1. Anatomical and histological structure and function of periodontal mortise ages of children. Etiology and pathogenesis periodontits. Classification. Symptoms, diagnosis and diferentdiagnosis of periodontitis in children. Lecturer: Dr. Katrin Duda

2. Periodontium is disposed in space, limited from one side the cortical plate of small hole, and from other — by cement of root. Child's dentistry must know the features of periodontium of the unformed tooth, in what periodontium stretches from the neck of tooth to part of root of, which was formed, where meets with the area of growth and is in touch with mash of root channel.

3. Periodontium  As the tooth develops and the root is formed, 3 main avenues for communication are created: 1. Apical Foramen 2. Lateral and Accessory Canals 3. Dentinal Tubules

5. Apical Foramen  It is the principal and the most direct route of communication between the pulp and periodontium  Bacterial and inflammatory byproducts may exit readily through the apical foramen to cause periapical pathosis  The apex may also serve as a portal of entry of inflammatory byproducts from deep periodontal pockets to the pulp

6. Apical Foramen

7. Lateral and Accessory Canals  These may be present anywhere along the root  Patent accessory and lateral canals may serve as a potential pathway for the spread of bacterial byproducts  30-40% of all teeth have lateral or accessory canals and the majority of them are found in the apical third of the root

8. Lateral Canals

9. Dentinal Tubules  Scanning electron micrograph of open dentinal tubules

10. Dentin Tubules  The tubules may be denuded of their cementum coverage as a result of perio disease, surgical procedures or developmentally when the cementum and enamel do not meet at the CEJ thus leaving areas of exposed dentin. Patients experiencing cervical dentin hypersensitivity are examples of such a phenomenon

11. Endodontic Disease and the Periodontium  When the pulp becomes inflamed or necrotic, inflammatory byproducts may leach out through the apex, lateral and accessory canals as well as the dentinal tubules to trigger an inflammatory vascular response in the periodontium

12. Periodontal Disease and the Pulp  The effect of periodontal inflammation on the pulp is controversial and conflicting studies exist:  It has been suggested that periodontal disease has no effect on the pulp, at least until it involves the apex  On the other hand, some studies suggest that the effect of perio disease on the pulp is degenerative in nature including an increase in calcifications, fibrosis and collagen resorption in the pulp. It has been reported that pulpal changes resulting from periodontal disease are more likely to occur when the apical foramen is involved

13. Differential Diagnosis of Endo/Perio Lesions

14. Primary Endodontic Disease  For diagnostic purposes, it is imperative to trace the sinus tract by inserting a gutta-percha cone and exposing one or more radiographs to determine the origin of the lesion  The sinus tract of endodontic origin is readily probed down to the tooth apex, where no increased probing depth would otherwise exist around the tooth

15. Primary Endodontic Disease  Typically, endodontic lesions resorb bone apically and laterally and destroy the attachment apparatus adjacent to a nonvital tooth  It is possible for an acute exacerbation of a chronic periapical lesion on a tooth with a necrotic pulp to drain through the PDL into the gingival sulcus. This clinical presentation mimics the presence of a periodontal abscess, or a deep periodontal pocket

16. Primary Endodontic Disease Pre-op #16 Post-op 2 yr follow-up

17. Primary Endodontic Disease Pre-op #17: periapical and furcal RL + a deep narrow perio defect

18. Classification of periodontitis on etiology : - infectious, - traumatic, - medical; for localizations: - apical, - marginal;

19. Classification of periodontitis on clinical motion: -sharp, -chronic -in the stage of sharpening; On pathomorphological changes in fabrics: - serenity - festering, - fibrosis, - granulematous, - granulating.

20. Primary Periodontal Disease  Pre-op: alveolar bone loss + a periapical lesion, a deep narrow pocket was traced on the mesial aspect of the root, the tooth tested vital

21. Primary Periodontal Disease The tooth was extracted. Note the deep mesial radicular developmental groove

22. The features of periodontitis of baby teeth. Frequent all meet chronic forms of periodontitu in the stage of sharpening in temporal teeth, however much it eliminates development of sharp forms of disease. General symptomatic of sharp apical periodontitis for children characterized active motion of inflammatory process in periodontium, rapid passing of the limited process to diffuse. The stage of inflammation usually did not last and passes to festering.

23. A prognosis at diagnostics of periodontitu of temporal teeth depends and from as rezorbtion of root: even, uneven, mainly in the area of bifurcation of root. Yes, if at even rezorbtion of root the border of conservative treatment is rarefaction of 2/3 lengths, at bifurcation - extraction of tooth are shown regardless of the state of root.

24. Periodontitis

25. Clinic of periodontitis of temporal teeth Clinic of periodontitis of temporal teeth Сhronic motion of periodontitis or his sharpening is most widespread In temporal teeth. Chronic periodontitis of infectious origin in temporal teeth can develop as a chronic process without the previous stage of sharp inflammation. It relates with the аanatomic-morphological features of temporal teeth, in particular with absence for the children of stability of structure of periodontitu, and also with the features of functioning of the immune system for the children of junior age. Chronic granulating periodontitis appeared in temporal teeth far more frequent comparatively with other forms of chronic inflammation.

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33. Thank you for attention