Reattachment and Osseous

Question 1

Repair

Answer 1

Healing that does not restore original ARCHITECTURE, FORM, or FUNCTION

Question 2

Regeneration

Answer 2

Healing that restores original ARCHITECTURE, FORM and FUNCTION

Question 3

Gingival Curettage

Answer 3

Removal of inflamed soft tissue lateral to the pocket wall

Question 4

What is the goal of osseous surgery? Citation

Answer 4

Establish minimal or physiologic probing depth and create a gingival contour compatible with good self-performed oral hygiene (Barrington 1981)

Question 5

What are the New Attachment procedures?

Answer 5

Gingival Curettage
ENAP
Modified ENAP
Modified Widman’s Flap
LANAP

Question 6

How does Curettage impact clinical results? Citation

Answer 6

Echeveirra & Caffesse 1983

Split mouth - SRP and 4wks later Curettage

Did not improve - No additional benefit

AAP no longer considers it a treatment

Question 7

What does ENAP stand for?

Answer 7

Excisional New Attachment Procedure

Question 8

How do you perform ENAP? What is it similar to?

Answer 8

Internal bevel from FGM to just below the pocket
Remove with curette
Root plane exposed cementum
Approximate wound
Sutures and PERIO DRESSING

Gingival curettage with a scalpel

Question 9

Citations for ENAP

Answer 9

Yukna 1976
Fedi & Rosenfeld

Question 10

How does ENAP heal? Citation

Answer 10

Long Junctional Epithelium (Yukna 1976)

Question 11

Fedi & Rosenfeld

Answer 11

ENAP modification

Instead of incising to just below the pocket - to bone crest

Question 12

What is the goal of MWF?

Answer 12

Expose root suface for instrumentation - NOT pocket reduction

Question 13

When is MWF indicated?

Answer 13

Esthetic zone
PD > 6mm
No pocket elimination needed

Question 14

How do you perform a MWF? How does it change in esthetic zones? How is it modified on the palate? (Citation)

Answer 14

Primary incision: PD >2mm: 0.5-1mm from GM directed at alveolar crest - PD <2mm/Esthetic zone: Intrasulcular

Secondary incision: intrasulcular to detach the tissue

Tertiary incision: horizontal along the crest to remove the tissue

Palatally - directed more palatally to help with flap adaptation

Ramfjord & Nissle 1974

Question 15

Healing after MWF? Citation

Answer 15

Caton 1980

LJE

Question 16

What are the 3 incisions termed for MWF?

Answer 16

Primary/Internal bevel

Secondary/Crevicular

Tertiary/Interdental

Question 17

What is LANAP?

Answer 17

Laser Assisted New Attachment Procedure

Question 18

What is the wavelength of Nd:YAG?

Answer 18

1064nm

Question 19

What are the first and second pass settings in LANAP?

Answer 19

1965mJ/mm^2

1st: 4W; 100µs pulse duration; 20Hz
2nd: 4W; 600µs pulse duration; 20Hz

Question 20

What is the objective of the first pass?

Answer 20

De-epithelialize the pocket (sparing CT)

Killing pigmented bacteria

Question 21

What is the objective of the second pass?

Answer 21

formation of a dense fibrin clot for periodontal regeneration

Question 22

What are the steps for LANAP?

Answer 22

1st pass

piezo

2nd pass

occlusal adjustment

Question 23

Citations for LANAP

Answer 23

Nevins et al. 2012

Dortaj et al. 2021

Question 24

Does LANAP result in regeneration? Citation

Answer 24

Some say yes

Nevins 2012 found 5/9 of LANAP teeth had regeneration

Question 25

How does LANAP compare to other treatments?

Answer 25

Dortaj et al. 2021 NSSD between SRP alone

Question 26

When is osseous resective surgery indicated? Citation

Answer 26

Whenever the infra-osseous defect depth is \<4mm or when a 1wall defect is present | (**Ochesenbein 1986**)

Question 27

Osetoplasty goal/function

Answer 27

To create a physiologic form without removing supporting bone Helps tissue adaptation

Question 28

Osteoctomy goal

Answer 28

Elimination of intrabony pockets

Question 29

What situations would you use osteoplasty?

Answer 29

Small buccal/lingual bony ledges Incipient furcation involvement

Question 30

When would you use osteoctomy?

Answer 30

shallow intrabony or hemiseptal defects To remove reverse architecture

Question 31

What is the difference between Infra/Intrabony defect? Citation

Answer 31

Goldman & Cohen 1958 **Infrabony** can be subdivided into **intrabony** (only 1 root surface involved) and **crater** (2 adjacent roots involved)

Question 31

What is the most common defect?

Answer 31

Crater Becker and Becker

Question 32

What kind of defects are there?

Answer 32

Supra-bony (horizontal) Infra-bony (vertical) Inter-radicular (furcation)

Question 33

Where are craters most commonly found? Why? Citation

Answer 33

posterior teeth interdental area collects plaque McGugh 1971

Question 34

What is a circumfrential defect?

Answer 34

one that includes more than 1 tooth surface

Question 35

Who is the father of osseous surgery?

Answer 35

Schluger

Question 36

What instrument should you use for osteoctomy?

Answer 36

Hand instruments (Ochsenbein Files) Ochsenbein 1958

Question 37

What are the rules of osseous surgery?

Answer 37

1: Full thickness flap should be raised 2a: **Scallop should aniticipate underlying bone** contour 2b: Scalloping should **reflect patient's healthy gingiva** 2c: Tissue/bone scalloping is reduced as interproximal space increases due to boneloss 3: Osteoplasty precedes ostectomy 4: Whenever possible - create positive architecture 5: no high speed next to teeth 6: final bone contour should reflect expected gingival contour

Question 38

Steps for osseous recontouring

Answer 38

vertical grooving Radicular blending/Flattening interproximal bone Gradualizing marginal bone

Question 39

What is the palatal approach?

Answer 39

Ochsenbein & Bohannan 1963 wider embrasure from divergence of palatal roots

Question 40

Lingual approach?

Answer 40

Tibbets eet al. 1976 Defects in mandible tend to happen beneath contact which is lingually displaced Buccal bone is usually higher - causes excessive removal of buccal bone to get to lingual

Question 41

Classify craters

Answer 41

Small: 1-2mm Med: 3-4mm Deep: _\>_5mm

Question 42

Classify root trunk

Answer 42

Ochsenbien Maxilla: Short: 3mm AVERAGE: 4mm Long: 5mm Mand: Short: 2mm Average: 3mm Long: 4mm

Question 43

What is palatal ramping?

Answer 43

in craters 2-3mm reduce palatal side to 10˚ from base of crater