Perio Flashcards
(271 cards)
1
Q
True or false… streptococcus gordonii is part of the normal oral flora
A
True. It is gram-positive cocci. It is one of the initial colonizers of the dental biofilm. It creates a binding site for other bacteria to adhere in the process known as congregation
2
Q
Name 3 bacterial species that are well-known pathogens responsible for causing periodontitis.
A
Aggregatibacter actinomycetemcomitans, pophyromonas gingivalis, tannerella forsynthia
3
Q
Name three medications that can cause gingival hyperplasia.
A
Calcium channel blockers
Phenytoin (Dilantin)
Cyclosporine
4
Q
During the first 48 hours of plaque formation the majority of the bacteria present are…
A
Gram-positive cocci and rods like streptococcus and actinomyces species
5
Q
What bacterial species is most associated with localized aggressive periodontitis?
A
Aggregatibacter actinomycetemcomitans
6
Q
The mechanism of action that influences the severity of localized aggressive periodontitis is ___
A
Defects in neutrophil chemotaxis
7
Q
What are the most common associated symptoms/signs with acute herpetic gingivostomatitis?
A
Self limiting disease that lasts 10 days
Caused by herpes simplex virus
Fever and lymphadenopathy - vesicles appear two days later
Recurrent gingivostomatitis has a clear preference for keratinized tissues
8
Q
Hermetic gingivostomatitis is typically treated with ___
A
Valacyclovir
9
Q
What bacteria is most commonly associated with acute necrotizing ulcerative periodontitis (ANUP)?
A
Treponema denticola
10
Q
What are the signs/symptoms of acute necrotizing gingivitis?
A
Pain
Interproximal necrosis of papilla
Bleeding gingiva
Fetid odor
Low-grade fever
Pseudomembrane
11
Q
What are the risk factors for acute necrotizing gingivitis?
A
Poor oral hygiene
Smoking
Malnutrition
Fatigue
Stress
Immunocompromised pts
12
Q
___ and ___ are most commonly associated with chronic periodontitis
A
Porphyromonas gingivalis*
Tannerella forsythia
13
Q
What is the difference between primary and secondary occlusal trauma?
A
Primary - trauma that is experienced by a tooth having a normal healthy periodontium
Secondary - condition where a tooth with a compromised periodontium may experience further trauma under normal occlusal loads
14
Q
What are 3 common causes of primary occlusal trauma?
A
Over-filled restorations
Crowns with high occlusion
Heavy biting of hard substances
15
Q
What is the most common cause of gingival recession?
A
Toothbrush abrasion
16
Q
True or false.. calculus on its own does not cause gingivitis
A
True. It provides a hard and rough surface for plaque to grow
17
Q
True or false… sex hormones in puberty can influence inflammation of gingiva
A
True it causes an exaggerated reaction over plaque build up
Estrogen is the primary hormone associated with puberty and pregnancy assocaited gingivitis
18
Q
Name three calcium channel blockers
A
Amlodipine
Verapamil
Diltiazem
All can cause gingival hyperplasia
19
Q
Which periodontal fibers are most likely to cause orthodontic relapse?
A
Supracrestal fibers
20
Q
True or false… the inflammatory response is conducive to healing in a bone graft
A
False. A good bone grating should be biocompatible and should not produce any immune response
21
Q
Aggressive periodontitis is rapidly progressing disease that can be better managed with ___ and ___
A
Complete root debridement
Antibiotic therapy
22
Q
True or false… systemic antibiotics are considered to ensure that the antibiotic molecule reaches the site better than locally placed antibiotics because with locally placed antibiotics, it may not reach the deep pockets.
A
True
23
Q
The ___ is the most important variable when determining the periodontal prognosis of a tooth
A
CAL (clinical attachment loss)
24
Q
What periodontal defect has the worst prognosis for bone grafting?
A
Class 4 furcation
25
____ is an essential factor that increases the success of a free gingival graft
Immobilization of the graft at the recipient site
26
Regeneration of junction all epithelium takes about ___ days to complete after surgery
10-14
27
Debridement of intraoral lesions are performed to remove dead and infected surfaces through the use of ___
3% hydrogen peroxide solution
28
____ also known as lugol’s solution, is a great antiseptic agent that has a wide spectrum of antimicrobial activity and is used to....
1% tincture of iodine
Pre-and post-surgical mouth rinse to reduce chances of bacterial infection over the surgical site
29
True or false... chlorhexidine is an antiseptic rinse that helps remove dead tissues
False
30
An apically repositioned flap usually requires displacement of the gingiva to a more apical position, requireing ____ except when the flap is made on the ___.
Vertical releasing incisions
Palate
31
True or false... the palatal mucosa is firmly attached to the palatal bone and due to its thick nature cannot be displaced apically
True
32
Ultrasonic cleaners produce ___, where rapid movement creates tiny vacuum bubbles in the liquid which burst once they come into contact with contaminants. This reaction is able to scrub particles of bacteria and calculus off of tooth surfaces
Cavitation
33
Ultrasonic ___ action is used for hard-to-reach areas like endodontic canals
Lavage
34
___ Movement differs from ultrasonic mechanism of action. Piezo Movement is in a ___ fashion. ultrasonic Movement is in a ___ fasion .
Piezo
Forward and backward linear
Ovoid
35
A gingivectomy may be used for what 4 things?
