midterm 2 - lecture 1

Question 1

periodontist patient
what happens if we don’t do anything
disease with no intervention

Answer 1

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

Question 2

periodontitis progress with no intervention in the rapid progressing 10%

Answer 2

0.91mm annual rate of all

complete loss in 19 years - ED by 35

Question 3

Primary advantage of opening a flap or surgery

Answer 3

you have direct vision and can see what is going on

easier manipulation/removal of tissues

disadvantage - morbidity-discomfort, esthetic compromises, cost

Question 4

No Tx, closed SRP, open SRP(full thickness flap, srugery)

outcomes for shallow mod and deep pockets % of calculus

Answer 4

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

Question 5

Difficult to get SRP instruments deeper than _MM

Answer 5

4-5 mm

Question 6

flap approach reduces calculus on tooth

what does this mean in terms of heath

Answer 6

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)

Question 7

no matter the technique to treat periodontist what is an essential part to keep disease away

Answer 7

maintenance every 3 months

Critical - personal maintenance and homecare are essential - doesn’t matter technique if patient doesn’t help

Question 8

surgical vs nonsurgical SRP on frequency of PD of 7mm or more

Answer 8

flaps - better

30% to after tx less than 1 percent

closed srp - 6-7% PD greaterthan 7

Question 9

long term outcomes of CS - prophy
MWF
OS with apically positioned flap
on PD

Answer 9

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

Question 10

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

Answer 10

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

Question 11

surgical vs non srugical and no tx changes in PD overtime

Answer 11

*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

Question 12

surgical vs non srugical and no tx changes in furcation (molars only) overtime

Answer 12

*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

Question 13

teeth that receive no treat or non-surgical treatment compared to teeth that recieve surgical tx show significant worsening of _ _ _ _

Answer 13

PD
furcations
prognosis
mobility

Question 14

teeth that receive _ tx show significant improvement in PD

Answer 14

surgical

Question 15

does it matter if srugical therapy results in better PD reduction

Answer 15

Yes because PD greater than 6 risk predictor of future aloss

Question 16

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

Answer 16

surgical SRP

Question 17

Surgical debridement vs closed SRP

In terms of attachment level and depth change of pockets initially >6mm

Answer 17

• favors surgical debridement

PD reduction - surgical debridement

Question 18

systematic review of long term (2+) effects

SRP vs WIDmin on PD change 4-6mm pockets

In terms of attachment levels _

Answer 18

PD of clinicall attachment - long JE Favors widman flap - surgery

• favors SRP nonsurgical

Question 19

initial moderate 4-6mm PD _ is preferable tx because it might result in less CAL

Answer 19

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

Question 20

Differene between PD surgery vs regenerative surgery is that regenerative surgery _

Answer 20

tries to replace loss tissues

Reconstruct anatomy and no pockets

Question 21

_ treatment is best both short term and long term - 3 walled defect on messial of 30

Answer 21

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

Question 22

Only way to confirm regeneration is _

New PDL, cementum and bone

Answer 22

histology

not radiographically

Question 23

guided tissue regeneration

Bone loss beyond apex - have to clean around and blood supply cut off

Elected endo

Bone grapft GTR

Answer 23

10 month laster actually put it thru ortho

5 years good

Question 24

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

Answer 24

regenerative srugery