Perio Midterm Flashcards
1
Q
What are 5 therapeutic goals of periodontal therapy?
A
- Resolve Inflammation
- Arrest Disease Progression
- Regenerate lost periodontium
- Deter recurrent disease
- Establish and maintain comfort, function and esthetics
2
Q
What are 4 therapeutic endpoints to periodontal therapy?
A
- Plaque control compatible with health
- Shallow sulci (3mm or less pocket)
- Eliminate / minimize BOP and inflammation
- Establish physiologic architecture of soft / hard tissue
3
Q
When does surgical periodontal therapy normally come into play in periodontal therapy?
A
After PIOE, diagnosis, scale and root plane 4 quadrants, and eval of intiial therapy
4
Q
What is included in initial therapy phase for perio?
A
- Medical consults
2 .OHI - Occlusal adjustments
- Scaling and root planing
5
Q
What is done at the end Evaluation of Initial Therapy (EIT)?
A
- Evaluate tissue response
- Evaluate oral hygiene
- Repeat exam and charting
- Determine next treatment options
6
Q
For scaling and root planing (Sc/RP) effectiveness, what is a general rule?
A
The deeper the pocket, the less effective
1-3 mm, get 86% calculus free
4-6mm, get 43% calculus free
>6mm get 32% calculus free
7
Q
With a 4-6mm probing depth, what improvement can be expected with Sc/RP therapy?
A
1mm improvement (0.96 decrease probing depth and 0.23 increase in attachment)
8
Q
For 7mm and greater probing depth, what improvement can be expected with Sc/RP therapy?
A
2mm improvement (2.2mm decrease probing depth and 0.91mm increase in attachment)
9
Q
For the initial probing depths and their intended outcomes, what is the remaining consideration about the periodontium after therapy?
A
There is still a probing depth
10
Q
Incomplete removal of subgingival plaque and calculus results in what two things?
A
- Persistent infection
2. Continued loss of attachment
11
Q
What is considered periodontal health with minimal probing depths at EIT?
A
Up to 4mm probing depth
12
Q
What is EIT with up to 5mm probing depth?
A
Periodontal health with residual moderate to severe probing depths
13
Q
What are 3 treatment options at EIT?
A
- Periodontal maintenance
- Continue initial therapy (Sc/RP again, systemic antibiotics, local antibiotics)
- Surgical Periodontal treatment
14
Q
What is the term for surgical manipulation of periodontal soft tissues, tooth roots and bone with the primary goal to create an oral environment that is conducive to maintaining the patient’s dentition in health, comfort, and function?
A
Periodontal surgery
15
Q
What are 5 objectives for periodontal surgery?
A
- Provide access to debride root and bone
- Modify osseous architecture
- Repair / regenerate the periodontium
- Pocket reduction
- Establish acceptable soft tissue contours
16
Q
What are 5 surgical options for the treatment of periodontitis?
A
- Open flap debridement
- Osseous resective surgery (pocket elimination)
- Regeneration (guided tissue regeneration)
- Root resection
- Extraction and replace root with implant
17
Q
What are 5 MORE objectives of surgery?
A
- Arrest inflammation and disease
- Improve pocket depth and attachment
- Modify osseous architecture
- Establish acceptable tissue contours
- Repair / regenerate the periodontium
18
Q
At what point is surgical treatment planned?
A
At EIT
19
Q
What are findings that indicate a need to continue from initial therapy or maintenance therapy into surgical therapy?
A
- Deep probing depths
- Increasing probing depths
- Continued BOP
- Suppuration
- Abscess
20
Q
What are treatment approaches that would allow the goals of stopping disease progression, allowing access to root surface, improving pocket depth and increasing attachment levels, modifying the osseous architecture, and establish acceptable tissue contours?
A
- Open flap debridement
- Osseous resection (flap and osseous surgery)
- Regeneration
- Mucogingival augmentation
21
Q
What are 3 types of wound healing following periodontal surgery?
A
- Reattachment
- New attachment
- Regeneration
22
Q
What is the term for healing of a wound by reconnection of tissue that has been surgically repaired?
A
Reattachment
23
Q
Reattachment would normally occur in what areas after periodontal surgery?
A
In areas where teeth were not periodontally involved
24
Q
What is the term for the union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus?
A
New attachment
25
What types of connections constitute new attachment after periodontal surgery?
1. Epithelial adhesion
2. Connective tissue adaptation / attachment
3. New cementum
26
Can new attachment be considered regeneration?
