#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

💡 سؤال قالت ممكن انجيبه د.لجين

what are the two bony defect around buccal plate ?
1.Dehiscence
2.Fenestration

#Pdl::
⭕️the connective tissue that surrounds the root and connect it to the bone.

🛑Radiographically::Pdl as space b/w the lamina dura and root of the tooth((Radiolucent)).

⛔️Average width of Pdl ~ 0.20mm(range 0.2_0.4mm)___Mcq.

🛑component of Pdl::
🔺periodontal fibers.
🔺cellular elements.
🔺Ground substance.

🔴the most important elements of Pdl➡️principal fibers.(((Sharpeyś fibers))).

🔵the principlal fiber are composed mainly #Collagen-type(l).
🔷collagen is synthesized by <<<Fibroblast>>>.
⚫️Fibres of peridontum ::
1_principal fibers collagen type I
2_Reticular fibers collagen type III
3_Basal fibers**collagen type IV

♥️principal fibers ((S.N))
1_Transseptal group::
Extend over alveolar bone Crest & embedded in the cementum of adjacent teeth.
NOT bone attachment.
Reconstructed immediately after destruction.

2_Alveolar Crest group ::extend obliquely from cementum just beneath the JE of the alveolar bone.
🚫Prevent the extrusion of the tooth and resist lateral tooth movement.

3_Horizontal group ::extend at right angles to long axis of the tooth from the cementum to the alveolar bone.

4_Oblique group:: largest group ((Mcq)).
Extend from the cementum in coronal direction obliquely to bone.

5_Apical group ::radiate in irregular fashion ((Mcq))
From the cementum to bone at apical region of socket.
Eruption tooth ((Open Apex))➡️No Apical fibers.[Mcq]

6_Interradicular fibers::fan out from cementum to the tooth in formation ((multirooted teeth))Mcq.

✴️Secondary group ::
1_indifferent fiber plexus
arranged in all directions.

2_Oxytalan fibers ::pre _elastic
Provide elasticity of Pdl.
Regulate vascular flow.
Parallel to the root surface in vertical direction &attach cementum.

3_Reticular fibers.

✳️general function of Pdl fibres?
Attachment protection.

✳️function of principles fibres?
Mainly attachment.

♣️ 4types of cell in Pdl::
1_C.T cells((fibroblast, cementoblast, osteoblast))
2_epithelial rest cells.
3_immune system cells.
4_cells associated with neurovascular elements.

🔴the most common cell in Pdl ➡️fibroblast.
Elongated cells with psedopodia processes.
They synthesize and degrade,regulate collagen.

🔴Epithelial rest of malassez ::form a latticework in Pdl.
⛔️proliferation when stimulated and participate in formation of peri-apical & lateral root cysts.

🔴ground substance :Glycosaminoglycans, proteoglycana,Glycoproteins.

✅High water content ((70%))Mcq

✳️function of Pdl? #S.N
1.physical.
2.formative and remodelling.
3.nutritional,and sensory.


💎physical functions ::
1_protect the vessels and nerves from injury by mechanical force.
2_transmission of occlusal forces.
3_attachment tooth to bone.
4_maintenance of the gingival tissue in proper relationship to teeth.
5_resistance to the impact of occlusal forces(shock absorption).

⛔️resistance to impact of occlusal forces ~~~~~ two theories relative to the of tooth support:
1_The tensional theory.
2_The viscoelastic systems theory.

💟In single rooted teeth,axial of rotation in ((area b/w apical third & middle third of the root)).
💟in multirooted teeth, axis rotation in the bone b/w the roots.
⛔️with the physiologic mesial migration of the teeth, Pdl thinner on mesial root surface than distal.
⛔️cells of Pdl participate formation and resorption of cementum, bone occur during :
*Repair of injuries.
*physiologic tooth movement.
*Accommodation of the periodontium to occlusal forces the repair of injuries.

💟Pdl supplies nutrients to the cementum, bone, and gingiva.
💟Pdl is supplied with sensory nerve fibers capable of transmitting tactile, pressure,and pain sensations by the trigeminal pathway.

بالتوفيق 👍👍

💡 which of the following drugs cause gingival enlargement and consider to be does related

a- nifedipine
b-asprin
c- cyclosporine ✔️
d- phenytoin

💡 Assessment short note
1.ethiological factors of gingival recession

2. Dehiscence and fenestration

3.role of saliva in gingiva defense

🔴 MCQS
مش متذكرين صيغة السؤال بضبط
❓❓1.about Cyclosporine, the gingival enlargement is characterized by

a.dose related
b.tacrolimus result in less gingiva growth
C.non inflammatory gingival enlargement
D.inflammatory gingival enlargement

عموما الدكتوره في المحاضره قايله انه حتجيبه وتبي dose related بس في الامتحان قالت مش انا اللي حطيت السؤال
والثلاث اجوبه صح شن يبو ماقالوش

❓❓2.not true about tooth associated plaque
a.minimal tissue destruction
b.gram positive bacteria and actinomyces
C.apical third adjacent to gingival margin separated from JE by leukocytes layer! تقريبا هكي الجمله
D.marginal plaque

❓❓3.most important iatrogenic factors
a.roughness and poorly contoured
b.overhang restoration
C.open margin located subgingival
D.all of the above

4.root planing
A.Remove etiologic factors from root surface✔

5.cannot distinguish betwee normal and initial state of gingivitis
A- inflammatory neutrophills migrate from oral cavity to the gingiva
B.predominantly of T-CELL ✔ تبي هذا الدكتوره قالت 😔

6.not considered as a stage of gingivitis
A.advanced ✔

7.Scaling strokes
A.short powerful ✔️

8.Working Angulation at
A.45-90 degrees✔️

9.gingival fibers
A.gingivodental, circular and transseptal ✔️

10.alveolar bone consist of the following except
A.external plate
B.inner socket
C.cancellous bone
D.basal bone ✔️

11.bundle bone contains a great number of
A.sherpeys fiber ✔️

12.valley like depression connects the facial to the lingual papilla
A. COL ✔️


❓❓13.Different between mateia alba and dental plaque
A.duration of Adherence
B-Lack internal structure

14.all are function of pdl except
A.defense ✔

15.13- Pyogenic granuloma
A- neoplasm
B- non specifc conditioned ✔
C- drug induced

16.drugs can cross gigniva بلمعنى هذا
A- metronidazole ✔
B- amoxillin

17.Which cause pegmintaion of gingiva
A- heavy metal ingestion
B- abnormal melanin
C - addison disease
D- all of te above✔

❓❓18.Calculus : all true except
A- aggrivate periodontal disease
B- Does reach the base of the pocket
C- premeable and absord toxins
D- facilaite plaque retention

19.Chronic inflammation all true except ;
A. sudden onset short duration✔

20.process by which Residual calculus removed from root to produce smooth,hard and clean surface
A.root planing ✔