Week 1 Flashcards
(26 cards)
What is the definition of repair in the context of wound healing?
Physiologic adaptation of an organ after injury to re-establish continuity without regards to exact replacement of lost/ damaged tissue.
Principal tissue involved is long junctional epithelium.
What is the definition of regeneration in the context of wound healing?
Replacement of lost/ damaged tissue with an ‘exact’ copy, such that both morphology and functionality are completely restored.
Principal tissues involved are periodontal ligament fibres, alveolar bone, root cementum.
List the principal wound healing events occurring after debridement.
- RBCs adhere onto root surface (immediate)
- Fibrin clot formation (60mins): cytokines released & increase permeability of capillaries
- Early inflammation phase (6hrs): Fibrin network attached to root, PMNs migrate to dentine
- Late inflammation phase (3 days): Reduced swelling 24-48hrs, LJE forms (BM & hemidesmosomes)
- Granulation tissue formation: highly vascular tx is remodelled, fibrin clot matures, fibroblasts
- Highly cellular connective tissue (7 days): attached to dentine surface
- 21 days: Immature collagen, JE reattaches via LJE, gingival tissues mature, min inflammation.
What is the role of Long junctional epithelium (LJE) in repair after debridement?
Replaces PDL lost through disease.
Is LJE more resistant to infection and inflammation than Junctional epithelium?
Not necessarily. Some studies suggest it is more susceptible to inflammation. Evidence not clear.
What microbiological changes occur to the plaque biofilm after debridement?
- Reduced mean counts & number of sites colonised by P. gingivalis, A. actinomycetemcomitans, P. intermedia, T. forsythia, T. denticola
- Increased proportions of streptococci several weeks after: S. gordonii, S. mitis, S. oralis, S. sanguis
- Remaining bacteria becomes planktonic - susceptible to host defenses.
What is the effect of oral hygiene on changes after debridement?
Supragingival plaque reestablishes & becomes more anaerobic with poor oral hygiene. Good oral hygiene is essential to maintain aerobic bacteria within periodontal pocket.
List site level factors that affect healing after debridement.
- Pockets >5mm
- Horizontal vs vertical defects.
List tooth level factors that affect healing after debridement.
- Anterior vs Posterior
- Single vs Multirooted
- Root irregularities and furcations.
List patient-level factors that affect healing after debridement.
- Level of oral hygiene
- Compliance with periodontal treatment plan.
What is the purpose of re-evaluating periodontal patients after initial phase therapy?
Confirm presenting compliant has resolved, confirm treatment has been effective, intervene early, establish next stage of treatment.
After how many weeks post treatment should we re-evaluate patients diagnosed with moderate periodontitis (stage II grade B)?
8-12 weeks.
What questions do we ask our patients at the re-evaluation visit?
- Has the presenting compliant been resolved for the patient
- Any changes in medical history, smoking habits or stressful events
- Problems with toothbrushing or interproximal cleaning.
List four changes indicating healing within a treated periodontal pocket.
- Reduction in probing depth
- Reduced BOP (whole mouth and/or site)
- Reduced mobility after occlusal adjustment for fremitus
- Reduced plaque index.
What measurable changes can we expect after non-surgical debridement in shallow sites (0-3mm)?
- Probing depth reduction: -
- Recession: < 1mm
- Attachment gain: Loss through trauma (recession).
How long does it take to heal probing depths of <4mm after thorough removal of root surface deposits?
1 month.
How do we determine which sites require re-treatment at the re-evaluation appointment?
- Healthy: PD ≤3mm, No BOP - Remove deposits & stain
- Controlled: PD reducing, PD unchanged but <5mm, No BOP - Remove deposits & stain
- Uncontrolled: PD increasing, PD unchanged and ≥5mm, BOP - Scaling & RSD.
Does the staging of a patient change after non-surgical debridement?
Yes.
How do we refer to the stability of a periodontal patient after treatment?
- Uncontrolled, recurrent: PPD ≥5 mm or ≥4mm & BOP
- In remission, gingivitis: BOP ≥10%, PPD ≤ 4mm, No BOP at 4mm sites
- Controlled healthy: BOP <10%, PPD ≤ 4mm, No BOP at 4mm sites.
To achieve periodontal health after treatment, does a patient need to have all probing depths <4mm at the re-evaluation visit?
No.
List major patient-level periodontal risk factors.
- Systemic
- Genetic
- Social
- Behavioural.
List major tooth-level periodontal risk factors.
- Medical status
- Bone loss/Age
- Restorative status
- Tooth position/crowding.
List major site-level periodontal risk factors.
- Probing depth
- Recession
- CAL
- BOP.
What is one long-term study supporting the efficacy of supportive periodontal therapy (SPT)?
Followed SPT over 30 years in a treatment and control group. Treatment Group had no attachment loss except small amount on buccals due to recession. Control group had caries & attachment loss.
Reference: Axelsson, P., Nystrom, B. & Lindhe, J. (2004).