No because there is no new bone
27
What is the term for formation of new bone, new cementum, and new periodontal ligament about a tooth root surface previously exposed to bacterial plaque?
Regeneration
28
What are the three requirements for healing to be considered regeneration?
1. New bone
2. New cementum
3. New PDL
29
What are 3 surgical methods to get a shallower pocket?
1. Surgery giving new attachment = open flap debridement
2. Surgery giving regeneration = freeze-dried bone and membrane
3. Osseous resection
30
What must be attained before any surgery?
Informed consent
31
What must a patient have after periodontal surgery?
Escort
32
What is an anxiolytic that can be prescribed to take 90 minutes before the procedure?
2mg Ativan
33
For IV sedation, what is the desired drug?
Long acting (valium, versed (barbiturates)) and demerol (opiod)
34
What is key for the surgical site to ensure an aseptic technique?
Copious irrigation
35
Are antibiotics indicated prophylactically for periodontal surgery?
Treating post op infection
36
Which has a higher post-op infection rate: quadrant surgery or sextant surgery?
Quadrant surgery
37
What are 4 parts of the aggressive treatment of post op infections?
1. Debridement
2. Drainage
3. Culture and Sensitivity
4. Antibiotics
38
What are 3 antibiotics common for treatment of post op infections?
1. Amoxicillin 500mg, tid 7 days
2. Clindamycin 300 mg qid, 7 days
3. Metranidazol
39
What are 5 ways to atraumatically manage tissue during surgery?
1. Crisp incision
2. Sharp dissection
3. Avoid flap tension
4. Avoid flap compression
5. Maintain tissue hydration
40
Where should a flap be widest?
At the base
41
The Pritchard curette, Young-Good 7/8 and the McCall 13-14 are all tissue curettes used for what? What order are they used in?
All used to debride soft tissue. Curette from larger to smaller. Start with Pritchard, then Younger-Good, then McCall
42
What is the term for a cut or surgical wound made by a knife, electrosurgical scalpel laser, or other such instrument?
Incision
43
What are 2 types of incisions?
1. Sulcular
| 2. Inverse bevel / step-back
44
What is a surgical incision type that puts the blade in the sulcus?
Sulcular
45
What is an incision type where the first incision is away from the tooth in order to make a new gumline?
Inverse bevel / step-back
46
What type of incisions increase access, aide in avoiding healthy sites, minimized flap tension, and allows flap postioning?
Vertical-releasing incisions
47
When are vertical incisions contraindicated?
1. Adjacent to osseous defects
2. Over or near extraction site
3. In area of membrane
4. Over canine eminence
5. Near mandibular PM to avoid mental nerve
48
What is an incision that leaves a layer of connective tissue over bone to provide a bed for a graft of gingiva?
Split thickness
49
Which arch has greater bleeding in surgery?
Mandibular
50
Is bleeding during surgery related to incision length or field size?
No
51
What is the average blood loss for a surgery of less than 2 hours?
134 mL
52
What is the desired INR for a patient on anticoagulation therapy for surgery?
INR 3 or less, 2.5 desired
53
What is the first line of defense to control hemorrhage?
Pressure
54
What are 4 local agents that can aide in hemorrhage control?
1. Surgicel - oxidized cellulose
2. Collacote, Avitene - microfiber collagen
3. Gelfoam - gelatin sponge
4. Thrombostat - topical thrombin
55
A blood loss greater than or equal to what mL requires fluid replacement?
Greater than or equal to 500 mL
56
If systolic pressure drops, how many mmHg indicates fluid replacement?
Greater than or equal to 20 mmHg
57
What diastolic pressure drop indicates a need for fluid replacement?
Greater than or equal to 10 mmHg
58
What suture material does perio use a lot?
Vicryl (polyglactin 910)
59
What suture needle does perio use a lot?
Reverse cutting needle
60
How many cutting edges does a reverse cutting needle have? Where is there no cutting edge?
3 cutting edges.
| No cutting edge on the inside of the curve`
61
Should you use as many sutures as possible when closing a wound?
No. Use the least number of sutures necessary, in keratinized tissue if able.
62
Is a periodontal dressing intended for hemostasis?
No, should have hemostasis before placing dressing.
63
What are 4 purposes for a periodontal dressing?
1. Protect wound
2. Enhance patient comfort
3. Flap stability
4. Retain osseous graft material
64
How long after perio wound is the weak fibrin linkkage and clot adhesion starting?
0-1 days
65
How long after perio wound is the weak granulation tissue forming?
