Perio Flashcards
(373 cards)
1
Q
Loss of tooth substance by mechanical wear is \_\_\_\_\_. A. Abrasion B. Attrition C. Erosion D. Abfraction
A
A. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
2
Q
The width of keratinized gingiva is measured
as the distance from the _____.
A. Free gingival margin to the mucogingival
junction
B. Cementoenamel junction to the mucogingival
junction
C. Free gingival groove to the mucogingival
junction
D. Free gingival margin to the base of the pocket
A
A. Keratinized gingiva extends from the free gingival
margin to the mucogingival junction. The attached
gingival extends from the free gingival groove to
the mucogingival junction.
3
Q
Which of the following best distinguishes peri-
odontitis from gingivitis?
A. Probing pocket depth
B. Bleeding on probing
C. Clinical attachment loss
D. Presence of suppuration
A
C. Gingivitis is characterized by inflammation of the
gingival tissues with no loss of clinical attachment.
Periodontitis is characterized by inflammation with
loss of clinical attachment.
4
Q
A 22-year-old college student presents with oral
pain, erythematous gingival tissues with blunt
papillae covered with a pseudomembrane,
spontaneous gingival bleeding, and halitosis.
There is no evidence of clinical attachment
loss. What form of periodontal disease does
this patient most likely have?
A. Gingivitis associated with dental plaque
B. Localized aggressive periodontitis
C. Generalized chronic periodontitis
D. Necrotizing ulcerative gingivitis
A
D. Because there is no loss of attachment, the diag-
nosis would not be periodontitis. The clinical
description of pain, erythema, blunt papillae,
pseudomembrane, and halitosis is consistent
with necrotizing ulcerative gingivitis.
5
Q
Which of the following methods of radi-
ographic assessment are best for identifying
small volumetric changes in alveolar bone density? A. Bitewing B. Periapical C. Subtraction D. Panoramic
A
C. Radiographs must be taken in a standardized
format at repeated visits to be assessed for small
changes in bone density over time, using sub-
traction radiography. Radiographs are usually
standardized by using a bite registration block to
relocate the x-ray at the same place and angula-
tion each time.
6
Q
What tooth surfaces should be evaluated for
furcation involvement on maxillary molars?
A. Palatal, facial, and distal
B. Mesial, distal, and palatal
C. Facial, palatal, and mesial
D. Facial, mesial, and distal
A
D. Maxillary molars usually have three roots (mesio-
buccal, disto-buccal, and palatal). Furcation
involvement can be assessed on these teeth from
the facial (bifurcation between the mesio-buccal
and disto-buccal roots), mesial (bifurcation
between the mesio-buccal and palatal roots) and
distal (bifurcation between the disto-buccal and
palatal roots).
7
Q
What bacterial species are found in increased
numbers in the apical portion of tooth-
associated attached plaque?
A. Gram-negative rods
B. Gram-positive rods
C. Gram-positive cocci
D. Gram-negative cocci
A
A. Subgingival plaque can be in the cervical area
or more apical. In both areas it can be either
tooth-associated or tissue-associated. The apical
tooth-associated plaque is composed primarily of
gram-negative rods.
8
Q
What are the major organic constituents of bacterial plaque? 1. Calcium and phosphorous 2. Sodium and potassium 3. Polysaccharides and proteins 4. Glycoproteins and lipids A. 1 and 2 B. 2 and 3 C. 3 and 4 D. 2 and 4
A
C. Calcium, phosphorous, sodium, and potassium
are inorganic components of dental plaque.
Polysaccharides, proteins, glycoproteins, and
lipids are organic components of dental plaque.
9
Q
Although many plaque bacteria coaggregate,
which of the following bacteria is believed to
be an important bridge between “early coloniz-
ers” and “late colonizers” as plaque matures
and becomes more microbiologically complex? A. Porphyromonas gingivalis B. Streptococcus gordonii C. Hemophilus parainfluenzae D. Fusobacterium nucleatum
A
D. Fusobacterium nucleatum can be found in health
and disease. This bacterium is an important bridge
between early and late colonizers of the dental
plaque biofilm.
10
Q
What features best characterize the predomi-
nant microflora associated with periodontal
health?
A. Gram-positive, anaerobic cocci and rods
B. Gram-negative, anaerobic cocci and rods
C. Gram-positive, facultative cocci and rods
D. Gram-negative, facultative cocci and rods
A
C. Periodontal health is characterized by a
microflora dominated by gram-positive, faculta-
tive cocci and rods.
11
Q
- Which of the following microorganisms is fre-
quently associated with localized aggressive
periodontitis? A. Porphyromonas gingivalis B. Actinobacillus actinomycetemcomitans C. Actinomyces viscosus D. Streptococcus mutans
A
B. Porphyromonas gingivalis has been associated
with chronic periodontitis. Actinomyces viscosus
is usually associated with health or gingivitis.
Streptococcus mutans is associated with dental
caries. Actinobacillus actinomycetemcomitans
has been associated with localized aggressive
periodontitis.
12
Q
Which of the following is the primary etiologic
factor associated with periodontal disease?
A. Age
B. Gender
C. Nutrition
D. Bacterial plaque
A
D. Although age, gender, and nutrition may have an
impact on periodontal disease, the accumulation
of the bacterial plaque biofilm is the primary ini-
tiator of the disease.
13
Q
Inadequate margins of restorations should be corrected primarily because they \_\_\_\_\_. A. Cause occlusal disharmony B. Interfere with plaque removal C. Create mechanical irritation D. Release toxic substances
A
B. Inadequate or overhanging margins serve as a
nidus for dental plaque accumulation and make
plaque removal difficult.
14
Q
Light smokers are likely to have less severe
periodontitis than heavy smokers. Former
smokers are likely to have more severe peri-
odontitis than current smokers.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A
C. Individuals who smoke cigarettes are more likely
to have periodontal disease than are nonsmok-
ers. The number of cigarettes smoked and the
number of years of smoking affect the severity of
disease. Former smokers usually have less dis-
ease than do current smokers.
15
Q
Well-controlled diabetics have more periodon-
tal disease than nondiabetics. Well-controlled
diabetics can generally be treated successfully
with conventional periodontal therapy.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A
D. The extent and severity of periodontal disease
in a patient with well-controlled diabetes is
usually no more than the extent and severity of
disease in patients without diabetes. Patients
with well-controlled diabetes can usually
be treated with conventional periodontal
therapy.
16
Q
Oral contraceptives can cause gingivitis. Oral
contraceptives can accentuate the gingival
response to bacterial plaque.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A
D. Oral contraceptives can exacerbate the impact of
bacterial plaque on the gingival tissues. However,
they cannot cause gingivitis.
17
Q
Which of the following cells produce anti-
bodies?
A. Neutrophils
B. T-lymphocytes
C. Macrophages
D. Plasma cells
A
D. Neutrophils are one of the primary defense cells of
the innate immune system. T-lymphocytes are
important activators of the adaptive immune sys-
tem. Macrophages are antigen-presenting cells.
Plasma cells produce antibodies.
18
Q
Defects in which inflammatory cell have most
frequently been associated with periodontal
disease?
A. The T-lymphocyte
B. The mast cell
C. The plasma cell
D. The neutrophil
A
D. Although defects in any of the host defense cells
could impact periodontal disease susceptibility,
defects in neutrophils have been most frequently
described.
19
Q
What is the major clinical difference between
the established lesion of gingivitis and the
advanced lesion of periodontitis?
A. Gingival color, contour, and consistency
B. Bleeding on probing
C. Loss of crestal lamina dura
D. Attachment and bone loss
E. Suppuration
A
D. The initial, early, and established lesions of gingivitis
do not have attachment loss associated with them.
20
Q
Which interleukin (IL) is important in the acti- vation of osteoclasts and the stimulation of
bone loss seen in periodontal disease? A. IL-1 B. IL-2 C. IL-8 D. IL-10
A
A. IL-1 is important in the activation of osteoclasts
and stimulation of bone loss.
21
Q
Scaling and root planing are used in which phases of periodontal therapy? 1. Initial (hygienic) 2. Surgical (corrective) 3. Supportive (maintenance) A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1 and 3 only E. 1, 2, and 3
A
E. Scaling and root planing are used in all phases of
periodontal therapy where there has been loss of
attachment through periodontitis.
