Final Revision Flashcards
(118 cards)
1
Q
What is an important prerequisite in order to begin treatment?
A
optimal oral hygiene
2
Q
maintenance of furcation involved teeth is done by
A
optimal plaque control
3
Q
What would you consider as a limitation concerning the major complication following tunnel preparation?
A
Must ensure optimal plaque control. Not always easy. Usually it is predictably performed in mandibular molars. Additionally, irrespective of Caries performing a tunnel preparation most of the times compromises the support of neighbouring teeth. This must be taken into account
4
Q
root trunk length its important for the
A
prognosis of the tooth
5
Q
adv of long root trunk
A
easier SRP
furcation wont appear early so more favourable prognosis
6
Q
disadv of long root trunk
A
if furcation is involved in the prognosis of the tooth then it is less favourable
limited tx option leading to extraction most probably
7
Q
furcation fornix =
A
furcation roof
8
Q
furcation =
A
area b/w individual root cones
9
Q
furcation entrance =
A
transitional area b/w undivided part and divided part of the root
10
Q
distance between the CEJ and the furcation entrance
A
± 8 mm
11
Q
The location of the entrance is in which third of the root of maxillary first premolars?
A
Middle or apical third
12
Q
classification for furcation involvement (Class I, II and III)
A
Class I: up to 3mm
Class II: more than 3mm, but not through and through
Class III: more than 3mm, through and through
13
Q
which has a shorter root trunk than the other?
a) first molar
b) second molar
A
a) first molar
14
Q
The selection of procedures to be used in the tx of periodontal disease at multirooted teeth can first be made when
A
the presence and depth of furcation lesions have been assessed
15
Q
Where would you expect to probe the mesial furcation of a maxillary molar
a) palatal
b) buccal
c) none
d) both
A
a) palatal
16
Q
name of curved probe to examine furcation
A
Naber’s probe
17
Q
wedge-like (triangle) formation can be observed on radiographs depicting a furcation involvement at maxillary molars but it can be misdiagnosed as
A
caries
18
Q
Where would you expect to probe the distal furcation of a maxillary molar
a) palatal
b) buccal
c) none
d) both
A
d) both
this furcation could be probed from either the buccal or the palatal aspect of the tooth
19
Q
two non-periodontitis related reasons, the diagnostic stages required to differentially diagnose the lesion and the relevant treatment steps
A
Pulpal pathology: Vitality test, if negative, endodontic treatment
Trauma from occlusion: Occlusal adjustments, night guard
20
Q
tx goals for furcation-involved teeth:
alternative tx goal:
A
- Elimination of plaque from exposed surfaces of root complex
- Establishment of anatomy of affected surfaces that facilitate proper self‐performed plaque control
alternative tx: extraction
21
Q
regenerative techniques can be predictable in which class furcation and in which teeth?
A
Class II furcation-involved MANDIBULAR MOLARS ONLY
22
Q
What would be the most common reason leading to the loss of furcation involved teeth following tunnel preparation?
A
Caries
23
Q
What in your opinion is the most important factor in the long-term prognosis of any treatment rendered for furcation-involved teeth?
A
Optimal plaque control
24
Q
possible tx options for:
- Class I:
- Class II:
- Class III:
A
•Class I: SRP, furcation plasty
•Class II: furcation plasty, tunnel prep, root resection, extraction, GTR at mandibular molars
-> GTR better for buccal defects
•Class III: tunnel prep, root resection, extraction
25
main diagnostic test to differentiate between periodontitis associated lesion and tooth associated infections
Vitality test
| Secondary would radiographic assessment
26
main clinical differentiation that might help with the diagnosis to differentiate between periodontitis associated lesion and tooth associated infections
Periodontitis: Multiple teeth are involved. Confined in the marginal periodontium
Endo: Single tooth. Typical clinical symptoms & radiographic signs (Tenderness to percussion, pain during chewing, periapical lesion, caries)
27
Typical symptoms of endodontic lesions:
| Typical clinical signs of pulpitis:
Typical clinical signs of pulpitis: spontaneous pain, thermal sensitivity or tenderness to percussion
Typical symptoms include throbbing pain, pain on percussion, tenderness to palpation, increased tooth mobility, and apical as well as marginal swellings
28
Why do endodontic (radiographic) lesions rarely present at the coronal third of the root?
