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Flashcards in Perio II Deck (111):
1

What Probe measures vertical depth?

What Probe measures horizontal depth?

Periodontal probe

Nabers Furcation probe

2

Maxillary Molar furcation measurements:

Facial 4 mm

Mesial 3 mm

Distal 5 mm

3

Maxillary Bicuspid furcation measurement:

Mesial 7 mm

Distal 7 mm

4

Mandibular Molar furcation measurements:

Facial 3 mm

Lingual 4 mm

5

What is the average root trunk length on the Facial of a Mb 1M?

3 mm

6

How often are there root concavities on the Mandibular molars?

neary 100%

7

_____ is present in 73% of mandibular molars

Bifurcation ridge

*bulge coming down from roof

8

What is the difference between Hamp and Glickman's furcation classification systems?

No class IV in Hamp

9

A Glickman's Class I furcation is incipient bone loss in the _______

Is it radiographically evident?

furca opening

No

10

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

11

Glickman's Class III furcation:

Radiograph:

Through and through covered by gingiva

Usually radiographically evident

12

Glickman's Class IV furcation:

Radiograph:

Through and through exposed

Almost always show

13

Hamp Class I:

Class II:

Class III:

less than 2 mm

greater than 2 mm

through and through

14

T/F
The furcation entrance is often more narrow than the standard curette in first molars

True

15

T/F
Cervical enamel projections are graded I-III depending on how far they go toward the furcation

True

16

____% of mandibular molars with furcation involvement also have CEP's

(cervical enamel projections)

90%

17

There is a ____% association between a CEP and a furcation involvement

50%

18

CEP's are present on ____% of Mandibular Molars and ___% of Maxillary Molars

28.6%

17%

19

Enamel pearls are present on 1.1% to 5.7% of permanent molars and ____% on third molars

75%

20

Accessory canals in the roof of the Furca

____% of Maxillary 1st molars

____% of mandibular 1st molars

___% of mandibular 2nd molars

___% of maxillary 2nd molars

36%

32%

24%

12%

21

T/F
Abscess blowouts happen in the furca zone with pulpitis/non-vital teeth

True

22

T/F
There is a very strong association between initial furcation involvement and losing teeth

True

23

Describe the pattern of tooth likelihood to be lost:

More root surface, more likely to lose

*multi-rooted teeth more difficult to clean

24

Concerning Molars, you are more likely to lose _____ teeth than _____.

Maxillary

Mandibular

25

Trauma from Occlusion is defined as damage to the ______ caused by opposing jaw

It is considered to be ______

Periodontium

Pathologic

26

T/F
Direction, Magnitude, Duration, and Frequency of force are variables that relate occlusal trauma to periodontal disease

True

27

What 3 parts of the Peridontium are affected by Occlusal Forces?

Cementum

PDL

Alveolar Bone


***gingiva/junctional epithelium NOT affected

28

Occlusal trauma will thicken the

PDL

29

Occlusal slide in centric relation or centric occlusion is a symptom of occlusal trauma

True

30

What is a tremulous vibratory movement of a tooth when teeth are in functional contact

(detected by finger palpation)

Fremitus

31

With occlusal trauma, there is an initial _____ in PDL width, loss of fiber orentation, hemorrhage, bone resorption, and then widening of PDL

(compression side)

decrease

32

What side has an initial increase in PDL space

Tension side

33

What happens to Cementum on the Tension Side?

Cemental Tearing

34

Describe Primary Occlusal Trauma:

Excessive occlusal forces

Normal alveolar bone support

35

Describe Secondary Occlusal Trauma:

Occlusal forces Normal or Excessive

Alveolar bone support reduced

36

Occlusal Hyperfunction is ____ increase in occlusal force

It is ______, not ______.

Slight

Physiologic, Pathologic

37

What happens to the PDL in occlusal hyperfunction?

What happens to the alveolar bone?

increase width, fiber bundles

Increased density/thickness

(also osteosclerosis)

38

A lack of physiologic stimulation leads to a mild weakeing of supporting structures and is called...

