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Spring 2018 > Perio Final > Flashcards

Perio Final Flashcards

1
Q

4 mechanic causes of gingival recession

A

Traumatic brushing, flossing
Ortho Tx
Trauma
Parafunctional habit

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2
Q

Generalized vs. localized causes of biological gingival recession (2 of each)

A

G: tissue biotype
Oral hygiene

L: anatomy
Defective restoration

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3
Q

Brushing abrasion commonly affects _ in young adults

A

Premolars

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4
Q

Miller classification of recession

A 
1- no interprox bone loss
Recession doesn’t extend to MGJ
100% Root coverage
2- No interprox bone loss
Recession to or past MGJ
100% root coverage
3-Interprox bone loss
May pass MGJ
Partial root coverage
4-Interprox bone loss PAST level of recession
No root coverage
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5
Q

Perio-ortho interrelationships

A

S

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6
Q

Who has a higher increase in plaque after ortho?

A

Adults. Adolescents have higher baseline and it doesn’t increase that much

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7
Q

After ortho, subgingival pathogens __. Several months later they _

A

Temporarily increase

Return to pretreatment levels

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8
Q

_ % of people have gingival enlargement that remains after ortho tx

A

30%. 50 start, 100 end tx, 80% after 3-12 mo.

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9
Q

What do normally erupting teeth look like at time of eruption

A

Developing root and 3/4 final root length complete

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10
Q

Unerupted teeth have a more _ than erupting teeth

A

More completely developed root

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11
Q

Order of frequency of impacted teeth

A 
3rd molars
Maxillary canine
Man 1st PM
Man 2nd PM
Man Canine
Max premolars
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12
Q

Most impacted max canines are _ impacted

A

Palatal

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13
Q

Buccally impacted canines are associated with _ deficiency

A

Arch length

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14
Q

Local causes of tooth impaction

A 
Failure of deciduous roots to resorb
Abnormal position
Supernumerary tooth
Tooth crowding
Dentigerous cyst
Thickened soft tissues
Soft/hard tiss. Pathology
Premature extraction of primary tooth
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15
Q

3 Systemic factors that can cause impaction

A

Childhood diseases
Hereditary factors
Genetic syndromes

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16
Q

Problems that can follow canine impaction

A 
Malpositioning of impacted tooth
Migration of neighboring teeth
Internal/external resorption
Dentigerous cyst formation
Referred pain
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17
Q

Surgical aims for impacted teeth (not extraction)

A

Provide conditions for normal, unimpeded eruption

Provide access for ortho appliances

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18
Q

Open eruption vs closed eruption

A

Open: cut a window, let it erupt
Closed: cut flap, ortho appliance, close flap

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19
Q

Advantage/disadvantage of closed and open eruption

A

Open: more pain, hard to eat, if ortho breaks, don’t need surgery

Closed: more comfortable, but if ortho breaks, need surgery again

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20
Q

ANUG starts where

A

Papilla then moves to gingiva

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21
Q

Characteristics of advanced ANUG

A

Lack of deep pockets
Papillary and marginal involvement
STINKS
Necrosis causing craters

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22
Q

4 microbes that cause ANUG

A

Treponema
Selenomonas
Fusobacterium
Prevotella

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23
Q

Treatment of ANUG
1st
2nd
3rd

A
  1. History
    Removal of necrotic tissue
    Emergency tx

1/2 rinse with H2O2

  1. Evaluation
    Scaling
    Emergency
    Confirm home hygiene
  2. No more rinses
    Plaque control
    Counsel on hygiene
    SRP repeated if needed
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24
Q

4 types of abscesses, causes of each

A

Gingival - Trauma
Pericoronal - Trauma

Periodontal - Infection
Periapical - Infection

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25
Q

Antibiotics are contraindicated for which abscess

A

Gingival

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26
Q

Perio abscesses most often happen on which teeth and under what condition

A

Molars

PD ≥ 5mm

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27
Q

Causes of perio abscesses

A

Periodontitis

Non-perio, acute infection from another source

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28
Q

Treatment of perio abscesses

A 
Drainage through pocket retraction or incision
SRP
Perio surgery
Extraction
Antibiotics if systemic complications
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29
Q

