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Patho Phys Exam 1 > Clinical Correlates > Flashcards

Clinical Correlates Flashcards

1
Q

When does the second phase (late phase) of wound healing start

A

Day 2-3

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2
Q

Late phase involves what cells (4)

A

Monocytes
Macrophages
Fibroblasts
Mesenchymal SC’s

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3
Q

Bone vs tissue in wound repair

A

Last phase can last long in bone- woven bone to mineralized

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4
Q

Most variable phase?

A

Matrix formation (the last one) 10-100+days

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5
Q

Granulation/tissue formation/proliferation stage involves (2)

A

T-cells and endothelium

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6
Q

Cells in early phase(1)

A

PMNs

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7
Q

Hemostasis components involved(3)

A

RBC
Fibrin
platelets

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8
Q

Pure Mucogingival
Defect 2nd Premolar

Cause?

A

tooth erupted too buccal/bone was absent to begin with….. Then gingiva was brushed away (from chronic trauma)

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9
Q

How to treat Pure Mucogingival

Defect 2nd Premolar (Graft and donor sites)

A

Marginal Free Gingival Graft – 1° intention

Donor Site – 2°
intention

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10
Q

Primary intention healing

A

close the wound

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11
Q

Secondary intention healing

Explain and used in what (2)

A

leave an ulcerated area (no tissue covering) i.e. extraction socket

ulcerations and gingivectomy

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12
Q 
Miller class recession for Pure Mucogingival
Defect 2nd Premolar
A

Class II/III

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13
Q

Treating the Recipient Site Prep for Marginal Free Gingival Graft

Procedure/Prep (3 steps)

Where do you do excision? leave what intact?

A
  1. Primary Incisions
  2. Split-thickness flap
    – Sharp dissection
  3. Excision of flap at
    base     leaving bleeding connective tissue bed with periosteum layer intact
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14
Q

Donor site split flap will heal via what method?

A

secondary intention

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15
Q

Take tissue from where (labial or near palate?)

split flap is taken off what?

A

Labial-by cheek

taken off the periosteum

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16
Q

Grafts are mobile or not after surgery?

A

Immobile-don’t move it

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17
Q

Epithelial (Epi) will start migrating in the repaired area of a graft in how long? What about blood vessels?

A

12 hours for Epi

24-48 hours for vessels

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18
Q

What is important after surgery (think hemostasis)

A

Direct pressure to form a thin clot which will seal the wound

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19
Q

Angiogenesis will occur how long after gingival graft in the repaired area?

A

24-48 hours

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20
Q

Antiseptic mouth rinse post gingival graft?

A

Some people say yeah (he does), some say no-but…. DO NOT BRUSH (has to be immobile)

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21
Q

Why can you not brush after gingival graft?

A

It has to be immobile!!!

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22
Q

Who wrote the first paper on gingival grafting and healing? When was it written?

A

Atkins in 1966…

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23
Q

First 24 hours of healing you only get what

A

diffusion of oxygen-aka plasmatic circulation?

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24
Q

Red good after grafting?

A

Yes-means blood vessels are moving in

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25
Q

7 Day Normal Healing

Migration? How much if so?
Sutures?

A

Incision lines closed
– Epithelial cell migration
– 0.5 mm/day

Remove sutures
– Could slow healing

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26
Q

8 weeks FGG

Tissue attached to what?
What happens the next 3 months?

A

Tissue attached to root

Remodeling of wound edges over the next 3 months

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27
Q

how long will it take for tissue from graft to heal to the point that they will not know (secondary healing)

A

~1 week

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28
Q

How long does it take a clot to form in the secondary intention healing? Thus you are past early inflammation phase

A

~24 hours

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29
Q

Epi (epithelium) migration between clot and CT in secondary intention healing takes how long

A

48-72 hours

30
Q

Osteoclast and osteoclast activity takes how long to begin after a large wound is opened in secondary intention healing

A

Osteoclastic activity
– Maxes out in 2-10 days

Osteoblastic activity takes over…
– Maxes out in 10-28 days

31
Q

When does CT begin to organize in secondary intention healing at graft site

A

~7 DAYS, clot will convert to granulation tissue

by 8 wks bone loss has regenerated

32
Q

Grafting in diabetic patients

A

Simply a much slower process

33
Q

Age and healing in grafts

A

As one ages, wound healing slows

34
Q

Is the effectiveness of wound healing between healthy and diabetic diff in the long run or just the rate?

A

Just rate-they will heal equally as well just diabetics will heal much slower

35
Q

Clinical Consequences of extraction (4)

A
  • Alveolar bone resorption-horizontal & vertical
  • Increase functional demands on remaining dentition (more stress)

• Need for restorative
dentistry

• Unesthetic appearance
– Loss of papillae – Shadows

36
Q

Modernly..Extraction: Clinical Considerations

What are we doing differently? Why?

