunctional habits, management of 115
Parathormone 242, 243
Parathyroid glands 125
Parotitis 132
Partial thromboplastin time 538
Pedicle
acquired 547
autograft 408, 416
Pemphigoid 46, 563
Pemphigus 45
vulgaris 46, 223, 224f, 225, 563
Pen grasp 328f, 544f
modified 328f, 544f, 560
Penicillin 345, 491
Penicillium 92
Peptides 400
Peptidoglycan 137
Peptostreptococcus micros 73, 74, 150, 268, 300
Periapical
abscess 188, 307
dental radiographs 464
infection, chronic 29
pathology 281, 298, 536
Pericementum 20
Pericoronal abscess 46, 188
Pericoronitis 210, 210f
treatment of 211f
Peri-implant
complications 468
diseases 468
types of 468
mucositis 468, 563
plaque 66
tissue 115
Periodic acid-Schiff stain 14
Periodontal
abscess 44, 4648, 188, 198, 307, 563
causes of 238
formation 88
bacteria, reclassification of 73t
blood supply 25f
considerations 460
cyst 234, 563
destruction 52, 54
diseases 3, 47t, 54, 71, 72, 85, 100, 102, 105, 107t, 118, 119, 123, 125fc, 138t, 140, 145, 147, 148, 150, 151, 151t, 158fc, 214, 221, 234, 235f, 247, 248, 256f, 273, 291294, 506, 536, 563
classification of 43, 44, 215, 216, 271
current classification systems of 43
diagnosis of 276
epidemiology of 49
gingivitis component of 51, 52
management of 476
microbiology of 215
necrotizing 46, 48, 288
pathogenesis of 136, 150, 151t
progression of 38, 113
recurrence of 472
severity of 150
types of 47
dressing 353, 354, 563
endodontic lesion 48, 564
endoscope 315
flap 375, 563
surgery 307
technique 383f
index 54
infection 131, 143t, 144, 146, 147f
instruments 314, 563
classification of 315
lesions 267
primary 452, 453
secondary 452
ligament 8, 20, 22f, 38, 215, 482, 482fc, 563
fibers, development of 23f
functions of 25
nerve innervation of 24t
principal fibers of 22t, 23
secondary fibers of 23
space 298
vessels of 19, 20
manifestations 120122, 220
medicine 142, 144, 148
membrane 20
microbiology 65
microsurgery 507
advantages of 508
disadvantages of 508
plastic surgery 564
pocket 229, 234, 234f, 236, 564
formation of 233fc
granulation tissue of 115
probes 295, 315
types of 315, 316f
regeneration 400
scores 54t
screening and recording 295, 297
splint 37, 456, 564
surgery 351, 375, 564
classification of 351t
contraindications of 350
indications of 350
principles of 350
surgical procedures 307
therapy 3, 152, 153t, 154, 157, 170, 308, 308fc, 310, 312f, 376f, 456, 479, 481, 488, 489, 494, 494t, 515
healing after 311
tissues 67f, 101f, 112t, 313fc, 451f, 452fc
biology of 8
damage 72
engineering, requirements of 506
infections of 121
trauma 564
treatment 52, 60, 310, 481, 515
vaccines 79
use of 156
Periodontia 3
Periodontics 3, 508, 513, 515, 516, 564
application of 482
reconstructive 403f
Periodontitis 43, 44, 4648, 73, 107, 123, 136, 147f, 151, 174, 182f, 215, 216, 220, 250, 263, 266, 268, 288, 292fc, 548, 564
aggressive 4648, 216, 219, 258, 259fc, 289, 289t, 548
chronic 46, 47, 216, 252, 253f, 256, 256fc, 289, 551
early onset 43, 44, 48, 216
generalized 254, 556
aggressive 219, 220, 258, 260f, 262, 264, 264t, 555
localized 216, 254, 559
aggressive 219, 258, 260, 260f, 261f, 263, 264, 264t
childhood 218
early onset 44
prepubertal 218
mild-to-moderate 473
moderate 254, 560
necrotizing 44, 47
prepubertal 43, 100, 107, 216
progressive 252
rapidly progressing 43, 44, 100, 107, 258, 262
recurrent 267, 267t
