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23 Periodontology > 6 - Periodontal Pocket Formation and Bone Loss > Flashcards

6 - Periodontal Pocket Formation and Bone Loss Flashcards

1
Q

what xray detects peri-radicular pathology and uses a long cone paralleling technique

A

periapical

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2
Q

what bitewing for early to moderate bone loss

A

horizontal BW

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3
Q

what BW for severe bone loss

A

vertical BW

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4
Q

what xray best evaluates bone loss amount and least interproximal bone distortion

A

BW

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5
Q

what is a pathologically deepened gingival sulcus with CAL

A

periodontal pocket

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6
Q

what are the two pocket classifications

A
  1. gingival pocket (pseudopocket)
  2. periodontal pocket
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7
Q

what is formed by gingival enlargement WITHOUT destruction of underlying periodontal tissues

A

gingival pocket (psudopocket)

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8
Q

what occurs with destruction of supporting periodontal tissues (gingival collagen fibers, PDL fibers, bone)

A

periodontal pocket

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9
Q

A

A

gingival pocket

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10
Q

B

A

suprabony pocket

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11
Q

C

A

intrabony pocket

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12
Q

what are 2 types of periodontal pockets

A
  1. suprabony (supracrestal)
  2. intrabony (infrabony, subcrestal)
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13
Q

what perio pocket has bottom of pocket CORONAL to underlying alveolar bone

A

suprabony (supracrestal)

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14
Q

what perio pocket has bottom of pocket APICAL to level of adjacent alveolar bone

A

intrabony (infrabony, subcrestal)

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15
Q

where does intrabony pocket wall lie

A

between tooth surface and alveolar bone

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16
Q

the initial lesion in the development of periodontitis is what

A

inflammation of gingiva in response to bacterial challenge

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17
Q

in pocket formation, what is destroyed?

A

gingival collagen fibers apical to junctional epithelium

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18
Q

steps in pocket formation

A
  1. inflammation in CT wall of gingival sulcus
  2. gingival collagen fibers apical to JE destroyed
  3. loss of collagen results JE proliferation and migrates apically along root
  4. coronal portion of JE detaches from root and sulcus bottom shifts apically
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19
Q

how does pocket affect root surface

A
  • cementum facing pocked becomes exposed to oral environment
  • bacteria penetrate the cementum and dentinal tubules
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20
Q

T/F: scaling and root planing should remove some cementum to DETOXIFY root surface with pockets

A

TRUE

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21
Q

is bacteria capable of evading the host defense and scaling and root planing efforts by hiding in the root surface

A

YES

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22
Q

___ + ___ = CAL

A

PD + GM (gingival margin)

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23
Q

can you have same pocket depths with different gingival margins

A

YES

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24
Q

gingival margin positions are relative to what

A

CEJ

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25
Q
A
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26
Q

gingival margin APICAL to CEJ is called what? positive or negative number?

A

recession; positive number for gingival margin

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27
Q

if gingival margin CORONAL to CEJ, is this positive or negative number?

A

negative

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28
Q

if gingival margin is at CEJ, is this a positive or negative number?

A

just 0

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29
Q

what CEJs are easily detected? what is more difficult?

A

facial and lingual are easily detected
interproximal CEJ is more difficult to detect

30
Q

what is used to detect subgingival CEJ? how?

A

use perio probe

Insert probe into sulcus to feel for the CEJ.
Helps to hold probe at 45° angle when detecting CEJ’s.
Measure where the gingival margin crosses the probe.
Record gingival margin as a “negative” number.

31
Q

the interproximal CEJ is located where in health?

A

subgingival

32
Q

what tells you how much attachment loss there is from CEJ

A

CAL

33
Q

what is the distance from CEJ to the base of the pocket

A

CAL

34
Q

what are periods of exacerbation and quiescense?

A

periodontal disease activity

35
Q

is perio disease site specific?

A

YES

Periodontal destruction does not occur in all areas of the mouth at the same time
Active destruction occurs at some teeth at a time at any given time
Periodontitis becomes more severe by the development of new disease sites or increased breakdown of existing diseased sites

36
Q

what marks the transition from gingivitis to periodontitis

A
  • Clinically measurable attachment loss
  • Bone loss as a result of inflammation reaching the bone
37
Q

what are mechanisms of bone destruction

A

bacterial and host mediated bone destruction

38
Q

what bacterial products induce differentiation of osteoclasts

A

LPS

39
Q

what are host factors released by inflammatory cells that induce bone resorption

A

IL-18
IL-6
TNF-a

40
Q

alveolar bone responds to inflammation how?

