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Perio--Surgical (Spring) > 1. Non-Surgical Perio Re-evaluation > Flashcards

1. Non-Surgical Perio Re-evaluation Flashcards

1
Q

What are the phases of perio therapy

A
  • 1= Initial therapy-OHI, address the plaque retentive features (close open contacts, overhangs,etc), and SRP
  • 2=Re-evaluate, determine the need for perio surgery
  • 3= Perio surgery when needed
  • 4= Re-eval and Maintenance (3 mo. recall)
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2
Q

Initial therapy addresses….

A

etiology of perio disease (which is mainly plaque)

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3
Q

Plaque on more than _% of surfaces is a contraindication for perio surgery

A

10%

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4
Q

Smoking can be a contraindication for what perio surgeries

A
  • Implants
  • Mucogingival surgery
  • NOT flap surgery (usually)
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5
Q

What medical disease may also be a contraindication for implants and mucogingival surgery

A

Poorly controlled DM

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6
Q

Poorly controlled DM has an A1C greater than _ is a contraindication for perio surgeries

A

7

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7
Q

Different plaque retentive areas in the mouth are

A

-Interproximal regions
-Calculus
-Overhanging restorations
-Open contacts
-Open margins/overbulked crowns
-Cracked teeth
-

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8
Q

How is calculus detected

A
  • X-rays (interproximal calculus only)

- 11/12 explorer

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9
Q

T/F Initial therapy (Phase I) includes treatment of pathogenic bacteria with systemic (antibiotics) and local (arrestin) factors

A

t

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10
Q

What systemic antibiotics are typically used to fight perio pathogenic bacteria

A

amoxicillin and metronidazole

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11
Q

Describe the difference between primary and secondary occlusal trauma

A

Primary= excessive forces on teeth with normal amounts of perio support

Secondary= normal or excessive forces on teeth with less than normal amounts of perio support

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12
Q

What can be done for patients with occlusal trauma to prevent the exacerbation of perio disease

A

occlusal equilibrium or splint

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13
Q

How long after intitial therapy should the re-eval be performed

A

Usually 3 months (the longer the better- but at the school it is 4-6 weeks)

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14
Q

What procedures are performed at the re-eval after initial therapy

A
  • Measure plaque (disclosing solution)– is it <10% surfaces?
  • Evaluate gingival inflammation and BOP
  • Measure pocket depths
  • Look for calculus
  • X-rays
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15
Q

More recovery of pocket depths are seen with (larger/smaller) pockets

A

larger (and they have greater attachment gain)

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16
Q

If you notice pockets got deeper at the re-eval what may be the reason

A

may have gotten inaccurate readings the first time you probe due to obstruction of calculus

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17
Q

T/F Absence of BOP means absence of gingival inflammation

A

F- But absence of gingival inflammation means absence of BOP

18
Q

Confused by slide 27?

A

ok

19
Q

What is the non-surgical treatment for aggressive periodontitis

A

-SRP + systemic antibiotics (amoxicillin and metronidazole)

20
Q

Why are antibiotics essential for treating aggressive periodontitis

A

Aggregatibacter actinomycetemcomitans invades the CT in the pocket (can’t be removed with SRP

21
Q

What is the name of the pathogenic variant of AA that causes LAP

A

JP2

22
Q

Describe the difference between JP2 and other AA

A

JP2 makes more leukotoxin

23
Q

Most of the improvement in Clinical attachment levels after SRP and antibiotic therapy in LAP patients occurs when

A

3 months after tx- then hits a plateau

24
Q

How do you decide on treatment following initial therapy

A

probing depths

-Greater than 5 mm is indication for perio surgery because 5 mm and greater the patient can’t clean on their own

25
Q

Indications for perio surgery are

A
  • Reduce deep pockets
  • Provide access to root surfaces and furcations
  • Correct gingival and osseous defects
  • Regenerate new CT attachment and alveolar bone
26
Q

What are the two approaches to perio surgery

A
  • Excisional

- Regenerative

27
Q

Which approach to perio surgery is more recent

A

regenerative

28
Q

Describe the excisional approach to perio surgery and give examples

A
  • Cutting pockets away
  • Reducing pocket depths
  • Can result in attachment loss

Types of surgery= gingivectomy and flap surgery

29
Q

Describe the regenerative approach to perio surgery and examples of these types of surgeries

A
  • Putting things back
  • Increasing attachment and alveolar bone

Types of surguries= Guide tissue regeneration and osseous grafting

30
Q

T/F Membrane + Graft gives just as good of a result as either alone

A

F- gives better results than either alone

31
Q

Healing following perio therapy occurs in what three ways

A
  • Long epithelial attachment
  • New CT attachment (New Ct without new bone)
  • Periodontal regeneration (New CT and bone)
32
Q

Epithelium grows (up/down) during healing

A

down (results in elongation of JE)

33
Q

Which method of healing after perio therapy is the strongest (Long epithelial attachment/CT attachment)

A

CT attachment

34
Q

Describe healing after periodontal regeneration

A
  • New CT and new bone

- Usually invovles a barrier membrane and osseous grafting

35
Q

What are the two types of incisions for perio surgery and compare/contrast them

A

External bevel incision

  • Used in gingivectomy
  • Not often used
  • More painful
  • Removes keratinized tissue

Internal bevel incision

  • Used in flap surgery
  • Most frequently used
  • Less painful
36
Q

After gingivectomy what are you left with

A
  • Reduced pocket depths

- Reduced keratinized tissue

37
Q

Describe how make make an internal bevel incision compared to external bevel

A

internal= 45 degrees from the long axis of the tooth (compared to 60)

  • Gives a new gingival margin (based on pocket depth and thickness of tissue
  • Scalloped
38
Q

Describe what happens after internal bevel incision

A
  • Pocket depth reduced

- Width of keratinized tissue preserved

39
Q

Describe the procedure for a modified Widman Flap

A
  • Internal bevel incision (flap) and reflection gives access to root surfaces
  • SRP
  • Suture
40
Q

Describe the steps for regenerative therapy

A
  • Flap
  • Graft and membrane
  • Suture

Perio--Surgical (Spring) (8 decks)

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