Types of mucogingival defects

A 
Gingival recession
Lack of gingival keratinization
Lack of attached gingiva
 -high frenum attachment
 -shallow vestibule
Recession with abrasion
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30
Q

Etiology of gingival recession can be divided into two categories _

The first has 4 types

The second has 2 types

A 
Mechanic/biological
M:
Traumatic brushing/flossing
Ortho
Trauma
Parafunctional habit
B:
Generalized (tissue type, oral hygiene)
Localized (anatomy, defective restoration)
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31
Q

Miller classifications for recession

A

I: no interprox bone loss, recession does NOT extend to MGJ

II: no interprox bone loss, recession extends to MGJ. Full root coverage

III: interprox bone loss, recession may reach MGJ. Partial root coverage (to level of interprox bone)

IV: interprox bone loss beyond level of recession. No root coverage

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32
Q

5 flap options for treating recession

A 
Coronally advanced flap
Tunnel
Lateral sliding flap
Double papilla
Semilunar
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33
Q

Mucograft:

A

Xenograft porcine collagen I and III

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34
Q

Indications and disadvantages of free gingival graft

A

I: increase KG/attached gingiva
Increase vestibular depth
Achieve root coverage

D: not predictable for root coverage
Color doesn’t match
Complications at donor site

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35
Q

3 phases of healing of free gingival graft

A

Initial phase 0-3d
Revascularization 2-11d
Tissue maturation 11-42d

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36
Q

4 classifications of labial frena, definitions

A

Mucosal - frenum ends in mucosa or at MGJ
Gingival - frenum ends in gingiva
Papillary - frenum ends at papilla
Papillary penetrating - frenum ends at papilla and penetrates to palate

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37
Q

Main syndrome associated with prominent max frenum

A

Ellis van Creveld syndrome

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38
Q

Genetic syndromes (2) associated with absence of max labial frenum

A

Ehlers-Danlos

Holoprosencephaly

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39
Q

3 types of tissues make up frena

A

Ortho and parakeratinized ep.
Collagen fibers
Chronic inflammatory infiltrate

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40
Q

4 indications for frenectomy

A

Recession
Interference with oral hygiene procedures
Diastema
Denture fabrication

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41
Q

Frenotomy vs frenectomy

A

Otomy: cutting of frenum, esp release of ankyloglossia

Ectomy: total removal of a frenum

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42
Q

4 surgery options for a frenectomy

A

V shaped
Z-plasty
Lasers
Electrosurgery

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43
Q

Do ortho before or after frenectomy

A

Before unless really wide and thick

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44
Q

1st

A

1st

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45
Q

6 factors determining LASER interactions with tissues

A 
Wavelength
Energy level
Waveform
How focused the beam is
Duration of exposure
Tissue characteristics
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46
Q

Disadvantages of laser use

A

Technical difficulties
Less precise
Hazardous
Can disperse viral particles in plume

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47
Q

LANAP:

How does it work

A

Laser assisted new attachment procedure

Remove sulcular epithelium
Modify root surface
New attachment will occur

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48
Q

How does photodynamic therapy work

A

Sensitizer is injected, absorbed by tissues. Light targets only sensitized tissue, kills whatever is absorbed

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49
Q

4 indications for perio surgery

A

Failure to resolve inflammation by SRP (hard to reach areas)
Regeneration of periodontium
Cosmetic improvements to periodontium
Resorative needs

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50
Q

Two purposes of perio surgery

A

Access and regeneration

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51
Q

T/F open flap debridement is statistically significant in its effect

A

TRUE

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52
Q

3 types of healing

A

Repair - doesn’t restore function
New attachment - CT + root surface, deprived of original attachment
Regeneration - new cementum, PDL and bone to reconstitute lost part

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53
Q

T/F surgical tx is necessary to arrest inflammatory progress of disease

A

TRUE

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54
Q

T/F surgical access to root surface is least common surgical treatment to arrest periodontal disease

