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Dr keaton perio exam 2 > exam 2 > Flashcards

exam 2 Flashcards

1
Q

—– —— is indicated to control the progress of perio destruction and attachment loss when more conservative non surgical treatment is insufficent

A

periodontal surgery

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2
Q

True or false

almost all dental procedures would be considered surgery

A

true

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3
Q

the major benefit and indication for perio surgery as an adjunct to non sugerical perio treatment is to gain access…

A

to the root surface for scaling and root planing. It also improves access for plaque biofilm control.

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4
Q

perio surgery results in better access to

A

furcations, complex root surfaces, and infrabony pockets

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5
Q

Improving access for plaque biofilm control by the patient may require removing tissues or bony forms that block the patient from adeqautely removing as much biofilm as necassary to control the disease

A

true

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6
Q

disadvantages of perio surgery include

A

health status
age of the patient
and the specific limitatons of each procedure

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7
Q

the patients opinion of the negatives of perio surgery are

A

time
cost
aesthetics
disomfort

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8
Q

the healing after non surgerical therapies is atleast

A

4 weeks

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9
Q

the amount of pocket reduction observed after these procedures inficates the extent of surgical procedures s

A

that are still required

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10
Q

in prescribing perio surgery the periodontist carefully considers

A

probing pocket depth
amount of bone loss
importantce of the tooth to function and aesthetics
patients level of plaque biofilm control
patients general health

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11
Q

is a deepended gingival sulcus with an infected root surface covered by an ulcerated epithelial surface with underlying inflamed connective tissue

A

periodontal pocket

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12
Q

the periodontal pocket is bound ——– by the gingival margin on one side by the root surfae on the other sie by the epithelial surface and at the base by the junctional epithelium

A

coronally

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13
Q

scaling and root planing is effective in controlling perio disease to probing depths of about 1

A

4 mm

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14
Q

pockets deeper than 5 mm are

A

difficult to intstrument and therefore often remain infected even after the best care

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15
Q

pockets greater than — -mm suggest extreme loss of attachment which makes the long term prognosis for retaing the affected teeth poor

A

9mm

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16
Q

perio surgery is most succesful when treating perio pockets with probing depths of

A

5-9 mm

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17
Q

probing depths is not always equal to

A

clinical attachment loss

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18
Q

measurement from the crest of the gingival margin to the base of the pocket

A

probing pocket depth

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19
Q

measured from the cemento enamel junction to the base of the pocket

A

attachment loss

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20
Q

if the gingival margin is on the root surface as when there has been recession the attachment loss is greater

A

than the probing depth

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21
Q

if the gingival margin is on the enamel surface of the crown as in the gingival hypertrophy than the attachment loss is less than the

A

probing depth

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22
Q

attachment loss represents

A

bone destruction

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23
Q

not all probing depths greater than five need surgery

A

true

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24
Q

the 5mm guideline is only the

A

first step in identifying if patients need perio surgery

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25
Q

patients with 5-6 mm may be monitored with a — and —- approach to determine whether non surgical perio therapy and careful maintence are adequate

A

wait and see

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26
Q

to know that a disease is definitely progressing a — mmm increase in probing depth must be observed over time. if surgery is postponed the dentist must be willing to risk this — mm loss

A

2

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27
Q

the base of the perio pocket is not at the

A

level of the crest of the alveolar bone

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28
Q

there is usually — to — mm of connective tissue attachment covered by the epithilium between the probing depth and the alveolar bone

A

1-2 mm

BIOLOGIC WIDTH

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29
Q

bone loss caused by perio disease results in

A

osseous defects

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30
Q

osseous defects may occur

A

in a horizontal dimension where the bone resorbs equally on the mesial and distal surfaces or a vertical dimension where the resorption is unequal around the teeth

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31
Q

pockets that are coronal to horizontal bone loss are often called

A

suprabony pockets

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32
Q

pockets that extend apicaly beyond the crest of the bone are called

A

infrabony pockets

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33
Q

– may also occur in a variety of configurations that are usually described by the number of bony walls remaining

A

vertical bone loss

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34
Q

when all the walls of the osseous defects are within the bone housing they may be termed

A

infrabony pockets

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35
Q

perio surgery that includes modification of the bone level or shape is called

A

osseous surgery

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36
Q

grafting or regenerations techniques may be required

A

if perio surgery isnt needed

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37
Q

generally osseous surgery performed to correct

A

irregulary shaped defects of the bony support around the tooth is indicated when at least half of the bone support remains.

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38
Q

an abutement tooth for a functioning fixed bridge can be importnat to the patient and often every attempt

A

to salvage a particular tooth through perio surgery is strongly indicated.

