Antimicrobial Therapy and Wound Healing, Repair and Regeneration Flashcards
what can be prescribed to treat localized aggressive periodontitis?
tetracyclines
why are tetracyclines effective in treating localized aggressive periodontitis?
- broad-spectrum abx
- concentrate in gingival crevicular fluid
- have anti-metalloproteinase properties (deactivate collagenase and elastase)
- interfere with bacterial protein synthesis
what is the current standard in tx’ing pts with aggressive perio?
- metronidazole 250 mg in combo with amoxicillin (or augmentin) 500 mg tid for 7-10 days along with SRP
amoxicillin is effective against what type of bacteria?
gram +
metronidazole is effective against what type of bacteria?
anaerobes
metronidazole may be used alone in cases of what?
NUP or periodontitis associated with systemic diseases such as HIV
what is currently the only approved antimicrobial rinse for treatment of gingivitis but has been used in subgingival irrigation, often used for medically compromised patients and during healing following periodontal surgery?
chlorhexidine (Peridex)
Chlorhexidine is a bis-biguanide antiseptic agent effective in prevention of what?
bacterial colonization by killing or inhibiting growth of microorganisms on surfaces of skin, mucous membranes, and teeth
T/F: Chlorhexidine has a bitter taste, stains teeth and alters taste perception
true
T/F: Listerine has been shown to control gingivitis but there is no evidence of efficacy in control of periodontitis
true
examples of controlled sustained local release of antibiotic/antimicrobial that may be placed in isolated non-responding sites at periodontal re-evaluation or periodontal maintenance
- Periochip
2. Arestin
anti-collagenase
systemic administratio nof low dosage tetracycline-doxycline (Periostat) has 20 mg of doxycycline (b.i.d. for 90 days)
collagenase is one of several matrix-metalloproteinase (MMPs) that catalyzes what?
breakdown of collagen
low dosage doxycycline stabilizes what?
gingival and PDL collagen and has no (subclinical) antibiotic effect
repair
healing of a wound by tissue that does not fully restore that architecture of fxn of the part (previously existing tissues)
T/F: repair results in new bone, cementum or PDL
FALSE, doesn’t
reattachment
reunion of epithelial and viable CT with non-diseased root surfaces and bone such as occurs after an incision or injury
types of new attachment
- true new attachment
2. long junctional epithelium
true new attachment
reunion of CT with a root surface that has been deprived of its periodontal ligament (may occur without new bone)
long junctional epithelium
epithelial attachment onto a previously diseased root surface
regeneration
reproduction of a lost or injured part
periodontal regeneration includes what?
- new cementum
- new bone
- fxnal collagen fibers (PDL) inserting into a previously diseased root surface
primary (first) intention healing
- close approximation of wound margins
2. minimal granulation
secondary intention healing
open wound that will heal through formation of granulation tissue
epithelium migrates how many mm/day during healing?
0.5 mm
epithelium covers a wound in how many days?
7-10 days
epithelium matures in how many days?
21-28 days
in periodontal regeneration, progenitor cells that differentiate into cementoblasts, osteoblasts and fibroblasts migrate more slowly. at what rate?
only 0.1 mm/day
more bone resorption occurs over what?
thin buccal and lingual root surfaces than interproximately
periodontal dressings
used to protect surgical area and help in tissue positioning, but may delay healing and favor plaque accumulation
splinting
accomplish for teeth with secondary occlusal trauma (weakened periodontium) and for patient comfort/fxn of mobile teeth
types of splints
- extracoronal
2. intracoronal
extracoronal splints
- occlusal guard
2. acid-etched Maryland bridge (reversible)
intracoronal splints
- amalgam or acrylic splint with preparation of occlusal surface of adjacent teeth
- castings/FPD (irreversible)
coronoplasty
IRREVERSIBLE occlusal adjustment by selective grinding
indications for coronoplasty
- periodontal occlusal trauma
- post-ortho
- pre-restoratively
- TMD (with caution)
when should occlusal adjustments be made?
should be done after S/RP because root planing decreases inflammation, therefore mobility
objective of occlusal adjustment by selective grinding
- to minimize lateral (jigging) forces on posterior teeth or weakened teeth - reduce non-working side (balancing) and working-side interferences
- to place forces in line with the long axis of teeth
- to establish smooth, gliding excursions, usually with canine guidance
how are periodontal abscesses managed?
- I&D
2. abx (amoxicillin)
how is nectrotizing ulcerative gingivitis/periodontitis managed?
- tx’d through ultrasonic debridement, Peridex (chlorhexidine) mouth rinses
- abx (metronidazole) used if there is fever, severe pain, lympadenapathy
- follow-up appts are needed for continued initial therapy
T/F: plaque induced, drug influenced gingival enlargement usually will not resolve completely non-surgically, even if pt is taken off meds
true
what is usually indicated for pts with plaque induced, drug influenced gingival enlargement?
gingivectomy with gingivoplasty
what have been shown to have lesser recurrence rates in pts with plaque induced, drug influenced gingival enlargement?
internally beveled flaps (internal gingivectomy)
in combined endo-perio lesions, what is treated first?
RCT before periodontal surgery
what is expected after S/RP and resective perio surgery?
blunting of interproximal papillae
why is periodontal maintenance therapy following tx for perio disease indicated every 3 months?
to monitor for new perio disease and intercept pathogenic subgingibal plaque which takes about 3 months to re-establish itself
