Dr. Wang says you should know...

Question 1

How do you define active disease? Why?

Answer 1

2mm of CAL progression over 12months

Probing error is 0.75mm (0.8mm) - 2.5x the error = Progression

Goodson

Question 2

How many milimeters deep should an implant be placed in posterior and anterior?

Answer 2

1.5-3mm below CEJ in posterior

3-4mm below CEJ in anterior

Question 3

What rule for M-D space for implants?

Answer 3

5-8-8-9 - Space from root - center of implant, center of implant to center of implant

Question 4

How can you create papilla

Answer 4

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

Question 5

What are characteristics of Gargiulo et al 1961 that we should consider?

Answer 5

Cadaver study on ERUPTION PHASE teeth

Range of Junctional Epithelium from 1 - 10mm!

Connective tissue is CONSTANT (~1mm)

Question 6

How do you treat Excessive Gingival Display?

Answer 6

Silberberg 2009

Question 7

Where should you create your periosteal incision in your flap to increase flap elevation?

Answer 7

3-5mm above the MGJ

Question 8

What happens to transseptal fibers after extraction/implant placement

Answer 8

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

Question 9

Edwards 1971

Answer 9

Supra-crestal fibrotomy every 2 weeks - 4x - reduce relapse to 30%

Question 10

What kind of bone formation do you get from BMP - why is this significant?

Answer 10

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

Question 11

4 things you must know about ONJ

Answer 11

No osteoclast activity

No blood supply

Impaired epithelial cell migration

Bacterial infection

Question 12

When predicting papilla fill. What percentage probability drop do you have from 5mm to 6mm?

Answer 12

Tarnow 1992

42%

4mm - 100%
5mm - 98%
6mm - 56%
7mm - ~25%

Question 13

What is the bone level to papilla tip that can be expected between 2 implants? Why?

Answer 13

3mm

Tooth is 5mm - Tooth has a CEJ - Biologic width is 2mm of CT - No CT on implant so lose 2mm

Question 14

How much of periimplantitis is caused by excess cement?

Answer 14

81% (Wilson 2015)

Question 15

What is the primary AND SECONDARY etiology of periimplantitis

Answer 15

Primary - bacterial dysbiosis and its biproducts in a suseptable host with exaggerated host response

Secondary - Calculus and its biproducts

Question 16

What is a predisposing factor?

Answer 16

Something that puts you at risk of developing a disease/condition (ie. overhang which traps plaque)

Question 17

What is a precipitating factor?

Answer 17

Something that causes the disease/condition (ie. Plaque causes the inflammation)

Question 18

Mechanisms of Diabetes and Smoking

Answer 18

• 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
  • Effects
    
    • Reduced chemotaxis of immune cells
      
      • impaired healing

Question 19

What are the links between Rheumatoid Arthritis and Periodontitis?

Question 20

How do restorations relate to periodontal disease

Answer 20

Position of the margin - must be accessible for patient to clean

Question 21

How does subgingival restoration effect gingiva?

Answer 21

Pontoreiero - recession in thin, inflammation in thick

Question 22

What is the prevalence of PIM and PI?

Answer 22

Derks & Tomasi 2015

PIM: 43%
PI: 22%

Question 23

KAN 2003

Answer 23

Interproximal bone level of a single implant is determined by the bone level of the adjacent teeth

Question 24

Dr. Wang’s graft formula for lateral window

Answer 24

4:1

Cortical : Cancellous

Question 25

How long does it take to scale posterior teeth?

Answer 25

39min Maxillary posterior

25min Mandibular posterior

Stambaugh 1981

Question 26

How is calculus adhered to the root?

How is this related to why we used to think we had to root plane?

Answer 26

RISP (Zander 1953)

Resorption

Irregularities

Secondary cuticle

Penetration (refuted by Canus 1979)

Theorized that planing would remove penetrated calculus

Question 27

How much calculus can you remove in non-surgical vs surgical? (3 citations to remember)

Answer 27

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%

Question 28

Furcation entrance according to Gher & Dunlap and Bower

Answer 28

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

Question 29

Why do they only achieve 50% clean of the root surface with surgical in the Caffesse study?

Answer 29

They were using MWF - which does not expose the crest!

Question 30

What is the difference between gingivitis and periodontitis?

Answer 30

Page and Schroeder

Apical migration of JE

Bone Loss

Clinical attachment loss

Question 31

What is the most consistant fiber in the gingival fibers?

Answer 31

Trans-septal fibers

Question 32

What are the 4 risk determinants

Answer 32

Age
Gender
Ethnicity
Gentics

Question 33

What are risk predictors?

Answer 33

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…

Question 34

Mattila et al. 1995

Answer 34

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.