EndoPerio Flashcards
% NaOCl for irrigation
0.5- 5.25%
Management for hypochlorite accident
Irrigate with NSS everyday to the point na it is not harmful to the tissues
PDL average width
0.2 - 0.25mm
Widest at cervical and apical
Thinnest at middle portion
Gingival epithelium histologic divisions
Oral epith - keratinized stratified squamous (parakeratinized > orthokeratinized)
Sulcular epith - non keraritinized but can be keratinized
Junctional - non keratinized, thicker near the sulcus and thinner at the apex
Contents of gingival crevicular fluid
Type of transudate
Contains cells (neutrophils), enzymes, IgA
Becomes exudate
Dead neutrophils, enzymes, proteins, microorganisms
Parallel to the surface of the root
Oxytalan fibers
How to prevent relapse
Retainers
Overcorrection
Circumferential supracrestal fiberotomy
Type of collagen: gingival fibers
Type 1 collagen
Gingival fiber group that resists rotational forces
Circular fibers
Gingival fiber associated with relapse of ortho tx
Transseptal fibers
Most numerous principal pdl fiber
Oblique - higher attachment at alveolar to cementum
Pdl fiber group; Most resistant to forces along long axis of the tooth
Oblique fiber group
Primary fibers that resists tooth towards occlusal direction/extrusion, compressed during intrusion/mastication
Apical fiber group
periodontal fibers embedded in cementum and bone are called
sharpey’s fibers - mineralized
most numerous cells found in periodontal ligament
fibroblast
elastic-like fibers that run parallel to the tooth surface and bend to attach to cementum
oxytalan fibers
oxyphilic cells are seen in the parathyroid gland. function is unknown
free gingival groove is a line between? does it coincide with any landmark?
marginal gingival and attached gingiva
coincides with apical border of JE
part of the gingiva where you can find stipplings
attached gingiva
-measured from the free gingival groove to the mucogingival junction
attached gingiva is thickest at? thinnest at?
thickest at maxillary anterior region (labial of lateral incisors
thinnest at mandibular posterior region (lingual of premolars)
what is the source of blood supply of autografts (FGG)?
revascularized –> bed of recipient tissue
most common cause of failure of FGG
loss of blood supply infection
other name for interdental col
interdental saddle
probing force
10-25g or 0.022 lbs - 0.055 lbs
calcular deposits are composed of what minerals?
calcium and phosphate
immediately after cleansing a tooth, a thin film of saliva covers the tooth. it is called?
salivary pellicle - made up of glycoproteins
source for free gingival graft (autograft)
PALATAL area or edentulous region -deepithelialized. connective tissue ang nilalagay.
autografts doesn’t retain its blood supply
joint between a tooth and alveolar bone
gomphosis
most critical factor in determining if a tooth is candidate for extraction or gan be saved with surgical periodontal therapy
clinical attachment loss*
mobility
most common location of furcation involvement
maxilla > mandi
distal aspect of 1st and 2nd molars
best indicator to evaluate success of scaling and root planing?
significant reduction of plaque index and bleeding index
most common post op complication for SRP?
tooth sensitivity
gracey curettes for anterior teeth
gracey #1-2 and 3-4
gracey curettes for anterior and premolar
gracey #5-6
gracey curette for posterior teeth: facial and lingual surfaces
gracey #7-8 and 9-10
gracey curette for posterior teeth: mesial surface
gracey #11/12, 15/16
gracey curette for posterior teeth: distal surface
gracey #13/14, 17/18
rationale for using periodontal dressing after gingivectomy
reduce bleeding and pain
promote healing
mechanical barrier/protection
create a debris-free environment
contents of periodontal dressing
The liquid contains eugenol, rose oil or peanut and resin. The powder contains zinc oxide, powdered resin and tannic acid.
different toothbrushing techniques
bass method - 45 degrees towards sulcus
modified bass - bass + rolling stroke
stillman
charters - 45 degrees towards occlusal
what is fones technique, leonard technique, scrub tech?
