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Classic Lit Fall 2021 > Conventional/advanced perio/implant diagnostics > Flashcards

Conventional/advanced perio/implant diagnostics Flashcards

1
Q

What parts of a visual inspection are important for diagnosing perio and periimplantitis?

A

Visual signs of inflammation (Redness, Heat, Swelling, Pain, Loss of function), color differences between KG and AM (Orban 1948)
Plaque, Calculus (Low 1967)

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2
Q

What are the traditional clinical diagnostic parameters for perio/periimplantitis?

A

PD, REC, CAL, BOP, MGJ, Furcation, Mobility,

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3
Q

What statistics are the for BOP

A

98% Negative Predictive Value (No BOP - No disease)
BOP+ Does not mean disease (Lang 1990)

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4
Q

What does recession indicate?

A

Traumatic habit
History of Perio
Jepson 2018

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5
Q

What does CAL tell us

A

Strong predictor of future breakdown (Van der Velden et al. 2006)
Key criterion for stage/grading (Tonetti)

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6
Q

How does furcation involvement effect tooth-loss risk?

A

2x risk for molar loss (Nibali et al. 2016)
Questionable prognosis (Becker)

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7
Q

What limitations does a prob have? What is the Probing error?

A

Measurements can vary: Inter-examiner difference in Force, Angle, Reading error, Proficiency, deeper pockets
0.8mm (Goodson et al. 1984)

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8
Q

What is the name of the pressure controlled probe?

A

the Florida Probe

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9
Q

How is BOP different for Implants?

A

Not as good an indicator.
0.5N force reaches 0.7mm further on healthy implant (Armitage et al. 1977)
Prob can reach CT in health (Lang et al. 1994)

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10
Q

What other methods are there for testing mobility?

A

Periotest (little hydrolic hammer)

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11
Q

How do you measure gingival thickness?

A

Probe transparency (Rasperini) (Kan 2010)
Transgingival probing

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12
Q

What differentiates peri-implant mucositis from peri-implantitis?

A

progressive loss of supporting bone
Berglundh 2018

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13
Q

What are inaccuracies of radiographs?

A

30% loss of mineral density has to occur before it shows up (Ortman et al. 1982)
Attachment loss precedes bone loss by 6-8mo (Goodson 1984)

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14
Q

What does presence of Lamina Dura indicate? Lack of LD?

A

Presence is a good indicator for health
Absence does not mean disease (Rams et al. 1994)
Presence had 100% Negative Predictive Value for bone loss at 24mo

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15
Q

What are downfalls of CBCT?

A

slight inaccuracy (low accuracy of buccal bone measurement if <1mm) Gonzalez-Martin 2016
High radiation dose

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16
Q

What visualizing method is advantages about US?

A

BMode - cross sectional, anatomical imaging - can visualize the anatomical structures of perio soft and hard tissues

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17
Q

How does ultrasound generate an image?

A

Based on:
reflection, scattering, and attenuation
each pixel is assigned a grey scale of the amplitude of the echo.

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18
Q

What does Color Flow do for us?

A

allows a visual inspection of tissue perfusion and inflammation in the scanned area

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19
Q

What does red and blue indicate in color flow?

A

Red - toward ROI
Blue - Away from ROI

20
Q

How can color flow show inflammation?

A

Can quantify visible blood vessel density as a surrogate for the degree of inflammation.

21
Q

What applications are there for US?

A

implant planning, intraoperative, post-op monitoring.
Eval of vital structures
Hard and soft tissue dimension (Chan et al. 2020)
Peri-implant health status (Barootchi et al. 2021)

22
Q

What biomarker has the best sensitivity and specificity?

A

Kinney et al. 2014
Saliva: 93/26
GCF: 23/95
Saliva + GCF + plaque + PDs: 70/70

23
Q

What are 1st generation probes?

A

Manual probes

24
Q

What are 2nd generation probes?

A

Constant force probes (Armitage 1977 0.25N)

25
Q

What are third generation probes?

A

Constant force with computer assistence (florida probe)

26
Q

What are 4th generation probes?

A

3d probes - sequential probe positions are measured

27
Q

What are 5th generation probes

A

3D and non-invasive - Ultrasound

28
Q

What is the probing error and why?

A

0.8mm Goodson 1986
Angle, pressure, inflammation, tooth surface

29
Q

What is the sensitivity, specificity, and NPV of BOP?

A

Lang 1990
29%
88%
98%

30
Q

When is BOP significant?

A

When it happens at multiple visits
Lang 1990 - sites with BOP at 5/6 visits had 2mm attachment loss

31
Q

How is pain associated with probing?

A

Pain is related to level of inflammation (Newcomb 2015)

32
Q

What pathologies are associated with a narrow PDL?

A

Hypophosphotemic rickets
Fibrous displaysia
Ankylosis

33
Q

What pathologies are associated with widened PDLs?

A

GOSH TB
TFO,
osteosarcoma,
Scleroderma,
BRON/J,
hyperparathyroidism,
Gaucher’s Disease

34
Q

How accurate is a furcation arrow?

A

Sensitivity of 38.7%
Deas et al. 2006

35
Q

How can we grade vertical furcation involvement?

A

Tarnow & Fletcher (10yr survival)
A: 0-3mm (91%)
B: 4-7mm (67%)
C: 7+mm (23%)
Tonetti 2017 (thirds)

36
Q

What is the OR of losing a tooth depending on vertical furcation?

A

9.83 Type A vs Type B/C
Nibali et al

37
Q

What are some inflammatory biomarkers?

A

IL1
IL4
IL6
IL8
IL10
TNFa

38
Q

What are some tissue destruction biomarkers?

A

MMPs (Collagenases/Gelatinases)
TIMPs
TGFb
Aspartate aminotransferase (dead/dying cells)

39
Q

What are some biomarkers related to bone remodeling?

A

RANKL
OPG
CTIP (fragmant of bone - type I COL)

40
Q

How heritable is periodontitis?

A

50%
Michalowicz et al. 2000
Increases with severity (Nibali et al 2019)

41
Q

What gene is predictive of severe perio?

A

IL1 genotype: OR 18.9 for severe perio
Kornman et al1997

42
Q

What are some new forms of imaging?

A

CBCT
Laser dopler flowtrometry
Ultrasound
Optical Coherence Tomography

43
Q

What is LDF? How does it work?

A

Real time technique for continues measures of blood perfusion
Dopler shift - change in wavelength due to reflection off moving objects (red blood cells)

44
Q

What is a benefit of LDF

A

No contact with tissue - no compression

45
Q

What is OCT? How does it work?

A

Optical Coherence Tomography
Uses a lightly focused near infrared light to provide high rez cross sectional images

Classic Lit Fall 2021 (29 decks)

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