Applied Anatomy

Question 1

What is passive eruption?

Answer 1

Once a tooth reaches the occlusal plane, the gingiva starts to recess, so the free gingival groove reaches the CEJ

Question 2

If a patient has deep pockets, does that mean they have poor gingival health?

Answer 2

Not necessarily. If a patient had altered passive eruption, their pockets can be deep and their gingival health still good

Question 3

In healthy gingiva, what structure does a perio probe reach?

Answer 3

It penetrates to the free gingival groove

Question 4

In diseased gingiva, what structure does a perio probe reach?

Answer 4

It penetrates past the junctional epithelium into the CT

Question 5

What is the diagnosis of periodontitis based on?

Answer 5

Attachment loss (not recession)

Question 6

Does recession mean a patient has periodontitis?

Answer 6

No

It can involve recession, but in order for it to be periodontitis, it has to follow specific steps

Question 7

What are the steps of periodontitis?

Answer 7

Plaque induced
Inflammatory in origin
Leading to bone loss
Finally attachment loss

Question 8

Periodontitis happens when?

Answer 8

Junctional epithelium migrates apically down the root surface and thickens

Question 9

At what rate does periodontitis occur?

Answer 9

Very slowly

~1mm every 5 years

Question 10

What are of gingiva is most prominent to periodontal disease? Why?

Answer 10

Col

Because it is non keratinized, and located just below a contact point

Question 11

What is the most important place to probe correctly in posterior teeth?

Answer 11

Contact area

Question 12

How does one properly probe the interproximals of posterior teeth?

Answer 12

Find interproximal contact
Use the contact as a guide to insert the probe
Open the angulation of the probe by 10 degrees

Question 13

Why is it so important to properly probe?

Answer 13

Improper probing can cause up to a 2 mm discrepancy, which is a huge difference between health and disease

Question 14

What was the original thinking of gingival width and recession?

Answer 14

If keratinized tissue got to be less than 2 mm, it predisposes it to recession

Question 15

What is the current thinking of gingival width and recession?

Answer 15

Gingival health can be maintained independent of its dimensions
Narrow gingiva has the same resistance to attachment loss as wide gingiva
So not everyone necessarily gets a graft

Question 16

What are some consequences of thin gingiva phenotype?

Answer 16

Increased recession
More vulnerable to trauma
More inflammation
Less favorable treatment outcome

Question 17

When would you recommend gingival grafts?

Answer 17

When recession causes symptoms (pain, caries, esthetic concerns)
Subgingival restorations on someone with the thin gingiva phenotype
Pre-ortho treatment (final tooth position will be buccal)

Question 18

What is the epithelial mesenchymal interaction?

Answer 18

The characteristics of the gingiva are genetically determined, rather than being the result of functional adaptation to environmental stimuli

Question 19

What is the clinical translation to the epithelial mesenchymal interaction?

Answer 19

Connective tissue determines epithelial characteristics

Question 20

What does keratinized gingiva correspond to?

Answer 20

Thick, fibrous CT

Question 21

What does nonkeratinized gingiva correspond to?

Answer 21

Thin, elastic CT

Question 22

What is the modern grafting procedure?

Answer 22

Connective-tissue graft

-Remove CT from the palate (or donor tissue) and stuff in in the desired area like a pita pit

Question 23

What is the minimum biological width? What happens if it is any less?

Answer 23

The minimum distance between the CEJ and alveolar ridge is 2mm (therefore, distance from crown margin to alveolar crest has to be 2mm - otherwise have to do crown lengthening)
IF the gingiva loses that 2mm, it will have bone recession to try and achieve it, but it doesn’t know when to stop

Question 24

What happens if crown margins are at the CEJ?

Answer 24

No issues

Question 25

Guided bone regeneration

Answer 25

After an extraction, you pack the socket withe bone or bone substitute to the get the socket you want - this preserves the ridge for an implant

Question 26

Collagen membrane

Answer 26

Prevents the epithelium form coming down to migrate

This gives the PDL time to regenerate

Question 27

What is the point of a barrier membrane?

Answer 27

It excludes the epithelium to create a tent that provides an area for bone regeneration