Basic Perio Flashcards
How do fibrous gingival enlargement differ from oedematous enlargement?
Oedematous tissue is soft and when touched may bleed spontaneously
Fibrous tissue is hard
Gingiva that appear enlarged can be caused by what?
Oedema or Fibrous tissue
How do you record gingival recession?
From the CEJ to the free gingival margin
What factors may influence the depth of the pocket recorded?
Presence of calculus Angle of probe Bulbosity of tooth Thickness of probe Pressure applied Presence of inflammation- a probe can more easily penetrate throu the pocket epithelium in inflamed tissues
What should you use to investigate furcation involvement?
A curved explorer
How can furcation lesions be classified?
Class 1: initial involvement, less than 1/3 destruction
Class 2: tissue destruction is more than 1/3
Class 3: through and through lesion
What should you record from
Radiographic analysis regarding periodontal disease?
Pattern of bone loss: horizontal or vertical Furcation involvement Varies root anatomy Subgingival calculus Widened pdl space Overhangs
What are the issues around microbial sampling in perio?
- Difficult to find a lab that wi do it
2. Difficult to ensure that the technique used to sample will ensure the anaerobic organisms stay alive
What method can be used instead of microbial sampling?
PCR
This detects bacterial DNA therefore the the bacteria can be dead or alive for this to work
Name some types of gingivitis
Chronic gingivitis Pregnancy gingivitis Plasma cell gingivitis Desquammative gingivitis NUG Primary herpetic gingivo stomatitis
What is chronic gingivitis?
Plaque induced inflammatory lesion if the gingiva
10-20 days following plaque establishment within the gingiva
How do you treat chronic gingivitis?
OHI
Interdental aids
Scaling supra and Subgingival
Eliminate plaque retentive factors
What causes pregnancy gingivitis?
Increase in circulating oestrogen and progesterone and their metabolites may aggravate pre existing gingivitis
How do the hormones in pregnancy and puberty affect the gingival tissues?
Increase the permeability of the vessels
When does pregnancy gingivitis become most severe?
Within the 2-8 the month
What other gingival feature other than gingivitis may be seen during pregnancy?
Gingival epulis
What are the features of pregnancy gingivitis?
Generalised, marginal, oedematous Inflam
What is the treatment for pregnancy gingivitis?
OHI and scale
What is plasma cell gingivitis?
Contact hypersensitivity reaction most commonly to cinnamon and toothpaste
What does the microscopical analysis show for plasma cell gingivitis?
Atrophic epithelium
Plasma cell infiltrate into epithelium
What are the features of plasma cell gingivitis?
Gingiva are red and fiery in appearance with varying degrees of swelling and lesions may be seen on tongue and palate
What is the difference between horizontal and vertical bone loss?
Horizontal bone loss is when the entire width of the interdental bone is lost
Vertical boneless is when the bone adjacent to the root surface is lost
How do you treat grade 1 furcation lesions?
OHI
Scale
Furcoplasty
How do you treat grade 2 furcation lesions?
OHI
Scale with or without flap
Root resection
GTR
How do you treat grade 3 furcation lesions?
OHI Scaling Root resection Hemisection Tunnel prep Xla
Why would you use flap surgery in furcation treatment?
This is more commonly used for grade 2 and 3 furcation lesions and enables you to obtain a complete view of the furcation once the granulation tissue is removed
What is the aim of a furcoplasty?
Produce a healthy gingival papilla n the furcation entrance
What 2 procedures does a furcoplasty comprise of?
Odontoplasty
Osteoplasty
What is an Odontoplasty?
The removal of tooth substance to the widen the entrance to the furcation but only a small amount should be removed to avoid post op sensitivity
What is an osteoplasty?
Re contouring of adjacent bone on the lingual, buccal or palatal alveolar plates that are not providing any tooth support
What is a tunnel preparation?