Accessory canals are relatively uncommon in cervical and mid‐root portions in adult teeth.
Many accessory canals have thin diameter.
An intact layer of root cementum blocks potential dissemination of bacteria and their products along the dentinal tubules.
29
name the possible drainage direction of endodontic lesions
• Along the periodontal ligament space and exit at the bottom of the sulcus
- It may readily be probed down to the apex of the tooth, where no increased probing depth otherwise may exist around the tooth/furcation lesion
• Extraosseous drainage with exits either in or near the sulcus
30
main methods of testing pulp vitality in non-restored teeth
mechanical, thermal, and electric stimulation
| -Air, Scratching, Rubber cup (heat), Cold, Electric
31
main method of testing pulp vitality in restored teeth (e.g. crown)
prepare a test cavity to make pulp testing possible
32
*
A non-restored tooth presents with a radiographically visible vertical bone loss. The tooth tests negative in all vitality tests. What would be a possible diagnosis? What would be the prognosis of this tooth?
Possible diagnosis would be periodontitis. It could be a perio-endo lesion that reached the apex of the root and the bacteria infected the pulp. In this case the prognosis is doubtful.
33
*
During initial radiographic evaluation of a periodontitis patient, you observe a partially visible RC filling or a periapical lesion on a previously endo treated tooth. What is the recommended tx and what is the scientific rational for this recommendation?
Ideally proceed with endo re-tx
Reason: root canals can sustain bacterial growth, and infectious products from these areas may reach the periodontium along the very same pathways as in an untreated tooth
34
Iatrogenic perforations during endo tx or post preparation are not uncommon. If it goes undetected it can lead to a
pocket formation
35
*
In a periodontally healthy patient what would a single deep periodontal pocket at a single tooth (with or without endodontic tx present) indicate?
What other diagnostic steps would you take to confirm your diagnosis?
Root fracture or palatogingival groove
```
Diagnostic steps:
• Dental history
• Radiograph
• Dye solutions
• Tooth slooth
• Exposed sulcus
• CBCT
• Diagnostic surgical access
```
In a non-periodontal patient even though a groove is present, due to the “resistance” of the host a periodontal lesion might never manifest.
A palotogingival groove is more often observed in upper lateral incisors
36
Cemental tears:
occur more frequently at:
=
tx:
incisors, due to heavy biting forces
= a superficial root fracture confined only in the cementum and/ or the dentin layer
surgical tx
37
palatogingival grooves tx
surgical tx is often necessary
38
reasons for root resorption:
Trauma
possible iatrogenic reasons:
• orthodontic tx
• trauma
• chemical injury in conjunction with intracoronal bleaching
39
What is the main clinical difference between a carious lesion and external root resorption?
bacterial acids that demineralize dentin leave a SOFT CAVITY SURFACE
resorption removes both the mineral and the organic phases of the hard tissues, resulting in a cavity floor that is HARD TO PROBING
40
Is the use of antibiotics advocated for the treatment of periodontitis?
What is the rationale behind the use?
they shouldn't be prescribed as a monotherapy for the tx of periodontitis
-they should be used in conjunction with adequate mechanical debridement
The rationale for use of adjunctive antimicrobials is to further reduce the bacterial load enabling resolution of the inflammation in the periodontal pocket.
41
What is the ideal antibiotic, its duration, dosage and timing?
There is no consensus on the ideal regimen. Principle: Prescribe an antibiotic in sufficient dose for adequate duration.
