Dr. Wang says you should know... Flashcards
How do you define active disease? Why?
2mm of CAL progression over 12months
Probing error is 0.75mm (0.8mm) - 2.5x the error = Progression
Goodson
How many milimeters deep should an implant be placed in posterior and anterior?
1.5-3mm below CEJ in posterior
3-4mm below CEJ in anterior
What rule for M-D space for implants?
5-8-8-9 - Space from root - center of implant, center of implant to center of implant
How can you create papilla
Surgical means: Difficult because no bone to support - unpredictable
Orthodontic means: Most predictable way to grow true papilla
Restorative means: Larger crown - longer contact point
What are characteristics of Gargiulo et al 1961 that we should consider?
Cadaver study on ERUPTION PHASE teeth
Range of Junctional Epithelium from 1 - 10mm!
Connective tissue is CONSTANT (~1mm)
How do you treat Excessive Gingival Display?
Silberberg 2009
Where should you create your periosteal incision in your flap to increase flap elevation?
3-5mm above the MGJ
What happens to transseptal fibers after extraction/implant placement
The fibers will span the space between the two teeth after extraction. When an implant is placed, it will wrap around the implant to attach to the next tooth
Edwards 1971
Supra-crestal fibrotomy every 2 weeks - 4x - reduce relapse to 30%
What kind of bone formation do you get from BMP - why is this significant?
Endochondral ossification
Oral cavity is intramembranous - resists resorption
When you take bone from extra-oral source, get a large amount of resorption/shrinkage
BMP bone shrinks
4 things you must know about ONJ
No osteoclast activity
No blood supply
Impaired epithelial cell migration
Bacterial infection
When predicting papilla fill. What percentage probability drop do you have from 5mm to 6mm?
Tarnow 1992
42%
4mm - 100%
5mm - 98%
6mm - 56%
7mm - ~25%
What is the bone level to papilla tip that can be expected between 2 implants? Why?
3mm
Tooth is 5mm - Tooth has a CEJ - Biologic width is 2mm of CT - No CT on implant so lose 2mm
How much of periimplantitis is caused by excess cement?
81% (Wilson 2015)
What is the primary AND SECONDARY etiology of periimplantitis
Primary - bacterial dysbiosis and its biproducts in a suseptable host with exaggerated host response
Secondary - Calculus and its biproducts
What is a predisposing factor?
Something that puts you at risk of developing a disease/condition (ie. overhang which traps plaque)
What is a precipitating factor?
Something that causes the disease/condition (ie. Plaque causes the inflammation)
Mechanisms of Diabetes and Smoking
- Both have:
- Vasoconstriction
- Smoking
- Nicotine - doesn’t tell you how much
- Cotinine - TELLS YOU HOW MUCH - use this in research, not nicotine
- Diabetes
- AGE
- RAGE is on the capilary walls
- AGE deposite on the walls and thicken the walls, narrowing the vessels
- AGE
- Smoking
- Effects
- Reduced chemotaxis of immune cells
- impaired healing
- Reduced chemotaxis of immune cells
- Vasoconstriction
What are the links between Rheumatoid Arthritis and Periodontitis?
How do restorations relate to periodontal disease
Position of the margin - must be accessible for patient to clean
How does subgingival restoration effect gingiva?
Pontoreiero - recession in thin, inflammation in thick
What is the prevalence of PIM and PI?
Derks & Tomasi 2015
PIM: 43%
PI: 22%
KAN 2003
Interproximal bone level of a single implant is determined by the bone level of the adjacent teeth
Dr. Wang’s graft formula for lateral window
4:1
Cortical : Cancellous
How long does it take to scale posterior teeth?
39min Maxillary posterior
25min Mandibular posterior
Stambaugh 1981
How is calculus adhered to the root?
How is this related to why we used to think we had to root plane?
RISP (Zander 1953)
Resorption
Irregularities
Secondary cuticle
Penetration (refuted by Canus 1979)
Theorized that planing would remove penetrated calculus
How much calculus can you remove in non-surgical vs surgical? (3 citations to remember)
Waerhaug:
Shallow: 83%
(Flip 8 and 3)
Mod: 38%
(Add 8 + 3)
Deep: 11%
Caffesse (Non-surgical):
Shallow: 86%
(Divided by 2)
Mod: 43%
(Minus 11 from Waerhaug)
Deep: 32%
Caffesse (Surgical):
Shallow: 85%
(Minus 10)
Mod: 75%
Deep: 50%
Furcation entrance according to Gher & Dunlap and Bower
G&D
Max M: 3.6
Max B: 4.2
Max D: 4.8
(Add 0.6 to each)
Bower
Mand B: 3.14
Mand L: 4.17
Why do they only achieve 50% clean of the root surface with surgical in the Caffesse study?
They were using MWF - which does not expose the crest!
What is the difference between gingivitis and periodontitis?
Page and Schroeder
Apical migration of JE
Bone Loss
Clinical attachment loss
What is the most consistant fiber in the gingival fibers?
Trans-septal fibers
What are the 4 risk determinants
Age
Gender
Ethnicity
Gentics
What are risk predictors?
Factors that are created by the disease, are not part of the causal chain of disease, but can aid in future disease progression.
ie. Contributing factors
Furcation - not the cause of disease, but risk for future
Calculus…
Mattila et al. 1995
poor dental health is
a predictor of the incidence of fatal and
non-fatal coronary events for persons with
preexisting coronary artery diseases.
However, it does not prove causality.
