exam 2 (L12) - preprosthetic periodontal surgery

Question 1

what are the 4 periodontal problem zones for fixed replacements

Answer 1

• supragingival crown margins
• open interdental spaces (embrasures)
• contact of pontic with tissue
• occlusion

Question 2

why is it bad to have excess space between restorations and gingiva in the interdental regions?

Answer 2

food impaction

Question 3

what are the principles of tooth preparation for crowns in relation to the gingival margin?

Answer 3

• margin level is important
• avoid gingival third
• place subgingival margins w/in 1-2 mm of FGM
• inflammation should be resolved before restoration placement

Question 4

what embrasures of crowns should be evaluated relative to the gingival margins?

Answer 4

• gingival embrasures (height, width, depth)

- contours of restorations (size, shape)

Question 5

what should be done instead of using a hemisectioned or root amputated tooth for an abutment for FPD?

Answer 5

use an implant instead

Question 6

what negative periodontal effects are related to RPD use?

Answer 6

• teeth involved with RPD’s show periodontal destruction
• metal (lingual) plates are bad; use bars instead so you aren’t placing metal at FGM
• avoid distally extending cantilevered pontics at all costs

Question 7

when are considerations/indications for prosthetic/restoration placement when periodontal tissues are involved?

Answer 7

• for pockets adjacent to an edentulous ridge:
  + establish a healthy gingival sulcus
  + eliminate extraneous mucosal tissue to permit adequate vertical space for the replacement
  + to provide a firm, healthy, mucosal base for placement of saddles or pontics

Question 8

what methods are available to make periodontal adjustments for crown placement?

Answer 8

• gingivectomy/gingivoplasty when:
  + gingival enlargement present
  + horizontal bone loss present
  + adequate KG
• flaps & osseous surgery when:
  + infrabony defects
  + only a thin band of KG

Question 9

picture…

Answer 9

A. do mesial wedge if enough tissue present, not going all the way to premolar if it is healthy. vertical incisions should be divergent in interproximal spaces to prevent vascular damage

B. combine mesial and distal wedge if both teeth adjacent the edentulous ridge are affected

Question 10

how do you know when a mucogingival problem needs managed?

Answer 10

• lack of keratinized and/or attached gingiva, especially on abutment teeth or edentulous sites
• shallow vestibular depth RPD and CD’s

Question 11

what methods can be used to manage mucogingival defects?

Answer 11

• subepithelial connective tissue graft
• free gingival graft
• vestibular extension

Question 12

how do you deal with class V cervical defects?

Answer 12

remove old composite, make split-thickness flap, do soft tissue graft

Question 13

when is vestibular extension done?

Answer 13

when lacking room for complete dentures (or RPD?)

Question 14

what factors are considered for CCL procedures?

Answer 14

• esthetic considerations
• restorative indications
• soft tissue removal
• hard tissue removal

Question 15

if only soft tissue needs to be removed, not hard tissue, which procedure can be done?

Answer 15

gingivectomy

Question 16

what is a gingivectomy contraindicated for soft tissue removal?

Answer 16

when the keratinized gingiva (KG) is very thin/small

Question 17

what are the indications of ridge augmentation procedures done to correct excessive bone loss?

Answer 17

• advanced perio disease
• periapical lesion
• traumatic tooth extractions
• external trauma

Question 18

what methods are there for ridge augmentation procedures?

Answer 18

• soft tissue augmentation only
• hard tissue augmentation only
• soft and hard tissue concomitant augmentation

Question 19

what kind of ridge augmentation procedures can be done?

Answer 19

• place thick mucosal autograft
• place CT graft beneath full/partial flap, or in tunnel by lateral incision
• roll technique?
• GTR

Question 20

what are indications for ridge reduction and removal of tori and exostoses? contraindications?

Answer 20

• indications:
  + excessive hard tissue
  + excessive soft tissue
  + excessive hard and soft tissue

- contraindications:
\+ gingivectomy/gingivoplasty
\+ distal wedges (sometimes mesial too)
\+ osseous surgery
\+ a combination of gingivectomy, gingivoplasty, and OS