42
Should systemic antibiotics be prescribed for the treatment of periodontal abscess?
it is controversial
- some say use of systemic antibiotics in combination with mechanical debridement or drainage
- others say systemic antibiotics only if a clear systemic involvement is present such as lymphadenopathy, fever or malaise or when the infection is not well localized
Mechanical debridement and drainage through the periodontal pocket without antibiotics is usually effective.
43
Should systemic antibiotics be prescribed for the treatment of necrotizing periodontal diseases?
Yes, if there are systemic manifestations such as fever or malaise
Metronidazole, targeting the Gram-ve anaerobes, should be prescribed
-Remember that this acute condition is caused by invading BACTERIA into the tissue and NOT by dental plaque on the teeth. This implies that local antisepsis, such as mouthrinses with essential oils, chlorhexidine, or other antimicrobials, has limited effect since the compounds do not penetrate into the affected tissue.
44
What are the common side effects following systemic antibiotics?
* git minor problems (diarrhoea and nausea)
* serious adverse effects (allergic, anaphylactic reaction and pseudomembranous colitis)
* resistance increases
45
As to what should the patient be informed before using antibiotics for treatment of periodontitis?
-possible side effects
-drug interactions
that may arise
46
Is the local antibiotic delivery more advantageous than the systemic in periodontitis treatment?
adv:
- it adds flexibility
- it improves the efficacy of perio care by providing a non-surgical local tx alternative with more powerful antibacterial effects than SRP
No local antimicrobial treatment has proven to be equally efficient or better than SYSTEMIC AMOXICILLIN PLUS METRONIDAZOLE
Systemic antimicrobials are more cost-effective though
47
What are the strategies to reduce the risk of bacterial antimicrobial resistance?
```
combination therapy
high dose for a short period
used as adjuncts to thorough mechanical debridement
use them where SRP is insufficient
limit prophylactic use to high risk pts
```
48
What are the selection criteria for periodontitis patients that may benefit most from systemic antibiotic therapy?
disease severity
patient compliance
diagnosis (aggressive, chronic)
adverse effects
49
What is the reason for not applying CHX systemically?
Too toxic to be administered parentally (injected)
| It is not adsorbed in the intenstine which enables local application in the mouth
50
significant markers of CAL are
plaque (P. gingivalis)
BoP
CAL = pocket depth + gingival recession
-indication of perio disease
51
What is the aim of periodontal regeneration?
to obtain shallow, maintainable pockets by reconstruction of the destroyed attachment apparatus and thereby limit gingival recession
In general:
1. an increase in the perio attachment of a severely compromised tooth
2. a decrease in deep pockets to a more maintainable range
3. a reduction of the vertical and horizontal furcation defects
52
suprabony defect =
pocket base located coronal to alveolar crest (e.g. horizontal defects)
53
infrabony defect =
the base of the pocket is located apical to the alveolar crest
(e.g. vertical defects; below the alveolar crest level)
-They can be subdivided into intrabony defects and craters
54
intrabony defect =
affects one tooth
55
Crater =
affects 2 adjacent teeth
56
interproximal crater =
a cup-/bowl- shaped defect in the interdental alveolar bone with bone loss nearly equal from the roots of 2 contiguous teeth
57
Can there be a 4-wall defect?
yes, circumferential defect
58
3-wall, 2-wall, and 1-wall defects depend on:
the no of residual alveolar bone walls
59
What is the most sensitive non-invasive diagnostic tool to “visualize” the morphology of bony defects?
CAL (PPD and recession) and in addition radiographs
| Do not forget BONE SOUNDING performed under anaesthesia usually before flap reflection
60
indications for regenerative periodontal therapy
* The function or long-term prognosis of the treated teeth may be improved
* Aesthetics
* Furcation-involved teeth (class ii)
* Residual pockets
* Vertical defects (infrabony defects)
NOT: horizontal defects
61
What factors play a role in the maintenance of perio defects?
treated with:
- regenerative approaches
- non-surgical
- other surgical approaches
* Compliance with OH
* Smoking habits
* Susceptibility to disease progression
* Maintenance *SOS*
62
How are successfully treated furcation defects following a regenerative approach maintained long term?
with:
- proper maintenance
- compliance with OH
63
cigarette smoking displays a dose-dependent detrimental effect on CAL gains in intrabony defects
The more you smoke the worse the result will be! Or the other way around.
