07112022 Flashcards
Supracrestal fibrotomy by Edwards 1971
2 weeks 4 weeks when done 3x Reduce relapse by 30%
Glickman TFO cause furcation involvement
Glickman TFO cause furcation involvement
BMP what kind of ossification?
Endochondral. Has a high chance of resorption
Cementum thicker and thinnest portions
Zander and Hurzeler
Thinner coronal
Thicket apical
Junction between implant and mucosa
Desomosomes??
4 points we need to know about BRONJ
1- Reduced Osteoclastic activity
2- Reduced epith migration
3- reduced blood supply
4- High potential for infection
Dr. Wang protocol for implant/ext Px taking Bisphosphonate for
Primary closure
Antibiotic for 10 days (2 days before and 8 days after)
Dennis Tarnow 1992 and 2003
From 5-6 mm –> papilla fill chance drops from 98 to 56% (42%)
how about the 2003 for implants?
3 mm due to soft tissue thickness
Gastaldo 2004
Distance between bone and contact point:
- distance of <4mm only attains complete papilla fill (Gastaldo 2004)
In teeth, we need to have ≥3.1 mm to have 2 independent infrabony defects
Between implants (Tarnow article)
Tal article for teeth
Tarnow for implants ≥ 3 mm
Difference between JE and oral epith
Difference between JE and oral epith
Waerhaug plaque free zone to justify BW
0.5-2.7
Wekisjo PTFE dog studies wound healing
Wekisjo PTFE dog studies
Wikesjö UM, Lim WH, Thomson RC, Cook AD, Wozney JM, Hardwick WR. Periodontal repair in dogs: evaluation of a bioabsorbable space-providing macroporous membrane with recombinant human bone morphogenetic protein-2. J Periodontol. 2003 May;74(5):635-47. doi: 10.1902/jop.2003.74.5.635. PMID: 12816296.
temperature of tissue in peri-implantitis and peri-mucositis
temperature of tissue in peri-implantitis and peri-mucositis
Temperature and periodontal disease
Temperature as a periodontal diagnostic +1
Calculus calcification from inside out
Calculus calcification from inside out
Peri-implantitis and mucositis prevalence
Derks and Tomasi for prevalence
PIM no bone loss beyond initial remodeling (12 months after prosth delivery) ==> 43%
PI bone loss beyond intial remodeling ==> 22%
Platform switching
Does not prevent bone loss but rather give space for soft tissue attachment
Percentage of peri-implantitis caused by residual cement
81% according to Wilson
More predominant bacteria around implants
T Forsythia and F nucleatum
Seymour periodontal disease lesions
changed from plasma cells to lymphocytes (in advanced lesions)
Plasma cells (old)
lymphocytes (young patients)
The main difference between established and advanced lesions in Page Schroeder
Attachement loss
Smoking
Diabetes
We measure cotinine not nicotine
Diabetes –> multiple abscesses in the periodontium
PMN, Collagenase, chemotaxis
Impaired healing
Nutrients
Loe 1986
Sri Lankan tea tree laborers followed from 1970 – 1985 (a longitudinal study of 15 years total). Study suggests that certain individuals were more susceptible to the disease than others.The entire population had no oral hygiene
- Despite the complete lack of oral hygiene, there were different rates of periodontitis in the population:
- No progression: 11% CALoss
- Moderate progression: 81% CALoss
- Rapid progression: 8% CALoss
TFO and plaque induced periodontitis articles
Fleszar
Burgett
Nun and Harrel
Read Lindhe Chapter on occlusion Chap 13
Read Lindhe Chapter on occlusion Chap 13
Bone loss from TFO is horizontal and cause horiz tooth movement but CALoss
TFO is reversible but CALoss is not
Bone loss from TFO is horizontal and cause horiz tooth movement but CALoss
TFO is reversible but CALoss is not
Does excessive occlusal load affectosseointegration? An experimentalstudy in the dog
Heitz-Mayfield et al. 2004
Results: At 8 months, all implants were osseointegrated. The mean probing depth was 2.5+/-0.3 and 2.6+/-0.3 mm at unloaded and loaded implants, respectively. Radiographically, the mean distance from the implant shoulder to the marginal bone level was 3.6+/-0.4 mm in the control group and 3.7+/-0.2 mm in the test group. Control and test groups were compared using paired non-parametric analyses. There were no statistically significant changes for any of the parameters from baseline to 8 months in the loaded and unloaded implants. Histologic evaluation showed a mean mineralised bone-to-implant contact of 73% in the control implants and 74% in the test implants, with no statistically significant difference between test and control implants.
