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1
Q

Benefit of surgery 1 quadrant at a time

A

Radvar - Clinical improvements in last untreated quadrant

Mechanism - removal of granulation tissue, disruption of microbial flora, improve AB avidity

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2
Q

How long until flap is stable after surgery?

A

Hiatt - at 2 weeks, suture pulled through w/o fully displacing flap

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3
Q

Clefts/craters

A

Jenkins - not an indication of poor healing, resolve within 6 months

Cleft - separated by 1mm
Crater - depression

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4
Q

Healing sequence after FO

A

Wilderman
Immediate - clot + PMN band
1-2 days - epithelial migration 0.5mm/day beneath polyband. MP clear debris
3-4 days - Increase fibroblasts, disorganized CT matrix, begin angiogenesis and osteoclast resorption
1-2 weeks - Increase collagen. Begin OB, decrease OC
1 month - Peak OB, collagen synthesis parallel to root
6 months - Mature CT/PDL insertion into bone. Woven to lamellar

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5
Q

Infection rate after surgery

A

Powell - 2%.

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6
Q

Perio-Pak and infection

A

Powell: No difference, trend towards infection

Cecchi & Trombelli - NO difference in analgesic usage

“There is evidence that there is no advantage”

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7
Q

Chlorhexidine post surgery (3 studies)

A

Powell - NO difference in infection rate w/ or w/o CHX or ABC

Newman - CHX SS lower PI/GI/plaque/bacteria vs control

Zambon - CHX SS improve post-op plaque/inflammation

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8
Q

CHX w/o mechanical therapy

A

Zanata - does not reduce bacteria

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9
Q

Suture technique FO

A

Nelson - no difference in continuous sling vs interrupted

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10
Q

Bone loss in thin bone

A

Wilderman - average 0.8mm

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11
Q

Crestal bone loss after surgery

A

Pennel - 0.54mm. 82% lost <1mm

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12
Q

Exposed bone covered w/ what?

A

Pfeifer - CT/PDL. Minimal bone loss

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13
Q

Bone loss in thick/thin

A

Wilderman/Wentz/Orban

More IP loss, but thicker cancellous section
Thicker = marrow bone
Thin = facial surface

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14
Q

Phases of hemostasis

A

Vascular - vasoconstriction after damage to vessel wall
Platelet - vWF released, platelet aggregation
Coagulation - clotting cascade, fibrin clot

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15
Q

Removal of granulation tissue during surgery?

A

Lindhe - Split mouth study, granulation tissue removal not critical. Debridement/SRP more important

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16
Q

Remove sulcular epithelium?

A

Pippin - it degenerates, not necessary to remove

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17
Q

Flap H/W ratio?

A

Mormann - angiographic study. MAX 2:1 H/W ratio

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18
Q

Where do cells come from for flap healing?

A

Wilderman - epithelial cells from edge of flap wound margin. CT cells from PDL

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19
Q

Distal wedge?

A

Robinson

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20
Q

Incision design

A

Cattermole: Scalloped vs linear. 2 weeks greater GI w/ linear, no difference at 12 weeks