This is used where there are deep grade 2 and 3 furcation defects which means the inter radicular osteoplasty should be more radical to create a tunnel through the furcation
What is the difference between root amputation and hemisection?
Hemisection is when crown and root are cut in half and amputation is Jen only the root goes
When should you place the root filling in a tooth that is going to be hemisected or amputated?
Before!!!!
What happens in gingival recession?
The width of the attached gingiva is reduced
What are two features of recession?
Still mans cleft
Mc calls festoon
What are the predisposing features I’m bone that may lead to recession?
Dehiscence and fenestrations
What is the difference between a dehiscence and a fenestration?
A fenestration is a window in bone and dehiscence is a cleft
How do you treat recession?
Good OH
Eliminate aetological factoris
Gingival veneer
Ginigival surgery
How can occlusal forces cause periodontal trauma?
According to Glickmans hypothesis: excessive ocusal forces in the presence of gingivitis acts as a co destructive factor. This means descruction is forced directly through the pdl
T/F
Calculus is the aetiological agent periodontal disease?
F
Plaque is
T/F
Plaque becomes mineralised by ions in GCF to form calculus?
F
Ions from saliva
T/F
Mature calculus contains HAP ions?
T and tricalcium phosphate
T/F
Calculus contains no bacteria
F
It contains non viable bacteria that have become mineralised
T/F
PG does not invade gingival tissues?
F
It is able to invade and replicate within gingival epithelial cells
T/F
PG is not encapsulated?
F
It is encapsulated which helps it resist being phagocytosed
T/F
Aa is effectively removed during RSD?
False
Because Aa is able t invade gingival tissues
T/F
Vertical bone defects are easier to treat than horizontal defects?
F
Which walled defect is the easiest to treat with GTR?
Three walled, it easier to isolate from the epithelium with the GTR membrane
When would use a simple flap in perio surgery?
Access root surface
Regenerative techniques
Osseous surgery
When would you use a modified widman flap in perio surgery?
Access rot surface
Crown lengthening
When would you use an apically repositioned flap in perio?
To allow for pocket reduction and crown lengthening
When would you perform a gingivectomy?
For pocket revision and crown lengthening
When would you perform a gingivoplasty?
Re contour gingival tissues
When would you use a free gingival graft and split graft?
Gingival recession
In what patients would perio surgery be carried out amongst?
Those with excellent plaque control
When would you use a coronally repositioned flap?
To get rid of recession
When would you place a peridontal pack following surgery?
When you are concerned that close adaptation between the flap and the bone has not occurred
What sutures should be used in the anterior region when suturing flaps?
Vertical mattress sutures and simple interrupted sutures may pull the labial papilla apically which causes an embrasure to appear as a dark triangle
What must peridontal dressings not contain?
Eugenol
This is irritant to the underlying bone
In which patient group are furcation involvement more commonly seen amongst? Reference
Smokers
Ziada et al 2007
What are the indications for root resection?
- Severe localised bone loss affecting one root only
- Grade 2/3 furcation disease with sufficient bone support for the root to be retained
- Deep caries extending in to the root for resection
- Endodontic complications eg perforation
- Root fracture of pulp floor perforation
What are the contraindications for root resection?
Unrestorable tooth Fused root pattern Excessive tooth mobility Insufficient bone support Other form of restoration may be more suitable Extensive caries Endo treatment unfeasible
Why is it better to carry out the root treatment before the perio surgery?
This will have an impact on the rest of the treatment. If the tooth does not stabilise following the RCT then it is not advantageous to embark on the surgery
What are the causes of local periodontal problems?
Mouthbreathing Developmental abnormalities Crowding Perio-endo Root fracture/perforation
How does mouth breathing cause problems?
Incompetent lips can lead to mouthbreathing and this can cause the mouth to dry out during sleep causing plaque to accumulate this then causes gingivitis followed by fibrotic lesions
How do Developemental abnormalities cause local perio problems?
Extra pits and grooves and cusps act as plaque retentive factors
