28 - Principles of Surgery II Mike Flashcards

1
Q

Systematic review for root surface modifiers

A

Mariotti 2003

BL: Citric acid, tetracycline, and EDTA provide no clinically significant benefit in terms of regeneration

Citric acid: 4/8 histology studies showed regeneration
Tetracycline: 1 histology study w/ 3/7 showing regeneration
EDTA: No histologic studies

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2
Q

Histologic animal study for attachment to roots with citric acid

A

Polson 1983

BL: With application of citric acid, fibrin linked to exposed root collagen fibrils to allow new CT attachment rather than apical migration of epithelium

  • Squirrel monkeys
  • Teeth extracted and rinsed with citric acid or saline and re-implanted. Teeth examined at 1/3/7/21 days
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3
Q

Histologic human study for attachment to roots with citric acid

A

Cole 1980

BL: Citric acid on root planed periodontally involved roots induced formation of CT attachment to dentin

  • Notch at apical extent of calculus
  • OFD + citric acid, extraction at 4 months for evaluation
  • JE 1.2-2.6mm above notch. Bone level increase 0.8mm
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4
Q

Effect of etching agents on periodontal tissues

A

Blomlof 1995

BL: Citric acid and orthophosphoric acid (low pH) have necrotizing effect on periodontal tissue at 20 seconds and 3 minutes. EDTA no necrosis

  • Monkey study
  • Measured with lactate dehydrogenase, a marker for cellular activity
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5
Q

Effect of EDTA on smear layer

A

Blomlof 1997

BL: EDTA sufficiently removes HA smear layer and preserves collagen fibers

  • Smear layer 2-10um w/ no difference using ultrasonic/curette/bur
  • EDTA removed smear layer the same for the 3 treatment modalities
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6
Q

Systematic review for efficacy of diode laser in conjunction w/ SRP

A

Slot 2014

BL: No significant difference in periodontal parameters with SRP/diode compared to SRP alone
-Some studies showed BOP were improved w/ diode, but effect was small and not clinically relevant

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7
Q

Histologic response to LANAP

A

Yukna 2007

BL: 6 single rooted periodontally involved teeth had a positive histologic response to LANAP, PD reduction, and CAL gain
-Tx then EXT at 3 months
-PD reduction 4.7mm vs 3.7mm
CAL gain 4.2mm vs 2.4mm
-New cementum and CT attachment
***Funded by Millennium Dental Technology

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8
Q

What is the LANAP protocol and what laser is used?

A

Nd:YAG laser (Periolase)

  • Occlusal adjustment + splint mobile teeth
  • Laser to remove pocket lining
  • SRP/ultrasonic for root debridement
  • Laser to seal pocket and form clot
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9
Q

What does LANAP stand for?

A

Laser Assisted New Attachment Procedure

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10
Q

Second histologic study for LANAP

A

Nevins 2012

BL: LANAP can result in periodontal regeneration and improve periodontal parameters

  • TX, monthly maintenance, EXT at 9 months
  • 12 defects in healthy, non-smokers
  • CAL gain 3.8mm, PD reduction 5.4mm, recession 2.7mm
  • Regeneration 5/10
  • Long JE 4/10
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11
Q

Who is the man or woman behind LANAP who is probably a millionaire because of it?

A

Yukna

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12
Q

Critical probing depth for CAL gain in LANAP is _____ according to ______

A

4.88mm

Nevins

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13
Q

Should Er:YAG laser be used as a monotherapy or adjunct to SRP

A

Zhao 2014

Systematic review

Answer = NO

BL: No SS difference in clinical outcomes when using Er:YAG as a monotherapy or adjunct compared to SRP alone.

-Had results up to a 12 month follow-up

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14
Q

Should lasers be used as an adjunct to surgical therapy?

A

Behdin 2015

Systematic review + meta-analysis

Answer: NO

BL: No SS difference in PD/CAL gain/recession for OFD and GTR w/ or w/o a laser. When considering OFD/Emdogain, there was a significant difference for PD reduction and CAL gain

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15
Q

Should lasers be used for implant surface decontamination?