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21
Q

MWF vs sulcular

A

Smith - 3 months, no difference

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22
Q

Goals of surgery - Access NM

A

Brayer - 4mm+ OFD/BCP more effective

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23
Q

Goals of surgery - Access All Teeth

A

Caffesse

% calculus free
4-6mm: 43% vs 76%
7mm: 32% vs 50%

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24
Q

Goals of surgery - Access, % plaque free

A

Waerhaug - 11% plaque free >5mm

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25
Goals of surgery - Access, Molars
Fleischer - OFD/BCP enhances calculus removal in molars w/ furcation invasion
26
Goals of surgery - Reduce inflammation
Levy - remove etiology, reduce inflammation, perio surgery reduced bacterial load
27
FO studies
Olsen/Ammons - OFD vs FO 5 years. OFD 2.3X more 4mm+ sites w/ BOP. FO fewer residual pockets and less inflammation Kahldahl/Kahlwarf - CS/SRP/MWF/FO 7 years. FO least breakdown
28
Goals of surgery - CAL gain
``` Froum - OFD 3.3mm PD reduction 2mm recession 1.4mm attachment gain 1.2mm radiographic bone fill 0.8mm resorption LJE ```
29
LJE resistance
Magnusson - LJE as resistant to plaque/inflammation as control (MONKEY)
30
Critical PD
Lindhe SRP - 2.9mm Surgery - 4.2mm Surgery > SRP - 5.4mm
31
Plaque infested dentition
Nyman & Lindhe - q2weeks vs q6months (2.2mm LOA vs 0.1mm CAL gain) for non-molars
32
Maintenance interval
Ramfjord - 3 months arbitrary | Mosques - bacterial repopulation
33
Different types of maintenance
Schallhorn - preventative, trial, compromised, post-treatment
34
Maintenance in a periodontists office?
Axelsson - better maintained w/ periodontist vs GP
35
Status of well-maintained patients over 22 years
Hirschfeld & Wassermann Well maintained (0-3): 83% Downhill (4-9): 13% Extreme downhill (10-23): 4%
36
Most extracted/stable teeth
``` Lost = maxillary 2nd molars Stable = mandibular canines ```
37
Tooth loss w/ or w/o maintenance
Becker T + M: 0.11/year T: 0.22/year NO T: 0.36/year
38
Surgery w/ no maintenance
Becker - Need maintenance in order to maintain results from surgery
39
Root caries
Reiker - OH significant factor. Need diet counseling/fluoride 82% of maintenance patients with 1 root surface caries/filling
40
Maintenance compliance
Wilson Complete 16% Erratic 49% None 34% Increased complete to 32% w/ flyers/calling
41
Expected results NST
Hunn & Douglass 1-3mm: Lose attachment 4-6mm: 1mm PD, 0.5mm CAL 7mm+: 2mm PD, 1mm CAL
42
What 3 things happen w/ NST?
Recession CAL gain Decreased probe penetration
43
Probe peneteration
Fowler Health - 0.73mm coronal to JE Disease - 0.45mm apical
44
How to pathogens change after SRP?
Cugini - clinical change during first 3 months. Reduce PG/TF/TD
45
How good are curettes?
Stambaugh - 3.73mm max PD for hard/smooth/calculus free 5.52mm = average PD for evidence of instrumentation 6.21 = max curette depth Spent 25-39 minutes per tooth. 7 teeth
46
Histology after SRP?
Caton - Reduced inflamed CT volume density. Lack of sulcular epithelium ulceration, less inflammatory infiltrate, more dense CT, less perivascular edema
47
Furcation response to NST
Nordland - poorer response to SRP compared to nonmolar and molar flat surfaces LOA: 21% furcations, 11% nonmolars, 7% molar flat surfaces
48
Furcation w/ ultrasonic or diamond?
Matia - <2.3mm, need ultrasonic vs curette Parashis - use diamond for calculus removal in furcation
49
% plaque free surfaces
Waerhaug <3 89% 3-5 63% >5mm 11%
50
Remove cementum during NST?
Nyman - NO
51
Healing w/ residual calculus?
Sherman - Yes, improvements w/ residual calculus BUT BOP/PD/CAL NOT useful for predicting residual calculus
52
What sites lose attachment w/ SRP?
Claffey - thin, non-BOP
53
Furcation sounding
Mealey - Accurate within 1mm 85%. Average difference 0.5mm
54
Bone sounding
Ursell - 0.97 correlation coefficient. Average difference 0.3mm
55
How far do oral hygiene aids go into socket?
TB 1mm Floss 2mm Proxabrush 2.5mm
56
Best IP aids?
Kotsakis - Interdental brush, Waterjet
