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NBDE Part II > Perio > Flashcards

Perio Flashcards

1
Q

poorest prognosis with furcation involvement?

A

Max 2M

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2
Q

GTR are successful in treating Class II furcations

A

No bone graft

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3
Q

CAL equation

A

PD + recession

Biologic width = 2.0 = JE (0.97) + CT attachment (1.07)
With implants = 3-4 mm

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4
Q

Most abundant microbes in healthy sulcus?

A

Strep. and Actinomyces

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5
Q

Most common exudate in gingivitis?

A

IgG

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6
Q

1 wall defect is AKA

A

hemiseptum

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7
Q

most common side effect of osseous grafts?

A

root resorption

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8
Q

2 wall defect is AKA

A

osseous crater
NOTE: infrabony defects are AKA as vertical osseous defects (all types).
Combined wall defects is when number of defects are more than the occlusal portion of defects.

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9
Q

most common teeth to be hemisectioned?

A

Mand molars with class II or III furcations

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10
Q

most common teeth to have root amputation?

A

Max 1M and 2M

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11
Q

one cannot access ___ mm beyond a given PD for an S/RP

A

5 mm

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12
Q

Nitrous has a _____, which makes it rapid in the blood stream on and off.

A

very low plasma solubility

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13
Q

Most common cause of recession

A

abrasion

  • [canines] > PMs
  • Found on left canines for right handed people
  • Primary symptom: cold sensitivity
  • Plaque control is the best treatment of choice to decrease symptoms.

Dentin is abraded 25x faster than enamel
Cementum is abraded 35x faster than enamel

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14
Q

Inflammation will give ___ PD readings

A

greater

  • not b/c the tissue is hyper plastic, but b/c the probe can easily got through the JE.
  • When probing, pressure equates to 1-2mm of depressed skin by the thumb (10-20 g of pressure)
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15
Q

T/F. Epithelium can form on both smooth and rough surfaces, including implants.

A

True

  • Attached via hemidesmosomes and basal lamina, with a long JE (v. similar to a natural tooth). Between the epithelium and marginal bone is dense CT. The rest of the implant and bone support is bone-implant interface.
  • Best time to augment tissue to gain as much keratinized tissue is stage II
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16
Q

Highest implant failure seen where?

A

Posterior maxilla due to the poorest bone quality (D4 grade)

MAX amount of taper required for proper draw of an over denture = 15 degrees

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17
Q

maximum heat when placing an implant?

A

47 C

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18
Q

purpose of GTR

A

eliminates bony defects around a site. This decreases CT generation and increases bone density in the defect.

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19
Q

To maintain an esthetic emergence profile, an implant should be placed ___ mm apical to the CEJ of the adjacent tooth.

A

2-3mm

Healing collar should be placed 1-2 mm above the tissue

Anterior loop = IA canal can extend as much as 4 mm anterior before looping back! To be safe, plan for 5 mm distance when placing implants.

If at Stage II, the collar seems to “rotate”, cover it with ST, take it out of function and wait 3 months for further osteointegration. Does not mean failure at this point.

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20
Q

implant maintenance recall

A

every 3 months

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21
Q

cement vs screw retained crowns on implants

A

cement retained requires more inter-arch space

22
Q

peri-implantitis

A

when bone loss occurs
peri-implantitis mucositis = ST issue, without bone loss

Caused by plaque or occlusal over-load

23
Q

Implants are kept sterile until placement, why?

A

to preserve the TiO2 layer which is key for osseointegration

24
Q

optimal angle for S/RP with an instrument?

A

45-90 degrees

  • Anterior sickles are long and straight
  • Wire edge is bad when sharpening instruments. Occurs when the last stroke of the stone is drawn AWAY from the cutting edge (should be towards the cutting edge instead).
  • natural stone need oil for lube
  • Synthetic stones need water for lube
25
Q

Define:

  1. Scaling
  2. Planing
  3. Curettage
A
  1. Removing root deposits
  2. Smoothing the root to remove deposits
  3. scraping the gingival wall of pockets to separate diseased ST with healthy CT (does not remove etiologic agents - bacteria). LA is required.

Probing post S/RP should not be done until re-epitheliazation occurs, which is 2 weeks post op (or else BOP will occur regardless of complete calculus removal)

26
Q

Furcation treatment

A

Class II furcations can be treated with GTR
Bone grafts have the little effect
Max 2M furcations have the poorest prognosis

27
Q

only way to confirm the amount of walls remaining from an osseous defect is via

A

exploratory surgery (NOT probing depths)

28
Q

Calculus buildup most common in the maxilla where and why?

