Sweep 1 Flashcards
(177 cards)
1
Q
mucogingival defect
A
Gingival recession
Lack of gingiva (Keratinization)
Gingival recession with abrasion
2
Q
Recession - generalized - due to
A
Tissue biotype, oral hygiene
3
Q
Recession - localized - due to
A
Anatomy, defective restoration
4
Q
Brushing and recession - in young adults —- most involved
A
premolars
5
Q
Hx of hard brush use
•Positive association with
A
% receded surfaces
6
Q
Miller class 1 when there is no
A
interproximal bone loss and the recession does not extend to mucogingival junction. 100% root coverage can be anticipated in miller class I recession defects.
7
Q
Miller class II When there is no
A
interproximal bone loss and the recession extends to or beyond mucogingival junction. 100% root coverage can be anticipated in miller class II recession defects.
8
Q
Miller class III there is
A
interproximal bone loss and the recession may or may not extend to mucogingival junction. Only partial root coverage up to the level of interproximal bone can be anticipated in miller class III recession defects
9
Q
Miller class IV there is
A
interproximal bone loss beyond the level of recession No root coverage can be anticipated in miller class IV recession defects.
10
Q
CAF - coronally advanced flap -
A
most predictable outcome. Full thickness, coronally positioned. Two vert incisions.
11
Q
Tunnel -
A
no incision, raise flap through sulcus, tunnel to underlying bone, insert graft
12
Q
Lateral sliding flap -
A
single tooth recession. Remove epi layer and slide flap from donor side over. Partial thickness, if concern for recession on donor side use collagen.
13
Q
Double papilla -
A
like lateral sliding from two sides
14
Q
SGCT -
Subepithelial connective tissue graft
A
increase tissue thickness at site.
15
Q
Allograft
• Recovered from
A
human donor skin
16
Q
• Mucograft
A
• Xenograft porcine collagen type I and III
17
Q
• Emdogain
A
– an extract of enamel matrix and contains amelogenins
18
Q
—– provides best outcome for root coverage
A
SGCT, CAF
19
Q
Free gingival graft INDICATIONS
• To increase ——-
• To increase —– depth
• To achieve ——-
A
KG/attached gingival
vestibular
root coverage
20
Q
Free gingival graft - DISADVANTAGES
• Not predictable to achieve —–
• Esthetic concern: —— at recipient site
• Complications at —–
A
root coverage
color discrepancy
donor site
21
Q
FGG healing - Initial phase (0-3 days) –
A
“Plasmatic circulation
22
Q
FGG healing - —— phase (2-11 days)
A
Revascularization
23
Q
FGG healing - ——- phase (11-42 days)
A
Tissue maturation
24
Q
Frenulum (frenum)
A small band or fold of ——– that controls, curbs, or limits the movement of organ or part
A
integument or mucous membrane
25
Aberrant Frenum
Atypical/abnormal insertion of ------- frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements.
labial, buccal, or lingual
26
Inability of ---------------- has been implicated in the persistence of aberrant frenum
frenum to migrate apically during alveolar growth and tooth development
27
Classification of labial frenum
Mucosal
Gingival
Papillary
Papillary penetrating
28
Mucosal frenum
| Insertion of frenum ends in
mucosa or, at the most, at mucogingival junction.
29
Gingival frenum
| Insertion of frenum ends in the
gingiva, between mucogingival junction and base of the interdental papilla
30
Papillary frenum
| Insertion of frenum ends at the
interdental papilla, but does not penetrate to the palatal aspect of the tissues
31
Papillary penetrating frenum
| Insertion of frenum ends at the
interdental papilla, and penetrates to the palatal aspect of the tissues.
