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Classic Lit Fall 2021 > Perio Plastics I > Flashcards

Perio Plastics I Flashcards

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1
Q

What ways can you distinguish gingiva from alveolar mucosa?

A

Visual assessment
Schiller’s iodine (detects glycogen in oral mucosa)
Roll test

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2
Q

How is the location of the MGJ determined

A

Genetically pre-determined

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3
Q

What happens with KG as we age? Citation

A

Increases due to continuous eruption of the teeth (Ainamo & Ainamo 1978)

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4
Q

Facial Attached Gingiva measurements/locations of widest/narrowest - citation

A

Bowers 1963

Ranges from 1-9mm
Widest: Maxillary Lateral Incisor
Narrowest: Mandibular 1st premolar

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5
Q

Lingual KG

A

Widest: 2PM, 1M
Narrowest: Anteriors

Voigt et al. 1978

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6
Q

Gingival thickness

A

Claffey & Shanley 1986

Thick: >2mm
Thin: <1.5mm

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7
Q

How thick is thin GT on average? Citation

A

0.8mm

Zweers et al. 2014

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8
Q

What makes up periodontal biotype?

A

Purposed by Zweers et al. 2014

Gingival Thickness
Keratinized Tissue Width
Bone morphotype

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9
Q

What types of periodontal biotypes were proposed?

A

Thin scalloped
Thick Flat
Thick Scalloped

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10
Q

Describe a thin scalloped phenotype
Prevalnce?

A

Zweers 2014

Slender triangular crowns
Thin delicate tissue with narrow KT
Thin alveolar bone
42.3% (Female > Male)

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11
Q

Describe a Thick Scalloped phenotype

A

Slender teeth
Clear thick fibrotic gingiva with narrow KT
Pronounced gingival scalloping

51.9% (Thick)

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12
Q

Describe thick flat phenotype

A

Square shaped crowns with pronounced cervical convexity
Thick fibrotic gingiva with broad KT
Thick alveolar bone

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13
Q

Name studies that say we need 2mm of KG

A

Lang and Loe 1972
Stetler and Bissada 1987 (subG Restorations)

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14
Q

Name studies that say we do NOT need 2mm of KG

A

Miyasato et al. 1977
Wennstrom & Lindhe 1983
Kennedy et al. 1985
Cortellini & Bissada 2018

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15
Q

What did they do in Miyasato et al. 1977? Results?

A

16 dental students - No OH for 25days
No difference in plaque induced inflammation in <1mm KG and >2mm KG groups

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16
Q

What did they do in Wennstrom and Lindhe 1983? Results?

A

Beagle dogs - excised KG then FGG in 50% of sites
Plaque control
NO clinical or histological inflammation in either group

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17
Q

What was the Stetler and Bissada 1987 Study?

A

Higher gingival scores in teeth with SubG restorations and narrow KG (<2mm)

NSSD when restorations were SupraG

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18
Q

What is the current view on KG around teeth?

A

In the presence of adequate OH, minimum KT is not needed to prevent CALoss
In the presence of inadequate OH, KG (2mm KG, 1mm AG) is crucial for maintenance of gingival health.

Kennedy et al. 1985
Cortellini & Bissada 2018

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19
Q

Name 1 study that says 2mm KG is needed around implants. Describe it

A

Thoma et al. 2018
Systematic Review
Autogenous grafts result in more favorable peri-implant health
Increased KTW improves BOP and marginal bone levels
Increase MT reduces likelihood of MBL

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20
Q

Name 1 study that says we do NOT need KG around implants. Describe it

A

Wennstrom & Derks 2012
Systematic Review
With goodOH, peri-implant soft tissue health can be maintained in absence of adequate amount of KG`

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21
Q

Name a RECENT study on KG around implants. What did it find?

