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Flashcards in 3rd Section Deck (68):
1

T/F patient’s old radiographs and perio charts are important

True

2

Fremitus:

Movement in occlusion

3

Diagnosis is affected by what 9 things

Probing depth
Gingival recession
CAL
Keratinized gingiva
BOP
Furcation involvement
Mobility
Fremitus
Bone defects

Casey
Kariya
Gets
More
For
Five
Bucks
By
Playing

4

CPITN probe increments

0.5 (Ball)
3.5
5.5
8.5
11.5

5

Williams probe increments

1.2
3
5
7
8
9
10

6

Mucogingival defect

When probe is at or past MGJ

7

Furcation involvement I-III

I - indent into furcation
II- most of the way through furcation
III - through and through

8

Furcation involvement is measured using

Nabers probe

9

Classic two walled defect

Crater

10

3 clinical signs that indicate health

Probing depth 1 to 3 mm
No history of attachment loss
No clinical signs of inflammation

11

Dental plaque induced gingivitis requirements (4)

≤3 mm probing depth
BoP
No gingival recession
Red/edematous soft tissue

12

3 things to have periodontitis

≥ 4 mm probing depth
Attachment loss
Clinical signs of inflammation

13

What determines if perio is slight, moderate or severe

How much CAL

14

Incidental attachment loss is also called

Gingival recession

15

Order of general perio treatment

Exam
Diagnosis
Risk factors for future
Prognosis
Treatment alternatives
Informed consent
Therapy (non-surgical)
Re-evaluation
Maintenance

16

Osseointegration:

How is rigid fixation different:

Direct attachment of bone to implant

It is just the clinical term to define osseointegration

17

T/F 100% bone to implant connection exists

FALSE - more like 60%

18

Important factors for osseointegration

Biocomp. Of implant
Design of implant
Surface of implant
Status of host bed
Surgical technique at insertion
Loading conditions

19

4 steps of implant insertion procedure

Incision
Mucoperiosteal flap elevation
Preparation of a bed in bone
Insertion of titanium device

20

3 ways to surgically manipulate alveolar bone for implants

Anatomical location
Augmentation techniques
Condensation

21

Bone healing at 24 hrs vs 1 week

24 - resorption at cortical bone, woven bone formation, blood clot, proliferation of vasculature into newly forming granulation tissue

1 week - reparative macrophage and undifferentiated mesenchymal cells. Modeling at the apical trabecular region and at the Furcation sites of a screw shaped implant

22

When can new bone first be detected at furcation sites of implant surface

2 weeks

23

Plateau effect of bone stability happens after when

6 weeks

24

What is jumping distance, what is the ideal range

Distance b/t implant and bone that can be filled with new bone

20-40 um

25

Healing period for max and mand. For osseointegration

Max - 6 months
Mand - 3 months

26

4 types of implant surfaces

Titanium plasma sprayed
Sand blasted acid etched
hydroxyapatite
Tricalcium phosphate

27

Implant needs how much thickness around it

1mm minimum

28

Minimum bone thickness b/t two implants

3mm

29

Minimum bone thickness b/t implant and adjacent tooth

4 mm

30

Coronal part of an implant should be placed _ apical to the adjacent CEJ

~5mm

31

Implant can be placed with max of _˚ angle

20˚

32

On an implant, what is the thickness of barrier epithelium?

Zone of connective tissue?

Barrier - 2 mm

ZoCT - 1-1.5 mm

33

Collagen fiber bundle run _ to implant surface

Parallel

34

Zone adjacent to implant surface is high in _

Zone lateral to that one _

Fibroblasts

Collagen fibers and blood vessels

35

Blood supply to bone around implants comes from _

Supraperiosteal blood vessels

36

Submerged vs. non-submerged tech

Sub - two stage implant placement

Non-submerged - one stage

37

Micro gap b/t implant and abutment is usually located at _

Alveolar crest

38

Biologic width exists around what type of implants?

How thick?

Around unloaded and loaded NON-SUBMERGED one-part titanium implants

3 mm

39

Clinical parameters to evaluate peri-implant health

1. No mobility
2. Radiograph
3. Absence of bone loss (≥0.2 mm/yr) after first year
4. Absence of pain, complain, infection
5. Functional and esthetic acceptance by pt and dr.
6. Success rate of 94-98% (5 yr), 90-94% (10 yr)

40

3 techniques to evaluate dental implants

Peri-implant probing
Mobility
Radiographs

41

Conditions associated with
Ailing implant:

Failing implant:

Failed implant

A: peri-implant mucositis
Peri-implantitis

Fing: peri-implantitis

Fed: peri-implantitis w/ mobility and complete loss of osseointegration

42

Peri-implant mucositis vs. peri-implantitis

Mucositis: reversible inflammation of the mucosa around the implant

implantitis: inflamm. Associated w/ loss of supporting bone around an implant IN FUNCTION

43

Peri-implantitis vs. periodontitis

PI - neutrophils surrounding implant, direct contact b/t plaque on implant and inflamed connective tissue

Both not seen in periodontitis

44

Bacterial plaque is a _ in PI and mucositis

Primary etiologic factor

45

Main type of bacteria that cause PI and mucositis

Gram - anaerobic

46

T/F implants and teeth can have a different microbiota

TRUE

47

Occlusal trauma is a _ etiological factor for periodontal disease, and can be a _ etiological factor for peri-implant disease

2˚ for perio

1˚ for peri-implant

48

What does bruxism do to implants

Complicates implant healing

49

Class 1-4 peri-implantitis

1. Slight horizontal bone loss, minimal peri-implant defects
2. Moderate horizontal bone loss, isolated vertical defects
3. Moderate to advanced horizontal bone loss, broad circular bony defects
4. Advanced horizontal bone loss, broad, circumferential vertical defects, loss of oral and/or vestibular bony wall

50

Treatment for class 1-4 peri-implantitis

1. Surgical reduction of pocket depth, cleaning
2. Repositioning more apically, implantoplasty, bone defects restored by GTR if necessary
3. GTR

51

T/F BOP shows risk for future disease

FALSE, indicates inflammation now

52

Goal after scaling/root planing

No Probe depths >5 mm

53

Treatment goal for Furcation involvement is _

≤3mm

54

4 phases of therapy (what they contain too)

Systemic
-eliminate/decrease influence of systemic conditions
-protection from infectious hazards
Initial hygiene phase
-removal or retentive factors
-removal of deposits
-patient motivation
Corrective phase
-perio/implant surgery
-endo, restorative, prosthetic therapy
Maintenance phase
-supportive periodontal therapy
-prevention/caries control

55

How long to wait to re-evaluate after scaling/root planing

4-6 weeks, takes around 6 weeks to regenerate collagen

56

When is prognosis established

After diagnosis is made, before treatment plan is established

57

Prognosis determinants are divided into 4 categories:

Overall clinical factors (age, compliance)

Systemic/environmental factors (smoking, systemic disease)

Local Factors (plaque, anatomic factors)

Prosthetic/Restorative Factors (abutment, caries, root resorption)

58

Overall vs. individual tooth prognosis

O: age, severity of disease, systemic factors, smoking, compliance

I: mobility, probe depth, bone loss, Furcation inv., local factors

59

BBB vs McGuire and Nunn classification

BBB: good, questionable, hopeless

MN: Very good, good, fair, poor, hopeless

60

Criteria of the McGuire and Nunn classification for:

Good
Fair
Poor
Hopeless

(Including: Aloss, Furcation, mobility, maintenance/pt cooperation, systemic factors)

Good:
-25% Aloss and/or Class I Furcation
-adequate remaining bone support
-can control etiologic factors
-patient cooperation
-no systemic environmental factors OR well controlled systemic factors

Fair:
-25-50% Aloss
-grade I or easily accessible grade II Furcation
-adequate maintenance possible
-few systemic complications

Poor
->50% Aloss
- Bad II or III Furcation
-Class 2 mobility
-difficult to maintain areas/ low pt compliance
-systemic/environmental factors

Hopeless
->75% Aloss
-Tooth mobility 2+
- II and III Furcation
-difficult maintenance/ doubtful pt compliance
-root proximity

61

Disease severity is classified according to what 2 parameters

Level of clinical attachment

Radiographic examination

62

Which is more important: pocket depth or attachment level, why?

Attachment level, pocket depth isn’t necessarily related to bone loss, but attachment loss is

63

_ is the primary etiologic factor associated with perio

Bacterial plaque

64

Which tooth anatomy usually causes a poor prognosis

Short, tapered roots and large crowns

65

3 main causes of tooth mobility

Loss of alv. bone

Inflammation in PDL

Trauma from occlusion

66

If inflammation can be controlled, slight to moderate perio prognosis is:

Good

67

Hypophosphatasia:

Decreased levels of alkaline phosphatase, severe alveolar bone loss, premature loss of teeth and connective tissue disorder

68

NUG:
Reversible?
Prognosis?

Difference in NUP
Who gets NUP

Tissue destruction is not reversible
Good except in repeated episodes which is fair

NUP extends to periodontal ligament and alveolar bone
Immunocompromised get NUP, have to treat systemic conditions too