Occlusal Hypofunction

39

Occlusal Hypofunction is considered physiologic or pathologic?

It can only be diagnosed by...

Physiologic

Histology

40

The PDL fibers have _____ orientation in Hypofunction

normal

41

Total removal of occlusal forces is considered physiologic (not pathologic) and is called...

Disuse Atrophy

42

What happens to the PDL in Disuse Atrophy?

Tooth mobility?

PDL fiber orientation?

bony trabeculae?

Decrease PDL width

increase mobility

Loss of orientation

decrease - localized osteoporosis

43

T/F
Trauma in the absence of inflammation causes Gingivitis, Periodontitis, and Pocket Formation

False

*causes none of these

44

Bone loss from trauma alone is....

reversible

45

Periodontitis + occlusal trauma will show remarkable ______ if both issues addressed

regeneration

46

Occlusal discrepancies greatly affect ______

Periodontal disease progression

47

What is a common iatrogenic disease that degrades the Periodontium?

Crown/restoration contour

48

Gingival margin overhangs (due to faulty/iatrogenic restorations) are associated with what 3 things?

Gingival inflammation

Bone loss

Microbial plaque and calculus accumulation

49

Normal crown to root ratio:

1:1.5

50

Mucogingival surgery, aka...

Periodontal Plastic Surgery

51

Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa

Periodontal plastic surgery

(mucogingival surgery)

52

What procedure is used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva.

The Pushback Procedure

53

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?

Pushback Procedure

54

How much keratinized and attached gingiva is enough to maintain health?

At least 2 mm

55

Tooth position that pushes out of alveolar bone can lead to ______ or ______.

fenestration

dehiscence

56

Gingival recession may be caused by a thin...

biotype

57

T/F
Keratinized tissue is always attached

False

58

T/F
Gingival recession defects are treated to increase the width of the keratinized attached gingiva or for root coverage

True

59

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

60

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

61

Describe the APF:

Cut top of margin, bring down, suture, new gingiva grows above

*apically positioned flap

62

What is the FGG (free autogenous gingival graft) most often used for?

Increase amount of keratinized gingiva

(even though first used for root coverage)

63

The FGG increases the width of the attached gingiva, removes ______, deepens oral vestibule, or augments _____.

abnormal frenulum

ridge

64

What are 3 advantages to the FGG

Not technically demanding

partial or full-thickness flap works

Many applications

65

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)

66

The CTG (subepithelial Connective Tissue Graft) is indicated to widen _____

to deepen _____

to remove ______

to cover _____

or:

attached gingiva

oral vestibule

frenulum

root surface

esthetics (color match)

67

The CTG is most often used for ______

esthetic purposes

68

What are 5 advantages to the CTG

Predictable

Good blood supply

Donor site (palatal) can be closed

Color match

multiple teeth

69

What are 2 disadvantages to the CTG?

Technically demanding

Gingivoplasty often need post (decrease thickness)

70

In the CTG, there is bleeding on both sides and the mucosa is induced to being

keratinized

71

Using the CTG technique, re-establishing root coverage is possible provided...

There is no bone loss

*blood supply

72

What is an inferior option when using the CTG:

Acellular dermal matrix from a cadaver

73

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

(Tarnow Procedure)

74

The Tarnow procedure can be complimentary after others (FGG, CTG, GTR) were used to obtain...

Root coverage

75

What are some (6) advantages to the Tarnow Procedure (semilunar w/ coronal positioning)?

No tension coronally

good esthetics

papillary height preserved

simple

minimal discomfort

multiple teeth

76

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

77

If dehiscence/fenestration is revealed in a Tarnow procedure, what should be done?

