💡 #bone

NÖÖR 🍒 5336🍒:
🌸 alveolar bone formed by ➡ #intermembranouce_ossification

🌸 osteoclast + asteoblast ➡ couping

🌸 more remodeling in peridontium ➡ #bone

🌸 main regulatory hormone of ca++ ➡ PTH

🌸 hydroxuapatite crystal #parallel of the fiber

🌸 lamella of the bone formed #parallel of long axil of the tooth

Amani 5105 Benkhial:

#Instrument

Diagnostic instrument
1_dental mouth mirror
2_periodontal probe
3-Explorer
🔵
Dental mirror ▶disposable
▶sterilizable revsable
Uses of dental mirror :
-indirect vision
-reflect light =indirect vision
-retraction
🔴priodontal probe عدة انواع اشهرها 🔽
(Michcan-0-with WILLIAMS
CALLUBRATION),


Scaling or root planning
- supra gingival scaling
▶2cuting edge
▶pointed tip
▶triangular 🔼in cross section
⭐sickle scaler اكثر واحد استخدام
Facial+lingual supra gingival scaling
🔵Sickle scaler يستخدم post+Ant
Facial+lingual in supragingival scaling
🔵Jagutte scaler يستخدم interptoximal supra gingival scaling
يوجد

🔵يوجد Ant.Gaguette
ويوجد post.Gagutte
For removal of calculus imter proximal supra gingival calculus
🔵Gumine _v.v.imp
Double end :
sickle end(thick for heavy calculus )
spoon end (for removal of stain)
🔵U 15/30
2 instruments كأنه
مع بعصهن
Sickle +. jaguute

(Facial). ( interproximal)
+
(Lingual)
🔵Nevi
هو نفسه modified post
Jugette
Round cutting edge + short blade
🔵chisel
Interproximal supra gingival scaling +push movement
ممكن يخش. 2mm sub gingival
🔵 Hoe
Notch طالع لبرا ،notch خاش لجوا
To remove ring of calculus

Amani benkhial

#instrument
Sub gingival instrument
🔵 Currete
-Round in section
-Blunt tip
-One/two cutting edge

🔵Universal currete
-two cutting edge
- curved one plane
- angle between shank + blade 90°

🔵Grasy
-Spesific
-one cutting edge
- curved in two planes
2angle between shank + blade 60-70
V.v.imp offcet angle ▶60-70°
(1-2,3-4) anterior
5-6 premolars
7-8 facial molars ,9-10 lingual molars
11-12 mesial molars
13-14 distal molars

🔵 uses of periodontal prope
1.to measure proping depth GM ▶base of pocket
2.CAL clincal attachement loss CEJ ▶base of pocket
3.bleeding on probing test
4.نفرق consisty of gingiva by base if probe
( firm +resilient) (odematous+ soft )

5.rolling test
Attached gingiva لاصقة ف bone normally
لا يحدث rolling الا اذا كان ف bone loss
Mucogingival junction يحدث فيها rolling

Noor
💡 #Periodontal_microbiology

🌸 disease➡ #specific_theory
🌸 traetment ➡#non_specific_theory
🌸 firs bacteria ➡ gram + aerobic cocci
اول ما تلتصق بالسن ولاكن لا تسبب المرض 👌

🌸 what causes periodental disease ?
multi fectorial disease ☺

🌸 true or false 👌
1- #only cause of periodental disease is bacterial ❌❌
2- #mainly cause of periodental diseases is bacteria ✔✔
انسو اي شيء فالشيت الا هذين غير مسموح تنسوهن 😁

Noor

💡 #Periodontal_microbiology

🌸 #material_alba
🌸 #bental_plaque
🌸 #calculus

بأذن الله جيات 😌 دكتور #فؤاد

📚 classificatio of dental plaque according to position :

🌸 superagingiva ➡ only attached in tooth

🌸 subgingiva ➡
1-tooth associated
2-tissue associated
3- unattached

🌸 marginal plaque

🤓 marginal plaque ➡ cause of #gingivitis
🙄 subgingival ➡ cause of #periodontitis ...
ومرات تسبب root caries 🌸
😳 subragingival ➡ cause of #caries

💎#Defense_mechanisms_of_the_gingiva

♦️sulcular fluid = (GCF)
🔺 In normal gingiva GCF called➡️ transudate
🔺 In gingival disease called ➡️ exudate


⛔️ Methods of collection GCF :-➡️
1⃣ absorbing paper strips
2⃣ twisted threads
3⃣ micropipettes
4⃣ intracrevicular washing

⛔️ substances have ability to penetrate sulcular epithelium have ➡️MOLECULAR WRIGHT➡️ *** 🆙 (1000KD) V.IMP☑️
⛔️ mechanism of penetrate through epi by ♦️((((intercellular movement)))) V.IMP☑️
along ((((intercellular spaces)))).