3 days
66
How long after perio wound is the moderately strong epithelial attachment and collagen adhesion forming?
14 days
67
How long after a perio wound is the strong maturation of connective tissue and cementum formation?
21 days
68
What are 2 types of periodontal dressing?
1. Coe-pak
| 2. Barricaid (light cure resin that Dr Sabatini like for anterior)
69
What are the motrin prescriptions for post op analgesia?
800mg Motrin, 24 tabs, 1 q8h prn pain
| 400 mg Motrin, 40 tabs, 2 q8h prn pain
70
What is the opioid prescription for post op analgesia?
Tylenol #3, 18 tabs, 1 or 2 tabs q4-6 hrs prn pain
71
What rinse and instructions are used for post-op oral hygiene?
Peridex D.12%, swish 1/2 or bid for 30 seconds
72
Where is the distance from the inferior alveolar nerve to the apex of the tooth the shortest?
3rd molar
73
The opening of the mental foramen faces which directions?
Upward and distal
74
How many branches does the mental nerve divide into?
Three branches:
One to skin of chin
Two to skin and mucous membrane of lower lip and labial alveolar mucose
75
Do you ever do a flap or thin the flap on the lingual of the mandible and why?
No. The lingual nerve is in that tissue and laying a flap there would risk damage.
76
Does the lingual artery travel with the lingual nerve?
No
77
Which 2 arteries are direct branches of the external carotid artery?
1. Lingual artery
| 2. Maxillary artery
78
The maxillary artery gives rise to what other branch?
Inferior alveolar artery
79
The inferior alveolar artery gives rise to what branch?
Mental artery
80
What is an anatomic region that is occupied by glandular and adipose tissue covered by unattached nonkeratinized mucosa?
Retromolar triange
81
What is a muscle that separates the sublingual space and the submandibular space which is a big consideration?
Mylohyoid muscle
82
What is a variant of normal that is a small soft tissue mound lingual of the mandibular cuspids that is only a development remnant and has no pathologic significance?
Retrocuspid papilla
83
What is the term for a sinus that expands around the roots of teeth?
Pneumatized sinus
84
What are 3 nerves that branch off CNV maxillary division?
1. Greater palatine nerve
2. Superior alveolar nerves
3. Nasopalatine nerve
85
What is the main reason we do not do palatine flaps?
Greater palatine foramen in the area of 2nd and 3rs molar dumping out the greater palatine nerve
86
What branch of the external carotid crosses the external angle of the mandible?
Facial arteru
87
Where are the palatal salivary glands more abundant: more anterior or more posterior?
More posterior
88
What is adjacent to the 2nd and 3rd molars on the palatal side, and can be masked by folds of tissue, with an incidence of 40% and can compleicate flap reflection
Palatal exostoses
89
What muscles are medial to the maxillary tuberosity?
Tensor palate muscles
90
What are 4 muscles of mastication?
1. Masseter
2. Temporalis
3. Lateral pterygoid
4. Medial pterygoid
91
What is the area where the vestibular mucosa joins the attached gingiva (can be elucidated by rolling up the tissue from the vestibule and seeing where it catches?
Mucogingival junction
92
The gingiva that is attached to the bone (i.e. the attached gingiva) contains what?
Contains the pocket (the free gingiva)
93
The greatest width of attached gingiva facially is in what region?
Lateral incisor region
94
Which arch has the broader area of attached gingiva facially?
Maxilla
95
Where is the least width of attached gingiva facially?
Cuspid and first premolar region
96
Where is the greatest width of attached gingiva lingually?
First and second molars
97
Where is the least width of attached gingiva lingually?
Incisors and canines
98
What are 3 types of epithelium in the mouth?
1. Oral
2. Sulcular
3. Junction
99
What epithelium type is keratinized, has prominent epithelial ridges, is stippled, and has desmosomes?
Oral epithelium
100
What epithelium is non-keratinized and has 2 cell layers?
Sulcular
101
What epithelium is non-keratinized, has large intercellular spaces, less desmosomes than oral epithelium, larger cells, and a rapid turnover rate?
Junctional epithelium
102
What attaches epithelium to connective tissue and epithelium to tooth?
Hemidesmosomes
103
What attaches bone to cementum?
Sharpey's fibers
104
What is the dimension of space that the healthy gingival tissues occupy above the alveolar bone, consisting of 1mm connective tissue attachment and 1mm junctional epithelium?
Biologic width
105
What is the minimum for crown margin to bone?
3mm (2mm for biologic width and 1mm for sulcus depth)
106
Encroaching on the biologic width can lead to what?
