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Case Presentation Flashcards

1
Q

Benefit of surgery 1 quadrant at a time

A

Radvar - Clinical improvements in last untreated quadrant

Mechanism - removal of granulation tissue, disruption of microbial flora, improve AB avidity

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2
Q

How long until flap is stable after surgery?

A

Hiatt - at 2 weeks, suture pulled through w/o fully displacing flap

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3
Q

Clefts/craters

A

Jenkins - not an indication of poor healing, resolve within 6 months

Cleft - separated by 1mm
Crater - depression

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4
Q

Healing sequence after FO

A

Wilderman
Immediate - clot + PMN band
1-2 days - epithelial migration 0.5mm/day beneath polyband. MP clear debris
3-4 days - Increase fibroblasts, disorganized CT matrix, begin angiogenesis and osteoclast resorption
1-2 weeks - Increase collagen. Begin OB, decrease OC
1 month - Peak OB, collagen synthesis parallel to root
6 months - Mature CT/PDL insertion into bone. Woven to lamellar

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5
Q

Infection rate after surgery

A

Powell - 2%.

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6
Q

Perio-Pak and infection

A

Powell: No difference, trend towards infection

Cecchi & Trombelli - NO difference in analgesic usage

“There is evidence that there is no advantage”

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7
Q

Chlorhexidine post surgery (3 studies)

A

Powell - NO difference in infection rate w/ or w/o CHX or ABC

Newman - CHX SS lower PI/GI/plaque/bacteria vs control

Zambon - CHX SS improve post-op plaque/inflammation

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8
Q

CHX w/o mechanical therapy

A

Zanata - does not reduce bacteria

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9
Q

Suture technique FO

A

Nelson - no difference in continuous sling vs interrupted

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10
Q

Bone loss in thin bone

A

Wilderman - average 0.8mm

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11
Q

Crestal bone loss after surgery

A

Pennel - 0.54mm. 82% lost <1mm

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12
Q

Exposed bone covered w/ what?

A

Pfeifer - CT/PDL. Minimal bone loss

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13
Q

Bone loss in thick/thin

A

Wilderman/Wentz/Orban

More IP loss, but thicker cancellous section
Thicker = marrow bone
Thin = facial surface

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14
Q

Phases of hemostasis

A

Vascular - vasoconstriction after damage to vessel wall
Platelet - vWF released, platelet aggregation
Coagulation - clotting cascade, fibrin clot

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15
Q

Removal of granulation tissue during surgery?

A

Lindhe - Split mouth study, granulation tissue removal not critical. Debridement/SRP more important

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16
Q

Remove sulcular epithelium?

A

Pippin - it degenerates, not necessary to remove

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17
Q

Flap H/W ratio?

A

Mormann - angiographic study. MAX 2:1 H/W ratio

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18
Q

Where do cells come from for flap healing?

A

Wilderman - epithelial cells from edge of flap wound margin. CT cells from PDL

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19
Q

Distal wedge?

A

Robinson

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20
Q

Incision design

A

Cattermole: Scalloped vs linear. 2 weeks greater GI w/ linear, no difference at 12 weeks

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21
Q

MWF vs sulcular

A

Smith - 3 months, no difference

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22
Q

Goals of surgery - Access NM

A

Brayer - 4mm+ OFD/BCP more effective

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23
Q

Goals of surgery - Access All Teeth

A

Caffesse

% calculus free
4-6mm: 43% vs 76%
7mm: 32% vs 50%

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24
Q

Goals of surgery - Access, % plaque free

A

Waerhaug - 11% plaque free >5mm

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25
Q

Goals of surgery - Access, Molars

A

Fleischer - OFD/BCP enhances calculus removal in molars w/ furcation invasion

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26
Q

Goals of surgery - Reduce inflammation

A

Levy - remove etiology, reduce inflammation, perio surgery reduced bacterial load

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27
Q

FO studies

A

Olsen/Ammons - OFD vs FO 5 years. OFD 2.3X more 4mm+ sites w/ BOP.
FO fewer residual pockets and less inflammation

Kahldahl/Kahlwarf - CS/SRP/MWF/FO 7 years. FO least breakdown

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28
Q

Goals of surgery - CAL gain

A 
Froum - OFD
3.3mm PD reduction
2mm recession
1.4mm attachment gain
1.2mm radiographic bone fill
0.8mm resorption
LJE
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29
Q

LJE resistance

A

Magnusson - LJE as resistant to plaque/inflammation as control (MONKEY)

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30
Q

Critical PD

A

Lindhe

SRP - 2.9mm
Surgery - 4.2mm
Surgery > SRP - 5.4mm

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31
Q

Plaque infested dentition

A

Nyman & Lindhe - q2weeks vs q6months (2.2mm LOA vs 0.1mm CAL gain) for non-molars

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32
Q

Maintenance interval

A

Ramfjord - 3 months arbitrary

Mosques - bacterial repopulation

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33
Q

Different types of maintenance

A

Schallhorn - preventative, trial, compromised, post-treatment

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34
Q

Maintenance in a periodontists office?