22
Q
What is the most objective clinical indicator of inflammation? A. Gingival color B. Gingival consistency C. Gingival bleeding D. Gingival stippling
A
C. Although changes in gingival color and consis-
tency and loss of gingival stippling can be indica-
tors of gingival inflammation, bleeding on
probing is the most objective clinical indicator.
23
Q
A 25-year-old patient presenting with general-
ized marginal gingivitis without any systemic
problems or medications should be classified with which periodontal prognosis? A. Good B. Fair C. Poor D. Questionable
A
A. Marginal gingivitis not complicated by systemic
problems or medications usually can be treated
successfully with phase 1 therapy, and a patient
with this diagnosis would have a good prognosis.
24
Q
Instrumentation of the teeth to remove plaque, calculus and stains is defined as \_\_\_\_\_. A. Coronal polishing B. Scaling C. Gingival curettage D. Root planing
A
B. Polishing is used to remove plaque and stains
from the teeth. Gingival curettage is used to
remove the epithelial lining of a periodontal
pocket. Root planing is used to create a smooth
root surface through the removal of calculus and
rough cementum. Scaling is used to remove
plaque, calculus, and stains from the tooth.
25
Scalers are used to remove supragingival
deposits. Curettes are used to remove either
supragingival or subgingival deposits.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Scalers, with their pointed ends and back, are
designed for supragingival instrumentation;
curettes, with their rounded ends and back, can
be used for both supragingival and subgingival
instrumentation.
26
Which of the following is not a characteristic of
sickle scalers?
A. Two cutting edges.
B. Rounded back.
C. Cutting edges meet in a point.
D. Triangular in cross section.
E. Used for removal of supragingival deposits.
B. Scalers have a pointed back; curettes have a
rounded back, making them suitable for subgin-
gival instrumentation.
27
The modified Widman flap uses three separate
incisions. It is reflected beyond the mucogingi-
val junction.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
C. Three incisions are made in the modified Widman
flap—internal bevel, crevicular, and interdental. It
is designed to provide exposure of the tooth roots
and alveolar bone. However, the flap is not
reflected beyond the mucogingival junction.
28
The free gingival graft technique can be used to
increase the width of attached gingival tissue.
Apically displaced full-thickness or partial-
thickness flaps can also be used to increase the
width of attached gingiva.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Surgical techniques designed to increase the
width of attached gingiva include free gingival
grafts and apically repositioned flaps.
29
Miller Class I recession defects can be distin-
guished from Class II defects by assessing the
_____.
A. Location of interproximal alveolar bone
B. Width of keratinized gingiva
C. Involvement of the mucogingival junction
D. Involvement of the free gingival margin
C. The Miller classification system for mucogingival
defects takes into consideration the degree of
recession (whether or not it extends to the
mucogingival junction) and presence or absence of
bone loss in the interdental area. Both Class I
and Class II defects are characterized by no loss
of bone in the interproximal areas. In Class I
defects, the marginal tissue recession does not
extend to the mucogingival junction. In Class II
defects, recession does extend to or beyond the
mucogingival junction.
30
The reshaping or recontouring of nonsupport-
ive alveolar bone is called _____.
A. Ostectomy
B. Osteoplasty
C. Osteography
D. All of the above
B. Ostectomy is the removal of supporting alveolar
bone. Osteoplasty is the reshaping or recontouring
of nonsupporting alveolar bone.
31
```
An interdental crater has how many walls?
A. One wall
B. Two walls
C. Three walls
D. Four walls
```
B. An interdental crater has two bony walls remain-
ing. These walls are usually the facial and lingual
walls.
32
32. During the healing of a surgically treated intra-
bony (infrabony) pocket, regeneration of a new
periodontal ligament, cementum, and alveolar
bone will only occur when cells repopulate the
wound from which of the following sources?
A. Gingival epithelium
B. Connective tissue
C. Alveolar bone
D. Periodontal ligament
D. Cells from the periodontal ligament are pro-
posed to allow for regeneration of the periodontal
tissues.
33
Which of the following is least likely to be suc-
cessfully treated with a bone graft procedure?
A. One-walled defect
B. Two-walled defect
C. Three-walled defect
D. Class III furcation defect
D. Through-and-through (Class III) furcation defects
are least likely to be treated with bone graft
procedures.
34
When osseointegration occurs, which of the fol-
lowing best describes the implant–bone inter-
face at the level of light microscopy following
```
osseointegration?
A. Epithelial attachment
B. Direct contact
C. Connective tissue insertion
D. Cellular attachment
```
B. When evaluated by light microscopy, there
appears to be direct contact at the bone-implant
interface.
35
```
The most effective topical antimicrobial agent
currently available is _____.
A. Chlorhexidine
B. Stannous fluoride
C. Phenolic compounds
D. Sanguinarine
```
A. Chlorhexidine is the most effective antimicrobial
| agent currently available.
36
```
What is the active ingredient in PerioChipTM?
A. Doxycycline
B. Tetracycline
C. Metronidazole
D. Chlorhexidine
```
D. PerioChip® is a biodegradable local delivery agent
| for chlorhexidine.
37
How many days does it usually take for surface
epithelialization to be complete following a gin-
givectomy?
A. 3–7
B. 5–14
C. 14–18
D. 20–27
B. Epithelial cells migrate approximately 0.5 mm/day.
Following a gingivectomy, it takes 5 to 14 days for
surface epithelialization to be complete.
38
The most obvious clinical sign of trauma from
occlusion is increased tooth mobility. The most
obvious radiographic sign of trauma from
occlusion is an increase in the width of the
periodontal ligament space.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A. Increased tooth mobility is the most common
clinical sign of trauma from occlusion. Increased
periodontal ligament width is the most common
radiographic sign.
39
```
Trauma from occlusion refers to _____.
A. The occlusal force
B. The damage to the tooth
C. The injury to the tissues of the periodontium
D. The widened periodontal ligament
```
C. The term trauma from occlusion refers to the tis-
sue injury that occurs when occlusal forces
exceed the adaptive capacity of the tissues. An
occlusion that produces such an injury is called a
traumatic occlusion. The tooth may become
damaged as a result of excessive occlusal forces.
The periodontal ligament also may become
widened as a result of the force.
40
```
Which of the following is the primary reason
for splinting teeth?
A. For esthetics
B. To improve hygiene
C. For patient comfort
D. As a preventive measure
```
C. Teeth are usually splinted to improve patient
| comfort during mastication.
41
```
In the treatment of an acute periodontal
abscess, the most important first step is to _____.
A. Prescribe systemic antibiotics
B. Reflect a periodontal flap surgery
C. Obtain drainage
D. Prescribe hot salt mouth washes
```
C. Establishment of drainage is the first step in treat-
ing an acute periodontal abscess. The patient may
then use self-applied mouth rinses and be
```
prescribed antibiotics if there is evidence of sys-
temic involvement (e.g., fever, lymphadenopathy).
```
A flap would be reflected in a subsequent
appointment if the abscess did not resolve and
became a chronic problem.
42
Which of the following medications often result
in overgrowth of gingival tissues?
A. Penicillin, calcium channel blockers, phenytoin
B. Calcium channel blockers, phenytoin, and
cyclosporin
C. Cyclosporin, penicillin, and cephalosporins
D. Ampicillin, tetracycline, and erythromycin
B. Calcium channel blockers, cyclosporin, and
phenytoin often result in overgrowth of gingival
tissues.
43
Which of the following is the most important
preventive and therapeutic procedure in peri-
odontal therapy?
A. Professional instrumentation
B. Subgingival irrigation with chlorhexidine
C. Patient-administered plaque control
D. Surgical intervention
C. Patient cooperation and effectiveness in removing
bacterial plaque is of primary importance in main-
taining a healthy periodontium.
44
How many hours after brushing does it usually
take for a mature dental plaque to reform?
A. 1–2
B. 5–10
C. 12–24
D. 24–48
D. Mature dental plaque usually reforms on the
teeth within 24 to 48 hours after effective plaque
removal.