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39
Q

patients with pocking depths exceeding 5 mm and half there supporting bone lost who are relatively young (younger than —) have an aggressive form of perio disease

A

30

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40
Q

patients oolder than — years with the same clinical condition usually have a more slowly progressing form of the disease

A

60

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41
Q

the goal of — — — is to reduce perio pocket depth by removing soft tissues to a level at which plaque biolfium control and maintence procedures are effective usually not exceeding 3 to 4 mm in depth

A

pocket reduction surgery

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42
Q

methods for pocket reduction include

A

excisoional perio surgery (gingevectomy) and incisional perio surgery (flap)

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43
Q

excisional perio surgery remove the excess tissue from

A

the wall of the perio pocket

used for rapid reduction of the gingival pockets

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44
Q

the most basic excisional surgical procedures are termed

A

gingivectomy or gingivoplasty

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45
Q

first consideriation for pocket reduction is usually

A

gingvectomy

you can do that and gingivoplasty together

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46
Q

the presence of deep perio pockets with thick fibrous tissue is the major indication for

A

gingivectomy

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47
Q

drug induced gingival hyperplasia is treated with

A

gingivectomy

caused by antiseizure meds phenytoin ccb to control blood pressure or immunosupressive drugs

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48
Q

perio scaling and root planing should be completed (– to – weeks) before surgery allows tissues to heal

A

4 to 6

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49
Q

often, the need for gingivectomy cannot be determined until tissue shrinkage ater scaling and root plaing has occured

A

true

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50
Q

edematous friable and hemorrahagic tissues are not easily incised and therefore require adequate healing time ater scaling and root planing and before surgery

A

true

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51
Q

gingevectomy the gingiva is excised with knifes at

A

45 degree angle to the gingival surfacekeeping the incsion with the keritinized gingiva

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52
Q

healing is usually uneventful and the gingial epithelium is reestablished — weeks after surgery

A

2

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53
Q

gingivectomy is rarely used for pocket reduction

A

due to the many contraindictions

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54
Q

the primary contraindiction to gingivectomy is

A

the procedure does not permit access to infrabony pockets, those below the crest of the alveolar bone, a highly common occurance in periodontisits

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55
Q

other negatives of gingivectomy is

A

wide wound is created, which makes healing slow discomfort.

the anatomy of the surrounding area may prevent incising the tissues at the proper angel or minimal width of attached gingiva may prevent keeping the incision with the keratinized tissue

unacceptable aesthetics sens. tp heat and cold and caries

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56
Q

incisional surgery

A

perio flap surgery or simple flap

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57
Q

incisional surgery

A

is the procedure of choice when excisional perio surgery cannot be performed for pocket reduction.

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58
Q

incisional surgery is called flap surgery because the

A

tissues are pushed away from the underlying tooth roots and alveolar bone much like a flap or envelope.

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59
Q

the usual incisional technique for pocket reduction with a flap surgery is called teh

A

apically positioned flap because the flap is sutured at a more apical location on the tooth roots to reduce pocket depths.

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60
Q

flap surgery has fewer contraindictions than

A

gingivectomy

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61
Q

the majority of implants used in dentristy are the root form type

A

endosseous implants which are based on the principles of osseointegreation

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62
Q

today in excess of 50 implant systems are avaiable with innovations being proposed and instituted by dinfferent manufactures through intense competition

A

true

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63
Q

ideally longitudinal trials of – years or longer are required to forecast the validity of emerging treatment concepts

A

5

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64
Q

subperiosteal and transosteal

A

still seen but less often

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65
Q

custom made cast framework that is placed beneath he periosteum over the alveolar bone

A

subperiosteal implant can be used on top or bottom

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66
Q

in subperiosteal the frame rests

A

on the jawbone with no evidence of direct union with the bone in most cases

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67
Q

transosteal implants

A

traverse the mandible in a apicocoronal direction. they protrude through the gingival tissues into the mouth for prosthesis anchorage

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68
Q

a stabilization plate is placed along the inferior border of the mandible

A

with transosteal implants

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69
Q

tranosteal implants are often called

A

staple implants

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70
Q

the interfacial adaption between the subperiosteal and transosteal implants and bone resmembles that of a scar tissue with no direct bone anchorage

A

creates a compromised arrangement under occlusal loads

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71
Q

endossesous two types

A

blade and root

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72
Q

root form

A

screw or cylindicral shaped with different lengths diameters and specific design character.

