ABGD - Oral Board Review Flashcards
(359 cards)
1
Q
What is an example of a gingival disease modified by malnutrition?
A
Ascorbic acid deficiency (Vitamin C)
2
Q
What drugs can cause drug induced gingival enlargement?
A
- Phenytoin (Dilantin)
- Cyclosporin
- Tacrolimus (Immunosuppresive Drug)
- Caclcium Channel Blockers
3
Q
What is the percentage of Gingival Enlargement for non-institutionalized patients taking Phenytoin?
A
50%
4
Q
What is the percentage of patients taking Cyclosporin that get Gingival Enlargment?
A
Adults: 25-30%
Children: >70%
5
Q
What percentage of people taking Tacrolimus experience Gingival Enlargement?
A
15%
6
Q
What percentage of people taking Calcium Channel Blockers experience Gingival Enlargment?
A
6-25%
Nifedipine = 6%
Other Calcium Channel Blockers have lower prevalence: Verapamil, Diltazem, Felodipine, Amlodipine
7
Q
What 4 categores can we have for Non Plaque-Induced Gingival Lesions?
A
- Bacterial
- Viral
- Fungal
- Genetic
8
Q
What are some Mucocutaneous Disorders that can manifest in the Gingiva?
A
- Lichen Planus
- Pemphigoid
- Pemphigus Vulgaris
- Erythema Multiforme
- Lupus Erythematosis
9
Q
Can allergic reactions create symptoms contributing to Gingival Manifestations of Systemic Conditions?
A
Yes!
10
Q
What is the Etiology of Necrotizing Ulcerative Gingivitis?
A
◆ Interaction between host and bacteria, most probably fusospirochetes
◆ Stress
◆ Smoking 98% (Pindborg)
◆ Immunosuppression
✦ HIV, cancer, mononucleosis
◆ Malnutrition
◆ Poor OH (87%)
◆ Not contagious
11
Q
What is the treatment protocol for Necrotizing Ulcerative Gingivitis?
A
◆ Local debridement
◆ Sc/RP
◆ In-office irrigation with CHX or Betadine (povidone-iodine)
◆ Establishment of meticulous OH
12
Q
In a severe patient experiencing Necrotizing Ulcerative Gingivitis, what would you consider?
A
In severe patient-Metronidazole 250mg take 2 tabs immediately then 2 tabs QID for 5-7 days (caution in HIV infected patients to avoid opportunistic candidiasis)
13
Q
What at home treatment would you recommend for someone with Necrotizing Ulcerative Gingivitis?
A
◆ At home, rinse with H2O2 and/or CHX
◆ Pain medication
14
Q
What would you do during the 2nd visit when treating someone with Necrotizing Ulcerative Gingivitis?
A
◆ 2nd visit, 48 hrs later
✦ Check for improvement
✦ Scale again
✦ Counseling on tobacco,
OH
15
Q
What would you do during the 3rd visit when treating someone with Necrotizing Ulcerative Gingivitis?
A
◆ 3rd visit, 48-72 hrs after 2nd visit
✦ Should be symptom-free
✦ Sc/RP and OHI
◆ Follow-up
16
Q
Define Periodontal Abscess…
A
Localized purulent inflammation in ther periodontal tissues
17
Q
How do you treat a Periodontal Abscess?
A
◆ Health hx (DM, Abx, Immune)
◆ Anesthesia
◆ Establish drainage
- Via sulcus in the preferred method
- Surgical access for debridement
- Incision and drainage
- Extraction
18
Q
When would you prescribe antibiotics for a Periodontal Abscess?
A
- If indicated due to fever, malaise, lymphadenopathy, or inability to obtain drainage
19
Q
What is the sig for treating someone with an Acute Periodontal Absccess?
A
Amoxicillin: Loading dose of 1.0 g followed by a maintenance dose of 500 mg/tid for 3 days, followd by a patient evaluation to determine whether further antibiotic therapy or dosage adjustment is required
20
Q
If one has an allergy to B-lactam drugs, what 2 drugs would you consider when treating an Acute Periodontal Abscess?
A
Azithromycin: loading dose of 1.0 g on day 1, followed by 500 mg/q.d. for days 2 and 3
Clindamycin: loading dose of 600 mg on day 1, followed by 300 mg/q.i.d. for 3 days.
21
Q
What is the prognosis of teeth with a Periodontal Abscess?
A
55%
22
Q
When discussing Refractor Periodontitis, why is it no longer a classification?
A
- Heterogeneous Group
- NOT A SINGLE DISEASE ENTITY
- Some cases in all forms of periodontitis may be “refractory”
- Thus, the term “refractory” may be applied to all forms of periodontitis
23
Q
Define Etiology…
A
Cause of the disease
24
Q
What is the primary etiologic agents for periodontal disease?
A
Bacterial Plaque/Host
25
Describe the Pathogenesis of Periodontitis...
1. Bacterial Challenge leads to...
2. LPS and Antigens...
3. Host Inflammatory Reponse
4. Cytokinds/Porstaglandins/MMPs...
5. Connective Tissue & Bone Metabolism
6. Clinical Signs of Periodontal Disease
\*Environmental Risk Factors and Genetic Risk Factors can effect Host Immuno Inflammatory Reponse and Connective Tissue & Bone Metabolism
26
What is the Composition of Plaque?
80% Water
20% Solid
27
What is the break down of the 20% poriton of Plaque?
* 35% cellular (bacteria)
* 65% extracellular (polysaccharides, dextrans, levans)
28
What are some colors of Putative (commonly accepted) Periodontal Pathogens?
* Blue
* Purple
* Green
* Yellow
* Orange
* Red
29
What are the 3 microbes in the Red Complex?
1. Tannerella Forsythia
2. Treponema Denticola
3. Porphyromonas Gingivalis
30
What kind of bacteria is Tannerella Forsythia?
Baccilus, gram neg, non-motile, anerobe
31
What kind of bacteria is Treponema Denticola?
Spirochete, gram neg, motile, aneaerobic
32
What type of bacteria is Porphyromonas Gingivalis?
Bacillus, gram neg, non-motile, anaerobic
33
What kind of bacteria is Aggregatibacter Actinomycetemcomitans?
Cocco-bacillus, gram neg, non-motile, capnophilic (thrive on concentrations of CO2)
34
What are 3 contriubting factors to Periodontal Disease?
1. Calculus
2. Smoking
3. DM
35
Where does Calculus like to hang out?
CEJs, root flutes, line angles
36
How far down the pocket does Calculus hang out?
1/2 depth of pocket
37
What determines the removal of calculus?
Based on Location and Probing Depth
38
How effective are we at removing calculus probing depths of 1-3, 3-5, and \>5?
