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Spring 2018 > Perio 2 Test 2 > Flashcards

Perio 2 Test 2 Flashcards

1
Q

What happens if we don’t do any tx to perio?

A

Tooth loss in susceptible individuals

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2
Q

What happens if we don’t do surgery?

A

Less reduction in probe depths

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3
Q

What happens if we do surgery?

Why?

A

Greater and sustained probe depth reduction

Flap approach reduces calculus, less calculus less inflammation

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4
Q

Advantages and disadvantages of surgical therapy (cutting open gums to work on perio)

A

A: direct vision
Easier manipulation and removal of tissues

D: moribidity
Esthetics
Cost

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5
Q

What are the short term vs long term benefits of surgery?

A

Surgery has better short term and long term pocket reduction

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6
Q

Benefit of regenerative surgery?

A

Favorable outcomes on even hopeless teeth (92% retention)

Stable 5 years after tx

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7
Q

Gingivectomy vs gingivoplasty

A

Ectomy: excision of the soft tissue wall of a perio pocket

Plasty: reshaping the gingiva to recreate physiological contours

Plasty is a step in a gingivectomy procedure

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8
Q

2 indications for gingivectomy

3 contraindications

A

Hyperplastic tissue
Suprabony pockets

Osseus involvement
Minimal attached gingiva/mucogingival involvement
Furcation involvement

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9
Q

Steps in gingivectomy

A
  1. LA
  2. Pocket depth marks (Bleeding Pts)
  3. External bevel
  4. Tissue removal
  5. Excision of tissue tags
  6. Gingivoplasty
  7. Application of surgical dressing
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10
Q

Complete healing after gingivectomy takes _ weeks

A

7

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11
Q

Gingivectomy vs. flap

A

Gingivectomy:
Cuts at 135˚ to tooth
External bevel
Exposed tissue during healing

Flap:
Leaves gap b/t leftover tissue and tooth
Internally beveled
Provides access to bone
Tissues not exposed during healing
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12
Q

Purpose of perio flaps

3 contexts for use

A

Provide access to bone and furcations

  1. Resection (removal of tissue)
  2. Conservative (access only)
  3. Regeneration (new perio support)
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13
Q

Flaps preserve _

A

Keratinized gingiva

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14
Q

Surgical access facilitates what 3 things

A

Calculus removal
Elimination of perio pockets
Perio regeneration

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15
Q

Other than calculus removal, 5 other applications for perio flaps

A 
Surgical extractions
Biopsies
Exploratory surgery
Clinical crown lengthening
Pre-prosthetic surgery
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16
Q

Blade used for primary incision

A

15

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17
Q

Steps of full thickness flap

A
  1. LA
  2. Incisions
  3. Flap elevation
  4. Removal of soft tissue
  5. Osseus surgery
  6. Flap placement
  7. Sutures
  8. Dressing
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18
Q

3 pre-flap-surgery essential considerations

A

Pocket depth
Amount of keratinized gingiva
Intended position of flap

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19
Q

3 problems that can occur with flap elevation

A
  1. Difficult if 1st incision doesn’t extend to bone
  2. tearing of flap with excessive force or improper direction of elevation
  3. Exostoses require special attention
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20
Q

Why place a wedge

A

Access to bone and Furcations
Internal thinning of bulky tissue
Closure and primary healing after reduction

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21
Q

2 conservative flap designs

A

Modified wild man

Flap curettage

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22
Q

A widman flap is 3 things

A

Scalloped
Replaced mucoperiosteal
With internal bevel incision

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23
Q

6 goals of suturing

A
  1. Tension that’s adequate enough for wound closure, but loose enough to prevent ischemia and necrosis
  2. Hemostasis maintained
  3. Primary intention healing permitted
  4. Post-op pain reduced
  5. Bone exposure prevented (faster healing)
  6. Proper flap position
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24
Q

4 points of a suture needle

A

Swage
Radius
Body
Point

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25
Q

2 types and subtypes of NON-resorbable sutures

A
  1. Silk
  2. Polyester
    A. Nylon
    B. PTFE
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26
Q

2 types and subtypes of resorbable sutures

A
  1. Natural
    A. Plain gut
    B. Chronic gut
  2. Synthetic
    A. Coated vinyl
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27
Q

Chromic gut

Pros/cons

A

Heals fast
BUT
Relatively weak
Moderate tiss. Rxn

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28
Q

Coated vicryl pros/cons

A

Strong
Minimal tissue rxn
BUT
56-70 day hydrolysis resorption

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29
Q

Surgical silk pros/cons

A

2+ strength
BUT
Moderate tissue rxn
Non-resorbable

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30
Q

ePTFE pros/cons

A

Strong
Extremely low tissue rxn
BUT
Non-resorbable

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31
Q

2 types of interrupted sutures

2 types of sling sutures

A

I: simple loop
Figure 8

S: single sling
Continuous sling

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32
Q

Sutures inserted through _ first

A

More mobile flap

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33
Q

Distance from sutures to the edge of the flap

A

2-3 mm

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34
Q

3 phases of postsurgical healing

A

Inflammation
Fibroblasts granulation
Matrix formation/remodeling

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35
Q 
Primary Intention healing at:
24 hrs (2)
1-3 days (2)
3-7 days (3)
1 week (1)
2 Weeks (2)
1 month (6)
2 months (2)
A