refractory 43, 44, 47, 74, 100, 107, 216, 266, 267, 267t, 566
retrograde 450, 566
role of 146
severe 254, 568
severity index 55
slight 254, 568
types of 218
Periodontium 8, 37, 38, 115, 120, 271, 450, 451, 481, 564
abscesses of 46, 74
adaptive remodeling of 112
aging of 37f, 548
development of 4
severe destruction of 269
structures of 3
Periodontology 3, 564
Periodontosis 259
Periosteogingival fibers 18, 20
Periosteum 28
Periotron readings, translation of 165t
Peripheral giant cell granuloma 199, 200
Peroxidase 96
Persistent gingival bleeding 198
Peutz-Jeghers syndrome 181, 566
Phagocytes 100
Phagocytosis 102, 162, 565
Phenolic compounds 345
Phenols 489, 501
Phenytoin 45, 190, 491
Phosphate 162
Phosphorus 84
Photodensitometric analysis 299
Photodynamic therapy 509, 509f
advantages of 511
application of 511
limitations of 511
principles of 509
Photophobia 269
Photosensitivity 491
Photothermal ablation 514
Phthalocyanines 510
Phylloerythrin 510
Piggy-backed fulcrum 329
Pituitary gland 125
disorders of 123
Plaque 65, 66t, 70, 287, 307, 308, 565
accumulation 294
attachment inhibitors 85
control 285, 337, 523, 565
measures 337
free score 52, 58
index 52, 56
inhibition agents 85
microflora 124
physical nature of 72
weight 52, 58
Plasma
cell 565
gingivitis 186, 196, 223, 528
rich growth factors 400
Platelet 98
activating factor 511
concentrates 511
action of 512fc
classification of 511
count 538
derivatives 400
derived growth factor 139, 156, 244, 400, 506, 511
disorder 531
rich fibrin 400, 511, 512
matrix 400
parts of 512, 513f
preparation 512
technology, limitations of 513
rich plasma 400, 511, 512
advantages of 513
parts of 512f
preparation 512
Plunger cusps 280
Pneumocystis carinii pneumonia 271
Pneumonia 132
hospital-acquired 148
Pocket
depth 234, 284, 307, 308
determination of 236
epithelium 397
ulceration of 231f
probing of 236f
reduction 307
types of 230f, 237fc
Polyacrylamide gel electrophoresis 303
Polyclonal B-cell activation 104f
Polycrystalline 463
glassy carbon 463
Polyethylene 463
terephthalate 463
Polyglycolide 397
Polylactide 397
Polymerase chain reaction 209, 274, 303
Polymers 463
Polymethyl methacrylate 463
Polymorphonuclear
leukocyte 96, 98, 103, 105, 107, 146, 219, 221, 262, 269, 365
function 124
neutrophil 260
count 120
Polyoxymethylene 463
Polypropylene 463
Polysaccharide plaque matrix 139
Polysulfone 463
Polytetrafluoroethylene 463
Porphyrins 510
Porphyromonas gingivalis 38, 66, 69, 73, 74, 76, 107, 132, 137, 138t, 146, 150, 155, 253, 255, 262, 263, 268, 289, 292, 300, 303, 454, 491, 515
Potassium 167
iodide solution 10
oxalate 361
Pouch and tunnel technique 408, 426
Povidone iodine 345
Preosteoclasts, formation of 244f
Prepubertal periodontitis, generalized 219
Pressure 115
sensitive probe 296
Prevotella
intermedia 66, 69, 73, 74, 78, 150, 205, 253, 303, 491
melaninogenica 73, 92
nigrescens 74, 150
Prichard's index 57
Pristine gingiva 172
Proflavine 510
Progenitor cells 20, 21
Prostaglandins 140, 167, 243, 244, 303
Protease 172, 272, 345
Protectins 156
Protein 84
derived growth factor 106
polysaccharide complexes, mixture of 84
Proteoglycans 22, 32, 565
Proteolytic enzymes 168
Prothrombin time 538
Protrusion 565
Proximal cementoenamel junction 11
Pseudohalitosis 131
Pseudomembranous candidiasis 273
Pseudopocket 47, 532, 533f, 556
Psychosomatic disorders 128, 566
Puberty 126, 126f, 186, 196, 196f, 215, 528