* 1-3 mm = 83%
* 3-5 mm = 39%
* \> 5 mm = 11%
39
What are 4 things that smoking causes in regards to Systemic Effects?
1. PMNs
2. Fibroblasts
3. Blood Flow
4. Wound Healing
40
What complex does smoking causes a change in its microbiology?
Red Complex Bacteria
41
How does Smoking effect non-surgical therapy?
Less PD reduction and less gain in CAL vs non-smokers
42
How does smoking effect surgical therapy?
Less PD reduction and \> attachment loss
43
What happens with PD in people who smoke \> 20 cigarettes/day?
Less PD reduction in initial therapy
44
How does smoking effect Implants?
GREATER failure rate in smokers than non-smokers, it doubles from 95% success to 90%
45
How does smoking effect Mucogingival root coverage therapy?
Less root coverage of Miller Class I or II defects
25% Smokers - 80% non-smokers...
46
How does smoking effect GTR/Bone grafts?
Greater risk of graft failure
47
How does smoking effect intrabony defects treated with DFDBA?
Less Improvement
48
In regards to smoking and periodontal disease...it can depend on what?
Dose and duration of smoking habit...
49
Overall, smoking causes what to the periodontium?
* \> Bone loss
* \> Attachment loss
* \> PD
50
What 2 things does Smokeless Tobacco cause?
1. Increase gingival recession and attachment loss
2. Decreased gingival blood flow
51
Describe the Pathology of Diabetes Mellitus...
1. Vascular Changes
2. Collagen Breakdown
3. Altered Flora
4. Altered GCF
5. Altered Defense Mechanisms
6. AGE (Advanced Glycation End-products) and RAGE interactions (receptor of advanced glycation end-products...
52
What body parts does Diabetes have influence on?
* Periodontium
* Nerves
* Central Blood Vessels
* Kidney
* Eye
* Peripheral Blood Vessels
53
How does Diabetes affect the Periodontium?
1. Altered Microbial Composition
2. Increased GCF Glucose Concentration
3. Vascular Changes
4. Impaired Host Defenses (AGE Formation)
5. Impaired Collagen Metabolism (AGE Foramtion, Collagenase)
54
What is the mechanism of Diabetic Influence on Disease Progression?
1. Diabetes induced production of reactive oxygen species, TNF and AGEs (advanced glycation end-products) which increased Osteoclasts formation/resorption and inhibit Osteoblast collagen production
2. Also, enhance apoptosis of Osteoblasts
3. AGEs lead to enhanced resorption and impaired coupling leading to diminished bone formation that occurs after resorption
55
How does poorly controlled diabetes effect attachment and alveolar bone?
Increase loss of attachment and alveolar bone
56
If you have DM longer than 10 years, what do studies suggest?
Increased attachment loss
57
What effects can Peridontal therapy have on level of glycemic control?
1. Decrease need for insulin
2. Reduction of HBA1c
3. Redcution in HbA1c with addition of doxycycline to Sc/RP
58
Has research shown that periodontal treatment can influence metabolic control?
Yes!
59
Can periodontal treatment influence glycemic control?
Yes!
60
What have studies shown about HbA1c levels in reponse to nonsurgical therapy in Type 2 Diabetics?
HbA1c levels decrease
61
Define Occlusal Trauma...
Injury resulting in tisue changes within the attachment apparatus as a result of occlusal force(s)
62
What is the definition of primary occlusal trauma?
Injury resulting in tissue changes from EXCESSIVE occlusal forces applied to a tooth or teeth with NORMAL support
63
What is the definition of Secondary occlusal trauma?
Injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with REDUCED support.
64
What is the primary etiology of periodontal disease?
Bacterial Plaque!
65
In the absence of periodontal diease, occlusal trauma is capable of producing adaptive changes in the _____ including increased \_\_\_\_\_\_and widening of the ____ - but no CAL
Periodontium, Mobility, PDL
66
In the presence of periodontal disease, occlusal trauma can increase ___ \_\_\_\_ and may enhance ___ \_\_\_\_
Bone loss, attachment loss
67
What is the % of CEPs on B surface of mandibular molars?
28.6%
68
What percent of B surfaces of maxillary molars have CEPs?
17%
69
What % of isolated mandibular furcation involvment have CEPs?
90%
70
What is the % of Enamel Pearl frquency?
2.69%
71
Which tooth has a better chance of having an enamel pearl, max 2nd molar or max third?
Max 3rd!
72
What is the % occurrence of Intermediate BIfurcation Ridges?
70-76.8%
73
What % of patients have Palato-radicular Grooves?
8.5% of patients with 4.4% on maxillary laterals
74
What percent of Palato-radicular grooves terminate on the root surface?
\>50% of the time
75
Is having a Marginal Ridge Discrepancie a big deal?
1. One study says if maintain good plaque control uneven marginal ridges DON'T correlate with increase probe depth and attachment loss
2. Another study says that there is a CORRELATION between attachment loss, probing depth and uneven marginal ridges
76
What can a Cemental Tear mimic? How do you treat it?
* Can mimic a root fracture
* Treat with removal of fragment
77
What percentage of adult patient have restoration overhangs?
32-90%
78
True or False - Bone loss was found to be greater around teeth with overhangining amalgams...
True!
79
True or False...Removal of amalgam overhangs during periodontal initial therapy reduced gingival inflammation...
True!
80
How do crowns affect gingival health?
* Increased plaque
* Increased PD
* Increased Gingival Inflammation
* Increased GCF with subgingival margins
* Increased Attachment Loss
81
Is there an association between food impaction and an increase in PD?
Some studies say yes, other say no...
82
After what age is there a greater chance for residual defects distal to 2nd molars after third molar removal?
Beyond mid 20's
Removal at an earlier age is beneficial
83
What is this an example of?
Factitial Injury
84
What are 3 ways to diagnose diabetes?
1. Symptoms of diabetes plus a casual plasma glucose concentration \> 200 mg/dl
2. Fasting plasma glucose \> 126 mg/dl (8+ hour fast)
3. 2 hour post-prandial (relating to a meal) glucose \> 200 mg/dl during Oral Glucose Tolerance Test
\* To make a firm diagnosis, test must be CONFIRMED on another day by any one of these methods
85
To what degree is periodontal disease influence CHD?
Low to Moderate
86
To what degree does periodontal diease influence stroke?
Moderate
87
There is a ___________ association between periodontitis and cardiovascular disease, especially stroke...
Moderate
88
Patients with periodontitis had a \_\_\_\_\_% increased risk of having CVD
25%
89
Can oral microorganisms play a role in development and progression of atherosclerosis?