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73
Q

the blade implant

A

no longer used because it has a high incidence of complications and failures

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74
Q

—- — — — provide direct osseous anchorage through formation of an intimate lattice between the implant surface and bone

A

root form endossesous implant

most predictable and accepeted

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75
Q

scanning electron microscopy of the interface reveals a narrow nonminerilized zone approx — to — between the bone and the implant containing chondrotin sulfate glycosaminoglycans

A

20 to 40

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76
Q

the def of osseointegration as propsed by brainemark is

A

direct structural and functional connection between ordered living bone an the surgace of a load bearing implant

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77
Q

because implant integration involves soft and hard tissues the term — —- implant has been suggested to describe implant integration better

A

stably integrated

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78
Q

—– observation of the bone interace has also demonstrated that because of thedynamic nature of the bone 100 percent integration never develops and the bone to implant contact is both time dependant and influenced by implant surface characterisitcs

A

longitudinal.

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79
Q

the amount of bone to implant contact varies among different implant systems

A

30 to 70 the exact amount of bone to implant contact required for sucess has not been determined.

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80
Q

the bioloical process involved in attainment and maintents of implant integration depends on factors that include

A 
biomaterials
bicompatibilty
implant design
bone factors
surgical and loading consideration
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81
Q

close contact of living cells at its surface which does not contain leachable that produce inflammation and which does not prevent growth and division of cells in culture

A

biocompatibility

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82
Q

molecules that seperate off the surface

A

leachables

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83
Q

gold, stainless steel, cobalt chromium alloys, bioactive glasses, niobium, hydroxyappetite, tricalcium, phosphate, polymers, zirconium, titatium

A

biomatierlas not all are compatible as an implant material.

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84
Q

any implanted material is consiered

A

a foreign body

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85
Q

metals in contact with tissue fluid are prone to

A

degration and dissoulotion by corrossion

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86
Q

exchange of protons with biological molecules leads to

A

antigen formation and cellular uptake

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87
Q

—– has become the standard in osseointegration

A

titanum

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88
Q

highly reative yet biocompatible metal

A

titanium

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89
Q

titanium rapidly forms a layer of surface oxides (— to —-) mm thick most notably of titanium oxide when exposed to air or fluid

A

.3-.5mm

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90
Q

the oxide layer prevents —– on the surface so that tissue integreation can occurs

A

erosion

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91
Q

advantages of titanium

A

light weight and can withstand occlusal forces

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92
Q

the length of implants are between — to — long

A

8 to 14

based on avaibable bone height and proximity to votal structures such as nerve trunks and blood vessels

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93
Q

implant diameters range from

A

3 to 6

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94
Q

the selection of diamter is based on

A

the width of the jaw ridge at the implant site

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95
Q

the jaw ridge is narrower in the —- so narrower implants are used there

A

lateral incisor

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96
Q

wider impants can be used in

A

molar region

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97
Q

the most common implant shape

A

cylindrical

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98
Q

implants exhibit

A

threaded surface design

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99
Q

there are — implants also avaiable with no threads

A

hollow

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100
Q

the initial stability of the implants is in part dependant on the

A

surface texture

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101
Q

many studies have shown that a higher bone to implant contact is attained around

A

rough surfaced implants

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102
Q

methods for producing roughened implant surfaces include

A

grit blasting acid etching plasma spraying and using additive surfaces such as hydroxyappating coating

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103
Q

the amount of bone to implant contact achieved at the time of the implant placement isrelated to the quantiy and quality of bone and determines

A

fixture stabilty

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104
Q

there is variability in the

A

amount of cortical and cancellous tissue with the arch and between the maxilla and mandible

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105
Q

the volum density or cortical bone is

A

three to four times that of cancellous bone

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106
Q

—— contribute less to implant stability at placement

A

cancellous

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107
Q

resorption of the alvelous is a natural sequeale to

A

tooth loss

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108
Q

the extent of the resorption process is dependent on

A

the history or trauma, length of time since loss occured, and loading removable prosthesis

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109
Q

quality of bone is also influenced by systemic condition such as

A

osteoporosis and social factors such as smoking

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110
Q

there are no fixed guideline for the length of healing time after surgery and before prosthetic loading of implants

A

true

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111
Q

brianne orginally advised — months for mandible and – months for maxilla

A

3

6

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112
Q

movement of the implant more than —- um during the healing phase may result in fibrous tissue encapsulation of the implant rather than osseointegration a result that does not provide long term functional occlusal load

A

100

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113
Q

——- is compatible with attaining osseointegration

A

immediate loading

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114
Q

treatment should be delayed in younger patients until growth is near completion because unlike the natural dentition

A

implant s remain stationary during dentoalveolar growth.