32
Ellis-van Creveld syndrome Orofacial-digital syndrome associated with
Prominent/Aberrant max frenum problems
33
Ehlers-Danlos syndrome Holoprosencephaly
Genetic Syndromes are associated with absence of maxillary labial frenum
34
Studies of excised frena agree on presence of :
both orthokeratinized and parakeratinzed epithelium.
collagen fibers.
chronic inflammatory infiltrate
35
With excised frena - Presence of ------- is inconsistent
muscle fibers
36
Aberrant labial frenum
| Can be associated with:
Frenal tension
Interference with oral hygiene procedures
Gingival Recession
Midline Diastema
37
```
Recession
Interference with oral hygiene procedure Trauma
Plaque retention
Diastema
Denture fabrication
```
Indications of frenectomy
38
Frenotomy: the cutting of a frenulum, especially the release of ---------.
ankyloglossia
39
Frenulectomy (frenectomy): the
excision (total removal) of a frenulum.
40
V-shaped incision, Archer incision, diamond-shaped incision
Simplest procedure
41
Z-plasty incision
More demanding, less relapse
42
Lasers (CO2, others)
Better patient outcomes
43
Frenectomy can result in scar formation between central incisors, which can lead to resistance to ------
orthodontic movement.
44
Orthodontic treatment should be considered before
the frenectomy. - however, Wide and thick frenum may require removal prior to space closure
45
Ankyloglossia
```
“Tongue tie”
Congenital oral anomaly characterized by an
abnormally short lingual frenulum
Partial or complete
Incidence: 0.02 - 10.7%
```
46
Anatomic indications: for ankyloglossia removal
notching of the ---------
inability of the tongue tip to contact the ------
restriction of ------- movement
restriction of tongue protrusion beyond the -------
protruding tongue tip
maxillary alveolar ridge
lateral tongue
mandibular alveolus
47
Ankyloglossia
----- is a safe procedure
Treatment may improve -------
Frenotomy
breastfeeding,
tongue mobility, and speech articulation
48
Laser: Common Components
ActiveMedium
ExcitationMechanism
HighReflectanceMirror
PartiallyTransmissiveMirror
49
ActiveMedium
solidcrystals(rubyorNd:YAG)
| liquiddyes(gaseslikeCO2orHelium/Neon) semiconductorssuchasGaAs.
50
ExcitationMechanism
Excitation mechanisms pump energy into the active medium by one
51
HighReflectanceMirror
A mirror which reflects essentially 100% of the laser light.
or more of three basic methods; optical, electrical or chemical.
52
PartiallyTransmissiveMirror
A mirror which reflects less than 100% of the laser light and
transmits the remainder (this is the LASER beam).
53
Technical difficulties
Lack of precision in depth of cut
Tissue not available for histopathology
Hazardous
Dispersal of viable virus particles in the plume
disadvantages of lasers
54
```
Periodontal applications - laser
Soft tissue surgery ------
------- uncovery
Frenectomy?
Uncovering ------
```
Gingivectomy
Implant
soft tissue impactions
55
Lasers for tooth exposure
| Indications
Soft tissue impactions
| Hard tissue palatal impactions
56
Lasers for tooth exposure
| Contra-indications
Hard tissue impactions with variable bone
| thickness Esthetics
57
LANAP
Laser Assisted New Attachment Procedure
not a ton of evidence for this, most of their claims can be countered.
58
LANAP - Basic concept:
Remove sulcular epithelium
Modify root surface
New attachment will occur
59
Lanap - protocol
1 pass of laser, SRP x 3, pass 2 of laser, periostat one week before and 3 months after
60
```
Photo Dynamic Therapy (PDT)
Advantages
Useful for -----
------ specific – since the photosensitizer can be formulated to target certain tissues (e.g. iodine-coupled dyes will target thyroid only)
No ----- (for bacteria)
```
hard to reach areas (inject the sensitizer through
IV, then shine a light on the target tissue)
Tissue
antibiotic resistance
61
PDT Disadvantages
Wavelength of light is very narrow (630-700nm), so big --------
Light source configuration is cumbersome (think rigid instrument in narrow spaces)
Photosensitivity can cause ----- injuries
tumors (and deep pockets) cannot be penetrated
severe burn
62
PDT not
FDA approved
63
Peri-implantitis does not seem to be treatable by
non-surgical means
64
PMT =
Periodontal MaintenanceTherapy
65
```
Rationale for PMT
• tooth loss ------- to SPT frequency
• reduced risk of future attachment loss despite -------
• monitoring
• plaque removal
```
inversely proportional
incomplete plaque removal
66
Components of PMT appointment
assessment of personal oral hygiene (cleaning more or less)
• active treatment (root planing, occlusal appliance, antimicrobials, surgery)
- communication
• planning
67
Frequency of PMT
• For most patients presenting with gingivitis but without history of attachment loss- performed on a -----
For patients with a history of periodontitis, PMT should be performed at intervals of less than --- months - most commonly every ------.
