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Classic Lit Fall 2021 > Principles of Periodontics > Flashcards

Principles of Periodontics Flashcards

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1
Q

What are the indications for periodontal surgery? Citation

A

Barrington 1981

BIIIRRD CRAP

Biopsy
Improve contour for better OH
Improve esthetic
Improve prognosis
Remove disease
Regenerate
Drain abscess

Correct MGDeformaties
Restorative access
Access
Pocket elimination

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2
Q

Critical probing depths

A

Lindhe 82
Critical PD for non-surgical: 2.9mm
Critical PD for surgical: 4.2mm

Heitz-Mayfield 2013
Critical PD for surgery indicated: 5.4mm

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3
Q

Citations for Why not just do SRP and no surgery?

A

Stambaught 1981

Caffesse 1986

Waerhaug 1978

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4
Q

how deep can a curette clean? whats its limit? Citation

A

3.7mm + 0.97mm
6.21mm

Stambaught 1981

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5
Q

What are major findings of Pihlstrom 1983

A

MWF Maintained pocket reduction in deep pockets (7+) for 6.5yrs vs SRP’s 3yrs

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6
Q

What does flap improve vs SRP? other than access - Citation

A

Caffesse 1986

Greater reduction of residual calculus with flap vs SRP

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7
Q

How much do we clean sub-G? Citation

A

Waerhaug SRP - Caffesse SRP - Caffesse Flap

Shallow : 83% - 86% - 86%
Mod : 38% - 43% - 76%
Deep : 11% - 32% - 50%

Waerhaug deep = >5mm
Caffesse 1-3, 4-6, 7+

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8
Q

What might complicate anterior implant placement? Citation

A

Mraiwa 2004

Nasopalatine on average 7.4mm from labial surface of unresorbed ridge (Range 3-14mm)
Big range - might be no space

Average width: 4.6mm

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9
Q

Where is the infraorbital nerve located?

A

9mm from infraorbital margin

30mm from midline

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10
Q

What articles research GP location?

A

Reiser 1996

Yu et al 2014

Tavelli et al. 2018

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11
Q

How does palatal vault impact GP N/A location? Where is the thickest tissue? Citation

A

Reiser 1996

Shallow: 7mm

Average: 12mm

High: 17mm

Between mesial of first molar and distal of canine (in the premolar region)

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12
Q

What paths does the GP artery take? Citation

A

Yu et al 2014

Type I - Lateral branch gives of Medial and Canine branch after the Bony Prominence (40%)

Type II - Lateral Branch gives of Medial branch before the Bony Prominence - Mb runs on Medial aspect of the BP (33%)

Type III - Lateral Branch gives off Canine Branch immediately after exiting the GPF (15%)

Type IV - Lateral Branch gives off Medial Branch immediately after exiting GPF (8%)

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13
Q

What is the average location of the GPN/A from different teeth? Where is the GPF located? Citation

A

Tavelli et al. 2018

M2 - 13.9 + 1
M1 - 13 + 2
P2 - 13.8 + 2
P1 - 11.8 + 2
C - 9.9 + 3

Mid-palatal aspect of 3rd molar (57%)

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14
Q

how large is the maxillary sinus?

A

15oz

35mm height

35mm width

45mm length

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15
Q

Articles for sinus

A

Cho et al. 2001

Chan et al. 2013

Monje et al. 2016

Pommer 2012

Rosano 2011

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16
Q

What anatomical factors influence perforation risk in sinus? Citation

A

Angle of floor (Cho 2001)

Location of PNR (Chan 2013)

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17
Q

Cho 2001

A

Higher perforation risk when elevating narrow sinus floor

<30deg = 62.5%

>60deg = 0%

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18
Q

Chan 2013

A

PNR higher/sharper in PM (14mm) lower/wider at 2M

more frequent in 2PM area

Angle <90 and location <15mm from crest = higher risk of perf

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19
Q

How thick is the schneiderian membrane?

A

CBCT: 1.33mm

Histo: 0.48mm

CBCT is 2.5x that of histology

Monje 2016

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20
Q

What is the prevalence of sinus septae?
Where are they located?
Orientation?

