EIT Skills Flashcards
Perio Staging
Perio Grading
Miller Classification of Mobility
Class 0:
* Normal physiologic mobility
Class 1:
* Slightly more than normal
Class 2:
* moderately more than normal (</= 1mm)
Class 3:
* severely more than normal (> 1mm) & Vertically depressable
Hamp Furcation Classification
Class 0:
* No furcation involvement
Class 1:
* Horizontal furcation involvement < 3mm
Class 2:
* Horizontal furcation involvement > 3mm
Class 3:
Through-and-through furcation invovlement
What are some factors that predispose a tooth to furcation involvement?
- Short root trunk
- Short Roots
- Narrow interradicular dimensions (B/w roots)
- Cervical enamel projections
Gingival Recession Classification
Type 1:
* recession w/no interproximal attachment loss
* Interproximal CEJ not detected clinically
Type 2:
* recession w/loss of interproximal attachment
* interproximal attachment loss </= buccal attachment
Type 3:
* recession w/interproximal attachment loss
* interproximal attachment loss > Buccal attachment
Prognosis: McGuire & Nunn
Good:
* Good control of hygiene
* High likelihood to maintain tooth w/proper maintenance
Fair:
* 25% CAL
* Class 1 Furcation-cleansable
Poor:
* 50% CAL
* Class 2 Furcation
* Maintenance possible but difficult
Questionable:
* >50% CAL
* poor clinical crown:root ratio
* Class 2/3 Furcation
* Class 2/3 mobility
Hopeless:
* Severe CAL
* ext suggested
Seibert’s Classification of Ridge Defects
Class 1=Horizontal
Class 2: Vertical
Class 3: Combination
Perio Tx Planning: Long Term Goal
Arrest CAL
Reduce Tooth Loss
Eliminate Pain
Stabilize Occlusal Function
Prevent recurrence
Phase 0 Tx planning
Tx emergencies
Ext hopeless teeth
Phase 1 Tx planning
Non-surgical
* Diet & Caries control
* OHI
* Pt education
Prophy/SRP + EIT
Local/Systemic Antibiotics
Phase 2 Tx planning
Surgical
Regenerate periodontal tissue & eliminate pockets
* includes implants and ends
Phase 3 tx planning
Restorative
Phase 4 tx planning
Maintenance
* Ongoing evaluation
* every 3 months for 1st year
Risk Factor
Causal Association
* Smoking causes perio
Risk Determinant
Unchangeable characteristic
* Genetics, Gender
Risk Indicator
Does not casual but still associated
* Stress
Flap Design
- Wider base-adequate blood supply
- Incisions over intact bone– NOT over bondy defects or eminences
- Rounded Corners
- Vertical Releases at Line angles
- Avoid Vital Structures
Partial Thickness Flap
Gingiva/mucosa, submucosa
* mucogingival surgery
* does not expose bone
* leaves vascular bed intact for grafting
Full thickness Flap
Gingiva/mucosa, submucoa, periosteum
osseous surgery & periodontal regeneration
exposes bone
* expect 1 mm of resorption
* bad for thin bone where dehiscence/fenestraction likely
If no response to SRP, whats next?
Open Flap Debridement
Osseous Surgery
Open Flap Debridement
Increased access for SRP
3 incisions (Modified Widman)
1. Internal/Reverse Bevel- 1mm from margin
2. Sulcular-horizontal across crest
3. interproximal-removes tissue collar
Apically-repositioned Flap
* attain pocket reduction
Distal wedge
* Pocket reduction
* after 3rd molar ext
* max- parallel
* mand- V
Osseous Surgery
Same as OFD, but recontours bone to resemble healthy periodontist
positive architecture
* interproximal bone is above radicular bone (normal)
Ostectomy vs osteotomy
Ostectomy
* remove supporting bone
Osteotomy:
* remove non-supporting bone
Regeneration vs Repair
Regeneration
* Complete restoration of architecture/function
Repair:
* not complete
* scarring/ form LJE
Periodontal Pack
contains ZOE (Zinc oxide Eugenol)
1 week after surgery
Gingivectomy vs Gingivoplasty
Gingivectomy
* excise supra bony pockets or enlarge gingiva
Gingivoplasty
* excise gingiva to reshape deformities
* heal by secondary intention due to NO PRIMARY CLOSURE
Free Gingival Graft
Widen keratinized tissue
Connective Tissue Graft
Root Coverage
Frenectomy vs Frenotomy
Frenectomy:
* Completely removes frenum
Frenotomy:
* incision only
Periodontal Regeneration
GTR-Guided Tissue Regeneration
* Regenerates bone, PDL, cementum
Barrier Membrane
* Prevents soft tissue downgrowth
* allows bone ingrowth
* non-resorabable: have to remove, but last longer
* resorbable: more common, resorbs quickly before optimal bone fill
Graft:
* osteoconductive: scaffold
* osteoinductive: progenitor cells-> osteoblasts
* osteogenic: make bone
* Autograft: you
* Allograft: Another human
* Xenograft: animal
* Alloplast: synthetic
Biologic Agent:
* creates environment conductive to tissue formation
In wound healing, tissues populate from quickest to slow in what order
Epithelium
CT
PDL
Bone
EDTA
expose collagen
might improve attachment
Tetracyclines
congregate in GCF (Gingival Crevicular Fluid)
Doxycycline-1 dose per day
Amoxicillin + Metronidazole
Amox: 500 mg TID
Metro: 250 mg TID
14 days
avoid alcohol
Arrestin
Common intramuscular antibiotic
PD>/= 5mm, GAIN in CAL
* Local minocycline
NSAIDs
inhibit prostaglandins that cause inflammation
Bisphosphonates
inhibit osteoclasts
SDD
Subantimicrobial Dose Doxycycline
* inhibit MMPs that destroy collagen
20mg TID for 3-9 mos
What biologic agents are used in periodontal regeneration?
Emdogain
PDGF
Critical Pocket Depth for SRP vs Surgical Therapy
SRP: 2.9 mm
Surgical Therapy (modified Widman flap): 4. 2 mm
PD above= attachment gain