45
Placing the toothbrush bristles at a 45-degree
angle on the tooth and pointing apically so the
bristles enter the gingival sulcus describes
which brushing technique?
A. Charter
B. Stillman
C. Bass
D. Roll
C. The Bass technique of brushing is designed to
direct the bristles of the brush toward the gingival
sulcus.
46
```
Dental wear caused by tooth-to-tooth contact is
_____.
A. Abrasion
B. Attrition
C. Erosion
D. Abfraction
```
B. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
47
Occlusal loading resulting in tooth flexure,
mechanical microfractures, and loss of tooth
substance in the cervical area is _____.
A. Abrasion
B. Attrition
C. Erosion
D. Abfraction
D. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
48
```
The distance from the CEJ to the base of the
pocket is a measure of _____.
A. Clinical attachment level
B. Gingival recession
C. Probing pocket depth
D. Alveolar bone loss
```
```
A. The periodontal examination includes probing
pocket depth (distance from the gingival margin
```
```
to the base of the pocket) and clinical attach-
ment level (distance from the CEJ to the base of
```
the pocket). Both of these measures are made
using a periodontal probe. Gingival recession can
be measured as the distance from the CEJ to the
free gingival margin. Alveolar bone loss is meas-
ured radiographically.
49
Your examination reveals a probing pocket
depth of 6 mm on the facial of tooth 30. The free
gingival margin is 2 mm apical to the CEJ (there
is 2-mm recession on the facial). How much
attachment loss has there been on the facial of
this tooth?
A. 6 mm
B. 2 mm
C. 8 mm
D. 4 mm
C. When the free gingival margin is apical to the
CEJ, recession has occurred. Attachment loss is
the measure from the CEJ to the base of the peri-
odontal pocket. With the free gingival margin 2
mm apical to the CEJ and the probing pocket
depth measurement 6 mm, there has been 8 mm
loss of attachment.
50
In general, what species are predominant in
supragingival tooth-associated attached plaque?
A. Gram-negative rods and cocci
B. Gram-negative filaments
C. Gram-positive filaments
D. Gram-positive rods and cocci
D. Supragingival plaque is either tooth-associated or
outer layer. Tooth-associated is composed pri-
marily of gram-positive cocci and short rods.
51
```
The inorganic component of subgingival plaque
is derived from _____.
A. Bacteria
B. Saliva
C. Gingival crevicular fluid
D. Neutrophils
```
C. Saliva is the source of inorganic components
(calcium, phosphorous) for supragingival plaque.
Gingival crevicular fluid is the source of inorganic
components of subgingival plaque.
52
What are the characteristics of the primary
(initial) bacterial colonizers of the tooth in
dental plaque formation?
A. Gram-negative facultative
B. Gram-positive facultative
C. Gram-negative anaerobic
D. Gram-positive anaerobic
B. Streptococcal and Actinomyces species are ini-
tial colonizers of dental plaque. They are gram-
positive, facultative micro-organisms.
53
```
Which of the following is an important
constituent of gram-negative microorganisms
that contributes to initiation of the host
inflammatory response?
A. Exotoxin
B. Lipoteichoic acid
C. Endotoxin
D. Peptidoglycan
```
C. Endotoxin or lipopolysaccharide is an important
constituent of the gram-negative outer mem-
brane that contributes to initiation of the host
inflammatory response.
54
```
Calculus is detrimental to the gingival tissues
because it is _____.
A. A mechanical irritant
B. Covered with bacterial plaque
C. Composed of calcium and phosphorous
D. Locked into surface irregularities
```
B. Calculus is calcified dental plaque. It is always
covered by a layer of uncalcified plaque, which is
detrimental to the gingival tissues.
55
Restoration margins are plaque-retentive and
produce the most inflammation when they are
located _____.
A. Supragingival
B. Subgingival
C. At the level of the gingival margin
D. On buccal surfaces of teeth
B. Supragingival margins are least detrimental to
the gingival tissues; subgingival margins are the
most detrimental due to the accumulation of
dental plaque.
56
```
Which of the following are cells of the innate
immune system?
a. Neutrophils and monocytes/macrophages
b. T cells and B cells
c. Mast cells and dendritic cells
d. Plasma cells
A. a and b
B. a and c
C. b and d
D. b and c
```
B. Cells of the innate immune system include neu-
trophils, monocytes/macrophages, mast cells,
and dendritic cells. Cells of the specific (adap-
tive) immune system include T cells, B cells, and
plasma cells.
57
```
Which of the following are antigen-presenting
cells?
A. Neutrophils
B. T-lymphocytes
C. Macrophages
D. Plasma cells
```
C. Neutrophils are one of the primary defense cells
of the innate immune system. T-lymphocytes are
important activators of the specific (adaptive)
immune system. Macrophages are antigen-
presenting cells. Plasma cells produce anti-
bodies.
58
Which of the following are the most important
proteinases involved in destruction of the
periodontal tissues?
A. Hylauronidase
B. Matrix metalloproteinases
C. Glucuronidase
D. Serine proteinases
B. Matrix metalloproteinases are the most impor-
tant proteinases involved in the destruction of
periodontal tissues.
59
```
The predominant inflammatory cells in the
periodontal pocket are _____.
A. Lymphocytes
B. Plasma cells
C. Neutrophils
D. Macrophages
```
C. Neutrophils are the predominant inflammatory
cells in the periodontal pocket and have mig-
rated across the pocket epithelium from the
subgingival vascular plexus.
60
```
Which of the following are part of Preliminary
Phase therapy?
a. Treatment of emergencies
b. Extraction of hopeless teeth
c. Plaque control
d. Removal of calculus
A. a, b, and c
B. b, c, and d
C. a and b only
D. b and d only
```
C. Preliminary Phase therapy is used to treat emer-
| gencies and remove hopeless teeth.
61
```
Polymorphisms in which of the following genes
have been associated with severe chronic
periodontitis?
A. IL-6
B. IL-1
C. TNF
D. PGE2
```
B. Polymorphisms in the IL-1 genes have been asso-
| ciated with severe chronic periodontitis.
62
Given the same amount of attachment loss and
same pocket depth, a single-rooted tooth and a
multirooted tooth have the same prognosis. The
closer the base of the pocket is to the apex of the
tooth, the worse the prognosis.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is false.
D. First statement is false. Second statement is true.
D. Single-rooted teeth have a poorer prognosis than
do multirooted teeth with comparable loss of
attachment. Loss of attachment that extends to
the apex of the root alters the crown-to-root ratio
and makes the prognosis worse.
63
```
Which of the following is most important in
determining the prognosis for a tooth?
A. Probing pocket depth
B. Bleeding on probing
C. Clinical attachment level
D. Level of alveolar bone
```
C. The amount of clinical attachment loss is most
important in determining the prognosis. Deep
pocket depths and bleeding on probing can be
found in both gingivitis and periodontitis.
Although the level of alveolar bone is usually con-
sistent with the amount of clinical attachment
loss, there are circumstances under which these
two measures are not comparable.
64
```
Offset angulation is a characteristic feature of
_____.
A. Sickle scalers
B. Universal curettes
C. Area-specific curettes
D. Chisels
```
C. Sickle scalers and universal curettes do not have
offset angulation of the blade. The working ends
of area-specific curettes are offset at a 60-degree
angle relative to the terminal shank. The working
ends of sickle scalers and universal curettes are
not offset—they are at a 90-degree angle relative
to the terminal shank.
65
```
Patients with which of the following should not
be treated with ultrasonic instruments?
A. Deep periodontal pockets
B. Edematous tissue
C. Infectious diseases
D. Controlled diabetes
```
C. Patients with active infectious diseases should
not be treated with ultrasonic instruments
because of the aerosol that is created when using
this type of instrument.
66
What is the most important procedure to perform
during the initial postoperative visits following
periodontal surgery?
A. Plaque removal
B. Visual assessment of the soft tissue
C. Periodontal probing
D. Bleeding index
A. Plaque removal during the initial postoperative
visits following periodontal surgery is essential to
healing of the periodontal tissues.
67
When performing a laterally repositioned flap,
which of the following must be considered
relative to the donor site?
