08/29 - Applied Anatomy of the Periodontium

Question 1

In health, the periodontal probe penetrates to ___. In disease, the probe penetrates ___.

Answer 1

• free gingival groove

- past junctional epithelium into connective tissue

Question 2

True or false: Diagnosis of periodontitis is based on probe depths.

Answer 2

FALSE. It is based on attachment loss, not probe depths.

Question 3

True or false: The position and dimensions of the contact area determine probe angulations in posterior teeth.

Answer 3

true

Question 4

What is the proper probe angulation and position when charting probe depths?

Answer 4

• find interproximal contact
• use contact as guide to insert probe
• open angulation by 10 degrees

Question 5

What was the initial thinking of why gingival recession occurred?

Answer 5

• width of keratinized tissue <2 mm predisposes to recession
• narrow gingiva cannot protect from friction and cannot buffer against muscle pull
• facilitates subgingival plaque formation since mobile tissue causes pocket to open, facilitates food impaction, and impedes oral hygiene

Question 6

What is the current thinking of how gingival health is related to the width of the gingiva?

Answer 6

• gingival health can be maintained independent of its dimensions
• narrow gingiva has same resistance to attachment loss as wide gingiva

Question 7

The thin phenotype has:
\_\_\_ (inc/dec) recession
\_\_\_ (more/less) vulnerable to trauma
\_\_\_ (more/less) inflammation
\_\_\_ (more/less) favorable treatment outcome (root coverage, GTR, etc.)

Answer 7

• increased recession
• more vulnerable
• more inflammation
• less favorable

Question 8

When would you recommend gingival grafts?

Answer 8

• when recession causes symptoms (caries, esthetic concerns, progressive recession, sensitivity)
• subgingival restoration margins on thin biotype
• pre-orthodontic therapy (final tooth position will be buccal)

Question 9

Are the characteristics of the gingiva determined by genetics or by functional adaptation to environmental stimuli?

Answer 9

genetics

Question 10

The initial thought was that gingiva will become keratinized in response to friction, but now we think ___.

Answer 10

connective tissue determines epithelial characteristics

Question 11

Early grafting procedures involved ___ and ___ with the rationale that ___.

Answer 11

• free gingival grafts
• coronally advanced flaps
• keratinized epithelium converted to firm attached gingiva

Question 12

What type of gingival graft is now used? With what rationale?

Answer 12

• connective tissue graft

- connective tissue determines epithelial prototype

Question 13

What are the 2 parts of the soft tissue attachment to the tooth? How large is each? How does this relate to the biologic width?

Answer 13

• fibrous connective tissue (1.06-1.08 mm)
• junctional epithelium (1.4 mm)
• approx 1 mm of free gingiva which allows for a 3 mm total biologic width

Question 14

The distance from the CEJ to the alveolar crest is ___. The distance from crown margins to alveolar crest has to be ___. If you don’t have this distance, then ___.

Answer 14

• 3 mm
• 3 mm
• crown lengthening

Question 15

Describe the process of healing after a tooth extraction.

Answer 15

• clot formation
• wound cleansing PMNs, monocytes, macrophages migrate into the wound
• new vasculature, mesenchymal cells (from PDL) form granulation tissue
• provisional connective tissue
• immature bone forms
• bundle bone (socket proper) is resorbed
• wound filled with woven bone
• bone maturation

Question 16

True or false: Socket preservation is important for preserving bone morphology.

Answer 16

true

Question 17

What is guided tissue regeneration? How is this clinically applied?

Answer 17

• epithelium grows faster than bone or connective tissue; epithelial exclusion will allow selective growth of these cells
• use barrier membranes