Periodontal attachment
Definitions & Key takeaways
Periodontal attachment refers to the structures that surround the tooth and support it in its position. It consists of the cementum, which covers the root of the tooth, and the periodontal fibers, which connect the cementum to the alveolar bone. The assessment of periodontal attachment can help to understand tooth prognosis and periodontal disease progression.
I'll be talking about periodontal attachment. In this video.
Understanding, periodontal attachment is very important since this is the basis for assessing tooth prognosis, periodontal disease progression and also establishing the correct periodontal diagnosis.
Peritoneal attachment are structure and tissue that surround the tooth and support in its position. It is composed of cementum which is a specialized calcified substance covering the root of a tooth and it anchors the peridontal ligament, alveolar bone, which is a bone that contains a socket or dental alveoli impaired on a ligament, commonly abbreviated as the PDL.
It's a group of specialized connective tissue fibers that essentially anchors the tooth to the alveolus and gingiva or soft tissue attachment to the tooth.
Part of the soft tissue will first to detach from the tooth or the root or cementum first and then apically down off from the alveolar bone and all these four structures, cementum alveolar bone PDL and gingiva also collectively called perdon.
There are two ways to assess paradontal attachment level around the tooth. One is radiographic examination and second is a clinical examination.
Radiograph will show you the tooth alveolar bone and the pedia or pedial space but not the soft tissue attachment. Therefore, you cannot make a definitive periodonal diagnosis by means of a radiograph alone.
Clinical exam gives you the additional and very critical data to give a clinical assessment by determining the proving depth, which is a distance from the gingival margin to the bottom of the pocket and the clinical attachment loss even on the same radiograph.
Clinical presentation may vary. Probing depth can be shallow or deep and attachment loss can be mild or severe based on the soft tissue attachment.
So the all these clinical parameters will give you a different prognosis and diagnosis and then likely lead to different treatment.
However, radiographs are absolutely necessary in the diagnosis and treatment of periodontal disease. By radiograph will give you the best picture of the relationship between CJ and the alveolar bone since it will project the image of both maxillar and mandibular teeth in the most parallel orientation.
So where is this healthy alveolar bone supposed to be on a binding radiograph? It is not located at the C EJ level but at a distance about 12 millimeters away from C EJ.
Apically, this distance can vary from 1 to 3 millimeters in healthy individuals. Remember biting radiograph is two dimensional view of what's actually three dimensional structure.
So the bone level has to be clearly more than two millimeter away from C EJ. For you to say there is bone loss and what you cannot visualize with radiograph.
You can detect it clinically. You use periodontal probe with marking to not only measure the proving depth but also to locate the bottom of the pocket, which is the most coronal part of this whole periodontal attachment.
And it starts from there and then down apically, the distance between the bottom of the pro to the alveolar crest is called supra Crestal attached tissue or previously called biologic width.
The average distance of supra Crestal attached tissue, although it depends on the location of the tooth in the ovular and it varies from tooth to tooth is about two millimeter about a millimeter of a junction epithelium and a millimeter of connective tissue attachment.
And this distance is what you don't see on the radiograph. And then why healthy attachment including soft tissue is at CJ coronal to C EJ versus the bone level is expected 1 to 2 millimeter away from C EJ if there's parotitis at work.
So there's continuous persistent inflammation, there's a host response and eventual attachment loss, all these interactions and so on.
The most coronal aspect of attachment, which is equivalent to the bottom of the pocket depth will move from C EJ apically down along the route.
And so you measure this distance of how much attachment you lost from C EJ to the bottom of the pocket. And this will give you the clinical attachment loss.
Probing can be uncomfortable for some patient because maybe probing is done too forcefully, um probe force to be about 20 to 25 g.
And this number can be slightly intractable or hard to grasp, right? So imagine you want to measure your how long your nail is since you grew last all the way to the plate, right?
So then you take your probe and you put that in the space right in between your skin and your nail. And then you use, use too much force and it will go into the nail bed and the attachment and it will not be accurate, it will hurt and it will might bleed.
So it's the same idea with the probing, you want to probe in between the space between your tooth and the circular epithelium to the bottom of the pocket without pushing too hard, pushing too deep or separating the soft tissue attachment.
Because otherwise that will give you inaccurate assessment. It will give you deeper probing depth, it will be painful and then it will get you bleeding on probing.
So I hope this helps you better understand the concept of peritoneal attachment. Mm Thank you.
No notes for this video yet
Try adding a note below