Citation

A

Pommer 2012
28%
25 - 55 - 20 (Retro M - M - PM)

~90% Transverse (Buccal/Palatal)

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21
Q

What artery do we need to be aware of with the sinus? How can we evaluate its location? Citation

A

Rosano 2011

47% seen on CBCT
Mean 11.25mm from crest
55% <1mm - 40% 1-2mm - 5% 2-3mm

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22
Q

Location of the mental foramen? Anomolies? Citation

A

Neiva 2004

Between 1st and 2nd PM 58%

Apical to 2nd PM 42%

Anterior loop 88% - Bilateral 75% - Extends 4.1mm anterior

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23
Q

What is the course of the lingual nerve vertically? Citation

A

Chan et al 2010

Vertical distance from mid-lingual CEJ
2M: 9.6mm
1M: 13mm
2PM: 14.8mm

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24
Q

What is the course of the lingual nerve horizontally? Citation

A

Chan et al. 2010

Turning point:

2ndM: 33%
1M: 42%
2ndPM: 25%

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25
How prevelant is an undercut in the posterior mandible?
Chan et al. 2011 Convex (C) Parallel (P) Undercut (U) Lingual concavity undercut 66% (most prevalent U)
26
Where is the most risk for lingual perf duuring implant prep?
2nd Molar (31%) are high risk
27
Who developed Gingivectomy?
Goldman 1951
28
What are the different flap designs discussed and their creators?
Original Widman Flap (Widman 1918) Neumann Flap (Neumann 1920) Kirkland Flap/Modified Flap Operation (Kirkland 1931) Gingivectomy (Goldman 1951) Apically Repositioned Flap (Nabers 1954) Modified Widman Flap (Ramfjord & Nissle 1974) Papilla Preservation Flap (Takei et al. 1985)
29
Which flaps are for pocket elimination?
Original Widman Neumann Flap Gingivectomy Apically Repositioned Flap
30
Which flaps are NOT meant for pocket ELIMINATION? What ARE they meant for?
Kirkland Flap (Access/Regeneration/Esthetics) Modified Widman Flap (pocket REDUCTION) Papilla Preservation Technique (Regenration/Esthetics)
31
What was the first flap? Aim? How to?
Original Widman 1918 Flap elimination - to remove pocket epithelium and inflamed CT and facilitate optimal cleaning of the roots 1 - Two vertical Releases - Connect with reverse bevel/scalloped (can be buccal and lingual) 2 - FTMPF to expose 2-3mm of bone 3 - Removetissue collar 4 - SRP 5 - Osteoplasty recommended 6 - Reposition flap at level of crest w/ interrupted sutures (interproximals often healing by secondary intension)
32
What was the FIRST modified widman flap? Describe it
Neumann 1920 (The Neumann Flap) ## Footnote 1 - Intrasulcular incision 2 - Curettage inside of flap 3 - SRP 4 - Osteoplasty 5 - Trim flap and place on crest
33
Describe the Kirkland flap and its use
Kirkland 1931 ## Footnote Open - Clean - Close Originally created for Periodontal Pus Pocket (perio abscess) 1 - Intrasulcular incision with M and D extension 2 - Flap reflected to expose diseased root 3 - Remove granulation tissue/calculus 4 - Reposition flap at original position
34
How to perform an Apically Repositioned Flap?
Vertical release Reverse bevel at a pocket depth distance from the margin FTMPF Remove tissue collar Osseous Flap positioned at newly recontoured alveolar bone
35
Contraindications for gingivectomy
narrow/absent attached gingiva infrabony pockets Exostoses
36
advantages of Widman Flap vs Gingivectomy
Less post op discomfort (primary healing) Access to contour alveolar bone
37
What are advantages of the Kirkland flap?
Bone regeneration potential Can be used in esthetic zone
38
Advantages of ArPF?
Pocket elimination minimal post op bone loss Controlled positioning of the gingival margin Maintain entire mucogingival complex
39
Disadvantages of ArPF?
Esthetics Root sensitivity problems
40
Advantages/Disadvantages of MWF?
Soft tissue closely adapted to root Minimal trauma to CT and bone Better aesthetics Less sensitivity Chance for remaining pockets
41
Furcation Classifications