A

Axelsson - better maintained w/ periodontist vs GP

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35
Q

Status of well-maintained patients over 22 years

A

Hirschfeld & Wassermann
Well maintained (0-3): 83%
Downhill (4-9): 13%
Extreme downhill (10-23): 4%

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36
Q

Most extracted/stable teeth

A 
Lost = maxillary 2nd molars
Stable = mandibular canines
37
Q

Tooth loss w/ or w/o maintenance

A

Becker
T + M: 0.11/year
T: 0.22/year
NO T: 0.36/year

38
Q

Surgery w/ no maintenance

A

Becker - Need maintenance in order to maintain results from surgery

39
Q

Root caries

A

Reiker - OH significant factor. Need diet counseling/fluoride

82% of maintenance patients with 1 root surface caries/filling

40
Q

Maintenance compliance

A

Wilson
Complete 16%
Erratic 49%
None 34%

Increased complete to 32% w/ flyers/calling

41
Q

Expected results NST

A

Hunn & Douglass
1-3mm: Lose attachment
4-6mm: 1mm PD, 0.5mm CAL
7mm+: 2mm PD, 1mm CAL

42
Q

What 3 things happen w/ NST?

A

Recession
CAL gain
Decreased probe penetration

43
Q

Probe peneteration

A

Fowler
Health - 0.73mm coronal to JE
Disease - 0.45mm apical

44
Q

How to pathogens change after SRP?

A

Cugini - clinical change during first 3 months. Reduce PG/TF/TD

45
Q

How good are curettes?

A

Stambaugh - 3.73mm max PD for hard/smooth/calculus free
5.52mm = average PD for evidence of instrumentation
6.21 = max curette depth
Spent 25-39 minutes per tooth. 7 teeth

46
Q

Histology after SRP?

A

Caton - Reduced inflamed CT volume density. Lack of sulcular epithelium ulceration, less inflammatory infiltrate, more dense CT, less perivascular edema

47
Q

Furcation response to NST

A

Nordland - poorer response to SRP compared to nonmolar and molar flat surfaces

LOA: 21% furcations, 11% nonmolars, 7% molar flat surfaces

48
Q

Furcation w/ ultrasonic or diamond?

A

Matia - <2.3mm, need ultrasonic vs curette

Parashis - use diamond for calculus removal in furcation

49
Q

% plaque free surfaces

A

Waerhaug
<3 89%
3-5 63%
>5mm 11%

50
Q

Remove cementum during NST?

A

Nyman - NO

51
Q

Healing w/ residual calculus?

A

Sherman - Yes, improvements w/ residual calculus BUT BOP/PD/CAL NOT useful for predicting residual calculus

52
Q

What sites lose attachment w/ SRP?

A

Claffey - thin, non-BOP

53
Q

Furcation sounding

A

Mealey - Accurate within 1mm 85%. Average difference 0.5mm

54
Q

Bone sounding

A

Ursell - 0.97 correlation coefficient. Average difference 0.3mm

55
Q

How far do oral hygiene aids go into socket?

A

TB 1mm
Floss 2mm
Proxabrush 2.5mm

56
Q

Best IP aids?

A

Kotsakis - Interdental brush, Waterjet

57
Q

Predict CAL loss?

A

Claffey

Residual PD >7mm + BOP at 75% of maintenance visits = 67% CAL loss

PD increase >1mm + BOP >75% of maintenance visits = 87% CAL loss

58
Q

Toothbrushing frequency

A

Lang - q48

Pinto - q24

59
Q

Furcation entrance width

A

Bower - 81% <1mm. 58% <0.75mm

60
Q

Furcation arrows

A 
Deas
Sensitivity 39%
Specificity 92%
PPV 72%
NPV 75%
61
Q

Radiographic calculus

A

Buchanon + Hyer

Sensitivity 43% (50%)
Specificity 92% (82%)
PPV 92% (94%)
NPV 46% (23%)

Hyer - NPV is low because of low prevalence of calculus negative surfaces. No major difference between any of the image enhancements. Step of calculus >0.5mm, more likely to see it. Surface area of calculus IP >30%, increase sensitivity.