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115
Q

conditions that increase the patients susceptibilty to infection such as uncontrolled diabetes may result in

A

high incidence of peri implantitis and implant failure

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116
Q

osteoporosis

A

age related disease

117
Q

decreased bone mass and increased susceptibility to fractures affects 20 million americans 80 percent of whom are older women

A

osteoporosis

118
Q

hormone replacement therapy and osteoporosis do not appear to influence

A

implant survival in this population

119
Q

therapy with bisphosphonates has been recently attribued to an increased risk of

A

jaw osteonecrosis and patients who have been treated with IV bisphosphonates are particularly at risk

120
Q

patients recieving anticoagulant therapy must be consulted before surgery because they are at risk

A

of hemmoraging during surgical procedures

121
Q

patients on steroid therapy may have

A

steroid induced complications

122
Q

the natural dentition is surrounded by the periodontium comprising the gingiva cementum alveolar bone and perio ligament

A

true

123
Q

the gingival sulcus is – to — mm deep in health

A

1 to 3

124
Q

the base of the sulcus is formed by the coronal aspect of the

A

Junctional epithelium

125
Q

the junctional epithilium is attacted to the root surface by

A

hemidesomosomes and a basal lamina

126
Q

the cells of the JE have a high turnover rate and can migrate on the root surface to reestablish

A

an attachment or form a new one

usually occurs after a trauma, inflammation, and bone loss, resorative procedures

127
Q

the peri implant soft tissue is shaped after

A

abutement connection or in the case of a single stage implant system forms aroun the transmucosal portion of the fixture

128
Q

the collagen fibers are aligned parallel to an organized in a circular arrangement around the

A

supracrestal portion of the implants

129
Q

there is no cemental layer over the implant surface so fiber insertion is

A

not possible

130
Q

perimplant soft tissues adheres to the titanium collar of the implant by a

A

hemidesmosomal and basal lamina attachment mechanism, analougous to that of the JE to enamel attachment

131
Q

the —– provides anchorage in the alveolous for natural teeth and allows physiologic mobility and proprioceptive sensation from the dentition

A

PDL

132
Q

the connective tissue fibers of the PDL attach to the alveolar bone and cememntum

A

perpendiculary and adapt to variations in occlusal load

133
Q

the pdl space is highly

A

vasculuar

134
Q

there is no pdl in

A

osseointegration

135
Q

once osseointegrated orthodontic movement is not possible

A

true

136
Q

unfavorable loading of implants is one etiologic factor for bone loss around implants

A

true

137
Q

the biologic width around teeth that is the dimension of the epithilial and connective tissue attachments is approx

A

2mm

138
Q

a similiar implant biologic width has also been described the per implant mucosa which

A

comprises a 2mm long JE and 1 mm zone of connective tissue

139
Q

the connective tissue zone is poorly organized and exists between the JE which is typically attatched to the prosthetic components. called the

A

implant abutement and bone

140
Q

the implant abutement exteneds from the implant through the soft tissues and can be

A

temporary or permanent.

141
Q

the root analogue device in the bone

A

implant fixture, by an abutment screw

142
Q

the osseous crest around natural teeth in healthy follows the outline of the cementoenamel junction at a distacne of

A

1 to 2 mm apically on the root surface

143
Q

the location of the crestal bone level around implant depends on the implant deisgn and may vary from

A

.5 to 3 from the top of the implant fixture

144
Q

the clinical success of implant therapy is assesed by

A

radiographic imaging, evaluation of tooth mobility, and obseving surrounding tissue

145
Q

in regards to the gingival sulcus depth the teeth are —- and the implants are —————————

A

shallow

depth dependent on implant type and prosthethic component and length

146
Q

in regards to the gingival fibers the teeth are —— and the implants are ———

A

inserted into supracrestal root cementum

fibers arranged parallel to implant

147
Q

in regards to the location of the crestal bone the teeth are —- and the implants are —–

A

1-2 mm from the cementoenamel junction

depended on implant design, ranges .5-2.5 mm from implant shoulder or to first thread

148
Q

in regards to the connective tissue attachment the teeth are — -and the implants are —-

A

sharpeys collagen fibers insrted into alveolar bone and cementum

bone implant interface has no fiber insertions filled with chondroitin sulfate glycosaminoglycans