A

bone formation and resorption

41
Q

what occurs when resorption dominates formation

A

periodontal bone loss

42
Q

factors that increase risks for periodontal bone loss

A

Smoking
Occlusal trauma
Osteoporosis
Open contacts (Food impaction)
Close root approximation to adjacent root
Overhanging restorations

43
Q

what increases risk for perio, is dose dependent, duration is important, and measured in pack years

A

smoking

44
Q

pack years equation

A

(# cigs/20) * # of years

45
Q

what bone destruction pattern:

Most common pattern
Bone is reduced in height
Bone margins remain perpendicular to root

A

horizontal bone loss

46
Q

what bone destruction pattern:

Bone loss is oblique to root surface
Intrabony pockets

A

vertical (Angular) bone loss

47
Q

what type of bone loss

A

horizontal

48
Q

what type of bone loss

A

vertical/angular

49
Q

radiographs [overestimate; underestimate] bone loss by up to ___mm

A

underestimate 1.6 mm

50
Q

how to determine bone loss

A

Measure distance from CEJ to osseous crest on bitewing radiograph
Subtract 2 mm (Supracrestal Attached Tissues)

51
Q

bone loss severity levels and percentage

A
  1. slight: <20% (<2mm bone loss)
  2. moderate: 20-40% (2-4 mm bone loss)
  3. severe: >40% (>4mm bone loss)
52
Q

how to determine facial and lingual bone loss on radiograph

A
  • difficult to visualize radiographically
  • look for horizontal lines across the roots
53
Q

what is an early radiographic change in periodontitis

A

loss of crestal bone lamina dura

54
Q

signs of occlusal trauma

A
  1. Widened PDL
  2. Angular (vertical defects in bone
  3. Mobile teeth
  4. Thickened lamina dura
  5. Root resorption
  6. Fremitus
55
Q

advantages of digital radiography

A
  1. Speed
  2. Lower radiation exposure
  3. Digital manipulation (Enhancement, Magnification, Contrast)
  4. Ease of transfer/storage
56
Q

when can a vertical defect only occur? why?

A

if interproximal space is wider than 2.5 mm

because radius of action for bone resorption factors is 2.5 mm (spaces </= 2.5 mm have horizontal bone loss)

57
Q

how is close root proximity measured? is bone loss vertical or horizontal

A

measured from CEJ to CEJ of adjacent teeth (</= 0.8 mm) so bone loss will be horizontal because not enough space for vertical defect

58
Q

what are the classifications of vertical defects

A
  1. one walled
  2. two walled
  3. three walled
59
Q
A
60
Q
A
61
Q
A
62
Q

does a narrow or wider defect have a better prognosis? why?

A

Narrow vertical defect has a better prognosis
than a wide vertical defect.

Narrow defects have greater bone fill after bone graft procedure.
Vertical defect must be at least 3 mm deep to place a bone graft.

63
Q

[vertical or horizontal] defects CAN be grafter. [vertical or horizontal] defects CANNOT be grafted

A

Vertical defects can be grafted. Horizontal
defects cannot be grafted.

64
Q

what are concavities in the interdental bone between the facial and lingual plates

A

osseous crater

65
Q

what are the different osseous architecture

A
  1. Positive - Interproximal bone crest is coronal to facial and lingual crests of bone
  2. Negative (Reversed) - Interproximal bone crest is apical to facial and lingual crests of bone
  3. Flat - Interproximal bone crest is at the same level as the facial and lingual crests of bone
66
Q

type and location of furcations for max 1st molar

A
  1. Mesial Furcation - 3 mm apical to CEJ
  2. Buccal Furcation - 4 mm apical to CEJ
  3. Distal Furcation - 5 mm apical to CEJ
67
Q

what is distance from CEJ to furcation entrance

A

root trunk length

68
Q

type and location of furcations of mandibular 1st molar

A

Buccal Furcation - 3 mm apical to CEJ
Lingual Furcation - 4 mm apical to CEJ

69
Q

when do you suspect furcation involvement for mesial maxillary 1st molar

A

3 mm CAL

70
Q

location of furcations on max 1st premolar? birfurcations how many % of the time? clinical implications

A
  • furcations on mesial and distal
  • bifurcation 40% of the time (8 mm apical to CEJ)
  • clinical implication: Severe bone loss and CAL before exposing the furcations
71
Q

what is buttressing bone that may be related to excessive occlusal forces

A

exostosis

72
Q

what is classified by number of walls fo bone remaining

A

vertical bone loss

23 Periodontology (13 decks)

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