Quiz Ch 14 Perio

Question 1

What is the incisional surgery commonly called

Answer 1

Periodontal flap surgery

Question 2

Periodontal flap surgery is the choice when what cannot be performed for pocket reduction

Answer 2

excisional periodontal surgery

Question 3

this procedure is called flap surgery becasue

Answer 3

the tissue are pushed away from the underlying tooth roots and alveolar bone, much like the flap of an envelope

Question 4

The usual incisional technique for pocket reduction with flap surgery is called

Answer 4

The apically positioned flap

Question 5

Why is it called the apically positioned flap

Answer 5

Because the flap is sutured at a more apical location on the tooth roots to reduce pocket depth

Question 6

what has fewer contraindications than gingivectomy , so incisional procedures are the most common type of surgery performed by periodontists

Answer 6

Flap surgery

Question 7

what are the primary indication for incisional surgery

Answer 7

deepened periodontal pockets

Question 8

What kind of pockets are best treated by flap surgery

Answer 8

suprabony pockets

Question 9

Flap surgery also allows access to

Answer 9

infrabony pockets

Question 10

what are the few contraindication for periodontal flap surgery

Answer 10

*gingival tissues must be wide and thick enough to allow proper incision, often the incision must be modified to preserve as much keratinized tissue as possible

Question 11

What are special modifications of pocket reduction surgery include

Answer 11

combinations of incisional and excisional techniques, such as distal wedge surgery and internal beveled gingivectomy.

Question 12

what does the distal wedge procedure permits

Answer 12

adequate plaque control on the distal surface of the last tooth in the mandibular arch

Question 13

the goal of access flap procedures is to what

Answer 13

provide access to the root surfaces for debridement and to create conditions for reattachment of the gingival tissue to the root

Question 14

what is the modified Widman flap

Answer 14

the excisional new attachment procedure, and open flap curettage

Question 15

What uses three incisions to separate the pocket lining from the tooth in a controlled manner, whereas the excisional new attachment procedure usually does not involve elevating the flap past the mucogingival junction

Answer 15

modified Widman flap

Question 16

what are the goal for access flap procedures

Answer 16

to gain access to the root surface for plaque biofilm and calculus removal, including scaling and root planning.

Question 17

pocket reduction by apical positioning is not the goal of what

Answer 17

access flap procedures

Question 18

what is access flap procedures are used to treat

Answer 18

periodontal pockets in aesthetically sensitive areas or where pocket reduction is not desired or indicated

Question 19

That procedure is when incisions are made through thee crest of the gingiva, and the gingival tissues are reflected only far enough to allow the clinician to see the root surfaces and the crest of the alveolar bone

Answer 19

Access flap techniques

Question 20

what is the major goal of access flap techniques

Answer 20

is to reattachment of the connective tissues to the root surface during healing or creation of a long junctional epithelium resulting in increased attachment for the teeth.

Question 21

contraindications for access flap procedures

Answer 21

pt should understand that pocket depths may continue to be greater than 3 or 4mm after therapy

Question 22

by definition involves attachment loss of the connective tissue to the root surface of the tooth and loss of alveolar bone

Answer 22

Periodontitis

Question 23

What does bone loss create around the tooth

Answer 23

osseous defects

Question 24

what makes healing unpredictable and result in gingival architecture that is difficult for the pt to maintain with acceptable plaque biofilm control and difficult for the hygienist to maintain with periodic scaling and root planning

Answer 24

osseous defects

Question 25

what is ostectomy

Answer 25

if the alveolar bone that contains periodontal fibers that support the tooth is removed

Question 26

what is osteoplasty

Answer 26

if only bony ledges or nonsupporting bone are removed

Question 27

what is the primary indications for osseous defects

Answer 27

when periodontal pockets that extend below the level of the osseous crest, or infrabony pockets.

