Perio Regeneration 2 Flashcards by Jon Misch

What is Compartmentalization? Purposed by who?

Melcher 1976

Cells of the periodontium divided into 4 compartments
Epithelial Cells
Connective Tissue Cells
Alveolar Bone Cells
PDL Cells

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How does barrier membrane compare to flap alone?

Gotlow 1984

Millipore vs Flap

SSD: More attachment with Milipore filter

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What factors influence success of GTR?

Kornman & Robertson 2000

Bacterial contamination
Innate wound healing potential
Local site characteristics
Surgical technique

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What patient factors should be considered before performing GTR?

Oral hygiene/Patient compliance
Smoking status

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How does oral hygiene effect GTR? Citations

Cortellini et al. 1996

1yr
Patients w/ FMPS >10% had worse outcomes and had attachment loss over time

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What effect does smoking have on GTR? Citations

Non-Smokers have 2.5x more CAL gain (2.1 vs 5.2)
(Tonetti et al. 1995)

Smokers: 0.8
Non- Smokers: 1.9
(Hietz-Mayfield et al. 1998)

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How does oral hygiene effect GTR Long term?

Cortellini & Tonetti 2015
96% success for 15yrs with optimal OH and recall

Cortellini 2020
10yr follow up study - 88% success of treating SEVERELY hopeless teeth - Economically better

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How does Mobility influence CAL gain after GTR

Fleszar et al. 1980

Inverse relationship between CAL gain and mobility after PERIODONTAL SURGERY (More for GTR probably)

Cortellini & Tonetti 2015

Limited mobility (<class II-III) is essential for early clot stability and overall success

Schulz 2000
Presplint: 5.1
Postsplint: 3.5
No-splint: 1.7

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When should you splint?

Schulz et al. 2000

Pre-splint: 5.1mm CALgain
Pos-splint: 3.5mm CALgain
Non-splint: 1.7mm CALgain

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What study found conflicting results for splinting?

Trejo and Weltmann - NSSD between splint/non-splint

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How does depth/width/walls of defect effect success?

Deep/Narrow/3-wall:
Protect/Stabilize wound
Keep regenerative cells in close approximation

Wide/Shallow/non-contained:
Risk coagulum displacement/wound instability

(Cortellini and Tonetti, 2000)

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What angles represent Narrow and Wide? (Citation)

Narrow: < 25˚ (Cortellini & Bowers 1995)

Wide: > 37˚ (Tonetti et al. 1993)

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What depth delineates Shallow/Deep?

Shallow: _<_4mm

Deep: >4mm

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What wall defects have the best results?

3 wall (Becker & Becker)

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Who classified Infrabony Defects?

Goldman et al. 1958

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What is the flowchart for predictability? Citation

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What are some findings of the AAP Regeneration Workshop?

Class I Furcation can be maintained without regeneration

Class II Should be Regenerated

Class III has limited evidence

Combined approach is better than mono-therapy (ie. use graft + membrane etc.)

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What kind of local factors can present an issue during GTR? What should be done with them? Citation

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Bifurcation Ridges
Restorations w/ apical margins
Enamel pearls
Crowns
CEPs
Palatoradicular grooves

Identified and removed

Mardam-Bey et al. 1991

If a CEP/enamel pearl/Restoration/etc is present, and you remove it before GTR, how is the success rate affected by its initial pressence? Citation

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it is not affected! Tsao et al. 2006

How have the theories around GTR evolved? Citations

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Competition theory (Melcher 1976)

Blood Clot Stability (Wikesjo 1990)

How does Wikesjo et al. 1990 impact the understanding GTR?

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Clot adheres to dentin via adsorbtion of plama proteins

No space for epithelium to migrate apically once there has been adhesion of the clot

Periodontal regeneration takes place apical to the most coronal adhesion of the clot

What was the first flap for soft tissue preservation in GTR?

How is it done and what is the disadvantage?