Class 1 / 2 / 3 **Hamp 1975** \<3mm _\>_3mm but not through/through through/through **Lindhe 2008** _\>_⅓ but not through/through through through
42
Vertical defect classifications
Grade A / B / C **Tarnow & Fletcher 1984** _\<_3mm 4-6mm _\>_7mm **Tonetti et al. 2017** Coronal third of root Middle third of root Apical third of root
43
Studies on post op infection
Powell 2005 Abu-Ta'a 2008
44
Powell 2005
Retrospective of 400patients NSSD of post op infection w/ vs w/out ABx CHX did lower infection
45
Abu-Ta'a 2008
JCP RCT NSSD when proper asepsis perameters. ABx lowered post-op pain
46
Studies on pain after surgery
Burkhardt 2015 Vogel 1992
47
Burkhardt 2015
Grafts between 1-2mm have significantly less post op pain (50% less) Residual donor site \>5mm = 60% less pain
48
Vogel 1992
600mg Ibuprofen immediately AFTER delays onset of pain more than immediately before
49
Studies on bleeding
Zigdon 2012 (JOP) Baab 1977
50
Zigdon 2012 + Baab 1977
Zigdon: Minimal blood loss during perio procedures Smokers bleed significantly more Asprin NSSD????? Baab: Average: 134ml blood loss Duration of surgery + Amount of anesthetic used significantly impacted blood loss
51
How did Zigdon isolate blood from other fluids?
Fructosamine - first time used - separates blood from other fluids
52
What citation for managing post op infection after GBR?
Fontana 2016
53
What groups demarcate different response to surgical site opening during healing?
_\<_3mm **WITHOUT exudate** \>3mm **WITH exudate** Membrane exposure **WITH exudate** No exposure **WITH ABSCESS**
54
First group of infection management - how do you manage? Citation
Fontana 2016 **_\<_3mm exposure w/ NO exudate** Topical CHX gel 2x/day Membrane left for maximum of 3-4wks
55
Second group of infection management - how do you manage? Citation
Fontana 2016 **\>3mm exposure WITH exudate** Remove membrane immediately If underlying graft NOT compromised - close/heal 4-5mo ABX
56
Third group of infection management - How do you manage? Citation
Fontana 2016 **Membrane exposure w/ exudate** Membrane immediately removed Curettage graft and removal of infected graft particles ABX
57
Final group of infection management - how do you manage? Citation
Fontana 2016 No membrane exposure - Abscess formation Immediately remove membrane Remove infected tissue ABX
58
Essentially - what is the procedure for treating exposure after GBR?
Anytime its infected - remove membrane and curette infected particles out - prescribe ABX * Exposure _\<_3mm * CHX 2x/day and remove membrane after 3-4wks * Exposure \>3mm * Remove membrane/assess graft * No infection? * Close/Heal 4-5mo * Infection? (Or exudate seen before membrane removed) * Curette graft/remove infected particles * ABX * No exposure but ABSCESS * Remove membrane/curette infection/ABX
59
Patient presents after GBR - what do you do?
* Assess healing * Exposure? * Yes * Size? * _\<_3mm * CHX * Remove membrane in 3-4wks * \>3mm * Remove membrane and assess graft * Infection? * Yes * Remove membrane * Remove infected particles * ABX * NO * Let heal 4-5mo * NO * Infection? * NO - good * Yes - Remove membrane/graft/ABX
60
What is the difference between inFRA-bony defect and inTRA-bony defect?
According to Goldman & Cohen 1958 **inFRA-bony** - base of the *pocket* is located *apical* to the *alveolar* *crest* **inTRA-bony** - base of the *pocket* is located *within* *surrounding* *bone* (3-wall defect) Infra-bony is any vertical defect - Intra-bony is a contained defect
61
How does pocket depth impact tooth prognosis?
Matuliene 2008 172pt 11yr Retrospective Odds ratio for tooth loss compared to 3mm PD 5mm - OR 7.7 6mm - OR 11 **7mm - OR 64.2**
62
What is the likelihood of closing based on their initial depth and single vs multirooted? How does smoking impact this?
Tomasi 2007 Multirooted reduces chance by ~20% **Non-Smokers** Single Rooted 7mm - 63% 8mm - 36% Multi Rooted 7mm - 43% 8mm - 19% **Smokers have about 50% these numbers**

Classic Lit Fall 2021 (29 decks)

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