A

buccal surface of max molars due to parotid duct location (stenson duct)

NOTE: subgingival calculus is dark, black due to exposure of GCF

29
Q

Periodontal dressings

A

ZOE and non-eugenol form (CoePak)

- remove 1 week

30
Q

Miller classification for recession

A

Class I recession not to MJG, no bone loss
Class II recession to MJG, no bone loss (good prognosis)
Class III recession to MJG + bone loss (only partial coverage expected)
Class IV recession to MJG + severe bone loss

31
Q

Bacteria presence

A

Healthy: Step. + filamentus actinomyces

Most common: viridans strep. (Alpha hem)

  1. S. salivarus (before teeth)
  2. S. Sanguinis (with teeth)

Age 4-5, flora represents an adult

32
Q

Pattern of movement with:

  1. Magnetostrcitive
  2. piezoelectric
A
  1. elliptical

2. linear

33
Q

Gingival Fibers Groups

A

Type I collagen = hydroxyproline = v. dense at gingival margins. These are not the same as other Type I collagen elsewhere (not as rapid turnover as the skin). Collagen Type IV connects the Type I collagen to the basement membrane fibers.

  1. Gingivodental Group: F, L, M and D surface fibers embedded in the cementum
  2. Circular Group: resist rotation = marginal and interdental gingiva
  3. Transseptal Group: principle gingival fibers = interproximal, horizontal fibers
34
Q

Principle Fibers

A
  1. Transeptal = keep teeth aligned = no osseous conenction
  2. Alveolar crest = prevent extrusion and lateral forces
  3. Oblique = bear vertical forces transformed them to tension on the bone
  4. Apical = found only on fully formed roots
  5. Inter-radicular = only in multi-rooted teeth
35
Q

most common cell type in gingiva

A

fibroblasts –> Type I collagen for tension strength

Lymph drainage of gingiva is submaxillary group
Gingival nerves are mostly myelienated

36
Q

Greatest curvature (contour)

A

mesial of Max CI (mesial anterior teeth)

  • are reduced M to D, and Anterior to Posterior
  • Curves toward the apex FL, away from apex MD

Interseptal bone is based on inter proximal contact:
Flat proximal tooth surface = narrow septa
Extremely convex tooth surfaces = flat crests

37
Q

JE

A
  • Circular stratified squamous non-keratinized tissue = 0.25 – 1.35 mm
  • Increases with age
  • Formed by the oral epi and the reduced enamel epi during tooth eruption, but the reduced enamel epi is not needed to form the JE (thus can form around implants)
  • Attaches to teeth via internal basal lamina (hemi-desmosomes) and to gingiva via external basal lamina
  • Need undifferentiated mesenchymal cells present to restore any diseased JE
  • Disease state = JE migrates = Long JE = occurs due to its proliferation along root surface (but coronal portion detaches, hence appears to undergo migration)
  • Pseudo-pockets are all suprabony due to gingival enlargement = has no JE migration and no bone loss = AKA false or relative pockets = gingival pockets
38
Q

Desquamative Gingivitis

A
  • clinical term, not a Dx.
  • Gingivitis in general is either plaque induced or desquamative

Characterized by: fiery red, PAIN (unlike plaque induced gingivitis), atrophy, OHI does not help (bc its not plaque induced). Requires histology for Dx.

Presents in:

  1. Lichen planus
  2. Benign mucsous membrane Pemphgoid
  3. SLE
  4. Chronic ulcerative stomatitis
  5. Linear IgA disease
  6. Dermatitis herpetiform
  7. Erythema multiform
39
Q

Attached gingiva and Keratinized gingiva

A

Attached gingiva = MGJ + sulcus base (free gingival groove)
• Widest on anteriors (4.5 mm on maxilla, 3.9 mm on mandible)
• Narrowest: F surface of mand. Canine and 1PM; and L of mand. incisors and canines
• Width increases with age due to loss of coronal aspect and with supra-erupted teeth
• This is where “stippling” is = they are located at the intersection of epithelial ridges that cause depression and interspersing of CT papilla between the intersections → bumps
• No rete pegs are found in attached gingiva (epithelial projections that extend to CT)

Keratinized gingiva = MGJ + Gingival margin
• Not keratinized = buccal mucosa, sulcus (has no rete pegs and is thin)

All tissue in oral mucosa regardless of keratinization, is stratified squamous epithelium with CT underneath.