semiannual basis
6
3 months
68
– poor plaque control =
no surgical treatment
69
– single site =
nonsurgical treatment
70
– continued inflammation =
surgical treatment
71
– attachment loss =
S/RP + antibiotics or surgery
72
– Increasing mobility =
occlusal adjustment
73
Clinical Parameters Assessed During Maintenance with Implants
* Tissue Health
* Crevicular Fluid
* Mobility and occlusion
74
* Blood clot or coagulum within the
first 24 hrs.
75
* Fibrinolysis within
1-3 days.
76
* Replacement of coagulum by granulation tissue
| within
2-4 days.
77
* Vascular network is formed by the end of
week 1.
78
* Socket is covered with new connective tissue rich in vessels and inflammatory cells by
week 2.
79
* Soft tissue becomes keratinized by
week 4-6.
80
* Alveolus is filled with woven bone by
4-6 weeks.
81
* Mineral tissue is reinforced with layers of lamellar bone that is deposited on woven bone by
4-6 months
82
*Significantly larger resorption in the ----- in both maxilla and mandible.
buccal aspect of alveolus
83
Tooth extraction and bone loss:
* Loss in the horizontal dimension ..
* Significant loss within ------ following extraction
* 40% of -----, 60% of ----- within the first 6 months
* Grafted versus non-grafted site..
5-7 mm within first year
8 weeks
height
width
1.2 versus 2.7 mm bone loss
84
Bone defects:
| Class I-
Extraction sockets
85
Bone defects:
| Class II and III-
Dehiscence defects
86
Bone defects:
| Class IV-
Horizontal defects
87
Bone defects:
| Class V-
Vertical defects
88
Alveolar Ridge Preservation (ARP) is a -------- application at the time of tooth extraction to control --------
guided bone regeneration (GBR)
bone resorption
89
Guided Bone Regeneration (GBR) is Guided Tissue Regeneration (GTR) targeting specifically the regeneration of
already resorbed/lost bone
90
Alveolar ridge preservation (ARP) Indicated After extractions to preserve original ridge dimensions and contours (hard and soft tissues), when -------
immediate
| implant placement is not possible.
91
Contraindicaations to ARP
infection, immediate implant placement, soft tissue limitations
92
* Osteoconductive – acts as a ------
scaffold
93
* Osteoinductive – Stimulates the -------
resident cells
94
Autogenous graft materials
(osteogenic, osteoinductive and osteoconductive).
95
Allografts
(osteoinductive and/or osteoconductive)
96
Xenografts (mainly
osteoconductive)
97
Synthetics
(fillers)
98
*Extraoral and intraoral autogenous grafts-
Iliac cancellous bone and marrow
| Bone obtained from maxillary tuberosity, extraction sites, or the osseous coagulum.
99
Combined procedures
1- Non-absorbable membranes combined with bone grafts or synthetic grafts.
2- Absorbable membranes combined with bone grafts
3- Coronally positioned flaps combined with bone grafts.
100
Factors affecting the outcome of
| alveolar ridge preservation
- Blood supply
- Space maintenance
- Membrane stability
- Tension-free flap closure
101
Compared to mandibular samples, maxillary samples had a lower percentage of ----- and higher percentage of -------------
bone
residual material and vascularization
102
* ARP prevented ------ following tooth
| extraction in both maxilla and mandible.
ridge height loss
103
Mean ridge width loss of ------mm in the maxilla
| and -------mm in mandible.
