Indications for surgery- Review Flashcards
Non-surgical periodontal therapy =
SRP
What are the goals of non-surgical perio therapy?
- removal of plaque and calculus
- microflora alteration
- endotoxin removal
- “smooth” the surface
- tissue shrinkage
Enotoxins are released via:
gram negative bacteria
List the disadvantages of non-surgical perio therapy:
- depths of pockets determine efficiency
- loss of CT by SRP in healthy sites
- thin vs. thick tissue
- instrumentaiton of furcations
Endpoint of periodontal therapy: (2)
- Eliminate inflammation, BOP, suppuration, and disease progression
- Result in a functional, comfortable, healthy dentition with stable probing and attachment levels
SRP efficiency vs. OFD efficiency
pockets 1-3 mm
SRP: 86%
OFD: 86%
SRP efficiency vs. OFD efficiency
pockets 4-6mm
SRP: 43%
OFD: 76%
SRP efficiency vs. OFD efficiency
pockets greater than 6mm
SRP: 32%
OFD: 50%
Give the parameters for PERIO MAINTENANCE post-SRP:
- 6 weeks post-op
- good oral hygiene
- plaque score of less than 30%
- few 4mm pockets
Give the parameters for COMPRISED PERIO MAINTENANCE post-SRP:
- 6 weeks post-op
- 90% plaque score
- few 6mm pockets
Give the parameters for PERIODONTAL SURGERY post-SRP
- 6 weeks post-op
- plaque score of less than 30%
- few 6mm pockets
Biofilm and calculus are most commonly found (trapped) at:
CEJ & Line Angles
Why might biofilm and calculus get trapped at the CEJ?
due to it being a transition zone with increased roughness- especially in cases where the CEJ is exposed due to recessed gingiva
There is a ___% chance of leaving residual calculus or biofilm in pockets that are ____
85%; greater than 5mm
Bone loss starts:
interproximally
Why does bone loss start interproximally?
- food trap
- less keratinized tissue
- harder area for patients to keep clean
T/F: Non-surgically treated areas have a GREATER percentage of defects that convert from non-diseased to diseased sites than surgically treated areas.
True
_____ areas have a greater percentages of defects that convert from non-diseased to diseased than _____ areas.
non-surgically treated areas; surgically treated
T/F: Single rooted teeth are better for BOTH non-surgical modalities than molars
true
This card is saying that when comparing single rooted teeth (incisors, canines, etc) to molars, it does not matter whether therapy is OFD or SRP, it will respond better due to it only having one root
When comparing single rooted teeth to molars, the better prognosis of single rooted teeth is due to:
easier access and no furcations
What is the gold standard of periodontal therapy?
regeneration
Reconstitution of a lost or missing part:
regeneration
In periodontics, regeneration refers to:
- new PDL
- new cementum
- new bone
Types of regeneration modalities include:
- autograft
- allograft
- alloplast
- xenograft
Regeneration modality in which the tissue is coming directly from the same patient:
autograft
Regeneration modality in which the tissue is coming from the same species:
allograft
Regeneration modality in which the tissue is synthetic:
alloplast
Regerenation modality in which the tissue is coming from a different species (example pig, calf, or cow)
xenograft
Addition of non-resorb able or reservable membrane between bone and tissue- used to exclude epithelium and CT from surgical site:
Guided tissue regeneration (GTR)
What is the goal of the membrane placed in GTR?
to exclude epithelial cells and allow bone and PDL cells into the area (do not want epithelium that grows at a faster rate than CT to fill in instead)
GTR is most effective with:
grade II furcation involvement
Osseous contouring with placement of the flap margin at the alveolar crest:
pocket elimination
When performing pocket elimination surgery, where is the flap placed?
at alveolar crest
What are the functions of placing the flap margin at the alveolar crest during pocket elimination surgery?
- creation of shallow sulk
- provides ease of maintenance by therapist and patient
In what form of periodontitis is characterized by bacterial penetration?
aggressive periodontitis
Localized juvenile periodontitis (LJP) & Generalized juvenile periodontitis (GJP) was renamed to ___ in 2017
periodontitis
What is the causative pathogen seen in aggressive periodontitis?
aggregatibacter actinomycetecomitans (A.a)
Osseous contouring with placement of flap margin at alveolar crest for creation of shallow sulci as well as ease of maintenance by therapist and patient:
Pocket elimination
Addition of non-resorbable or restorable membrane between bone and tissue, with the goal of excluding epithelial cells and allowing bone and PDL cells to grow into that area (do not want epithelium that grows at a faster rate than CT to fill in instead)
Guided tissue regeneration (GTR)
Where is the membrane placed during GTR?
between bone and tissue
Performed in order to regain periodontium, remove frena, increase root coverage, or increase keratinized tissue, restore gingival topography, or for pre-prosthetics and pre-orthodontic reasons:
mucogingival surgery/periodontal plastic surgery
List the reasons for performing mucogingival surgery/periodontal plastic surgery:
- regain periodontium
- remove frena
- increase root coverage or keratizined tissue
- restore gingival topography
- pre-prosthetic or pre-orthodontic reasons
Occurs when non-surgical therapy has failed AND surgical therapy has failed so new techniques or material are attempted:
Retreatment of case
List some examples of pre-prosthetic surgery:
- crown lengthening
- bone augmentation
- palatal recontouring
- gingivectomy/gingivoplast
- ridge or tuberosity reduction
Hardest to accomplish HEIGHT and should NOT use free gingival graft that is formally positioned
bone augmentation
Drugs that cause gingival overgrowth include:
- DIlantin/Phenytoin (anti-seizure)
- Cyclosporine/Sandimmune (immunosupressant)
- Procardia/Nifedipine (calcium channel blocker)
Classes of drugs that can cause gingival overgrowth include:
- anti-convulsant meds
- immunosuppressents
- calcium channel blockers
Your patient comes in and has multiple periodontal abscesses, what must you consider?
diabetes
When can you safely and effectively place implants in a periodontitis patient?
Implants are NOT indicated until periodontal disease has been controlled and ALL other dental needs are addressed in a comprehensive treatment plan
