PERIODONTOLOGY

1. PERIODONTOLOGY

2. PERIODONTOLOGY • STUDY OF SUPPORTING STRUCTURES OF THE TOOTH • SUPPORTING STRUCTURES INCLUDE GINGIVA,PERIODONTAL LIGAMENT,CEMENTUM AND ALVEOLAR BONE. • PERIODONTAL DISEASES ARE THE COMMONEST CAUSE FOR TOOTH LOSS

3. Crown Gingival epithelium Cementum Root Periodontal Ligament Alveolar Bone

4. FACTORS CAUSING PERIODONTAL DISEASES • dental plaque and calculus • systemic diseases • genetic disorders and gene polymorphism • - IL1a(-889),IL1b(+3954),TNFa,RAGE,N-acetyl transferace, Fcy receptor . Etc. • iatrogenic factors • habits • hormonal factors • malalignment of teeth • nutrition

6. Periodontal medicine • Periodontal infection and atherosclerosis (CRP levels) • Periodontal infection and Myocardial infarction • Periodontal infection and stroke( CVA) • Periodontal infection and Diabetes mellitus • Periodontal infection and preterm low birth weight child (TNF-a, PGE2) • Periodontal infection and respiratory diseases

7. Actinomyces species Eubacterium species Camphylobacter species Lactobacillus Porphyromonas gingivalis Prevotella intermedia Tanerella forsynthesis Actinobacillus actinomycetemcomitans Fusobacterium species Treponema denticola Streptococcus species Peptostreptococcus species Bacteroides gracilis PERIODONTAL MICROFLORA

8. Virulence factors • Leukotoxins - death of leukocytes . Endotoxins - infl.reponse,cytokine prod., bone resorp., • Flagella - Bact.attach., Prevnt. phagocytosis • Fimbrillae - -do- • Capusule - -do- • Lipopolysaccharide - Protect. From immune system and complement. • Collagenase - conn. tissue breakdown • IG Proteases - degrades antibodies • Superoxide dismutase - protects anerobes (0xy. breakdown

9. MAJOR CYTOKINES AND MOLECULES ASSOCIATED WITH PERIODONTAL DESTRUCTION • IL-1, TNF-a - infl., osteoclast stim, mmp act. • IL-6 - pro-infl., stim IL-1, • IL-8 - pmn chemo., epithe. Migration. • PGE2 - osteo. stim., mmp product. • MMP-1 - matrix degradation • MMP-8 - -do- • MMP-9 - -do- • MMP-13 - -do-

10. Periodontal diagnostic techniques • Clinical diagnosis(pockets, mobility, • Immunological examination(levels of cytokines) • Microbial evaluation (culture,Immunohistochemical techinques,ELISA,DNA Probe, PCR analysis • Radiographic interpretation(xero radiography,subtraction radiography. Etc.) • Digital imaging

11. Wound healing • Vascular changes • Cellular exudate • Cell migration • Phagocytosis • Phases of wound healing • Cells involved in wound healing • Factors affecting wound healing

12. Wound healing cont. • Formation of granulation tissue, contraction • Growth factors influence • tgf-b, igf, fgf,bmp,pdgf,angiogenin,IL-1 etc. • Cells involved in healing-epithelial cells,fibroblast,mesenchymal cells, myofibroblasts,

13. Factors affecting healing • Mobility • Type of cells • Tobacco • Cirrhosis of liver • Old age • Radiation • Steroids • Vitamin c • Diabetes millitus

14. Role of biotechnology in periodontal diagnosis • Evaluating pockets and root surface pathology

15. Cont. • Dentistry is vast field, with scope for better technology in clinical treatment modalities, restorative materials, biomaterials, dental materials, research, public health dentistry, forensic dentistry, laser radiations etc. Biotechnology and Biopharmaceuticals are a big leap enhancing every aspect of dentistry. • Current research in biotechnology includes recombinant DNA, protein technology, tissue culture and molecular genetics. Many Biotechnology firms are identified as Biopharmaceutical companies to differentiate them from the mainstream pharmaceutical industry.

16. Biodontics: 'Biodontics' is a significant contribution to promote Biotechnology to Dentists. An emerging dental specialty, Biodontics, was conceptualized, developed and refined by Dr. Edward Rossomando, a professor of Biostructure and Function, in the U Conn School of Dental Medicine in an effort to move biotechnology more efficiently from scientists and inventors to dental practitioners. Biodontics applies molecular biology and biotechnology to clinical dentistry. It will train dental students, dental residents and dental school faculty in the best use of biotechnology to improve the oral health of the public. Attempts are being made to bring the concept to educational reality.

17. Radiographic evaluation in periodontal diseases.

19. Periodontal defects

20. Scaling and root planing Subgingival curettage Periodontal flap surgery Guided tissue regeneration Bone grafting Periodontal plastic surgery Local drug delivery Dental implants Periodontal therapy

21. Conventional treatment outcome of periodontal therapy

22. Ideal treatment outcome • New attachment • New bone formation • New cementum formation • New periodontal ligament formation • Gingival tissue reconstruction • Stability of the achieved results

35. Optics and biotechnology in Dentistry: Some interesting findings have been noted in the field of medical optics and biotechnology as applied to dentistry. They are particularly useful for caries detection and optic diagnosis

36. Imaging of occlusal dental caries (decay) with near-IR light at 1310-nm • It helps the detection of new dental decay occurring in the pits and fissures of the occlusal surfaces which cannot be detected by x-rays during the early stages of decay due to the overlapping topography of the crown of the tooth. • - The near-IR images show high contrast between sound and demineralized areas as in the differentiation of decay from stains, pigmentation, and hypo mineralization (fluorosis). • - The high transparency of the enamel enables imaging at greater depth for the detection of subsurface decay hidden under the enamel.