Treat suprabony periodontal pockets
Treat gingival enlargement/hypertrophy
Treat suprabony periodontal abscesses
Provide visibility and accessibility for calculus removal and cleaning
36
The apical extent of a gingivectomy may be ___ to the bottom of the periodontal pocket as long as the termination point is ___ the mucogingival junction
Equal or apical
Above
37
Bone defects with ___ walls in the alveolar bone and teeth that exhibit ___ bone loss are good candidates for bone grafting
2-3
Angular
38
True or false... gingivectomies can be performed to reduce pocket depths
False
39
Ultrasonic instruments should NOT be used for patients with ___ because ____
Active infectious diseases
Of the aerosol created by the instruments
40
The technical term for dry socket is ____
Localized alveolar osteitis
41
True or false... systemic antibiotics are indicated in the extraction of mandibular 3rd molars with acute pericornitis
True
42
True or false... systemic antibiotics are needed in a full mouth extraction case with a patient with severe periodontal disease
True
43
Cavitrons work by what 4 mechanisms?
Lavage (flushes the pocket)
Cavitation
Vibration
Acoustic turbulence (agitation observed in fluids by mechanical vibrations that disrupts bacterial cell walls.
44
A partial thickness flap may be used to...
Cover up the dehiscence or fenestration of a root
Or free gingival grafts
45
What is an isograft?
Tissue grafts between two genetically identical people (monozygotic twins)
46
What is the difference between an ostectomy and an osteoplasty?
Ostectomy - surgical procedure that removes supporting bone to reduce/eliminate periodontal pockets
Osteoplasty - surgical procedure that removes non-supported bone.
47
Which is completed first, the ostectomy or the osteoplasty?
Osteoplasty is completed before the ostectomy to allow for the most conservative removal of supporting bone (bundle bone) around the teeth
48
What is the first line of treatment for HIV-associated ANUG?
Debridement with prescription of chlorhexidine 0.12%
49
ANUG and ANUP usually occurs because of the predominance of what bacteria?
Anaerobic fusobacteria and/or spirochetes within the oral cavity, specifically underneath the gingiva
50
A partial thickness flap is indicated when there is less than __mm of attached gingiva
2mm
51
A partial thickness flap is raised with a ___ incision
Internal bevel
52
What are three objectives of the internal bevel incision?
Allows for better adaptation of the gingiva to the junction of the alveolar bone to the tooth
Conserves gingival tissue
Removes the epithelial lining of the periodontal pocket
53
The forming capillary anastomoses of gingival grafts provide the source of nutrients for the free gingival graft after __ days postsurgically
3
54
A barrier such as teflon membrane is placed during a guided tissue regenerative procedure in order to ___
Prevent the formation of long junction all epithelium
55
What is the best way to manage postsurgical root sensitivity? Why?
Plaque control
Acidic metabolites from plaque may cause sensitivity to the exposed root surface
Desensitizing dentrifice may provide temporary relief but it takes up to two weeks to take effect.
56
What are the three types of gingival embrasures?
Type 1 - no loss of interdental papilla
Type 2 - partial loss of interdental papilla
Type 3 - complete loss of interdental papilla
57
The ___ surface of the ___ typically has a type 2 or 3 gingival embrasure resulting in moderate to severe recession with exposure of the root concavitiy. Interdental brushes clean the root concavity much better than floss.
Mesial
Maxillary first premolar
58
What is the intended function a home dental water-irrigation system?
Reduce gingival bacterial load (not bacterial load on tooth surface)
59
___ wound healing involves the approximation of the flaps using the surgical sutures. While the new junctional epithelium will form in approximately ___ weeks, formation and maturation of the ___ takes considerably longer.
Primary
2 weeks
Underlying connective tissue attachment
60
____, is the most common sign of occlusal trauma
Mobility
Another sign of occlusal trauma is a widened PDL
61
What antibody is the most prevalent in saliva? Which antibody is more associate with sulcular fluid?
IgA
IgG
62
What is the purpose of IgA?
To prevent adhesion of the bacteria to the oral tissues because it is bound it IgA instead.
IgA is known as the agglutinizing antibody because it clumps or “glues” bacteria together
63
___ arise from the ___, a remnant of odontogenesis that is more common in middle-aged adult males. ___ are usually not associated with pain, and they usually appear as a unilocular radiolucency on the side of the canines or premolar roots. They are most commonly seen in the mandibular bicuspid area. The involved tooth is usually vital and presents no indication for RCT unless the signs of non-vital or necrotic pulp tissue wer confirmed. They are typically treated by surgical ____
Lateral periodontal cysts
Epithelial rest of malassez
Lateral periodontal cysts
Enucleation
64
Early exfoliation of primary teeth as a result of defective bone mineralization, due to an enzyme deficiency is a characteristic of ____. It is a hereditary disease where there is a marked deficiency in the ____ enzyme.
Hypophosphatasia
Tissue non-specific alkaline phosphatase
65
True or false... calculus rubbing against the gingival tissues causes severe gingival irritation.
False.
The main deleterious effect of calculus is that bacteria attaches to the calculus and releases irritants
66
What does pain upon lateral percussion indicate?
Pressure on an inflamed PDL, not an apical infection
67
Junctional epithelium reattaches to cementum and dentin after an apically repositioned flap by re-establishing ___. Regeneration of junctional epithelium takes about ___ [days/weeks] to complete after the surgery.
Tight junctions
10-14 days
68
Describe the fours stages of pathogenesis of periodontitis
Initial - characterized by the presence of an acute inflammatory reaction as the normal healthy gingiva reacts to plaque accumulation
Early lesion - occurs when an infiltrate of lymphoid cells, particularly T lymphocytes appear on the site of inflammation
Established lesion - B lymphocytes and plasma cells suddenly predominate the site
Advanced lesion - manifests itself as periodontitis and physiologically irreversible loss of bone
69
The severity of ___ is directly related to the amount of plaque accumulation. When ___ are released by the plaque, the gingiva becomes irritated, initiating a defensive reaction through an inflammatory response
Gingival inflammation
Bacterial toxins
70
____ is defined as a white blood cell count above the normal range and is a sign of an inflammatory response that is most commonly the result of infection. It is also observed with __, __, ___ ___, ___, ___, __, and ___
Leukocystosis (neutrophilia is the most common form)
Certain parasitic infections
Cancer
After strenuous exercise
Emotional stress
Pregnancy
Anesthesia
Steroid
Epinephrine administration
71
The epithelium of the free gingival graft experiences ___ a few days after the transplant takes place due to the lack of direct blood supply. The FGG is able to survive through... ___. FGG procedures are performed to ___ . It is usually harvested in which location?
