Flashcards in Perio II Deck (111):
What Probe measures vertical depth?
What Probe measures horizontal depth?
Nabers Furcation probe
Maxillary Molar furcation measurements:
Facial 4 mm
Mesial 3 mm
Distal 5 mm
Maxillary Bicuspid furcation measurement:
Mesial 7 mm
Distal 7 mm
Mandibular Molar furcation measurements:
Facial 3 mm
Lingual 4 mm
What is the average root trunk length on the Facial of a Mb 1M?
How often are there root concavities on the Mandibular molars?
_____ is present in 73% of mandibular molars
*bulge coming down from roof
What is the difference between Hamp and Glickman's furcation classification systems?
No class IV in Hamp
A Glickman's Class I furcation is incipient bone loss in the _______
Is it radiographically evident?
Glickman's Class II furcation involvment can be a _____ or ______ cul de sac.
Is it radiographically evident?
Shallow / Deep
May or may not appear on radiographs
Glickman's Class III furcation:
Through and through covered by gingiva
Usually radiographically evident
Glickman's Class IV furcation:
Through and through exposed
Almost always show
Hamp Class I:
less than 2 mm
greater than 2 mm
through and through
The furcation entrance is often more narrow than the standard curette in first molars
Cervical enamel projections are graded I-III depending on how far they go toward the furcation
____% of mandibular molars with furcation involvement also have CEP's
(cervical enamel projections)
There is a ____% association between a CEP and a furcation involvement
CEP's are present on ____% of Mandibular Molars and ___% of Maxillary Molars
Enamel pearls are present on 1.1% to 5.7% of permanent molars and ____% on third molars
Accessory canals in the roof of the Furca
____% of Maxillary 1st molars
____% of mandibular 1st molars
___% of mandibular 2nd molars
___% of maxillary 2nd molars
Abscess blowouts happen in the furca zone with pulpitis/non-vital teeth
There is a very strong association between initial furcation involvement and losing teeth
Describe the pattern of tooth likelihood to be lost:
More root surface, more likely to lose
*multi-rooted teeth more difficult to clean
Concerning Molars, you are more likely to lose _____ teeth than _____.
Trauma from Occlusion is defined as damage to the ______ caused by opposing jaw
It is considered to be ______
Direction, Magnitude, Duration, and Frequency of force are variables that relate occlusal trauma to periodontal disease
What 3 parts of the Peridontium are affected by Occlusal Forces?
***gingiva/junctional epithelium NOT affected
Occlusal trauma will thicken the
Occlusal slide in centric relation or centric occlusion is a symptom of occlusal trauma
What is a tremulous vibratory movement of a tooth when teeth are in functional contact
(detected by finger palpation)
With occlusal trauma, there is an initial _____ in PDL width, loss of fiber orentation, hemorrhage, bone resorption, and then widening of PDL
What side has an initial increase in PDL space
What happens to Cementum on the Tension Side?
Describe Primary Occlusal Trauma:
Excessive occlusal forces
Normal alveolar bone support
Describe Secondary Occlusal Trauma:
Occlusal forces Normal or Excessive
Alveolar bone support reduced
Occlusal Hyperfunction is ____ increase in occlusal force
It is ______, not ______.
What happens to the PDL in occlusal hyperfunction?
What happens to the alveolar bone?
increase width, fiber bundles
A lack of physiologic stimulation leads to a mild weakeing of supporting structures and is called...
Occlusal Hypofunction is considered physiologic or pathologic?
It can only be diagnosed by...
The PDL fibers have _____ orientation in Hypofunction
Total removal of occlusal forces is considered physiologic (not pathologic) and is called...
What happens to the PDL in Disuse Atrophy?
PDL fiber orientation?
Decrease PDL width
Loss of orientation
decrease - localized osteoporosis
Trauma in the absence of inflammation causes Gingivitis, Periodontitis, and Pocket Formation
*causes none of these
Bone loss from trauma alone is....
Periodontitis + occlusal trauma will show remarkable ______ if both issues addressed
Occlusal discrepancies greatly affect ______
Periodontal disease progression
What is a common iatrogenic disease that degrades the Periodontium?
Gingival margin overhangs (due to faulty/iatrogenic restorations) are associated with what 3 things?
Microbial plaque and calculus accumulation
Normal crown to root ratio:
Mucogingival surgery, aka...
Periodontal Plastic Surgery
Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa
Periodontal plastic surgery
What procedure is used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva.
The Pushback Procedure
What procedure, used Pre-1965, exposes denuded bone during healing, resorbs crestal bone, has a stormy healing phase, poor esthetics, and poor long term results if infrabony lesions aren't adequately treated?
How much keratinized and attached gingiva is enough to maintain health?
At least 2 mm
Tooth position that pushes out of alveolar bone can lead to ______ or ______.
Gingival recession may be caused by a thin...
Keratinized tissue is always attached
Gingival recession defects are treated to increase the width of the keratinized attached gingiva or for root coverage
What are the 3 treatment options for increasing the width of the Attached Gingiva?
APF - Apically positioned flap (full thickness)
FGG - Free autogenous gingival graft
CTG - Subepithelial connective tissue graft
What are the 3 treatment options for Obtaining Root Coverage?