⛔️composition GCF
cellular & non cellular elements
⛔️ majority GCF elements are (Enzymes)
🔴 Leukocytes ➡️ v.imp cells in GCF
🔴 electrolytes ➡️ v.imp non cellular elements in GCF

⚛ cellular ➕ humoral activity in GCF ⬆️ responses in:
Healthy ➕ periodontal disease.


Imp 🔴⛔️ Drugs that Excreted in GCF:
1⃣ Tetracycline
2⃣ Metronidazole (flagel)


♦️ major role of saliva in gingiva defense :
1⃣ influence on plaque by mechanical cleaning
2⃣ control bacterial activity

✳️ major salivary antibody present in saliva (IgA)


🔴 most important salivary buffer in saliva ➡️ (Bicarbonate carbonic acids)


⛔️PMN in saliva referred as ((Orogranulocyte)) v.imp
🌸 أهم النقاط اللي ركزت عليهم الدكتورة.

Short note :
السنة اللي فاتت 💡
1 types of fibers in pdl
2 difinition of materia alba

Abeer

💡#bone
اهم حاجات ف Bone 😌
⛔️alveolar Bone Disappears in tooth lost

⛔️basal bone located apically in jow unrelated to the teeth

⛔️consists compact &cnacellous
Fasial and lingual compact ,apical &interdental &anterradicular cancaellous

⛔️in Bone cover periosteum two layer and endosteum one layer

⛔️Growth Bone By intramembranous ossification

⛔️Haversian Systems:supplied Blood for compact Bone

⛔️tooth two thirds inorganic ,one third organic

⛔️Remodeling of Alveolar Bone :Local ,systemicاهم شي (parathyroid)

⛔️Deposition and resorption coupling action

⛔️more cancellous bone exists in the maxilla than mandible

⛔️distance between crest of alveolar bone and CEJ in young adults 0.75and1.49mm ,distance increases with age 2.81

⛔️fenestration and Dehiscence تعريفات امتاعهن مهمات بكل بكل بكل

⛔️blood supply (inferior and superior alveolar arteries to the mandibular and maxilla

⛔️blood supply in mesial and Distal more than facial and lingual
Mesial more Distal
Molar more anterior
And more in gingival third in anterior and molar
In molar middle and apical same
But anterior apical more middle

Color of gingiva is infuleced by
▪️ vascular supply
▪️ thickness of epithelium
▪️ degree of keratinization
▪️ degree of melanin pigmention

generlized papillary gingivitis ➡️in mouth breather pt

#Cementum
✳️calcified avascular mesenchymal tissue covering the anatomical root.
⭕️two main types of cementum are acellular ((primary))and cellular ((secondary)).

🛑two sources of collegen fibers in cementum :
Sharpeys fiber ((extrinsic))
Fibers belong to cementum matrix ((intrinsic)).

⚫️Acellular cementum ((⬆️Ca & fibers.
🔺Sharpeys fiber comprise most structure of acellular cementum.
▪️this size, number, distribution ⬆️ with age.

🔴cellular cementum ⬇️Ca & Fibers than acellular.

🔵permeability of cementum ⬇️ with age.

⬛️ CEJ:
Type ((I))---cementum overlaps enamel. _Most common.
Type ((II))---edge to edge _Less common.
Type ((III)) ---Gapping ____hypersensitivity cause the dentin is exposed.

🔶thickness of cementum ⬆️with age.
Greater thickness (up to 150 to 200Am) in the apical third & in the furcation area..