24 hrs

  • Neutrophils infiltrate
  • Epithelium starts to migrate from wound margins

1-3 days

  • Space b/t flap and tooth narrows
  • Ep cells migrate over border of flap

3-7 days

  • Neutrophils replaced by macrophages
  • Blood clot replaced by granulation tissue
  • revascularization

1 Week
-Ep attaches to root

2 Weeks

  • Collagen fibers oriented parallel to tooth (non-functional, immature)
  • Union of flap to tooth is weak

1 Month

  • Inflammatory cells gone
  • Fibroblasts multiplying, making collagen
  • Less revascularization
  • Ging. Crevice is epithelialized
  • Ep attachment is well defined
  • Functional arrangement of supracrestal fibers

2 Months

  • Collagen remodeled and cross-linked
  • Wound regained tensile strength
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36
Q

How does exposed bone heal

A

Superficial bone necrosis (1-3 d)

Osteoclastic resorption (4-6 days)

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37
Q

How much bone is lost if exposed to oral environment

A

1mm

38
Q

4 things to do for best surgical outcome

A

Minimize tissue trauma
Minimize wound desiccation (irrigate)
Suture meticulously
Address systemic health issues b4 surgery

39
Q

Healing by secondary intention:

3 things that are worse than primary

A

More inflammation
More granulation tissue
More wound contraction during healing

40
Q

Where do growth factors and cytokines come from

A

Blood clot

41
Q

3 growth factors released from the blood clot

A

PDGF- induces fibroblast and macrophage migration, proliferation and activation
EGF-induces epithelial proliferation
TGF-Beta - induces migration of inflammatory cells and proliferation of fibroblasts

42
Q

What do TNF and IL-1B do and from where are they released

A

They activate endothelium and induce neutrophil migration

Fibroblasts and macrophages

43
Q

Epithelial healing requires _ days

Healing is complete in _

A

7-14 days

Complete in 6-7 weeks

44
Q

What 3 things happen to cause alveolar bone loss

A

Gingival inflammation is extended
Trauma from occlusion
Systemic disorders

45
Q

How does gingival inflammation extend? 4 ways

A

Extends along collagen fiber bundles

Follows course of blood vessels

Enters alveolar bone

Enters max sinus

46
Q

Angular defects happen if interdental septum is _ wide. If less than that, horizontal bone loss will occur.

A

> 2.5mm

47
Q

5 types of osseus defects

A 
Horizontal bone loss
Angular bone loss
Ledges
Reverse architecture
Furcation involvement
48
Q

Tx options for horizontal bone loss

A

SRP
Gingivectomy
Open Flap Debridement
Osseus Surgery

49
Q

Angular defect tx options

A

OS

GTR

50
Q

Osseus surgery flap vs regenerative surgery flap

A

Both are full thickness

FLAP:
Osseus is apically positioned
Regen is coronally positioned

Incision:
Osseus is usually scalloped but if keratinized tissue is limited, sulcular incision
Regen is sulcular

51
Q

Ostectomy

A

Removal of bone ATTACHED TO TOOTH

52
Q

How to correct reverse architecture

A

Bring interdental bone up

Lower facial bone

53
Q

4 requirements for ostectomy

A
  1. Horizontal bone loss with irregular marginal bone height
  2. Intrabony defects that we can’t regenerate
  3. No esthetic or anatomic limitations
  4. Sufficient remaining bone for establishing physiologic contours w/o attachment compromise
54
Q

Contraindications for ostectomy

A 
Insufficient remaining attachment
Unfavorably affect adjacent teeth
Anatomic limitations
Esthetic limitations
Effective alternative
55
Q

Ostectomy vs osteoplasty

A

Ectomy: removal of bone attached to tooth
Plasty: removal of bone not attached to tooth

56
Q

Indications for osteoplasty

A 
Tori
Intrabony defects adjacent to edentulous ridges
Incipient furcations
Reduction of buttress bone or exostoses
Shallow osseus craters
57
Q

Guided tissue regen:

A

Procedures that allow a perio defect to get cells that can form new connective tissue attachment and alveolar bone

58
Q

3 principles of GTR

A

Exclude unwanted
Protect wanted
Hold the space

59
Q

6 qualities of an ideal oral membrane

A 
Absorbable
Biocompatible
Cell Occlusive
Space Maintenance
Tissue Integration
Clinically Manageable
60
Q

3 types of materials used for GTR

A

Non-resorbable

Resorbable

Stem cells, functionally graded membranes

61
Q

Gore-Tex is otherwise known as _ which stands for _

A

e-PTFE

Expanded Poly Tetra Fluoro Ethylene

62
Q

Two types of resorbable membranes

A

Polylactic acid

Collagen (bovine/porcine, need consent)

63
Q

Graded membrane components

A

HA surface layer
Two core (protein) layers
Metronidazole epithelial layer

64
Q

How is space maintained after extraction

A

Reinforcing the membrane

Creating a scaffold (screws and fillers)

65
Q

Cells in:
Osteogenesis vs osteoinduction vs osteoconduction

Which are Conductive, inductive, genic?