Question 28

this is a indication for osseous defects

Answer 28

thick bony ledges

Question 29

what is a type of bone loss in which the interproximal bone is apical to the facial and lingual bone (the reverse of the configuration in health), permits periodontal pockets to re-form during healing

Answer 29

Reverse alveolar bony architecture

Question 30

Areas of serve bone loss are often best treated by what

Answer 30

reducing pocket depths and performing frequent maintenance care

Question 31

recession is a common finding among pts with

Answer 31

periodontal disease

Question 32

recession can lead to extension of the periodontal pockets beyond the mucogingival junction so that no attached gingiva exists on the tooth surface, what are these areas called

Answer 32

mucogingival defects and have been implicated in the spread of periodontal disease into deeper tissues , although this role remains controversial

Question 33

mucogingival defects may be developed by what

Answer 33

orthodontic tx | forceful toothbrushing

Question 34

this includes a variety of periodontal plastic surgery procedures to augment the thickness of keratinized tissues, increase the zone of attached gingiva, improve gingival aesthetics by covering root surfaces, or augment edentulous spaces

Answer 34

Mucogingival surgery

Question 35

how are the areas of recession tx

Answer 35

pedicle grafts or free mucosal grafts, althrough connective tissue grafts have been increasingly used

Question 36

what should be considered for tissue-grafting

Answer 36

area of recession that significantly reduce the width of the keratinized gingiva or have progressed beyond the mucogingival junction

Question 37

what is the most quoted idea for attached gingival tissue

Answer 37

3mm

Question 38

what are some other indications for surgical intervention to control mucogingival problems

Answer 38

broad labial or lingual frenum attachments near the gingival margin that may result in unsightly diastemata and a shallow vestibular depth that must be deepened to improve the fit and retention of removable dental prostheses

Question 39

what are the most common procedures for mucogingival defects

Answer 39

lateral pedicle gingival graft free autogenous gingival graft subgingival connective tissue graft

Question 40

what type of graft is sliding of gingival tissue from an adjacent tooth or papilla, has been suggested as the best technique to attempt to cover exposed root surfaces bec it bring their blood supply with them

Answer 40

Lateral Pedicle Grafts

Question 41

what are the limitations to pedicle grafts

Answer 41

depend largely on the availability of an adequate source of donor tissue adjacent to the area that needs augmentation

Question 42

another important limitation to pedicle grafts is

Answer 42

risk of causing gingival recession to the donor site, particularly if the alveolar bone housing is thin or bony dehiscences are exposed during the surgical procedure

Question 43

this grafts have donor sites located somewhere in the mouth away from the site that requires grafting

Answer 43

Free gingival graft

Question 44

what is the most common donor site for free gingival graft

Answer 44

the palate, but edentulous areas are also used edentulous areas are also used

Question 45

How long should the free gingival graft tissue be immobile for

Answer 45

the first week after surgery to allow for the establishment for circulation to the grafted tissue

Question 46

what is generally not included as part of the donor tissue for free gingival graft

Answer 46

palatal rugae

Question 47

includes a variety of surgical techniques that attempt t restore the periodontal tissues lot through disease

Answer 47

Regeneration surgery

Question 48

by definition, periodontal regeneration is

Answer 48

the formation of new alveolar bone, new cementum, and new periodontal ligament on a tooth root surface that was previously diseased

Question 49

this category of surgery is reserved for procedures that increase the predictability of the growth of new tissues of the attachment apparatus

Answer 49

regeneration surgery

Question 50

what is created from donor bone from the pts own body. Bone may be taken from intraoral sites, such as tori, the maxillary tuberosity, or bone removed during osteoplasty

Answer 50

Autografts

Question 51

created from bone that comes from another person. Cadaver bone, obtained from bone banks accredited by the American Association of Tissue Banks, is the most common source of bone allografts used in periodontics

Answer 51

Allografts

Question 52

this graft uses a variety of synthetic bone materials.