50 human carotid endarterectomies
44% positive for at least 1 periodontal pathogen
90
Periodontal ______ are preesnt in athersclerotic plaques and may play a role in ______ and other sequelae...
Pathogens, CVD
91
What type of condition is Ahterosclerosis?
An Inflammatory Condition
92
In Atherosclerosis, there can be damage to the blood vessel lining caused by ____ - Inflmmation in wall leads to ______ formation
Bacteria, Atheroma
93
Periodontal infection can have indirect effects on what in regards to CVD?
* Elevated fibrinogen
* Elevated C-Reactive Protein in periodontal disease
94
Elevated CRP and Fibrinogen which are indirect effects from periodontal infection are risk factors for what 3 things?
1. Ischemia
2. MI
3. Stroke
95
If one has periodontal disease, one study found that there is a \_\_\_\_% increase risk of recurrent CV event in non-smokers...
43%
96
How do you define Low Birth Weight?
* Less than 2500 g
* \< 37 weeks
97
There is _____ evidence that suggests an association between periodontitis and adverse pregnancy outcomes...
Moderate
98
\_\_\_\_ ______ periodontal intervention in the second trimester might reduce adverse pregnancy outcomes
Non Surgical
99
Human studies show women with periodontitis have a ____ to ____ fold increased risk of pre-term/low birth weight delivery
4 to 8
100
Periodontal Pathogens release what?
Cytokines
Interleukins
Inflammatory Mediators
101
What type of association is there between Periodontitis and COPD?
Moderate
102
What is the mechanism of Periodontitis being associated with COPD?
* Aspiration of oral pathogens
* Modification of mucosal surfaces by periodontal pathogen enzymes allowing colonization
* Cytokines from periodontal pathogens may alter respiratory epithelium allowing infection
103
What is the best clinical indicator of inflmmation?
BOP!
104
If we have BOP, what is this indicative of?
Gingivits/Periodontitis
105
What % is BOP predictive of future attachment loss?
30%
106
In the absence of BOP, what is this an indication of?
EXCELLENT indicator of stable site
107
Is there is suppuration on probing, what cells are likely involved?
PMN's - localized infection
108
What % is suppuration on probing having on future attachment loss?
20%
109
From the Lindhe study, what are the Critical Probe Depths?
* Sc/RP - gainof attachment if PD \> 2.9
* Surgery (MWF) - gain of attachment if PD \> 4.2
110
What is the new critical probing depth to consider?
5.4 mm
111
What is a Degree I Hamp Furcation?
Horizontal loss \< 3 mm
112
What is a Hamp Degree II Furcation?
Horizontal loss \> 3 mm but not encomassing the entire width of the furcation area
113
What is a Hamp Degree III Furcation?
Horizontal "through and through" destruction
114
Regarding the Maxillary 1st pre-molar how far below is the mesial concavity from the CEJ?
2.35 mm
115
For max 1st premolars, how many mm is the furaction from the CEJ?
7.91 mm
116
What is the Furcation Entrance Diameter in 1st Molars?
* **58% of furcas \< 0.75 mm - makes it difficult to clean**
* 81% of furcas \< 1 mm
* Curette width 0.75 - 1.1 mm
117
What is the goal of nonsurgical therapy?
* **Removal of plaque, calculus, and endotoxin**
* Alteration of subgingival microbiota to reduce inflammation and pocket depth
* **Arrest disease**
118
What is the bottom line with goals of non-surgical therapy?
Alter root surface to make it compatible with health
119
What is the effect of non-surgical therapy on PD from 1-3 mm in regards to PD and AL?
0.5 mm decrease in PD, 0 mm AL
120
What is the effect of nonsurgical therapy if the PD range from 4-6 mm?
Decrease PD 1.0 mm, 0.5 mm Change in AL
121
What is the effect of non-surgical therapy if the Initial PD is \> 7 mm?
Decrease 2 mm PD, 1 mm change in attachment loss
122
What is our success % if PD range from 1-3, 3-5 and \> 5 mm?
* 1-3 mm = 83%
* 3-5 mm = 39%
* \> 5 mm = 11%
123
What are some limitations regarding nonsurgical therapy?
* Furcations
* Multi-rooted teeth
* Root-grooves/concavities
* Operator ability
124
Describe the Charters Method for teeth brushing...
* Used for areas of recession and open embrasures
* Britles angled toward occlusal surface at 45 degrees forcing bristles into spaces
125
Describe the Bass Technique for tooth brushing?
* Soft brush, 45 degree angle directed toward sulcus, vibratory movement
* Mod Bass adds rolling motion over the crown before vibratory movement
126
When using the Mod Bass Technique, how far can the toothbrush britles penetrate?
0.5 - 1.0 mm
127
How far can Proxabrush bristles penetrate subgingivally?
2.0 - 2.5 mm
128
Irrigation at the gingival margin penetrates how many mm below the gingival margin?
0.1 - 0.2 mm
129
What are 3 Rationales for prescribing antibiotics?
* Impossible to elimiante all pathogens by mechanical therapy
* Multiple bacterial reservoirs in the oral cavity (tongue, tonsils, pocket tissues, exposed roots) increase the likelihood of re-infection
* Quadrant by quadrant therapy allows re-infection of treated sites by untreated sites
130
What are some Systemic Antibiotics to consider?
* Amoxicillin
* Tetracyclines
* Metronidazole
* Periostat
131
What are 3 local delivery systems in the antibiotic realm?
1. PerioChip
2. Arestin
3. Doxycycline
132
What effects does Tetracycline HCL have?
Inhibitis Collagenase, certain other MMPs
133
What effects does Doxycycline therapy have?
* Reduce mammalian collagenolysis
* Reduced Gingival Inflammation
134
What are some reasons one would prescribe Doxycycline over Tetracycline HCL?
■ DCN used in decreased doses with increased efficacy
■ DCN is absorbed more readily than TCN
■ DCN does not interact with food, dairy products, antacids
■ DCN has less effect on GI flora, decreasing GI side effects
■ DCN has longer half life, allowing qd or bid dosing and therefore better compliance
■ DCN associated with less photophobia than TCN
■ DCN inhibits PMN superoxide production better than TCN
■ DCN excreted in bile; OK in pts w/decreased renal function
135
What is Periostat?
Doxycycline Hyclate
136
What is Periostat and how do you use it?
■ Systemically delivered collagenase inhibitor consisting of a 20 mg capsule of doxycycline hyclate
■ FDA accepted for host modulation as an adjunct to Sc/RP
■ Twice daily dose for periods up to 9 months or longer
■ Found to reduce elevated collagenase activity in gingival fluid of patients with chronic periodontitis
137
What are 4 kinds of Local Delivery Systems for antibiotics?
