E2 Flashcards
Root trunk length for maxillary molars?
F 4mm
M 3mm
D 5mm
Root trunk length for mandibular molars?
F 3mm
L 4mm
Root trunk length for maxillary bicuspids?
M 7mm
D 7mm
What is defined as a short root trunk length?
1-2 mm
What is defined as a long root trunk length?
> 4mm
Why do premolars with furcation involvement have a very poor prognosis?
bc of their long root trunk length
What is the average root trunk length? And what teeth commonly have this length?
3 mm
Facial Mandibular 1st molar
Bifurcation ridges are present in ___% of _____ molars
73%
mandibular
From what aspect would you probe a mesial maxillary furcation?
from the palate
Glickman’s Class I Furcation Involvement
Incipient bone loss
Radiographically not evident
(defined as incipient bone loss in the furca opening)
Glickman’s Class II Furcation Involvement
Partial bone loss (cul-del-sac)
Depth will vary: early or advanced
Radiograph may or may not appear
Glickman’s Class III Furcation Involvement
Through-and-through bone loss (all the way through the furca to the other side)
Inter-radicular bone is completely absent
Radiographic evidence is a usual finding
Glickman’s Class IV Furcation Involvement
Through-and-through with furcation exposure due to gingival recession
Almost always shows on radiographs
What are the 4 root anatomy modifying factors of furcation involvement?
form
proximity
grooves & concavities
bifurcation ridges
How is the Hamp classification system for furcations different from Glickman?
Hamp is the same except is doesnt recognize a class IV. Hamp combines class III and IV so the hamp system only goes up to class III (i.e. class I 2mm; class III is through-and-through)
CEP Grade I
Distinct changes in the CEJ that projects toward the furca
CEP grade II
CEP approaching furcation
CEP grade III
CEP at the roof of or into the furcation
Noted CEPs in > __% of isolated mandibular molars with furcation involvement
90%
__% associated b/w the presence of a CEP and furcation involvement
50%
Where are enamel pearls most common?
third molars (75%)
Percentage of molar teeth with accessory canals that exit in the roof of the furca: \_\_% max 1st molars \_\_% mand 1st molars \_\_% mand 2nd molars \_\_% max 2nd molars
36%
32%
24%
12%
In non-vital teeth or those with pulpitis, accessory canals are often associated with…
Abscess “blow-outs” of the furcal bone
What are the top four teeth most frequently lost?
List in order starting with most frequent
Max 2nd molar
Max 1st molar
Mand 2nd molar
Mand 1st molar
Top two types of teeth LEAST frequently lost? List in order from more frequently to least
Maxillary cuspid (2nd least frequently lost) Mandibular cuspid (least frequently lost tooth)
Treatment options for increasing the width of attached gingiva?
1) apically positioned flap (APF)
- full thickness flap
2) free autogenous gingival graft (FGG)
3) Subepithelial connective tissue graft (CTG)
Treatment options for obtaining root coverage?
1) Subepithelial connective tissue graft (CTG)
2) Semi-lunar incision + coronal positioning (Tarnow Procedure)
3) Lateral pedicle flap (LPF)
Indications for The Free Autogenous Gingival Graft (FGG)?
increase width of attached gingiva remove abnormal frenulum attachment deepen oral vestibule ridge augmentation procedures cover exposed roots (*****rarely used for this purpose)
Advantages of FGG?
Not technically demanding
May be accomplished with partial or full-thickness flap reflections
Wide variety of clinical applications
Disadvantages of FGG?
Poor ability to provide blood supply to graft for root coverage
Esthetic results are comprised due to scarring during healing resulting in poor color match
Surgery required at two intraoral sites
Donor site may present problems with bleeding, pain, and slow healing
Indications for The Subepithelial Connective Tissue Graft (CTG)?
Acquire a width of attached gingiva Deepen oral vestibule Remove frenulum and muscle attachment Acquire esthetic attached gingiva (color match) Cover exposed root surface
Advantages of CTG?
High predictability
Graft received abundant blood supply
Palatal wound (donor site) can be surgically closed, thereby facilitating rapid healing with little to no discomfort or bleeding
Good color match
Applicable for recession on multiple teeth
Disadvantages of CTG?
Technically demanding
Gingivoplasty may be necessary after healing to obtain better tissue contours and to decrease thickness
Indications for Semi-lunar incision with coronal positioning (Tarnow Procedure)?
Maxillary anterior teeth with no more than 2mm of recession and 3-5mm of remaining keratinized gingiva
A complimentary procedure for small areas of gingival recession remaining after other procedures were used for root coverage
Advantages of Tarnow Procedure?
No tension or coronal positioned flap No narrowing of the oral vestibule Good esthetics due to color match Papillary height is preserved Simple surgical procedure Minimal post-op discomfort Applicable to minimal gingival recession across multiple teeth
Disadvantages of Tarnow Procedure
Not applicable in cases of moderate to advanced gingival recession, i.e greater than 2mm
Requires 3-5mm of thick keratinized tissue
Healing is by secondary intention and therefore some contraction occurs
May require a second procedure depending on occurrence of tissue contraction
Where osseous dehiscence or fenestration exists apical to the gingival recession area, a FGG or CTG should be performed after coronal positioning of the semi-lunar flap