Degeneration
The help of the underlying connective tissue bed that provides nutrition to its surviving epithelial cells.
Increase the keratinized gingival tissue support of an implant material or to cover up areas of gingival recession
Palatal area
72
Wha this the most common reason for maxillary incisors to harbor chromogenic plaque?
Poor oral hygiene
73
What are Miller classifications?
Assess the degree of recession and the amount of interdental bone loss. Class 1 and class 2 recessions do not involve interproximal bone loss.
74
Describe miller classifications 1-4.
Class 1 recession - does not extend to the mucogingival junction
Class 2 recession - extends to or beyond the mucogingival junction, but demonstrates no loss of interproximal clinical attachment
Class 3 recession - extends to or beyond the mucogingival junction, with loss of interproximal clinical attachment or tooth rotation
Class 4 recession - extends to or beyond the mucogingival junction, with severe loss of interproximal bone or tooth rotation
75
True or false.. the presence of fremitis always indicates splinting.
False. Unstable teeth that cannot maintain normal position during centric occlusion need additional support to maintain their position. Splinting to the adjacent teeth provides support for unstable teeth that are experieincing discomfort.
76
Which furcation class has the best prognosis with guided tissue regeneration procedures?
Class 2 - because they are the least severe of pathosis.
77
___ is the most important variable when determining the prognosis of a tooth.
Clinical attachment loss
78
The experimental gingivitis model does not prove that gingivitis always evolves to periodontitis. What 4 things does it accomplish?
Supports the non-specific plaque hypothesis
Demonstrates that the bacterial ecology changes as plaque accumulates
Demonstrates the relationship between plaque formation and gingivitis
Demonstrates that gingivitis is a reversible disease
79
What is the maximum distance between the contact point of two restorations and the crest of the bone in order to achieve 100% complete interproximal papilla to fill?
5mm
6mm, the papilla was present 56% of the time
7mm, the papilla was present 27% of the time or less
80
What is the expected rate of infection after periodontal surgeries? What should the patient do to avoid infection?
What is the most common complication of esthetic crown lengthening?
2%
Avoid any trauma or tooth brushing in the treated area for 2 weeks. 0.12% chlorhexidine rinses are usually prescribed.
Recession, if excessive bone resection has been done.
81
When fabricating a complete mandibular denture for a patient with severe ridge resorption and persistent tissue inflammation, what should the clinician due?
Maximize the extension of the denture distally to distribute the masticatory forces over a broader area
82
When casting gold, shrinkage porosity is associated with ___. Wha happens if the sprue is too narrow? Where should the sprue be placed?
Sprue diameter
The sprue is the channel that allows the molten alloy to reach the mould within the investing material of the wax out procedure.
If the sprue is too narrow, it will prevent the smooth flow of the molten material into the mould, allowing the molten alloy to harden without flowing into all areas of the mould, resulting in shrinkage porosities
Placement of sprue is also important to prevent shrinkage porosities. The sprue must be placed ideally where the wax pattern has its greatest bulk, which is approximately 45 degrees perpendicular to the flat surface of the wax pattern.
83
The pterygomandibular raphe acts as a tendon between which two muscles? It is a landmark used for the ___ when performing ___.
Buccinator and superior constrictor
Pterygomandibular space when performing an IA block.
The injecting needle pierces the buccinator muscle to inject the local anesthetic solution in the pterygomandibular space
84
What is the only property of a base metal alloy that is numerically lower than gold?
Specific gravity.
85
What is the purpose of using a liner when casting gold with a casting ring?
It allows for uniform setting of the casting
Liners are placed along the internal aspect of the casting ring and provide space for uniform investment expansion, allowing for the uniform setting of the casting.
Allowing investment expansion prevents distortion of the wax pattern during investment
The liner acts as a spacer that prevents pressure from building up betwen the investment material and the casting ring during the expansion of the investment
86
Liners are usually placed __ shorter than the casting ring and demos to a thickness of ___
3mm
1mm
87
The ___ major connector is the best RPD connector option for patients with a shallow lingual vestibule
Lingual plate
88
Patients with a ___ total vestibular depth with respect to the free gingival margins must be restored with the lingual plate major connector.
6mm
89
The free gingival margin must be about ___ away form the major connector. The bar itself must be ___ thick for strength. Because this distance is not possible with a shallow vestibule, the placement of a lingual plate is indicated.
3mm
5mm
Interruptions in major connectors are supposed to prevent plaque deposition and facilitate cleaning
90
___ is the ability of a material to resist fracture while bending and is also known as a modulus of rupture, bend strength, or fracture strength. The ___ test is the most frequently employed to evaluate the ___ of a material using a 3-point flexural test technique
Flexural strength
Transverse bending
Flexural strength
The significance of flexural strengh is commonly expressed in class V cervical restorations
91
___% of platinum, palladium, or gold is required for an alloy to be considered a noble metal. High noble alloys have ___% noble metals with ___% or more being gold
25%
>60%
40%
Note that silver is not considered a noble metal although it does improve castability
92
____ release alcohol as a by-product during their setting reaction
Condensation silicones (not addition silicones)
93
When extra water is added to gypsum-bonded casting investments, you should expect [more/less] setting expansion.
Less
94
What type of RPD direct retainers is considered the most esthetic?
