Sweep 1.3

Question 1

Important acute phase proteins

Answer 1

Complement components: opsonization, lysis, chemotaxis (CTX) 
Protease inhibitors (2-macroglobulin)
C-reactive protein (CRP):  opsonization
Fibrinogen:  coagulation factor, CTX
Plasminogen:  degrades blood clots

Question 2

S. sanguis and P. gingivalis can induce

Answer 2

thrombo-embolic events (Herzberg & Meyer, 1996). This action is mediated by collagen-like platelet aggregation associated proteins made by bacteria.

Question 3

A. actinomycetemcomitans LPS enhances

Answer 3

foam cell formation by macrophages incubated in vitro with LDL (Morishita et al, 2013)

Question 4

Gingipains from P. gingivalis up-regulate expression of

Answer 4

angiopoetin 2 (pro-inflammatory action) and down-regulate expression of antiopoetin 1 (anti-inflammatory) in human aortic smooth muscle cells. This change in gene expression increases migration of smooth muscle cells and promotes atherosclerosis (Zhang et al, 2015)

Question 5

Subjects with severe periodontitis are more likely to have elevated

Answer 5

HbA1c levels than subjects in health or with moderate periodontitis.

Question 6

If you remove plaque and lesion, the signal for turning on basal layer of epithelium

Answer 6

goes away. You stop producing pro-inflammatory cytokines.

Question 7

Early lesion

Accumulation of

Answer 7

lymphoid cells immediately subjacent to JE

Question 8

Early lesion

Cytopathic alteration in

Answer 8

resident fibroblasts

Further loss of collagen network

Question 9

Early lesion

Early proliferation of

Answer 9

basal cells of JE

Inflammatory changes are clinically evident

Question 10

Established lesion histopathology

Answer 10

Increased swelling clinically evident
Increased fluid exudation, leukocyte migration
Plasma cells increase around blood vessels and in coronal CT
Collagen loss continues as infiltrate expands

Question 11

Established lesion

In addition to macrophages and serum proteins,

Answer 11

T and B cells and plasma cells are present

Question 12

Established lesion

Activated T cells produce

Answer 12

cytokines (IL-2, 3, 4, 5, 6, 10 and 13, TNF-) and chemotactic substances (MCP, MIP and RANTES)

Question 13

Established lesion

Plasma cells produce

Answer 13

Ig and cytokines (IL-6 and TNF-)

Question 14

Established lesion

Fibroblasts produce

Answer 14

MMPs and TIMPs

Question 15

TIMP =

Answer 15

tissue inhibitor metalloproteinase – counter proteinaise, balance still shifts to protenolysis.

Question 16

Conversion of JE to PE

Answer 16

The JE and sulcular epithelium proliferate, migrate deep into CT
The sulcus deepens and the coronal portion of the JE is converted into permeable pocket epithelium (PE)
The PE is not attached to tooth surface
The PE is loaded with PMNs

Question 17

Switch from T- to B-cell predominance signals conversion from

Answer 17

gingivitis to periodontitis

Question 18

Destruction of CT attachment to root surface and apical migration of epithelial attachment indicates

Answer 18

first clinical sign of periodontitis.

Question 19

Bone destruction begins around

Answer 19

communicating blood vessels along crest of septum
Apical proliferation of PE into deep CT
PE is not attached to tooth

Question 20

Advanced lesion summary

Answer 20

Persistence of established lesion features
Increased proportion of plasma cells (~50%)
Extension of lesion into alveolar bone and PL, with significant bone loss
Continued loss of collagen fibers and matrix subjacent to PE
Formation of periodontal pocketing and apical migration of JE from CEJ

Question 21

Pregnancy, puberty and menopause

Estrogen affects

Answer 21

salivary peroxidases

Question 22

Estrogen increases

Answer 22

collagen metabolism, angiogenesis

Question 23

Pregnancy puberty and menopause

Increased

Answer 23

vascular response and inflammatory mediators

Question 24

Gingival inflammation

Answer 24

increases in puberty & pregnancy

Question 25

INcrease in gingival bleeding during

Answer 25

menstrual cycle in women with gingivitis

Question 26

Pregnancy | Effects on microbiota

Answer 26

 in P. intermedia Naphthoquinones from steroids support growth of P. i.  in spirochetes

Question 27

Pregnancy | Effects on host

Answer 27

 in vascular permeability, resulting in  gingival exudate decrease in keratinization decrease in PMN chemotaxis and phagocytosis decrease Ab and T-cell responses

Question 28

Pregnancy | Periodontal treatment

Answer 28

Best during 2nd trimester | Best to avoid use of antibiotics during pregnancy

Question 29

Ailing implant

Answer 29

Peri-implant mucositis | Peri-implantitis

Question 30

Failing implant

Answer 30

Peri-implantitis

Question 31

Failed implant

Answer 31

Peri-implantitis with mobility and complete loss of osseointegration

Question 32

Peri-implantitis and peri-implant mucositis

Answer 32

Definitions (Consensus report of the 1st European Workshop on Periodontology, 1994) Peri-implant mucositis: Reversible inflammation of the mucosa surrounding the implant. Presence of bacterial plaque and calculus. Edema, redness and mucosal hyperplasia. Bleeding on probing. Exudate or pus formation on occasions (gingival microabscess). No radiological evidence of bone resorption. Peri-implantitis: Inflammatory reactions associated with loss of supporting bone around an implant in function

Question 33

Peri-implantitis in humans: histology

Answer 33

Peri-implantitis lesions are characterized by the presence of numerous neutrophils in the tissue surrounding the implant In peri-implantitis, there is direct contact between plaque on the implant surface and inflamed connective tissue. These features are not seen in periodontitis

Question 34

Classification of peri-implantitis(Jovanovic 1990, Spiekermann 1991) Class 1

Answer 34

Slight horizontal bone loss with minimal peri-implant defects

Question 35

Classification of peri-implantitis(Jovanovic 1990, Spiekermann 1991) Class 2

Answer 35

Moderate horizontal bone loss with isolated vertical defects

Question 36

Classification of peri-implantitis(Jovanovic 1990, Spiekermann 1991) Class 3

Answer 36

Moderate to advanced horizontal bone loss with broad, circular bony defects

Question 37

Classification of peri-implantitis(Jovanovic 1990, Spiekermann 1991) Class 4

Answer 37

Advanced horizontal bone loss with broad, circumferential vertical defects, as well as loss of the oral and/or vestibular bony wall

Question 38

Class 1

Answer 38

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.

Question 39

Class 2

Answer 39

``` 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. ```

Question 40

Class 3 and 4

Answer 40

In peri-implantitis class 3 and 4, the presence of vertical defects almost always requires the use of GTR techniques.

Question 41

Good prognosis: | implants

Answer 41

25% attachment loss and/or class I furcation involvement Adequate remaining bone support Adequate possibilities to control etiologic factors and establish a maintainable dentition, Adequate patient cooperation No systemic environmental factors or well controlled systemic factors.

Question 42

Implants | Fair prognosis:

Answer 42

25-50% attachment loss grade I or easily accessible Grade II furcation involvement, adequate maintenance possible Few systemic complications

Question 43

Implants | Poor prognosis:

Answer 43

>50% attachment loss Class 2 tooth mobility Inaccessible grade II furcation involvements, grade III furcation difficult-to-maintain areas and/or doubtful patient cooperation, presence of systemic/environmental factors.

Question 44

Implants | Hopeless prognosis:

Answer 44

>75% attachment loss Tooth mobility 2+ grade II and III furcation involvements, difficult-to-maintain areas and/or doubtful patient cooperation, Root proximity