Indications for Surgery Flashcards
List the goals of non-surgical therapy: (5)
- removal of plaque & calculus
- microflora alteration
- endotoxin removal
- “smooth” surface
- tissue shrinkage
For a periodontal pocket of the following measurements, give the efficacy of SRP & OFD:
A) 1-3mm
B) 4-6mm
C) >6mm
A) SRP= 86% OFD=86%
B) SRP= 43% OFD= 76%
C) SRP= 32% OFD= 50%
In pockets greater 5mm, ____% chance of leaving residual calculus & biofilm
85%
Where is most residual calculus & biofilm left in deep pockets?
CEJ & line angles
List the disadvantages of non-surgical therapy: (5)
- depth of pocket determines efficiency
- loss of connective tissue by SRP in healthy sites
- thin vs. thick tissue
- instrumentation of furcations
What are the two concerns with instrumentation of furcations with nonsurgical therapy?
- size of instruments
- size of furcation entrances
What is the ENDPOINT of SRP?
Eliminate inflammation, BOP, suppuration & disease progression
What is the FINAL GOAL of SRP?
Final goal of a functional, comfortable, healthy dentition with stable probing attachment levels
List the 9 indications for periodontal surgery:
- Root & defect access
- Regeneration
- Pocket elimination
- Removal of bacteria
- Mucogingival surgery/Periodontal plastic surgery
- Retreatment of case
- Pre-prosthetic surgery
- Drug-induced gingival overgrowth
- Abscess debridement
T/F: In terms of root & defect access, plaque and calculus removal by non-surgical means is more difficult to accomplish in deeper pockets
True
With root & defect access, it is difficult for _____ without surgical access
furcation instrumentation
In terms of root & defect access, surgical therapy allows for: (2)
- granulation tissue removal
- access to osseous defects
The ‘gold standard’ of periodontal surgery?
Regeneration
What is regeneration?
Reconstitution of a lost or missing part
In periodontics what are the three components of regeneration?
- New PDL
- New cementum
- New bone
What are the types of regenneration in periodontal surgery?
- autografts
- allografts
- alloplasts/xenografts
- guided tissue regeneration
T/F: Not every person is susceptible to periodontal disease due to risk factors & genetics
True
What are the two factors that determine whether a person is susceptible to periodontal disease?
- risk factors
- genetics
Following SRP, most calculus is left at:
CEJ & line angle
Prophys should ONLY be done in:
periodontal health
In patients with thin phenotype gingiva, these patients are more susceptible to:
Recession
What does BOP tell us?
Presence of inflammation
What is the instrument of choice in furcation areas?
Cavitron
Regenerates involving bone from self:
autograft
Regeneration that involves bone from the same species:
allograft
Regeneration that involves bone from different species (sheep, cow, etc.):
xenografts
Synthetic product made in lab that stimulates replication/regrowth of the bone:
alloplasts
Because cells move at a very different pace, excluding the epithelium or connective tissue & allowing the bone cells to move in at a slower pace, guiding the cells we want to grow in that area:
Guided tissue regeneration
Guided tissue regeneration membrane will provide:
epithelial exclusion
Gram negative anaerobic microflora produce _____ causing mediators to come in and we get ____
endotoxins; inflammation
What type of bacteria in the microflora cause inflammation leading to periodontitis?
Gram negative anaerobic microflora
T/F: Periodontal disease typically causes pain
False
T/F: Hand instruments are best option for scaling furcation areas
False- cavitrons are better option due to hand instruments not being able to fit
How do you prove regeneration has occured?
Measure from the CEJ to the alveolar crest is a good start because it tells you something has filled that gap but the only way to measure for true regeneration is to take the tooth out so obviously that’s counterproductive
To prove regeneration has occured by extracting the tooth (you really wouldn’t do this) you would look under the microscope for:
- Osteoblasts
- Cementoblasts
- PDL cells
-Osseous contouring with placement of the flap margin at the alveolar crest
-Creation of shallow sulci
-Ease of maintenance by therapist & patient
Pocket elimination via surgical therapy
What is seen in AGGRESSIVE peridontitis?
Bacterial penetration (into the soft tissue)
Aggressive periodontitis was formerly known as:
LJP/GJP
What is the causative bacterial pathogen associated with aggressive peridontitis?
A.a
-Regain periodontium
-Remove frena
-Increase root coverage
-Increase keratinized tissue
-Restore gingival topography
-Pre-prosthetics & Pre-orthodontics
Mucogingival surgery/Periodontal plastic surgery
Retreatment of case is an indication for surgery and is performed when:
- Non-surgical therapy had failed
- Surgical therapy has failed
- New techniques or materials are available
-Crown lengthening
-Ridge augmentation
-Palatal recontouring
-Gingivectomy/Gingivoplasty
-Ridge or tuberosity reduction
These are all forms of:
Pre-prosthetic surgery
What drugs may lead to drug-induced gingival overgrowth:
- Dilantin
- Cyclosporin
- Calcium channel blockers (Nifedipine)
T/F: Non-surgically treated areas have a lesser percentage of defects that convert from non-diseased to diseased sites that surgically treated sites
False- greater percentage
_____ areas have a greater percentage of defects that convert from non-diseased to diseased sites than ____ sites
Nonsurgically treated; surgically treated sites
All studies show that results in single-rooted teeth are ____ for both non-surgical AND surgical modalities than molars
better
____ are NOT indicated until periodontal disease has been controlled and all other dental needs are addressed in a comprehensive treatment plan
Implants
Implants are NOT indicated until:
Periodontal disease has been controlled & all other dental needs are addressed in a comprehensive treatment plan