FGG or CTG after coronal positioning of flap

78

Describe the LPF (lateral pedicle flap) procedure:

lateral flap cut halfway (not to bone) and flapped over

79

3 Drugs that induce gingival enlargement:

Phenytoin (Dilantin)

Cyclosporine (Sandimmune)

Nifedipine (Procardia)

80

2 Types of Leukemia that can cause a gingival enlargement:

Acute lymphocytic

Acute myelocytic

81

Classifications of Inflammatory Gingival Hyperplasia:

Acute/Chronic

Localized/Generalized

Slight, moderate, severe

82

Name 3 Hormonally induced types of gingival enlargement:

Pregnancy

Pyogenic Granuloma

Puberty

83

Manadione is an essential nutrient for ______

P. intermedia

84

Menadione = Methyl-maphthalenedione

Progesterone = ________

Napthoquinone

*P. intermedia substitutes

85

What bacteria is associated with Pyogenic Granuloma Formation?

P. intermedia

86

What is Phenytoin (Dilantin) prescribed for?

Epilepsy (and trauma induced seizures)

Severe depression

Severe cluster headaches

87

What is the incidence of Phenytoin (Dilantin) induced gingival enlargement?

When does it begin?

50%

1-3 months

88

T/F
There is a positive correlation between Dilantin, gingival enlargement, and poor OHI

T/F
The initial lesion involves gingival papillae

True

True

89

The incidence and severity of gingival enlargement associated with Dilantin has no correlation with what 3 factors?

Dosage

Plasma levels

Duration

90

Gingival overgrowth incidence by drug: Carbamezepine:

Phenytoin sodium:

Phenytoin sodium + Sodium valporate:

Phenytoin sodium + Carbamazepine:

Phenytoin sodium + Carbamazepine + Phenobarbital:

0%

52%

56%

71%

83%

91

Dilantin, mechanism of Gingival Enlargement:

Suppresses 3

Increases 2

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)

92

T/F
Dilantin can cause gingival enlargement in the endentulous and under partial dentures and around implants

True

93

Histologically speaking, Dilantin produces epithelial _______ elongation

rete ridge

94

Dilantin causes the accumulation of 2x the amount of _______ and less ______ than normal

Type III collagen

Type I collagen

95

Aside from increasing the amount of collagen, Dilantin increases the volume and density of ________

non-collagen protein matrix

96

What is the most important Ca++ Channel blocker to know?

Nifedipine (Procardia)

97

What is Nifedipine (Procardia) prescribed for?

(two things)

Angina pectoris

Post-myocardial syndrome

98

What is the mechanism of Nifedipine (Procardia)?

Blocks influx of Ca++ into heart cells thereby reducing oxygen demands

99

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

100

What condition is Cyclosporine (Sandimmune) prescribed?

Major organ transplantation (immune suppression)

101

How does Cyclosporine (Sandimmune) suppress the immune system?

Suppresses CD8 specifically

mildly all B-lymphocytes

102

WHO claims 1 Billion people will be on Cyclosporine (Sandimmune) for what 5 conditions?

Rueumatoid Arthritis

Sarcoidosis

Malaria

Psoriasis

MS

103

What are 2 theories concerning the mechanism of Cyclosporine (Sandimmune) induced gingival enlargement?

Genetic predisposition

increased PDGF (platelet derived growth factor), which increases fibroblast proliferation

104

Describe the epithelial rete ridges in Nifedipine (Procardia)/Cyclosporine (Sandimmune) hyperplasia:

Describe the collagen composition:

Elongated

Normal

105

If Nifidipine/Cyclosporine doesn't alter the collagen composition, what is increased?

matrix macromolecules by fibroblasts

106

What are the 2 types of Leukemic gingival Enlargement?

Acute lymphocytic

Acute myelocytic

107

What chromosome is associated with Hereditary Gingival Fibromatosis?

What gene is mutated?

2p21

SOS1

108

Activation of the SOS1 gene in Hereditary Gingival Fibromatosis results in overproduction of protein which signals the _____ pathway

ras

109

The ras pathway prompts cells do what 3 things?

Grow

Differentiate

Apoptosis

110

A false gingival enlargement is a buccal _____

tori

111

T/F
If there's no Fremitis there's no occlusal trauma

False

*fremitis is a sign but not necessary for occlusal trauma to be present

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