A

Ravida et al. 2022
Systematic review, Meta analysis, and Trial Sequential Analysis

NSSD and Low power evidence for KMW impact on PD, recession, MBL

SSD mean Plaque Index for implants with 2mm+ KG

Strength of evidence of KMW as a risk factor for Pi remains low - need more control studies with larger samples

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22
Q

What is the INCIDENCE of recessions? Citation

A

O’Leary 1967

27.7% in at least 1 segment

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23
Q

What is the PREVALENCE of GR? Citation

A

Varies by size of recession

Albander & Rams 2002 (1999 NHANES Data)
_>_1mm: ~60%
_>_3mm: 23%

Rios et al. 2014 (Brazil)
_>_1mm: ~70%
_>_3mm 28%
_>_5mm: 23%

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24
Q

Who classified Mucogingival Deformities in the current AAP/EFP Classification?

What publication provided evidence to support it?

A

Jepsen et al. 2018

Cortellini & Bissada 2018

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25
What is the difference between Periodontal Phenotype and Periodontal Biotype?
Biotype is genetically predetermined Phenotype is determined by genetics & environmental factors
26
What is included in periodontal phenotype?
Gingival Phenotype(KTW, MT) Bone Morphotype (buccal bone thickness)
27
What is the underlying etiology of all gingival recession? Citation
Localized inflammatory process causing CT breakdown and Epi proliferation in its place Baker & Seymour 1976
28
What etiological factors are there for recession?
According to Zucchelli * *Traumatically induced** (Brushing, Flossing, Piercings, Prosthodontics (restorative margin), Occlusion (impinging bite), Orthodontics * *Bacteria induced** (Plaque) * *Virus induced** (Herpes Simplex) * *Unknown** (Children/Teens) * *Mixed** (Trauma/Bacteria)
29
What are Predisposing and Precipitating factors? Citation
Hall 1977 Predisposing factorsL pre-determined/non-modifiable (periodontal Biotype) Precipitating: Environmentally acquired/modifiable (trauma, plaque buildup, restorations)
30
What are examples of Predisposing factors?
``` Thin Periodontal Biotype Root prominence (dehisence) Shallow Vestibule Frenula insertion in gingival margin ```
31
How does Frenum impact recession?
Impedes patient's oral hygiene Breaks marginal seal favoring plaque accumulation
32
What are examples of Precipitating factors?
**Traumatic factors** (improper brushing, piercings) **Iatrogeneic factors** (Ortho wires/brackets, SubG Restos) **Pathologic factors** (periodontal disease/other bacteria/viruses)
33
Why is there increased CALoss with age? Citation
Billings et al. 2018 More recession with age - NOT deepening pocket
34
Is there an association between TFO and Recession?
No - Fan & Caton 2018 Bernimoulin 1977
35
What are the different classifications of Recessions?
Sullivan & Atkins 1968 Miller 1985 Cairo et al. 2011
36
What classifications are there for local factors effecting recession coverage?
Pini-Prato et al. 2010 (Identifiable CEJ: A or B, + or -) Rasperini et al. 2018 (NCCL)
37
Sullivan & Atkins (year?) How much coverage can be expected for each?
1968 3mm cutoff for deep/shallow and wide/narrow Deep/Wide Shallow/Wide Deep/Narrow Shallow/Narrow * *Wide = 1-2mm coverage can be expected** * *Narrow = 100% coverage (deep) or maintain (shallow)**
38
Miller 1985
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39
Cairo et al. 2011
RT1: GR - no interproximal CAL (Miller 1-2) RT2: GR with interproximal CAL _\<_ facial CAL (Miller 3) RT3: GR with interproximal CAL \> facial CAL
40
Pini-Prato 2010
A: CEJ detectable B: CEJ non-detectable +: Step -: No step
41
Prevalence of different Pini-Prato classifications
A+: 45% A-: 15% B+: 25% B-: 25%
42
What methods are there for measuring gingival thickness?