Gingival inflammation
107
What is a surgical method to treat periodontitis?
Open flap debridement
108
What is the term for a loosened section of tissue separated from the surrounding tissues except at its base?
Flap
109
What is the term for the removal of inflamed, devitalized, or contaminated tissue or foreign material from or adjacent to a lesion?
Debridement
110
What is the term for surgical debridement of plaque, calculus, and granulation tissue following the reflection of the soft tissue flap?
Flap debridement surgery
111
Does flap debridement surgery involve osseous re-contouring by definition?
No, but limited contouring could be done to improve osseous contour
112
Does flap debridement surgery include scaling and root planing?
Yes
113
What type of healing is desired for flap debridement surgery?
New attachment
114
What are 3 instances to consider surgery after EIT?
1. Deep probing depth
2. Increasing probing depth
3. Continued BOP
115
What are 2 considerations for surgery type planning?
1. Type of defect
| 2. Where is the area of surgery (esthetic, posterior, palatal)
116
What is the goal of scaling?
To remove calculus whether supra or subgingival
117
What is the goal of root planing?
Remove layer of disease cementum (infected by bacterial endotoxins causing inflammatory response by the immune system)
118
The following indicate what surgical intervention?
- Moderate to deep pockets with BOP
- Non-regenerable defects
- Moderate to severe bone loss that precludes extensive osseous resection for defect elimination
- Minimize residual recession
Flap debridement surgery (clean off root and generate new attachment)
119
What is the goal of flap debridement surgery?
Achieve new attachment thus coronally positioning the probing attachment level and reducing probing depths
120
What is the nature of the new attachment after flap debridement surgery: connective tissue or long junctional epithelium?
Long junctional epithelium
121
What are 4 types of periodontal wound healing?
1. Reattachment
2. Repair
3. New attachment
4. Regeneration
122
What is the term for the union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus (i.e. it has been scraped clean of its previously diseased surface)?
New attachment
123
Can new attachment include new cementum?
Yes
124
What is the overall goal for the open flap debridement?
Improve access for debridement of roots and removal of infected tissue
125
What is the name of a scalloped, replaced mucoperiosteal flap, accomplished with an internal bevel incision that provides access for root planing with the objective of maximizing healing and reattachment with minimum loss of periodontal tissues?
Modified widman flap
126
Is the modified Widman flap used in the anterior?
No
127
Is the modified widman flap taken to the mucogingival junction?
No
128
What are the overall steps of a modified widman flap?
1st incision - inverse bevel to alveolar crest, reflect full thickness flap, not past mucogingival junction
2nd incision - intrasulcular between tooth and gingiva beyond the base of the pocket
3rd incision - horizontal to take out cuff of tissue
129
What closure is given with a modified widman flap?
Primary
130
What suture type is used to close a modified widman flap?
Interrupted
131
Is there a mucogingival junction on the palate?
No
132
What is the major difference between the modified widman flap and the now more accepted fully reflected flaps?
Reflect past the mucogingival junction
133
With a fully reflected flap, when would replacing it to previous height be indicated over apically positioning it for pocket reduction?
1. Esthetics
| 2. Regeneration procedures
134
A triangular or trap door distal wedge is used behind what tooth?
Posterior of maxillary molar with a probing depth
135
How can a palatal flap be repositioned if there is no mucogingival junction?
Thin flap and replace
136
With open flap debridement, what is the reduction of pocket depth for 4-6mm probing depth?
1.44mm
137
With open flap debridfement, what is the reduction of pocket depth for a greater than or equal to 7mm pocket?
2.9-3.4mm
138
What is the gain in attachment for open flap debridement of a 4-6mm pocket?
0.18mm
139
What is the gain in attachment for open flap debridement of a greater than 7mm pocket?
1.16 to 1.4mm
140
Overall, open flap debridement reduces recession by how much?
1-2mm
141
Overall, open flap debridement gives how much attachment gain?
1mm
142
Overall, open flap debridement gives how much pocket reduction?
3mm
143
What is the histologic healing of open flap debridement?
Long junctional epithelium
144
What type of periodontal surgery involves modification of the bony support of the teeth?
Osseous resective surgery
145
What are 2 main reasons to perform osseous resective surgery?
1. Reduce or eliminate osseous defects caused by periodontitis
2. Provide crown lengthening for restorations or esthetics
146
What type of process is osseous resective surgery: additive or subtractive?
Subtractive. Removes tissue and bone.
147
Supporting alveolar bone includes what bone?