2. 44±0.71
| 2. 54±0.5
104
Higher percentage of immature tissue was noted in
| ---------
mandible
105
* Micro CT analysis revealed greater mineralization per unit volume in ------- than in ---------- in mandible (p=0.03).
newly forming bone
residual bone graft
106
There was a higher rate of -------- in mandible following ARP, consistent with histologic and micro-CT analyses.
angiogenesis
107
When placed in mature bone, an implant should have at least----mm of
bone on all sides
1
108
At least 7 mm of interocclusal (interarch) distance is needed from the top (shoulder) of the implant to the --------
occlusal surface of the opposing tooth
109
At least----- space between two adjacent implants and at least ------ space between an implant and adjacent tooth.
3 mm
2-3 mm
110
• Early placement: the implant is placed in a site where the
soft tissues have healed and a mucosa is covering the socket entrance.
111
Late:
theimplantisplacedinanextractionsiteatwhich substantial amounts of new bone have formed in the socket.
112
• Conventional:the implant placed in a
fully healed ridge
113
Immediate implant placement • Disadvantages:
- Site morphology may complicate optimal placement
- Tissue biotype may compromise optimal outcome
- Potential lack of keratinized mucosa for flap adaptation - Adjunctive surgical procedures may be required
- Technique-sensitive procedure
114
Immediate implant placement • advantages:
- Less surgeries
- Less overall treatment time
- Optimal use of available/existing bone
115
Implant placement in a fresh extraction socket may -------- physiologic modeling/ remodeling that occurs following tooth extraction
not prevent the
116
Buccalportionoftheimplantgraduallylosesitshard tissue coverage, and the metal surface may become visible through a thin peri-implant mucosa with
immediate implant placement
117
Early Implant Placement
• Advantages:
- Easier --------
- Allows resolution of ------
flap adaptation
local pathology
118
```
Early implant placement
• Disadvantages:
- Site morphology may complicate ------
- Longer ------ time
- Varying amount of --------- at socket walls
- Adjunctive -------- may be necessary
- Technique-sensitive procedure
```
optimal placement
treatment
bone resorption
surgical procedures
119
With early and immediate - • Insiteswheretheavailableboneheightapicalto the socket is less than ------- it is frequently impossible to obtain primary implant stability.
3 mm,
120
---------- plays major role in immediate and early implant placement indications
Softtissuebiotype
121
For immediate/early - • -------socket walls have to be intact with/without a dehiscence or fenestration on buccal wall.
Threeoutoffour
122
Late implant placement (typically >16 weeks)
• Advantages:
- Clinically healed ridge
- Mature soft tissues; easier ---------------
• Disadvantages:
- Increased treatment time
- Adjunctive surgical procedures may be required
- Large variation in available -------
flap management
bone volume (increased bone loss with longer waiting time)
123
• Theratefornewboneformationdecreasedafter-------months of healing.
3-4
124
Two piece (------) versus one piece (-------) implants
submerged
non-submerged
125
One-stagesurgicalprotocol:
| The mucosal flap can be adapted to the
neck
| (healing cap) of the implant
126
Two-stagesurgicalprotocol:
| The mucosal flap is sutured on top of
implant (cover screw) obtaining primary wound closure.
127
Disadvantages of one-stage implant placement:
- Exposure to oral cavity during -------- period
•
- Difficult to control loading especially with removable temporary restoration
osseointegration
128
Apicocoronally, the implant shoulder should be placed about----- apical to CEJ of the adjacent teeth in patients without gingival recession.
2 mm
129
• Full thickness flap elevation with special incision designs to preserve papilla and/or keratinized mucosa for
implant placement - single tooth
130
Implants - • Minimum of ---- buccal bone thickness
| • Minimum of ----- interproximal bone thickness
2 mm
131
Multiple Unit Implant Supported Restoration
- Implants have to be ----- to each other.
- At least ----- bone thickness should exist between two implants.
