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Oral surgery > Examination, diagnosis and treatment of periodontal diseases > Flashcards

Examination, diagnosis and treatment of periodontal diseases Flashcards

1
Q

Periodontitis defintion

A
  • Inflammatory process in periodontal space
  • Affects alveolar bone, soft tissues and lymphatics
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2
Q

Two main parts of periodontium

A
  • Periodontium periapicale(around root tip)
  • Periodontium marginale(Around alveolar ridge)
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3
Q

Periodontitis can be classified according to:

A
  • Aetiology
  • Type of inflammation
  • Location
  • Clinical course
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4
Q

Periodontitis classifications according to aetiology

A
  • Infectious
  • Trauma
  • Chronic
  • Chemotaxic
  • Allergic
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5
Q

Infectious organisms of Periodontitis

A
  • Micro-organisms from infected root canals or periodontal pockets
  • Aerobes
  • Anaerobes
  • Lactobacillus
  • Fusobacterium
  • Staphylococci
  • Streptococci
  • Actinomyces
  • Clostridium
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6
Q

Causes of infectious periodontitis

A
  • Untreated pulpitis
  • Improper treatment
  • Failure of root canal
  • Gangrenous roots
  • Periodontal defects
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7
Q

Types of trauma that cause periodontitis

A
  • Acute
  • Chronic
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8
Q

Acute trauma in periodontitis

A
  • Fracture of crown->
  • Disruption of vascular bundle
  • Influx of MO
  • Necrosis of pulp
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9
Q

Chronic trauma in periodontitis

A
  • Poorly designed restorations overload periodontium
  • Crowns
  • Bridges
  • Parafunction
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10
Q

Allergic causes of periodontitis

A
  • Allergy to dental materials
  • Hyperergic antigen antibody reactions
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10
Q

Chemotoxic causes of periodontitis

A
  • Irritating toxic drugs
  • Arsenic
  • Phenolic derivatives
  • Improper use of composite materials
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11
Q

Periodontitis classification according to location

A
  • Periapical
  • Total
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12
Q

Periodontitis classification according to type of inflammation

A
  1. Exudative
    * Serous
    * Purulent
  2. Proliferative
    * Granulomatous
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13
Q

Periodontitis classification according to Clinical course

A
  • Sharp
  • Chronic
  • Excacerbated
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13
Q

Acute periodontitis classifications

A
  • Periodontitis periapicalis acuta- serosa et purulenta
  • Periodontitis marginalis acuta- Serosa et purulenta
  • Periodontitis totalis acuta
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14
Q

Chronis periodontitis classifications

A
  • Periodontitis periapicalis chronica granulomatosa diffuse(sin/cum fistulae)
  • Periodontitis periapicalis chronica granulomatosa localisata
  • Periodontitis periapicalis chronica fibrosa
  • Periodontitis chronica exacerba
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15
Q

The clinical course of periodontitis depends on:

A
  • Aetiology
  • Location and type of process
  • Microbial contamination
  • Virulence of microorganisms
  • Local and general immune status
  • Age
  • Contomitant diseases
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16
Q

Important anamnestic data for diagnosis of periodontitis

A
  • Presence of pain
  • Socrates
  • Site
  • Onset
  • Character
  • Radiation
  • Associated symtoms
  • Time
  • Exacerbating factors
  • Severity
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16
Q

Important criteria assessed during periodontitis examination

A
  • Adjacent teeth
  • Mucous membranes
  • Percussion of tooth-horiontal/vertical
  • Pressure on tooth(V/H)
  • Palpation(root tip/marginal gingiva)
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17
Q

Acute periapical periodontitis definition

A

Acute inflammation of periapical periodontium and adjacent bone

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17
Q

Acute serous periodontitis characteristics

A

Inflammation of pulp causing:
* Hyperemia
* Extravasation of cellular elements and exudate
* Edema
* Bone resorption
* Serous exudate->purulent

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18
Q

Acute serous periodontitis clinical presentation

A
  • Pain similar to pulpitis
  • Pain on percussion
  • May or may not be able to localise
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19
Q

Treatment of Acute serous periodontitis

A
  • Endodontic treatment
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20
Q

Phases of Acute Purulent periodontitis

A
  • Periodontal
  • Endosteal
  • Subperiosteal
  • Submucosal
21
Q

Periodontal phase of Acute Purulent periodontitis characteristics

A
  • Serous exudate-> Purulent
  • Mixed virulent microflora
  • Complement activation
  • Infiltration of neutrophils and macrophages
  • Spreading bone resorption
  • Strong constant pain intensifying on percussion
22
Q

Periodontal phase of Acute Purulent periodontitis general symptoms

A
  • Slightly enlarged and painful lymph nodes
  • General malaise
22
Q

Periodontal phase of Acute Purulent periodontitis paraclinical tests

A
  • No radiological changes
  • Tooth doesnt react to pulp testing
23
Q

Differential diagnosis of Periodontal phase of Acute Purulent periodontitis

A
  • Purulent pulpitis
  • Pulp-periodontitis
  • Localised ostemyelitis
24
Q

Treatment of Periodontal phase of Acute Purulent periodontitis

A
  • Endodontic treatment
  • Extraction
  • Antibiotics
25
Q

Endosteal phase of Acute Purulent periodontitis characteristics

A
  • Process continues expansion into bone
  • Constant throbbing pain
  • Unbearable pain on percussion
  • Regional lymph nodes enlarged and pain
26
Q

Endosteal phase of Acute Purulent periodontitis general condition

A
  • Malaise
  • Tremor
  • Low grade fever
  • Rapid heart beat
  • Headache
  • Insomnia