Pulpal disease 451
Pulpitis 536
retrograde 450
Purpura, non-thrombocytopenic 561
Pus formation, significance of 237
Pyogenic granuloma 45, 196f, 197f, 566
Pyorrhea 566
Pyrophosphate 85, 347
Q
Quéntin furcation curettes 319
Quigley-Hein plaque index 52, 56
Quorum sensing 66
R
Radiation 91, 500, 513
Radicular bone 393f
Ramon syndrome 187, 193
Ramus graft, harvesting of 435f
Random burst theory 255
Random walk model 255
Rapid orthodontic extrusive force 485
Red blood cell
count 538
disorders 122
Removable partial dentures, design of 86, 87, 91
Reproductive system 143
Resorptive cells 20, 21
Respiratory
infection, acute 143, 148
system 143
tract, recurrent infections of 269
Restoration
contour of 86
margins of 86, 86f, 91, 484
Reticular lichen planus 225f
Reticulin fibers 17, 21
Retroviruses 507
Rheumatic fever, acute 131
Rhinitis 132
Riboflavin 217, 510
Ritonavir 274
Roll method 341
Roll technique 523
Roll test 10, 532
Root
amputation 567
biomodification 399, 399f, 494
cementum, deficiency of 31f
complex 439
concavities 287
cone 439
coverage 415
denudation of 205
fracture 46, 536, 539
hypersensitivity 361
length of 443
morphology 433
planing 315, 331, 542, 567
instruments 315, 545
stroke 331, 567
technique 332
proximity 287, 433, 481
resection 444, 567
resorption 287, 481
separation 440, 444, 567
degree of 443
sheath
fragmentation of 5f
proliferation of 5f
surface
caries 539
preparation of 399
trunk 439
length 440
Rutherford's syndrome 187, 193
S
Saliva 96, 567
functions of 162t
role of 70f, 96
Salivary
calculus 82
components 162
dysfunction 123
gland diseases 273
peroxidase system 96
Sarcoidosis 198, 199
Sarcoma 200
Scaling 189, 315, 317, 331, 542, 567
principles of 331
Schiller's potassium iodide solution 531
Schonlein-Henoch purpura 531
Schwartz periotrievers 315, 319
Sclerosis, tuberous 187, 193
Screening test 274, 538
Scrub technique 341, 523
Scurvy, periodontal features of 119
Serratia marcescens 92
Serum protease inhibitor 169
Sex hormones 169
Sharpey's fibers 5, 22, 25, 30
Sickle cell anemia 123
Silver nitrate 361
Simplified oral hygiene index 52, 56
calculus component of 58
Sinuses, maxillary 464, 539
Sinusitis 132, 273
Skin 37
diseases 44, 45
rashes 491
Skinner's iodine solution 68
Smoker's palate 90f, 522
Sockets, lingual portions of 27
Socransky's microbial complexes 74, 74t
Sodium 84, 167
citrate 85
fluoride 85, 347, 361
hypochlorite 345
lauryl sulphate 223
valproate 190
Soft tissue 280, 529
enlargement 47
implant interface 461, 462
recession 46
situation 464
wall 233
Sonic instruments 320
Sonic scalers 320t
Spiramycin 345
Spirochetal infiltration, zone of 206
Spirochetes 73, 454
Splinting
contraindications of 458
indications of 458
principles of 457
Splints 568
classification of 457
Split thickness flap 376, 377f
Squamous cell carcinoma 200
Stabilization, period of 457
Stains, classification of 91
Standard periodontal therapy 262
Stannous fluoride 361
Staphylococcal enterocolitis 491
Staphylococcus intermedius 268
Stem cells, mesenchymal 506
Stensen's duct 83
Sterilization 496
conditions 499
control 498, 499
methods of 496, 497fc
Steroids
systemic 227
therapy 227
Stevens-Johnson syndrome 209
Stillman's cleft 111, 183, 183f, 568
Stillman's method 340
modified 340, 340f, 524
Stochastic model 255
Stomatitis 132, 491
aphthous 209
necrotizing 272274
