Aggressive Periodontitis (formerly Juvenile Periodontitis)

• Historical Names: Previously referred to as periodontosis, deep cementopathia, diseases of eruption, Gottleib’s diseases, and periodontitis marginalis progressive.
• Risk Factors:
  • High frequency of Actinobacillus actinomycetemcomitans.
  • Immune defects (functional defects of PMNs and monocytes).
  • Autoimmunity and genetic factors.
  • Environmental factors, including smoking.
• Clinical Features:
  • Vertical loss of alveolar bone around the first molars and incisors, typically beginning around puberty.
  • Bone loss patterns often described as "target" or "bull" shaped lesions.

Electrosurgery

• Frequency: 1.5 – 7.5 million cycles/sec

Flap Incisions & Blades

• Internal bevel: #15 blade
• Crevicular: #12 blade
• Interdental: Orban's knife

Suturing Techniques

• Horizontal mattress: For diastema/wide spaces
• Anchor suture: For flap closure mesial/distal to tooth

Specific Procedures

• Modified Widman flap: Does not reduce pocket depth
• Apically displaced flap: Increases attached gingiva width

Osseous Surgery Sequence

1. Osteoplasty: Vertical grooving, radicular blending
2. Ostectomy: Flattening interproximal bone, gradualizing marginal bone

Bone Grafts

• FDBA: Osteoconductive
• DFDBA: Osteoinductive
• Hydroxyapatite: Ca:P ratio 1.67
• Beta – TCP: Ca:P ratio 1.5

Furcation Treatment

• Grade 2: "Cul – de – sac" defect
• Most common hemisection: Distobuccal root of maxillary 1st molar

Root Coverage Procedures

• Laterally displaced pedicle: Grupe & Warren technique
• Subepithelial connective tissue graft: Langer & Langer technique
• Papilla preservation flap: First choice for maxillary anterior (esthetics)

Healing Timeline

Scaling & Curettage

• Epithelialization: 2 – 7 days
• Immature collagen: 21 days

Gingivectomy

• Surface epithelialization: 5 – 14 days
• Complete repair: 1 month

Flap Surgery

• Epithelial attachment: 1 week

Finger Rests in Dental Instrumentation

Use of finger rests is essential for providing stability and control during procedures. A proper finger rest allows for more precise movements and reduces the risk of hand fatigue.

Importance of Finger Rests

• Stabilization: Finger rests serve to stabilize the hand and the instrument, providing a firm fulcrum that enhances control during procedures.
• Precision: A stable finger rest allows for more accurate instrumentation, which is crucial for effective treatment and patient safety.
• Reduced Fatigue: By providing support, finger rests help reduce hand and wrist fatigue, allowing the clinician to work more comfortably for extended periods.

Types of Finger Rests

1. Conventional Finger Rest:

   • Description: The finger rest is established on the tooth surfaces immediately adjacent to the working area.
   • Application: This is the most common type of finger rest, providing direct support for the hand while working on a specific tooth. It allows for precise movements and control during instrumentation.

2. Cross Arch Finger Rest:

   • Description: The finger rest is established on the tooth surfaces on the other side of the same arch.
   • Application: This technique is useful when working on teeth that are not directly adjacent to the finger rest. It provides stability while allowing access to the working area from a different angle.

3. Opposite Arch Finger Rest:

   • Description: The finger rest is established on the tooth surfaces of the opposite arch (e.g., using a mandibular arch finger rest for instrumentation on the maxillary arch).
   • Application: This type of finger rest is particularly beneficial when accessing the maxillary teeth from the mandibular arch, providing a stable fulcrum while maintaining visibility and access.

4. Finger on Finger Rest:

   • Description: The finger rest is established on the index finger or thumb of the non-operating hand.
   • Application: This technique is often used in areas where traditional finger rests are difficult to establish, such as in the posterior regions of the mouth. It allows for flexibility and adaptability in positioning.

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