A

FALSE - it is the most common

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55
Q

T/F Regenerative surgery is rapidly changing the way perio disease is managed

A

TRUE

56
Q

Biologics are generally comparable to _ and _ and superior to _ in improving clinical parameters in treatment of intrabony defects

A

Demineralized freeze-dried bone allograft AND GTR

OFD

57
Q

In the infrabony defects meta-analysis, clinical outcomes appear most influenced by _ rather than by tooth and defect characteristics

A

Patient behaviors and surgical approach

58
Q

T/F periodontal regeneration in intrabony defects is impossible on previously diseased root surfaces

A

FALSE

59
Q

T/F surgical treatment is necessary to arrest inflammatory progress of disease

A

TRUE

60
Q

_ is the most common surgical treatment to arrest periodontal disease

A

Surgical access to root surfaces

61
Q

The two most frequent causative factors for gingival recessions

A

Toothbrushing trauma

Bacterial plaque

62
Q

What is the bilaminar technique, why use it

A

Coronally advanced flap covering a connective tissue graft

Use of graft increases the likelihood of achieving complete root coverage (especially long term)

63
Q

Tooth loss is _ proportional to perio maintenance therapy

A

Inversely

64
Q

3 therapeutic goals of PMT

A

Prevent recurrence and progression of perio disease in patients treated ja

Prevent tooth loss by monitoring teeth

Increase probability of treating other diseases in mouth

65
Q

Ideal frequency of PMT

A

3 months

66
Q

What requires retreatment during maintenance

A 
Continued inflammation (surgery)
Aloss (SRP + antibiotics or surgery)
67
Q

2 species of bacteria around teeth/implants with inflamed tissues

A

Prevotella intermedia

Pophyromonas gingivalis

68
Q

In maintenance of implants, what 3 things are we looking at

A

Tissue health
Crevicular fluid
Mobility and occlusion

69
Q 
Soft tissue healing:
First day
1-3 days
3-4 days
Week 1
Week 2
Week 4-6
A

Day 1: blood clot/coagulin
1-3d: fibrinolysis
3-4: mesenchymal cells, replacement of coagulum by gran tiss.
1w: vascular networks formed
2w: socket covered w/ new conn. Tiss with blood vessels and inflammatory cells
4-6w: soft tissue keratinization

70
Q

Hard tissue healing:
4-6 weeks
4-6 months
6mo+

A

4-6w: woven bone in alveolus
4-6m: lamellar bone on woven
6mo+: bone deposition continues, won’t reach coronal bone level of neighboring teeth

71
Q

More resorption occurs in the _ of the max and mand

A

Buccal aspect of alveolus

72
Q

Resorption occurs more on _ (type) alveoli and in the presence of _ or _ or after the formation of a _ following healing

A

Thin, cortical, knife edged facial alveoli

Dehiscence or fenestration

Buccal concavity

73
Q

Bone loss in the first 6 months-1 yr occurs more in _ direction

A

Horizontal

74
Q

Following extraction, what 3 things can affect the amount of residual bone

A

Surgical trauma
Elevation of a flap
Age of the patient

75
Q

Class I-V bone defects

A

I: extraction sockets
II/III: dehiscence defects
IV: horizontal defects
V: vertical defects

76
Q

ARP:
Definition
Purpose
Diff b/t GBR

A

Alveolar ridge preservation at time of extraction.

Control resorption

GBR targets regeneration of already resorbed/lost bone

77
Q

When to do ARP

A

When immediate implant placement isn’t possible

78
Q

3 contraindications for ARP

A

Infection
Indication for immediate implant placement
Soft tissue limitation

79
Q

Bone grafting materials can be either _ (scaffold) or _ (stimulates resident cells)

A

Osteoconductive

Osteoinductive

80
Q

Which materials are osteogenic, osteoinductive, osteoconductive

A

Autogenous grafts: all 3
Allografts: OI/OC
Xenografts: OC
Synthetics: none. Just fillers