64
factors for a successful regenerative outcome:
patient factors, defect factors, tooth factors
```
● Patient factors:
○ periodontal infection
○ smoking
○ age
○ genetics
○ systemic conditions
○ stress levels
```
● Defect factors:
○ type of a defect (Supra-Infrabony-crater-furcation)
○ morphology of the defect (Deep-shallow, narrow-wide, X-wall defect)
● Tooth factors:
○ endo status
○ mobility
65
What are the characteristics that a barrier membrane must have in order to function optimally?
* Biocompatible
* Excludes undesirable cell types (epithelial cells and CT cells - if the migrate first we will have ankylosis)
* Tissue integration
* Capable of creating and maintaining a space
* Provide stability to the blood clot
66
Name the 2 groups of biologically active regenerative materials used in periodontal regeneration
Which of the two groups is more widely used?
* Growth factors
| * Enamel matrix derivatives (this) - emdogain
67
What in your opinion are the additional benefits provided to GTR with the use of bone grafts?
* Space maintenance
| * Blood clot stabilization
68
During the years regenerative techniques and materials have evolved tremendously. In your opinion is there one regenerative technique that can be used universally?
Of course not
So many variables to evaluate and decide!
There is no technique that is more superior than the other and there is not one technique alone that you would use it universally
Each patient is different. Each defect is different.
69
differences in maintenance between
mild to moderate periodontitis patients
and
moderate to severe periodontitis patients
o Mild to moderate can maintain health with recall intervals of 12 months
o Moderate to severe can maintain health with recall intervals of 2-4 months
70
Which patients tend to be more compliant?
The ones that have a more severe condition thus a higher rate of acceptance
71
*SOS*
At the patient level what would represent a risk for tooth loss?
Measurements
Pocked Depth:
BoP:
at least 1 site with a PD > 6 mm
BoP score of ≥ 30%
-absence of bleeding is a +ve predictor for tooth retention
72
Why is supportive periodontal therapy important?
* post‐therapeutic professional maintenance care is an integral part of perio tx
* the only means of assuring the maintenance of long‐ term beneficial therapeutic effects
* re‐infection could be prevented or kept to a minimum in most patients
73
What does the term “Supportive Periodontal Therapy” express?
The essential need for therapeutic measures to support the patient’s own efforts to control periodontal infections and to avoid re‐infection
74
Which patients are at risk for recurrence of periodontal disease?
* Patients susceptible to periodontal disease since they are at high risk for re‐infection and progression of periodontal lesions
* Non‐complying, but periodontitis‐susceptible, patients receiving no Supportive Periodontal Therapy
75
If children are enrolled in a maintenance program, will this halt periodontal disease progression later in life?
- Not necessarily
- It is effective in controlling gingivitis, but this does not mean they will not have periodontitis in the future
- Supportive Periodontal Therapy is a lifelong commitment
76
What plays the biggest effect in preventing gingivitis, personal oral hygiene or professional maintenance?
Personal OH
77
Does the initial periodontal status (e.g. moderate or advanced disease) of patients plays a role on the frequency of maintenance?
YES!
Patients with advanced periodontitis may need SPT at a regular and rather short time interval (3–4 months), while for mild‐to‐moderate forms of periodontitis, one annual visit may be enough to prevent further loss of attachment
78
Can teeth be maintained for life following a proper maintenance protocol? Even in private practice?
YES!
If proper SPT is provided, a minimal number of teeth might be lost!
The key is individualized maintenance protocols!
79
How often a patient needs to be planned for Supportive Periodontal Therapy?
What should be taken into consideration?
It depends on the initial situation, the risk of disease, general health, home oral hygiene etc
Rule of thumb: for moderate to advanced disease 2-4 months intervals seem to control re-infection.
