Indications for surgery- Review Flashcards
Non-surgical periodontal therapy=
SRP
What are the goals of nonsurgical perio therapy?
- removal of plaque and calculus
- microflora alteration
- endotoxin removal
- “smooth” the surface
- tissue shrinkage
Endotoxins are released via:
gram negative bacteria
List the disadvantages of non-surgical perio therapy:
- depth of pockets determine efficiency
- loss of CT by SRP in healthy sites
- thin vs. thick tissue
- instrumentation of furcations
Endpoint of periodontal therapy: (2)
- Eliminate inflammation, BOP, suppuration, and disease progression
- Results in a functional, comfortable, healthy dentition with stable probing attachment levels
SRP efficiency vs. OFD efficiency:
Pockets 1-3 mm
SRP: 86%
OFD: 86%
SRP efficiency vs. OFD efficiency:
Pockets 4-6 mm
SRP: 43%
OFD: 76%
SRP efficiency vs. OFD efficiency:
Pockets >6 mm
SRP: 32%
OFD: 50%
Give the parameters for PERIO MAINTENACE post-SRP:
1) 6 weeks post-op
2) good oral hygiene
3) plaque score of less than 30%
4) few 4mm pockets
Give the parameters for COMPROMISED PERIO MAINTENACE post-SRP:
1) 6 weeks post-op
2) 90% plaque score
3) few 6mm pockets
Give the parameters for PERIODONTAL SURGERY post-SRP:
1) 6 weeks post-op
2) plaque score of less than 30%
3) few 6mm pockets
Biofilm and calculus are most commonly found (trapped) at:
CEJ and 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 ginigiva
There is a ___% chance of leaving residual calculus or biofilm in pockets that are ____mm
85%; >5mm
Bone loss starts _____
interproximally
Why does bone loss commonly start interproximally?
- Food trap
- Less keratinized tissue
- Harder area for patient 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 percentage of defects that convert from non-diseased to diseased than _____ areas
non-surgically treated areas; surgically treated areas
T/F: Single rooted teeth are better for BOTH non-surgical and 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 having one root
When comparing single rooted teeth to molars, the better prognosis of single rooted teeth is due to:
- easier access
- 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 directly coming from the same patient:
Autograft
Regeneration modality in which the tissue is coming from the same species (ex: human to human):
Allograft
Regeneration modality in which the tissue is synthetic:
Alloplast
Regeneration modality in whch the tissue is coming from a different species (ex: pig, calf, cow):
Xenograft
Addition of non-resorbable or resorbable 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 margin placed?
At the alveolar crest
What are the functions of placing the flap margin at the alveolar crest during pocket elimination surgery?
- Creation of shallow sulci
- Provides ease of maintenance by therapist and patient
What form of periodontitis is characterized by bacterial penetration?
Aggressive periodontitis
Localized juvenile periodontitis (LJP) and generalized juvenile periodontitis (GJP) was renamed to ______ in 2017
periodontitis
What is the causitive pathogen seen in aggressive periodontitis?
Aggregatibacter actinomycetecomitans
(Aa)
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 nonresorbable or resorbable 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 tp 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 keratinized tissue
- restore gingival topography
- pre-prosthetic or pre-orthdontic surgery
Occurs when non-surgical therapy has failed AND surgical therapy has failed so new technique or materials are attempted:
Retreatment of case
List some examples of pre-prosthetic surgery:
- Crown lengthening
- Bone augmentation
- Palatal recontouring
- Gingivectomy/gingivoplasty
- Ridge or tuberosity reduction
Hardest to accomplish HEIGHT and should NOT use free gingival graft that is coronally positioned:
Bone augmentatino
Drugs that cause gingival overgrowth include:
- Dilantin/Phenytoin (anti-seizure)
- Cyclosporin/Sandimmune (immunosuppressant)
3 Procardia/Nifedipine (calcium channel blocker)
Classes of drugs that can cause gingival overgrowth include:
- anticonvulsant medications
- immunosuppressants
- calcium channel blockers
Your patient comes in with 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