A. Presence of bone on the facial
B. Width of attached gingiva
C. Thickness of attached gingiva
D. All of the above
D. Laterally positioned flaps should only be per-
formed when there is adequate bone and ade-
quate width and thickness of attached gingiva on
the facial of the donor site.
68
```
Which class of bony defect responds best to
regenerative therapy?
A. One-walled
B. Two-walled
C. Three-walled
D. Shallow crater
```
C. Three-walled defects respond best to regenera-
| tive therapy.
69
```
The most common clinical sign of occlusal
trauma is _____.
A. Tooth migration
B. Tooth abrasion
C. Tooth mobility
D. Tooth attrition
```
C. Although tooth migration can be a sign of
occlusal trauma, tooth mobility is the most com-
mon clinical sign.
70
```
For most periodontitis-affected patients, what is
the recommended interval for maintenance
appointments?
A. 1 month
B. 3 months
C. 6 months
D. 1 year
```
B. The majority of patients who have been treated for
periodontitis should be seen at 3-month intervals
for supportive periodontal therapy (maintenance).
71
Controlled diabetes has same perio problems as those who don’t have diabetes:
TRUE
72
What is not true regarding patient with diabetes and perio? either increase of crevicular fluid or increase of sugar in crevicular fluid
increase of crevicular fluid
73
QUESTION: Patient with diabetes, which finding is not consistent?
Increase collagenase in crevicular fluid
Increase glucose in crevicular fluid
Increase gram negative in crevicular fluid
Decrease in thickness of basilar lamina of blood vessels in periodontium
Increase gram negative in crevicular fluid
74
Diabetic patients have more of the following except: higher glucose levels in gingiva, increased anaerobic bacteria in pockets,
increased IL-1, increased collagenase
increased anaerobic bacteria in pockets,
75
Diabetics are more prone to perio and are less resistant to the effects of bacteria.
Both statements are true.
76
By recent studies, which one has a correlation with periodontitis?
Diabetes - diabetics are 15x higher at risk.
77
Pt presents with aggressive bone loss, bleeding gums, mobile teeth. What condition?
* uncontrolled diabetes
* non-Hodgkin’s lymphoma
• uncontrolled diabetes
78
ASA III:
uncontrolled diabetes
79
Periodontal disease is associated with what systemic diseases?
Diabetes and HIV
80
Which ethnic group has the most chronic periodontitis?
Black males
81
syndromes assoc with periodontitis
papillon-lefevre
chediak-higashi
ehlers-danlos
down
82
Red complex has 3 bacteria’s:
P. Gingivalis, Tannerella forsythia, Treponema denticola
83
what is red complex responsible for
BOP, deep pockets
84
which complex is earlier, red or orange
orange
85
what is orange complex responsible for
plaque formtaion and maturation, precedes red complex
86
orange complex bacteria
fusobacteria, prevotella, campylobacter
87
Which cells are predominant in sulcular fluid?
PMN’s
88
What cells predominate in established gingivitis?
plasma cells
89
Which of the following species is a usual constituent of floras that are associated with periodontal health?
Streptococcus gordonii
90
What bacterial species is not associated with periodontal disease?
A. Actinomyces species
B. P. gingivalis
C. Capnocytophaga
A. Actinomyces species
91
```
Bacteria that is not in chronic periodontitis?
Actinomyces viscosus
C. rectus
T. forsytiaas
P. gingivalis.
```
Actinomyces viscosus
92
Which is related to periodontal disease?
Gram negative bacteria
93
What is the 1st step in bacterial plaque formation on a tooth?
Pellicle formation (glycoproteins, enzymes, proteins,
phosphoproteins) .
- 2nd step is adhesion and attachment of bacteria
- 3rd step is colonialization and plaque maturation
94
Which is not part of plaque formation? Host antigen, extracellular bacterial polymers, bacterial interactions
Host antigen
95
Most plaque retentive thing –
calculus
96
Gingival recession, other than plaque amount, is related to – age, tobacco, etc
age
97
```
Plaque index is used for what?
track gingivitis progression
track disease activity
to know plaque amount
patient motivation
```
patient motivation
98
Which one is not a periodontal risk factor? Smoking, oral hygiene, malnutrition, diabetic mellitus
malnutrition
99
Which of the following things are associated w/ periodontal disease? Atheroschlerosis, Diabetes Mellitus, Low birth weight of
babies
Diabetes Mellitus
100
Difference between primary and secondary occlusal trauma?
Periodontal support/healthy periodontium in primary
normal bone level, normal attachment level, but excessive occlusal forces
101
Healthy patient, probing shows bleeding, what could this be due to?
Gingivitis
102
Which is least likely to occur with occlusal trauma?
Gingivitis
103
Gingival index/perio index. Know their flaws:
Perio index flaws are that the gingival recession was not taken into account.
Gingival index: each of the 4 gingival areas of the tooth is given a score from 0 (normal) to 3 (severe inflamed), mostly based on color.
Score is totaled per tooth or added all together/ (total teeth #) to give GI person score.
- GI doesn't consider PD, degree of bone loss or any other qualitative changes in periodontium.
104
What is Gingival Plaque Index?
a. Nominal
b. Ordinal
c. Interval
d. Ratio
ordinal
a. Nominal like mild, moderate, severe
b. Ordinal include numbers: like furcation involvement 1,2,3
c. Interval like Celsius degree
d. Ratio e.g. Kelvin degree, or BP measurement (cannot be zero), length (cannot be negative), weight
105
What is CPITN?
Community Periodontal Index of Treatment Needs
106
What is predominant in plaque 2 days after prophy?
Gram (+) cocci and rods
- gram + cocci and rods normally present, gingivitis transition includes Gram (–) rods and filaments followed by spirochetal and motile
organisms.
107
With the development of gingivitis, the sulcus becomes predominantly populated by
a. gram-positive organisms.
b. gram-negative organisms.
c. diplococcal organisms.
d. spirochetes.
a. gram-positive organisms.
108
QUESTION: Supragingival calculus main crystals
main crystals are hydroxylapatite 58%
109
Chronic periodontitis has which bacteria
G (--) anaerobes.
110
Chronic periodontitis: has which bacteria
P. gingivalis (gram -)
111
Fusobacteria nuceatum has what specific characteristic?
Bridging microorganism between early & late colonizers of dental plaque
112
All syndromes are associated w/ periodontal problems except
a. Stevens-Johnson syndrome
b. Pap-lefev syndrome
c. down syndrome
d. hypophosphatasia
e. acrodynia
Stevens-Johnson
a. Stevens-Johnson syndrome (target lesions - conjunctiva and genital problems)
b. Pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
c. down syndrome (related)
d. hypophosphatasia (bone disease similar to rickets, premature loss of primary teeth)
e. acrodynia (pain, discoloration of hand/feet, chronic heavy metal
113
Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque
plaque
114
Which of the following causes bone loss?
a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase
Interleukin
115
What cytokine responsible for osteoclasts? IL-1, IL-8, IL-5, IL-3
IL-1
116
Stress long term cause problem in periodontium b/c
it increases cortisone and cortisone and brings immune system down
117
fenestration in perio
isolated areas where root is denuded of bone and root surface is covered by gingiva and periosteum, but marginal bone is intact
118
dehiscence in perio
denuded areas extend through marginal bone
119
What is it called when you have a hole in the bone that exposes the root?
Fenestration
120
QUESTION: Dehiscence:
Loss of buccal or lingual bone overlying a tooth root, leaving the area covered by soft tissue only
121
which side is dehiscence usually on and what shape
facial, lingual is rare
characteristic oval shape
122
```
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION?
A. A trough
B. A dehiscence
C. A hemiseptum
D. An interdental crater
```
B. A dehiscence
123
Biological width is
2 mm.
124
Biological width is from
the alveolar crest to the base of the sulcus.
125
Biologic width definition: junctional epithelium and _______ attachment to the tooth above the alveolar crest (at least 2mm)
a. gingival sulcus
b. epithelial attachment
c. connective tissue
c. connective tissue
126
How to determine attachment loss?
From CEJ to sulcus (depth of pocket)
127
Which of the following factor is most critical in determining the prognosis of periodontal disease?
