Dental 1 Flashcards
give canine adult dental formula
2 (3/3 1/1 4/4 2/3) = 42
give cat adult dental formula
2 (3/3 1/1 3/2 1/1) = 30
no: max P1, max M2, man P1 or 2, man 2 or 3
label
1, Vestibule; 2, canine tooth; 2a, philtrum; 3, hard palate; 4, soft palate; 5, tongue; 6, sublingual caruncle; 7, palatoglossal arch; 8, palatine tonsil; 9, frenulum. (From Dyce KM, Sack WO, Wensing CJ: Textbook of veterinary anatomy, ed 4, St Louis, 2010, Saunders/Elsevier.)
label
how many apical foramina do dogs have
multiple
directional terminology: incisional teeth are labelled (name 4 sides)
palatal replaces lingual if referring to maxillary teeth
directional terminology: occlusal teeth are labelled (name 4 sides)
palatal replaces lingual if referring to maxillary teeth
what are 4 parts of the periodontium
PDL GAC: periodontal ligament, gingiva, cementum, alveolar bone
***what lines the gingival sulcus and is non-keratinized stratified squamous epithelium, extending from coronal limit of JE to gingival margin, and is a very important semipermeable barrier to the bacterial and gingival crevicular fluid; low PMNs
sulcular epithelium
!!!
***what is the epithelial barrier between the gingival sulcus and bacteria that directly attached to tooth at CEJ, PMNs present, and allows gingival crevicular fluid into sulcus
junctional epithelium
!!!!
this transudate or exudate has biochemical factors and is present in a small amount in healthy sulcus.
gingival sulcular fluid ie gingival crevicular fluid GCF
what are 4 functions of gingival sulcular fluid ie gingival crevicular fluid GCF
cleanse material from sulcus
has plasma proteins to improve tooth adhesion
possible antimicrobial properties
Abx activity to defend gingiva
what Is the vascular and highly cellular connective tissue continuous with connective tissue of gingiva, containing collagen fibres including Sharpey’s fibres
PDL periodontal ligament
what are some cells in PDL
connective tissue: fibroblasts, cemetoblasrts, osteoblasts
rests of malassez: epithelial rest cells
immune cells
neurovascular elements
what is purpose of PDL
soft tissue to prevent vessels and nerves from injury, transmit occlusal forces to bone and resist their impact, and keep teeth and gingiva in proper relationship to one another
this material, is avascular, no innervation, little/no remodelling, acellular and cellular components, and is permeable
cementum
this material contains 2/3 hydroxyapatite, 1/3 organic material, is lamellate and bundle bone, houses teeth, constantly remodelled
alveolar bone
6 ways PDD is classified
gingival dz
chronic periodontitis
aggressive peridontitis
necrotizing periodontal dz
periodontitis assoc w endodontic leisons
developmental or ac acquired abnormalities
reversible plaque-induced inflammation of gingival tissues is called
gingivitis
this develops in 2-4 days within accumulation of plaque, clinically healthy gingiva, edema may develop, and gingival sulcus may be deeper due to edema
initial gingivitis
this occurs when there is significant inflam filtrate in gingiva, collagen depletion, JE and SE form pocket epithelium loosely connected to tooth, there is increase operability to underlying tissues and bleeding on probing
Grade II or established gingivitis
this phase/grade/? marke transition from gingivitis to periodontitis: neutrophils predominate of the inflammation cells, JE migrates apically in attempt to maintain an epithelial barrier, osteoclastic bone resorption begins, and a deeper PD pocket develops promoting PD pathogen growth
advanced gingivitis
what is periodontitis
microbial assoc host mediated inflammatory that results in loss of periodontal attachment, detected as clinical attachment loss (CAL) by probing with reference to CEJ
what is difference between extent and severity of periodontitis
extent - how many teeth it affects (localized <30% dentition, generalized >30%)
severity - how it affects each tooth (mild <25%, moderate 25-50%, severe >50% AL)
stages of periodontitis: I, II, III, IV
I 1-2 mm interdental CAL; II 3-4, III and IV both => 5
I and II horizontal bone loss mostly; III and IV also vertical bone loss and furcation
IV add on secondary effects to rest of mouth
grading of periodontitis: slow, moderate, and rapid rate are called
Grade A, B, C
3 steps to staging and grading a periodontitis patient are
initial case overview to assess disease
establish stage
establish guide
it is a continuum of disease not just “stage XYZ dental””; needs to be treated over time to accurately assess and diagnose
what are the 3 types of periodontal pockets
gingival pocket
suprabony pocket
infrabony pocket
what is the most common pattern of bone loss, in which the alveolar margin is lost parallel to CEJ
horizontal bone loss
what is bone loss that is vertical or angular defect parallel to root surface, with accompanying infra bony or infra bony pocket, and defects classified by number of osseous walls (4 walls best, 1 wall worst)
vertical bone loss
red arrow
what are 4 phases of periodontal tx
diagnostic phase, hygiene phase, phase I, phase II
order???
