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Year 4, Sem 2 > Week 6 Sharma- Interdisciplinary Periodontics > Flashcards

Week 6 Sharma- Interdisciplinary Periodontics Flashcards

1
Q

What is rationale for performing periodontal therapy first?

A
  • Stable gingival margins before tooth prep
  • Adequate tooth length
  • Perio tx after ortho tooth movement and restos may change tooth position
  • Successful aesthetic and implant procedures need specialised perio procedures
  • Non inflamed, healthy tissues are less likely to change (shrink) as a result of subgingival resto tx
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2
Q

What is role of periodontist in preprosthetic surgery?

A
  • Management of mucogingival problems
  • Preservation of ridge morphology after tooth exo
  • Crown lengthening procedures
  • Alveolar ridge reconstruction
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3
Q

How can we preserve ridge morphology following exo?

A

Bone graft placed in socket after exo rather than compressing socket

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4
Q

Do bone graft stay in place forever?

A

No, act as template or scaffold for new bone formation. Hold the space.

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5
Q

What is SCAT?

A

Supracrestal attached tissues = junctional epithelial + supracrestal tissue (2.04mm)

Used to be called biologic width

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6
Q

What is issue with subgingival vs supragingival resto margins?

A
  • Supra: unaesthetic in anteriors
  • Sub: can affect gingival tissues (SCAT)
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7
Q

How to evaluate SCAT?

A
  • MOST ACCURATE: bone sounding
  • Radiographic interpretation can suggest IP violations of SCAT
  • Pt discomfort when resto margin is assessed with perio probe indicated SCAT violation
  • Histological evaluaiton is definitive but not clinically possible
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8
Q

What is bone sounding? What measurement indicated SCAT violation?

A
  • Measure distance between bone and resto margin using a sterile perio probe under LA
  • Probe is pushed through attachment tissues from sulcus to underlying bone
  • Can be done on healthy gingiva tissue on B/L bone or IP bone surfaces.
  • <2mm at one or more locations = SCAT violation
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9
Q

How to manage SCAT violation?

A
  • Surgically removing bone away from proximity to the restoration margin (faster outcome)
  • Orthodontically extruding the tooth and thus moving the restorative margin away from the bone.
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10
Q

What is the rule for clinical margin placement?

A
  1. Sulcus ≤1.5mm, restoration margin no more than 0.5mm below the gingival tissue crest.
  2. Sulcus >1.5mm, margin at half the depth of the sulcus below the tissue crest.
  3. Sulcus >2mm, gingivectomy to lengthen the teeth and create a 1.5mm sulcus. Then use Rule 1.
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11
Q

What is crown lengthening?

A

The surgical procedure to expose adequate clinical crown to prevent placement of the crown margin into the area of biologic width.

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12
Q

What is the aim of crown lengthening?

A

At least 3 mm between the most apical extension of the restorative margin and alveolar bone.

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13
Q

What are indications for surgical crown lengthening?

A
  • Subgingival caries or fracture
  • Inadequate clinical crown length for retention
  • Unequal or unaesthetic gingival heights
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14
Q

How to do crown lengthening when there is >3mm soft tissue vs <3mm soft tissue?

A
  • >3mm: soft tissue crown lengthening (remove soft tissue)
  • <3mm: crown lengthening with osseous reduction
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15
Q

What are contraindications of surgical crown lengthening?

A
  • Surgery would create unaesthetic outcome
  • Deep caries or fracture would require excessive bone removal on contiguous teeth
  • Poor prognosis in restorative context
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16
Q

How can ortho extrusion be done?

A
  • Slow force (months)
  • Rapid force (weeks)
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17
Q

What is rapid force ortho extrusion?

A
  • Weeks
  • Tooth movement only
  • Supracrestal fibrotomoy- releasing fibres with scalpel every few weeks as force is being applied
18
Q

What is slow force ortho extrusion?

A
  • Months
  • Bone and teeth move
  • Need surgical correction after tx to remove excess bone
19
Q

When is ortho extrusion indicated?

A

SCAT violation is on the interproximal side, or if the violation is across the facial surface with ideal gingival tissue level.

20
Q

When is alveolar ridge reconstruction done?

A

Prior to fixed prosthesis or implant therapy in the form of soft or hard tissue augmentation.

21
Q

How is papillary height established?

A

Contact area

  • Level of bone
  • Biological width
  • Form of gingival embrasure
22
Q

How much interdental papilla will there be based on interproximal tooth contact to bone distance?