Intracoronal attachment
95
When soldering a FPD before porcelain application, the greatest risk of failure is in ___ resulting in ___
Overheating
Surface pitting, internal porosity, other microstructural changes resulting in a weak joint
96
Which problem can occur when a custom tray without occlusal stops is used to make a polysulfide final impression?
An inaccurate final impression occurs due to permanent distortion incurred during the setting reaction
Occlusal stops prevent overheating of the impression on insertion as well as removal
Both condensation silicones and polysulfide impression materials undergo polymerization shrinkage during setting
Polyethers are also known to readily absorb water, making them less dimensionally stable if the impression is not poured within 24 hours
97
A stiffer or a rigid substance will have a [higher/lower] modulus of elasticity and vice versa
Higher
98
Elastic modulus is also defined as a measure of ___/___.
Stress/strain
99
What is the most probable explanation for the margins of a metal framework for a PFM crown being sealed during the framework try-in, then NOT being sealed after the porcelain is applied two days later?
The porcelain proximal contacts were overcontoured
100
When comparing high-noble alloys to base-metal alloys. Base metal alloys have a higher ___
Melting point
High-noble metals also have a lower modulus of elasticity since they are less rigid
101
True or false... high-noble metals resist oxidation
True
102
True or false.. high-noble alloys are more difficult to case because of their lower melting point.
False. It is easier
103
True or false... base-metal alloys are harder and stronger than high-noble alloys
True
104
___ interferences are the most destructive types of interferences
Non-working
105
A lingual bar major connector requires a minimum of __mm in cervicoocclusal height and should be approximately ___mm away from the marginal gingiva
4
4
106
After packing acrylic resin into the denture flasks, one should wait to cure the resin to...
Make sure temperature equilibrium exists between the flask and acrylic
Allowing the dental flask packed with acrylic to remain under the bench press until equilibrium in temperature is achieved will give enough time for the acrylic to achieve better monomer-polymer interaction and create a stronger chemical bond
107
Relining a RPD is indicated when ____.
The distal extensions are depressed due to loss of support along the distal alveolar ridge
108
The thinnest/weakest portion of the wax pattern should be placed ___. Sprue formers should be attached to the __ part of the wax pattern to ensure the smooth flow of alloy
In the deepest part of the ring or farthest from the sprue base to ensure that the margins of the wax pattern will not be insufficient when contraction occurs
Bulkiest
109
The path of insertion of the key into the key way should be parallel to the path of insertion of the retainer [carrying/NOT carrying] the key way.
NOT carrying
110
Brittle materials can be hard solid material that can withstand heavy compression but not ___.
They exhibit low ___ strength and may fracture or break instead of ring deformed.
Tension
They exhibit low tensile stress
111
A retainer tooth for an FPD is severely tipped mesially. A short ___ axial wall most diminished the long-term prognosis.
Distal
112
Name 5 uses for surveyors.
Measuring the depth of an undercut
Determine the best path of draw for an RPD
Identifying bony areas to be removed with alveoloplasty
Identifying undercuts for survey crowns
Blocking out master casts when fabricating RPDs
113
___ is the impression material most prone to fracture when forcibly removed from the mouth due to its stiffness
Polyether
114
___ is a non-aqueous hydrophilic elastomeric impression material that is considered the most rigid impression material. It is the stiffest among the elastomeric impression materials and will fracture when forcefully removed when it is engaged in an undercut. It is a stable impression material and can be used in a moist environment since its hydrophilic.
Polyether
115
Increasing the ___ (which includes the ___) helps establish a more balanced occlusion during lateral excursive and protrusive movements when fabricating a denture.
Compensating curve
Curve of spee, curve of monson, curve of Wilson
116
___mm is the minimum distance between the major connector of a maxillary RPD and the free gingival margin of a tooth. Having a space this large between the framework and the gingival margin prevents ___. The border of the mandibular RPD framework should be at least ___mm from the gingival margin and ___-___mm from the floor of the mouth
6mm
Irritation of the gingiva
3mm
6-8mm
117
Clasped teeth in RPDs must have more than ___ degrees encirclement so that the prosthodontic device doesn’t have any ___ effect.
180
Orthodontic
118
True or false... reciprocation clasp arms do not need to be flexible, because they are placed above the height of contour and not in the undercuts
True
119
What is the name for a 1 wall, 2 wall, 3 wall, and 4 wall infrabony defect? Which is the most common?
1 wall = hemiseptal
2 wall = crater (most common)
3 wall = trough
4 wall = circumferential (extraction site)
120
In a 2 wall defect, which bony walls remain?
Buccal and lingual
121
What does miller classification classify?
Recession
Determines likelihood of regaining root coverage
122
Define miller classification 1-4.
Class 1 = marginal tissue recession not extending to the mucogingival junction. No loss of interdental bone or soft tissue
Class 2 = mariginal tissue recession extends to or beyond the mucogingival junciton. No loss of interdental bone or soft tissue
Class 3 = marginal tissue recession extends to or beyond the mucogingival junction. Interproximal bone or soft tissue loss present or tooth malpositioning prevents total root coverage.
Class 4 = marginal tissue recession extends to or beyond the mucogingival junction. Interdental bone or soft tissue loss or tooth malpositioning is so severe that root coverage is not anticipated
123
What is hereditary gingival fibromatosis?
Hereditary condition in which gingiva is enlarged, non-hemorrhagic and firm
124
Localized aggressive periodontitis has a predilection for which sites?
Molars and incisors
125
Bacteria in the plaque that are closest to the tooth structure tend to be gram ___. Bacteria in the plaque that are furthest away from the tooth (closer to the epithelium) tend to be gram ___.
+
-
126
Supragingival components of plaque are derived from ___. Subgingival components are derived from ___.
Saliva
GCF
127
The dental pellicle forms within ___. It consists of what things?