* Fibers
* Gels
* Microspheres
* Chips
138
What is Atridox?
◆ Biodegradable formulation of 10% doxycycline hyclate (DH), 33% poly DL-lactide and 57% NMP
◆ Delivered with a bluntended 23-gauge cannula
139
Can you lable the structures in this picture?
140
Where does the vascular supply of the periodontium originate?
* External Carotid Artery and its branches...
* Lingual, facial, maxillary arteries
* These make the vascular supply to the periodonium
* Locally the blood supply comes from supraperiosteal vessels and vessels from the PDL and bone
141
What is the main innervation for the periodontium?
Trigeminal
142
What is attached gingiva?
* The attached gingiva is the area from the base of the sulcus to the mucogingival junction.
* It prevents the free gingiva from being separated from the tooth.
* It consists of thick lamina propria and deep rete pegs
143
What is keratinized attached gingiva?
The keratinized attached gingiva is that found from the gingival margin to the mucogingival junction.
144
Define alveolar mucosa...
* Covers alveolar process
* Nonkeratized
* Unstippled
* Movable
* Extends from MCJ to the floor of the mouth and vestibular epithelium
145
What is clinical attachment loss (CAL)?
If the marginal gingiva is below the cementoenamel junction (CEJ):
CAL = pocket depth + [CEJ to marginal gingiva]
If the marginal gingiva is above the CEJ:
CAL = [marginal gingiva to CEJ] – [marginal gingiva to bottom of pocket]
146
What are the characteristics of healthy gingiva?
* Coral pink
* Firm
* Follows CEJ of teeth
* May be stippled
* In dark haired individuals, gingiva can be darker than that in blond patients
147
What are the 5 types of gingival fibers?
1. Dentogingival Group
2. Alveologingival Group
3. Dentoperiosteal Fibers
4. Circular Group
5. Transseptal Group
148
What are the 3 fibrers within the Dentogingival Group?
* Fibers extending coronally toward the gingival crest
* Fibers extending laterally to the facial gingival surface
* Fibers extending horizontally beyond the alveolar crest height and then apically along the alveolar bone cortex
149
Describe the Alveologingival Group...
Alveologingival group: Fibers in this group run coronally into the lamina propria from the periosteum at the alveolar crest
150
Describe Dentoperiosteal Fibers...
Dentoperiosteal fibers: These fibers insert into the periosteum of the alveolar crest and fan out to the adjacent cementum.
151
Describe the Circular Group...
Circular group: These are the only fibers that are confined to the gingiva and do not attach to the teeth.
152
Describe the Transseptal Group...
Transseptal group: These fibers bridge the interproximal tissue between adjacent teeth and insert into the cementum.
153
What is the composition of the oral mucosa (tissue lining the oral cavity)?
There are 3...
1. Masticatory (gingiva and hard palate)
2. Lining (Alveolar mucosa, floor of the mouth, lips)
3. Specialized (dorsum of the tongue)
154
Describe Oral (masticatory) epithlium...
* Orthokeratnized, stratified squamous
* Surface cells lose their nuclei and contain keratin
* Made of the following: free gingiva (base of the sulcus to the free gingival margin, ie. the most coronal part of the gingiva), attached gingiva, and palatal tissue.
155
Describe the composition of Junctional Epithlium...
* Attaches to the tooth via a hemidesmosomal layer and a basal lamina
* Nonkeratinized and has a fast turnover
* Permeable
* Most apical part lies at the CEJ in healthy tissue
156
What are the 4 layers of the masticatory epithlium?
1. Stratum Basale
2. Stratum Spinosum
3. Stratum Granulosum
4. Stratum Corneum
157
Describe the Stratum Basale (1/4)...
* Cuboidal cells at basement membrane
* Epithelial cell replication take place here
* Contain melanocytes and Merkel cells
158
Describe the Stratum Spinosum (2/4)...
* The "Spines" are desmosomes allows intracellular contacts
* Thickest layer and conatins Langerhans cells
* They are derived from bone marrow and take part in immune surveillance
159
Describe the Stratum Granulosum (3/4)...
* Cells in this layer appear flat
* Kertinocytes migrating from the underlying stratum spinosum become knowns as granular cells in this layer
* These cells contain keratohyalin granules, protein structures that promote hydration and cross-linking of keratin
160
Describe the Stratum Corneum (4/4)...
* Outermost layer
* Contains dead cells consisting of ortho and parakeratinization
* Composed of compactly packed tonofilaments
161
What is the composition of connective tissue?
* Type I Collagen
* Ground substances
* Mucopolysaccharides
* White Blood Cells
* Blood Vessels
* Lymphatics
* Nerves
162
What determines whether epithelium is keratinized or nonkeratinized?
The underlying connective tissue
163
What provides blood supply to the PDL?
* Superior and Inferior Alveolar arteries
164
What are the functions of the PDL?
* Protect vessels and nerves
* Transmit occlusal forces
* Attach the tooth to bone
* Perform formative and remodeling functions
165
What are the fibers of the PDL?
* Alveolar Crest
* Horizontal
* Oblique (most numerous)
* Interradiclar
* Apical Fibers
166
Describe and define ankylosis...
* Ankylosis is the fusion of the cementum and alveolar bone with obliteration of the PDL.
* It develops after chronic periapical inflammation, tooth reimplantation, and occlusal trauma.
167
What is the composition of alveolar bone?
* Cortical bone
* Cancellous trabeculae (more prevalent in the maxilla)
* Alveolar bone proper (lines the tooth socket)
168
What are the functions of the alveolar bone?
There are 3...
1. Protection
2. Support
3. Calcium metabolis
169
Where is acellular cementum located?
* On the enamel at the CEJ
* Does NOT contain cementocytes
* Forms slowly
170
Where is cellular cementum located?
* Apical third of the root
* More irregular
* Forms rapidly
* With age, increase in width of cellular cementum
171
What percentage of the cementum and enamel overlap?
* 60% of the cementum and enamel overlap
* 30% of the cementum and enamel form a butt joint
* 10% of the cementum and enamel are separated by a gap
172
What is the difference between extrinsic and intrinsic cementum?
173
How does the junctional epithlium attach to the cementum?
* Hemidesmosomes
* Replicates every 5 days
174
What results from violation of the biologic width?
* Periodontal bone loss
* Inflammation
* Body will try to make room between the margin of the restoration and the alveoalr bone to allow for reestablishment of the biologic width
175
What is biologic width?
* Junctional epithlium + connective tissue attachment
* Measured from most coronal part of JE to the crest of the alveolar bone
* Biologic width is about 2 mm
176
Which complexes show an association with increased PD?
Red and Orange
Yellow and Green showed no statistically significant relationship with pocket depth
177
In health, which type of bacteria are present?
