Biomedical Engineering Reference
In-Depth Information
Plaque
Gingiva
Periodontal
pocket
Cementum and
periodontal
ligament
Reduced
bone level
Bone
(A) Healthy gingivae
(B) Gingivitis
(C) Periodontal pocket
(D) Periodontitis
FIGURE 23.6
Schematic representation of the stages of periodontal diseases. (A) Healthy gum tissue, tooth anchored by
periodontal structures. (B) Plaque formation (oral biofilm) causing gingivitis. (C) Formation of periodontal
pocket (lesions between teeth and the junctional epithelium) and tooth connective tissue attachment
gradually destroyed. (D) Periodontitis, destruction of gingiva, and bone that support the tooth and the
cementum that protects the root.
of the disease that is confined to the gingiva, (ii) mild periodontitis, (iii) moderate periodontitis,
and (iv) advanced periodontitis [53] . Periodontitis denotes inflammation of the gingival and adja-
cent deeper periodontal tissues, leading to gingival swelling, bleeding, and bad breath. In the last
phase of the disease, the supporting structures of the periodontium are degenerated, alveolar bone
begins to resorb, and the gingival epithelium migrates along the tooth surface, forming a periodon-
tal pocket [7,56,58] . The periodontal pocket provides an excellent environment for the growth of
pathogenic microorganisms, such as Actinobacillus actinomycetemcomitans, Bacteroides spp.
(B. gingivalis and B. intermedius), Wolinella recta, Eikenella spp. Porphyromonas gingivalis, and
Provetella intermedia [7,57,59] . Progressive pocket formation leads to the destruction of the sup-
porting periodontal tissues and to loosening or exfoliation of the teeth [58] . Figure 23.6 shows the
evolution patterns of periodontal disease from healthy gingiva to pathological periodontitis.
As soon as gingivitis with pocket formation occurs, the therapeutic approaches should be aimed
at reducing the etiologic factors in order to decrease or eliminate inflammation and control the
interaction between the plaque bacteria and the host response. The aim of periodontal therapy is to
eliminate bacterial deposits or dental plaque (biofilm) from the tooth surface by mechanical treat-
ment in combination with an adequate oral hygiene to prevent reinfection of the subgingival area
by periodontopathic microorganisms and consequently to preserve the tooth [7,53,59] . Furthermore,
various regenerative treatment options are available.
Local and/or systemic delivery of several antimicrobial and antibacterial agents has been effec-
tively used to manage periodontal infections [54,56,57] . Systemic doses of antibiotics reach the
periodontal tissues by transudation from the serum and then cross the crevicular and junctional epi-
thelia to enter the gingival sulcus [54] . There are however, some disadvantages such as a rapid
decline of the therapeutic plasma antibiotic concentration, the development of microbial resistance,
and high peak plasma antibiotic concentrations, which may be associated with side effects such as
gastrointestinal complaints, depression, and tachycardia [7,59] . The systemic administration of
Search WWH ::




Custom Search