nicotinic 90
Stratum
basale 12, 14
corneum 12, 14
germinativum 12
granulosum 12, 14
spinosum 12, 14
Streptococcal gingivostomatitis 207
Streptococcus
constellatus 74
gordonii 74
intermedius 74
mitis 73, 74
mutans 75
oralis 74
pneumoniae 148
sanguinis 69, 73, 74, 137, 145
Streptokinase 169
Stress 286, 294
Strip technique 412
Stroke 143, 146, 330, 331t
direction 330
scaling 331, 567
Strontium
chloride 361
fluoride 345
Stryker implant system 464
Sturge-Weber syndrome 187, 193
Subepithelial connective tissue 408
graft 424, 425f, 427f
Subgingival
bacteria 47
calculus 82, 83, 83f, 84, 84t, 568
curettage 363, 364f, 568
home irrigation devices 494
plaque 66, 66t, 67, 67f, 67t, 71, 568
bacteria 67f
epithelium associated 67
tooth associated 67
restorations 286, 287
scaling 315, 332
Submandibular fossa 539
Subtractive osseous surgery 568
Sulcular
bleeding index 53
epithelium 11, 569
fluid 162
incisions 380f
Sulcus
anatomy of 162
bleeding index 51
depth 9f
Superficial papillary layer 17
Supine hypotensive syndrome 194
Supportive periodontal
therapy 471
treatment 471473
Supra-alveolar connective tissue 17
Suprabony
pocket 236, 236t, 532, 533f, 569
treatment of 237fc
Supracrestal pocket 558
Supragingival
calculus 82, 83f, 84, 569
home irrigation devices 494
plaque 66, 66t, 67, 67f, 70, 569
accumulation of 231f
control 345, 489
extension of 231
scaling 315
technique 332
Supraperiosteal arterioles 19, 20, 20f
Surgery, healing after 395
Surgical gingivectomy, healing after 372
Suturing
principles of 352
techniques 353
Swelling 45, 360
Syncope 360
Synthetic cells 20, 21
Syphilis 203
Systemic disease 43, 44, 132, 186, 215, 216, 285
manifestation of 46, 47, 268, 288
Systemic lupus erythematosus 491
T
T lymphocytes 98, 101, 101f, 103
Tacrolimus 190
Tactile method 537
Talbot's iodine 217
Tannerella forsythia 73, 74, 77, 150, 155
Tantalum 463
Taste dysfunction 123
T-cell 101
maturation 269
types of 102
Teeth
congenital morphologic abnormalities of 87
correcting crowding of 480
crowding of 280
fracture 433, 539
index 60t
irregular alignment of 88
long axis of 532f
migration 111
pathologic 114
mobility 286, 569
indices 57
reimplantation 29
Temporomandibular
disorders 476
joint 220, 280, 476
Tension test 10, 532, 532f
Tensional theory 25
Tetracycline 490, 491, 491t, 494
anti-inflammatory actions of 490
fibers, intrasulcular placement of 493f
hydrochloride 268
solution 399f
Tetralogy of Fallot 569
Tetrapyrroles 510
Thermal
injury 46
sensitivity 111
Thiamine 217
Thrombin 244
Thrombocytopenic purpura 121, 122f, 569
idiopathic 531
Thymol 345
Thyroid gland 125
disorders of 123
Tissue
destruction 107, 138
engineering
principles of 506
scaffold-based 506
forceps 315
invasion of 72
keratinized 47, 467
management 352
Titanium 463
oxide 463
plasma 463
Tongue 280
coating 132
lichen planus of 224f
thrusting 89, 90, 114f, 522
ulceration of 224f
Toxemia 131
Transgingival fibers 18, 20
Trans-septal fibers 18, 20, 22
Trauma 109, 110, 114, 241, 569, 570
acute 110, 547
chronic 551
Trench mouth 204
Treponema 73
denticola 74, 76, 132, 255, 454
pallidum 45
Tricalcium phosphate 463
Triclosan 345
Tuberculosis 131, 132, 203
Tuberosity, maxillary 403, 539
Tumors 132
benign 186
malignant 186
necrosis factor 101, 106, 101f, 146, 147, 244
production of 139
Turesky-Gilmore-Glickman modification 52, 56
Tzanck smear 209
U
Ulcerative
