Done by: Donya Ganboa (4521), Waad Bajaber (5377) Dhay Al Tawi (5594), Neama Al Sehli (5633) Mernan Mufti (5431),Nedaa Banamah (5068)

Clinical attachment loss :

Generalized sever Chronic periodontitis with modified Endocrinal disease.

Chronic periodontitis is a site-specific disease. Localized: 30% or less of sites demonstrate attachment loss and bone loss. Generalized: more than 30% of sites demonstr ateattachment loss and bone loss.

- We reach the diagnosis by measuring the ( CAL) clinical attachment level. - The last classification in 1999 American Academy of Periodontology: - 1. Plaque induced gingivitis. 2. Chronic periodontitis.

Based on : 1- Age: 36 years old. 2-Bleeding. 3- Plaque 4- Gingival condiation. 5- Gingival recession  17, 12, 11, 21, 22, 26, 27, 35, 31, 41, 45, bone loss.

Bleeding index O'leary Plaque index Ainamo & Bay 1975 O ’ leary 1972

Diabetes and Periodontal Disease: Diabetes is often associated with increased gingival inflammation in response to bacterial plaque. While some diabetic people develop periodontitis, especially those with poor metabolic control. Poorly controlled diabetics had greater attachment loss and bone loss than patients with well controlled diabetes.

Local Factors : 1)Primary etiologic factor ( Plaque ) : -Plaque is the primary etiologic factor associated with periodontal disease -Calculus ( supra gingival, sub gingival ) -Overhang restoration on Tooth # 27 with old amalgam, which increase plaque accumulation, increase inflammation and increase bone loss. -Untreated Caries on teeth : # 35 class v # 45 class II -Teeth mobility.

Systemic Factors: Diabetes mellitus: diabetes is a major systemic risk factor for periodontitis; Diabetic patients have higher prevalence of periodontal disease and greater attachment and bone loss. Periodontal changes have been described in Diabetes mellitus such as: 1)Sever gingival inflammation 2) Deep periodontal pocket and chronic periodontitis 3) Periodontal abscess 4) Increase bone loss and tooth mobility 5) Increase bleeding tendency 6) Increase incidence of infection 7) Xerostomia and increase caries due it 8) Fungal infection due to defect in immunity history of rheumatic fever

1- Gingival recession 2- deep pocket 3-less attachment level 4- high frenum

Upper Right Less keratinized gingiva

Upper anterior

Upper Left Less keratinized gingiva # 28

Lower Left Less keratinized gingiva #35

Lower anterior Less keratinized gingiva

Lower Right Less keratinized gingiva

Thank You