A

OG: viable bone cells
OI: uncommitted CT cells induced
OC: non-viable scaffold

Autograft is all 3
Allograft is 1.5
Alloplast/xenograph is conductive only

66
Q

3 things you use when doing a graft

A

Membrane
Graft
Mediator

67
Q

What are 2 types of biological mediators

A

Enamel matrix proteins

rhBMP - recombinant human bone morphogenetic protein

68
Q

What does an enamel matrix derivative (Emdogain) do

A

Helps grow bone, PDL, cementum and matrix

69
Q

What does PDGF do?

A

Aids in formation of bone, PDL and cementum by stimulating osteoblasts, fibroblasts, and cementoblasts

70
Q

3 reasons for GTR

A

Space maintainer
Exclude epithelium
Protect and promote bone and PDL growth

71
Q

The Furcation transitional part?

The crotch?

A

Entrance

Fornix

72
Q

Width of a blade of a new gracey curette

A

0.75mm

73
Q

Order of Furcation sizes in max molar from biggest to smallest

A

Mesial
Distal
Buccal

74
Q

Most often root concavities can be found where (which sides of which molars)

A

Almost always (94-100)

  • M/D of mandibular
  • MB of max

Rare

  • DB (31)
  • Palatal max (17)
75
Q

CEPs:
What
Frequency
Main type

A

Cervical enamel projections
13% of molars
Enamel pearl

76
Q

Glickman vs Hamp, Nyman and Lindhe’s Classifications

A 
G: 1-4
1-catch, not visible on r-graph
2-visible on r-graph, can be shallow or deep
3-through and through
4-clinically visible

HNL: 0-3
Basically same thing, but 3 is through and through, no 4

77
Q

3 things a Furcation radiolucency could be:

How to tell?

A
  1. Perio
  2. Drainage of infection from accessory canal from chamber (non-vital tooth)
  3. Trauma from occlusion (won’t have deep probe depths)
78
Q

Most effective way to treat grade 2 furcations

A

Osseus surgery (plasty and ostectomy)

79
Q

Root resection is indicated when?

Contraindications

A

Grade 2 severe, or grade 3 Furcation

CI: inadequate bone support, fused roots, inoperable endo, patient considerations

80
Q

Window to do root canal after root resection

A

2 weeks

81
Q

If doing root resectioning, what is the sequence

A 
Endo
Provisional
RSR
Perio surgery
Final prosthetic
82
Q

When is hemisection indicated

A

Mandibular molar
Grade III Furcation
Widely separated roots
Soft tissue below level of pulp chamber

83
Q

Regen of Furcation defects works best on _ and is done by _

A

Type II furcations

GTR

84
Q

Treatment of furcations:
Class I
Class II
Class III

A

I- SRP
II- open flap, SRP, osseus surgery, GTR, tunneling, root resection
III-tunnel, hemisection, resection, extraction

85
Q

Survival of treated furcated molars

A

70%

86
Q

6 pre-prosthetic perio surgical procedures

A 
Tooth prep to gingival margin
Restorative in perio surgery
Crown-lengthening
Gingival grafting
Ridge plumping
Ridge reduction
87
Q

T/F gingival retraction works on inflammed tissue

A

FALSE

88
Q

Crown lengthening to treat excessive gingival display is indicated and contraindicated when

A

I: not enough of anatomic crown is exposed (altered passive eruption)

CI: hypermobile lip
Skeletal problem

89
Q

Dentinogingival complex vs. biologic width

A

DGC: sulcus, JE, connective tissue

BW: JE, Connective

90
Q

Optimal distance from GM to alveolar crest

From alveolar crest to tooth structure?

A

At least 3
2 for attachment, 1 for sulcus

At least 4

91
Q

How long do you need to wait after crown lengthening to do a restoration

A

6 weeks

92
Q

2 indications to do mucogingival alteration not on a tooth

3 methods to alter it

A

Lack of keratinized/attached gingiva
-For abutment teeth or edentulous site

Shallow vestibular depth

  • for RPD
  • for complete denture
  1. Subepithelial connective tissue graft
  2. Free gingival graft
  3. Vestibular extension

Spring 2018 (18 decks)

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