Applied Anatomy of the Periodontium

Question 1

___ eruption is when the gingiva moves toward the CEJ and ___ eruption is when the tooth exits the socket to the occlusal plane.

Answer 1

passive; active

Question 2

T/F. Healthy gingival sulcus is potential space.

Answer 2

True.

Question 3

T/F. Inflammation leads to inaccurate probe depths.

Answer 3

True.

Question 4

Where does the probe penetrate in healthy conditions?

Answer 4

to the free gingival groove

Question 5

Where does the probe penetrate in disease states?

Answer 5

past JE into CT

Question 6

Probing depth ___ (increases/decreases) in inflammation due to swelling and probing error.

Answer 6

increases

Question 7

T/F. The diagnosis of periodontitis is based on probe depths not attachment loss.

Answer 7

False, it is based on attachment loss NOT probe depths.

Question 8

Why does gingival recession with attachment loss not always lead to periodontitis?

Answer 8

gingival recession is usually a sign of the effects of oral hygiene. Attachment loss needs to be accompanied with bone loss for disease to occur.

Question 9

What determines the probe angulations in posterior teeth?

Answer 9

the position and dimensions of the contact area

Question 10

What are the proper steps in probe angulation and positioning?

Answer 10

1. find interproximal contact
2. use contact as a guide to insert probe
3. open angulation by 10 degrees

Question 11

Which of the following was the Initial thinking of gingival width and recession?

1. width of keratinized tissue is less than 2mm predisposes to recession
2. narrow gingiva cannot protect from friction
3. cannot buffer against muscle pull
4. facilitates subgingival plaque formation since:
   - mobile tissue causes pocket to open
   - facilitates food impaction
   - impedes oral hygiene

Answer 11

All of the above was the initial thinking

Question 12

T/F. Now, gingival health cannot be maintained independent of its dimensions.

Answer 12

False, Now, gingival health CAN be maintained independent of its dimensions.

Question 13

T/F. Narrow gingiva has the same resistance to attachment loss as wide gingiva.

Answer 13

True.

Question 14

Scalloped gingiva is also called ___ (thin/thick) and flat gingiva is called ___ (thin/thick).

Answer 14

thin; thick

Question 15

Which phenotype of gingiva, thin or thick, has increased recession, is more vulnerable to trauma, has more inflammation and has a less favorable treatment outcome?

Answer 15

thin phenotype

Question 16

Would you recommend gingival grafts in the following scenarios?

1. when recession causes symptoms (caries, esthetic concerns, progressive recession, sensitivity)
2. subgingival restoration margins on thin biotype
3. pre-orthodontic therapy when the final tooth position will be buccal

Answer 16

Yes to all of the above

Question 17

Is tissue differentiation in the adult organism influenced by environmental or genetic factors?

Answer 17

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

Question 18

Early thinking - gingiva will become ___ in response to friction.
Now - ___ ___ determines epithelial characteristics.

Answer 18

keratinized; connective tissue

Question 19

T/F. Keratinized tissue means that the underlying CT is thin and elastic.

Answer 19

False, Keratinized tissue means that the underlying CT is THICK and FIBROUS.
Non-keratinized tissue means the underlying CT is thin and elastic.

Question 20

Early grafting procedures included ___ ___ grafts and coronally advanced ___. The rationale was that keratinized epithelium converted to firm, ___ gingiva because they believed that ___ directs new epithelium.

Answer 20

free gingival; flaps; attached; epithelium

Question 21

Now, ___ ___ grafts are used because we know that ___ __ determines epithelial prototype.

Answer 21

connective tissue; connective tissue

Question 22

In the past, why were free gingival grafts taken from the palate?

Answer 22

because the palate contains keratinized tissue. Now they make a pouch and add the CT so it’ll transform the epithelium into keratinized gingiva.

Question 23

Soft tissue attachment to tooth includes what two parts?

Answer 23

1. fibrous tissue

2. junctional epithelium

Question 24

What are the dimensions of the biologic width?

Answer 24

1mm of CT (1.06-1.08mm)

1mm of JE (or attached epi) (1.4mm)

Question 25

What structure is not included in the biologic width?

Answer 25

1mm of sulcus

Question 26

The distance of the CEJ to the alveolar crest should measure ___mm. What should be done if you don’t have this distance?

Answer 26

2mm; crown lengthening

Question 27

After extraction, how does healing occur?

Answer 27

clot formation
wound cleansing - PMNs, monocytes, macrophages migrate into wound
New vasculature, mesenchymal cells (from PDL) form granulation tissue
Provisional connective tissue
Immature bone forms
Bundle bone (socket proper) is resorbed
Wound filled with woven bone
Bone maturation

Question 28

Why is it important to have proper wound healing following an extraction?

Answer 28

Socket preservation is important for preserving bone morphology. Sockets can shrink with healing

Question 29

What is the principle behind guided tissue regeneration (GTR)?

Answer 29

epithelium grows faster than bone or connective tissue

Question 30

Epithelial exclusion allows for selective growth of ___ cells.

Answer 30

PDL

Question 31

Describe how barrier membranes work?

Answer 31

the barrier slide between two teeth and contains ectomesenchymal cells from PDL.