1. Probing depth
2. Mobility
3. Class 3 furcation
4. Attachment loss
4. Attachment loss
128
Attachment loss:
loss of connective attachment w/ apical migration of the JE away from the CEJ
129
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is the attachment loss:
2 mm
130
If recession is 2 mm and probing is 1 mm, how much attachment loss?
3 mm
131
If you have 1 mm recession and can probe 3 mm, how much attachment loss is there?
4mm
132
Perio treatment sequencing for mild-moderate chronic periodontitis?
Plaque control, Sc/Rp, caries control, perio surgery
133
When is the perio prognosis that poor?
Class 2 mobility
deep class 2 furcation
deep probing with suppuration
deep probing with suppuration (indicates tooth fracture)
134
Which teeth commonly relapse after perio tx (poor long-term prognosis)?
maxillary molars due to furcation anatomy
135
Where perio Tx is more difficult?
Maxillary molars due to trifurcations.
136
Which tooth is most commonly lost due to long term care in periodontal patients? max molar, max pm, man molar, man pm
max molar
137
```
QUESTION: If you have a through-and-through furcation involvement (class III furcation) on a tooth with 5 mm of root left in the bone, what do
you do?
Extract the tooth
Splint
Place Implant
```
Extract the tooth (preferred treatment)
138
QUESTION: Patient with class III furcation and 3 mm exposure?
Extract
139
If you have a grade III furcation, you can do all of the following except
a. Section it and crown both as PFMs
b. Tunneling procedure
c. GTR
GTR - Better for Class II, least successful for class III
140
Tx option: Class 2 almost class 3 furcation?
Main goal of tx on class 2 is converted to class 1 furcation by doing GTR
141
Recommended treatment for a Class II that is almost a class III:
- convert class II to a class I by doing GTR
- tunneling
- extraction
- convert class II to a class I by doing GTR
142
Most likely shape of furcation is?
Wide but still not very accessible to dental tools,
143
When you have a through and through furcation (Grade 3 at least),
a. It’s wide enough and you can clean it
b. It’s wide enough and the curette is too big to clean it
c. It’s narrow enough and you can’t clean it
d. Its narrow enough and the currete is too small to clean it
b. It’s wide enough and the curette is too big to clean it
144
Root amputation of MB root –
cut at furcation and smoothen for patient to keep clean
145
What is most common periodontitis in school-aged children: aggressive PD, ANUG, marginal gingivitis
marginal gingivitis
146
Which therapy in which adding antibiotic + debridement have minimal effect for? anug, Localized aggressive, chronic periodontitis
chronic periodontitis
147
How do you treat gingivitis in puberty:
debridement and OHI
148
Percentage to be considered generalized perio?
> 30%
149
Diagnosis for 40-year-old female w/ generalized bone loss, localized vertical bone defect, and gross calculus:
Chronic periodontitis
150
Which of the following PDL disease causes rapid destruction of alveolar bone?
1. Periodontal abscess
2. ANUG
3. Chronic periodontitis
1. Periodontal abscess
151
Two patients, old and young person w/ same perio. Which has better prognosis?
```
Older patient (b/c younger pt had shorter time
frame to get to the same condition so more aggressive in nature)
```
152
```
Which of these is reversible with tooth movement?
• Tooth mobility
• Bone resorption
• Crestal bone
• Gingival recession
• Attachment loss
```
• Tooth mobility
153
Best for interproximal plaque removal in teeth without contacts: floss, waterpick, interproximal brush
interproximal brush
154
QUESTION: What is not able to reach the interproximal?
Toothbrush
155
Best brushing technique to clean periodontal pockets:
A. Charters
B. Sulcular
C. Whitman’s
. Sulcular (another name for modified Bass)
156
Least effective for crevicular plaque? Water irrigating device (waterpik), nylon, toothbrush
waterpik
- Water irrigation removes debris (not plaque)
157
Which of the following is likely to be abrasive after osseous surgery? Water pik, toothbrush, toothpick, rubber gum stimulator
Water pik,
158
Class 2 furcation, which instrument is the worst to clean a class II furcation? Tooth brush, floss, waterpik, rubber stimulating tip
rubber stimulating tip
| - Rubber tip is for interdental papilla
159
Toothbrush and floss, how much can it reach in perio pocket?
Toothbrush 0 mm, floss 2-3 mm
Toothbrush 2-3 mm, floss 0mm
Toothbrush = 1 mm, floss = 2-3 mm
Toothbrush = 1 mm, floss = 2-3 mm
160
What can make teeth green? Bacteria, gingival hemorrhage, medications or hyperbilirubinemia
(ALL of them)
161
```
QUESTION: Green and orange stains on maxillary incisors can usually be attributed to
A. drugs.
B. diet.
C. poor oral hygiene.
D. fluoride consumption
E. Genetics
```
C. poor oral hygiene.
162
What are proper ways to reinforce OHI: verbal and written in the dental office, verbal only, video tape
verbal and written in the dental office,
163
What is most difficult to maintain oral hygiene with home preventive care?
* pit and fissure
* proximal smooth surface
* facial smooth surface
* lingual smooth surface
• proximal smooth surface
164
Why don’t you use Acidulated Fluoridated Toothpaste?
Ruins Polish of Crown
165
How does Listerine act?
Antiseptic mouth rinse is a broad-spectrum antimicrobial & kills bacteria associated with plaque and
gingivitis by disrupting the bacterial cell wall.
- bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides.
166
Action of Listerine?
Uncharged phenolic compound
167
What daily oral rinse would you give to a medically compromised child for plaque control? CHX, Listerine, Nystatin, stannous
fluoride, sodium fluoride
CHX
168
The role of chlorohexidine is cause:
Substantivity (anti-plaque)
169
Action of chlorhexidine:
binds to cell wall à cell membrane disruption/rupture à fluid leaks out, cell lysis (CHX bursts membranes)
170
Use of chlorhexidine à
reduce plaque accumulation
| - broad spectrum against gram positive and negative bacteria and fungi – Positively charged
171
What does sodium pyrophosphate do?
Plaque removal
- removing crystals of Ca+ and magnesium, inhibits mineralization of biofilm/staining (inhibits Ca+ phosphate from binding)
172
charge on listerine
uncharged
173
charge on chlorhexidine
+
174
Why are inorganic pyrophosphates in anti-tartar toothpaste? I
t acts as a tartar control agent, serving to remove calcium and
magnesium from saliva and thus preventing them from being deposited on teeth (chelating + abrasion)
175
Why is inorganic pyrophosphate in tooth paste? prevent calcium phosphate crystals, decrease number of bacteria growth
prevent calcium phosphate crystals
176
Periostat:
2x daily 20 mg has doxycycline, which works by inhibiting collagenase/protein synthesis
177
Periostat’s mechanism of action: inhibits collagenase, inhibits ribosome 50s, periochip,
inhibits collagenase,
- Reduces elevated collagenase activity in gingival crevicular fluid of patients with adult periodontitis; no antibacterial effect reported at
this dose
178
Doxycycline use?
Intramicobial which inhibits MMP (matrix metaloprometase)
| - Sub-antimicrobial dose doxycycline (SDD, periostat) inhibits matrix metalloproteinase (MMP)
179
Root surface tx with what agents?
Use citric acid, fibronectin and tetracycline
180
Which is least complicating for OH? Fixed bridge, rheumatoid arthritis, open contact
open contact
181
from which side better to probe furcations
better access to facio-mesial furcation from facial
182
Best way to detect furcation – curve perio probe, curette, straight perio probe
curve perio probe (naber probe)
183
Best angle to place curette on root is
45- 90 degrees for working strokes.
184
What edge of curette do you want to be in contact at line angle?
Lower 1/3
185
Curette, which third adapts tooth? Apical Third, Middle Third
Apical Third
186
Which part of instrument do you place on line angle of tooth:
middle third
third including tip
third closest to handle or entire edge
third including tip
187
Which gracey curette is used for the mesial surface of distal root in max tooth?
11-12
188
What is not the initial treatment for gingivitis? s/rp, OHI, corticosteroids
corticosteroids
189
Sc/RP removes
diseased cementum
190
Just did Sc/RP on pt w/ recession. What’s the best way to prevent sensitivity to newly exposed root surface?
Keep root surface free
| of plaque
191
After you do Sc/RP, how does new attachment form?