62
Q

Kwok & Caton

A

Favorable - stabilized w/ tx and maintenance
Questionable - local/systemic factors, stabilized w/ tx
Unfavorable - local/systemic factors can’t be controlled, breakdown likely
Hopeless - Extract

63
Q

General factors Kwok & Caton

A

Maintenance
Smoking
Diabetes
Systemic disease (NP disorders)

64
Q

Local factors Kwok & Caton

A 
Deep PD
Root form
Furcation
Root anatomy
Plaque retentive factors
Furcation
Mobility
65
Q

ChP causing systemic inflammation

A

Herrera
PMN from ChP release more cytokines/chemokines. Primed for inflammation

OC from ChP differentiated w/ RANKL. Usually need M-CSF as well

66
Q

Calculus as etiology

A

Tan - Viable bacteria in calculus
Allen & Kerr - guinea pig
Anerud - Sri Lankans
Richardson - calculus 1/2 depth of defect

67
Q

Root proximity

A

Kim - <0.6mm, 56% more likely to lose >1mm bone over 10 years
Tal - 2.5 to 3.1
Heins & Weider - <0.3, 0.3-0.5, >0.5

68
Q

Stress

A

Genco - Financial most damaging. OR 2 for stress + inability to cope with it.

69
Q

Staging severity is based on what?

A

Interdental CAL (>5mm)
Radiographic bone loss to mid 1/3 of root
Tooth loss 4 or less

70
Q

Staging complexity is based on what?

A

PD 6mm+
Vertical bone loss
Furcation invasion
Ridge defect

71
Q

Grading direct evidence

A

A - no loss over 5 years

B - <2mm loss over 5 years

72
Q

Grading other evidence

A

% bone loss - A is <0.25 and B is 0.25-1

Destruction commensurate w/ biofilm deposits OR heavy biofilm deposits with low levels of destruction

73
Q

Grading modifiers

A

Non-smoker (B) or <10 cigarettes

74
Q

Lingual bonded retainer

A

Heier - American journal of orthodontics and dentofacial orthopedics

75
Q

PRG

A

Kogon - 3.5 CI, 5.5 LI, 4.5 incisors
-50% onto root, 60% of these go >5mm

Withers - 8.5% subjects, 2/3% incisors. 4.4% lateral, 0.28% centrals

76
Q

Maxillary sinus pneumatization

A

Sharan - extraction of multiple adjacent teeth, roots protruding into the sinus, 2nd molar EXT, superiorly curving sinus floor

77
Q

Radiographs and bone

A

Jeffcoat - 30-50% demin

Bender & Seltzer - need erosion of cortical bone for radiograph to show

78
Q

Tori

A

Sonnier

Palatal tori - 20% (female/white)
Mandibular lingual tori - 27%, 74% bilateral (males/AA)

79
Q

More common in females

A

Palatal tori
Impacted canines
Fused roots

80
Q

BOP

A

Meitner - earliest sign
Davenport - increased plasma cells, intercellular space, ulcerated sulcular epithelium, increased GCF flow, leukocytes, tortuous rete pegs
Caton - resolve BOP, histology returns to normal
Lang - BOP 98% NPV, 6% PPV. 4/4 BOP 30% CAL

81
Q

Repeated SRP

A

Anderson - 24 hours apart, no difference
Badersten - 1/3 months, no difference
Magnusson - NO MAINT for 16 weeks, redo SRP. SS difference

82
Q

Alcohol

A

Tezal - OR 1/22 and 1/39 for CAL for 5/10 drinks/week

Wang - Risk of ChP increase 0.4% for every 1g/day of alcohol consumed

83
Q

SSRIs and implants

A

Chappuis - OR 3

Increase osteoclast differentiation, negatively altering osseointegration

84
Q

Depression and ChP

A

Nascimento - depressive symptoms higher risk of periodontitis RR 1.19

Behavioral or systemic

85
Q

Former smoker

A 
Al-Harthi
10-20 41%
20-30 55%
30+ 73%
Each year 2.5-5.2%

Tomar - Smokers 4X to have ChP. 11 years = same OR

86
Q

Obesity

A

Suvan - OR 1.27 overweight, 1.81 obese

Nascimento - gain weight, OR 1.13X and 1.3X

87
Q

Metabolic syndrome

A

Nibali OR 2.10

88
Q

Alcohol content

A

Listerine 29.6%

CHX 11.4%

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