Seconds
Glycoproteins
Proline-rich proteins
Other molecules that serve as attachment sites for bacteria
128
Adhesion and attachment of bacteria occurs within ___. Initial adhesion is due to what kind of forces? Firm attachment is due to what kinds of forces?
Minutes
Van der waals electrostatic forces
Strong, irreversible interactions between specific bacterial adhesion molecules and host pellicle receptors
129
What is the third step of dental plaque formation? How long does it take for this step to occur?
Colonization and plaque maturation
24-48 hours
130
In the colonization and plaque maturation step of dental plaque formation, firmly attached ___ provide newreceptors for attachment of other bacteria in a process called ___. As bacteria grow and the biofilm matures, there is a shift from ___ to __.
Primary colonizers
Coadhesion
Facultative gram-positive to anaerobic gram-negative
131
Secondary (late) colonizers tend to feed on ___ rather than ___ like primary (early colonizers)
Amino acids
Sugars
132
What is the role of fusobacterium nucleatum in dental plaque?
It serves as a bridge between primary and secondary colonizers. It “glues” the bacteria together.
At this point the plaque is living and active
133
What is quorum sensing?
Referees to communication among bacteria in a biofilm to encourage growth of beneficial species and discourage growth of competing species.
Note that biofilm bacteria are more restitant to antimicrobial than plankonic (free-swimming bacteria )
134
The red complex is associated with __ and __. Name the three bacteria species that are in this complex.
BOP and deeper pockets
p. Gingivalis
T. Denticola
T. Forsythia
135
The orange complex precedes the presence of red complex supporting sequential nature of plaque maturation. Name the three bacteria species that make up the orange complex.
Fusobacterium
Prevotella intermedia
Campylobacter rectus
136
A. Actinomycetemcomitans is involved in ___ periodontitis. It a ___, ___ rod. It is capnophilic (meaning... )
Aggressive
Nonmotile, gram negative
Grows well in carbon dioxide environment
137
A. A. Have what 4 toxins? What do they do?
Leukotoxin - kills human neutrophils, monocytes, and lymphocytes
LPS (endotoxin) - component of all gram-negative outer membranes
Collegenase
Protease that cleaves IgG
138
P. gingivalis is involved in ___ Periodonttis. It is a nonmotile, gram ___ rod. It has ___ which are important in adherence. It has a capsule. It has what 3 toxins/proteins?
Chronic
Negative
Fibriae
Gingipain - protease that cleaves host proteins
Collegenase
Hemolysin
139
T. Denticola is involved in what type of periodontitis/gingivitis? It is a motile, gram ___ ____. It penetrates epithelium and connective tissue. It has protease that can degrade collagen, immunoglobulins, and complement factors.
ANUG/ANUP
Negative, spirochete
140
_____ is in the orange complex and is involved in pregnancy gingivitis. It is a nonmotile, gram-negative rod. It becomes darkly pigmented when grown on blood agar plates
P. Intermedia
141
C. Rectus is part of the ___ complex. It is a [motile/nonmotile] gram ____ rod and has ____
Orange
Motile
Negative
Polar flagellum
142
F. Nucleatum is part of the ___ complex. It is a nonmotile, gram negative rod that induces apoptosis of leukocytes and release of tissue-damaging substances from leukocytes. What else is important about this bacteira?
Orange
It is the “bridge” bacteria that “glues” the plaque together.
143
What two types of bacteria tend to associated with implants?
Pseudomonas
Staph
144
Precipitation of mineral salts into plaque usually occurs within __-___ days.
1-14
145
Subgingival calculus is mineralized via ___
GCF
146
Describe orange stains
Usually on anterior teeth
Due to poor oral hygiene
147
Describe brown stains
Due to drinking dark-colored beverages and poor oral hygiene
148
Describe dark brown and black stains
Due to tobacco
149
Describe yellow-brown stains
Due to chlorhexidine and stannous fluoride
150
Describe black stains.
Thin lines on cervical third. Found in healthy mouths, due to consumption of iron
151
Describe green and yellow stains.
Usually on anterior teeth, due to poor oral hygiene and chromogenic bacteria
152
Describe bluish-green stains
Occupational exposure to metallic dust.
153
True or false... green/yellow stains on teeth due to poor oral hygiene and chromogenic bacteria are easily removed by brushing
False. They are nearly impossible to remove.
154
___ and ___ associated with missing teeth can lead to food impaction and plaque retention
Mesial drift
Extrusion
155
True or false... overcontoured restorations are worse for gingival health than undercontoured restorations
True
156
Even when not faulty, subgingival crown margins are associated with __, ___, and __.
Plaque accumulation
Gingival inflammation
Deeper pockets
157
True or false... periodontal health must always be established before initiating orthodontic therapy
True
158
___ are the first line of defense in controlling the bacterial challenge and inconsequently destroy the periodontal tissue via release of destructive molecules
Neutrophils
159
How do neutrophils get to the periodontal pocket?
Migrate from subepithelial vascular plexus into the periodontal pocket by directed locomotion called chemotaxis where they form a barrier to protect the body from periodontal bacteria
160
Neutrophils internalize bacteria via ___ and kill them using “biological bleach” which consists of __ and ___
Phagocytosis
Myeloperoxidase
Oxygen radicals
161
What is the most important proteinase involved in the destruction of periodontal tissues by neutrophils. It is inhibited by ___
MMP-8 (neutrophil collegenase)
Tetracyclines
162
Defective neutrophil chemotaxis leads to ___
Aggressive periodontitis
Too much neutrophil activity leads to self-inflicted tissue destruction. Too little neutrophil activity leads to unchecked microbial challenge which also leads to tissue destruction
163
Name 4 neutrophil abnormalities
Neutropenia
Chediak-Higashi syndrome
Papillon-lefevre syndrome
LAD-1 and LAD-2
164
Macrophages regulate the immune response via cytokines like ___
IL-8
165
Mast cells are responsible for causing vascular [constriction/permeability] . What antibody do they release?