gingivitis, necrotizing 43, 44, 46, 67, 73, 100, 107, 137, 152, 179, 197, 198, 203, 204, 204f, 205, 205fc, 205t, 206, 206t, 207, 209, 215, 216, 217, 266, 272274, 293, 488
periodontitis, necrotizing 44, 46, 127, 204, 216, 266, 267, 272, 272f, 273, 274, 561
stomatitis, chronic 223
Ulcers
aphthous 132, 215
atypical 273
Undisplaced flap 379, 382, 385f387f
technique 388f
Universal curettes 318, 319t, 331, 570
Urea 167
Uremia 132
Urinary glucose 124
Urokinase 169
V
Vaginitis 491
Vanadium 463
Vancomycin 345
Varicella zoster 45
virus 209
Vascular endothelial growth factor 511
Veillonella parvula 73
Verapamil 190
Vertical incision, location of 379f
Vesicles, herpetic 208f, 216ff
Vestibuloplasty 433
Vincent's angina 207, 570
Vincent's infection 204
Viral
infection 203, 273
origin, gingival diseases of 45
Viruses 142
neutralization of 105
Viscoelastic theory 25, 26
Vision
direct 326f
indirect 326f
Vitamin 119
A 120
B
complex 120
supplements 207
C 85, 119, 347
deficiency 186, 196, 311, 528, 531
supplements 207
D 242
deficiency 119
deficiency 215
E 120
K deficiency 531
Vomiting 491
von Recklinghausen's disease 181
W
Waerhaug's concept 113, 114
Warfarin sodium 491
Wasserman's index 57
Waste
category 503
types of 503
Wasting disease 280, 570
Water lavage 334
Water test 522
Wegener's granulomatosis 198
Western blot assay 274
Wharton's duct 83
White blood cell
count 538
disorders 120
precursors, malignant neoplasias of 221
Widman flap, modified 379, 382, 383f, 385f, 560
Williams probe 315
Wolinella recta 73, 74
Wound
healing 515
protection 399
X
Xanthotoxin 510
Xenograft 400, 403, 570
Xeroradiography 298
Xerostomia 123, 131, 132, 464
Y
Yeaple probe 296
Yeasts 142
Z
Zimmermann-Laband syndrome 187, 193
Zinc 345
chloride 217, 361
salts 85, 347
Zirconium 463
Zoster virus infections 203
×
Chapter Notes

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1Normal Periodontium
Outlines
  1. Anatomy and Development of the Structures of Periodontium
  2. Biology of Periodontal Tissues
  3. Periodontal Structures in Aging Humans
2

Anatomy and Development of the Structures of PeriodontiumCHAPTER 1

Chapter Outline
  • → External Anatomic Features
  • → Development of Periodontium
    • ◊ Early Development of Cementum
    • ◊ Later Development of Cementum
    • ◊ Development of Junctional Epithelium
 
INTRODUCTION
The term periodontium arises from the Greek word peri meaning “around” and odont meaning “tooth”; thus, it can be simply defined as the “tissues investing and supporting the teeth”. The periodontium is composed of the following tissues namely alveolar bone, root, cementum, periodontal ligament (supporting tissues) and gingiva (investing tissue).
The various diseases of the periodontium are collectively termed as periodontal diseases. Their treatment is referred to as periodontal therapy. The clinical science that deals with the periodontium in health and disease is called periodontology. The branch of dentistry concerned with prevention and treatment of periodontal disease is termed periodontics or periodontia.
 
EXTERNAL ANATOMIC FEATURES
The oral mucosa consists of three zones: masticatory, specialized and lining mucosa.
Among all the structures of the periodontium, only the gingiva is visible clinically. The gingiva is divided anatomically into free or marginal, attached and interdental gingiva.