Answer 52

Alloplasts

Question 53

this graft is made out of hydroxyapatite material or ceramics, such as plaster of Paris and tricalcium phosphate

Answer 53

Alloplasts

Question 54

these are created from bone taken from another species, such as bovine (cow) or porcine (pig) bone

Answer 54

Xenografts

Question 55

the most successful use of this materials has been had been as fillers for large osseous defects, using graft materials with all organic tissue chemically removed

Answer 55

Xenografts

Question 56

indications for bone grafts is

Answer 56

defects with sufficient osseous walls to promote healing, ideally three-wall defects

Question 57

what are some other defects indications for bone grafts

Answer 57

furcation defects, particularly mandibular molar buccal furcation of grade 2 (not through and through)

Question 58

Are they any contraindication for bone fill procedures

Answer 58

NO

Question 59

what is guided tissue regeneration

Answer 59

healing by selected cell repopulation

Question 60

what appears to be the best candidates for guided tissue regeneration

Answer 60

infrabony defects and furcation's

Question 61

what are the most promising sites for guided tissue regeneration

Answer 61

osseous lesions that are likely to respond well to other forms of bone fill or grafting

Question 62

what is the procedure for guided tissue regeneration

Answer 62

Flaps are reflected and after debridement of the intraosseous lesion, a membrane is placed over the opening in the bone or furcation and fastened to the tooth by suturing or other stabilizing methods

Question 63

when the epithelium is closed over the membrane in the guided tissue regeneration procedure how long is the wound allowed to heal for

Answer 63

a period of 30 to 60 days

Question 64

how long does it take for the polylactic acid material resorbs through hydrolysis

Answer 64

within 6 to 12 months

Question 65

what is required to close the periodontal surgical wounds and to secure grafts into position

Answer 65

sutures

Question 66

What type of sutures does periodontal surgeons generally use

Answer 66

Braided black silk sutures

Question 67

when does the sutures have to be removed

Answer 67

7 to 14 days

Question 68

what is the infection called resulting from sutures retained too long

Answer 68

stitch abscess

Question 69

at least __ or __ mm of suture "tail" should be left beyond the knot

Answer 69

2 to 3 mm

Question 70

what must be documented in the chart

Answer 70

the location and number of sutures placed

Question 71

this is sometimes placed over the sutures to hold the flaps tightly to the teeth and underlying bone when pocket reduction surgery has been performed

Answer 71

periodontal dressing or pack

Question 72

what is the most common type of pack

Answer 72

consists of a paste mixture that sets chemically to a firm, rubbery consistency,

Question 73

postoperative procedures include

Answer 73

prescription for an analgesic and possibly an antibiotic

Question 74

what type of mouthwash may be used to freshen the mouth and inhibit plaque during primary healing in the first week or two after surgery

Answer 74

chlorhexidine or essential oil

Question 75

what are some postoperative instructions

Answer 75

physical activity should be limited soft diet avoid smoking homecare plaque

Question 76

when should the pt return for a postoperative visit

Answer 76

1 week after periodontal surgery

Question 77

the area if surgery shouldn't be probe for how long

Answer 77

1 month

Question 78

Relative Contraindications to Periodontal Surgery

Answer 78

1. Patients with certain systemic diseases/conditions A. Uncontrolled hypertension B. Recent history of myocardial infarction C. Uncontrolled diabetes D. Certain bleeding disorders E. Kidney dialysis F. History of radiation to the jaws G. HIV infection 2. Patients totally non-compliant with self-care. 3. Patients with a high risk for dental caries. 4. Patients with unrealistic expectations.

Question 79

what is root SENSITIVITY cause by

Answer 79

1. Exposure of root surfaces (previously covered by gingiva) to the oral environment. 2. Apically positioned periodontal flaps, 3. Gingival shrinkage during healing, 4. Root planning with cementum removal 5. Dentinal tubules exposed to the oral environment and hydrodynamic forces.