Permeability (and dilation)
IgE
166
Name 5 important proinflammatory mediators
```
IL-1
IL-6
PGE2
TNF-alpha
MMPs
```
167
IL-1 is associated with ___
Bone resorption
168
TNF-alpha is associated with ___
Macrophage activation
169
MMPs are involved in ___
Collagen destruction
170
Name 3 important anti-inflammatory mediators
IL-4
IL-10
TIMPs
171
In stage 1 gingivitis, the ___ lesion, occurs in __-__ days. What occurs in this stage?
Initial
2-4 days
Neutrophil infiltration, increased GCF
172
In stage 2 of gingivitis, the ___ lesion, occurs in __-___ days. What occurs in this stage?
Early
4-7 days
T lymphocyte infiltration
Increased collagen loss
BOP
173
In stage 3 of gingivitis, the ___ lesion, occurs in __-___ days. What occurs in this stage?
Established
14-21 days
B lymphocyte infiltration including mature plasma cells
Collagen loss
Clinical changes in color, contour, consistency
174
In stage 4 of gingivitis, the ___ lesion, what occurs?
Advanced
Transition to irreversible damage of periodontitis
175
What is the short term goal of periodontal therapy?
Reduce gingival inflammation by correcting conditions that cause it
176
What are the long-term goals of periodontal therapy?
Eliminate pain
Arrest hard and soft tissue destruction (CAL)
Establish occlusal stability and function
Reduce tooth loss - NOT designed to save all teeth
Prevent disease recurrence
177
How many phases are in periodontal treatment planning?
5
178
What is the purpose of the 0 stage (preliminary phase) of periodontal therapy?
Treat emergencies
Extract hopeless teeth***
179
What is the first phase of periodontal therapy? What occurs in this phase?
Non-surgical phase
Plaque control and patient education
Diet control
Caries control
Prophylaxis, SRP, OHI to remove local factors
Correct restorative irritational factors
Local or systemic antibiotics
periodontal re-evaluation after 4-8 weeks***
180
Periodontal re-evaluation should occur __-___ weeks after the completion of phase 1 therapy to allow for healing and formation of the ___
4-8 weeks
Junctional epithelium
181
What is the second phase of periodontal therapy? What does it involve?
Surgical phase
Reduce or eliminate pocket depths***, correct soft and hard tissue defects, regenerate periodontal tissues, or place implants
Periodontal therapy, including placement of implants
Endodontic therapy
182
What occurs in the third phase of periodontal therapy? What is it called?
Restorative phase
Final restorations
Fixed and removable prosthodontics
183
What is the 4th phase of periodontal therapy? What does it involve?
Maintenance phase
Also called supportive periodontal therapy, involves Periodic ongoing evaluation of OHI and condition of periodontal tissues
Periodontal maintenance performed in a continuum with phase 2 and phase 3 therapy every 3 months for the first year
184
Define risk factor
Casually associated with the disease (smoking leads to periodontal disease)
185
Define risk determinant
Unchangeable background characteristics, increases likelihood of disease (gender, genetics)
186
Define risk indicator
Not casually associated with the disease (stress, osteoporosis may influence periodontal disease)
187
Define risk marker or predictor
Quantitative association with disease (previous history, attachment level)
188
Name 4 risk factors of periodontal disease
Smoking
Diabetes
Pathogenic bacteria
Microbial tooth deposits
189
Name 4 risk determinants of periodontal disease
Genetic factors - periodontitis may be heritable, polymorphisms in IL-1 genes may contribute to severe chronic periodontitis
Age - due to prolonged exposure to etiologic factors rather than the actual aging process
Gender - males have more CAL than females
Socioeconomic status - decreased dental awareness, frequency of dental visits, and more smoking
190
And 4 risk indicators of periodontal disease
HIV/AIDS - ANUG/ANUP is more often seen in immunocompromised individuals
Osteoporosis - reduced bone mass may have an impact on progression of periodontal disease
Infrequent dental visits
Stress - emotional stress may interfere with normal immunologic function
191
Name 3 risk markers
BOP
CAL***
Previous history of disease
192
Define prognosis
Prediction of the outcome of a disease
Prognosis for individual teeth must be considered in the context of the entire dentition
193
True or false.. a younger patient with the same level of disease as an older patient has a worse prognosis
True
194
True or false... PPD is more important than CAL in determining prognosis
False. CAL is more important
195
Name 5 clinical factors that affect prognosis
Age
Disease severity
Plaque control
Patient compliance
Type of bone loss
196
Which has a better prognosis, vertical or horizontal bone loss?
Vertical bone loss has a better prognosis than horizontal bone loss because it can potentially be treated with regenerative therapy (especially in 3-wall defect)
197
Name 3 systemic factors that affect the prognosis
Smoking - smokers have increased prevalence and severity of periodontal disease and decreased healing response to both nonsurgical and surgical therapy
Diabetes - poorly controlled diabetes has worse prognosis than well-controlled diabetes
Parkinson’s - compromise the pts ability to perform oral hygiene
198
What is the most important fact in determining prognosis?
CAL
199
Define exploratory stroke
Light feeling stroke used with probes and explorers
200
Define scaling stroke
Short, strong pull stroke to remove hard deposits
201
Define root planing stroke
Light to moderate pull stroke for final smoothing
202
Describe the strokes used for ultrasonics
Light intermittent strokes with tip parallel to the tooth surface and in constant motion
203
When initially inserting a curette into the pocket, angulation between the blade and the tooth should be ___ degrees (___-angle). when scaling and root planing, the angulation is changed to __-___ degrees (___-angle)
0
Closed
45-90
Open
204
What is a prophy jet?