149
Q

in regards to mobility the teeth are — and the implants are —-

A

physiolologic as a function of pdl

no pdl fixation similar to that of functional ankylosis

150
Q

in regards to propriocetion the teeth are —– and the implants are —

A

receptors with the pdl

no receptors within interface

151
Q

criteria for implant success

A
  1. no peri implant radiolucency
  2. absense of mobilitiy
  3. bone loss no greater than 1/3 of implant
  4. provide functional service for 5 years in 85 percent of cases in the anterior maxilla and 90 percent in the anterior mandible after 10 years, 80 percent sucess in the maxilla and 85 percent in the mandible
  5. absense of persistent or irreversible signs or symptoms such as pain, infection, neuropathies, paresthesia, and violation of the manibular canal.
  6. bone loss less than .2 mm annually after first year of service
  7. implant design allows restoration satisfactory to patient and dentist
  8. absense of continuous marginal bone loss
    9 absense of continous marginal bone loss
  9. probing depth less than 4-5 mm bone loss less than 4
  10. no mechanical failure
152
Q

trauma to bone during implant recipent site prepartion through overheating or use of excessive fore must be avoided to ensure treatment success

A

true

153
Q

bone cells are irreversibly damaged if heated above —– degree celcius for — minute so copious irrigation with a coolant is required during surgery

A

47

one

154
Q

there is no recommended aseptic protocol for implant surgery because the outcome of a therapy is similar when implant placement is performed under aseptic and clean conditionss

A

true

155
Q

implant immobility throughout the healing period ranging from

A

3 to 6 months

156
Q

to minimize the potential for a functional load on the implant during the healing phase

A

2 stage surgical approach

157
Q

superstructure

A

restorations

158
Q

after a throurough examination and planning process that includes appropriate radiographs, study casts, and fabrications of surgical guides (stents) implants are placed with the use of a submerged or non submerged protocol

A

true

159
Q

requires two surgical procedures before the fabrication of the restorations that will be placed on the implants

A

submerged protocol

160
Q

in submerged protocol the first surgery place the implant fixture with in the bone followed by a second surgery – to — months later to uncover the impant so it can be assesed through the e—-

A

3 to 6

mucosa

161
Q

after anesthesia is administered a —- — is made in the soft tissue along the crest of the alveolar ridge and a flap is reflected in the location where the impant is to be placed

A

crestal incision

162
Q

with the aid of a —- —– drills specific for the implant system of choice are used under copious saline soloution irrigation to prepare the endosseous implant recipentant site to the pre determined lengeth and diameter

A

surgical stent

163
Q

— — are used to verify the angulations and distance between implants or between the implant and surrounding teeth.

A

guide pins

164
Q

implants are either slowly threaded into place in thecase of screw design implants or gently tapped in place in the case of non threaded cylindrical designs

A

true

165
Q

the internal aspect of the implant is protected from ingrowht of tissue by placing a device called a —– — on top of the implant.

A

over screw

166
Q

the patient should not wear dentures over the implant site for — to — weeks after surgery to avoid pressure on the implants

A

2-3 weeks

167
Q

in postopeartive procedures the area should be cleansed with a ….. chlorexidine mouth wash twice daily and use of systemic antibiotics should be considered to minimize the chance of infection

A

.2 percent

168
Q

3 months healing for

A

mandible

169
Q

6 months healing for

A

maxilla

170
Q

the cover screws are than replaced with

A

healing abutements

171
Q

are transmucosal posts that allow healing and adaptation of the peri implant soft tissues to take place

A

healing abutements

172
Q

restorative procedures can usually being after — to —- of soft tissue healing

A

3 to 4 weeks

173
Q

the surgical approach for the nonsubmerged protocol for implant placement is similar to that described for the two stage submerged procedure excet that after implant placement the tissues are closed around the specially designed transmucoal portion of the implant or around the healing abutement

A

this eliminates the need for a 2nd surgery to uncover the implant which maiy reduce both the treatment time and patient discomfort

174
Q

additional procedures may include soft tissue augmentation to increase the thickness or amount of keratinized tissue bone grafting guidied tissue regeneration or a combo of these procedures

A

true

usuaully for deformalilties

175
Q

immediate placement of implants into extraction sockets leave

A

a gap between the nonengaged implant surface and the inner aspect of the socket wall

this distance is referred to as jumping distance

176
Q

it is not known how wide a space can be tolerated and still permit normal healing. studies suggests that gaps of – to – mm can fill with bone without the use of adjunctive grafting materials

A

1 to 2 mm

177
Q

if multiple implants are placed the temp restorations are typicallyu splinted together to minimize movement and promote even load distribution

A

true

178
Q

prosthetic restoration mus be designed to avoid an excessive load on implants to protect them from bone loss and prosthetic component failure.

A

true

179
Q

a delayed placement is

A

6-10 weeks after extraction

180
Q

a late placement is

A

6 months or longer after extraction

181
Q

implant location and aesthetic demand may favor

A

cementretained restorations.