Long junctional epithelium
192
Direction of root planing?
From base of pocket to CEJ
193
What kind of gingiva is favorable for S/RP?
More edematous gingiva
194
QUESTION: Best results from S/RP will be from a patient who has: edematous gingiva, fibrotic gingiva, loss of attachment
edematous gingiva
195
What do you do if after S/RP, there are 2 probing sites of 6 mm?
Perio Surgery
196
Pt had SRP & they came back for perio maintenance but there are still 5-6 mm pocket. What do you do?
Open debridement
197
Why do you check occlusion in pts with perio abscess?
- many perio lesions are caused by occlusion
- edema can cause teeth to supra erupt
- some other choices were pretty good to, but I can’t remember what they were
edema can cause teeth to supra erupt
198
What’s the FIRST thing you do in maintenance appointment (recall)?
Update medical history
199
QUESTION: What do you not do at the perio maintenance apt.?
SRP pockets of 1 – 3mm
200
What happens after the periodontal re-eval, what should the recall interval be set as? The recall interval is set but may be changed
if the patient’s situation changes, should be less to motivate pt, should be more to motivate pt
The recall interval is set but may be changed
| if the patient’s situation changes
201
The normal recall appointment between periodontal treatment:
3 months
202
Best time for supportive periodontal therapy? 1, 3, 6, 9, months post s/rp
3
203
How you determine perio maintenance recall –
different for each patient
204
Pt is on a periodontal recall system. What best denotes good long term prognosis? BOP, Plaque, Deep pockets
BOP (bleeding)
205
BOP most indicative of what?
Inflammation
206
How long does it take to form mature plaque after removal?
24-36 hours
207
```
Mature plaque in
• 1-2 hrs.
• 6-8 hrs.
• 10-12 hrs.
• 24-48 hrs.
```
• 24-48 hrs.
208
How many hours until plaque accumulation (after brushing or eating?)?
1 hour
209
Which part of dental anatomy on a central collects the most plaque? Facial surface, lingual surface, cingulum, mamelon,
gingivopalatal groove
lingual surface
210
Magnetostrictive instrument:
elliptical vibration pattern, all sides of tip are active (4 sides total)
211
Piezoelectric instrument:
linear vibration pattern, 2 sides are more active
212
contraindication to ultrasonics
pacemaker, communicable diseases, titanium implants (use plastic tip), kids
213
```
QUESTION: Each of the following is a mode of action of an ultrasonic instrument EXCEPT one. Which one is this EXCEPTION?
A. Lavage
B. Vibration
C. Cavitation
D. Sharp cutting edge of tip
```
D. Sharp cutting edge of tip
214
Mode of action of ultrasonic:
Vibration in elliptical (magnetostrictive), sonics is linear
215
what kills bacteria in sonic instruments
water and air
216
serum response in localized aggressive
robust. IgG-2
217
serum response in generalized aggressive
poor
218
bacteria in localized aggressive
Aa, capnocytophaga
219
bacteria in generalized aggressive
Aa, sometimes P. gingivalis
220
Localized aggressive periodontitis show bone loss on
first molars and incisor.
221
Where are the most teeth lost in local aggressive periodontitis?
Max molars
222
What kind of bone loss do you see in aggressive periodontitis? Vertical, horizontal, mesial distal, interprox.
Vertical
223
Reason pts get aggressive periodontitis?
Host can’t fight off
224
What are two things in common among generalized aggressive periodontitis & chronic periodontitis?
Distribution among the teeth
225
Classical sign of aggressive periodontitis? T
ooth mobility & deep pockets with lack of inflammation are initial signs of LAP.
226
What is not a characteristic of localized aggressive periodontitis (LAP)?
Severe bone loss in anteriors
Deep probing depths for first molars
Generalized gingival inflammation
Generalized gingival inflammation
227
```
Which of the following is not true about local aggressive periodontitis?
Affect less than 30%
Tx is scaling & systemic antibiotic
Genetic component
Gingival inflammation
```
Gingival inflammation
228
What is not associated with LAP (Localized aggressive periodontitis):
Calculus
229
```
Initial tx for Localized aggressive periodontitis
Sc/RP
Antibiotics
Sc/RP and Antibiotics
Antibiotics for 1 week and then Sc/RP
```
Sc/RP and Antibiotics
230
Best way to treat localized aggressive periodontitis?
a. chlorhexidine
b. H2O2 rinse
c. systemic antibiotic
c. systemic antibiotic
| - Localized aggressive perio, treat with tetracycline
231
18-year-old female w/ > 5 mm pocket on central and 1st molars?
Localized aggressive Perio
232
bacteria in ANUG
anaerobic fusobacteria + spircohetes (Prevotella intermedia)
233
tx for ANUG
For ANUG: Normally, you don’t give antibiotic. You only do debridement, rinse, and oral hygiene. But if the patient has a fever or
systemic indications like HIV, give metroniadozle.
234
For NUG or ANUG, which microorganisms predominate?
Spirochetes
235
Patient comes in with gingivitis, no pocketing, pseudomembranous coating that’s gray on gingiva?
ANUG
236
Patient has interpapilla damage, periodontal condition, what could this be due to?
ANUG
237
Cratered gingiva
l = ANUG (NUG) – punched out papilla
238
Which of the following is the most appropriate initial treatment for a patient with HIV-associated necrotizing ulcerative gingivo-
periodontitis?
A. Debridement and anti-microbial rinses
B. Definitive root planning and curettage
C. Administration of antibiotics
D. Gingivectomy and gingivoplasty
A. Debridement and anti-microbial rinses
239
Tx for NUG pt with no systemic involvement?
Debridement, chlorhexidine, OHI
240
First step in initiation treatment of HIV necrotizing ulcerative gingivitis? debridement and antibacterial rinse, antibiotics,
gingivectomy
debridement and antibacterial rinse,
241
Pregnancy gingivitis has
altered metabolism of progesterone.
242
Pregnant women have more gingivitis why?
Hormones (progesterone)
243
Which one of these bacteria are associated with pregnancy?
P. intermedia
244
Pregnancy gingivitis caused by?
hormones (progesterone) & P intermedia
245
Pregnant patient, you should not give what meds?
Tetracycline, metronidazole, gentamicin and vancomycin should be avoided
246
Bacteria most associated with puberty?
P. Intermedia
247
Picture of gingival hyperplasia on 14-year old girl –
hormonal-induced
248
meds associated with gingival hyperplasia
anticonvulsants (phenytoin, valproate, carbamazepine)
calcium channel blockers (dipines, verapamil, diltiazem)
immunosuppressants (cyclosporine, tacrolimus)
249
QUESTION: Patient’s interpapilla gingiva is
| swollen -
anticonvulsant meds
| Dilantin/phenytoin
250
What’s the #1 cause of medication
| induced gingival hyperplasia?
```
Anti-convulsant
meds Dilantin (30% of all drug induced)
```
251
```
All the following drugs cause
gingival enlargement (hyperplasia) except?
a. phenytoin
b. cyclosporin
c. nifedipine
d. digoxin
```
d. digoxin
252
All of the following drugs cause gingival hyperplasia except? Verapamil, diltiazem, phenytoin
(Dilantin), nifedipine and cyclosporine
—all do.
diltiazem is CCB!
253
Patient is on calcium blockers, picture show gingival hyperplasia, what do you do?
Tell them to see their doctor to switch meds
254
When pt is on immunosuppressant’s for transplanted liver, what happens in the mouth?
CT overgrowth & hyperplasia à
| cyclosporine will lead to gingival hyperplasia
255
Modified Widman flap:
Internal bevel incision & instrumentation for root therapy, not pocket depth reduction but removes pocket lining
& pocket shrinks after healing.
256
Displaced flap:
PD reduction. Excisional procedure of gingiva = gingivectomy. Internal bevel gingivectomy but also reverse bevel. Final
placement of flap determined by first incision.
257
Apical positioned flap:
Internal bevel incision for pocket elimination (by apical position) and/or increases width of attached gingiva. Best
position is 2 mm apical to alveolar crest.
258
Distal wedge =
cut to removal of excessive soft tissue distal to a terminal tooth. It’s to treat
pockets through internal thinning to gain access to bone on the distal aspect of terminal
teeth.