- Apical-coronally, implants should be placed at the same -----
- Buccal-lingually implants should be in harmony by leaving enough buccal space for ----- work but not positioned to ----- which would cause major cantilever or cross-bite type occlusion.
- Angulation of the implants compared to ------ should be minimal.
parallel
3 mm
level (sinked into bone about the same amount).
metal-ceramic
lingual
occlusal plate
132
- ----------- is difficult to achieve and related surgical techniques lack prospective clinical long-term documentation.
Vertical bone augmentation
133
------- cannot predictably be re-established
Inter-implant papillae
134
• ------ screw secures the prosthesis to the
| abutment.
Prosthetic retention (if not cement retained)
135
: Inflammatory reactions associated with loss of supporting bone around an implant in function
Peri-implantitis
136
A reversible inflammatory reaction in the soft tissues surrounding a functioning implant
Peri-implant mucositis:
137
Ailing implant
Peri-implant mucositis
138
Failing implant to failed implant
Peri-implantitis
139
Treatment of failing implants
• Resolve inflammation
– debride plaque
– Improve oral hygiene
– adjunctive antibiotics as indicated
• Correct unfavorable soft tissue morphology (pseudopockets) by flap surgery or gingivectomy
• Re-osseointegration - decontaminate implant surface with citric acid or tetracycline solutions, guided bone regeneration
140
Periimplantitis
| Class 1
Slight horizontal bone loss with minimal peri- implant defects
141
Periimplantitis
| Class 2
Moderate horizontal bone loss with isolated vertical defects
142
Periimplantitis
| Class 3
Moderate to advanced horizontal bone loss with broad, circular bony defects
143
Periimplantitis
| Class 4
Advanced horizontal bone loss with broad, circumferential vertical defects, as well as loss of the oral and/or vestibular bony wall
144
Peri implantitis Class 1
| Treatment protocols
* Surgical reduction of pocket depth, thinning of mucosal flaps and apical repositioning of flaps at a bone edge level, using the corresponding suture technique.
* The implant surface is cleaned and decontaminated.
* Implantoplasty is only performed if threads are exposed.
145
Peri implantitis Class 2 treatment protocols
* Similar to class 1, but repositioning is performed more apically, leaving more implant surface exposed, thus requiring an implantoplasty.
* If local vertical resorption has three or more walls, this bone defect is restored using classical GTR techniques.
* In cases where the defect involves one or two walls, osteoplasty or bone leveling is performed to favor soft tissue repositioning, to fulfill self-cleaning criteria.
146
Peri implantitis Class 3+4 treatment protocols
Class 3 and 4
• In peri-implantitis class 3 and 4, the presence of vertical defects almost always requires the use of GTR techniques.
147
Human BMP-2 (INFUSE®)
• Action: stimulation of bone formation via ---------
• With INFUSE, rhBMP-2 powder is mixed with sterile water and applied to ------
recombinant human bone morphogenetic protein-2
collagen sponges
148
Plastic probes used when checking around
implants
149
Prophy paste and a rubber cup on a prophy head / handpiece can be used to polish ------ when removal is not indicated
implant bars
150
Plastic scalers are appropriate for cleaning around ------- supporting implant bar substructures, ------ and implant supported ----- restorations.
standard abutments
hybrid prostheses
splinted
151
ANUG: Early Clinical Signs
* Necrotic lesion of the papilla initially then progressing to gingival margin. Punched-out appearance
* Spontaneous bleeding
* Pain
152
```
ANUG: Advanced Lesion
• Lack of -------
• Merging of -------- involvement
• Characteristic -----
• Central necrosis results in -------
```
deep pockets
papillary and marginal
foetor
crater formation
153
ANUG: Other Findings
* Fever and malaise. Moderate elevation of temperature can be observed
* Poor oral hygiene.
* White membrane of desquamated cells, bacteria, saliva proteins.
* Membrane can be easily removed
154
ANUG microbiology
TypicalfloraincludesTreponemasp.,Selenomonassp., Fusobacterium sp., and Provetella intermedia.
