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Advanced Restorative > Esthetic Periodontics > Flashcards

Esthetic Periodontics Flashcards

1
Q

what are the goals of esthetic periodontics

A
  • describe the esthetic smile
  • make a proper diagnosis
  • create a periodontal and restorative plan
  • cases
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2
Q

what are the essentials of a smile

A
  • the teeth
  • the gingiva
  • the lips
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3
Q

what are the components of an esthetic smile

A
  • minimal gingival exposure
  • display of 75-100% of the crowns and all interproximal tissue
  • symmetric display and harmony between the maxillary gingival line and the upper lip
  • lower lip parallel to the incisal edges of the maxillary teeth and in close approximation
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4
Q

what is another name for excessive gingival smile and how common is it

A
  • the gummy smile
  • descriptive term rather than a dx
  • seen in 14% of women and 7% of men
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5
Q

dentists and laypeople did not notice gingival display until central incisors were altered:

A

1.5-2mm

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6
Q

orthodontists noticed gingival disaplay at:

A

0.5mm

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7
Q

when measuring face height in repose:

A

the length of the middle third of the face should equal the length of the lower third

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8
Q

where is the midface measurement

A

from the glabella (the most prominent point of the forehead between the eyebrows) to the subnasale (the point beneath the nose

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9
Q

where is the lower face measured from

A

the subnasale to the soft tissue menton (lower border of the chin_

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10
Q

where is lip length measured from

A

when in repose the lip is measured from the subnasale to the inferior border of the lip

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11
Q

what is the lip length in repose in young females

A
  • 20-22 mm lip length measurement
  • 3-4mm display of maxillary central incisors
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12
Q

what is the lip length in repose in young males

A

-22-24mm lip measurement
- 1-2mm display of maxillary central incisors

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13
Q

what should the lip in full smile be

A
  • the maxillary lip should move to the tooth-gingiva interface on the maxillary central incisors and canines
  • if the maxillary lip exposes more than 1.5-2mm of marginal gingiva, this is considered excessive gingival display
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14
Q

if the maxillary lip does not fall in the norms of 20-22mm for women and 22-24mm for men one of the etiologies is:

A

a short upper lip

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15
Q

what are the treatments for a short maxillary lip

A
  • lip repositioning surgical procedure
  • botox therapy
  • facial plastic surgery
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16
Q

when is a hyperactive maxillary lip a dx

A

if the face height, gingival levels, lip length and length of the central incisors are all within acceptable limits and the pt has excessive gingival display

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17
Q

in a full smile the maxillary lip should generally translate ______ from repose

A

6-8mm

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18
Q

a patient with a hyperactive maxillary lip may translate _______ times that

A

1.5-2

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19
Q

what is the tx for a hyperactive maxillary lip

A
  • lip repositioning surgical procedure
  • botox therapy
  • facial plastic surgery
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20
Q

when does dentoalveolar extrusion happen

A

when one or more maxillary teeth overeruptw

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21
Q

when does dentoalveolar extrusion happen

A

lack of opposing dentition the maxillary alveolar complex moves down with the overerupting teeth

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22
Q

when cases are dentoalveolar extrusion seen in

A

class II malocclusion cases

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23
Q

in dentoalveolar extrusion anterior gingival line is:

A

concave from canine to canine

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24
Q

what is the tx for dentoalveolar extrusion

A
  • movement of the overerupted teeth into their desired positions
  • this can be done by surgical treatment with a segmental osteotomy and ortho therapy
  • occlusion with stable anterior stops must be restored
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25
Q

when would vertical maxillary excess be the etiology of excess gingival display

A

if the lower face is longer than the midface

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26
Q

in vertical maxillary excess in a full smile the incisal edges:

A

of maxillary anterior teeth may be hidden by the lower lip

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27
Q

what can be used to dx vertical maxillary excess

A

cephalometric radiographs

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28
Q

what is the tx for vertical maxillary excess

A
  • orthognathic surgery is usually required
  • a section of bone is removed and the maxilla is then impacted to the desired position
  • sometimes a mandibular advancement procedure is also necessary in addition to the maxillary osteotomy to establish a stable occlusion
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29
Q

what is altered passive eruption

A

when there is a short clinical crown length and the gingiva demonstrates a healthy appearance and there is no incisal edge wear, altered passive eruption is the dx

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30
Q

what is active eruption

A

eruption of the teeth through the bone and soft tissue into occlusion with the opposing teeth

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31
Q

what is passive eruption and where is the gingival margin

A
  • apical migration of the dentogingival complex following the completion of active eruption
  • this normally concludes when the sulcus depth is at the level of the CEJ
  • the gingival margin in 1-2mm coronal to the CEJ
32
Q

what are the stages of passive tooth eruption

A
  • Stage I: dentogingival junction is located on enamel
  • stage II: dentogingival junction is located on enamel and cementum
  • stage III: dentogingival junction is located entirely on cementum, extending coronally to the CEJ
  • stage IV: dentogingival junction is located entirely on cementum and the root surface is exposed resulting in gingival recession
33
Q

what should the crown length of central incisors be

A

10-11mm

34
Q

what is the width to height ratio of the central incisor

A

75-80%

35
Q

what is the zenith position for the centrals lateral and canines

A
  • centrals: 1mm distal to midline
  • laterals: 0.3mm distal to midline, 1mm coronal to centrals and canines
  • canines: centered M-D
36
Q

what is the golden proportion

A
  • the ratio of a line segment cut into two pieces of different lengths such that the ratio of the whole segment to that of the longer segment is equal to the ratio of the longer segment to the shorter segment
    -1:1.618 is the ratio
37
Q

what is crown lengthening

A

it involves the surgical removal of hard and soft periodontal tissues to gain supracrestal tooth length, allowing for longer clinical crowns and re-establishment of the biological width