- Advantages: close wound procedure (healing by primary intention), access to bond,
preserve zone of keratinized gingiva
259
The most common incision given by oral surgeons is?
a. envelope flap
b. y incision
c. Z incision
d. Semilunar incision
a. envelope flap
| 2 teeth anterior, 1 tooth posterior
260
Doing flap surgery on mandible, what structure do you watch for?
Mental nerve (If 3rd molar TE= Lingual)
261
Apical position flap are contraindicated in what location?
Maxillary palatal
262
An apically displaced flap is generally impossible in which of the following areas?
a. mandibular facial
b. mandibular lingual
c. maxillary facial
d. maxillary palatal
d. maxillary palatal
263
Where can you not do apical flap?
lingual of maxillary molars
264
When doing extrusion of canine, these flap techniques can be used except
1) Envelope flap
2) Semilunar flap
3) Apical repositioning flap
3) Apical repositioning flap
265
Where are you most likely to damage a nerve in vertical release of flap?
Lingual, Wharton’s duct and the sublingual gland
| - avoid vertical incisions in lingual and palatal
266
Vertical or oblique flap, where do you make incision?
At line angles
267
QUESTION: Modified Widman flap can be characterize by all BUT? internal bevel incision,
replaced flap, reflected beyond mucogingival line
reflected beyond mucogingival line
- It is internal bevel incision and replaced/nonrepositioned flap.
- Flap reflection with the MWF approach is only 2-3 mm beyond the alveolar crest
and not beyond the mucogingival junction. (Mosby)
268
What type of incision for maxillary palatal tuberosity reduction? T, Y
Y
269
Which of the following statements about the flap for the removal of a palatal torus is correct?
A. The most optimal flap uses a midline incision which courses from the papilla between teeth #8 and 9 posteriorly to the junction of the hard
and soft palates.
B. The most optimal flap is a reflection of the entire hard palate mucoperiosteum back to a line between the 2 first molar teeth.
C. The most optimal flap uses a midpalatal incision that courses from the palatal aspect of tooth #3 across to the palatal aspect of tooth #14
D. The most optimal flap is shaped like a "Double-Y", with a midline incision and anterior and posterior side arms extending bilaterally from
the ends of the midline incision.
D. The most optimal flap is shaped like a "Double-Y", with a midline incision and anterior and posterior side arms extending bilaterally from
the ends of the midline incision.
270
Distal wedge contraindication?
On 3rd molars without attach gingiva
271
CI when using distal wedge technique:
Not enough keratinized tissue
272
Distal Wedge limited to:
• Formation of the ramus
• Long buccal nerve
• Mental nerve
• Formation of the ramus
273
A tooth had epithelium above CEJ, what flap would you use?
Undisplaced/Replaced flap
274
Long jxn epithelium is coronal to CEJ and margin is around CEJ, what type of flap would you use?
apical position flap, Widman flap, replace flap
apical position flap
275
What type of flap do you use in crown lengthening?
Apical Repositioning Flap
276
RCT w/ post and core and crown lengthening, why do crown lengthening?
Ferrule effect,
277
To expose a mandibular lingual torus of a patient who has a full complement of teeth, the incision should be...
a. Semilunar
b. Paragingival
c. In the gingival sulcus and embrasure area
d. Directly over the most prominent part of the torus
e. Inferior to the lesion, reflecting the tissue superior
In the gingival sulcus and embrasure area
278
If removal of torus must be performed to a patient with full-mouth dentition, where should the incision be made?
a. Right on the top of the torus
b. At the base of the torus
c. Midline of the torus
d. From the gingival sulcus of the adjacent teeth
From the gingival sulcus of the adjacent teeth
279
What has the biggest effect on the flap?
a. initial incision
b. extensiveness of reflection
c. post-op oral hygiene
d. final position of flap
d. final position of flap
280
During maintenance therapy, pt has recurrent 6mm pocket on M of #4 and D of #20. What is 1st tx option?
flap surgery
scaling root planning with local microbial administration
flap surgery
281
To prevent exposure of a dehiscence or fenestration, what kind of flap do you do?
partial or split
| thickness flap
282
Split thickness flap involves what tissues? Mucosa (only) or submucosa, epithelium and CT
(submucosa)
epithelium and CT
(submucosa)
- surface mucosa (consisting of epithelium, basement mem brane, and connective tissue lamina propria
283
In a partial thickness flap, what do you cut through?
Epithelium, connective tissue, but NOT periosteum
284
Perio flap that expose bone -
Full thickness
285
```
Full thickness flap will result in bone atrophy (or loss) in:
thin periradicular bone
thick periradicular bone
thick interproximal bone
thin interproximal bone
```
thin periradicular bone
| so do partial-thickness flap for this)
286
goal of gingivectomy
Eliminate suprabony pockets, eliminate gingival enlargements or eliminate suprabony periodontal abscess
287
DO NOT DO gingivectomy if osseous recontouring is needed, if pocket depth is apical to mucogingival junction, if there is inadequate
attached gingiva, or is esthetics is a concern.
osseous recontouring is needed, if pocket depth is apical to mucogingival junction, if there is inadequate
attached gingiva, or is esthetics is a concern.
288
Gingivoplasty:
Reshaping of gingival to create physiological gingival contours in the absence of a pocket.
289
Primary Intention healing –
tissue surface has been approximated/closed. Ex. stitch, flap, glue. Very little tissue loss
290
Secondary Intention healing –
extensive wound, considerable tissue loss, edges can’t be brought together. Ex. ulcer, Sc/RP, gingivectomy.
Repair time is longer, greater scarring, increased infection
291
Tertiary Intention Healing –
delayed/secondary closure, delayed suturing/wound closure. Ex. poor circulation or drainage to wound area
so wait, tissue grafts
292
What direction is the reverse bevel (internal bevel) incision?
axial toward bone
293
Know about internal bevel incision and where to cut:
apical to the base of the periodontal pockets, but coronal to the MGJ.
294
What is purpose of “bleeding incisions” in gingivectomy?
location of dehiscence
location of alveolar defects
guide for incision
guide for incision
295
Bleeding spots established in gingevectomy to?
outline incision line
296
How does a site heal after a gingivectomy?
Long junctional epithelium
| secondary intention
297
QUESTION: Indications for gingivectomy –
hyperplastic gingiva & suprabony pockets
298
when not to do gingivectomy?
infrabony pockets, little attached gingiva, high smile line
299
Which is contraindicated in 2nd molar region to reduce deep pocket with limited attached gingiva?
Gingivectomy
300
Patient has very little keratinized gingiva, which of the following flaps should you not do:
gingivectomy
301
Pt has a PFM #18 molar with minimum keratinized gingiva with deep pocket depth. Which of the following way is not acceptable is
a way to minimize pocket depth?
Gingivectomy
302
Gingivectomy is contraindicated in:
when the sulcus is apical to gingival groove
sulcus is apical to convexity of tooth
sulcus is apical to the crest of alveolar bone
sulcus is apical to the crest of alveolar bone
303
Gingivectomy is contraindicated with?
Minimum attached gingiva
304
Gingivectomy is contraindicated when bottom of the pocket is
apical to alveolar crest (infrabony bony pocket)
also beyond mucogingival junction
305
What should be considered for gingivectomy?
level of attached gingiva
degree of attachment loss
level of attached gingiva
306
The base of the incision in the gingivectomy technique is located
A. in the alveolar mucosa.
B. at the mucogingival junction.
C. above the mucogingival junction.
D. coronal to the periodontal pocket.
E. at the level of the cementoenamel junction
C. above the mucogingival junction.
307
Gingivectomy incision:
Excisional (external bevel incision)
308
How many mm per day does epithelium grow over connective tissue? 0.5-1 mm, 1-2 mm, 2-3 mm
0.5-1 mm,
309
How does external bevel gingivectomy heal? Primary intention, secondary, tertiary, granular tissue formation
secondary
310
How does a gingivectomy heal?