Question 80

Treatment of Tooth Sensitivity:

Answer 80

Home Fl gels/rinses for 1 month post operatively (containing potassium nitrate) At Office- application of topical desensitizing agents containing potassium oxalate or ferric oxalate Sensitivity usually diminishes in 1-2 months

Question 81

what can cause the tooth to become mobile

Answer 81

periodontal surgery as the result of swelling of the periodontal ligament. OR Removal of calculus bridge.

Question 82

Healing After Periodontal Surgery

Answer 82

Blood clot forms at the surgical site. The blood clot acts as a matrix or scaffolding. Should be thin. Firm pressure helps thin the clot, decrease bleeding, and approximate the edges of the flap.

Question 83

Four Potential Sources of Cells in a Healing Periodontal Surgical Wound

Answer 83

Gingival Epithelium Gingival Connective Tissue Bone Cells Periodontal Ligament Cells

Question 84

what are the 4 Categories for healing

Answer 84

Repair Reattachment New Attachment Regeneration

Question 85

In the category of repair what does not form

Answer 85

new bone, new cementum, or PDL during the healing process.

Question 86

what category is Healing of a periodontal wound by the reunion of the connective tissue and root surface where they have been separated by incision or injury – NOT by disease.

Answer 86

reattachment

Question 87

Describes the union of a pathologically exposed root with connective tissue or epithelium (where periodontitis had previously destroyed this attachment.)

Answer 87

new attachment

Question 88

this results in the regrowth of the precise tissues that were present before the disease or damage occurred. (ie. Reformation of lost cementum, lost PDL, and lost alveolar bone.)

Answer 88

Healing by regeneration

Question 89

Can be accomplished with modern periodontal surgical procedures but cannot be regenerated predictably in all sites.

Answer 89

regeneration

Question 90

what are the 3 forms of healing

Answer 90

Primary Intention Secondary Intention Tertiary Intention

Question 91

what form of healing is this Wound margins and edges are closely adapted to each other. Heals Quickly (Ex. Flap surgery-incisional flap)

Answer 91

primary intention

Question 92

what type of graft Obtain their nutrients by diffusion for the first 2 weeks after surgery from the prepared site.

Answer 92

free gingival graft

Question 93

Wound margins are not close to each other. Heals more slowly A large clot must form over the entire surface Epithelial cells must migrate long distances. Can result in more post-operative pain. (Ex. Gingivectomy-Excisional removal of tissue.)

Answer 93

secondary intention

Question 94

Wound temporarily left open with the intention of closing at a later date.

Answer 94

Tertiary Intention

Question 95

Window-like openings in the alveolar bone over a root surface

Answer 95

Fenestration

Question 96

Root is denuded of bone and portions of the root surface are covered only by soft tissue. Characterized by a long, narrow defect of bone.

Answer 96

Dehiscence

Question 97

refers to a fissure in the gingival tissues and may be caused by abnormal frenula, trauma from occlusion, or pierce related trauma.

Answer 97

Gingival cleft

Question 98

a severe abscess or multiple boil in the skin, typically infected with staphylococcus bacteria.

Answer 98

Carbuncle

Question 99

what are the 2 techniques for removal of aberrant fremun

Answer 99

frenoectomy | frenectomy

Question 100

this refers to the complete removal of the frenum, including its attachment to the underlying bone

Answer 100

frenectomy

Question 101

this is the incision of the frenum, it usually is done to relocate the frenal attachment so as to create a zone of attacked gingiva between the gingival margin and the frenum

Answer 101

frenoctomy

Question 102

is a specialized dental procedure, whereby one root is removed from a multi-root tooth. The tooth is then stabilized and rendered fully functional with a crown or filling.

Answer 102

Root amputation

Question 103

This procedure may be successful to maintain teeth where bone loss has exposed the furcation. Treatment also involves treating the pulp of the tooth with root canal therapy and placement of a crown.

Answer 103

Root amputation