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D2 - Perio > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Define trauma from occlusion.

A

Damage to the periodontium caused by stress on the teeth produced directly or indirectly by teeth in opposing jaw

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2
Q

Trauma from occlusion happens when? And is considered to be?

A

Considered to be pathologic.

Forces of occlusion that exceed the adaptive capacity of the periodontium.

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3
Q

What are the variables to the relationship of occlusal trauma to periodontal disease?

A
  • Direction of force
  • Magnitude of force
  • Duration of force
  • Frequency of occurance
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4
Q

What parts of the periodontium are affected by occlusal forces?

A
  • Cementum
  • PDL
  • Alveolar bone proper
  • NOT - the gingiva and junctional epithelium
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5
Q

What is fremitus?

A

A tremulous vibratory movement of a tooth when teeth come into functional contact - generally detected by a finger palpation

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6
Q

What happens during trauma from occlusion on the compression side?

A
  • Compression of PDL fibers - initial decrease in width of PDL space
  • Loss of fiber orientation
  • Rupture of capillaries and hemorrhage into PDL spaces
  • Resorption of alveolar bone proper followed by widening ot PDL space
  • Root resorption if severe
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7
Q

What happens during trauma from occlusion on the tension side?

A
  • Tension (stretching) of fibers with initial increase in PDL space
  • Rupture of PDL fiber bundles
  • Compression of PDL capillaries and hemorrhage into PDL perivascular spaces
  • Apposition of new alveolar bone proper followed by decrease in PDL space
  • Cemental tearing
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8
Q

When does Primary Occlusal Trauma occur?

A

When occlusal forces are excessive (increased) and the amount of alveolar bone support is normal.

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9
Q

When does Secondary Occlusal Trauma occur?

A

When occlusal forces are normal or excessive and the amount of alveolar bone support is reduced.

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10
Q

What is occlusal hyperfunction, and what is it considered to be?

A

Slight increase in occlusal force, considered to be a physiologic adaptation and not a pathologic entity.

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11
Q

What are the clinical characteristics of Occlusal Hyperfunction?

A
  • Increase in # and diameter of collagen fiber bundles in PDL
  • Increased width of PDL
  • Increased density and thickness of alveolar bone proper (lamina dura)
  • Radiographic evidence of osteosclerosis of alveolar bone with PDL insertions
  • Slight or undetectable tooth mobility
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12
Q

What are the characteristics of Occlusal Hypofunction?

A
  • Mild weakening of the tooth supporting structures due to a lack of physiologic stimulation
  • Considered to be a physiologic adaptation and not a pathologic entity.
  • Can only be diagnosed by histology
  • Decrease in # of PDL fiber bundles but normal orientation
  • Decrease physiologic turnover and remodeling of alveolar bone
  • Narrowing of PDL space, no change in tooth mobility
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13
Q

What is the total removal of occlusal forces resulting in lack of the level of physiologic stimulation required to maintain normal form and function called?

A

Disuse Atrophy

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14
Q

What is disuse atrophy considered to be?

A

A physiologic adaptation rather than a pathologic feature of disease

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15
Q

What are the clinical characteristics of disuse atrophy?

A
  • Radiographic evidence of decreased width of PDL space
  • Increased tooth mobility - always
  • Absence of occlusal antagonist
  • Loss of orientation of principle fiber bundles of PDL
  • Significant decrease in # of bone trabeculae (localized osteoporosis)
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16
Q

Trauma from occlusion, in the absence of inflammation does not cause:

A
  • Gingivitis
  • Periodontitis
  • Pocket formation

But it makes these worse

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17
Q

What is the key concept of the animal study dealing with occlusal trauma and periodontal disease?

A
  • Periodontitis with superimposed occlusal trauma produces more bone loss than periodontitis alone
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18
Q

What is the key concept in the human study dealing with occlusal trauma and periodontal disease?

A
  • Strong association between initial occlusal discrepancies and periodontal prognosis and increased periodontal probing depth of posterior teeth
  • Strong association between untreated occlusal discrepancies and the progression of periodontal disease.
  • Occlusal treatment significantly reduces the progression of periodontal disease over time.
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19
Q

What is the creation of additional problems or complications as a result of treatment called?

A

Iatrogenic Disease

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20
Q

Gingival margin overhangs are associated with what?

A
  • Gingival inflammation
  • Bone loss
  • Microbial plaque and calculus accumulation
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21
Q

For a furcation involvement - how much bone loss must there be?

A

33%

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22
Q

What are some characteristics of interproximal caries?

A
  • Occur below the contact point
  • Follows the direction of enamel rods
  • Cone-shaped radiolucency
  • Spreads along the DEJ
23
Q

What is the microbial agent for interproximal caries?

A

Streptococcus Mutans

24
Q

What are some characteristics of Root Caries?

A
  • Involves cementum and dentin
  • Initiated in areas of food impaction
  • Common in periodontal patients following surgical exposure of root surfaces
  • Saucer-shaped morphology
  • Enamel is not involved
  • Microbial agent:
    • Actinomyces viscosus
    • Candida albicans?
25
Q

What does caries detection by radiographic exam require?

A
  • Very thorough clinical exam
  • Flawless radiographic technique
  • Experience in radiographic interpretation
26
Q

How sensitive are X-rays in the diagnosis of proximal caries?