182
Q

with cementum the abutement is attached to the implant with a conventional screw system but the crown is

A

cemented on to the abutement typically with a temporary cement so that it can be removed if necassary

183
Q

the purpose of regular periodic clinical evaluation of patients is to

A

detect early disease activity and to provide individualized maintenance protocols.

184
Q

healthy implants are

A

osseointegrated

185
Q

the absense of pdl around implants creates

A

a rigid bone implant interface the maintenace of which is key for the long term success of implants

186
Q

studies have indicated that probe tip penetrates closre to bone in infalmed peri implant tissues than in healthy sites and that there is a tendenecy toward deeper probe depths around

A

implants

187
Q

depths of —- or less than – to —- are considered consitent with health because patients are able to maintain these depths with good oral hyg.

A

3

4-5

188
Q

probing depths are dependent on

A

individual implant design abutement height and depth of fixture within bone

189
Q

probing with implants

A

not very valuable

190
Q

not probing during the first – months after loading is advised so that healing is not distubered

A

3

191
Q

—- around implants provides an assesment of inflammation parameters such as bleeding and supuration

A

probing

192
Q

—- radiographs and panoramic images are used in conjunction with standard clinical examination to asses bone levels available for implant sites

A

periapical

only a 2 dimensional view of alveolar bone

193
Q

after implants are placed images are used to asses the height of proximal bone the presence of anatomic structure anomolies or pathogenic lesions

A

true

194
Q

3d view of implants

A

cross sectional and tomographic images can be obtained with the use of computed tomography

helps with bone density

195
Q

quality of bone is better assessed at the

A

time of surgery

196
Q

bone loss should not exceed —– annually after the first year after loading in the absense of peri implant radiolucencies or associated conditions

A

.2 mm

197
Q

radiographic follow up is recommend for implant sites at –,—,— months and than every — to — years thereafter unless clinical symptoms are seen

A

6/12/36

2-3

198
Q

some periodontists continue radiographs every – months for the first year to ensure bone levels are stable

A

3 months

199
Q

the need for kkeratinized tissue around implants remains

A

controversial

200
Q

you can have good oral health with minimal or no —-

A

keritinzed tissue

201
Q

factors determining whether the attached ginigiva is enough would include

A 
inflammation present?
gingival recession 
oral hyg status
patient complance 
relationship between the ginigva and alveolar bone
tooth position with the arch
presence of restorations
asethetic demands
tooth sensitivity
202
Q

asthetic demands may dictate that —- be present at the implant stite

A

keritinzed tissue

203
Q

is a collective term of inflammatory reactions in the tissues surrounding an implant

A

peri implant diseae

204
Q

describes a reversible inflammatory reaction in the soft tissuess surrounding a functioning implant

A

peri implant mucositis

205
Q

is a term for inflammatory reactions that affect soft and hard tissues around the implant leading to deepening of probing pocket depths and loss of supporting bone on functioning implants

A

peri implantitis

206
Q

peri implant mucositis and peri implantis are associated with

A

bleeding on gentle probing

redness and rarely pain

207
Q

peri implantisis occurs in about — to — of implants

A

4 to 19 percent

208
Q

is not synoymous with peri implantisis and refers to an implant that has loss osseointegration and is no longer an effective prosthetic anchor

A

failing implant

209
Q

as with teeth — — is the primiary microbial etiologic fctor in peri implantitsi

A

plaque biofilm

210
Q

perimplantisis and

A

periodontisis are similar

211
Q

the microbiota around implants in edentulous implants form

A

early and appear to remain stable in the long term

212
Q

teeth in partially dentate paients are a source of biota that colonize implants wihtin 2 weeks of exposure in the oral environment

A

true

213
Q

subgingival sites in healthy implants are populated by high percentages of coccoid cells and nonmotile rods with few spirochetes

A

whereas actinobacillus actinomycetemocomitans porphyromonas gingivalis and prevotella intermedius have been cultured from implants in patient with min. visible plaque biofilm who had not had maintence visits for 6 months or more

214
Q

in implants the only attachment mechanism involvees the

A

basal lamina and hemidesomnosomes or the epithelium.

215
Q

inflammation within the peri implant tissues have a tendency to spread circumferetially and progression to bone may result in angular osseous defects radiographically where as clinically

A

it assumes the shape of a well circumscribed saucer

216
Q

early implant failures are typically considered to be biologi

A

occuringwithin weeks or a few motnhs after placement

217
Q

impants result in failure to achieve osseointegration possibly because

A

of inherent host tissue factors, bacterial contamination of wounds, poor surgical technique or instability of the implant at placement.