81
Q

Synthetic grafts can be absorbable or non-absorbable. Examples of each

A

A: plaster of paris, calcium carbonate

NA: bioglass, HA, PMMA

82
Q

Where is autogenous bone graft material taken from

A

Iliac

Max tuberosity, extraction site, osseus coagulum

83
Q

3 types of allogenic bone grafts

A

Frozen iliac cancellous bone
Freeze-dried bone allograft (mineralized/demineralized)
(D)FDBA w/ autogenous bone

84
Q

What is the role of the barrier in the ARP

A

Type of tissue in a space is determined by what cells have access. Block off unwanted cells

85
Q

6 types of membranes

A 
Millipore filter
ePTFE (w/ or w/o titanium)
Cross-linked bovine collagen barrier
Bioabsorbable polymer: polylactic acid base
Autogenous conn. Tiss membranes
86
Q

4 things affecting outcome of ARP

A

Blood supply
Space maintenance
Membrane stability
Tension in flap closure (want none)

87
Q

In mature bone, implants should have _ mm on all sides

At least _ mm of interocclusal distance is needed from top shoulder of implant to occlusal of opposing tooth

At least _ mm space b/t two adjacent implants and _ mm b/t implant and adjacent tooth

A

1

7

3, 2-3

88
Q

3 types of mandible shapes, best one for implants

A

C P U

C is best, U is worst (concave)

89
Q

4 implant placement types based on timing

A

Immediate
Early
Late
Conventional

90
Q

Immediate implant placement
Advantages
Disadvantages

A

A: less surgeries, less treatment time, optimal use of bone

D: site morphology needs to be good
Tissue biotype needs to be good
Need keratinized mucosa for flap
Adjunctive surgeries may be necessary
Technique sensitive
91
Q

Immediate implant placement may not prevent _ that follows tooth extraction

A

Physiologic modeling/remodeling

92
Q

Early implant placement has two advantages

A

Easier flap adaptation

Allows resolution of local pathology

93
Q

Disadvantages of early implant placement

A 
Bad site morphology
Longer treatment time
Bone resorption at socket walls
May need adjunctive surgery
Technique sensitive
94
Q

At least _ mm of bone height is needed apically to the socket for immediate and early implant placement

A

3

95
Q

_ biotype is indicated for early implant placement

A

Soft

96
Q

Early/immediate implants need _ walls and no _)

A

3/4 walls and no dehiscence or fenestration of buccal

97
Q

Advantages for late implant placement

A

Clinically healed ridge

Mature soft tissues, easy flap management

98
Q

Disadvantages of late implant placement

A

Treatment time
Adjunctive procedures
Large variation in available bone (more bone loss with longer wait time)

99
Q

New bone formation is decreased after

A

3-4 months

100
Q

Indications for early implant placement of a single-rooted tooth

A 
Good extraction (preserve bone)
Thick biotype soft tissue
Manageable gap following placement
Root length (mand ant., max lat)
101
Q

Contraindications for immediate/early placement of implant of single rooted tooth

A 
Oval shaped socket
Rotated tooth
Malocclusion
Esthetic zone
Anatomical landmarks
Long root length (canines)
102
Q

Indications/contraindications of early implant placement for a multi-rooted tooth

A

I: large intact septum b/t divergent roots
Non-esthetic area

CI: multiple sockets
Lack of soft tissue
Heavy occlusal forces
Anatomy

103
Q

T/F Immediate implant placement is best

A

T

104
Q

Why wouldn’t immediate implant placement be done (2 reasons)

A

Infection

Soft tissue issues

105
Q

_ implant placement is done unless _ or _,
in which case _ is done until _ can be done, unless _
In which case _ will be done and delayed implant placement will be done.