40
Q

Tissue Layers

A
  1. Epithelium (Masticatory mucosa = gingiva, hard palate = keratinized, Linining Mucosa = non-keratinized = all else)
  2. Lamina Propria = BV, nerves, lymphatic
  3. Submucosa = “ “ “ “ + minor salivary glands
  4. Specialized mucosa = taste buds
41
Q

Bone composition %

A

2/3 inorganic (Hydroxyappetite) + 1/3 organic (Type I collagen)

Gingival collagen = Type I = Hydroxylation of proline and lysine via Vit C

HA%: Enamel (90%) > Dentin (70%) > Bone (65%) > Cementum (50%)

42
Q

Bone Formation

A

Mesenchyme cells → fibrous or cartilage

Fibrous = osteoproginator cells = Intramembranous ossification = cranial vault, max., mand.
- Mandible grows most at max. tuberosity site with apposition on the of bone inferiorly and resorption anteriorly

Hyaline Cartilage = Endochondral = osteocytes replace the cartilage = short and long bones (cranial base)

43
Q

Cementum

A
  • Developes from dental sac AFTER Hertwigs sheath is disintegrated.
  • Calcified
  • Avascular
  • New cementum is laid throughout life

Types

  • Acellular = primary cementum = High [sharpey] fibers = attached to the root
  • Cellular = secondary cementum = made only after tooth reaches the occlusal plane = more irregular with cementocytes = less calcified = smaller [sharpey]

Repair occurs on cellular cementum that is NOT in perio pockets or exposed.

Cementum deposits is most at apex to compensate for eruption.

44
Q

Gingival curettage

A
  • Remove ST lining of the pocket only, not the CT, plaque or bacteria
  • non-definitive procedure
  • Used in maintenance visits

NOT used:

  • infrabony defects
  • Fibrotic tissue
  • Acute inflammation
  • MGJ invovlement
  • thin tissue

BEST response seen with edematous and granulomatous inflammation

45
Q

Plaque mineralizes via:

A

High pH –> precipitation of Ca + P ions via low ppt constant

46
Q

Implant success

A

Alberketsson rule:

  1. 85% 5 year survival, 80% 10 year
  2. immobile , no PA radiolcency
  3. no pain or paresthesia
  4. bone loss is
47
Q

Biting force of dentures vs implant supported over dentures vs dentate person

A

1/6 of biting force in CD/CD

Most biting force in dentate person, and is equivalent in an implant case

48
Q

implant level impression

A

impression coping (post) was attached to the implant thus recording the implant position at the implant “level”

If the coping was attached to the abutment, it is called an abutment level impression

If no coping was used, and only the abutment (like a standard crown impression with the abutment), then its a direct abutment impression

49
Q

Perio Brushes

A
  1. Perio-Aid = clean furcations. Note: Bone grafts have little effect on treating furcations. But, Class II furcations have great treatments with GTR.
  2. Stim-U-Dent = Gingival massage or interdental recession or narrow interproximal spaces
  3. Interproximal Brushes = cleans wide interproximal spaces
  4. Interdental stimulator = stimulates circulation of the interdental gingiva. May cause injury to ST, thus not used when papilla is normal.
50
Q

Countersinking in implantology refers to what>

A

Countersinking occurs during the end of an oteotemy (during implant placement) where a bur is inserted in the occlusal end of the osteotomy to increase the diameter off the opening slightly. Used to compensate for dense corticol bone or prepare the bone for a specific implant shape.

Some require “tapping” which is placing a screw threaded groove inside the osteotomy for the same purpose as the countersinking (some implants are self-tapping)

51
Q

Random Implant notes

A
  • The term relative attachment levels is used for implants since no CEJ exists as a landmark.
  • Restorative platform should be placed apical to the CEJ of adjacent teeth for esthetics
  • Cement retained crowns require long implant abutments for high surface area
  • Titanium surfaces can have plaque build up. Thus, 3 month recalls are needed.
  • Over-denture require a 15 degree POW.
  • Cone in socket = morse taper = anti-rotational abutment type = abutment to implant connection
  • Platform switching = combining an abutment and implant that have different diameters = less crestal bone remodeling when the abutment diameter is smaller than the implant diameter, but results in more micro-graps, and bacteria accumulation.

NBDE Part II (13 decks)

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