Periodontal Considerations

Question 1

How long after periodontal treatment should we monitor the gingiva before placing definitive restorations and why?

Answer 1

monitor for 3-6months

gingival tissues recede after treatment so we need to achieve stability before they are placed.

Question 2

how can poorly fitted crowns and bridges cause periodontal problems? (3)

Answer 2

Cause plaque retention if the fit/contours or pontics are incorrect

Create unfavourable transmission of occlusal forces

Cause pulp damage

Question 3

how can poorly made RPD’s cause periodontal problems? (3)

Answer 3

Cause plaque retention if the gingival margin is covered

Cause direct trauma

Create unfavourable transmission of occlusal forces

Question 4

why are fixed prosthesis preferred in terms of maintaining periodontal health? (3)

Answer 4

The provide effective tooth support

They allow clearance of gingival margins

They have rigid connectors

Question 5

what does the biological width measure mm?

Answer 5

2mm (variable)

Question 6

what are the supracrestal tissues composed of? (2)

Answer 6

junctional epithelium

supracrestal connective tissue

Question 7

where should we place restoration margins in mm?

Answer 7

ideally the margin should be 3mm away from bone however If the margin is placed 0.5mm into the sulcus = still acceptable

however 80% of people have recession over 5 years later

Question 8

what occurs if restoration margins encroach supracrestal attachment? (2)

Answer 8

There is persistent inflammation

There is loss of attachment i.e. pocketing and recession

Question 9

describe Ante’s law. (1)

Answer 9

The combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth/teeth to be replaced.

Question 10

what periodontal procedures can aid restorative dentistry? (3)

Answer 10

Gingivectomy

surgical crown lengthening = Removing gingival tissue and alveolar bone

Camouflage of gingival recession ‘to remove the black triangle’

Question 11

What patients require surgery to increase crown height? (1)

Answer 11

Patients with wear

Question 12

what are gingivectomies used to correct? (2)

Answer 12

Gummy smiles

Gingival overgrowth

Question 13

describe the gingival margin heights in healthy tissues. (2)

Answer 13

The gingival margin of the lateral incisor should be 1mm below the gingival margin zenith.
This is the highest point – which is the margin of the canine

The gingival margin line across the incisors from the right canine to the left canine should run parallel to the interpapillary line.

Question 14

Describe the force that causes periodontal problems? - name examples

Answer 14

Intermittent non orthodontic Horizontal loading i.e. jiggling from Parafunction, abnormal tooth loading and Clasps from dentures

Question 15

define excessive occlusal forces.

Answer 15

When more force than the body can handle is applied and exceeds the reparative capacity of the periodontal attachment apparatus.

Question 16

what are excessive occlusal forces caused by? (2)

Answer 16

trauma

parafunction

Question 17

what are the outcomes of excessive occlusal forces? (2)

Answer 17

• Occlusal trauma
• Excessive tooth wear

Occlusal trauma = injury from occlusal forces that results in changes to the tooth attachment apparatus i.e. PDL, supporting bone and cementum.

Question 18

what factors impact how mobile a tooth will be (4)

Answer 18

Increased width of PDL

Low height of PDL

Inflammation – in health there is a tight collar of fibrous tissue and collagen = restricted movement, swollen gingiva filled with inflammatory fluid = increased movement.

Morphology of roots: Number, shape and length = small, short root makes teeth more mobile

Question 19

is tooth mobility always pathological? (2)

Answer 19

No

• it can indicate successful adaptation to functional demands
• physiologic adaption to allow the tooth to bounce and to spread the load.

Question 20

when should tooth mobility be addressed/when should we intervene? (3)

Answer 20

• Progressively increasing
• Symptoms are present
• Creates difficulty with restorative treatment

Question 21

how can we treat occlusal trauma and reduce mobility from the widened PDL? (3)

Answer 21

1. Control plaque induced inflammation
2. Correct abnormal occlusal relations
3. Splinting healthy teeth to spread the load and allow the healthy teeth to support

Question 22

define primary occlusal trauma.

Answer 22

Tissue changes from excessive occlusal forces on a dentition with normal periodontal support (no perio disease)

Question 23

what are the outcomes of excessive occlusal forces on a healthy periodontium (primary OT) ? (2)

Answer 23

• creates a wider PDL space without the present of periodontal disease

1. PDL width increases until forces are dissipated
   - Width then stops increasing and stabilises when the force is adequately dealt with
   - This is a successful adaptation
   - Once the force is removed, the width should go back to normal = reversible
2. If excessive loading is more than the adaptive capacity
   - Width increases until it becomes a functional problem = pathological problem

Question 24

is inflammation associated with primary and secondary occlusal trauma?

Answer 24

NO - there is no loss/further loss of attachment

Question 25

define secondary occlusal trauma.

Answer 25

Tissue changes from normal/excessive occlusal forces on a dentition with a reduced but healthy periodontium has less PDL and bone support.

• There is no plaque induced inflammation
• The trauma will not lead to further loss of attachment, just increased mobility

Question 26

what is fremitus?

Answer 26

• Palpable or visible movement of a tooth when subjected to occlusal forces

Question 27

How do we assess fremitus?

Answer 27

Put finger on the tooth and ask the patient to close = can feel the movement on the finger

Question 28

what causes tooth migration/splaying teeth? (3)

Answer 28

• Loss of perio attachment
• unfavourable soft tissue profile
• Unfavourable occlusal forces

Question 29

what occurs in plaque induced periodontal disease and excessive occlusal force and why? (4)

Answer 29

More bone and attachment loss than in a healthy periodontium.

Why is there more bone loss?
There are Zones of co-destruction;
- Bone resorbed from plaque induced inflammation
- Bone resorbed from excessive occlusal loading

When these happen at the same time = more attachment loss.

Question 30

what causes horizontal bone loss?

Answer 30

(not related to the occlusal trauma)

When thin bone between two teeth resorbs in inflammation = horizontal bone loss

Question 31

what causes vertical bone loss?

Answer 31

not related to the occlusal trauma.

When there is resorption caused by inflammation in thick bone with teeth further apart (from increased bone between) = vertical bone loss

Question 32

does excessive occlusal forces cause gingival recession?

Answer 32

no

Question 33

when is splinting used to reduce mobility? (3)

Answer 33

(last resort)
When there is mobility due to advanced loss of attachment

When mobility is causing discomfort/difficulty in chewing

If the teeth have to be stabilised before HPT