218
Q

late implant failures result from factors that cause

A

breakdown of osseointegration

mech. overload fatigue failure of components and peri implant infection.

219
Q

an inportnat treatment for periimplantisis is

A

antimicrobial therapy

220
Q

antimicrobial therapy examples

A

combo of local or system ant. mic. therapy, debridge ment that involves thorough removal of plaque and calluclus, implant surface decontamination and regernation of defects.

221
Q

plastic nylon titaniumm graphite or gold plated curette and air abrasive devices can be used safely around implants

A

true

222
Q

what is a good choice for polishing around implants

A

tin oxide with rubber cups

223
Q

is an inflmmation of microbial origin that is associated with accumulations of suppuration or purluence in the perio tissues

A

periodonatl abcess

pain swelling discomfort

224
Q

the periodontal absess is characterized by —- that have become established in the tissue as a result of trauma advancing disease process or incomlete scaling and root planing

A

microbiota

225
Q

3 types of abscesses

A

periodontal gingival periapical

each can be acute or chronic

226
Q

chronic perio abscesses is likely an acute absess that drains

A

true and they can be the combo

227
Q

are associated with pre existing perio disease. they may occur around any tooth in the mouth when the perio pocket becomes occluded often as a result of a foreign object

A

acute perio absesess

228
Q

in acute perio absesses if the pocket can drain through a sulcus or a fistula the infection can

A

stablized and be considered a chronic state

229
Q

stabiliziation will not occur if

A

a foreign object such as a peanut skin popcorn hull or berry seed remains in the pocket

230
Q

acute perio absesses appear as

A

shiny red raised and rounded masses on the gingival or mucosa pus is usually seen but not always

231
Q

the most common sypmtom of acute perio absesses is pain others include

A

swelling
deep red to blue discoloration of the affected tissue
tooth sens to pressure
mobility

232
Q

in acute perio absess patient may complain that the tooth feels high

A

true

233
Q

a sinus opning on the lateral aspect of the tooth is usally associated with a periapical rather than perio absess

A

true

234
Q

the microbiota in the acute perio absess are predominately

A

gram negative and anaerobic.

235
Q

treatment of acute perio absess is mainly

A

drainage and the use of antibiotics or antimicrobial agents. must be treated immediately to alleviate pain and prevent spread of infection. it may be drained through the pocket opening or by access through incisoin

236
Q

post operative instructions call for

A

rest fluid intake and warm salt water rinses to help reduce swelling.

237
Q

overgrowth of pathogenic organsms that result in suppuration. usually painless because they drain into oral cavity either through opening or sinus tract

A

chronic perio absesses

238
Q

in chronic perio the associated ginigva is

A

red and swollen as long as its draining it shouldnt be painful so patients tolerate it or dont even know its happenin

239
Q

chronic treatment the affected tooth crown and root surfaces must be scaled and root planed curretage performed local antimicrobial therapy completed if needed and the patient seen for a follow up care to evalutate the need for further perio treatment often including perio surgery

A

true

240
Q

perio absesses do not always result in tooth extraction

A

true

241
Q

primarily distuingished from acute perio abcesses by taking a good medical and dental history

A

gingival absesses

242
Q

gingival absesses often occur

A

in disease free areas and they may be related to a forceful inclusion of some forgein object in to the area

243
Q

usually gingival absesses are found on the

A

marginal gingiva and are not associated with any abnormality of deeper tissues

244
Q

gingival absesses usually appear

A

shiny raised area of acute inflammation that may be painful the swelling is large but usually confined to the marginal gingivia.

245
Q

sometimes difficult to distuingish from an acute perio absesses

A

endodontic abcess

246
Q

endodontic abssess result from

A

infection through caries traumatic failure of the tooth or trauma from a dental procedure.

247
Q

most commonly microorganisms are spread from a carious lesion into the pulp through the denintal tubules

A

true

248
Q

the endondontic abcess often appears on radiographs as

A

rounded radioluceny at the apex of the tooth,

249
Q

—- percent of tooth pain is pupal and — is periodontal

A

85

15

250
Q

periapical pain is

A

sharp severe intermitten and difficult to localize

251
Q

periodontal pain is

A

less severe constant localized.

252
Q

treatment of endodontic absess requires

A

endodonti therpay or extrction from tooth.

253
Q

if not treated endodontic absesses can lead to

A

absesses of brain or fascitis of the neck or chest wall

can be life threathing

254
Q

combination absesses

A

can spread from the pulp to the periodontium or the perdidontium to the pulp

255
Q

periodontal and periapical absesses can cause extensive damage to the surrounding peridontium because

A

systems can be intermittent causing patients to delay treament

256
Q

combo absesses require

A

extensive therapy both perio and nedontic and often result in tooth loss.