In mild to moderate bigger intervals are adequate
* Percentage of BoP
* Prevalence of residual pockets > 4 mm
* Loss of teeth from a total of 28 teeth
* Loss of periodontal support in relation to the patient’s age
* Systemic and genetic conditions
* Environmental factors such as cigarette smoking
80
What percentage of Full mouth plaque score should be considered compatible with periodontal stability, in a clinical setting during maintenance?
20-40% might be tolerated by most patients. It is important to realize that the full‐mouth plaque score has to be related to the host response of the patient, in other words compared to inflammatory parameters
81
What would be considered as the max accepted percentage of BoP during maintenance, to reduce the possibility of future periodontal breakdown?
25%
82
Which Probing Pocket Depth measurement (even at a single site) would be a warning for future periodontal breakdown?
≥ 6 mm
83
Which teeth are more frequently lost during long term periodontal maintenance (which have the worst prognosis)?
Furcation involved molars
-in a study it was found that second maxillary molars were the teeth most frequently lost
84
indicator for progression of periodontal breakdown
a) increased mobility
b) increasing mobility
b) increasing mobility
85
What are the treatment steps that should be performed at each recall appointment during SPT?
* ERD: Examination/ Re-evaluation/ Diagnosis
* MRI: Motivation/ Re-instruction/ Instrumentation
* TRS: Tx of re-infected sites
* PFD: Polishing/ Fluorides/ Determination of future SPT
86
Which early observations were indicative of a genetic influence on periodontal disease?
Genetic Susceptibility to Periodontal Disease: New Insights and Challenges
QUESTION 1
????
87
How is the individual variation in susceptibility to periodontal disease explained through the genetic model?
Genetic Susceptibility to Periodontal Disease: New Insights and Challenges
Question 2:
????
88
Heritability =
It’s a measurement of the proportion of phenotypic variation that can be attributed to genetic variation
89
early onset form of periodontitis
vs
chronic onset form of periodontitis
early onset: influenced by the genes
chronic onset: influenced by the environment
90
Which criteria is the peri-implant health based on?
1) absence of peri‐implant signs of soft tissue inflammation (redness, swelling, profuse bleeding on probing)
2) the absence of further additional bone loss following initial healing
91
Which group of bacteria are in active periodontitis?
gram negative anaerobic
92
How much bone loss should be found to say there is peri-implantitis?
> 3 mm
93
*SOS IMPORTANT for FINALS*
peri-implantitis clinical symptoms:
bone loss
BoP
pus
94
What are the differences between peri-implant mucositis and peri-implantitis?
Peri‐implant mucositis = inflammatory lesion that resides in the mucosa
Peri-implantitis = inflammatory lesion that resides in the mucosa that ALSO affects the supporting bone
peri‐implantitis requires detection of both bleeding on probing, pus and more than 3 mm bone loss on radiographs while for peri-implant mucositis there is no need to check with radiographs
95
What are the risk factors for peri-implantitis?
Local factors:
Systemic factors:
Implant factors:
Local factors: smoking, poor OH
Systemic factors: genetics, diseases (ex: diabetes)
Implant factors: surface roughness (the more rough it is the more plaque can be retained) and if it allows enough cleaning of the implants, or solutions placed on the implants which might not be so hygienic while others are better suited
96
What is the prevalence of peri-implant diseases?
Peri-implant mucositis is more common than peri-implantitis.
The prevalence reported varies in the various studies. Mucositis appears quite common with a prevalence of 40-50% of implants being affected. The corresponding value for peri-implantitis is lower, about <20% in most studies.
97
Are there any histopathological differences between the peri-implantitis and periodontitis affected tissues?
peri‐implantitis sites:
-no. of cells +ve for IL-A and IL-6 were larger
-no. of TNF-A were smaller
than periodontitis
98
common features between gingivitis and peri-implant mucositis
the clinical signs of inflammation (swelling and redness)
99
Why is it difficult to define a physiological probing depth at implant sites?
