ABP Board - basic review topics Flashcards
What is the Becker ‘84 Hopeless prognosis?
7 total criteria (of which at least 2 must be seen in the tooth):
1. > 75% bone loss
2. > 8 mm PD
3. Class III furcation
4. Class III mobility
5. Poor crown-root ratio
6. Root proximity with minimal / no bone remaining
7. Repeated periodontal abscesses
What is the Becker ‘84 Questionable prognosis?
6 total crtieria (of which at least 2 must be fulfilled):
1. > 50% bone loss
2. 6 - 8 mm PD
3. Class II furcation involvement with minimal interradicular space
4. Deep vertical palatoradicular groove in Maxillary incisors
5. Mesial furcation involvement of 1st premolars
6. Large, extensive decay
What is the prevalence of bifurcation ridges?
Hou & Tsai ‘97
68% 1st Mn molars (Taiwan)
Everett ‘58
73% 1st Mn molars (USA)
How reliable is a radiographic “furcation arrow”?
Hardekopf ‘87 Only 39% sensitivity for detecting an actual furcation.
Deas ‘06
However, specificity (absence confirming clinical absence) of furcation arrows = 92% accurate
So, sensitivity: 40%
Specificity: 90%
Positive predictive value: 72%
Negative predictive value: 75%
Deas: “These data suggest that the furcation arrow has limited usefulness as a diagnostic marker of furcation invasion. The image is difficult to interpret and highly subjective and can correctly predict furca-
tion invasions only 70% of the time when present on the radiograph. In addition, when furcation invasions
are truly present, the furcation arrow is seen in < 40% of sites.
Describe the Mcguire-Nunn classification
Good Prognosis:
* Adequate periodontal support and control of the etiologic factors to assure the tooth would be relatively easy to maintain, assuming proper maintenance.
Fair Prognosis: (one or more of the following)
* attachment loss to the point that the tooth could not be considered to have a good prognosis
* Class I furcation involvement. The location and depth of the furcation would allow proper maintenance with good patient compliance.
Poor Prognosis: (one or more of the following)
* moderate attachment loss
* Class I and/or Class II furcations. The
location and depth of the furcations would allow proper maintenance, but with difficulty.
Questionable Prognosis: (one or more of the following)
1. Severe attachment loss resulting in a poor crown-to-root ratio.
2. Poor root form.
3. Class II furcations not easily accessible to maintenance care
4. Class III furcations.
5. 2 + mobility or greater.
6. Significant root proximity.
Hopeless Prognosis:
* Inadequate attachment to maintain
the tooth in health, comfort, and function. Extraction was
performed or suggested.
Teeth deemed hopeless at the initial examination and extracted during the initial active periodontal therapy were
not included in the study. The cause of tooth loss was
recorded when possible.
What is the Kwok & Caton ‘07 prognosis?
Favorable: The periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and periodontal maintenance. Future loss of the periodontal supporting tissues is unlikely if these conditions are
met.
Questionable The periodontal status of the tooth is influenced by
local and/or systemic factors that may or may not be able to be controlled. The periodontium can be stabilized with comprehensive periodontal treatment and periodontal maintenance if these factors are controlled; otherwise, future periodontal breakdown may occur.
Unfavorable The periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled. Periodontal breakdown is likely to occur even with comprehensiveperiodontaltreatmentand maintenance.
Hopeless: The tooth must be extracted.
What systemic / local factors were specifically mentioned in the Kwok & Caton ‘07 prognosis as affecting periodontal stability?
Systemic factors: Compliance to maintenance, Smoking, Diabetes, other Systemic diseases (syndromes).
Local factors:
* Deep PD ≥ 5mm
* attachment loss,
* plaque-retentive factors (furcation involvement, CEP’s, Bifurcation ridges, palato-gingival grooves),
* tooth position (crowding, root proximity, open contacts),
* overhanging restorations
* TFO and parafunctions
* Mobility
What are the 2017 Classifications for Periodontal Diseases and Conditions?