57
Predict CAL loss?
Claffey Residual PD >7mm + BOP at 75% of maintenance visits = 67% CAL loss PD increase >1mm + BOP >75% of maintenance visits = 87% CAL loss
58
Toothbrushing frequency
Lang - q48 | Pinto - q24
59
Furcation entrance width
Bower - 81% <1mm. 58% <0.75mm
60
Furcation arrows
``` Deas Sensitivity 39% Specificity 92% PPV 72% NPV 75% ```
61
Radiographic calculus
Buchanon + Hyer Sensitivity 43% (50%) Specificity 92% (82%) PPV 92% (94%) NPV 46% (23%) Hyer - NPV is low because of low prevalence of calculus negative surfaces. No major difference between any of the image enhancements. Step of calculus >0.5mm, more likely to see it. Surface area of calculus IP >30%, increase sensitivity.
62
Kwok & Caton
Favorable - stabilized w/ tx and maintenance Questionable - local/systemic factors, stabilized w/ tx Unfavorable - local/systemic factors can't be controlled, breakdown likely Hopeless - Extract
63
General factors Kwok & Caton
Maintenance Smoking Diabetes Systemic disease (NP disorders)
64
Local factors Kwok & Caton
``` Deep PD Root form Furcation Root anatomy Plaque retentive factors Furcation Mobility ```
65
ChP causing systemic inflammation
Herrera PMN from ChP release more cytokines/chemokines. Primed for inflammation OC from ChP differentiated w/ RANKL. Usually need M-CSF as well
66
Calculus as etiology
Tan - Viable bacteria in calculus Allen & Kerr - guinea pig Anerud - Sri Lankans Richardson - calculus 1/2 depth of defect
67
Root proximity
Kim - <0.6mm, 56% more likely to lose >1mm bone over 10 years Tal - 2.5 to 3.1 Heins & Weider - <0.3, 0.3-0.5, >0.5
68
Stress
Genco - Financial most damaging. OR 2 for stress + inability to cope with it.
69
Staging severity is based on what?
Interdental CAL (>5mm) Radiographic bone loss to mid 1/3 of root Tooth loss 4 or less
70
Staging complexity is based on what?
PD 6mm+ Vertical bone loss Furcation invasion Ridge defect
71
Grading direct evidence
A - no loss over 5 years | B - <2mm loss over 5 years
72
Grading other evidence
% bone loss - A is <0.25 and B is 0.25-1 Destruction commensurate w/ biofilm deposits OR heavy biofilm deposits with low levels of destruction
73
Grading modifiers
Non-smoker (B) or <10 cigarettes
74
Lingual bonded retainer
Heier - American journal of orthodontics and dentofacial orthopedics
75
PRG
Kogon - 3.5 CI, 5.5 LI, 4.5 incisors -50% onto root, 60% of these go >5mm Withers - 8.5% subjects, 2/3% incisors. 4.4% lateral, 0.28% centrals
76
Maxillary sinus pneumatization
Sharan - extraction of multiple adjacent teeth, roots protruding into the sinus, 2nd molar EXT, superiorly curving sinus floor
77
Radiographs and bone
Jeffcoat - 30-50% demin | Bender & Seltzer - need erosion of cortical bone for radiograph to show
78
Tori
Sonnier Palatal tori - 20% (female/white) Mandibular lingual tori - 27%, 74% bilateral (males/AA)
79
More common in females
Palatal tori Impacted canines Fused roots
80
BOP
Meitner - earliest sign Davenport - increased plasma cells, intercellular space, ulcerated sulcular epithelium, increased GCF flow, leukocytes, tortuous rete pegs Caton - resolve BOP, histology returns to normal Lang - BOP 98% NPV, 6% PPV. 4/4 BOP 30% CAL
81
Repeated SRP
Anderson - 24 hours apart, no difference Badersten - 1/3 months, no difference Magnusson - NO MAINT for 16 weeks, redo SRP. SS difference
82
Alcohol
Tezal - OR 1/22 and 1/39 for CAL for 5/10 drinks/week | Wang - Risk of ChP increase 0.4% for every 1g/day of alcohol consumed
83
SSRIs and implants
Chappuis - OR 3 Increase osteoclast differentiation, negatively altering osseointegration
84
Depression and ChP
Nascimento - depressive symptoms higher risk of periodontitis RR 1.19 Behavioral or systemic
85
Former smoker
``` Al-Harthi 10-20 41% 20-30 55% 30+ 73% Each year 2.5-5.2% ``` Tomar - Smokers 4X to have ChP. 11 years = same OR
86
Obesity
Suvan - OR 1.27 overweight, 1.81 obese Nascimento - gain weight, OR 1.13X and 1.3X
87
Metabolic syndrome
Nibali OR 2.10
88
Alcohol content
Listerine 29.6% | CHX 11.4%

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