A

Socket Grafting/Ridge
Preservation

Post- extraction ridges shrink over time
– 2-3mm horizontal ridge reduction
-1 mm vertical ridge reduction

37
Q

Study by who and when on extraction socket anatomy

A

Januario 2011

38
Q

From what to what is thin bone found (what tooth to what tooth)

A

Canine to canine, particularly on the facial

39
Q

Two things supplying blood to the bone area

A

PDL and gingiva

40
Q

What happens during– Hemostasis/Inflammation (2)

A
  • Clotting

* PMN clean up

41
Q

Proliferative phase of socket extraction healing (2)

A

Angiogenesis/Granulation and provisional matrix

42
Q

Modeling and remodeling phases of socket extraction

A

Woven bone to lamellar bone

43
Q

Most variable stage of healing after graft

A

The mineralization of bone

44
Q

Overview: Socket healing by day

Day 1,2-3,7,20,38

This is from what study?

A

Day1
– Clot forms / PMN’s clean up

Day 2-3
– granulation tissue at base of socket

Day 7
– early CT & bone formation at base

Day 20
and bottom 1/3 of socket – complete clot organization & CT
fills socket

Day 38
– immature bone fills 2/3rd of socket

From Amler 1999

45
Q

Factors Influencing Resorption (7)

A

-Smoking
-General systemic health
-Condition of the socket pre and post op
-Influence of the tissue biotype
-Local differences in the sites of the mouth and the dental arches
-Type and quality of the intermin prosthesis
(flipper that does blanch the tissue)

46
Q

Early socket healing between 2-4 weeks of granulation tissue was studied by who and when

A

Trombelli 2008

47
Q

Early socket healing between of granulation tissue in one study was seen as fast as what?

A

2-4 weeks. This was that Trombelli guy.

Granulation Tissue
– Rapid angiogenesis
– Seen in 4 of 10 samples

– Other 6 samples had moved past this
phase

48
Q

Provisional matrix in early socket healing at 2-4 wks is made up of what 3 things?

A

– Densely packed
mesenchymal cells

– Highly vascular

– Dense fibrous tissue

49
Q

Immature woven bone makes up what % of intermediate socket healing from 6-8 wks?

What is the makeup of the rest???

A

immature woven bone (~33%)

Provisional matrix
(~60%)
– Cell & fiber rich

Very little granulation tissue remains (<5%)

50
Q

Early disruption dry socket clot formation research done when

A

1999

51
Q

Early disruption dry socket clot formation research… Pus leaving after 20 days means?

A

bad…. Neutrophils should have left a long time ago

52
Q

osteomyelitis and why?

A

infection of the bone, calculus was not removed in extraction

53
Q

Tx for osteomyelitis

A

Placed on metronidazole & Chlorhexidine rinses

54
Q

Why is healing on lower lingual bone hard

A

cortical bone-thick and does not heal well-little vasculature

55
Q

What to know about extraction in esthetic zone

A

prep for healing ahead of time

56
Q

Fractured ant tooth preferred Tx is what

A

placement
Extraction #8 &9
• Socket Preservation • Delayed Implant Placement
• FPD #7-10

57
Q

used to remove coronal aspect of roots

A

Periostomes

58
Q

Capset is made of

A

Calcium phosphate-artificial bone placement/holder

59
Q

Purpose of capset/FBDA + Biomend in socket

A

holding place for gingival tissue

60
Q

If you Flap it, you cause two things to happen…

2

A

– Lose periosteal blood supply temporarily

– Lose PDL blood supply permanently

61
Q

SIE stands for what?

A

• SIE

– Support immersion endoscopy

62
Q

WOUND repair progression (4 main phases)

A

Hemostasis –> Inflammation –> Granulation tissue Formation/Proliferation –> Matrix formation/remodelling

63
Q

Wound contraction starts in which stage and around what day in the phases of wound repair?

A

In early granulation formation stage which is around day 3

64
Q

How long after a graft will the stage of re-vascularization take to begin?

A

~30 hours, before this it is just circulation (oxygen diffusion)

65
Q

How long after a graft will the stage of vascular re-organization take to begin?

A

~9 days, goes through 28 days.

66
Q

When is the stage of organic union?

A

Part of stage of revascularization and vascular re-organization… Not really sure what this is though.

67
Q

Late socket healing (12-24 weeks) has components of what (4 things)

What makes up the bulk of most samples?

A

Woven bone~33%

Lamellar bone in deeper regions ~10%

Adipocytes in marrow spaces

Provisional matrix ~60% and makes up the bulk of most samples

68
Q

Over time in socket healing, what is replaced by what?

A

Granulation tissue is essentially replaced by lamellar bone

69
Q

Dry sockets are caused by a disruption in what

A

Fibrin clot-at about 2 days

70
Q

By what day will you have a dry socket after fibrin clot disruption?

A

~4 days

71
Q

20-30 days after clot disruption post socket surgery, what will be seen?

A

Dry sockets which have let to suppurative osteitis w/ boney sequestrum-The point is PMNs dominate the area and it is infected-Osteomyletis

Patho Phys Exam 1 (14 decks)

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