* Gram positive
* Cocci
* Nonmotile
* Facultative
178
In disease, which types of microbes are present?
* Gram-negative
* Rods
* Motile
* Obligate Anaerobes
179
What is currently known about the risk of periodontal surgery while patients are on bisphosphonate therapy?
* High affinity for calcium
* Inhibit Osteoclasts - thus decrease bone turnover
* Osteonecrosis can result from temporary or permanent loss of blood to the bone
* Tends to affect posterior mandible
* Osteonecrosis following oral surgical procedure
* Higher incidence found in Fosamax
180
How should a dentist manage a pt on bisphosphonates?
* Best for patients to have all dental procedures (extractions and surgery) done BEFORE bisphosphonate therapy
* Consider discontineu for 3 month perio before and after elective invasive dental surgery
* Work with physician
181
What are some treatment a dentist would consider if he sees BAO?
Bisphosphotnate Associated Osteonecrosis
* Pain meds
* Antibiotics
* Antibacterial mouth rinse
* Quarterly follow up
* Superfiical debridement to relive soft tissue irriation
182
What is PerioChip?
◆ Bioabsorbable crosslinked gelatin matrix with 34% chlorhexidine gluconate (CHX)
◆ Chip dimensions: 5mm long, 5mm wide, 1 mm thick
◆ 2.5mg of CHX maintains 125 µg/ml for 1 week in gingival fluid
183
What are some advantages of PerioChip?
◆ Quick and easy to use
◆ Sustained high concentration of CHX delivered to localized site
◆ Professional application no patient compliance issues
184
What are some Disadvantages of PerioChip?
◆ May be uncomfortable
◆ May require multiple applications
185
How much Minocycline HCL is in one application of Arestin?
1 mg per vial
186
What are some functions of Arestin?
◆ Broad-spectrum, semisynthetic TCN
◆ Bacteriostatic
◆ Maintains GCF MIC of common pathogens for 14 days (≥ 2.00 µg/ml)
◆ Microspheres activate and adhere on contact with moisture
187
What does research suggest regarding using Arestin in conjunction with Sc/RP?
Promising short term results
188
What is the technique for applying Arestin?
◆ Unit dose cartridge and handle
◆ No loc anes required (sometimes)
◆ Insert cartridge to base of pocket. Press down on thumb ring while gradually withdrawing.
189
What periodontal conditions should you consider using Antibiotics?
■ Continual periodontal breakdown in spite of diligent mechanical therapy
**■ Aggressive periodontal disease**
■ Medical conditions predisposing to infection (HIV, DM)
■ Acute or recurrent severe periodontal infections (NUG, periodontal abscesses)
■ Peri-implantitis
190
What are some indcations to use local delivery systems?
■ Site(s) with **PD \>5mm with persistent BOP**
■ **Not a surgical candidate**
■ Refuses surgery
■ **Smoker**
■ Non-regenerable site
■ Esthetic zone
191
What is the cheapest local delivery system?
Arestin - $8.20 per site!
PerioChip: $16.75 per site
Atridox: $19.67 per site
192
When would you consider therapies OTHER than local delivery of antibiotics?
■ Multiple sites with PD ≥5mm exist in the same quadrant
■ Previous use of LDA has failed to control periodontitis
■ Anatomical defects are present (e.g., intrabony defects)
193
What Periodontal Prognosis Classification do we use?
Kwok & Caton
194
How does Kwok & Caton define Favorable?
Favorable – local and systemic etiologic factors **can be controlled** and the periodontal status **can be stabilized** with comprehensive periodontal treatment and maintenance. Future loss of the periodontal tissues is unlikely if these conditions are met
195
How does Kwok & Caton define Questionable?
Questionable - periodontal status is influenced by local or systemic factors which **may or may not be able to be controlled**. Periodontium can be stabilized with comprehensive treatment and maintenance if these factors are controlled. **Future periodontal breakdown may or may not occur**
196
How does Kwok & Caton define Unfavorable?
Unfavorable - periodontal status of tooth is influenced by local and / or systemic factors that **cannot be controlled**. Periodontal **breakdown is likely to occur even with comprehensive periodontal treatment** and maintenance
197
How does Kwok & Caton define Hopeless?
The tooth must be extracted
198
How long should wait after initial therapy to conduct a re-eval?
4-6 weeks
199
What types of things should you try and observe during a Perio Re-Eval?
■ Look for signs of disease/disease recurrence
◆ BOP
◆ Increasing PD
◆ Radiographic bone loss
◆ Progressive mobility
200
During a Perio Re-Eval what would you consider deep PD's and BOP a greater risk for?
Loss of Attachment
201
What are some Contraindications for Surgery?
■ Inadequate plaque control
■ Non-compliance
■ Shallow probe depths
■ Medical conditions
■ Esthetic concerns
■ Psychosocial factors
■ Advanced lesions that may limit prognosis
202
What are 4 surigcal approaches to managment of diseased sites?
✦ Reflective
✦ Resective
✦ Additive
✦ Combination
203
In regards to Osseous Resective Sugery: define Osteoplasty?
Reshaping of the alveolar process to achieve a more physiologic form without removal of supporting bone
204
In regards to Osseous Resective Surgery, define Ostectomy?
Removal of supporting bone to correct or reduce deformities caused by periodontitis
205
What are 3 indications for Osseous Resection?
◆ Goal - probe depth reduction with the sacrifice of CAL
◆ Shallow - moderate crater defects not amenable to regeneration
◆ Improve the hard and soft tissue architecture (create positive architecture)
206
What are some Contraindications to Osseous Resection?
■ Maxillary anterior
■ 3-walled defects (regenerate if possible)
■ Deep defects
■ Advanced bone loss
■ Anatomic considerations
◆ Sinus floor, root prox
■ Sensitivity
207
What is a good rationale for a palatal approach to sugery?
■ Avoids buccal furcation exposure
■ Avoids dealing with shallow vestibule
■ More cancellous bone
■ All keratinized tissue
■ Wider interdental space
■ Greater access
■ Natural cleansing action of tongue
208
What is the rationale for taking a Lingual approach for osseous surgery?
■ Avoids buccal furcation exposure
■ Avoids dealing with shallow vestibule
■ Base of defects are usually lingual
■ Thicker bone
■ Slightly wider embrasures
■ Natural cleansing action of tongue
209
What are 3 different descriptors of Oeesous Defects?
■ Horizontal
■ Vertical
■ Combination (most common)
210
What is another name for a one-wall defect?
Hemiseptal
Difficult to regenerate
211
What kind of defect is this?
* Two-wall defect (crater)
* Most common
* 1/3 of all defects
212
What does the treatment of a 2 walled defect depend on?