Conclusion: In the presence of peri-implant mucosal health, a period of 8 months of excessive occlusal load on titanium implants did not result in loss of osseointegration or marginal bone loss when compared with non-loaded implants.
Root proximity classifi
Heins and Weider 1986
>0.5 mm – cancellous bone
<0.5mm – no cancellous, only lamina
dura
<0.3 mm – Only PDL space
Peri-mucositis
Peri-implantitis
(Definitions)
PIM:
- Presence of peri-implant signs of inflammation (redness, swelling, line or drop bleeding within 30 seconds of probing)
- No additional bone loss
PI:
- Presence of peri-implant signs of inflammation (redness, swelling, line or drop bleeding within 30 seconds of probing)
- Radiographic evidence of bone loss following initial healing (> 2 mm after 1 year following prosth delivery.
- Increasing PD compared to PD collected after prosth. delivery.
In the absence of previous radiographs ==> RBL of ≥ 3mm with PD of ≥ 6 mm + BOP
Mechanism of calculus attachment to tooth surface
(Zander 1953) RISP
1- Areas of cementum resorption
2- Microscopic irregularities
3- Secondary cuticle
4- Microbial penetration (Refuted by Canis)
Implant system coated with Fluoride
Dentsply
CPITN (Jo’s assignment 07182022)
Community Periodontal Index for Treatment Needs (CPITN)
The dentition is divided into six sextants (one anterior and two posterior tooth regions in each dental arch). Third molars are NOT included except where they are functioning in place of second molars.
When only one tooth is present in a sextant, it is included in the adjacent sextant.
Probing assessments are performed either around all teeth in a sextant or around certain index teeth
Only the most severe measure in the sextant is chosen to represent the sextant.
Effect of the vertical and horizontal distances between adjacent implants and between a
tooth and an implant on the incidence of interproximal papilla.
Gastaldo JF
Vertical distance at papilla between
- Tooth & implant: 5 mm (additional 2 mm for distance from CEJ)
- 2 implants: 3 mm (Implants have no CEJ)
Thickness of buccal bone around implants
Spray article (1.8 mm minimum) –> dog study
(Benic et al. 2012) –
Clinical prospective study examining the buccal bone 7 years after immediate implant placement.
Result: 24 patients started the study, and 14 completed the follow-up. 5 had no buccal bone, 9 had some buccal bone present (as determined by CBCT). The cases without buccal bone had an average of 1mm less soft tissue level compared to those with the buccal bone.
(Chappuis, Araújo, and Buser 2017)—
“Clinical studies indicated that thin bone wall phenotypes exhibiting a facial bone wall thickness of 1 mm or less revealed progressive bone resorption with a vertical loss of 7.5 mm”
(Buser, Martin, and Belser 2004) –
Implant “saucerization” is usually 1.0 – 1.5 mm in the horizontal direction.
The purpose of GBR is to create a thick facial bone of 2 – 3 mm thickness, to allow sufficient bone to remain on facial plate after resorption. (That’s why Buser does ridge crest prep)
When do you do ridge crest prep?
For both tissue level??? and bone level implants???
Can a patient ́s Stage change over time? (Jose’s SBR)
look up Jose 07/18/2022
Biological plausibility of a link between periodontal diseases and cardiovascular diseases
Biological plausibility of a link between periodontal diseases and diabetes
What causes periodontal abscess?
- SupraG scaling
- Baking Soda + H2O2 –> Keyes technique
https: //www.cap-acp.ca/en/public/keyes.html#:~:text=In%20the%20late%201970s%20an,salt%2C%20baking%20soda%20and%20peroxide.