Secondary intention
311
External bevel incision for a gingivectomy, where is the incision made?
apical to epithelial tissue
vascular bundle
Junctional epithelium
Junctional epithelium (apical to base of pocket (epithelial attachment))
312
Regeneration -
type of healing that completely replicates the original architecture & function. It involves the formation of a new cementum,
PDL, and alveolar bone.
- See PDL, bone, cementum
313
Repair -
replacement of loss apparatus with scar tissue, which doesn’t completely restore the architecture or the function of the part replaced.
End product is the establishment of long junctional epithelium attachment at the tooth-tissue interface.
- See long junctional epi, CT
314
Following flap surgery, new junctional epithelium can form on either cementum or dentin, junctional epithelium is reestablished as
early as one week.
First is False, second is true.
| - Not on dentin, JE is reestablished in 1-3 weeks
315
After you perform a flap surgery, where you see regeneration?
Epithelial attachment via long junctional epithelium & connective
tissue adhesion.
316
```
The soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease
is a
E. collagen adhesion.
F. reattachment by scar.
G. long junctional epithelium.
H. connective tissue attachment.
```
G. long junctional epithelium.
317
Periodontal regeneration involves –
Sharpey’s Fibers, Cementum and Alveolar Bone
318
Type of healing in S/RP and free gingival graft:
LJE and CT
319
What do you want from perio flap?
Regeneration of PDL, cementum & bone
320
After flap surgery, where does repair occur? PDL moves occlusally, apically, laterally
occlusally
321
After periodontal surgery, what type of healing is it most of the time?
Repair
322
3 things you need when doing GTR:
bone, Sharpey’s fibers, & cementum
323
```
Correction of an inadequate zone of attached gingiva on several adjacent teeth is best
accomplished with a/an?
a. apically repositioned flap.
b. laterally positioned sliding flap.
c. double-papilla pedicle graft.
d. coronally positioned flap.
e. free gingival graft.
```
e. free gingival graft.
324
How do you fix gingival recession in anterior region?
pedicle graft (laterally repositioned flap, never lose blood supply)
325
Purpose of lateral graft (Pedicle graft) à
For gingival recession
326
8-year-old with anterior crossbite, has recession on anteriors. What type of tx would you do?
a. chlorhexidine
b. lateral sliding graft
c. pedicle graft
c. pedicle graft
327
```
Free gingival graft: Which area can be affected:
§ Greater palatine nerve bundle
§ Nasopalatine nerve bundle
§ Nasopalatine artery
§ Greater palatine artery
```
§ Greater palatine nerve bundle
328
Most likely to be damage (complication) when you take tissue from gingival graft?
Damage to greater palatine neurovascular
| bundle
329
What nerve is most likely injured when transferring donor tissue to area of free gingival graft (mucosal graft)?
Greater palatine
330
Mucosal graft epithelization by
connective tissue from underlying tissue (recipient site)
331
Where does the epithelial cells for a graft come from?
a. Donor epithelium
b. Donor connective tissue
c. Recipient epithelium
d. Recipient connective tissue
d. Recipient connective tissue
332
What has ultimate effect on the thickness of epithelium of free gingival graft?
a. Recipient epithelial tissue,
b. donor epithelial tissue,
c. donor CT
d. recipient CT
d. recipient CT
333
What is the disadvantage of a connective tissue graft?
Two surgical sites
334
You only have 4 mm of bone (alveolar ridge) above max sinus, how do you do bone graft?
fill graft towards sinus
fill graft towards alveolar ridge
fill graft towards mesial
# fill graft towards sinus
- Don’t add to alveolar ridge, it’s not going to integrate so fill towards sinus
335
What graft is best for sinus lift?
Autogenous & alloplastic
336
Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were advised that she was going to need a
sinus lift procedure with placement of an autogenous bone graft. What is the definition of that graft?
A. The graft will use an artificial, bone-like material.
B. The graft uses bone from another human being.
C. The graft uses the patient's own bone, taken from another site.
D. The graft uses bovine bone, or bone from another animal species.
C. The graft uses the patient's own bone, taken from another site.
337
Which is the most predictable when restoring an edentulous mandibular ridge?
Autograft
338
What is a graft from a different species?
Xenograft
339
How to replace large chunks of mandible?
Autogenous graft
340
What is the most osteogenic?
ONLY autograft
341
alloplast
xenograft
allograft
autograft
conductivity, inductivity, genesis
alloplast + --
xenograft + --
allograft + +/- -
autograft + + +
342
Freezed dried cadaver bone is a type of what graft?
Allograft
343
Decalcified freeze dried bone allograft: has ____ )
bone morphogenetic proteins (BMP
344
Best allograft material:
dried freezed bone
345
Freeze dried bone has the advantage of having which protein:
bmp/pdgf (bone morphogenic protein, Platelet-derived growth
| factor)
346
Which hormone is used to bone graft?
BMP (bone morphologic protein)
347
Which type of grafts causes bone growth? Osteoinductive, Osteoconductive
- OsteoINDuctive --> Allograft, autograft
348
contraindication to grafting procedure
mx canine
349
Least likely to need bone graft? one wall, two wall, three wall wide, three wall narrow
three wall narrow
- Wide & deep 3 wall defect = GTR,
narrow 3 wall defect = bone graft regeneration
350
Best prognosis for bone graft:
narrow 3 wall defect
351
Best prognosis for a guided tissue regeneration?
three walled defect
352
Recession of a single tooth, what do you do?
• Double papilla graft
• Free gingival graft
• Apical repositioning
• Free gingival graft
353
QUESTION: Facial recession on mandibular canine of 14-year-old à
graft not indicated? Reposition with ortho?
354
Least desirable place to place graft:
mandibular 1st premolar space
355
Tx for Class II furcation involvement (also called cul-de-sac)?
GTR
356
Class 3 furcation, which tx not an option?
GTR
| - Class III furcations are least successful in GTR procedures.
357
The purpose of GTR is to prevent: Long J.E, migration of PDL cells, migration of CT cells
Long J.E,
also CT
want regeneration of attachment apparatus
358
The purpose of a barrier: Apical movement of PDL cells, coronal movement of PDL cells
coronal movement of PDL cells
359
Which tx is best for Class III furcation?
a. guided tissue regen
b. apical flap
c. hemisection
d. root amputation
- hemisection = mand molar, to treat Class II or III furcation invasions
- root amputation = max molars
360
In a through and through furcation lesion, which is the least appropriate treatment?
GTR
361
Contraindication for max molar with class II furcation?
hemisection w/ crown
362
How to treat an RCT mand molar that has Class III furcation involvement:
hemisection and place 2 crowns to act as 2 premolars.
| Root amputation is for maxillary teeth.
363
Hemisection of mandibular molar, which has best prognosis:
• Furcation that is more coronal or apical
• Furcation that is more coronal
Furcation that is more coronal
364
QUESTION: Bony area between two premolars has no mesial, facial and lingual wall, what is it called?
Hemiseptum
365
Indication for periodontal/surgical dressing: Healing the tissue, Protect the wound
Protect the wound
366
Reverse architecture-
interproximal is lower than on facial and lingual
interdental bone is apical to crestal bone
367
After periodontal surgery, the dentist leaves interproximal bone apical to radicular bone. What
is this called?
negative architecture.
368
Most important issue that determines success after periodontal surgery?
Plaque control of the area
369
Sequence to close diastema in a child with low labial frenum:
1) wait for the canines to erupt
2) close the diastema with ortho
3) perform the frenum surgery
370
10 y/o kid has a thick upper buccal frenum with diastema between 8 & 9. Tx?
wait til upper permanent canines erupt
frenectomy
use elastics
wait til upper permanent canines erupt (then, do frenectomy)
371
If diastema is caused by a frenum, when should frenectomy happen? .
you don’t do a frenectomy until the canines have erupted
372
QUESTION: All of the following are risk for ortho treatment except? Frenal displacement, plaque management, bone loss,
resorption
Frenal displacement
373
Which of the following explains why the Z-plasty technique used in modifying a labial frenum is considered to be superior to the
diamond technique?
a. it is less traumatic
b. it is technically easier
c. it requires fewer sutures
d. it decreases the effects of scar contracture
e. it allows for closure by secondary intention
it decreases the effects of scar contracture
- improves the appearance of scars and purpose is to relax the frenum pull -- less contracture
