midterm 2 - lecture 1 Flashcards
periodontist patient
what happens if we don’t do anything
disease with no intervention
attachment loss and further disease progression in SUSCEPTIBLE PERSON/HOST
10% rapid highly susceptible
10% nonprogressing - 2mm or less anytime
neither RPnor NP somewhere inbetween
aloss over time
then starts accelerating once around 2mm
0.22mm annual rate
average tooth root length 17mm - completed tooth loss in 77
periodontitis progress with no intervention in the rapid progressing 10%
0.91mm annual rate of all
complete loss in 19 years - ED by 35
Primary advantage of opening a flap or surgery
you have direct vision and can see what is going on
easier manipulation/removal of tissues
disadvantage - morbidity-discomfort, esthetic compromises, cost
No Tx, closed SRP, open SRP(full thickness flap, srugery)
outcomes for shallow mod and deep pockets % of calculus
FLAP APPROACH REDUCES CALCULUS
Nonsurgical/closed- better than none
Shallow 1-3 no advantage of closed vs open
Moderate 4-6mm biggest advantage to remove calculus open srp
Severe >= 7mm reduces calculus but not as much
Difficult to get SRP instruments deeper than _MM
4-5 mm
flap approach reduces calculus on tooth
what does this mean in terms of heath
Evidence - healing responds( cumulative bleeding) - have less calculus means you have less inflammation,of tissue and less disease disease
Host inflammatory response - the destruction of periodontitis - we want to reducee those bacteria and biofilm and stop the host response (causes bone loss)
no matter the technique to treat periodontist what is an essential part to keep disease away
maintenance every 3 months
Critical - personal maintenance and homecare are essential - doesn’t matter technique if patient doesn’t help
surgical vs nonsurgical SRP on frequency of PD of 7mm or more
flaps - better
30% to after tx less than 1 percent
closed srp - 6-7% PD greaterthan 7
long term outcomes of CS - prophy
MWF
OS with apically positioned flap
on PD
osseous surgery with apically positioned flaped greatest reduction and sustained after 2 years - 4mm
Prophy - not much go from 8-7
SRP - reduces 2mm
Flap - better - 3mm long term
Oseous surgery - greatest pocket reduction and stays after 2 years
surgical vs non-surgical on yearly incidence of breakdown sites
Break down site - a site that was stable for some time then lost 2 or more mm in attachment
more likely to happen in deeper sites to begin with
OS with apical positioned flap least incidence of breakdown sites
FLAP - better able to prevent these breakdown sites in deeper pocket
Osseous surgery - even less incidence of the breakdown sites - almost half less compared to SRP
surgical vs non srugical and no tx changes in PD overtime
*severe pts more likely to have better maintenance
OS 82% improved 4% got worse PD
SRP 13% improved PD overtime 57% increased over
no Tx- 13 improved 44 worse over time
surgical vs non srugical and no tx changes in furcation (molars only) overtime
*severe pts more likely to have better maintenance
OS 22 improved 1% worse
SRP - 5% improved - 34 worse
no tx 1% improved 30% worse furcation invlovement
teeth that receive no treat or non-surgical treatment compared to teeth that recieve surgical tx show significant worsening of _ _ _ _
PD
furcations
prognosis
mobility
teeth that receive _ tx show significant improvement in PD
surgical
does it matter if srugical therapy results in better PD reduction
Yes because PD greater than 6 risk predictor of future aloss
in advanced periodontitis patients, _ therapy when compared to nonsurgical therapy
~provides better short and long term pocket reduction
~may lead to fewer subjects needing additional tx
surgical SRP
Surgical debridement vs closed SRP
In terms of attachment level and depth change of pockets initially >6mm
- favors surgical debridement
PD reduction - surgical debridement
systematic review of long term (2+) effects
SRP vs WIDmin on PD change 4-6mm pockets
In terms of attachment levels _
PD of clinicall attachment - long JE Favors widman flap - surgery
- favors SRP nonsurgical
initial moderate 4-6mm PD _ is preferable tx because it might result in less CAL
SRP
in deep 7mm or more PD, osseous surgery results in higher PD reduction
This is the evidenve to tell patient at this stage you need to have periodontal surgery
Out come if we don’t do it - more aloss and eventually tooth loss
Differene between PD surgery vs regenerative surgery is that regenerative surgery _
tries to replace loss tissues
Reconstruct anatomy and no pockets
_ treatment is best both short term and long term - 3 walled defect on messial of 30
guided tissue regeneration
ad everything back as closely as anatomcaiily possible
Just GTR with membrane to block epi from growing because they replicate faster
Membrane barrier placed to allow bone to grow also can pack bone graft and then place barier or not
Year after tx
Only way to confirm regeneration is _
New PDL, cementum and bone
histology
not radiographically
guided tissue regeneration
Bone loss beyond apex - have to clean around and blood supply cut off
Elected endo
Bone grapft GTR
10 month laster actually put it thru ortho
5 years good
92% hopeless teeth supposed to be extract - _ keep them and form stable 5 years
Have to have great patient compliance
At home and in office
regenerative srugery