The border or groove between marginal and attached gingiva is called free gingival groove, a shallow depression on the faciogingival surface that roughly corresponds to the base of the gingival sulcus. The junction between the attached gingiva and alveolar mucosa is called mucogingival line or junction (Fig. 1.1).4
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Fig. 1.1: Surface characteristics of the clinically normal gingiva
The normal gingiva is pink in color (salmon coral pink) and accumulation of melanin pigmentation is normal. The surface of the gingiva exhibits an orange peel-like appearance referred to as stippling.
In health, the gingiva completely fills the embrasure spaces between the teeth and is known as the interdental gingiva. In the posterior teeth, where the contact areas between the teeth are usually broad, the interdental gingiva consists of two papillae, facial and lingual, which are connected by the col.
The significance of col is that, it is made up of non-keratinized epithelium and hence represents the most frequent site for initiation of disease process.
 
DEVELOPMENT OF PERIODONTIUM
To understand the development of periodontal tissues, one has to have a clear understanding of the root formation. Development of cementum and roots of the teeth starts once the formation of enamel is completed. The outer and inner epithelia together form the epithelial root sheath of Hertwig, which is responsible for determining the shape of the root.
 
Early Development of Cementum
The outer and inner epithelial layers become continuous (without stratum intermedium or stellate reticulum) in the area of the future cementoenamel junction and form a two-layered sheath, which grows into the underlying mesenchyme.
The apical portion of the root sheath remains constant whereas the coronal portion, which is associated with dentin and cementum formation moves in the direction of the oral cavity. The root sheath bends horizontally at the level of future cementoenamel junction forming the epithelial diaphragm, following which the cervical opening becomes smaller (Figs 1.2 and 1.3).
Once the crown formation is complete, the cells of the inner enamel epithelium lose their ability to form enamel and are called reduced enamel epithelium. They retain the ability to induce perimesenchymal cells to differentiate into odontoblasts and to proceed with the formation of predentin and dentin. After the dentin formation is completed, certain changes occur in the root sheath.
Recent studies have shown that, the epithelial cells of the root sheath produce a layer on the root dentin, which is 10 µm thick, has a hyaline appearance and contains fine granules and fibrils. This layer is called the hyaline layer of Hopewell-Smith or intermediate cementum.
The epithelial cells of the root sheath secrete enamel proteins, such as amelogenin or enameloids. The root sheath at this stage becomes discontinuous and enables the surrounding follicular mesenchyme to come in contact with the amelogenin. These follicular cells then differentiate into cementoblasts and deposit the organic matrix of cementum on the root surface (Figs 1.4 and 1.5).
 
Later Development of Cementum
Cementoblasts are cuboidal cells that are arranged on the outer surface of the hyaline layer. These cells are responsible for the deposition of the organic matrix of cementum, which consists of proteoglycan ground substance, intrinsic collagen fibers and is followed by subsequent mineralization of the organic matrix (Fig. 1.6).
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Fig. 1.2: Root sheath of Hertwig
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Fig. 1.3: Proliferation of root sheath and further dentin formation in an apical direction
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Fig. 1.4: Fragmentation of root sheath
Mineralization starts with the formation of a thin layer called cementoid. Mineral salts are derived from the tissue fluid containing calcium and phosphate ions and are deposited as hydroxyapatite crystals.
The disintegrated Hertwig's root sheath slowly moves away from the root surface and remains in the periodontal ligament as epithelial cell rests of Malassez. The periodontal ligament forms from the dental follicle soon after root formation begins.
Before a tooth erupts, fibers from the follicle are incorporated in the cementum and they lie parallel to the root surface. Once the tooth erupts, the fibers are arranged in an oblique manner and are regarded as the precursor of the periodontal ligament fibers.
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Fig. 1.5: Follicular cells and fibers contact dentin surface
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Fig. 1.6: Early deposition of matrix
As the cementum continues to increase in thickness, more fibers become incorporated into the cementum and eventually called Sharpey's fibers, when periodontal ligament becomes established.