CTG - subepithelial Connective Tissue Graft
Tarnow Procedure - Semi-lunar incision + coronal positioning
LPF - Lateral pedicle flap
Describe the APF:
Cut top of margin, bring down, suture, new gingiva grows above
*apically positioned flap
What is the FGG (free autogenous gingival graft) most often used for?
Increase amount of keratinized gingiva
(even though first used for root coverage)
The FGG increases the width of the attached gingiva, removes ______, deepens oral vestibule, or augments _____.
What are 3 advantages to the FGG
Not technically demanding
partial or full-thickness flap works
What are 4 disadvantages to the FGG
Poor blood supply
Esthetics (looks like tire patch b/c of keratinization)
2 intraoral sites required
Donor site problems (bleeding, pain, slow healing)
The CTG (subepithelial Connective Tissue Graft) is indicated to widen _____
to deepen _____
to remove ______
to cover _____
esthetics (color match)
The CTG is most often used for ______
What are 5 advantages to the CTG
Good blood supply
Donor site (palatal) can be closed
What are 2 disadvantages to the CTG?
Gingivoplasty often need post (decrease thickness)
In the CTG, there is bleeding on both sides and the mucosa is induced to being
Using the CTG technique, re-establishing root coverage is possible provided...
There is no bone loss
What is an inferior option when using the CTG:
Acellular dermal matrix from a cadaver
What is used for maxillary anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva?
Semi-lunar incision with coronal positioning
The Tarnow procedure can be complimentary after others (FGG, CTG, GTR) were used to obtain...
What are some (6) advantages to the Tarnow Procedure (semilunar w/ coronal positioning)?
No tension coronally
papillary height preserved
What are 4 disadvantages to the Tarnow Procedure (semilunar w/ coronal positioning)?
Can't use if greater than 2 mm recession
requires 3-5 mm keratinized tissue
contraction b/c secondary intention
2nd procedure often required
If dehiscence/fenestration is revealed in a Tarnow procedure, what should be done?
FGG or CTG after coronal positioning of flap
Describe the LPF (lateral pedicle flap) procedure:
lateral flap cut halfway (not to bone) and flapped over
3 Drugs that induce gingival enlargement:
2 Types of Leukemia that can cause a gingival enlargement:
Classifications of Inflammatory Gingival Hyperplasia:
Slight, moderate, severe
Name 3 Hormonally induced types of gingival enlargement:
Manadione is an essential nutrient for ______
Menadione = Methyl-maphthalenedione
Progesterone = ________
*P. intermedia substitutes
What bacteria is associated with Pyogenic Granuloma Formation?
What is Phenytoin (Dilantin) prescribed for?
Epilepsy (and trauma induced seizures)
Severe cluster headaches
What is the incidence of Phenytoin (Dilantin) induced gingival enlargement?
When does it begin?
There is a positive correlation between Dilantin, gingival enlargement, and poor OHI
The initial lesion involves gingival papillae
The incidence and severity of gingival enlargement associated with Dilantin has no correlation with what 3 factors?
Gingival overgrowth incidence by drug: Carbamezepine:
Phenytoin sodium + Sodium valporate:
Phenytoin sodium + Carbamazepine:
Phenytoin sodium + Carbamazepine + Phenobarbital:
Dilantin, mechanism of Gingival Enlargement:
Interferes with 1
Suppresses: MMP-1, TIMP-1, cathepsin B/L (lysosomal cystein proteinase)
Increases: gycosaminoglycan, PDGF-beta
Interferes: Folic Acid (affecting tissue w/ high turnover rates)
Dilantin can cause gingival enlargement in the endentulous and under partial dentures and around implants
Histologically speaking, Dilantin produces epithelial _______ elongation
Dilantin causes the accumulation of 2x the amount of _______ and less ______ than normal
Type III collagen
Type I collagen
Aside from increasing the amount of collagen, Dilantin increases the volume and density of ________
non-collagen protein matrix
What is the most important Ca++ Channel blocker to know?
What is Nifedipine (Procardia) prescribed for?
What is the mechanism of Nifedipine (Procardia)?
Blocks influx of Ca++ into heart cells thereby reducing oxygen demands
What are 2 components of the pathogenesis of gingival enlargement caused by Nifedipine?
Genetic predisposition (must have "responder" fibroblast phenotype - produces more collagen/matrix)
Collagenolysis is Ca++ dependent
What condition is Cyclosporine (Sandimmune) prescribed?
Major organ transplantation (immune suppression)
How does Cyclosporine (Sandimmune) suppress the immune system?
Suppresses CD8 specifically
mildly all B-lymphocytes
WHO claims 1 Billion people will be on Cyclosporine (Sandimmune) for what 5 conditions?
What are 2 theories concerning the mechanism of Cyclosporine (Sandimmune) induced gingival enlargement?
increased PDGF (platelet derived growth factor), which increases fibroblast proliferation
Describe the epithelial rete ridges in Nifedipine (Procardia)/Cyclosporine (Sandimmune) hyperplasia:
Describe the collagen composition:
If Nifidipine/Cyclosporine doesn't alter the collagen composition, what is increased?
matrix macromolecules by fibroblasts
What are the 2 types of Leukemic gingival Enlargement?
What chromosome is associated with Hereditary Gingival Fibromatosis?
What gene is mutated?
Activation of the SOS1 gene in Hereditary Gingival Fibromatosis results in overproduction of protein which signals the _____ pathway
The ras pathway prompts cells do what 3 things?
A false gingival enlargement is a buccal _____