fones - circular - least effective
leonard - vertical
horizontal -scrub - most commonly used by px
gingival enlargement involving the marginal and attached gingiva and papillae
diffuse
discrete- an isolated sessile or pedunculated, tumor-like enlargement
diseases associated with desquamative gingivitis
pemphigus vulgaris
pemphigoid
lichen planus
chronic ulcerative stomatitis
causative agent of NUG and NUP
fusobacterium
prevotella intermedia
spirochetes (treponema denticola)
how to classify localized or generalized aggressive periodontitis
localized - involves molars and incisors + at most 2 other teeth
causative agent of localized aggressive periodontitis
Aggregatibacter/actinobacillus actinomycetemcomitans
capnocytophaga ochracea
causative agent of generalized aggressive periodontitis
prevotella intermedia
eikenella corrodens
syndromes associated with severe periodontitis
chediak-higashi syndrome - cafe au lait
papillon-lefevre syndrome / palmoplantar keratoderma periodontitis - hyperkeratosis of palms and soles
down syndrome - due to increase P. intermedia
Lazy leukocyte syndrome
Leukocyte adhesion deficiency
primary proteinase that destroys periodontal tissue
matrix metalloproteinase (MMP) - degradation of ECM
contributing factor: Reactive oxygen species (ROS) - disrupt cellular proteins, depolymerize matrix components; can be protective as ROS kills pathogen but leaks out to CT
first colonizer of plaque
s. sanguis
(streps / yellow complex)
way of communication of microorganisms
quorum sensing
early/primary colonizers
yellow complex (strep)
blue complex (actinomyces)
late/secondary colonizers
*green complex
eikenella corrodens
actinobacillus actinotherapeutics
capnocytophaga
*orange complex
fusobacterium
prevotella
campylobacter
*red complex - causes bleeding
porphyromonas gingivalis
treponema denticola
tannerella forsythia
other name for the osseous defects
one wall - hemiseptum
two wall - osseous craters
three wall - INTRAbony defect
complete healing of tissue after flap surgery takes ____
1 month
full thickness flap (mucoperiosteal flap) vs partial thickness flap (split thickness)
full - inclues epith, ct and periosteum
-uses periosteal elevator
- less than 2mm width of attached gingiva
-alveolar bone exposed
partial - epith and CT only
-Bard parker knife
- >2mm width of attached gingiva
- alveolar bone not exposed
- diameter of periodontal probe
- UNC vs WHO probe
0.4 - 0.5mm
with graduation in millimiters
blunt, rod-shaped working end
UNC probe vs WHO probe
UNC - 12mm to 15mm, 1.0mm graduation
WHO - has a 0.5mm ball at the tip; measurements: 3.5, 5.5, 8.5, 11.5mm
Jacquette scaler vs sickle scaler
jacquette - straight blade
sickle - curved blade
face meets terminal shank at a right angle
area specific curette vs universal curette
universal - 90 degree, 2 cutting edge
asc - 70 degrees, 1 cutting edge
only hand instrument that is used with a push stroke to remove deposits on the lingual surface of anterior teeth
chisel
hoe- pull motion, 100 degree angle with terminal shank
the free gingival groove is most pronounced with what tooth/teeth in oral cavity
mandibular premolar and incisor regions
least frequent in mandi molars and maxi premolars
shape of interdental papilla
dependent on the space provided by two adjacent teeth
anteriors: pyramidal
molars: flattened mesiodistally
diastema: none
fibers located mostly at the apical 3rd for the viability of the blood vessels and support the functions of the root
reticulin fibers
fibers mostly found near blood vessels for dilation and constriction of blood vessels, for tooth mobility within the socket
elastic fibers
produces elastin which gives the gingiva its ability to recoil when food toches it
Sharpey’s fibres are derived from_____________?
A. Hertwig’s root sheath
B. Epithelial rests of malassez
C. Alveolar bone
D. Dental follicle
D
composed of epithelial cells, bacteria, bacterial byproducts but it is not adherent (airwater syringe or gargling can remove this.
material alba
*biofilm is adherent os it needs mechanical disruption
when is the biofilm considered as mature?
marked increase in the gram (-) anaerobic bacteria
calculus crystalline forms
brushite - supragingival
whitlockite - subgingival
octa calcium phosphate - exterior
hydroxyapatite - inner
chemical mediators in healthy periodontium
IL-10, TGF-b, Tissue inhibitors of MMPs (TIMP) ==> decrease in MMPs
chemical mediators with periodontal disease
IL-1b, IL-6, TNFa, INF-y, PGE2 ==> increase MMPs
*PGE2 at low levels regulates bone formation; osteoclastic at high levels
signals pre-osteoclast to mature into a fully functional osteoclast which will resorb bone?
RANK-L (receptor activator nuclear factor kappa-B ligand) - induced by TNF, IL1, PGE2, IL6)
*decoy receptor: Osteoprotegerin (OPG) - blocks the binding of RANKL to RANK
inc RANKL, dec OPG = osteoclastogenic activity
rate of progression by Loe et al 1986
rapid rate = 0.1-1mm
moderate = 0.05-0.5mm
minimal/no progression = 0.05-0.09mm
clinical attachment loss per year
classification of periodontitis according to extent? severity?
generalized > 30% of sites are affected (sites affected divided by number of sites examined)
severity:
slight/mild 1-2mm CAL
mod 3-4mm
sev >= 5mm
1999 classification
refers to the destructive periodontal disease in patient who demonstrate additional attachment loss at one or more sites despite well executed therapeutic and patient efforts to stop progression (NON RESPONSIVE TO TX)
refractory periodontitis
component of endo ice
difluorodichloromethane
where to drill for test cavity?
up to DEJ (most sensitive part)
most accurate test for pulp vitality?
laser doppler test (checks flow of RBC)
where to deposit anes during anesthetic test for diffuse or vague pain?