* Depth of crater
* Root trunk length
213
What type of defect is this?
* Three wall defect
* 3 osseous walls; tooth is 4th wall
214
How do you treat a 3-wall defect?
* Open flap curettage
* Osseous or alloplastic grafting
* Guided tissue regeneration
215
What type of defect is this?
Circumferential Defect
216
What kind of defects are in this picture?
* Combinations
* Apical three-wall
* Coronally one, two or both
217
What is the sphere of influence of plaque?
0.5 - 2.7 mm
218
What are the 5 steps to Osseous Resective Surgery?
1. Bulk Reduction
2. Interdental Fluting
3. Elimiantion/reduction of defect walls
4. Resection to achieve positive architecture
5. Final shaping
219
What does research suggest in regards to F/O to achieving minimal probe depths?
If minimal probe depth is the goal, then osseous recontouring is the procedure of choice
220
F/O is indicated for PD above how many mm?
\> 5 mm - F/O helps achieve greater PD reduction
221
Is F/O indicated in PD in the range of 1-4 mm?
No!
F/O with greater LOA in sites 1-4 mm
222
What are some indications for Crown Lengthening?
■ Fractured Teeth
■ Caries
■ Excessive Wear
■ Incomplete Passive Eruption
■ Root Perforation/ Resorption
■ Supra-eruption
223
What are the components of Biologic Width?
JE + CT
224
What is the least and most variable mesurements regarding BW?
■ Connective tissue measurement least variable
■ Junctional epithelium was the most variable
225
What happens with Biologic Width as you go posterior?
It Increases!
226
What MUST you do when considering a Gingivectomy?
Must Bone Sound!
227
What are the 3 choices in treating Gingivectomy?
1. Internal
2. External
3. Laser
228
How much crown length do you ideally need when considering APFs with or without Ostectomy/Osteoplasty?
9 mm
To be determined by bone sounding and radiographic appearance of crestal bone
229
What are some risks regarding using a laser for gingivectomy?
Easy to damage root surface
230
When conducting Extrusion with Fibertomy, how often do you conduct the Fiberotomy?
Every 1 to 2 weeks
231
How long should you wait after surgery to replace a restoration in a non-esthetic site?
6 weeks
232
How long should you wait after perio surgery to place a restoration in an ESTHETIC site?
6 Months
233
What are 5 causes of a "Gummy Smile"?
1. Altered Passive Eruption
2. Dental Alveolar Extrusion
3. Vertical Maxillary Excess
4. Short Upper Lip
5. Hyperactive Upper Lip
234
What is Altered Passive Eruption?
235
What are the 4 stages of Altered Passive Eruption?
236
Flow chart for Altered Passive Eruption
237
How do yout treat Altered Passive Eruption?
238
What measurement indicates a short upper lip?
\< 20 mm
239
If you have a Hyperactive Upper Lip, how much is it moving?
6-8 mm
240
What is one way you can treat a hyperactive upper lip?
Botox
241
What are your tx options for a Grade 1 Furcation?
* Sc/RP
* Flap Debridement
* Osteoplasty
* Odontoplasty
* Modified Widman Flap
* Osseous Resective Surgery
242
What are you tx options for a Grade II Furcation?
* Guided Tissue Regeneration
* Root Conditioning
* Coronally Positioned Flap
* Osseous Graft
* Synthetic Graft
243
What are your treatment options for a Grade 3 furcation?
* Root Amputation
* Hemisection
* Bicuspidization
* Tunneling
* Extraction
244
What approach and what instrument is the best way to clean a furcation?
* Calculus removal better with an ultrasonic scaler
* Calculus removal better with an open approach
245
Do furcations respond favorably or less favorably to nonsurgical threapy and maintenance?
Less Favorably
246
What is the main risk of performing a tunneling procedure for furcations?
23-57% developed caries
Pt's must have great hygiene!
247
What are some indications for Bicuspidization of a tooth related to endodontics?
* Root fracture
* Perforation
* Failing RCT
* Root resorption
* Root caries
* Inability to prepare canal
248
What are some indications for bicuspidization in the world of Periodontal?
* Severe vertical bone loss
* Close root proximity of adjacent teeth
* Grade II or Grade II Furcation
249
What is the prognosis for VITAL root resection WITHOUT concurrent endodontic therapy?
Poor!
250
Is Endodontic therapy recommend before of after root resection?
Prior!
251
What is the main reason for failure of a maxillary tooth after a root amp?
Periodontal Reasons
252
What 2 reason contribute to failure of a root amp for mandibular teeth?
Root Fractures/Caries
253
In regards to Regenerative Therapy, define Repair...
Healing of a wound by tissue that DOES NOT full restore the architecture or the function of the part. ie. LJE
254
In regards to Regenerative Therapy, define Regeneration...
* Reproduction or reconsitutioon of a lost or injured part
* New bone, cementum and PDL in a region that has been deprived of its attachment apparatus
255
Define New Attachment...
* The union of CONNECTIVE TISSUE or EPITHELIUM with a root surface that has been deprived of its original attachment apparatus
* ie. LJE and/or CT and may include new cementum
256
Define GTR...
* Procedures attempting to regenerate lost periodontal structures through differential tissue responses
* Can do this through Non-Resorbable membranes and Resorbable membranes
257
Define Reattachment...Is there Disease?
Reunion of epithelial and connective tissue with root surfaces and bone after incision or injury - NO DISEASE!
258
What do barrier help provide in GTR?
* Barrier retard apical migration of epithlium and exclude CT
259
What are some keys for success regarding Regenerating Intrabony Defects?
◆ Preserve soft tissue for primary closure
◆ Adequately debride defect
◆ Thorough root planing
◆ Root surface biomodification?
◆ Space maintenance (membrane, membrane and graft)
◆ Walls of defect 3\>2\>1
◆ Wound stability (flap and tooth stability)
260
How do success rates differ from 3 wall to 1 wall defects?
* 3 wall - 95%
* 2 wall - 82%
* 1 wall - 39%
261
What are key factors to success when Regenerating Mandibular Furcations?
* Access \> 2.3 mm
* Grade II
* Buccal \> Lingual
* Adjacent inter-proximal bone should be more coronal
* Root trunk
* Remove CEP and barrel
262
Regarding maxillary furcations, which grade and site is the only statistically significant site with good results?
Grade 2, Buccal Furcation
263
Are Grade 3 furcations predictable for GTR?
No!
264
Are M and D Furcations predictable regarding GTR?
No!
265
What is better...Bone Graft + Membrane, or just placing a Membrane?
Bone Graft + Membrane
266
What are the 4 different types of Bone Grafts?