CAP position on Keyes technique
In the late 1970s an oral hygiene program called the Keyes technique was widely promoted as a nonsurgical alternative for treating advanced periodontal disease (pyorrhea)*. The technique includes:
Microscopic examination of the plaque.
Cleaning the teeth and gums with a mixture of salt, baking soda and peroxide.
Use of antibiotics.
As in any medical field, treatment approaches vary according to the condition being treated. The Keyes technique attempts to treat all periodontal conditions the same way. This brings some risks and limitations:
Bacterial monitoring using a phase contrast microscope is a technique sensitive, inaccurate and outmoded technology, which does not accurately differentiate between bacteria associated with a healthy periodontal environment and that associated with aggressive periodontal disease.
Local therapy, consisting of scaling and root planing (deep cleaning) has always been part of conventional periodontal therapy. However numerous studies, short and long term, have shown that the adjunctive use of baking soda and hydrogen peroxide have not demonstrated any particular added benefit over conventional techniques.
The use of systemic antibiotics in conjunction with root planing has shown minimal or no added value over local therapy alone in treating adult periodontitis. In addition, the possible minor benefit would only be of short duration and the use of antibiotics significantly increases the chances of developing bacteria resistant to many antibiotics.
In conclusion, the Keyes technique offers a single treatment approach, with limited benefits and substantial disadvantages, to a multifactorial disease requiring different therapeutic responses.
The Canadian Academy of Periodontology recommends a thorough assessment of any periodontal condition followed by an informed, comprehensive therapeutic approach. A ‘one size fits all’ approach offers a significant risk of under or over treatment and the CAP therefore cannot endorse or recommend this technique.
Periodontal Abscess in Perio patients
Kaldahl 1996:
Periodontal Abscess : may occur in perio maint, after scaling may be due to incomplete scaling but
coronal tissue heals and occludes pocket
4 layers of necrotizing Perio disease lesion
Listgarten 1965
1) Superficial bacterial area, 2) neutrophil-rich zone, 3) necrotic zone, 4) spirochaetal infiltration zone
Loesche 1982: constant flora (Prevotella intermedia, Fusobacterium, Treponema, Selenomonas) + variable flora (array of types)
PI bone loss
Derks 2016
bone loss in PI 0.36 mm/ year
3.5 mm after 9 years
Jon Perio healing
PRP/ PRP –> WITH or without anti-coagulant
L-PRF or A-PRF?
PDGF and VEGF
TGF-B1 –> or Epidermoid GF (soft tissue healing)
TGF-B2 –> more for bone healing
5 cascades of wound healing
attahment
migrate
proliferate
differentiate
Maturation
primary, secondary, tertiary intention examples
- Primary: OFG
- Secondary: APF
- Tertiary: Marsupalization
Magnusson Long JE length
longer than 1 mm??
PD Miller rule for vital vs non-vital bed in FGG
15-20% of the graft at max should be on non-vital/non vascularized root surface
Epith migration rate Engler (1961)
Epith migration rate 0.5 mm/day
bone resorption after osseous Sx
Tensile strength of sutures during healing (dog study)
“in other words, a relatively limited periodontal wound might not reach functional integrity until 2weeks postsurgery.”
“wound integrity during the early healing phase depends primarily on the stabilization of the gingival flaps achieved by suturing”
Periodontitis Case definition..is there a cutoff for PD??
Periodontitis Case definition..is there a cutoff for PD??