deposit first at the distal side of most distal tooth
used to determine necrotic pulp or fractured teeth
transillumination - fiberoptic light source
what is pink tooth mummery
internal root resorption
Tx for deciduous: observe/exo
for permanent: rct/exo
Rx: moth-eaten, asymptomatic
increase radiopacity of adjacent bone tissues and can be positive or negative to percussion and palpation
condensing osteitis or chronic focal sclerosing osteomyelitis
- usually seen with low grade infection and px with good immunity
other term for condensing osteitis
chronic focal sclerosing osteomyelitis
inflammation of the periosteum adjacent to the area of an infected tooth with a periapical lesion is called
garre’s osteitis aka proliferative periostitis
an exophytic overgrowth of pulpal tissue with a present epithelial surface
pulp polyp/ chronic hyperplastic pulpitis
root fractures are common to what tooth?
mandibular molars
vertical vs horizontal root fracture
vertical - j-shape, teardrop or halo-like radiolucency; isolated probing defect but without perio disease; poor prognosis
tx for monorooted teeth with vertical fracture? for multi-rooted?
mono - exo
multirooted - hemisection
hemisection vs root amputation
hemisection- splitting of mandi molar and removal of affected root involving the crown
root amputation - removal of portion of a root without involving the crown
types of horizontal root fracture
coronal - tx: stabilize and observe (poorest prognosis due to oral fluids)
middle - usually stabilization and observe
apical - usually observe (best prognosis)
RCT if necessary and apicoectomy if there is continuation of fracture for middle and apical. for coronal, remove the coronal portion.
when can you do direct pulp capping
pinpoint (0.25 - 0.5mm) mechanical exposure of asymptomatic pulp in a clean, dry field
type of medicament for pulpotomy contraindicated for deciduous? and young permanent tooth?
deciduous - CaOH - causes internal resorption
open apex - Formocresol - causes cessation of apical closure
obturation material for pulpectomy of deciduous
vitapex (Calcium hydroxide)
ZOE
Akala ko CaOH causes resorption sa deciduous?
tooth that usually have C-shaped orifice
mandi 2nd molars
mandi 1st molars
maxi pm (check rudman)
outline forms of access prep
incisors - ovoid or triangular
canines - ovoid
premolars - ovoid
mx molars - triangular or rhomboidal
md molars - trapezoidal
exacerbation of an otherwise asymptomatic apical periodontitis
phoenix abscess -same features with acute apical abscess but this happens after initiation of treatment
degree of taper of files
0.02mm per 1mm
For #15 file at D0 = 0.15mm
D4 = 4 x 0.02 = 0.08 + 0.15mm = 0.23mm
length of cutting edge of files
16mm
remember ADA spec No. 28 ang endo files
number of orifice
Maxi incisors = 1
Maxi canines and 2nd PM and mandi incisors to 2nd premolars = 1 but may be 2
Maxi 1st PM = 2 but may be 1
Maxi 6 = 4 but may be 3
maxi 7s and mandi 6s = 3 but may be be 4
mandi 7 = 3 but may be 2
laws of access cavity prep
law of centrality - always at the center of tooth at the level of CEJ
law of concentricity - wall of pulp chamber are always concentric to the external surface
law of color change - darker floor
first law of symmetry (except mx molars)- orifice are equidistant from a line drawn in MD direction across the floor of the chamber
second law of symmetry - canal orifices lie on a line perpendicular to a line drawn in a MD across the center of the pulp chamber floor
law of orifice location - orifice at junction of walls and floors; always located at the terminus of the root’s developmental fusion lines
extra root of mandibular molar
radix entomolaris if lingual
radix paramolaris if buccal
most common anterior tooth associated with 2 orifices
Md lateral incisor (lingual) pero all md anteriors and premolarts can have 2 canals
the canal orifice that is most dificult to locate
MB2 of mx 1st molars located palatal to MB1
posterior tooth with highest endo failure rate
mx 1st molar, md 1st molar, mx PM
file that cuts only during pulling
hedstrom file ( O )
k-files - watch wind and push and pull
file number and color
6 - pink
8 - gray
10 - purple
12 - orange
white yellow red blue green black
Wala yata red, bruha go black
Irrigants and concentration
sodium hypochlorite (0.5% to 5.25%)
hydrogen peroxide (3%)
NSS (0.9% NaCl)
chlorhexidine (2% …chx perio is 0.12%; chx medicament is in GEL form)
EDTA 17% (chelator)
chelating agent, removes smear layer
EDTA 17%
ethylene diamine tetraacetic acid
also used as etchant
NaOCl + CHX =
parachloroaniline (PCA) orange-red substance
Ethylene diamine tetraacetic acid + CHX =
white foggy precipitate
Medicaments used in RCT
calcium hydroxide
camphor monochlorophenol (CMCP)
principal component of GP
zinc oxide
solution to soften GP during retreatmetn
chloroform, eucalyptol, xylene/xylol
most predominant bacteria in an infected root canal cavity
strep and enterococcus (dmf)
primary infection: bacteroides
secondary - enterococcus faecalis
extraradicular - actinomyces
recall the patient after root canal after ___
6 months
apicoectomy cut the root up to?
3mm of root with 0-10 degree bevel
then prep another 3mm for retrograde filling
autoclave
dry heat
glass bead
autoclave (250F) 121C for 20-30mins 15psi
dry heat (320F) 160C for 1hr (dmf) 170C for 1 hr or 160C for 2hrs (decks)
glass bead 450F or 232C for 10 seconds (dmf) 216C (up lec)