Delivers slurry of water and sodium bicarbonate to remove extrinsic stains and soft deposits
205
Gingival flap designs should have a [narrower/wider] base to ensure adequate blood supply. Incisions should be over ___ bone, not over ___. The corners of the flaps should be [rounded/sharp]. Vertical releases should be made at ____. Make sure to avoid vital structures. What is the most important post-operative consideration after periodontal surgery?
Wider
Intact. (Not over bony defects or eminences)
Rounded
Line angles of teeth
Plaque control
206
What are some areas to avoid when making incisions?
Canine eminence
Piriform ridge
Lingual of mandible
Bony defects
Be careful in the labial maxilla (infraorbital region) and lingual of mandible
207
What kinds of flaps are indicated for mucogingival surgery? Why?
Split thickness (AKA partial thickness, AKA mucosal) flaps
Exposing the bone is unnecessary
208
What type of flap is indicated for osseous surgery, apically repositioned flaps, and periodontal regeneration? Why?
Full thickness (AKA mucoperiosteal) flaps
The bone is necessary to access
209
Whenever alveolar bone is exposed, like in full thickness flaps, expect about ___mm of bone resorption and remodeling.
1mm
210
A full thickness flap involves three horizontal incisions. Describe them.
Internal (reverse) bevel - about 1mm from the gingival margin, removes pocket lining yet conserves outer gingiva
Sulcular (crevicular) - through the base of the pocket to the alveolar crest
Interdental (interproximal) removes the collar of tissue around the tooth you created with the first two incision.
211
What is the modified widman flap? What is its goal?
Involves three incisions (internal bevel, sulcular, and interdental) and provides access to subgingival areas for debridement with the goal of new attachement
212
What is an internal bevel incision?
About 1mm from the gingival margin, removes pocket lining yet conserves outer gingiva
213
What is an apically repostitioned flap?
Modified widman flap with additional vertical releasing incisions made beyond the mucogingival junction in order to attain pocket reduction.
214
The periodontal pack consists of ___. It is left in place for ___. Packs are placed. To protect the surgical wound, minimize discomfort, maintain tissue placement, and help prevent post-op bleeding. They [do/do not] enhance healing.
ZOE
1 week
Do not
215
True or false... periodontal packs enhance healing
False
216
What are the two types of gingival surgery?
Gingivectomy
Gingivoplasy
217
What is the difference between gingivectomy and gingivoplasty?
Gingivectomy = excision of gingiva to eliminate suprabony pockets or gingival enlargements. More aggressive.
Gingivoplasty = excision of gingiva to reshape tissue deformities. Less aggressive, more for esthetics.
218
In gingival surgery, healing is by ___ intension because...
Secondary
There is no tissue to approximate
219
What is the purpose of distal wedge surgeries ( a type of gingival surgery)?
Pocket reduction distal to terminal molars
220
What is the difference between maxillary and mandibular distal wedge procedures?
Maxillary = full thickness flap with parallel incisions
Mandibular = full thickness flap with V-shaped incisions
221
The second category of periodontal surgery is mucogingival surgery. This includes both the gingiva and the mucosa below and above the mucogingival line. What is the purpose of a free gingival graft? What is the purpose of a connective tissue graft?
Free gingival graft = widen band of keratinized tissue
Connective tissue graft = increase root coverage
222
Name 5 different types of mucogingival surgeries. Describe them.
Free gingival graft - widen band of keratinized tissue. (Occurs at or apical to the gingival margin)
Connective tissue graft - increase root coverage (occurs at or above the gingival margin
Frenecotmy - complete removal of frenum
Frenotomy - incision of frenum
Vestibuloplasty - deepen the vestibule
223
Why is a free gingival graft considered “free”?
A free graft by definition is transplanted without a nourishing blood supply so it must undergo revasularization from the recipient bed.
224
What is the ideal thickness of a free gingival graft?
1-1.5mm
225
No minimum width of attached gingiva has been established, but at least ___ is a good amount.
2mm
226
Why is keratinized tissue so great?
Attached gingiva helps enhance plaque removal (less painful brushing), improves esthetics, and reduces inflammation around abutment teeth and implants.
227
Why is connective tissue grafting less painful than free gingival grafts?
Harvest the inner connective tissue and not the epithelium
Donor sites should always have tough attached gingiva
228
Where is the most common donor site for both free gingival grafts and connective tissue grafts?
Hard palate
229
The third category of periodontal surgery is osseous surgery. Visualization of bony architecture allows clinician to determine the types of bony defects that are present and the extent of those defects. What are the three different types of bony architecture?
Positive architecture
Flat architecture
Negative architecture
230
Describe the three different types of bony architecture.
Positive architecture - interproximal bone is coronal to radicular bone, (normal ideal alveolar bone morphology)
Flat architecture - interproximal and radicular bone are at same height
Negative architecture - interproximal bone is apical to radicular bone
231
What is the difference between ostectomy and osteotomy?
Ostectomy - removal of supporting bone
Osteotomy - removal of non-supporting bone
232
After ostectomy, peaks of bone often remain at the line angles called ____ which predispose to periodontal pockets in these area.
Widow’s peaks
233
Define regeneration, repair, reattachment, and new attachment
Regeneration - completely restore architecture and function
Repair - not completely restore architecture and function, involving healing by scar or formation of long JE
Reattachment - reunion of epithelial and connective tissue with root surface after incision or injury
New attachment - embedding of new PDL fibers into new cementum that has been previously deprived of its original attachment
234
The fourth category of periodontal surgery is periodontal regeneration. It seeks to regenerate bone, cementum, and PDL. This is called GTR (____)
Guided tissue regeneration
235
What are the three “B’s” of periodontal regeneration? What are their roles?
