Drug – Induced Enlargement

• Phenytoin: Fibrotic nature
• Cyclosporine: Vascular nature

Pregnancy Gingivitis

• Angiogranuloma: Appears after 3rd month
• Raspberry appearance: Characteristic finding
• Peak severity: 8th month, decreases in 9th month
• Cause: Increased progesterone levels

Children vs Adults

• Children: T – lymphocyte dominated response

Desquamative Gingivitis

• 75% have dermatological origin
• 50% localized to gingiva only

• GTR Membrane Placement:
  • Apical border: 3 – 4 mm below defect margin.
  • Lateral extension: 2 – 3 mm beyond defect.
• Root Surface Biomodification: Citric acid (pH 1.0) for 2 – 5 min.
• Enamel Matrix Derivative: Emdogain (from porcine teeth).
• Cervical Enamel Projections: Seen in 8.6 – 28.6% of molars.
• Smoking: Preventable risk factor; damages cilia via hydrogen cyanide.

Periodontal Fibers

Periodontal fibers play a crucial role in maintaining the integrity of the periodontal ligament and supporting the teeth within the alveolar bone. Understanding the different groups of periodontal fibers is essential for comprehending their functions in periodontal health and disease.

1. Gingivodental Group

• Location:
  • Present on the facial, lingual, and interproximal surfaces of the teeth.
• Attachment:
  • These fibers are embedded in the cementum just beneath the epithelium at the base of the gingival sulcus.
• Function:
  • They help support the gingiva and maintain the position of the gingival margin.

2. Circular Group

• Location:
  • These fibers course through the connective tissue of the marginal and interdental gingiva.
• Attachment:
  • They encircle the tooth in a ring-like fashion.
• Function:
  • The circular fibers help maintain the contour of the gingiva and provide support to the marginal gingiva.

3. Transseptal Group

• Location:
  • Located interproximally, these fibers extend between the cementum of adjacent teeth.
• Attachment:
  • They lie in the area between the epithelium at the base of the gingival sulcus and the crest of the interdental bone.
• Function:
  • The transseptal fibers are primarily responsible for the post-retention relapse of orthodontically positioned teeth.
  • They are sometimes classified as principal fibers of the periodontal ligament.
  • Collectively, they form the interdental ligament of the arch, providing stability to the interproximal areas.

4. Semicircular Fibers

• Location:
  • These fibers attach to the proximal surface of a tooth immediately below the cementoenamel junction (CEJ).
• Attachment:
  • They go around the facial or lingual marginal gingiva of the tooth and attach to the other proximal surface of the same tooth.
• Function:
  • Semicircular fibers help maintain the position of the tooth and support the gingival tissue around it.

5. Transgingival Fibers

• Location:
  • These fibers attach to the proximal surface of one tooth and traverse the interdental space diagonally to attach to the proximal surface of the adjacent tooth.
• Function:
  • Transgingival fibers provide support across the interdental space, helping to maintain the position of adjacent teeth and the integrity of the gingival tissue.

🧬 Blood Disorders

• Polycythemia vera: Common cause of Budd – Chiari
• PNH: Rare cause of Budd – Chiari
• Thalassemia & Hemolytic anemia: Lead to unconjugated hyperbilirubinemia
• Anemia: Can cause high-output heart failure
• Hemophilia A: Deficiency of Factor VIII
• ITP vs TTP: ITP = isolated thrombocytopenia; TTP = microangiopathy

Periodontal Medicaments

Periodontal diseases often require adjunctive therapies to traditional mechanical treatments such as scaling and root planing. Various medicaments have been developed to enhance the healing process and control infection in periodontal tissues.

1. Elyzol

• Composition:
  • Elyzol is an oil-based gel containing 25% metronidazole. It is formulated with glyceryl mono-oleate and sesame oil.
• Clinical Use:
  • Elyzol has been found to be equivalent to scaling and root planing in terms of effectiveness for treating periodontal disease.
  • However, no adjunctive effects beyond those achieved with mechanical debridement have been demonstrated.

2. Actisite

• Composition:

  • Actisite consists of tetracycline-containing fibers.
  • Each fiber has a diameter of 0.5 mm and contains 12.7 mg of tetracycline per 9 inches of fiber.

• Clinical Use:

  • The fibers are placed directly into periodontal pockets, where they release tetracycline over time, helping to reduce bacterial load and promote healing.

3. Arestin

• Composition:

  • Arestin contains minocycline, which is delivered as a biodegradable powder in a syringe.

• Clinical Use:

  • Arestin is indicated for the treatment of periodontal disease and is applied directly into periodontal pockets, where it provides localized antibiotic therapy.

4. Atridox

• Composition:

  • Atridox contains 10% doxycycline in a syringeable gel system that is biodegradable.

• Clinical Use:

  • The gel is injected into periodontal pockets, where it solidifies and releases doxycycline over time, aiding in the management of periodontal disease.

5. Dentamycin and Periocline

• Composition:

  • Both Dentamycin and Periocline contain 2% minocycline hydrochloride.

• Clinical Use:

  • These products are used similarly to other local delivery systems, providing localized antibiotic therapy to reduce bacterial infection in periodontal pockets.

6. Periochip

• Composition:

  • Periochip is a biodegradable chip that contains chlorhexidine.

• Clinical Use:

  • The chip is placed in the gingival crevice, where it releases chlorhexidine over time, providing antimicrobial action and helping to control periodontal disease.