28 - Principles of Surgery II Mike Flashcards
Systematic review for root surface modifiers
Mariotti 2003
BL: Citric acid, tetracycline, and EDTA provide no clinically significant benefit in terms of regeneration
Citric acid: 4/8 histology studies showed regeneration
Tetracycline: 1 histology study w/ 3/7 showing regeneration
EDTA: No histologic studies
Histologic animal study for attachment to roots with citric acid
Polson 1983
BL: With application of citric acid, fibrin linked to exposed root collagen fibrils to allow new CT attachment rather than apical migration of epithelium
- Squirrel monkeys
- Teeth extracted and rinsed with citric acid or saline and re-implanted. Teeth examined at 1/3/7/21 days
Histologic human study for attachment to roots with citric acid
Cole 1980
BL: Citric acid on root planed periodontally involved roots induced formation of CT attachment to dentin
- Notch at apical extent of calculus
- OFD + citric acid, extraction at 4 months for evaluation
- JE 1.2-2.6mm above notch. Bone level increase 0.8mm
Effect of etching agents on periodontal tissues
Blomlof 1995
BL: Citric acid and orthophosphoric acid (low pH) have necrotizing effect on periodontal tissue at 20 seconds and 3 minutes. EDTA no necrosis
- Monkey study
- Measured with lactate dehydrogenase, a marker for cellular activity
Effect of EDTA on smear layer
Blomlof 1997
BL: EDTA sufficiently removes HA smear layer and preserves collagen fibers
- Smear layer 2-10um w/ no difference using ultrasonic/curette/bur
- EDTA removed smear layer the same for the 3 treatment modalities
Systematic review for efficacy of diode laser in conjunction w/ SRP
Slot 2014
BL: No significant difference in periodontal parameters with SRP/diode compared to SRP alone
-Some studies showed BOP were improved w/ diode, but effect was small and not clinically relevant
Histologic response to LANAP
Yukna 2007
BL: 6 single rooted periodontally involved teeth had a positive histologic response to LANAP, PD reduction, and CAL gain
-Tx then EXT at 3 months
-PD reduction 4.7mm vs 3.7mm
CAL gain 4.2mm vs 2.4mm
-New cementum and CT attachment
***Funded by Millennium Dental Technology
What is the LANAP protocol and what laser is used?
Nd:YAG laser (Periolase)
- Occlusal adjustment + splint mobile teeth
- Laser to remove pocket lining
- SRP/ultrasonic for root debridement
- Laser to seal pocket and form clot
What does LANAP stand for?
Laser Assisted New Attachment Procedure
Second histologic study for LANAP
Nevins 2012
BL: LANAP can result in periodontal regeneration and improve periodontal parameters
- TX, monthly maintenance, EXT at 9 months
- 12 defects in healthy, non-smokers
- CAL gain 3.8mm, PD reduction 5.4mm, recession 2.7mm
- Regeneration 5/10
- Long JE 4/10
Who is the man or woman behind LANAP who is probably a millionaire because of it?
Yukna
Critical probing depth for CAL gain in LANAP is _____ according to ______
4.88mm
Nevins
Should Er:YAG laser be used as a monotherapy or adjunct to SRP
Zhao 2014
Systematic review
Answer = NO
BL: No SS difference in clinical outcomes when using Er:YAG as a monotherapy or adjunct compared to SRP alone.
-Had results up to a 12 month follow-up
Should lasers be used as an adjunct to surgical therapy?
Behdin 2015
Systematic review + meta-analysis
Answer: NO
BL: No SS difference in PD/CAL gain/recession for OFD and GTR w/ or w/o a laser. When considering OFD/Emdogain, there was a significant difference for PD reduction and CAL gain
Should lasers be used for implant surface decontamination?
Mailoa 2014
Systematic review and meta-analysis
BL: Similar results for PD reduction, CAL gain, and X-ray bone fill for CO2 and Er:YAG lasers
- 4 human surgery studies, 3 human non-surgery studies. NO difference for laser vs control
- Animal studies showed greater CAL gain and higher bone-to-implant contact in rough surface implants vs smooth surface
Perio 2000 article on periodontal and peri-implant wound healing following laser therapy
Aoki 2015
-This is a long article, review the abstract for more in depth information
What determines the degree of absorption of a laser?
What lasers are deeply penetrating?
What lasers are superficially penetrating?
The wavelength (lower absorption into water, deeper penetration into tissue)
Deep: Nd:YAG, diode
Superficial: CO2, Er:YAG (less heating of tissue, implant)
What effect does epinephrine in anesthetics have on catecholamine levels?
Davenport 1990
BL: Significant elevations in venous epinephrine and norepinephrine 2 and 8 minutes after administration of 2% lidocaine w/ 1:100K epi. No change in heart rate or mean arterial pressure
- Levels returned to baseline by 16 minutes
- Reported that Lidocaine alone was unacceptable for hemostasis and anesthesia
What is the effect of IV sedation on patient stress during surgery?
What drugs were used?
Shepherd 1988
Pentobarbital, Meperidine, Diazepam
BL: Cortisol SS increased in the surgery group with only local anesthetic
- Took venous blood samples
- 10 males w/ surgery 3 weeks apart during the same time of day due to diurnal nature of cortisol
Where did the evidence for 2 carpules of anesthetic for cardiovascular disease patients come from?
A textbook, according to Mealey
Comparison of IV Midazolam and Diazepam
Indications for each?
What test did they use?
Staretz 2004
Midazolam: Short procedures for fast onset of action, rapid recovery, and predictable amnesia
Diazepam for procedures 45+ minutes, wider margin of safety during titration, consistent amnesia, and gradual recovery
Perceptual speed test
JADA article on oral sedation
What is the problem with sedating children?
Dionne 2006
Kids: Unpredictable rate of absorption, delayed onset, and prolonged recovery. Hard to titrate orally. Pulse ox cannot reduce death/injury in office
Skill of monitoring/resuscitation more important
Benzodiazepine
- MOA
- Therapeutic effects
- Adverse effects
Agonist of y-aminobutyric acid receptor
Therapeutic: Anticonvulsant, anxiolytic, muscle relaxant, amnesia, sedation
Adverse: Memory/psychomotor impairment, drowsiness, altered EEG, and cortisol/growth hormone influence
Triazolam
- Characteristics
- Dose
- Peak effect
- Metabolism
- Bioavailability
Short half-life, minimal respiratory/CV effects
- 25-0.5mg = 10-20mg diazepam IV
- Peak effect may take over 1 hour
- CYP3A metabolism in intestine/liver
- 45% bioavailability
Is continuous or interrupted suture better for apically positioned flaps?
Nelson
BL: No difference at 6 months for PD, loss of attachment, recession, and bone loss
Clinical impression: Interrupted produced better flap adaptation
What is the tissue response to silk vs e-PTFE sutures?
Leknes 2005
BL: Silk demonstrates a greater inflammatory reaction, conduction of bacterial migration, and risk of slack of the suture loop than ePTFE
Two studies discussing infection rates with periodontal surgery?
Pack 1983 - 1% infection rate
Powell, Mealey, Deas 2005 - 2.09% infection rate
Prophylactic or post-surgical ABC did not demonstrate a lower infection rate
Background knowledge question - lasers and their wavelength
diode laser (most common) = 809-980 nm NdYAG = 1064 nm CO2 laser = 10600 nm
What would you use a diode laser for?
soft-tissue applications (incision, hemostasis, coagulation, removal of pocket epithelium)
soft tissue penetration from 0.5-3 mm (Aoki) with poor energy absorption on mineralized tissues (thus it is not good for calculus removal)