Most are minor symtoms

27
Q

Treatment of Endosteal phase of Acute Purulent periodontitis

A
  • Endodontic treatment
  • Extraction
  • Medication

Medication: Anti-inflammatory, antibiotic(Clindamycin), analgesic, Antipyretic

28
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis characteristics

A
  • Increased invasion of bone
  • Increase in purulence
  • Spontaneous very strong pain, mucosa hyperemic and edematous
  • Mobility

MOST PAINFUL STAGE

29
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis general condition

A
  • Regional lymph nodes enlarged
30
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis paraclinical tests

A
  • X-ray same as endosteal phase
31
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis treatment

A
  • Draining of abcess
  • Endo
  • Medication- Analgin, Ibuprofen(400mg), Amoxicillin(1000mg x2), metranidazole
32
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis differential diagnosis

A
  • Different phases of periodontitis
  • Osteomyelitis
  • Exacerbated cysts
33
Q

Submucosal abcess Acute Purulent periodontitis characteristics

A
  • Purulent collection below periosteum forms abcess
  • Decrease in pain
  • Hyperemia and severe edema-spread
    => Abcesses and phlegmons

Edema spreads to: lips, cheeks, nasolabial folds, eyelids, sublingual, submental and submandibular space

34
Q

Submucosal abcess Acute Purulent periodontitis general condition

A
  • Tremor
  • fatigue
  • Loss of apetite
  • Headache
  • High temperature
  • Increased HR
35
Q

Submucosal abcess Acute Purulent periodontitis paraclinical studies

A
  • Radiographic changes difficult to detect
  • Leukocytosis
  • Accelerated ESR
  • C- reactive protein
36
Q

Characteristics of Chronic periodontitis

A
  • Can occur w/ low virulence mo and good immune status
  • Long course-months/years
  • Proliferation->Blood vessels+tissues
  • Fibrosis of connective tissue
37
Q

Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) characteristics

Chronic granulating periapical periodontitis

A
  • Chronic purulent proliferative process in bone
  • Bone resorption
  • No subjective complaints/pain
  • Tooth may be darker in colour
  • Tooth apex that leaks
  • Fistula that may be located away from causative tooth
  • Acute exacerbations may occur- painful, edema and hyperaemia
37
Q

Diagnosis of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)

Chronic granulating periapical periodontitis

A
  • Periodic exacerbations
  • Presence of fistula
  • Blurred outline of bone on x-ray
37
Q

Treatment of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula)

Chronic granulating periapical periodontitis

A
  • Endo
  • Tooth extraction
  • Resection of root tip
  • Hemisection
  • Anti-inflammatory treatment-osteotrophic drugs
38
Q

Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) differential diagnosis

Chronic granulating periapical periodontitis

A
  • Chronic osteomyelitis
  • Other chronic periodontitis
39
Q

Periodontitis periapicalis chronica granulomatosa localisata characteristics

Chronic periapical granulomatous localisaed periodontitis

A
  • Necrosis and bone destruction replaced by granulation tissue
  • Granulation tissue formation followed by fibrosis w/ proper treatment and optimal response
  • Granulation tissue becomes granuloma with inadequate treatment or poor response
40
Q

Granulation tissue cells

A
  • Well vascularised and rich in cells
  • Fibroblasts
  • Endothelial cells
  • Plasma cells
  • Mast cells
41
Q

Granuloma characteristics

A
  • Chronic inflammatory response-
    Granulation tissue rich in cells and blood vessels
  • Connective tissue capsule-> limits penetration of infection
42
Q

Types of Granuloma according to their histology

A
  • Common Granuloma/granuloma simplex
  • Epithelialising granuloma
  • Cystic granuloma/Granuloma cycsticum
43
Q

Diagnosis of granuloma

A
  • Ask about past pain
  • Exacerbations?
  • Mild pain on percussion
  • Round shadow around root radiographically
44
Q

Differential diagnosis of Granuloma

A
  • Diffuse granulating and fibrous periodontitis
  • Localised osteomyelitis
  • Radicular cyst
45
Q

Treatment of granuloma

A
  • Extraction
  • Endo
  • Surgical removal of granuloma
  • Hemisection of roots
  • Less common-reimplantation and autotransplantation of root
46
Q

Periodontitis periapicalis chronica fibrosa characteristics

A

Following endo treatment
* Granulation tissue replaced w/ fibrous tissue
* Reduction in cells- w/exception of fibroblasts
* Reduction in blood vessels
* Fibrous tissue replaced w/ bone after some months

Healing phase of acute and chronic periodontitis

47
Q

Treatment of chronic periodontitis

A
  • Extraction-Followed by removal /currettage of pathologically altered tissue/granuloma
  • Endo-rare
  • Surgical methods
48
Q

Surgical methods of treatment of Chronic Periodontitis

A
  • Apical osteotomy
  • Hemisection
  • Amputation
  • Reimplantation
  • Autotransplantation
  • Coronory radicular seperation
49
Q

Apical osteotomy/resection of root tip/Resectio apics dentis Indications

A
  • Chronic periapical periodontitis
  • Radicular cysts
  • Curved/impossible to access canals w/ pain, discomfort and inflammation
  • Perforation of root near apex
  • Failed endo
  • Root fractures(distal)
50
Q

Apical osteotomy/resection of root tip/Resectio apics dentis Contraindications

A
  • More than 1/3 root involved and poor chance of healing
  • Advanced periodontal process
51
Q

Apical osteotomy/resection of root tip/Resectio apics Procedure

A
  • LA
  • Incision at apex
  • Flap
  • Bone perforated w/ round bur
  • Detection of apex and granulation tissue
  • Removal of GT
  • Obturation of root canals w/ non absorbable material
  • Retrograde filling of canals also can be done
  • Suturing

Oral surgery (106 decks)

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