Perio and sex hormones
Mascarenhas
Janet 07.20.2022 Assignment
Oral contraceptives –> accelerated progression of Perio
Calculus Attachment to Root Surface
Zander 1953
R: areas of cemental resorption
I: Areas previously occupied by previous Sharpey’s fibers
S: secondary cuticles
P: penetration of bacteria (Refuted by Canis)
1st layer of calculus –> octacalcium
2nd layer –> hydroxyapatite
SubG –> Whitlockite
Lyndon Cooper
Genetic testing for PI
Bacteria involved in initiation of peri-implantitis
Difference between PI and PD bacteria
S. Aureus
Heitz-Mayfield 2010
Liana’s 07202022 Assignment
Different probes markings
Marquis color coded probe –> 3, 6, 9, 12
UNC probe –> 1-15
Michigan “O” probe –> 3, 6, 8
WHO probe –> 0.5 mm ball, 3.5, 5.5, 8.5 and 11.5
BOP around implants
Mombelli 1987: dot, line and drop bleeding
French 2015: Suppuration
KG/AG around teeth implants
Teeth –> yes (Lang and Miyasato)
Implants: KM
- Pure Ti surface –> no need (Wennstrom)
- Rough implant surface –> KM is essential (Thoma,
Smoking effect and osseointegration
Pure Smooth surface –> negative
Rough Surface –> no impact
Probing around implants causes damage?
Probing of implants results in a short-term trauma that is repaired completely over 5-7days (etter et al. 2002)
Types of Perio Abscesses
Janet SBR 07182022
With Perio pockets –> only in pditis patients
Without Perio pockets –> in Perio and non-perio patients
In Perio patients:
Either Acute exacerbation: unttt perio, refractory perio, during SPT
After treatment: Post SRP, post Sx, after medication
In non-Perio patients:
- Impactions, Ortho factors
- Gingival overgrowth
- Alteration of root surface
- Harmuful habits
Superior alveolar artery likely passes through the outer/inner surface of the sinus wall and should be evaluated. (percentage of detection on CBCT)
5 or 50%
Detection of furcation involvement on CBCT
There is a best evience article on Frucation treatmemt
Superior alveolar artery likely passes through the outer/inner surface of the sinus wall and should be evaluated. (percentage of detection on CBCT)
Agular defect when trying to treat
TFO, open contact, VRF
Nibali (look depth, angulation, # of walls)
FGG Ratio of Vascular to avascular
Bed to graft size
PD miller lecture
Relationship and similarities between Perio disease and Rheumatoid Arthritis
Jad’s answerACPA
Merkado 2001 –>
Results: No differences were noted for the plaque and bleeding indices between the control and rheumatoid arthritis groups. The rheumatoid arthritis group did, however, have more missing teeth than the control group and a higher percentage of these subjects had deeper pocketing. When the percentage of bone loss was compared with various indicators of rheumatoid arthritis disease activity, it was found that swollen joints, health assessment questionnaire scores, levels of C-reactive protein, and erythrocyte sedimentation rate were the principal parameters which could be associated with periodontal bone loss.
Conclusions: The results of this study provide further evidence of a significant association between periodontitis and rheumatoid arthritis. This association may be a reflection of a common underlying disregulation of the inflammatory response in these individuals.
Both affect the joint
and the one that showed benefit of TNF blockers on Perio disease
Typical Board questions:
Relationship between Perio and Diabetes
Relationship between Perio and Smoking
Violation of STA
Recession or pocket
Pontoriero and Carnevale 2001
https://pubmed.ncbi.nlm.nih.gov/11495130/
Conclusions: The results of the present clinical investigation demonstrated that during a 1-year period of healing following surgical crown lengthening, the marginal periodontal tissue showed a tendency to grow in a coronal direction from the level defined at surgery. This pattern of coronal displacement of the gingival margin was more pronounced (P < 0.001) in patients with “thick” tissue biotype and also appeared to be influenced by individual variations in the healing response (P < 0.001) not related to age or gender.
