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perio: the complete summary > chpt 5: local factors > Flashcards

chpt 5: local factors Flashcards

1
Q

definition of biofilm

A

A multispecies community of microorganisms that adhere to each other and a surface and are encased in an extracellular matrix. The extracellular matrix is a complex polymeric substance that protects the microorganisms from environmental stresses. Bacteria living in a biofilm have a different physiology from free-living bacteria and are more difficult to eradicate with antibiotics. Dental plaque is the prototypical example of a biofilm.

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2
Q

define Calculus

A

A hard concretion that forms on teeth or dental prostheses through calcification of microbial plaque.

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3
Q

define cemental tears

A

A specific type of root surface fracture and characterized by the detachment of a cemental fragment.

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4
Q

define cementicles

A

Calcified spherical bodies (0.2 to 0.3 mm) composed of cementum lying free within the periodontal ligament, attached to the cementum, or embedded within it

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5
Q

how does bacteria attach to the tooth

A

in the biofilm, through van der Waals forces, glycocalyx, and glycoprotein receptors within a salivary pellicle and negative surface charges mediated by teichoic acid of gram-positive bacteria

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6
Q

composition of supra versus sub gingival calculus

A

supra: high conc of carbonate and Mn

sub: high conc of Ca, Mg, and F; irregular distribution of F

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7
Q

mineral content of supra vesus sub gingival calculus

A

supra: 37%
sub: 58%

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8
Q

source of minerals for supra and sub

A

supra: saliva
sub: GCF

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9
Q

crystal type in supra and sub

A

supra: octacalcium phosphate and hydroxyapetite
sub: whitlockite

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10
Q

formation of supra versus sub

A

supra: heterogenous nucleation and crystal growth; variable calcification

sub: heterogenous nucleation and crystal growth; homogenous calcification

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11
Q

microorganisms in supra versus sub

A

supra: more filamentous, faster growing
sub: less filamentous, slower growing

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12
Q

morphology of supra versus sub

A

supra: heterogenous with small needle-shaped; large-ribbon-like; and bundle/rosettes crystals

sub: several crystal types like spiny, crusty, nodular, ledge/ring, individual islands, smooth veneers, and finger/fern-like

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13
Q

pathogenic potential of supra versus sub

A

supra: little evidence
sub: associated with perio disease

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14
Q

modes of calculus attachment according to zander 1953

A

1) secondary cuticle
2) direct attachment into irregularities of cementum * 20%
3) penetration into cementum *10%
4) mechanical retention in areas of resorption

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15
Q

what is the favored site for calculus formation?

A

CEJ

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16
Q

define enamel pearl

A

A focal mass of enamel that has formed apical to the CEJ and is typically located in the areas between the roots of molars

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17
Q

Define enamel projection

A

An apical extension of enamel, usually toward a furcation.
May prevent true attachment of periodontal ligament fibers upon the root surface

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18
Q

modes of attachment according to canis

A

Canis et al rejected the possibility that microorganisms can penetrate the cementum surface and considered this phenomenon as an artifact due to superimposition of a detached cementum onto the tooth structure during sample preparation. These findings were confirmed using light microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM).

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19
Q

grade I CEP (Masters and Hoskins)

A

A distinct change in CEJ attitude with enamel project- ing toward the bifurcation.

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20
Q

grade II CEP (Masters and Hoskins)

A

Enamel projection approaching the furcation but not actually making contact with it.

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21
Q

grade III CEP (Masters and Hoskins)

A

Enamel projection extending into the furcation proper.

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22
Q

prevalence of CEP in mandibular molars

A

28.6%

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23
Q

prevalence of CEP in max molars

A

17%

24
Q

how many isolated furcation involvements are associated with CEPs? (Masters and Hoskin)

A

90% (mainly buccal)

25
Q

how many isolated furcation involvements are associated with CEPs? (Hou and Tsai)

A

prevalence of 63.2% furcation defects with CEPs and IBRs

26
Q

IBRs affect primarily which tooth

A

mandibular molars

27
Q

prevalence of CEP according to Swan and Hurt (overall and by max and mand)

A

32.6% overall
mand M: 33.7%
max M: 31.4%

28
Q

which teeth are affected by CEPs according to Swan and Hurt

A

-mand 2nd M
-max 2nd M
-max 3rd M
-mand 1st M
-mand 3rd M
-max 1st M

29
Q

Palatal groove

A

A developmental, anomalous groove usually found on the palatal aspect of maxillary central and lateral incisors

29
Q

Plunger cusp

A

an active passage of food into the embrasure area during function

30
Q

Plaque

A

An organized mass, consisting mainly of microorganisms embedded in a matrix of glycopolymers, that adheres to teeth, prostheses, and oral surfaces and is found in the gingival crevice and periodontal pockets. Other components include an organic, polysaccharide-protein matrix consisting of bacterial by-products such as enzymes, food debris, desquamated cells, and inorganic components such as calcium and phosphate.

