Case defense Flashcards
Why is it not PTM?
According BURNSVOLD 2005
ther’s No teeth elongation (defying Thielman’s Law), no increased overjet (is in accordance, with the lower) no biprotusion of both of them, patient is going to do orthodontic ttm and it is reversible after perio-ttm.
Root trunk length?
OSCHENBEIN 1986 (upper 3, 4, 5; Lower 2, 3, 4)
PDL widening?
LINDHE & ERICSSON 1976 presented that PDL widening is an early indicator of perio breakdown when EP is combined with Occ.Trauma
Root proximity?
VERMYLEN 2005: <0,3, 0,3-0,5, 0-8. OR 3.6. , In Perio pt +prevalent coronal third, frequently symmetical, worsens tooth prognosis.
Open contacts?
HANCOCK 1980: Open contacts per se are not a factor, only when there’s food impaction leading to an increase of PPD, loose contacts are the worst.
Calculus?
MENDEL & GAFFAR 1986, indirect and direct way: Porosity increase retention of toxic products, ATB without debridement limited efficacy, Subgingival calculus has a pathogenic effect, Frequent removal to prevent progression, Calculus cause periodontal disease. JEPSEN 2011: Calculus is a retentive facto for plaque accumulation.
Restorations and EP/PPD?
Overhanging restaurations: HIGHFIELD & POWELL 1978, overhanging restauration, trappes more plque, therefore worse periodontal parameters
BOP
LANG 1990, 1986. Low+predictive value 6% (90) for AL predictability and 30% (86). Lang 1990 says Absence of BOP has high+predictive value 98% for perio status stability.
MATULIENE 2008: (in SPT) Sites with BOP+PPD>=5mm had +probability TL and OR 44 for EP progression.
Furcation involvement?
McGUIRE 1996, DONNEWITZ 2016, NIBALI 2016 demonstrated a worst prognosis for F.I., but mostly with F.I. 3&2.
Salvi 2014 OR 2.9 FI-2, type-3 OR 6.8
Tonetti 2017 FI-2 10y survival was 52%. Subclass A-90% (9.5-10y), B-70%, C-23%
Nibali 2016: RR of 1.7 (type II vs I), 1.8 (III vs II) and 3.1 (III vs I) with statistical significance
Why this staging and grading?
Pt presents PD>=6mm (stage III) and %BL/age<0.25 (grade A)
Crowding / malpositon?
ERCOLI 2018: Harder to maintain a good IHO.
Why wait 8 weeks?
SEGELNICK 2006 4-8w C.Tx repair and 4-8w recolonization (mobility 1m to 6-12m); MAGNUSON 1984 also 4-8w recolonization, MOUSQUES 1980 Spirochette to baseline ~42d (6w)
Calculus elimination?
BRAYER 1989: Experienced vs non experienced operator, (remove less calculus), RATEISCHAK plus 1992: calculus is present at the base of 75% of the PPD.
Mobility?
KERRY 1982: After nst, there’s an increase of movility, due to the reorganization of the collagen fibers, that later mobility will reduce.
SPT based on PRA
TONETTI & LANG 2003
LANG 2015: Validated PRA
Overweight?
SUVAN 2015. OR: 2,5. Overweight & obese individuals seem to have an + risk of EP in comparison with normal BMI
Female and EP?
Progesterone, increases permeability of the soft tissues and therefore maybe enhancing the predispose to periodontal disease.
SALVI 2014: OR: 2
Mouth breather and EP?
its more predisposed to suffering gingivits, but not periodontitis.
What do you expect from a NST?
PD reduction, CAL gain, pocket closure, reduction in BOP.
BADERSTEN 1981:Higher INITIAL PPD = higher PD reduction and attachment gain, Higher RESIDUAL PPD = higher BOP, SHALLOW PPD had CAL and recession. BADERSTEN 1984: Same+ Decision of surgery postponed at 6-9m. MATULIENE 2008: (in SPT) Sites with BOP+PPD>=5mm had +probability TL and OR 44 for EP progression.
What type of healing do you have after NST?
FOWLER 1982. Long JE.
SEGELNICK 2006 2 weeks Epith.attach. ,4-8w C.Tx repair and 4-8w recolonization (mobility 1m to 6-12m)
If we would have given ATB, how many mm would we expect to reduce?
KEESTRA 2015: ATB+SCRP; PD Moderate: 0.25mm Severe: 0.74mm CAL Modere: 0.21mm Severe: 0.61mm BoP:3.8%
Lindhe’s 2008 prognosis: Doubtful
Doubtful: good prognosis by means of additional therapy o Periodontal - F.I. II or III - Angular bony defects - Horitzontal bone loss involving 2/3 root o Endodontic - Incomplete root canal therapy - Periapical pathology - Presence of voluminous post/screws o Dental - Extensive root caries
Lindhe’s 2008 prognosis: Irrational to treat
Irrational to treat o Periodontal - Recurrent periodontal abscesses - Combined periodontal-endodontic lesions - Attachment loss to the apical region o Endodontic - Root perforation in the apical half - Extensive periapical lesions o Dental - Vertical fracture - Oblique fracture in the middle third of the root - Caries lesions extending into the root canal
Why haven’t you gave ATB?
She has a lot of contributory factors that once we remove them and perform step II cause related therapy, the patient will have a good response to treatment and we do not need to give her an adjunctive antibiotic therapy.
Based on EICKHOLZ 2019 ATB threshold study, Vanessa might be a good candidate to ATB adjunctive ttm by her young age 28y (<55y), But her PPD sites =>5mm was 24% (should be >35%).
Changes in the OHI? Why electric? Why inteproximal?
Electric: VAN DER WEIJDEN 1993: electric vs manual. electric vs recession ROSEMA 2014 and McCRACKEN 2009: It can not be demonstrated the association of electric and recessions.
Interprox.Brush: SALZER 2015: interdental hygiene Interproximal hygiene reduces gingivitis in 34% and plaque in 32%. JACKSON 2006: interproximal vs floss: More reduction of interproximal plaque, PD, BoP, and papilla shortening
Triclosan
Rule 2005, due to the ph= Cancerigeno.
GI (Escribano 2010, Figuero 2019) showed best results for dentifrice GI ttm
Toothpaste? Elimination of plaque
Valkenburg 2017: Same plaque removal, with or without tooth paste 49% vs 50%.
Oral contraceptives and EP / PD?
KNIGHT 1974: GI slightly higher for test group but not significant. BUT women taking oral.contrac. for more than 1.5y showed a significant perio-destruction. (0.6 vs 0.8mm)
PRESHAW 2001: study demonstrated that current OC formulations do not affect the inflammatory response of the gingiva to dental plaque.