🔴hypercementosis اكثر شيء عند ((apical third of the root)).
اما يكون Nodular او Spikes
سبب هذه الاشكال
1.cementicles that adhere to the root.
2.calcification of periodontal fibers at the sites.
🔺generalized hypercementosis is found in Paget disease.
🔺
Cementum of eruption as well as unerupted teeth.
🔺
70% of all resorption area were confined to the cementum without involving dentin.
Resorption caused by local & systemic cause.
Local :: TFO, orthodontic movement, cyst, tumors, tooth without functional antagonists, embedded teeth,pressure from malaligned eruption teeth, transplant teeth, periapical disease, periodontal disease.

Systemic ::: Ca deficiency, hyperthyroidism, hereditary fibrous osteodystrophy, Paget disease.
⛔️Cementum resorption under microscope as ((baylike concavities in the root surface.
🔺if epithelium proliferation into an area of resorption,repair will not take place.

✅Ankylosis ---fusion of the cementum and alveolar bone with obliteration of the Pdl.
🔺Ankylosis occur in teeth with cementoid resorption.
🔺Ankylosis results in resorption of the root.

#Alveolar-bone
🔴Alveolar process ➡️supports the tooth sockets.
🔺Function of Alveolar process ➡️ Attachment.
🔴The jaw bones consist (basal bone) located #Apically.
🔴Alveolar process consists ➡️Cancellous bone +Compact bone.
🔴Most of facial and lingual sockets are formed by (((compact bone))).
🔴cancellous bone surrounds the lamina dura in apical, apicolingual and interradicular area.
✅Alveolar process consists:

❇️outer cortical bone formed (haversian bone +compact bone lamellae).
❇️inner socket wall thin compact bone (((Alveolar bone proper)))
يتغير اسمه 👇
✅ in radiograph ((lamina dura))
✅in histologically (((cribri form plate))).

🔴Cancellous trabeculae b/w two compact layer act supporting Alveolar bone.

🔴Osteoblast ➡️cells produce the organic matrix of bone.
🔴Alveolar bone formed during fetal growth by ➡️intramembranous ossification... Mcq✔️

🔴haversian system:internal mechanisms that bring vascular supply to bone.... supplied only by surface vessels.
Found primarily in outer cortical plates and alveolar bone proper.
🔴inorganic matter is composed :Calcium, phosphate form of ((hydroxyapatite crystals)).
🔴organic matter :mainly#collagen type <<<I>>> non collagenous protein ((osteocalcin, osteonectin,bone macrophogenetic protein, phosphoprotein, protoglycans.

🔴Bone deposition by➡️Osteoblasts is balanced by resorption by ➡️Osteoclasts during tissue remodeling and renewal.
🔴Alveolar bone is the least stable of periodontal tissues.. Mcq✔️
🔴amount of internal remodeling by means of resorption and formation are regulated by local and systemic influences.
Local influence ____functional requirements on the tooth and age changes.
Systemic influence_____parathyroid hormoneوهو اهم واحد، calcitonin or v.D.
🔺The remodeling of A.b affect it's
height, contour,and density.

🔵Remodeling...
Major pathway of bony change in shape, resistance to force, repair of wounds and calcium and phosphate homeostasis in the body.
Has to phases :deposition and resorption.

🔷Reversal line :separateing line b/w old bone and new bone.

🔴deposition ----bone contains 99%of Ca ions monitored by the parathyroid gland.
🔺PTH stimulates osteoblast release ((IL 1,6)) stimulates monocytes to migrate into the bone area.

🔴Resorption ---by multinucleated cells((osteoclast))
🔺activity of osteoclast modified and regulated by___parathyroid hormone, calcitonin.

🔵This interdependency of osteoblast and osteoclast in remodeling is called ➡️Coupling.

🔴Socket Wall consists of dense, lamellated bone, arranged in haversian systems and bundle bone.

🔵some sharpeys fibers are completely calcified but most contain an uncalcified central core within a calcified outer layer.

🔴The cancellous bone consists of trabeculae ___irregularly shaped bone marrow spaces lined with layer of thin endosteal cells.
🔴 cancellous bone found in interradicular and interdental spaces and in limited amount facially or lingually #except in the palate.
⚫️more cancellous bone exists in the maxilla than in the mandible.

🔴periosteum consist of an inner layer of osteoblasts surrounded by osteoprogenitor cells And outer layer rich blood vessels, nerve, collagen fibers and fibroblasts.
🔴The endosteum ----single layer of osteoblasts and small amount C.T .