257
Q

perio absess are

A

constant localized severe sharp , tooth are vital, bone loss no apical radiolucencey

258
Q

endodontic absesses are

A

intermittenet hard to localize extreemely severe usually non vital apical radiolucency common, widened pdl and other subtle changes and can sometimes be seen

259
Q

is an abcess associated with a partially or fully erupted tooth that is covered completely or parly by a flap of tissue called an operculum

A

pericoronitis

260
Q

the most commonly affected tooth is the

A

mandibular third molar but max third molar and other teeth that are the most distal in the arch and are also associated with the condition.

261
Q

pericoronitis is generaly seen in

A

young adults and has been a serious problem form military personnel most of whom are 17 to 26 years old.

262
Q

the symptoms of acute pericornotis are

A

swelling of the operculum and other gingiva associated with the most distal tooth in the arch redness and extreme pain. may be so swollen that it intereferes with mastiaction because it may be compressed durng chewing

263
Q

wwith pericoronitis initial therapy is pallative. a topical anestic is applied the infected area must be debrided with instruments may not be tolerable at the first visit. usually bl flushing with warm water or chlorexidine.

A

the patient should return the next day, should be flushed and instrumented in possible.

264
Q

opportunisitci infection of the ginigiva that is associated with stress lifestyles and some chronic illesses and condition such as blood dyscrasias human immunodeeficency virus inection and down syndrome

A

NUG

265
Q

nug

A

trench mouth

266
Q

is a recurring disease with a complex bacteriology consiting of large portions of spirochetes and gram negative roganisms

A

nug

267
Q

the bacteria invade the tissue and cause teh characteristic

A

pseduomembranous appears of the disease

268
Q

recurrent nug can result in

A

attachemtn loss

when this happen it is calle dnecrotizing ulerative periodontitis

269
Q

with nug the involved papillary gingiva becomes

A

necrotic and appears cratered or punched out

270
Q

with nug the surface of gingiva has a

A

pseduomembranous coaing made up of a necrotic bacteria and tissue. the gingiva is reddened and painful.

271
Q

with nug the lesions may be

A

localized to specific areas or generalized throughout the mouth and patients often have a strong breath odor described as fetor oris.

272
Q

three sings of nug

A

acute necrosis and ulceration of the interproximal papillae
pain
bleeding

273
Q

necrotic papillae pain and bleeding occured

A

100 percent of the imte

274
Q

fetis breath odor occured in

A

97 most cases
pseudomembranous in 87
lymp in 61
fever in 39

275
Q

—- percent of patient with nug smoke

A

83

276
Q

the goal of the treatment of nug is

A

to reduce the microbial load and remove necrotic tissue to assist healing

277
Q

the first visit for nug requires a limited amount of debridgement only what the patient can tolerate

A

true

278
Q

during the course of emergency management of nug the patent should be obstructed

A

to rest drink plenty of fluid avoid spicy foods rinse with warm salt water and refrain from smoking.

279
Q

is the oral manifestation of primary infection with the herpesvirus usally herpes simplex virus one

A

acute herpetic gingivostomatis

280
Q

approx — to —- of patients with intial infection with hsv1 are symptomatic

A

10 to 20

281
Q

acute herpetic gingivostomatic has been seen primarily in

A

infants and young children

it is now found in young adults 20-30s possibly representing primary infection with genital herpesvirus herpes simplex virus 2

282
Q

primary herpetic gingivstomtis in adolescents and older adult is usually caused by hsv 1 but may be the

A

inital manifestiation of hsv 2

283
Q

acute herpetic gingivostomatisis is commonly associated with

A

prodromal symptoms such as fever malaise headache irritability and lumphadenopathy

284
Q

oral lesions begin as

A

small yellow vessicles

285
Q

the yellow vessicles coalese to form

A

larger round ulcers with graycenters and bright red borders.

can be on the lips tongue gingiva and bucca muscoasa

286
Q

after the primary infection has occured the herpes virus travels through the nerves to reside in neuronal ganglia.

A

there it can be active again and recur most commonly in the form of herpes labialis.

287
Q

the secondary lesions occur in about 1/3 of the world pipulation and are triggered by

A

sunlight trauma fever or stress

288
Q

the treatment of acute herpetic gingivostomatitis is supportive because the disease runs its courise in

A

7 to ten days

extremely contagious .

Dr keaton perio exam 2 (1 decks)

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