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