A
  • ≤ 5mm (bone to contact area) → papilla always fill the space
  • 6mm → 56% of the papillae fill the space
  • 7mm → 37% of the papillae fill the spaces
23
Q

How does embrasure of contact point impact papilla shape?

A
  • Embrasure too wide, papilla flattens out, assumes a blunted shape.
  • Embrasure ideal width, papilla assumes a pointed form, normal sulcus
  • Embrasure too narrow, papilla grows out to the facial and lingual, and become inflamed.
24
Q

Options to manage black triangles?

A
  1. Tissue-colored (pink) ceramics to make porcelain papillae directly on the restoration.
  2. Carry the interproximal contacts apically toward the papilla with fillings

Remember- excessively long interproximal contacts creates rectangular, somewhat unaesthetic, tooth forms.

25
Q

What is a provisional prosthesis used for in perio/implants?

A
  • Soft tissue sculpting to establish ideal emergence profile
  • Develops the ovate pontic receptor site
  • Maintains interdental papilla
  • Useful in single and multiple implant sites
26
Q

How to manage perio, endo and ortho surgical tx?

A

Perio (stabilise BL) → endo/exo (after 4 months) → ortho → orthognathic surgery → post op ortho

27
Q

What is the benefit of ortho tx in perio patients?

A
  • Aligning crowded/malposed teeth permits better OH
  • Vertical ortho tooth repositioning can improve certain osseous defects in perio patients.
  • Improve the aesthetic relationship of the maxillary gingival margin levels before restorative dentistry.
  • Forced eruption to permit adequate restoration of the fractured tooth.
  • Open gingival embrasures to be corrected to regain lost papilla.
  • Improve adjacent tooth position before implant placement or tooth replacement.
28
Q

What is pathologic tooth migration (PTM)? What are contributing factors?

A

Defined as a change in tooth position that occurs when there is disruption of forces that maintain teeth in normal relationship. Common finding in pts with severe periodontitis. Major factors affecting tooth position include:

  • Periodontal tissues
  • Soft tissues of cheeks, tongue, lips
  • Occlusal forces
  • Oral habits
29
Q

What is an osseous crater?

A

IP 2-wall defect that does not improve with orthodontic treatment—surgical reshaping is required

30
Q

What are hemiseptal defects and how are they managed?

A

One-or two-wall osseous defects that often are found around mesially tipped or supra-erupted teeth
• Tipped teeth: managed by up-righting
• Supra-erupted teeth: managed by intrusion

31
Q

How is brackets position determined in periodontally healthy and unhealthy individuals?

A
  • In periodontally healthy pt, positon of brackets is determined by anatomy of crowns of teeth.
  • If pt has significant alveolar BL around certain teeth, this can result in unfavourable crown-root ratio- use bone level as guide to position brackets on teeth
32
Q

How is a class III furcation defect commonly managed?

A

Hemisecting crown and root of tooth

Sequence: endo-perio-ortho-pros

33
Q

What is is the length of gingival sulcus + junction epithelium + connective tissue

A

3mm

34
Q

What is an example of when soft tissue augmentation is required?

A

May be used to correct black triangles

35
Q

Why can the papilla appear inadequate?

A

Bone loss or IP contact located too high coronally

36
Q

What is most common pontic?

A

Modified ridgelap

  • Used anteriorly and posteriorly
  • Balance of aesthetics and ease of cleaning
37
Q

What is the issue with this patients dentition

A
  • Significant recession
  • Extrusion/supraeruption of teeth
  • Pathological migration
  • Multiple teeth missing
  • Open bite
38
Q

What are factors to consider for tx of fractured teeth (crown lengthening and forced eruption)?

A
  • Root length (fracture to level of bone, erupt at least 4mm)
  • Root form (broad and non-tapering)
  • Level of fracture (too deep from bone makes difficult)
  • Relative importance of tooth (pt age)
  • Aesthetics (high lip line)
  • Endo/perio prognosis (perio defect and vertical fractures have poor prognosis)
39
Q

What is required before orthodontics?

A
  • Perio assessment
  • Hx: prev perio disease, drug hx, systemic diseases
  • Clinical exam: BOP, mobility, thin fragile gingiva, pockets
40
Q

What happens when an extruded tooth with vertical bone defect is intruded with orthodontics?

A

Bone can fill in the defect (may need to do bone graft before ortho)

41
Q

What are some common ways ortho is a useful adjunct to perio management?

A
  • Managing vertical bone defect
  • Managing pathological tooth migration

Year 4, Sem 2 (38 decks)

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