1. Autograft
2. Allograft
3. Xenograft
4. Alloplast
267
What are the 2 different types of membranes?
1. Resorbable
2. Non-Resorbable
268
What are 4 Biologics you should know?
1. Emdogain
2. PDGF (Platlet Derived Growth Factor)
3. BMPs (Bone Morphogenic Proteins)
4. PRP (Platlet Rich Plasma)
269
What are the 3 O's of Bone Grafts?
1. Osteogenic - Autografts
2. Osteoinduction - Allografts
3. Osteoconduction - Xenografts
270
Define Osteogenic...
* Any tissue or substance with the potential to induce growth or repair of bone.
* Contains viable bone cells
271
Define Osteoinduction...
* Stimulation of host cells to differentiate and form new bone
272
Define Osteoconduction...
* Formation of new bone by hose cells where the graft merely provides a scaffold for growth
273
Where are different places you can get Autografts Intraorally?
* Osseous Coagulum
* Bone Blend
* Maxillary Tuberosity
* Edentulous Ridges
* Extraction Sites
* Chin
* Ramus
274
Where are some Extraoral sites you can get Autografts?
* Iliac Crest
* Tibia
* Remember - these contain properties of Osteogenic, Osteoinductive and Osteoconductive
275
What 'O' is FDBA?
Osteoconductive
276
What 2 'Os' are involved in DFDBA?
Osteoconductive/Osteoinductive
277
What are some examples of Xenografts tha we use?
* Bio-Oss - Cancellous Bovine Bone
* Bio-Oss Collagen - Cancellous Bovine Bone combined with 10% porcine collagen
* Osteograft (Microporous HA)
* Osteoconductive
278
What are 2 types of Alloplasts in regards to Ridge Pres?
* Non-ceramics (resorbable and non-resorbable)
* Ceramics (resorbable and non-resorbable)
279
What are 5 disireable qualities of Membranes?
■ Biocompatible
■ Cell occlusive
■ Space maintenance
■ Tissue integration
■ Clinically manageable
280
What are some qualties of a Bio-Gide Collagen Membrane?
◆ Resorbable bilayer collagen membrane
◆ Porcine Type I and III collagen without further crosslinking
◆ Bilayer structure
✦ Porous surface faces bone, dense surface faces soft tissue
■ Absorbs within 24 wks
281
Name 3 Collagen Membranes...
* Bio-Gide
* BioMend
* Ossix Plus
282
Describe BioMend in regards to Membranes...
◆ Resorbable Collagen membrane
◆ **Bovine Type I collagen** deep flexor tendon
◆ Completely absorbed in 4-8 weeks
◆ Trim using template provided
■ BioMend-Extend - 18 weeks
283
Describe Ossix Plus in regards to Membranes...
■ Ossix®Plus
◆ **Porcine type I collagen**
◆ Resorption starts at 6 months and complete by 8 months?
◆ Ossix®Plus may act as a source for ossification
284
Describe OsseoGuard in regards to Membranes...
◆ Type I bovine Achilles tendon
◆ Resorption 26-38 weeks
◆ Requires bone graft
285
Where does Emdogain come from?
Enamel matrix derivative from porcin tooth buds
286
What is Emdogain marked for?
1, 2, and 3 wall defects and treatment of furcations
287
What are some characteristics of Emdogain?
■ Enamel matrix derivative from porcine tooth buds
■ Sterile aqueous Propylene Glycol Alginate
■ Marketed for 1, 2, and 3 wall defects and treatment of furcations
288
What is PDGF? What can it be used for?
* Platelet Derived Growth Factor
* May be used in combination with bone graft
289
What are BMPs? What can they be used with?
* Bone Morphogenic Proteins
* Recombinant BMP-2
* May be used with a collagen sponge
290
When a tooth is extracted, what dimension looses more bone...Horizontal or Vertical?
Horizontal
291
What is the range of Horizontal Bone Loss after an extraction?
2.6 - 4.4 mm
292
What is the range of Vertical Bone Loss after extraction?
0.9 - 1.2 mm
293
What are some factors that contribute to Resorptive Changes after tooth extraction?
* Blood supply to alveolar bone surrounding a tooth
1. Periosteal
2. Endosteal
3. PDL
* Theory of bundle bone
* Thickness of remaining bone
294
What is Bundle Bone?
Bundled Collagen Fibrils Surrounded by Osteocytes
295
What is greater in composition? Buccal bone or Bundle Bone?
Buccal Bone \> Bundle Bone
Buccal \> 1 mm
Lingual \< 0.5
296
What is the blood supply to bundle bone?
PDL
297
What is the % resorption following extraction of the buccal and lingual bone?
■ Following extraction
◆ Buccal horizontal resorption = 56%
◆ Lingual horizontal resorption = 30%
298
What can be some Iatrogenic factors that could contribute to resorptive changes following an extraction?
* Bur
* Overheating Bone
* Flap Reflection?
299
What are the 3 blood supplies to the alveoalr bone surround a tooth?
300
What kind of Seibert defect is this?
Seibert I
Defect in a horizontal direction (Bucal-Lingual)
301
What kind of Seibert defect is this?
* Seibert II
* Defect in a vertical direction (Incisal - Gingival)
302
What type of Ridge defect is this?
* Seibert III
* Combination of BL and IG Defects...Horizontal and Vertical
303
How far do you want an implant below adjacent CEJs?
4 mm
304
How many mm of Attached Gingiva is recommended for subgingival restorative margins?
* 5 mm KT of which 3 mm is attached
305
What has the strongest association with soft tissue recession?
Thin Periodontium and Thickness of Tissue!
Investing bone is thin or absent
Investing soft tissue is thin
306
How thick should tissue be in front of periodontium to prevent soft tissue recession?
1 mm
Look for prominent roots
307
What are some indications for grafting?
■ Progressive recession
■ Esthetics
■ Sensitivity
■ Deepen the vestibule
■ Relieve aberrant frenum pull
■ Pre-prosthetics (augmentation)
■ Pre-Orthodontic tooth movement
308
What % of root coverage is anticipated regarding Miller I and II defects?
100%
309
What % of root coverage is anticipated regarding Miller III and IV defects?
Not predictable...
310
What is the goal of a Free Soft Tissue Autograft?
Increase the zone of keratnized tissue
311
What is the timeline for a Free Soft Tissue Autograft regarding healing?
■ Plasmatic circulation (24 – 48 hrs): diffusion through the fibrin clot (reduce dead-space)
■ Vascularization (2-3 days): invasion of capillaries, adequate blood supply at 8 days
■ Organic Union (4-10 days): fibrous attachment of graft to recipient site
312
What are some contraindications for dental implants?