1. Alveolar bone proper
2. Cribriform plate
3. Compact bone
4. Attachment apparatus
148
Non-supporting alveolar bone has what character?
1. No attachment to tooth
2. Cortical / compact bone
3. Cancellous / trabecular bone
149
What is the term for the removal of tooth supporting bone to achieve a more physiologic form?
Ostectomy
150
What is the reshaping of the alveolar process to achieve a more physiologic form without removal of supporting bone?
Osteoplasty
151
What is the term for bony architecture that is scalloped over root prominences and has interproximal peaks?
Positive architecture
152
What is a bony architecture that has minimal or no scallop and flat contours interproximally?
Flat architecture
153
What is a bony architecture where bone loss alters anatomy giving interproximal craters and widow's peaks?
Reverse architecture
154
Bone should follow the shape of what?
CEJ
155
What bone loss contraindicates osseous resective surgery?
Severe bone loss, risk removing too much bony support
156
What are 2 phases of eruption?
1 Active eruption: tooth moving through bone and tissue, stopping when it meets opposing tooth
2. Passive eruption: periodontium moving apically presenting the clinical crown
157
What is a must for the patient if resective surgery is indicated and why?
Good oral hygiene. Will be at increased risk for root caries?
158
What are 4 indications for osseous resective surgery?
1. Active perio after EIT
2. Moderate to severe probing depths
3. Mild to moderate bone loss
4. Existing osseous defects
159
What is an osseous defect with buccal and lingual wall, teeth bounding and an interproximal crater?
2 wall defect
160
What is an osseus defect with 3 bony walls and fourth wall is the tooth itself?
3 wall defect
161
What is an osseus defect with no walls adjacent to tooth and wraps around the tooth?
Circumferential defect
162
Mild to moderate osseous defects such as 2 wall craters, shallow 1,2,3 wall defects, etc are (pick one: eliminated or reduced) by osseous resective surgery?
Eliminated
163
Severe osseous defects, such as those near furcations or already compromised by existing bone loss are eliminated or reduced by osseous resective surgery?
Reduced
164
What bone pattern is favorable for achieving complete defect elimination and positive osseous architecture (i.e. mild-moderate osseous defects)?
Definitive osseous resection
165
Ideal architecture not possible when required bone removal would result in excessive loss of support or exposure of furcations (i.e. severe defects)?
Compromised osseous resection
166
Would osseous resective surgery be indicated in the anterior maxilla?
No, due to esethetics
167
What are 5 objectives of osseous resective surgery?
1. Access to root to debride
2. Remove, reduce osseous defects
3. Modify osseous architecture
4. Pocket reduction
5. Improve soft tissue conditions
168
What is the sequence of osseous resective surgery?
1. Bulk reduction of bone
2. Interdental grooving
3. Elimination / reduction of defect walls
4. Resection to acheive positive architecture
5. Final shaping
169
Are bulk reductions and interdental fluting normally osteoplasty or ostectomy?
Osteoplasty
170
A resection to achieve positive architecture is osteoplasty or ostectomy?
Ostectomy
171
At the completion of osseous resective surgery, what is now the highest part of the architecture?
The base of the defect. Eliminate defect by trimming surrounding the bone to the floor of the defect
172
The following would be indications for what procedure?
- loss of tooth structure subgingivally or in proximity of the alveolar crest
- inadequate crown height for restoration
- iatrogenic considerations subgingivally or near the alveolar crest
- esethetically or functionally short clinical crowns (gummy smile)
Osseous resective surgery for crown lengthening
173
What are 3 drugs that can cause gingival overgrowth?
1. Calcium channel blockers
2. Dilantin
3. Cyclosporin
174
What is the only difference between osseous resective surgery for osseous defects and osseous resective surgery for crown lengthening?
Crown lengthening does not have the elimination of a defect wall like osseous resective surgery for osseous defect does
175
If sending a patient for osseous resective for crown lengthening, when is it ideal to have the crown prep completed and why?
Prior to surgery. Periodontist can see maring and ensure greater than or equal to 3mm is given from margin to bone.
176
What are 2 benefits of osseous resective surgery for crown lengthening?
1. Gives healthy margin
| 2. Increases wall length for crown retention
177
What must be determined before sending the patient for osseous resective surgery for esthetic crown lengthening to decrease a gummy smile?
Is gummy appearance a skeletal (too much maxilla) or tooth (too little crown or too much gingiva) issue?
178
The gingival height of the maxillary central incisor should be at the height of what tooth?