♣️Inner layer ➡️ osteogenic layer.
♠️outer layer ➡️ fibrous layer.

⛔️interdental septum-----cancellous bone bordered by socket wall.

⛔️The distance b/w Crest A.b and CEJ in young adults (0.75 and 1.49mm)(average 1.08mm)
Distance Increase with age to average of 2.81...Mcq

⭕️the height and thickness of the facial and lingual bony plates are affected by the alignment of the teeth, angulation of the root to bone, occlusion force.

🛑the bone margin is thinned to knife edge and accentuated arc in the direction of the Apex.

⛔️Fenestrations ------isolated areas in root is denuded of bone and root surface is covered #Only by ((periosteum)).

🛑Dehiscence -----denuded area extend through the marginal bone..
مهمات S.N
✅They occur on facial bone than lingual.
✅more common on anterior teeth than on posterior.
✅ both of them are complicate the outcome of periodontal surgery.

🔵The mesenchymal cells of the dental follicle to contact the dentin ➡️start forming layer of cementoblasts.

🔴cementum deposition of meshwork of irregularly arranged collagen fibrils in ground substance or matrix called((((precementum or cementoid)).

⚫️The hydroxyapatite are aligned with their long axes #parallel to the collagen fibers.

🔴Alveolar bone undergoes constant physiologic remodeling in response to external forces particularly occlusal forces.

🔶Osteoblasts and newly formed osteoid line the socket in areas of ➡️tension.

🔶Osteoclasts and bone resorption occur in areas of ➡️
pressure.

🔴forces exerted on the tooth influence the :number, density, alignment of cancellous trabeculea. #S.N

⚫️Forces that exceed the adaptive capacity of the periodontium produce injury➡️-(((Trauma from occlusion))). #S.N
♠️⬆️External forces ➡️TFO.

♣️⬇️External forces ➡️
Atrophy in cementum, bone,Pdl.

✅The blood supply of supporting structures of tooth is derived from (((Inferior and superior Alveolar arteries to the mandible and maxilla.
❇️Reached the Pdl from 3 sources :apical vessels, vessels from Alveolar bone, vessels from gingiva.

✅The blood supply ⬆️from incisors to the molars,is greatest in the gingival third of ➡️single tooth,less in apical, least in the middle.
🔺in mutirooted teeth (apical third =middle third.
🔺greater mesial & distal surface than facial &lingual.
🔺greater mesial surface than distal in ((mandibular molars)).
🔴venous drainage accompanies the arterial supply.
⛔️lymphatic supplement through H&N are submental &sub mandibular reaching the cervical region.

هذين ملخص ال cementum and bone 👆
اللي ملحقش يقراهن يشوفهن من هنا

ĔŃÁŚ MĤMĔĎ 5152.:
1.Classification of gingval enlargement مهمات بكل
2. Main cause of inflammatory enlargement is retentive plaque.
3.mcq drug indue gingival enlargement 1anticonvulsant
Immunosuppressant 3calcium channel blocker مهمات
3. Anticonvulsant ( phenytoin.dilantin) not related to dosa.
4.immunosuppression drug ( cyclosporin) related to dosa يعني مع زيادة جرعه ايزيد تضخم فى الثه بس عند بديل ودكتورة ركزت عليهاTacrolimus.
5.nonspecific conditioned صفحه27مهم بكل
6.false enlargement ركزت عليااا واجد

المهم في أغلب الشيتات
Periodontal treatment of hypertensive patients

البيشنت اللي يكون عنده heart disease مانحطش في supaine position

Patient with early onset periodontitis
أكثر بكتيريا نلقوها عندهم A.A
ولازم نعالجه ب tetracycline

البيشنت اللي يقعد عنده renal faliur
وقاعد تحت الغسيل أفضل وقت انعالجه فيه هوا اليوم اللي بعد الغسيل

ف DM أنواع التحاليل مهمات
هذا شيت medical compromised

شيت أل calculus
أكثر مكان نلقى فيه calculus
Buccal surface of upper molars
Lingual surface of lower anterior

Calculus dose not reached junctional epithelium


Calculus formation steps
هذي جتنا شورت نوت

The calcium concentration in the plaque is 2-20 times than that found in saliva

أنواع ال principal fiber مهمات