* Hemophilia
* Uncontrolled DM
* IV Bisphosphonates
* Immunocompromised
* Psychologicla Factors
313
What does BIOMET 3i coat their implants surfaces with?
Osseotite Surface
Dual Acid Etch - HCL/H2SO4
314
How do you actually observe Osseointegration?
A direct contact, on the LIGHT MICROSCOPIC LEVEL, between living bone tissue and an implant
315
What are the 4 pillars of Albrektsson Criteria for success of dental implants?
1. Implant is clinically immobile
2. Absence of a peri-implant radiolucency
3. Vertical bone loss is less than 0.2 mm/yr after the 1st year
4. Absence of pain, infection, neuropathies, paresthesia, or violation of mandibular canal
316
According to Albrektsson, what are the success rates for dental implants at 5 years, and at 10 years?
5 years: 85%
10 years: 80%
317
How would you describe an Ailing Implant?
* Exhibits bone loss with pocketing, but the situation is STATIC at the 3-4 month maintenance checks.
* A lamina dura may be present at the borders of the defect
318
How would you describe a Failing Implant?
* May present with bone loss
* Pocketing
* BOP
* Purulence
* PROGRESSIVE BONE LOSS irrespective of therapy
319
How would you describe a Failed Implant?
* Exhibits MOBILITY
* Dull sound when percussed
* Peri-Implant Radiolucency on X-Ray
320
What are some different radiographs you could use to diagnose and tx plan dental implants?
* PA
* Pano
* CBCT
* Linear Tomogram
* Computer Tomography
321
Describe Type 1 Bone...
Homogenous Compact Bone
322
Describe Type 2 Bone...
Thick layer of cortical bone surrond dense trabecular bone
323
Describe Type 3 Bone...
Thin layer of cortical bone surrounding a core of dense trabecular bone
324
Describe Type 4 bone...
Thin layer of cortical bone surrounding a core of low density trabecular bone
325
What are 5 advantages of Immediate Single Tooth Implants?
■ May help preserve alveolar bone height and width
■ Preservation of papilla and soft tissue contours
■ Simultaneous integration and socket healing
■ Shortens edentulous period
■ Eliminates 1 surgical procedure
326
What are 3 Disadvantages of Immediate Single Tooth Implants?
■ Compromised fixture stability
■ Augmentation required
■ Primary closure difficult (but not always necessary)
327
What are 4 criteria for an ideal Immediate Single Tooth Implant?
■ Absence of infection?
■ Sufficient residual socket walls
■ Adequate apical bone for primary stabilization
■ Available soft tissue for primary closure
328
What are the procedural steps for an Immediate Single Tooth Implant?
■ Intrasulcular incisions
■ Full thickness flap reflection vs flapless approach
■ Atraumatic extraction
■ Debride socket
■ Fixture placement
■ Bone augmentation
■ Flap closure
329
For Immediate Single Tooth Implants, if you extrated a Maxillary incisor/premolars, where would you place the fixture?
Palatal aspect of socket
330
For immediate single tooth implants, if you extracted a mandibular molar, where would you place the fixture?
Interradicular Bone
331
For immediate single tooth implants, if you extracted a maxillary molar, where wold you place the fixture?
Interradicular Bone
332
What does reserach say about immediate single tooth implants?
* 96% Overall Survival Rate
* 3i or Nobel Biocare
* No difference between smokers and non-smokers
333
What is Delayed Immediate Placement?
Disadvantages: Immature Alveolar Bone
Resorption of Alveolar Bone
334
What are some advantages/disadvantages of Delayed Single Tooth Implant Placement?
Advantages:
* Allows soft tissue closure
* Augmentation/Preservation of Ridge
* MAture Alveolar Bone
Disadvantages:
* Ridge Resorption
* Prolonged Treatment Time
335
What is the current implant SURVIVAL rate?
97%
336
What are some implant considerations in esthetic areas?
* High Smile Line
* Papilla Preservation
337
What is the critical temperature of implant Osteotomy?
47 C for 1 minute
Will cause bony necrosis
Temperatures above this caused bone resorption and and replacement by fat cells
338
What is the difference between Single Stage and Two Stage Implant Placement?
* Single Stage (healing abutment, provisional)
* 2 Stage (Cover screw only)
339
What is the difference in torque value between Single Stage and 2 Stage implant placement?
* Single Stage: Torque Value \> 30 Ncm
* 2 Stage: Torque Value \< 30 Ncm
340
What do most master clinicians believe about Attached Gingiva related to implant placement?
* It helps esthetic blending for partially edentulous patients
* Ease of surgical manipulation
* Reduction in plaque accumulation
341
For implants, do you have greater succes in the Anterior or Posterior areas?
Anterior
342
For implants, do you have greater success in the Mandible or Maxilla?
Mandible
343
What are some % of success regarding implants in grafted sites on the max and man?
* 100% success in man
* 83& in maxilla
344
What torque value are you looking for before you load an implant?
\> 32 Ncm of insertion torque
345
Should you load an implant if it was placed in combination with a bone graft?
No!
346
If you are doing a 2 stage implant, what is the MINIMUM time to wait before loading?
4-6 Months
347
What are the 4 types of Periodontal Maintenance?
1. Preventive
2. Trial
3. Compromise
4. Post-Treatment
348
Describe Preventive Maintenance?
■ Preventive: In periodontally healthy patients to prevent inception of disease
349
Describe Trial Maintenance...
■ Trial: To maintain borderline conditions over a period of time while assessing the need for corrective therapy
350
Describe Compromised Maintenance...
■ Compromise: To slow the progression of disease in patients unable to receive needed corrective therapy
351
Describe Post-Treatment Maintenance?
■ Post-treatment: To prevent recurrent disease and maintain health achieved during therapy
352
What is a good Periodontal Maintenance Interval?
Average Interval is 3-4 Months
Supported by Ramfjord
353
When should you consider increasing the perio maintenance?
* Excellent OH
* Clinically Stable
354
When should you Decrease a perio maintenance interval?
* Inadequate OH
* Clinically Unstalbe
355
What should you do to monitor implants?
* Imlants SHOULD ROUTINELY BE PROBED just like teeth in order to continually monitor and evaluate the health of the implant
356
What are the 3 C's when evaluating soft tissues around implants?
* Color
* Consistency
* Contour
357
Probing in conjunction with what are the best way to monitor imlants over time?
Radiographs!
358
When do we take radiographs for implants?
◆ Fixture placement
◆ Abutment insertion
◆ Prosthesis insertion
◆ 6 months after restoration
◆ Annually
359
Research has shown that perio maintenance helps decrease peri-implantitis...T/F?
True!
No Maintenance: 43.9%
Maintenance: 18%