Thin phenotype –> recession
Thick phenotype –> pocket
ratio of thin vs thick phenotype –> 15 to 85% (Lindhe
Maximum depth a tooth brush can go into the sulcus
1 mm (Waerhaugh 1981) vs,
Youngblood
For implant crown contours
yodalis
Underdcontour is better than overcontour
Wenwen BLX TLX assignment VIIIIP
Regular vs wide base
E dimension o.33 mm for plaform switching
Effective or repeated Non Sx verus access flaps
residual PD
6 mm ==> access flap
4-5 mm ==> repeated non Sx
Curette efficiency and curette limit
Stambaugh 1981
(Stambaugh et al. 1981) average curette efficacy 3.73 mm, instrument limit 6.21 mm
Critical PD
Critical probing depth
● Critical PD for non-surgical therapy: 2.9mm (Lindhe et al. 1982)
● Critical PD for access flap surgery (MWF): 4.2 mm (Lindhe et al. 1982)
● Critical PD for surgical procedure indication: 5.4 mm (Heitz-Mayfield et al. 2013)
Review papilla preservation techniques
Review papilla preservation techniques
Effect of defect anatomy on predictability of GTR
Bower’s furcation entrance
Bower et al 1979: 81% of furcation entrances of 1st molars are < 1.0 mm and 58% are < 0.75 mm
Furcation classification (Horizontal and vertical)
Decision tree for treatment of furcation involvement
Consensus report about furcation treatment
Class I: why not try GTR
You don’t treat it because you don ‘t have a deep enough defect to contain the bone graft or even enough blood supply
Class III –> you don’t have a contained defect
Adv and disadv of local antimicrobials
Adv and disadv of local antimicrobials
Super labial frenum classification
Dr. Gargallo
Superior labial
inferior Labial
ttt options
mucosal incision
Z-plasty
Rhomboid flap
Laser
..
Inferior labial Frenulum
V or Y shape
Laser in Frenulectomy
Co2 diode
Er:YAG and Nd:YAG –> bleeding but no thermal effect so faster healing
Er, Cr: YSSG laser –> you can do it w/t local anaesthesia
Types of Hypersensitivity?
I –> immediate (humoral)
II –> Cytotoxic (humoral)
III –> Immune complex (Arthus reaction) (humoral)
VI –> cell mediated
V –> Autoimmune
VI –> Tumor rejection,
Hypersensitivty Reaction in dentistry?
Pablo’s assignment
Cox 1 ( MORE physiologic)
COX 2
CYP 450
COX 2 –> CONTRAINDICATED for hypertensive patients CVS disease
CYP 450 is inhibited by erythromycin
ZZchen
Regeneration Lindhe Chap 38
- Deep and narrow intrabony defects at either vital or endodontically treated teeth are the ones in which the most significant and predictable outcomes can be achieved with GTR treatment.
- Number of walls and width of the defect are influential when non‐supportive biomaterials are used.
- The influence of defect anatomy appears to be reduced to some extent when a more stable flap design is applied.
- Severe, uncontrolled dental hypermobility (Miller class II or higher) may impair the regenerative outcomes.
- Significant clinical improvements can be expected only in patients with optimal plaque control, with reduced levels of periodontal contamination, and who are non__‐__smokers.
Determining factor
Crater depth
Root Trunk length
Buccal upper/lower bucc and lingual : leave behind at least 2 mm KG
Palatal: PD is most crucial
PTFE membrane in GTR
high risk of exposure when it’s touching the tooth
EMD
Proliferation and migration effect
Split thickness flap
need to leave at least 0.4 mm thickness (There is a high chance of sloughing)
That’s why Zucchelli does full thickness on the mid-facial
Fickle article on partial thickness flap
Fickle article on partial thickness flap showed more resorption that full thickess.
When you do split you traumatize the blood vessels more with more osteoclastic activity.
Ratio is vascular to avascular bed in FGG
Avascular –> 15-20%
Vascular –> 75-80%
Bernimoulin 1975 2 step technique for ROOT COVERAGE
FGG then CAF
Hall 1977
Etiological factors for recession
in ABP exam –> list all factors then mention the specific cause relating to the case at hand
Recession after Ortho relationship
The reported prevalence of recessions at the end of orthodontic treatment ranges between 5%-12%; i.e. according to Kim and Neiva’s systematic review in 2015. Of course, in thinner phenotypes, much higher numbers were reported, such as by Yared in 2006, showing 93% of teeth developed recession and were <0.5 mm in gingival thickness. Consequently, grafting procedures may likely to precede the initiation of orthodontic therapy (Boyd 1978, Hall 1981). As long as the movement of teeth is within alveolar bone, soft tissue recession is not to be anticipated (Wennstrom 1987). Thus, the direction of tooth movement is key. Regarding soft tissues, the thickness rather than the quality of the marginal soft tissue on the pressure side of the tooth is the determining factor for the development of recession. Plaque control in these situations is key as well.
