Periodontitis as a manifestation of systemic disease
Systemic disorders with major impact on loss of periodontal tissues by influencing periodontal inflammation: • Genetic disorders - - Diseases associated with immunological disorders (e.g. Papillon-Lefèvre syndrome) - - Diseases affecting the oral mucosa and gingival tissue (e.g. epidermolysis bullosa) - - Diseases affecting connective tissues (e.g. Ehlers-Danlos syndromes) - - Metabolic and endocrine disorders (e.g. hypophosphatasia) • Acquired immunodeficiency diseases (e.g. HIV infection) • Inflammatory diseases (e.g. inflammatory bowel disease) Other systemic disorders that influence the pathogenesis of periodontal diseases: • Diabetes mellitus • Obesity • Smoking (nicotine dependence)
Systemic diseases or conditions that affect the periodontal supporting tissues
Systemic disorders that can result in loss of periodontal tissues independently of periodontitis: • Neoplasms (e.g. oral squamous-cell carcinoma) • Other disorders that may affect periodontal tissues (e.g. Langerhans cell histiocytosis)
Mucogingival conditions The importance of the gingival phenotype – including gingival thickness and width – is now recognised and a new classification for gingival recessions has been introduced. This combines clinical parameters such as the gingival phenotype, the interproximal attachment loss, and the characteristics of the exposed root surface.
Classification of mucogingival conditions (gingival phenotype) and gingival recessions
Gingival site
Tooth site
Recession depth
Gingiva thickness
Width of keratinised gingiva
CEJ (A/B)
Step (+/-)
RT = recession type ( Cairo et al. 2011 )
CEJ = cemento-enamel junction (Class A = detectable CEJ, Class B = undetectable CEJ) Step = root-surface concavity (Class + = presence of a cervical step > 0.5mm. Class – = absence of a cervical step > 0.5mm) ( Pini Prato et al. 2010 )
No recession
RT1
RT2
RT3
Systemic and other periodontal conditions
3
Guidance for clinicians
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