A

Immediate, infection, soft tissue issues
Socket preservation until early placement
Not enough bone, guided bone regeneration

106
Q

5 steps in drilling sequence for implant

A 
Round bur
Pilot hole
Parallel pin (radiographs)
Widen hole
Final diameter
107
Q

Advantages/disadvantages of ONE STAGE implant placement (3/2)

A

A: no 2nd surgery to uncover implant
Better evaluation of wound healing
Early temporization

D: Exposure to oral cavity during osseointegration
Difficult to control loading

108
Q

Contraindications for one stage implant placement

A

Torque value less than 35 Ncm
Smokers
Thin tissue (soft and hard) biotype

109
Q

All _ problems should be solved prior to any types of implant placement surgery

A

Periodontal health related

110
Q

The implant shoulder should be placed _ to CEJ of adjacent teeth in patients without gingival recession

A

2 mm apical to CEJ

111
Q

Implant pre-op procedures to control bacteria and prep for surgery

A

Antibiotic prophy
Chlorhexidine rinse
NSAIDS
Prep for sedation

112
Q

The incision for an implant is where

A

Mid-crestal or slightly lingual

113
Q

What happens in post op visits
7-10d post op
1 mo post op

A

7-10:

  • chlorhexidine rinse
  • review OHI
  • remove sutures if necessary

1 mo:
-check that implant is covered still

BOTH:
Check for signs of infection

114
Q

At least _ mm bone thickness b/t two implants

A

3mm

115
Q

It is harder to create alveolar bone _ than _

A

Height than width

116
Q

T/F inter-implant papillae can be predictable re-established

A

FALSE

117
Q

3 ways dentures can be supported by implants

A

Ball attachments
Bar and clips
Hybrid (fixed implant supported denture)

118
Q

Lateral vs vertical bone augmentation

A

Lateral is predicable and achievable

Vertical is difficult

119
Q

Multiple anterior implants should be aligned _ with _ between each other

A

Parallel

3mm

120
Q

Three components of an implant

A 
Implant fixture (first part in)
Abutment (screws into fixture)
Restoration
121
Q

Infection indicator that is more common on implants than teeth

A

Suppurations

122
Q

Peri-implantitis vs peri-implant mucositis

A

PI- Inflammation and loss of supporting bone around implant in function

PIM- gingivitis around implant

123
Q

Ailing vs. failing vs. failed implant

A

A: PI mucositis
Failing: P-implantitis
Failed: P-implantitis, hopeless, non-functional, pain

124
Q

Peri-implantitis is almost always _ shaped

A

Cup

125
Q

3 goals in treating failing implants

A

Resolve inflammation

  • plaque debridement
  • improve oral hygiene
  • adjunctive antibiotics

Correct pseudo pockets by flap surgery/gingivectomy

Re-osseointegration (decontaminate implant, GBR)

126
Q

How to treat peri-implantitis
Class I
II
III/IV

A

I: repositioning of flaps
Cleaning implant surface
Implantoplasty if needed

II: same as one
GTR if vertical with 3+ walls
1/2 walls = osteoplasty/bone leveling

III/IV: GBR

127
Q

Active ingredient in infuse

What does it do, when do you use it

A

Recombinant human bone morphogenic protein-2

Stimulates bone formation

Regeneration after peri-implant bone defect

128
Q

Why perio before restorative? (4)

A

No inflammation means ideal tooth access and prep ability

More stable, less Aloss

Better esthetics

129
Q

6 steps in treatment sequence

A
  1. Etiologic phase (faulty rest.s)
  2. Pre-prosthetic surgery (preservation, augmentation)
  3. Restoration design
  4. Pre-implant surgery
    - sinus lift
  5. Post-prosthetic surgery
    - tissue deformities/gummy smile
  6. Maintenance
130
Q

When is perio necessary before ortho

A

When there is inflammation/perio problems

131
Q

When can you do ortho in perio patients

A

Reduced but healthy and stable periodontium

Active perio with ortho will have problems

132
Q

Pre-ortho, what perio procedures can help with ortho (5)

A 
Tooth exposure
Root coverage
Frenectomy
Perio accelerated ortho
Implants for anchorage
133
Q

Post/during ortho, what perio procedures can help with ortho

A

Fiberotomy
Frenectomy
Gingivectomy
Root coverage

134
Q

Adjunctive ortho can help what perio problems (4)

A

Diastemas
Gingival margin discrepancies
Intrabony defects
Implant site development (space/ridge development)

135
Q

Clinical data doubles ever _

A

18 months

136
Q

3 types of gingival grafting

A

Free gingival graft
Pedicure (lateral)
Sup-epithelial connective tissue graft

Spring 2018 (18 decks)

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