Barrier membrane - the “tank” - it prevents soft tissue downgrowth and permits hard tissue ingrowth
Bone graft - the “damage” - osteoconductive, osteoinductive, and/or osteogenic
Biological agent - the “healer” - creates an environment conducive to tissue formation
236
Name the cells that populate a wound area during the healing process from fastest to slowest.
1 - epithelial cells
2 - CT cells
3 - PDL cells
4 - bone cells
237
Why do we need a barrier in GTR?
Because bone cells are the slowest to populate a wound area. We want to prevent soft tissue to populate the wound area, we want bone and PDL cells
238
Root surface treatment involves the use of chelating agents such as ___ and ___ which can expose the ___- through demineralization and may improve new attachment
EDTA and citric acid
Collagen fibrils
239
What is an alloplast bone graft?
Synthetic or inorganic bone graft material
240
What is the difference between osteoconductive, osteoinductive, and osteogenic?
Osteoconductive = scaffold
Osteoinductive = convert neighboring progenitor cells into osteoblasts
Osteogenic = make bone directly
241
An autograft has which regeneration quantities? What about allograft, xenografts and alloplast?
Autograft = osteoconductive, osteoinductive, and osteogenic
Allograft = osteoconductive, osteoinductive (not osteogenic)
Xenografts and alloplasts are osteoconductive only
242
What is the treatment for 1 and 2 wall bony defects?
Resection (ostectomy), recontour bone to restore positive architecture
243
What is the treatment for 3 and 4 wall bony defects?
Regeneration, better blood supply and cell source proximity
244
____ is the ideal for regenerating infrabony defects
Deep narrow 3 wall
Because it provides protection to the graft and allows more room for healing cells to populate
245
___ is ideal for regenerating furcation defects.
Hamp class 2 (buccal upper or either buccal or lingual of lower)
246
___ is ideal for regenerating recession defects
Miller class 1 with thick gingival biotype and wide band of keratinized tissue
247
Antibiotics are most often used for ___ and ___ perio cases during phase ___ treatment.
Aggressive
Refractory periodontitis
1
248
Tetracyclines concentrate in the ___ which make it helpful for perio. ___ only requires one dose per day which may improve patient compliance
GCF
Doxycycline
249
What is the most powerful combination for periodontal disease?
Amoxicillin and metronidazole for 14 days
Duration is more important than dose - the longer the better
Avoid alcohol with metronidazole
250
When are local delivered antibiotics used?
When localized recurrent and/or residual PD of 5 or greater with inflammation still present following conventional therapies
251
Name three local delivery antibiotics? (Brand name and drug type)
Arrestin - Minocycline
Atridox- Doxycycline
PerioChip = Chlorhexidine gluconate
252
Host modulation therapy aims to ____. When should/can it be used?
Downregulate the destructive aspects of the host response
Should only be used as an adjunct to mechanical debridement during phase 1
Chronic periodontitis
253
What are three different types of medicaments used for host modulation therapy systemically? What are their purposes?
NSAIDS - inhibit prostaglandins thus inhibiting inflammation
Bisphosphantes - inhibit osteoclasts (BRONJ is a significant side effect)
Subantimicrobial dose doxycycline - inhibits MMPs (collagenases) 20mg twice daily for 3-9 months (periostat). Only one of these three that is currently approved by the FDA and accepted by ADA
254
Name 2 locally administered host-modifying agents
Emdogain = enamel matrix proteins
PDGF = GEM 21S
These surgical adjuncts may also influence periodontal regeneration
255
Define traumatic occlusion
Injury to the periodontium resulting from occlusal forces that exceeds the reparative capacity of the attachment apparatus
256
Define teh two types of traumatic occlusion
Primary = caused by excessive forces on a normal periodontium
Secondary = caused by normal occlusal forces on a reduced periodontium
257
True or false... in regards to traumatic occlusion, occlusal therapy should be delayed until after inflammation is resolved
True
258
What is a furcation plasty?
Smooth the furcation and enlarge it so the patient can easily clean it
259
What is furcation tunneling?
Move the tissues and bone apically to create a grade 4 furcation so the furcation is easy to clean
260
How is root amputation helpful for furcation involvements?
Leaves an open area so the furcation is easier to clean (DB root of maxillary molars are most common because it is the smallest root)
261
How is a hemisection useful for furcation correction?
Cutting the molar in two, leaving room to easily clean the furcation area.
262
Name 4 ways to correct furcation involvements
Furcation plasty
Tunneling
Root amputation/root resection
Hemisection/premolarization
263
What is the best method of toothbrushing?
Bass method
Bristles at 45 degrees and extend about 0.5mm subgingival to effectively disrupt plaque buildup
264
Periodontitis is most prevalent in what population?
Males of African descent
265
The distance from the CEJ to the base of the pocket is a measure of...
Clinical attachment level
266
What is the primary treatment objective of guided tissue regeneration?
Coronal movement of the PDL
267
Which type of bacteria is routinely involved in cases of chronic periodontitis?
```
P. Gingivalis
T. Forsythia
P intermedia
C rectors
A.A
```
P gingivalis
268
Which of the following is not a feature of the modified Widman flap?
Full thickness flap
Reduction of osseous defect
Precise horizontal incisions
Provides improved visual access to periodontally involved tissues
Reduction of osseous defects (no ostectomy with the modified widman flap, ostectomy IS performed with the normal widman flap)
269
The best indication of success of periodontal therapy is ___
The best indication of for determining prognosis is ___
Lack of BOP
CAL
270
What is the mechanism of action as used in host modulation therapy?
Prevents further breakdown of periodontal tissues by blocking collegenase**
(Host modulation therapy = less than the usual dose, it is not being used as an antibiotic)
271
The predominant inflammatory cellsin the periodontal pocket are which of the following?
Lymphocytes
Plasma cells
Neutrophils
Macrophages
Neutrophils
