Indications for Surgery Flashcards
List the goals of non-surgical therapy: (5)
- removal of plaque and calculus
- microflora alteration
- endotoxin removal
- “smooth” surface
- tissue shrinkage
For a periodontal pocket of the following measurements, give the efficiency of SRP and OFD:
a) 1-3 mm
b) 4-6 mm
c) >6mm
a) SRP= 86% OFD= 86%
b) SRP= 43% OFD= 76%
c) SRP= 32% OFD= 50%
In pockets that are greater than 5mm, there is a ___% chance that residual calculus and biofilm is left.
85%
Where is most residual calculus and biofilm left in deep pockets?
CEJ & line angles
List the disadvantages of nonsurgical therapy: (4)
- depth of pocket determines efficiency
- loss of connective tissue by SRP in healthy healthy sites
- thin vs. thick tissue
- instrumentation of furcations
What are the two concerns with instrumentation of furcations with non-surgical therapy? (2)
- size of instruments
- size of furcation entrances
What is the END POINT of SRP?
Eliminate inflammation, bleeding on probing, suppuration, and 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 and 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 and defect access, plaque and calculus removal by non-surgical means is more difficult to accomplish in deeper pockets
True
With root and defect access, it is difficult for ____ without surgical access
furcation instrumentation
In terms of root and defect access, surgical therapy allows for: (2)
- granulation tissue removal
- access to osseous defects
The gold standard periodontal surgery:
regeneration
What is regeneration?
reconstitution of a lost or missing part
In periodontics, what are the 3 components of regeneration?
- new PDL
- new cementum
- new bone
What are the types of regeneration in periodontal surgery?
- autografts
- allografts
- allowlists/xenografts
- guided tissues regeration
T/F: Not every person is susceptible to periodontal disease due to risk factors and genetics
true
What are the two factors that determine if a person is susceptible to periodonta 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 gingival, these patients are more susceptible to:
recession
What does bleeding on probing tell us?
inflammation is present
What is the instrument of choice in furcation areas?
cavitron
Regeneration that involves bone from self:
autografts
Regeneration that involves bone of the same species:
allograft
Regeneration that involves bone from different species (sheep, cow, etc):
xenografts
Synthetic product made in lab that stimulates replication/growth of the bone:
alloplast
Because cells move at a very different pace, excluding the epithelium or connective tissue and allowing the bone cells to move in at a slower place, guiding the cells we want to grow into 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
T/F: Periodontal disease typically causes pain
false
T/F: Hand instruments are best option when scaling in furcation areas
False- cavitron is better fit due to hand instruments being too big
How do you prove regeneration?
measure from CEJ to alveolar crest is a good start to because it tells us something has filled that gap, but the only way to measure for TRUE regeneration is to take out the tooth (which you won’t do)
To prove regeneration has occurred by extracting a tooth (you really wouldn’t do this), you would look under the microscope for:
- osteoblasts
- cementoblasts
- periodontal ligament cells
- Osseous contouring with placement of the flap margin at the alveolar crest
- creation of shallow sulci
- ease of maintenance by therapist and patient
pocket elimination via surgical therapy
What is seen in AGGRESSIVE periodontitis?
bacterial penetration
Aggressive periodontitis was formerly known as:
LJP/GJP
What is the causative bacterial pathogen seen in aggressive periodontitis?
A.a
- regain periodontium
- remove frena
- increase root coverage
- increase keratinized tissue
- restore gingival topography
- pre-prosthetics & pre-orthodontics
Mucogingival surgery/ Periodontal plastic surgery
Re-treatment of case is an indication for periodontal surgery and is performed when:
- non-surgical therapy has 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 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 than surgically treated sites
false- greater percentage
____ areas have a greater percentages of defects that convert from non-diseased to diseased sites than ____ sites
non-surgically treated; surgically treated
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 and all other dental needs are addressed