A

Mailoa 2014

Systematic review and meta-analysis

BL: Similar results for PD reduction, CAL gain, and X-ray bone fill for CO2 and Er:YAG lasers

  • 4 human surgery studies, 3 human non-surgery studies. NO difference for laser vs control
  • Animal studies showed greater CAL gain and higher bone-to-implant contact in rough surface implants vs smooth surface
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16
Q

Perio 2000 article on periodontal and peri-implant wound healing following laser therapy

A

Aoki 2015

-This is a long article, review the abstract for more in depth information

17
Q

What determines the degree of absorption of a laser?

What lasers are deeply penetrating?

What lasers are superficially penetrating?

A

The wavelength (lower absorption into water, deeper penetration into tissue)

Deep: Nd:YAG, diode

Superficial: CO2, Er:YAG (less heating of tissue, implant)

18
Q

What effect does epinephrine in anesthetics have on catecholamine levels?

A

Davenport 1990

BL: Significant elevations in venous epinephrine and norepinephrine 2 and 8 minutes after administration of 2% lidocaine w/ 1:100K epi. No change in heart rate or mean arterial pressure

  • Levels returned to baseline by 16 minutes
  • Reported that Lidocaine alone was unacceptable for hemostasis and anesthesia
19
Q

What is the effect of IV sedation on patient stress during surgery?

What drugs were used?

A

Shepherd 1988

Pentobarbital, Meperidine, Diazepam

BL: Cortisol SS increased in the surgery group with only local anesthetic

  • Took venous blood samples
  • 10 males w/ surgery 3 weeks apart during the same time of day due to diurnal nature of cortisol
20
Q

Where did the evidence for 2 carpules of anesthetic for cardiovascular disease patients come from?

A

A textbook, according to Mealey

21
Q

Comparison of IV Midazolam and Diazepam

Indications for each?

What test did they use?

A

Staretz 2004

Midazolam: Short procedures for fast onset of action, rapid recovery, and predictable amnesia

Diazepam for procedures 45+ minutes, wider margin of safety during titration, consistent amnesia, and gradual recovery

Perceptual speed test

22
Q

JADA article on oral sedation

What is the problem with sedating children?

A

Dionne 2006

Kids: Unpredictable rate of absorption, delayed onset, and prolonged recovery. Hard to titrate orally. Pulse ox cannot reduce death/injury in office

Skill of monitoring/resuscitation more important

23
Q

Benzodiazepine

  • MOA
  • Therapeutic effects
  • Adverse effects
A

Agonist of y-aminobutyric acid receptor

Therapeutic: Anticonvulsant, anxiolytic, muscle relaxant, amnesia, sedation

Adverse: Memory/psychomotor impairment, drowsiness, altered EEG, and cortisol/growth hormone influence

24
Q

Triazolam

  • Characteristics
  • Dose
  • Peak effect
  • Metabolism
  • Bioavailability
A

Short half-life, minimal respiratory/CV effects

  1. 25-0.5mg = 10-20mg diazepam IV
    - Peak effect may take over 1 hour
    - CYP3A metabolism in intestine/liver
    - 45% bioavailability
25
Q

Is continuous or interrupted suture better for apically positioned flaps?

A

Nelson

BL: No difference at 6 months for PD, loss of attachment, recession, and bone loss

Clinical impression: Interrupted produced better flap adaptation

26
Q

What is the tissue response to silk vs e-PTFE sutures?

A

Leknes 2005

BL: Silk demonstrates a greater inflammatory reaction, conduction of bacterial migration, and risk of slack of the suture loop than ePTFE

27
Q

Two studies discussing infection rates with periodontal surgery?

A

Pack 1983 - 1% infection rate

Powell, Mealey, Deas 2005 - 2.09% infection rate

Prophylactic or post-surgical ABC did not demonstrate a lower infection rate

28
Q

Background knowledge question - lasers and their wavelength

A
diode laser (most common) = 809-980 nm
NdYAG = 1064 nm
CO2 laser = 10600 nm
29
Q

What would you use a diode laser for?

A

soft-tissue applications (incision, hemostasis, coagulation, removal of pocket epithelium)

soft tissue penetration from 0.5-3 mm (Aoki) with poor energy absorption on mineralized tissues (thus it is not good for calculus removal)