2003 Cardaropoli article
Dynamics of bone tissue formation
Pablo Galindo
The bevel of the foceps has to be congruent with the root anatomy
Pablo Galindo
The bevel of the foceps has to be congruent with the root anatomy
6 factors influencing the outcome of regeneration
- Deep and narrow intrabony defects at either vital or endodontically treated teeth are the ones in which the most significant and predictable outcomes can be achieved with GTR treatment.
- Number of walls and width of the defect are influential when non‐supportive biomaterials are used.
- The influence of defect anatomy appears to be reduced to some extent when a more stable flap design is applied.
- Severe, uncontrolled dental hypermobility (Miller class II or higher) may impair the regenerative outcomes.
- Significant clinical improvements can be expected only in patients with optimal plaque control, with reduced levels of periodontal contamination, and who are non__‐__smokers.
Abx prophylaxis and prosthetic joint replacement
“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection” ~2015 clinical guideline by the ADA Council on Scientific Affairs
In cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and when reasonable write the prescription:
Medically compromised patients
patients with a history of complications associated with their joint replacement surgery
patients with immunocompromising disease
Periodontal maintenance and rate of tooth loss
Becker et al 1979. Untreated periodontal disease: a longitudinal study
- 30 moderate to advanced periodontitis p’t without treatment
- T0: initial, T1: 1.5 ~ 9.5 years later
- Increased PD: 0.24 ~2.46 mm/yr, esp DL, ML interproximal surfaces
- Bone loss: posterior segments had the largest amounts
- Molars had the greatest percentage of tooth loss
- Tooth loss: 0.36 teeth / year
Becker et al 1984. Periodontal treatment without maintenance. A retrospective study in 44 patients
- 44 p’t, OHI + SRP + pocket reduction surgery 🡪 no maintenance
- T0: initial, T1: 5.25 years later
- Worsen bone level, esp furcation area
- Tooth loss: 0.22 teeth / year
- Periodontal therapy without maintenance is of little value in terms of restoring periodontal health
Becker et al 1984. The long term evaluation of periodontal treatment and maintenance in 95 patients
- 95 moderate to advanced periodontitis p’t
- OHI, SRP, pocket reduction surgery 🡪 3-4M SPT for average 6.5 years (3-11 years)
- Tooth loss: 0.11 teeth / year
- Periodontal therapy and maintenance are successful in reducing moderate to deep periodontal pockets with minimal bone loss
SPT and Perio VIIIP Additionaln assignment 08/01/2022
- Periodontitis must be treated.
No Tx à Tooth loss: 0.36 teeth / year (Becker 1979) - Regular SPT is important.
