Local risk factors for Perio

Local risk factors for Perio

1. Definition of 'local risk factors'

   • Factors associated with the teeth and supporting tissues that may initiate or predispose to periodontal disease

2. Anatomical risk factors

   • Trauma from occlusion
     • Traumatic incisor relationships
       • Overbite
         • Akerly classification for overbite
           • I = The lower incisors occlude with the palatal mucosa causing mucosal trauma away from the patatal gingival margin
           • II = Lower incisors are traumatising the palatal gingiva of the upper incisor
           • III = Trauma to the upper palatal gingiva & trauma to lower labial gingiva
             • AKA attrition
             • Also known as complete overbite
             • Class II DIv 2
     • Traumatic occlusal interferences and contacts
       • Primary occlusal trauma
         • Pt who are periodontally healthy
       • Secondary Occlusal trauma
         • Pt's who are already periodontally involved
       • Premature contacts
         • Anatomical
   • Furcations
     • Treatment
       • Surgical options
         • Furcationplasty
           • Not really done now
         • RSI with flap surgery for access
         • Tunnel preparation
           • Not really done now
           • Mandibular molars
         • Guided tissue regeneration (GTR)
           • Best in Class II Furcations
           • Allows new bone, new periodontal ligament and new cementum to colonise.
           • Excludes the undesirable cells from the would so that desirable tissue can repopulate the wound space.
           • Make flap, RSD, place a membrane in the pocket made up of collagen which will enable a blood clot to form which causes healing
         • root resection/hemisection
       • Non-surgical options
         • Plaque control & Calculus removal
         • RSD
   • Enamel pearls
     • Localised deep pocket
     • PDL cant attach to cementum
   • Gingival recession
   • Tooth-arch relationships
   • Root morphology

3. Iotrogenic risk factors

   • Trauma from occlusion
     • Traumatic occlusal interferences and contacts
       • Premature contacts
         • Poor restorations
         • After orthodontist
   • Overhanging restorations
   • Crown margins
     • Poor margins can be plaque retentive
   • Orthodontist appliances