A

60%

27
Q

What are the modifying factors of furcation involvement?

A
  • Anatomic
  • Supervised neglect
  • Difficult cleansibility
  • Restorations
28
Q

For a maxillary molar - what are the facial, mesial, and distal furcation depths?

A
  • Facial - 4 mm
  • Mesial - 3 mm
  • Distal - 5 mm
29
Q

For a maxillary bicuspic (canine) what are the mesial and distal furcation depths?

A
  • Mesial - 7 mm
  • Distal - 7 mm
30
Q

For a mandibular molar - what are the facial and lingual furcation depths?

A
  • Facial - 3 mm
  • Lingual - 4 mm
31
Q

For root trunk furcations - what is considered short, average, and long?

A
  • Short - 1-2 mm
  • Average - 3 mm (facial mandibular 1st molar)
  • Long - >4 mm
32
Q

Why do premolars with furcation involvement have a very poor prognosis?

A

Because of the root trunk length

33
Q

On a mandibular molar - how often are there root concavaties on the mesial and distal roots?

A
  • Mesial - 100% (0.7 mm)
  • Distal - 99% (0.5 mm)
34
Q

On a maxillary molar - how often are there root concavaties on the Mesial Buccal, Distal Buccal and Palatal roots?

A
  • MB - 94% (0.3 mm)
  • DB - 31%
  • P - 17%
35
Q

Bifurcation ridges are present in what percentage of mandibular molars?

A

73%

36
Q

What angle do you need to come from with a Nabors probe to measure furcations on the mesial and distal?

A
  • Mesial - Palate
  • Distal - Buccal
37
Q

What is Glickman’s Class I furcation involvement?

A
  • Incipient bone loss
  • Radiographically not evident
38
Q

What is Glickman’s Class II furcation involvement?

A
  • Partial bone loss (cul-del-sac)
  • Depth with vary: early or advanced
  • Radiograph may or may not appear
39
Q

What is Glickman’s Class III furcation involvement?

A
  • Through and through
  • Inter-radicular bone is completely absent
  • Radiographic evidence is a usual finding
40
Q

What is Glickman’s Class IV furcation involvement?

A
  • Through and through with furcation exposure due to gingival recession
  • Almost always shows on radiographs
41
Q

What’s the difference between the Glickman classification system and the Hamp sytem?

A
  • Glickman Classification
    • Class I - IV
  • Hamp System
    • Class I - III (III and IV are combined)
    • Class I < 2 mm, Class II > 2 mm, Class III through and through
42
Q

What’s a problem with measuring furcations in first molars?

A

The furcation entrance is more narrow than standard curette in most first molars - 81% < 1.0 mm

Curette width = 1.25 mm

43
Q

What are the different grades of Cervical Enamel Projections?

A
  • Grade 1 - distinct change in the CEJ that projects toward the furca
  • Grade 2 - CEP approaching the furcation
  • Grade 3 - CEP at the roof of or into the furcation
44
Q

What are the percentages of Cervical Enamel Projections on mandibular molars, maxillary molars?

A
  • Mandibular - 28.6%
  • Maxillary - 17%
45
Q

What is the association between the presence of a cervical enamel projection and furcation involvement?

A

50%

46
Q

What are the percentages of accessory canals on maxillary and mandibular 1st and 2nd molars?

A
  • Max 1st - 36%
  • Mand 1st - 32%
  • Max 2nd - 24%
  • Mand 2nd - 12%
47
Q

What is the order of frequency of individual tooth loss?

A
  1. Max 2nd molar
  2. Max 1st molar
  3. Mand 2nd molar
  4. Mand 1st molar

The least likely are:

  1. Max Cuspid
  2. Mand Cuspid ***
48
Q

What are the percentages of patients with gingival overgrowth by drug regimen?

Carbamazepine?

Phenytoin Sodium?

Phenytoin Sodium + Sodium Valporate?

Phenytoin Sodium + Carbamazepine?

Phenytoin Sodium + Carbamazepine + Phenobarbital?

A
  • 0% - Carbamazepine
  • 52% - Phenytoin Sodium
  • 56% - Phenytoin Sodium + Sodium Valporate
  • 71% - Phenytoin Sodium + Carbamazepine
  • 83% - Phenytoin Sodium + Carbamazepine + Phenobarbital
49
Q

What does Wennstrom (1996) say about how much keratinized and attached gingiva is enough?

A

At least 2 mm attached - keratinized mucosa is necessary for maintaining health

50
Q

What are the 2 types of grafts and what do they involve?

A
  1. Free Gingival Graft
    1. Increased keratinized tissue
  2. Connective Tissue Graft
    1. Increased keratinized tissue and root coverage
51
Q

What are the treatment options for increasing the width of attached gingiva?

A
  • Apically positioned flap (APF)
  • Free autogenous gingival graft (FGG)
  • Subepithelial connective tissue graft (CTG)
52
Q

What are the treatment options for obtaining root coverage?

A
  • Subepithelial connective tissue graft (CTG)
  • Semi-lunar incision + coronal positioning (Tarnow procedure)
  • Lateral pedicle flap (LPF)
53
Q
A

D2 - Perio (5 decks)

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