what is the diagnostic phase of periodontal tx
dental charting and full mouth rads (dog 14 views, cat 10 views)
need to correlate clin and rad findings… each tooth gets own periodontal dx
what is phase I therapy for periodontitis
complete removal plaque and calculus, correct orthodontic conditions, treat food impaction areas, treat occlusal trauma, extract hopeless teeth, adjunctive tx as needed
what is hygiene phase of periodontal tx
operator prep and patient prep, then supra and sub gingival scaling (using hand or mechanical instruments), then can assess sib gingival spaces and PE pockets to see if further intervention needed
what is advanced non-surgical therapy for periodontitis and when is it indicated
therapy not designed to tx periodontal pockets, indicated when pockets are under 5 mm in depth and/or furcation defects present
what does advanced non surgical therapy for periodontitis consist of
scaling and root planing
subgingival curettage
periodontal debridement
after periodontal therapy, can you expect a gain in attachment? why about restoration of continuity of marginal gingiva at base of pocket?
nnec; yes, will restore continuity by arresting bone destruction and healing by scar
is polishing teeth needed
cosmetic, little therapeutic value, unnecessarily extends anes, can cause changes to tooth strs
what is critical to success of non-sx or surgical periodontal therapies
home care: tooth brushing daily
what is phase II therapy for periodontitis? when is it done?
techniques perofrmed for pocket therapy and for correction of deep pockets and bone loss that couldn’t be addressed by phase I
4 weeks after phase I
types of pocket surgery
resective (gingivectomy/gingivoplasty, apically displaced flaps, undisplaced flaps, extraction of tooth)
reconstructive (periodontal reconstructive surgery, which is GTR guided tissue regeneration)
we aim to eliminate pathologic changes in pocket walls, increase accessibility to root surface reduce or eliminate pocket depth, and/or reshape hard and soft tissues to attain harmonious topography. what are we doing?
phase II therapy for periodontitis - specifically, surgical pocket therapy
gingival cleft reconstruction, free gingival grafts, and crown lengthening procedures are all types of what
correction of anatomic/morphologic defects for periodontal surgery
what are indications for periodontal surgery
regions with bony contours, deep craters
pockets >5mm in depth bc can’t be cleaned non-surgically
infra bony pockets or medial and distal aspects of mandibular 1st MR pr palatial aspect of maxillary canines
stage II furcation defects
- Characteristics of the pocket: depth, configuration etc
- Accessibility to instrumentation
- Existence of mucogingival problems
- Response to Phase I therapy
- Client cooperation
- Age and health of the patient
- Overall diagnosis of the case (type of periodontitis present, etc)
… these are all criteria for what
method selection for periodontal surgery
what are contraindications for periodontal sx
poor systemic health
unmanaged systemic illness
terminal periodontitis
noncompliant O
inexperienced operator (consider referral)
4 critical zones in pocket surgery
soft tissue pocket wall
underlying bone
tooth surface
attached gingiva
what is gingivectomy and what margins do you need
excision of gingiva
2 mm of gingival around tooth needed to maintain healthy perfusion
4 kinds of this procedure: scalpel, Bur, electrosurgical, laser (type of respective pocket surgery). also which of these kinds is not recommended.
gingivectomy (a type or respective periodontal pocket surgery)
electrosurgical (risk of bony injury higher)
why do we use periodontal flaps for periodontal surgery
direct visualization for effective cleaning and allowing access to hard tissues, as well as eliminating pathological pocket wall and covering exposed surfaces
how are periodontal flaps classified? 3 ways
- bone exposure after flap reflection (full vs partial thickness)
- placement of flap after sx (displaced or not displaced)
- management of papilla (preservation vs non preservation)
periodontal flap incisions can be positioned ____ or _____
horizontally or vertically
what are 2 common types of periodontal flaps
undisplaced flap (to completely remove PD pocket, most aggressive type)
apically displaced flap (move gingival attachment apically on toot, reducing the pocket depth; only done on single rooted teeth)
what are 2 problems with crown root fracture
increased probing depth
complicated fracture
what are 2 solutions to crown root fracture
crown lengthening type II
root canal therapy
main indication for this flap is to cover denuded areas of root, ie gingival cleft defects, and it is a combination of full thickness and partial thickness flap
lateral sliding flap
need 2 mm gingiva at all teeth
PD reconstruction: what is ideal outcome? are resective techniques used?
creating new attachment (bone regrowth and PD repair (healing)) via regeneration of PD tissues
no this is not a respective technique, it is a reconstructive technique for periodontal pocket surgery
healing after GTR (guided tissue regeneration): healing is determined by what
which cell popn arrives in pocket first
indications for guided tissue regeneration
vertical bone defects (2, 3, or 4 wall defects; 1 wall defect poor px)
stage II furcation defects (mandible good px, maxilla guarded px)
what are most common locations for guided tissue reconstruction in vet patients
medial and distal aspects of mandibular first molar
furcation defects in mandibular first molar
furcation defects in maxillary fourth premolar
palatal aspect canine teeth
- Design and raise appropriate flap
- Meticulously clean the pocket and root surface
- Place graft material
- Contour and secure membrane
- Meticulous closure
…this is the process for what
guided tissue regeneration (type of regenerative PD pocket surgery)
- Meticulous cleaning of the pocket
- Appropriate placement of the membrane is critical
- Ensure membrane does not become exposed
- Homecare
- Follow-up is critical
…these are the keys to success for what
guided tissue regeneration (type of regenerative PD pocket surgery)