- Periodontal Health, Gingival Diseases and conditions
* Periodontal Health and Gingival Health
* Gingivitis: Dental biofilm-induced
* Gingival diseases: Non-dental biofilm-induced - Periodontitis
* Necrotizing periodontal diseases
* Periodontitis
* Periodontitis as a manifestation of systemic disease - Other conditions affecting the periodontium
* Systemic diseases or conditions affecting the periodontal supporting tissues
* Periodontal abscesses and Endo-perio lesions
* Mucogingival deformities and conditions
* Traumatic occlusal forces
* Tooth- and prosthesis- related factors
What are the 2017 classifications for Peri-implant diseases and conditions?
- Peri-implant health
- Peri-implant mucositis
- Peri-implantitis
- Peri-implant hard and soft tissue deficiencies
What are the sub-classifications of periodontal abscesses? (2017 WW)
Periodontal abscess in a periodontitis patient (pre-existing pocket):
* Acute exacerbation: Untreated periodontitis, non-responsive to therapy periodontitis, supportive periodontal therapy
* After treatment: Post-scaling, post-surgery, post-medication (Systemic antimicrobials, or other drugs: Nifedipine)
Periodontal abscess in a non-periodontitis patient (no pre-existing pocket):
* Impaction (dental floss, ortho elastic, toothpick, rubber dam, popcorn hulls)
* Harmful habits (wire or nail biting, clenching)
* Ortho factors (Ortho forces or cross-bite)
* Gingival overgrowth
-
Alteration of root surface.
Subclasses: - Severe anatomic limitations (invaginated tooth, dens evaginatus or odontodysplasia)
- Minor anatomic alterations (cemental tears, enamel pearls, developmental grooves)
- Iatrogenic conditions (perforations)
- Severe root damage (fissure or fracture, cracked tooth syndrome)
- External root resorption
What are the 2017 WW classifications for perio-endo lesions?
Endo-perio lesion with root damage:
* Root fracture or cracking
* Root canal or pulp chamber perforation
* External root resorption
Endo-perio lesion without root damage:
* In periodontitis patient:
Grade 1: Narrow deep pocket on 1 surface
Grade 2: Wide deep pocket on 1 surface
Grade 3: Deep pocket on > 1 surface
* in non-periodontitis patients:
Grade 1: Narrow deep pocket on 1 surface
Grade 2: Wide deep pocket on 1 surface
Grade 3: Deep pocket on > 1 surface
What are the 2017 WW subcategories for Necrotizing Periodontal Diseases?
Necrotizing periodontal diseases in chronically, severely compromised patients:
Clinically manifest as NG, NP, NS, Noma. Possible progression.
* In adults: HIV/AIDS with CD4 < 200 and detectable viral loads, or other severe immunosuppressive systemic conditions
* In children: Severe malnourishment, extreme living conditions, severe (viral) infections.
Necrotizing periodontal diseases in temporarily and/or moderately compromised patients:
* In gingitivis patients: Uncontrolled stress, nutrition, smoking, habits; Previous NPD (residual craters), Local factors: Root proximity, tooth malpositions.
* In periodontitis patients: Same factors as for gingivitis patients.
What are the Systemic diseases and conditions affecting the periodontal supporting tissues? (2017 WW)
Jepsen ‘18
1. Rare systemic conditions such as Papillon-Lefevre Sydnrome, leucocyte adhesion deficiency, and others
2. More common systemic conditions (such as Down Syndrome)
3. Neoplastic diseases (Squamous cell carcinoma, Langerhans cell histiocytosis)
This is an area where more longitudinal studies are needed
What are the subcategories of the tooth- and prosthesis-related factors?
- Tooth factors: Root abnormalities, fractures, positioning.
- Tooth-supported and tooth-retained restorations may affect plaque retention and loss of attachment.
- Hypersensitivity reactions to dental materials can occur
- Restoration margins placed into the JE and CT may cause inflammation and possible recession.
What are the subcategories for mucogingical deformities and conditions?
- Gingival/soft tissue recessions (either interproximally, or facial/lingually)
- Lack of KT
- Decreased vestibular depth
- Aberrant frenum/muscle position
- Gingival excess (Pseudo-pocket, inconsistent gingival margin, excessive gingival display, gingival enlargement)
- Abnormal color
