SCENARIO 2

BLOK 9
“PERIODONTITIS”
By:
Group 3
 The Members of the group:
• Leader : Annisa Nabilah Dira
• Secretary : Melani Wulandhari
• Other Members:
 Edo Prasetiawan
 Nurmayunika
 Dita Anugerah Ilahi
 Shifa Khumaira Safitri
 Wahyu Wulandari
 Sisri Oktaviani Agja
 Mitha Ari Cahaya
 Sari Puspita Wati
 Bima Prabu Sanjaya
 Dea Marta Agrippina
 SCENARIO 2
An 56-year-old man, came into dentist practice with complaints of his upper jaw
teeth rocking and feels forward. Its been felt since 1 year ago, that causes the patient
difficult to bite the food. Patients also feel the front teeth grew longer and aching when
it exposed to air. As a result of these conditions, patient are rarely laughed because he
was embrassed his friends saw his teeth . The patient asks the dentist what the
treatments can be performed and about how the results will be treated later. Patients
admitted that he is rare to check the condition of the oral cavity to the dentist, and
there is no systemic history and allergies.
Extra oral examination : There is no abnormality
Intra oral examination : Gingival erythema, pathologic migration of 12&11 cross bite
teeth, 21&42 extrusion gear accompanied by mobility grade 2. Visible trauma of
anterior occlusion. Recession of gingiva regio 33-43. The presence of periodontal
pocket (true pocket) in the anterior region with 3-4 mm average, attachment value of
2 mm level and gingival recession as high as 2 mm.
OHI-S score is bad and Index Plaque 84%.
Radiographic examination seen bone damage reached 1/3 cervical with a horizontal
pattern.
 Clarify Unfamiliar Terms
1. Gingival Recession
2. Periodontal Pocket
3. Cross Bite
4. Extrusion
5. Pathological Migration
6. Mobility
7. Level Attachment
8. Plaque Index
9. Allergi
10.Trauma Occlusion
 Learning Objective
1. Students are able to know and explain about the
classification of periodontitis
2. Students are able to know and explain about the diagnosis
of the scenario case
3. Students are able to know and explain about the etiology
and pathophysiology of periodontitis
4. Students are able to know and explain about the
prevention of periodontitis
5. Students are able to know and explain about the
severity/prognosis of periodontitis
6. Students are able to know and explain about the stages of
treatments of periodontitis
 1. Classification of Periodontitis
According to the American Association of b.Associated with genetic disorders
Periodontology (AAP) classification in 1999, i.Familial and cyclic neutropenia
periodontitis is divided into: ii.Down syndrome
1.Cronic Periodontitis iii.Leukocyte adhesion deficiency syndromes
a.Localized iv.Papillon-Lefevre syndrome
b.Generalized v.Chediak-Higashi syndrome
2.Aggressive Periodontitis vi.Histocytosis syndrome
a.Localized vii.Glycogen storage disease
b.Generalized viii.Infantile genetic agranulocytosis
3.Periodontitis as a Manifestation of Systemic ix.Cohen syndrome
Disease
x.Ehlers-Danlos syndrome (Type IV and VIII)
a.Associated with hematological disorders
xi.Hypophosphatasia
i.Acquired neutropenia
xii.Other
ii.Leukemias
Not otherwise specified (NOS)
iii.Other
 2. Diagnosis of the Scenario Case
Based on the above classification it is known that the diagnosis of the
scenario is chronic periodontitis with sub localization because the
characteristics of the scenario show that the presence of pathological
migration with the teeth showing mobility, extrusion, gingival recession,
and attachment loss in the gingiva is a symptom of periodontitis. This has
happened for 1 year, so it shows chronic symptoms. Then the
occurrence only on the front of the maxillary front teeth which means
only on certain parts only that included in sub localized.
 3. Etiology and Pathophysiology of
Periodontitis
• Etiology • Pathophysiology
Systemic The earliest bacteria colonizing the
Local Factors
Factors root particles of the root are
Streptococcus gondomi and
Actinomyces naeslundii. Bacteria
cause tissue destruction indirectly
1. Systemic by activating various components
Bacterial Plaque
States of the host defense system.
2. Systemic
Disturbances
 4. The Prevention of Periodontitis
Rasinta Tarigan (1989) said that
success in the prevention of
Periodontal disease depends not
only on the dentist who cares for it
but also depends on the patient's
dedication, if there is a good
brushing tooth plaque is the most
effective way to control plaque on
the teeth. Calculus must also be
cleaned every 6 months, as well as
healthy false patches or dentures
should be well polished to prevent
stopping the plaque inside the
mouth.
 5. The Severity&Prognosis of Periodontitis
• Based on the severity of periodontitis is divided into three namely:
1. Mild periodontitis: attach loss 1-2 mm
2. Moderate periodontitis: attach loss 3-4 mm
3. Severe periodontitis: attach loss> 5 mm

• For prognosis based on the classification of prognosis McGuire and Nunn, 1996 in the
case of periodontitis, there are four classifications are as follows:
1. Good
2. Fair
3. Poor
4. Questionable
5. Hopeless
 6. The Stages of Periodontitis Treatments
1. First Phase
Initial therapy phase, is a phase by eliminating some etiological factors
that may occur without performing periodontal surgery or perform
restorative and prosthetic treatments.
2. Second Phase
Corrective therapeutic phase, including correction of anatomical
deformities such as periodontal pockets, tooth loss and occlusive
disharmony that develop as a result of previous illness and to be a
predisposing or recurrent factor of periodontal disease.
3. Third Phase
Phase of maintenance therapy, performed to prevent recurrence of
periodontal disease.