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Takai 1985

Papilla preservation technique

semilunar incision through palatal IDP - intrasulcular buccal - feed papilla through facial

How much space is needed for the Papilla Preservation Technique?

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>2mm interproximally

What are the different preservation techniques? in order

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Papilla preservation technique

Modified papilla preservation technique

Simplified papilla preservation technique

Minimally invasive surgical technique

Modified minimally invasive surgical technique

Entire papilla preservation technique

Non-incised papilla surgical approach

How does MPPT perform in comparison to other incision techniques? Citation

Cortellini et al. 1995 **Significantly more attachment gain vs conventional GTR or Flap** 5.2 _+_ 2.2mm vs 4.1 _+_1.9mm vs 2.5 _+_ 0.8mm **Improved primary closure** 73% at 6wks

What incision design would you use if there was \<2mm interproximal space? How is it designed? Citation

Crotellini et al. 1999 Simplified Papilla Preservation Technique Buccal: M Line angle to under contact point Palatal/Lingual: Intrasulcular

How does the SPPT perform?

4.9 _+_ 1.8mm attachment gain 67% primary closure

What technique could you use if you have an isolated, deep defect in the esthetic zone?

Minimally Invasive Surgical Technique

What is MIST? Citation

Basically a SPPT incision, except only include 1 papilla Cortellini & Tonetti 2007

What is the Modified MIST? When do you use? Citation

MIST, except only incise on 1 side of the tooth (buccal or lingual) Microscope - when only ⅓ of the interproximal has the defect Cortellini & Tonette 2007

What is the EPP? Citation

Entire Papilla Preservation Technique Aslan et al. 2020 Vertical release on the opposite side of the tooth from the defect (same tooth) Intrasulcular Tunnel under defect associated papilla

What is the incision called that only has a horizontal incision in the mucosa? Citation?

NIPSA Non-Incised Papilla Surgical Approach Rodriguez et al. 2018

How often do membranes get exposed in GTR? Citation?

70-80% Murphy et al. 1995

What happens if a membrane gets exposed? Failure? What should you do?

Unlikely to cause failure if plaque is controlled in the area Antimicrobial rinses, more frequent recalls, systemic antibiotics

Bone gain with exposure?

Trombelli et al. 1997 6mo post op: With exposure: **2.2mm** Without exposure: **4.1mm**

How does exposure impact GTR in teeth vs GBR in implants?

Machtei et al. 2001 Meta-analysis of Furcation vs Infrabony defects vs GBR implants Membrane exposure had a major negative impact on GBR but minimal effect on GTR in teeth \<1mm difference in GTR groups 6x greater gain in non-exposed GBR group

How can we assess GTR outcomes? Pros/cons of each

**Clinically** (PD/CAL/Bone sounding - no regeneration assessed) **Radiographically** (underestimates bone loss/radiodensity depends on graft material and healing time) **Re**-**entry** (second surgery needed - Attachment type?) **Histology** (Gold standard - removal/biopsy required)

How does OFD vs Bone Graft vs Membrane (GTR) compare?

Laurell 1998 meta analysis Bone fill: 1. 1 2. 1 3. 2 do-ray-me CAL 1-2-4

How does healing look histologicallly from GTR?

Most likely - Most apical portion has true regeneration, and repair in the coronal Similar to Stravapoulus et al. 2011

What should be done before completing a GTR procedure on a patient?

Cause-related therapy SRP - OHI - Motivation

What is the critical gap concept and what size is it? citation

The gap beyond which incomplete healing occurs without use of a graft 0.5-1.25mm - Botticelli

Why is the research on the critical gap smaller than the real critical gap?

Was done on the buccal aspect of teeth - in between teeth we need space for PDL (0.5-0.8mm) so at least 1mm Distal w/ no tooth: \>2mm use membrane

What is the difference between Guided Bone Regeneration and Protected Bone Augmentation?

Protected Bone Aug is using titanium mesh! does not have cell occlusion, just protects the space

Perio Regeneration 2 Flashcards

(43 cards)