Because the vertical mucosal thickness at healthy implant sites varies considerably
100
Is there any association between clinical parameters and severity of peri-implant diseases?
all clinical parameters investigated (i.e., BoP, PD, and Supp) increased with disease severity
101
What is the current knowledge on the etiopathogenesis of peri-implant diseases?
it is a biofilm disease
102
definition of trauma from occlusion:
= damage in periodontium of teeth caused by stress produced directly or indirectly by teeth of the opposing jaw
103
What is a jiggling-type trauma and how does it affect the gingiva and the periodontal ligament?
= when forces from more than one direction are exerted on the tooth; there is a combination of pressure and tension on both sides of the jiggled tooth
- The periodontal ligament space increased in width on both sides of the tooth
(1) inflammatory changes were present in the ligament tissue
(2) active bone resorption occurred
(3) the tooth displayed signs of gradually increasing (progressive) mobility
-No change in gingiva
104
What is a major complication following tunnel preparation?
caries
105
Why to use the patient as the unit of analysis and not the defect?
Since the role of OH and maintenance are to be evaluated then this could not be performed if the unit of analysis was for example the defect sites
106
Clinical attachment gained by GTR in vertical defects could be maintained for how many years?
for at least 4 years
107
Stability of gained clinical attachment is associated with:
stringent OH which is more predictably enforced by a regular supportive periodontal care program
108
lost previously gained attachment to pre-treatment levels are the patients who:
who received only sporadic care
109
Aggressive periodontitis tx:
SRP in conjunction with systemic antibiotics
-it will come back again
110
How to evaluate results:
```
FMPS
FMBS
PPD
Radiographic
CAL
```
111
If a tooth root has on average 16 mm of length, this means that:
- half of the support is lost
| - furcation is quite narrow making it very difficult to efficiently SRP
112
What is the difference between a complex and a monogenic disease from a genetic point of view? Give an examples.
- complex diseases (ex: periodontitis) are caused by many genetic and non-genetic factors
- monogenic diseases (ex: Papillon–Lefèvre syndrome) are fully heritable
People who carry a causative allele in a single gene will inevitably develop the disease
In monogenic disease one gene is missing. If your parents are missing the gene then you have the possibility of not having it as well. You cannot change the gene, until now. Your own organism is counteracting these mutations that happen.
113
What is a case-control association study and how did such studies help to examine the genetic associations in periodontitis patients?
is a powerful method to detect associations of alleles with a disease phenotype
It plays a role in the identification of the genetic risk factors in periodontitis
Such studies ensure a good match between the genetic background of cases and controls, so that any genetic difference between them is related to the disease and not to biased sampling and use a case selection strategy that is designed to enrich specific disease‐predisposing alleles
114
How long can clinical attachment gained by GTR in vertical defects be maintained?
for at least 4 years
115
Periodontal regeneration is selected to obtain:
1. an increase in the periodontal attachment of a severely compromised tooth
2. a decrease in deep pockets to a more maintainable range
3. a reduction of the vertical and horizontal component of furcation defects
116
What findings and what clinical examination steps are necessary to detect the presence of peri‐implantitis?
Clinical examination:
1. Plaque assessment
2. Soft tissue inflammation
3. PPD
4. Soft tissue recession
5. Bleeding on probing
6. Redness
7. Suppuration
Radiographic bone loss (suggests peri-implantitis)
Histological findings and composition of biofilm
117
occlusal trauma =
= damage in periodontium of teeth caused by stress produced directly or indirectly by teeth of the opposing jaw
118
What is a jiggling-type trauma and how does it affect the gingiva and the periodontal ligament?
= when forces from more than one direction are exerted on the tooth; there is a combination of pressure and tension on both sides of the jiggled tooth
- The periodontal ligament space increased in width on both sides of the tooth
(1) inflammatory changes were present in the ligament tissue
(2) active bone resorption occurred
(3) the tooth displayed signs of gradually increasing (progressive) mobility
-No change in gingiva