31
Q

mean diameter of enamel pearl

A

0.96 mm

32
Q

prevalence of enamel pearl

A

4.6%

33
Q

location of enamel pearl

A

coronal third of the root with a mean distance of 2.8 mm from the CEJ.

34
Q

Moskow and Canut: incidence rate of enamel pearl

A

-1.1% to 9.7% (mean: 2.69%)

35
Q

predilection for enamel pearl (Moskow and Canut)

A

maxillary third and second molars

36
Q

location of furcation entrance from CEJ (Gher and Dunlap) for max 1st M

A

M: 3.6
B: 4.2
D: 4.8

37
Q

location of furcation entrance from CEJ (Dunlap and Gher) for mand 1st M

A

4 for B and L

38
Q

location of furcation entrance from CEJ (Gher and Vernino) for max 1st premolar

A

6

39
Q

which root of max M has the highest root surface area (Hermann)

A

MB (25%) and P (24%)

40
Q

which root of mand M has the highest root surface area (Gher and Dunlap)

A

M (37%)
D(32.4%)

41
Q

prevalence of IBR in mand 1stM

A

(Everett) 73%

42
Q

what are highly associated with IBRs (Hou and Tsai)

A

CEPs (63%) and class 3 furcations (25%)

43
Q

prevalence of palatoradicular grooves

A

Everett and Kramer: 1.9%
Gher and Vernino: 3%
Withers: 2.33% (4.4% in laterals)
Kogon: 4.6%
Hou and Tsai: 18.06% (Taiwanese)

44
Q

which teeth are affected by palatoradicular grooves

A

maxillary lateral incisors and central incisors with a possible predilection for individuals of Asian descent

45
Q

what is the effect of palatoradicular grooves on the periodontal health

A

-higher GI, PI, PD (mean: 8.8 mm)

45
Q

Cementicles

A

calcified spherical bodies (0.2 to 0.3 mm) composed of cementum lying free within the periodontal ligament, attached to the cementum, or embedded within it

45
Q

According to Holton et al, cementicles are often observed in which teeth? prevalence?

A

canines and molars with an overall prevalence of 34%

45
Q

cementicles in periodontal condition

A

The presence of cementicles has not been correlated with the pathogenesis of periodontal disease; however, root surfaces with cementicles might hinder mechanical instrumentation.

46
Q

Cemental tears

A

specific type of root surface fracture and characterized by the detachment of a cemental fragment

47
Q

cemental tear and perio (Moskow)

A

-located mostly at the coronal
third of the cementum, serving as susceptible sites for
calculus formation
-could be the result of inadvertent root gouging during mechanical instrumentation and can be associated with traumatic occlusion or traumatic events

48
Q

how to clinically detect cemental tear

A

-very localized deep pocketing and radiographically (about 50% of the cases) with a localized radiolucency surrounding a “prickle-like body”
-abscess
-pockets greater than 6 mm
-a positive vitality test, healthy opposing teeth, and moderate to severe attrition.

49
Q

how do dental materials affect periodontal health (Chan and Weber)

A

-aluminum-oxide base had minor plaque retention (32%), whereas PFM crowns (90%), natural teeth (110%), cast gold restorations (148%), and acrylic resin veneer crowns (152%) had substantially more plaque retention.
-van Dijken and Sjöström: no difference in plaque and GI with glass ionomer cement and composite versus enamel for Class V subgingival
-Proceedings from the 2017 World Workshop on the classification of Periodontal and Peri-implant Diseases and Conditions concluded that dental materials act similar to enamel as plaque retentive factors to initiate gingivitis

50
Q

effect of subgingival margins on periodontal health with respect to the Schatzle and Lang studies.

A

-Schatzle 2001: A 26-year longitudinal study; subgingival margins exert a detrimental effect to gingival and periodontal health; loss of attachment clinically detectable 1-3 years after subgingival resto but then a “burn-out” effect occurs.
-Lang 1983: restorations with overhanging margins resulted in changes in subgingival microflora - increased proportions of gram
neg anaerobic bacteria, black-pigmented Bacteroides, and an increase in anaerobe:facultative ratio were noted. These changes may potentially initiate periodontal disease associated with iatrogenic factors.

51
Q

effect of overhang margins on perio health, WRT Jeffcoat and Howell; Pack

A
  • Jeffcoat and Howell: amalgam overhangs on the alveolar bone height. only medium and large (so over 20% interprox space occupied) overhanging restos had sig bone loss when compared with control teeth

-Pack: most overhangs were associated with PD >3mm (64.3%) and BOP (32%).

-Lang: overhangs produce more gingival inflammation and shift the microbiome more towards gram -’ve + anaerobic + elevated levels of black pigmented bacteriodes.

52
Q

does removing overhangs help in periodontal health

A

Removal of overhangs+plaque elimination results in significant reduction of GI and it is recommended during the initial phase of periodontal therapy

Rodriguez-Ferrer 1980: greatest change in the first 4 weeks

perio: the complete summary (1 decks)

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