– Somespecies(Treponemasp.;P.intermedia)invadetissue and release endotoxins
155
Treatment of ANUG
• Alleviation of the acute inflammation by reducing the ------ and removal of -------
• Treatment of chronic disease either underlying the ------- or elsewhere in the oral cavity
• Alleviation of generalized symptoms such as fever and malaise
• Correction of systemic conditions that contribute to the initiation or progression of gingival changes
bacterial load
necrotic tissue
acute involvement
156
Gingival Abscess
– A localized purulent infection that involves the marginal gingiva or interdental papilla
157
• Pericoronal Abscess
– A localized purulent infection within the tissue surrounding the
crown of a partially erupted tooth. • Periodontal Abscess
– A localized purulent infection within the tissues adjacent to the periodontal pocket that may lead to destruction of periodontal ligament and alveolar bone.
158
• Periapical Abscess
– Inflammatory condition characterized by formation of purulent exudate involving the dental pulp remnants and the tissue surrounding the apex of the tooth.
159
Gingival Abscesses
| • Treatment
– Removal of noxious agent(s)
– Incision and drainage (if necessary) – Antibiotics are contraindicated
– Home care: rinse with warm NaCl H20
160
Pericoronal Abscesses
| • Treatment
```
– Removal of noxious agent(s)
– Irrigation under soft tissue operculum – Systemic complications: antibiotics
– Home care: rinse with warm NaCl H
O – When infection under control:
• Extraction
• Operculectomy
```
161
Peri-Apical Abscesses
| • Treatment
– Removal of tooth – Root canal therapy
162
Periodontal Abscesses • Types
– Periodontitis-related
– Non-periodontitis-related
163
```
– Periodontitis-related
• Acute infection as the result of ----
in a deep periodontal pocket
– Non-periodontitis-related
• Acute infection from bacteria originating from -------
```
subgingival bioflim
another source - e.g., foreign body impaction
164
Periodontal Abscesses • Treatment
```
– Drainage through pocket retraction or incision
– Scaling and root planing
– Periodontal surgery
– Systemic complications: antibiotics*
– Extraction
```
165
Excluding third molars, the frequency of impaction is as follows:
```
MAXILLARY CANINE
Mandibular 1st premolar
Mandibular 2nd premolar
Mandibular canine
Maxillary premolars
```
166
Estimated incidence of maxillary canine impaction is
~2%.
167
---of patients with impacted canines have bilateral impactions.
8%
168
Several local factors may become an obstacle to the normal eruption process:
Failure of deciduous tooth roots to resorb
Abnormal position (eruptive path)
Supernumerary tooth
Tooth crowding
Dentigerous cyst (enlarged dental follicle)
Thickened oral soft tissues (genetics, trauma) Oral soft tissue pathology
Hard tissue pathology (odontoma)
Premature extraction of deciduous teeth
169
Systemic factors may also affect the normal eruption process:
Childhood diseases Hereditary factors Genetic syndromes
170
Surgical Techniques
| Open eruption.
Window technique.
| Apically positioned flap technique.
171
Techniques - Closed eruption.
Flap elevated, orthodontic appliance applied, flap closed.
172
Open Eruption Approach
Advantages:
If bonding of bracket/chain fails, --------
```
Disadvantages:
Greater -------
Interference with -------
Delayed --------
Bone exposure
```
no
additional surgery needed
discomfort (pain, bad taste)
function (eating)
healing (secondary intention)
173
------ movement of teeth did not lead to gingival recession
Labial
174
------ out of alveolar bone may be associated with higher tendency for developing gingival recession.
Incisor movement
175
Ortho Tx in Perio Patient
| Key Considerations:
Eliminate or reduce plaque accumulation Eliminate or reduce gingival inflammation
176
PRE-ORTHO TX
Tooth exposure Root coverage Frenectomy
PAO
Periodontally-
accelerated orthodontics Implants for anchorage
177
POST-ORTHO TX
Fiberotomy
Frenectomy
Gingivectomy
Root coverage