37. 2. Laser Ablation of Dental Tissues with Picosecond Pulses of 1.06-µm Radiation Transmitted through a Hollow-Core Photonic-Crystal Fiber Sequences of picosecond pulses of 1.06-µm Nd:YAG laser radiation are transmitted through a hollow-core photonic-crystal fiber and are focused onto a tooth's surface in vitro to ablate dental tissue. The fiber is used to transmit emission from plasmas produced by laser pulses onto the tooth's surface in the backward direction for detection and optical diagnostics.  

38. Determination of bacterial activity by use of an evanescent-wave fiber-optic sensor A novel technique based on fiber-optic evanescent-wave spectroscopy is proposed for the detection of bacterial activity in human saliva. The sensor determines the specific concentration of Streptococcus mutans in saliva. The acidogenic profile of Streptococcus mutans is estimated by use of evanescent-wave absorption spectra at various levels of bacterial activity.  

39. Curing of dental composites by use of InGaN light-emitting diodes The application of blue-light-emitting InGaN LED's as a polymerizing source for dental composite materials indicated that a device consisting of several InGaN LED's would be an effective instrument for curing certain light-sensitive materials, particularly dental composites. It has the advantage of lower material temperature rise during the curing process using the array over the conventional one. 

40. Biotechnology implication in periodontal therapy • Growth factor therapy • Gene therapy • Bone grafting procedures • Implant dentistry • Local drug delivery using nano- technology

41. Tissue engineering triad Scaffolds (Eg.Collagen,bone mineral,synthetics) time Regen. Of tissues Appropriate environment Signaling molecules (eg. Growth factors, Morphogens,adhesins) Cells (eg. Osteoblasts, fibroblasts,chondro)

42. TISSUE ENGINEERING • TISSUES PRODUCED IN CULTURE BY CELLS SEEDED IN VARIOUS PORUS ABSORBABLE MATRICES. • CELLS CAN PROLIFERATE AND MAINTAIN THEIR PHENOTYPE WHEN CULTURED IN PRIMARILY TWO-DIMENTIONAL SUBSTRATES AND THREE DIMENTIONAL PORUS MATRICES AND GELS IN VITRO.

43. TISSUE ENGINEERING IN VITRO • ability to examine the material as it is formed • perform specific measurements prior to Implantation. • Drawback – production of musculoskeletal tissue that must play a load-bearing role, is the absence of the physiological mechanical environment during formation. • Union of implanted tissue with the host organ-degradation and new tissue formation. • Implanted tissue may be degraded by the mechanical forces invivo.

44. Various matrices for T.E. • ABSORBABLE- synthetic polymers like PLA, PGLA, natural polymers like collagen, fibrin, chitosan. Natural mineral like Anorganic bone. • NON-ABSORBABLE --- synthetic polymers like PTFE , synthetic ceramics like calcium phosphate.

45. Cells and Regulators for T.E. • Autologous parenchymal cells • Allogenic parenchymal cells • Marrow stromal stem cells • REGULATORS – Growth factors(polypeptide mitogens) and Differentiation factors (BMPs).

46. Role of Matrix • Structural reinforcement of defect • Serve a barrier to ingrowth of surrounding cells • Serve as a scaffold for migrating and proliferating cells invivo or invitro • Serve as insoluble regulator of cell function • Serve as a carrier of regulator molecules and drugs.

47. Platelets a principle source of growth factors Growth factors Major source at wound site • PDGF - PLATELETS, macrophages epithelial cells,endothelial cells • TGF-b - PLATELETS, macrophages osteoblasts,activated T- Lymphocytes. • EGF - PLATELETS, macrophages, epithelial cells • IGF- 1 - plasma, epithelial cells, fibroblasts

48. Platelet rich plasma(PRP) • PDGF & TGF-b have shown to stimulate bone, peiodontal and skin healing. • PDGF , TGF-b high conc. In platelets. • Thrombin and calcium are added to PRP , the platelets are activated and release the contents of a-granules containing pdgf,tgf. • PRP can also be mixed with bone grafts

49. Bone grafts • AUTOGENOUS GRAFTS • ALLOGRAFTS- DFDBA &FDBA • XENOGRAFTS- Deprotienized bovine bone • ALLOPLASTS - Calcium phosphate ceramic(HA,TCP), calcium carbonate, HTR polymers, bioactive glass ceramics • COMPOSITE GRAFTS

50. TERMINOLOGIES • Osteogenesis- formation and development of bone. • Osteoinduction- process of stimulating osteogenesis. Have instrinsic bone formation capacity. • Osteoconduction- provides a physical scaffold or matrix suitable for deposition of new bone. They don’t have intrinsic bone production capacity.