No SPTà Tooth loss: 0.22 teeth / year (Becker 1984)
With SPT à Tooth loss: 0.14 teeth/ year (Graetz 2017, Pretzl 2018)
0.11 teeth/ year (Becker 1984)
APT without SPT is of little value in restoring and maintaining periodontal health
SPT regularity is more important that then quantity, esp in higher staging and grading
ASA classification
Lateral sliding flap for RC
See caffesse paper
Jumping distance vs critical gap
2 mm
1 - 1.25 mm –> critical gap
Factors affecting lateral sinus augmentation outcomes
Lindhe Gustavo Avila sinus chapter
lateral Sinus Aug. Techniques
Wall on
Wall Off
Wall gone
How long does it take for perforated sinus membrane to heal
Average anterior Antral artery diameter
4 months according to Huang et al. 2006. (Lindhe Sinus Chapter)
AAA diamter: 2 mm
Dr. Wang’s lateral Sinus technique
Dr. Wang’s lateral Sinus technique
Loma Linda Sinus Tear Technique
Loma Linda Sinus Tear Technique
Bone loss after Full thickness and partial thickness flaps
Wood 1972
Full Thickness –> 0.62
Partial thickness –> 0.98
The other article is Fickle which is a dog study
When to splint implants? Dr. Wang
Stress distribution
Soft bone (Sinus graft, max. posterior)
Heavy Occlusal load (Bruxer, narrow or short implant)
Long abutment/Long span
to prevent tooth migration
Minimize Biomechanical complications:
- Prevent embrasure/Interproximal opening (diffcult to have good contact between 2 adjacent implant with non-splinted crowns)
5 factors causing implant fracture
Chrcanovic et al. (2018)
Grade of titanium
Bruxism
Implants adjacent to cantilevers
Increased implant length Decreased implant diameter
Everette bifurcation ridges
73%
What negates the cadioprotective effects of Aspirin
Ibuprofen. Competes with Aspirin for Cox binding sites on platelets
How much bacteria is needed to induce disease
Critical mass theory Cobb
Alcohol in mouth wash
Listerine original 29%
cut back –> 16%
now there is alcohol free listerine
Hirshfeld and Wasserman
Down hill 0-3
extreme dowhill
TYLENOL + Codeine combinations
Which antibiotics cause torsades de pointes
Abdusalam SBR 08032022
Clinda, Clari, Levo
except Levofloxacin
Split-thickness flap for the management of a maxillary sinus wall bony fenestration during lateral window sinus augmentation: case reports and technical surgical notes Testori paper
Split-thickness flap for the management of a maxillary sinus wall bony fenestration during lateral window sinus augmentation: case reports and technical surgical notes Testori paper
1 complication of lateral sinus
50% chance, 1/3 is coming from septum (33% chance of patients have sinus septa)
Classification and Management of Antral Septa for Maxillary Sinus Augmentation
Authors: Shih-Cheng Wen, Hsun-Liang Chan, Hom-Lay Wang
Source: IJPRD 2013
Classification and Management of Antral Septa for Maxillary Sinus Augmentation
Authors: Shih-Cheng Wen, Hsun-Liang Chan, Hom-Lay Wang
Source: IJPRD 2013
Title: Influence of Sinus Floor Configuration on Grafted Bone Remodeling After Osteotome Sinus Floor Elevation
Angle sinus floor configuration was most difficult to elevate
Iliac Crest is associated with higher chances of root resorption
highly active osteoclastic activity so we freeze
2 processes for Allograft
Freeze dried vs solvent dehydration (Puros)
Solvent dehydration preserves the structure
Title: Predictable Single-Tooth Peri-Implant Esthetics: Five Diagnostic Keys
Author: John C Kois
What kind of case can the 5 diagnostic keys address?
- Loss of an anterior tooth results in a natural healing process that yields undesirable esthetic outcomes
- Facial mucosa recedes apically and palatally
- A placed implant will look too long and have black triangles due to lost interdental papilla
- In such a case, the goal will be to place and restore an implant with adjacent gingiva that
harmonizes with the restoration and the adjacent teeth
- Loss of an anterior tooth results in a natural healing process that yields undesirable esthetic outcomes
- Facial mucosa recedes apically and palatally
- A placed implant will look too long and have black triangles due to lost interdental papilla
- In such a case, the goal will be to place and restore an implant with adjacent gingiva that
harmonizes with the restoration and the adjacent teeth
Socransky Active versus non-active disease
New concepts of destructive periodontal disease
CAL of > 2 mm
Socransky 1984
Listgarten and Hellden 1978
ratio
1: 1
1: 49
Ratio of non-motile to motile
diseased sites 1:1
normal 1:49
The rate of orthodontic extrusion for implant site preparation is _____ the rate for crown lengthening.
a. faster than
b. similar to
c. slower than
slower because for implants you want the PDL to move with tooth movement
Photodynamic Therapy
Use Atropine for symptomatic Bradychardia
Use Atropine for symptomatic Bradychardia
154 mg/dl..how much in HbA1c?
7%
Duration of effects of Aspirin on Platelets
10 days
Cancers with widened PDL
Ostesarcoma
Scleroderma