38
Q

what are the indications for esthetic crown lengthening

A
  • excessive gingival display
  • gingival overgrowth
  • altered passive growth
39
Q

what are the indications for functional crown lengthening

A
  • subgingival restorative margins
  • tooth fracture
  • endo perforations
  • cervical root resorption
  • inadequate tooth length to produce the ferrule effect
40
Q

what are the contraindications for crown lengthening

A
  • removal of supporting bone
  • furcation exposure
  • esthetic concerns
  • anatomic landmarks
  • poor OH
  • medical considerations
41
Q

what is a gingivectomy

A

the excision of a portion of the gingiva, usually performed to reduce the soft tissue wall of a periodontal pocket

42
Q

what are the indications for a gingivectomy

A
  • elimination of suprabony pockets
  • elimination of gingival enlargements
43
Q

what are the contraindications for a gingivectomy

A
  • when there is a need for osseous surgery
  • when the bottom of the pocket is apical to the MGJ
  • esthetic considerations
44
Q

what needs to be done prior to crown lengthening

A
  • get a restorative consult to make sure the tooth is restorable
  • remove caries and/or existing restoration and prepare tooth as best as possible
  • temporize prepared tooth
  • if endodontic therapy is indicated, it should be completed prior to crown lengthening surgery
45
Q

what are the 2 possible outcomes when a restorative margin is placed too depp into the supracrestal tissue attachment

A
  • the bone will resorb to re-create the supracrestal attachment that has been violated
  • gingival inflammation will occur
46
Q

what are the steps in restoring anterior teeth

A
  • decide if the restorative margin can be left supragingival or equigingival or will need to be placed subgingival
  • indications for placing the margin subgingivally may be structural issues exist
  • the tooth is discolored and a more opaque restoration is needed to mask the underlying color
47
Q

how do you determine the type of supracrestal tissue attachment

A
  • probe the sulcus to know the pocket depth
  • bone sounding
  • subtract the depth of the pocket from the depth of the bone sounding to determine the measurement of the supracrestal tissue attachment
48
Q

how do you probe the sulcus to know the pocket depth

A
  • remember that when probing the tip of the probe will penetrate the soft tissue approximately 0.5mm so this needs to be figured into your measurement for knowing where the supracrestal tissue attachment is
49
Q

how is bone sounding done

A

anesthetize the patient and place the probe into the sulcus along the tooth until you hit the bone

50
Q

where should crown margins be placed

A

2.5mm from the bone

51
Q

how far should the gingiva be from the bone according to biological width

A

3mm

52
Q

why should the margin be 2.5mm from bone

A

to allow adequate distance from the bone but also leave the margin subgingival

53
Q

where do we want to place the subgingival margin

A

below the gingival margin but above the epithelial attachment

54
Q

what is the concern with a pt with deeper sulcus depth (2-4mm)

A

high risk of recession following subgingival crown placement due to several mm of unattached gingiva above the supracrestal tissue attachment

55
Q

what is the concern with a pt with deeper supracrestal tissue attachment (3-4mm)

A
  • high risk of violating the supracrestal tissue attachment following subgingival crown placement
56
Q

when is surface epithelialization is complete in:

A

5-14 days

57
Q

when does vascularity appear normal

A

after 15 days

58
Q

how long does complete epithelial repair take

A

4 weeks

59
Q

how long does complete repair of the CT take

A

about 6 weeks

60
Q

how long does more bone dentist loss occur after surgery

A

4-6 weeks

61
Q

when can marginal tissue grow coronally

A

1 year

62
Q

when does tissue rebounding occur

A

following crown lengthening is stable after 6 months

63
Q

where is the gingival embrasure

A

the embrasure cervical to the interproximal contact

64
Q

when is the gingival embrasure considered open

A

if it is not completely filled with gingiva

65
Q

how often do open gingival embrasures occur

A

in 1/3 of the adult population

66
Q

what is the etiology of the black triangle

A
  • dimensional changes of papilla during orthodontic alignment
  • loss of periodontal attachment resulting in recession
  • loss of height of the alveolar bone relative to interproximal contact
  • length of embrasure area
  • root angulation
  • interproximal contact position
  • triangular shaped crowns
67
Q

what are the treatment options

A
  • orthodontic treatment to correct divergent roots
  • restorative therapy to re-shape the crowns of the teeth and/or place the contact 5mm or less from crest of alveolar bone
  • periodontal surgery to augment the papilla
68
Q

why is periodontal surgery to augment the papilla not a great option

A
  • not a predictable procedure due to lack of blood supply to the interdental papilla and to fragility of tissue
  • patients with a thick biotype have more success with treating the interdental papilla
69
Q

how is orthodontic treatment done to fix a black triangle

A

paralleling divergent roots will decrease a black triangle
- bracket positioning to follow long axis of the tooth and correct the black triangle

70
Q

what does electrosurgery use

A

alternating current at high frequency

71
Q

is there a difference on wound healing between electrosurge and periodontal knives when gingival resection was shallow

A

no

72
Q

what is the result of electrosurgery in deep resections

A

intense inflammation and loss of bone height resulting from bone necrosis

73
Q

electrosurgery wound healing shows more:

A

inflammatory response and more tissue destruction

74
Q

electrosurgery can ______ if used improperly

A

necrose bone

75
Q
A

Advanced Restorative (16 decks)

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