Indications for Surgery

Question 1

List the goals of non-surgical therapy: (5)

Answer 1

1. removal of plaque and calculus
2. microflora alteration
3. endotoxin removal
4. “smooth” surface
5. tissue shrinkage

Question 2

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

Answer 2

a) SRP= 86% OFD= 86%
b) SRP= 43% OFD= 76%
c) SRP= 32% OFD= 50%

Question 3

In pockets that are greater than 5mm, there is a ___% chance that residual calculus and biofilm is left.

Answer 3

85%

Question 4

Where is most residual calculus and biofilm left in deep pockets?

Answer 4

CEJ & line angles

Question 5

List the disadvantages of nonsurgical therapy: (4)

Answer 5

1. depth of pocket determines efficiency
2. loss of connective tissue by SRP in healthy healthy sites
3. thin vs. thick tissue
4. instrumentation of furcations

Question 6

What are the two concerns with instrumentation of furcations with non-surgical therapy? (2)

Answer 6

1. size of instruments
2. size of furcation entrances

Question 7

What is the END POINT of SRP?

Answer 7

Eliminate inflammation, bleeding on probing, suppuration, and disease progression

Question 8

What is the FINAL GOAL of SRP?

Answer 8

Final goal of a functional, comfortable, healthy dentition with stable probing attachment levels

Question 9

List the 9 indications for periodontal surgery:

Answer 9

1. Root and defect access
2. Regeneration
3. Pocket elimination
4. Removal of bacteria
5. Mucogingival surgery/ Periodontal plastic surgery
6. Retreatment of case
7. Pre-prosthetic surgery
8. Drug-induced gingival overgrowth
9. Abscess debridement

Question 10

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

Answer 10

True

Question 11

With root and defect access, it is difficult for ____ without surgical access

Answer 11

furcation instrumentation

Question 12

In terms of root and defect access, surgical therapy allows for: (2)

Answer 12

1. granulation tissue removal
2. access to osseous defects

Question 13

The gold standard periodontal surgery:

Answer 13

regeneration

Question 14

What is regeneration?

Answer 14

reconstitution of a lost or missing part

Question 15

In periodontics, what are the 3 components of regeneration?

Answer 15

1. new PDL
2. new cementum
3. new bone

Question 16

What are the types of regeneration in periodontal surgery?

Answer 16

1. autografts
2. allografts
3. allowlists/xenografts
4. guided tissues regeration

Question 17

T/F: Not every person is susceptible to periodontal disease due to risk factors and genetics

Answer 17

true

Question 18

What are the two factors that determine if a person is susceptible to periodonta disease?

Answer 18

1. risk factors
2. genetics

Question 19

Following SRP, most calculus is left at:

Answer 19

CEJ & line angle

Question 20

Prophys should ONLY be done in:

Answer 20

periodontal health

Question 21

In patients with thin phenotype gingival, these patients are more susceptible to:

Answer 21

recession

Question 22

What does bleeding on probing tell us?

Answer 22

inflammation is present

Question 23

What is the instrument of choice in furcation areas?

Answer 23

cavitron

Question 24

Regeneration that involves bone from self:

Answer 24

autografts

Question 25

Regeneration that involves bone of the same species:

Answer 25

allograft

Question 26

Regeneration that involves bone from different species (sheep, cow, etc):

Answer 26

xenografts

Question 27

Synthetic product made in lab that stimulates replication/growth of the bone:

Answer 27

alloplast

Question 28

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:

Answer 28

guided tissue regeneration

Question 29

Guided tissue regeneration membrane will provide:

Answer 29

epithelial exclusion

Question 30

Gram negative anaerobic microflora produce ___ causing mediators to come in and we get ___

Answer 30

endotoxins; inflammation

Question 31

What type of bacteria in the microflora cause inflammation leading to periodontitis?

Answer 31

gram negative anaerobic

Question 32

T/F: Periodontal disease typically causes pain

Answer 32

false

Question 33

T/F: Hand instruments are best option when scaling in furcation areas

Answer 33

False- cavitron is better fit due to hand instruments being too big

Question 34

How do you prove regeneration?

Answer 34

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)

Question 35

To prove regeneration has occurred by extracting a tooth (you really wouldn't do this), you would look under the microscope for:

Answer 35

1. osteoblasts 2. cementoblasts 3. periodontal ligament cells

Question 36

- Osseous contouring with placement of the flap margin at the alveolar crest - creation of shallow sulci - ease of maintenance by therapist and patient

Answer 36

pocket elimination via surgical therapy

Question 37

What is seen in AGGRESSIVE periodontitis?

Answer 37

bacterial penetration

Question 38

Aggressive periodontitis was formerly known as:

Answer 38

LJP/GJP

Question 39

What is the causative bacterial pathogen seen in aggressive periodontitis?

Answer 39

A.a

Question 40

- regain periodontium - remove frena - increase root coverage - increase keratinized tissue - restore gingival topography - pre-prosthetics & pre-orthodontics

Answer 40

Mucogingival surgery/ Periodontal plastic surgery

Question 41

Re-treatment of case is an indication for periodontal surgery and is performed when:

Answer 41

1. non-surgical therapy has failed 2. surgical therapy has failed 3. new techniques or materials are available

Question 42

- crown lengthening - ridge augmentation - palatal recontouring - gingivectomy/gingivoplasty - ridge or tuberosity reduction these are are all forms of:

Answer 42

pre-prosthetic surgery

Question 43

What drugs may lead to drug-induced gingival overgrowth?

Answer 43

1. dilantin 2. cyclosporin 3. calcium channel blockers (nifedipine)

Question 44

T/F: Non-surgically treated areas have a lesser percentage of defects that convert from non-diseased to diseased sites than surgically treated sites

Answer 44

false- greater percentage

Question 45

____ areas have a greater percentages of defects that convert from non-diseased to diseased sites than ____ sites

Answer 45

non-surgically treated; surgically treated

Question 46

All studies show that results in single rooted teeth are ___ for both non-surgical AND surgical modalities than molars

Answer 46

better

Question 47

____ are NOT indicated until periodontal disease has been controlled and all other dental needs are addressed in a comprehensive treatment plan

Answer 47

Implants

Question 48

Implants are NOT indicated until:

Answer 48

periodontal disease has been controlled and all other dental needs are addressed