Alveolar bone forms around the periodontal ligament. With continuous bone deposition the periodontal ligament space gradually becomes narrower. The alveolar process develops during the eruption of the teeth and cells responsible for bone formation are osteoblasts (Fig. 1.7).6
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Fig. 1.7: Advanced formation of cementum
 
Development of Junctional Epithelium
When the enamel formation is complete, the ameloblasts become shorter, and they leave a thin membrane on the surface of the enamel called primary enamel cuticle.
The inner enamel epithelium after laying down enamel reduces to a few layers of flat cuboidal cells, which is then called reduced enamel epithelium. It covers the entire enamel surface extending till the cementoenamel junction.
During eruption, the tip of the tooth approaches the oral mucosa leading to fusion of the reduced enamel epithelium with the oral epithelium. As the crown emerges into the oral cavity, the former ameloblasts that are in contact with the enamel get transformed into junctional epithelium (Figs 1.8A to D).
Coronally, the junctional epithelium is continuous with the oral epithelium. As the tooth erupts, the reduced enamel epithelium grows shorter gradually. A shallow groove, the gingival sulcus may develop between the gingiva and the tooth surface.
Hence, the ameloblasts pass through two phases: in one, they form enamel, and in the other phase, they help in formation of primary epithelial attachment or junctional epithelium. When the junctional epithelium forms from the ameloblasts, it is called primary epithelial attachment. Junctional epithelium that forms after surgical therapy takes its origin from the basal cells of oral epithelium instead of ameloblasts. This is called secondary epithelial attachment.
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Figs 1.8A to D: Development of junctional epithelium
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REVIEW QUESTIONS
  1. Define periodontology and periodontics.
  2. What are the parts of periodontium?
  3. Describe the development of structures of periodontium.
MULTIPLE CHOICE QUESTIONS
1. Cementum:
  1. Is derived from the sheath of Hertwig
  2. Is acellular in the apical third of the tooth
  3. Often overlaps enamel
  4. Does not contain collagen fibers.
2. Cementum is:
  1. Avascular
  2. Vascular
  3. Has blood supply initially only
  4. None of the above.
3. Bundle bone is a part of:
  1. Periodontal ligament
  2. Alveolar bone
  3. Cementum
  4. Long bones.
4. Intermediate cementum is:
  1. Between enamel and cementum
  2. Found at dentinocemental junction
  3. Apical third
  4. Coronal third.
5. Which of the following are the predominant connective tissue cells of PDL ligament?
  1. Cementoblasts
  2. Fibroblasts
  3. Osteoblasts
  4. Cell rests of Malassez.
6. Remnants of Hertwig's root sheath are found in:
  1. Gingiva
  2. Alveolar bone
  3. Periodontal ligament
  4. Cementum.
7. All of the following cells of periodontal ligament are of mesenchymal origin except:
  1. Fibroblasts
  2. Multitotipotent cells
  3. Cementoblasts
  4. Cell rests of Malassez.
8. Sharpey's fibers are derived from:
  1. Hertwig's root sheath
  2. Epithelial rests of Malassez
  3. Alveolar bone
  4. Dental follicle.
9. The rests of Malassez in the periodontal ligament are derived from:
  1. Dental pulp
  2. Lamina propria
  3. Odontogenic epithelium
  4. Vestibular lamina.
10. Development of supporting tissues of the tooth is initiated by:
  1. Cells of dental follicle
  2. Cells of odontogenic layer
  3. Cementoblasts
  4. Cells of gingiva.
Ans:
1 c
2 a
3 b
4 b
5 b
6 c
7 d
8 d
9 c
10 a
BIBLIOGRAPHY
  1. Bhaskar SN. Orban's Oral Histology and Embryology, 10th edition. New Delhi: CBS Publishers and Distributers.  pp. 41–4.
  1. Jansen van Rensburg BG. Oral Biology. Quintessence Publishing Co Ltd;  1995. pp. 301–7.
  1. Tencate. Oral Histology, Development, Structure and Function, 3rd edition. Jaypee Brothers Medical Publishers (P) Ltd.  pp. 228–43.
  1. Varma BRR, Nayak RP. Current Concepts in Periodontics. Arya Publishing;  2002. pp. 4–8.