Transgingival probing Ultrasonic measurement Probe visibility
43
How accurate is transgingival probing and how do you do it?
accurate within 0.5mm (Studer et al. 1997) Anesthetize Pierce w/ perio probe Use endo stopper
44
Who used ultrasonic measurement? Pros/cons
Eger et al. 1996 Highly reproducable Intra-examiner error more pronounced in 2nd and 3rd molar region
45
What can be done to use probe visibility for gingival thickness?
**Kan et al. 2010** Thin (_\<_1mm) - Probe visible Thick (\>1mm) - Probe not visible **Rasperini et al. 2015** Color coded probe Thin, Medium, Thick, Very thick White \< Green \< Blue \< None
46
What are the indications for perio-plastic surgery?
Esthetics Hypersensitivity Root expsure/Abrasion/Caries Inconsistent gingival margin
47
What are the aims of Soft Tissue Autmentation?
Increased MT Increase KMW Root coverage Deepen vestibule
48
What important studies have been done on Gingival Thickness?
Hwang & Wang 2006 Baldi et al. 1999 Tavelli et al. 2019a Barootchi et al. 2022 Cairo et al. 2016 (RCT) Zuhr et al. 2021
49
How does thick tissue help CAF? Citation
**Hwang & Wang 2006** Resists: Inflammation/Trauma/Recession Enables: Manipulation/Creeping Attachment/Predictable surgery
50
How thick does tissue need to be for predictable complete coverage in a CAF?
0.8mm (Baldi et al. 1999)
51
How can gingival margin/thickness be effected by ortho movement? Citation
Wennstrom 1996 Facial movement results in thinning and apical migration Lingual movement results in thickening and coronal movement
52
What factors predict gingival margin stability after root coverage with ADM? Citation
Tavelli et al. 2019 12-yr follow up of RCT GT of 1.2mm at 6mo predicted stability after multiple recession coverage w/ ADM
53
What factors predict gingival margin stability after root coverage with CTG? Citation
Barootchi et al 2022 When GT was 1.46mm or more at 6mo, REC change was \<0.5mm at 10yrs
54
Aguido et al. 2016
18-35yr follow up study 84% of treated recessions exhibited recession reduction 48% of untreated recessions exhibited an increase
55
Who proposed vestibular extension? Why?
Nabers 1966 Shallow vestibule promotes food impaction Oral hygiene more challenging
56
Who proposed FGGs? Why?
Nabers 1977 High morbidity of APF Concurrent increasing of KT
57
How do we evaluate outcomes of root coverage procedures?
mRC (mean root coverage) cRC (complete root coverage) Both are percentages
58
What factors could have a negative impact when attempting complete root coverage according to Miller?
Inadequate Classification of gingival tissue recession Inadequate root planing Inadequate size of interdental papilla Inadequate graft size/thickness Graft dehydration Inadequate adaptation of the graft Inadequate adaptation of the graft to root or periosteal bet Graft instability Excess pressure in coaptation of sutured graft Trauma during healing Smoking Miller 1987
59
What factors play a role in root coverage according to Cairo?
Interproximal bone height/CAL
60
What factors can influence root coverage according to Zucchelli?
papilla loss tooth extrusion/rotation Zuchelli et al. 2006
61
What are some long term studies/systematic reviews on root coverage?
Tavelli et al. 2019 (LT) Chambrone & Tatakis 2015 (SR)
62
What is 1 systematic review comparing FGG with Soft tissue substitutes?
Bertl et al. 2017 (Stravropoulos)
63
Tavelli et al. 2019
CTG more stable over time Recession defects tend to relapse over time
64
Chambrone et al. 2015
CAF+CTG, CAF+ADM, CAF+EMD, CAF+CMX 2015 AAP Regeneration Workshop CTG had better mRC and cRC as well as increased KT
65
Bertl et al. 2017
With Stravropoulos FGG vs ADM for KT increase Larger, more predictable increase in KT width w/ FGG ADM more aesthetic

Classic Lit Fall 2021 (29 decks)

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