Gingival height of canine
179
Before placing incisions for esthetic crown lengthening, what also must be determined?
Bone level to allow for gingival attachment
180
Glickman furcation classifications are based on what direction probing?
Horizontal
181
What furcation class has a pocket formation into the flute, but interradicular bone is intact (the probe will not go down into it)?
Glickman I
182
What furcation class has pocket formation into the furcation flute, and loss of some interradicular bone?
Glickman II
183
What furcation class has pocket formation through to the other side and a complete loss of interradicular bone?
Glickman III
184
What furcation class has a loss of attachment making through and through furcation visible on the clinical exam?
Glickman IV
185
Which of the furcation classes is usually intentionally created?
Glickman IV
186
Which is a better tooth trunk in perio?
Longer tooth trunk. Will take the periodontitis longer to reach the furcation in a longer tooth trunk.
187
What is the average root trunk length?
4mm
188
For maxillary and mandibular 1st molars, 81% of the furcations entrance is how small, indicating what instrument to clean?
Less than 1.0mm
| Use ultrasonics, tip will fit better than curette
189
Which root on maxillary 1st molar has the highest percentage for a root concavity?
MB root 94%
190
What percentage of maxillary 1st premolars are 2-rooted?
56%
191
Of the 56% of maxillary 1st premolars that are 2 rooted, what percentage will have a root concavity on the furcation surface of the buccal root?
62-100%
192
On which roots will there be a root concavity in the furcation for manidbular 1st molars?
Both mesial and distal
193
What are found primarily on the buccal of molars, found more often on the mandibular, and have been noted in more than 90% of of mandibular furcation involvements?
Cervical enamel projections
194
What are 2 ways to diagnose furcation involvment?
1. Clinical probing
| 2. Radiographic evaluation
195
What is the best way to diagnose furcation involvement?
A combination of clinical and radiographic evaluation
196
What is Dr Sabatini's treatment of choice on a Grade II furcation?
Regeneration
197
What is a common procedure in the mandible for a Class III furcation?
Tunnel procedure changes a Class III into a Class IV
198
What is required for a regeneration procedure?
Container-like defect
199
When doing guided tissue regeneration (GTR), what are material requirements?
Bone and membrane
200
What are 3 steps in a root resection (note: tooth must be endo treated first)?
1. Root amputation
2. Odontoplasty
3. Osteoplasty
201
Hemisection and bicuspidization do what to a molar?
Split tooth into two
202
For a tunneling procedure what must be done during healing?
Gingiva held down inside the furcation to prevent it from filling in the tunnel
203
Anytime the gingiva is placed below the CEJ and the root is exposed, what is there an increased risk for?
Root caries
204
What is the critical probing depth (CPD) for Sc/RP?
2.9mm
205
What is the critical probing depth (CPD) for surgery?
4.2mm
206
What are contraindications for surgery?
1. Systemic health factors (unstable angina, MI or stroke within 6 months, uncontrolled hypertension, uncontrolled diabetes)
2. Poor plaque control
3. High caries rate
4. Severe root sensitivity
5. Patient expectations and desires
207
What are the advantages of the modified widman flap?
1. Provides Access
2. Adapts healthy tissues to the root surface
3. Conserves esthetics better than APF
4. Less root sensitivity and root caries
5. Preserves width of attached gingiva
208
What are the disadvantages of the modified widman flap?
1. Soft tissue craters post-operatively
2. Limited access to bone
3. Limited access to deep intrabony defect
4. Residual probing depths
5. Unpredictable new attachment
6. Esthetic results not ideal
209
What are indications for fully reflected flaps?
1. Esthetics needed
2. High caries risk
3. Root sensitivity present
210
What are the advantages of fully reflected flaps?
1. Access to roots and intrabony defects
2. New attachment possible
3. May combine with other techniques (ostectomy, regeneration, root resection)
211
What type of incision should you use if there is not much keratinizated tissue?
Sulcular incision
212
Why should you always use a scalloped incision on the palate?
Because the palate is bound-down gingiva
213
What factors make some root furcations more susceptible than others>
1. Root trunk length
2. Furcation entrance size
3. Root concavities
4. Cervical enamel projections
214
What distances constitute short, medium, and long root trunk lengths?
Short: 3mm or less
Average: 4mm
Long: 5mm or more
215
What are some treatment options for surgical therapy for furcations?
1. Access for Sc/RP
2. Flap currettage or flap osseous
3. No bone removal in the furca
4. Resulting shallow pockets are easier to maintain
