midterm 2 - lecture 6

Question 1

Following suture placement a periodontal dressing may be applied. In general dressings have no curative properties; they assist healing by _.
Periodontal dressings are mainly used for the following reasons:
-To protect the wound postsurgically
-To obtain and maintain a close adaptation of the mucosal flaps to the underlying bone (especially if the flap has been _ positioned)
-For patient comfort.

Answer 1

protecting tissues during the healing stage

apically

comfort - patient exposed roots - deceases sensitivity

Question 2

disadvantage of using a _ is that mouth rinsing with antibacterial agents does not prevent the formation of plaque under the dressing. Results from clinical studies suggest that a periodontal dressing may often be unnecessary after periodontal flap procedures and may be usefully replaced by rinsing with chlorhexidine only.

Answer 2

periodontal dressing

Question 3

A commonly used periodontal dressing is CoePakTM, which is supplied in two tubes. One tube contains _ of various metals (mainly zinc oxide ) and lorothidol (a fungicide). The second tube contains non-ionizing carboxylic acids and chlorothymol (a bacteriostatic agent). Equal parts from both tubes are mixed together immediately prior to insertion

Answer 3

oxides of various metals

Question 4

Post operative _ control is the most important variable in determining the long-term result of periodontal surgery. Patients should be advised to rinse with 0.12% chlorhexidine (Peridex, Periogard) twice daily during the post operative period until normal plaque control technique can be resumed. It is important to return to and maintain good mechanical oral hygiene measures as soon as possible since antibacterial mouthrinses are not likely to have any influence on subgingival recolonization of plaque.

Answer 4

plaque

Question 5

Maintaining good postsurgical _ is another important factor affecting the outcome of some types of periodontal flap procedures. This can be accomplished by adequate suturing technique and protection from mechanical trauma to the marginal tissues during the healing phase

Answer 5

wound stability

Question 6

Following standard flap surgery procedure sutures are usually kept in place for _ days.

Answer 6

7- 10

If tight adaptation of the flap to the root surface is required for a specific procedure one may consider keeping the sutures in place for a longer period of time

Question 7

Suture removal techniques

A disinfecting mouthwash such as chlorhexidine can be utilized to clean the wound of all debris. The _ is then elevated off the tissue utilizing cotton pliers. The suture is cut as close to the tissue as possible in order to avoid contamination of the wound with suture-associated bacteria.

Answer 7

suture knot is elevated

When removing continuous sutures, each section should be cut and pulled out individually.

Question 8

Healing wounds proceed through a number of well-defined steps during the process of repair following injury.
These have been categorized into three phases _ _ _

Answer 8

1) inflammation
2) fibroblastic-granulation
3) matrix formation and remodeling.

Question 9

During the early phase of repair, a _ is formed. In epidermal wounds, this _ bridges the space between two vascular wound margins and serves as a base that epithelial cells migrate across to cover the wound,
providing protection to the underlying connective tissue as healing progresses.

Answer 9

fibrin clot

Question 10

Periodontal surgical wounds follow a similar healing pattern, but there are differences in this specific wound healing environment from an epidermal wound. When periodontal wounds are sutured, one of the wound margins _ surface.
Additionally, because of the tooth, the healing site communicates with the oral environment during all phase of wound healing.
_ routinely migrates along the inner surface of the wound resulting in a long junctional epithelium interface with the root surface.

Answer 10

is an avascular root surface

Epithelium migrates

Question 11

Healing by _ intention

(e. g., a clean surgical incision associated with flap surgery)
a) Immediate response after suturing: A blood clot forms between the flap and the tooth or bone surface. The clot contains fibrin reticulum, neutrophils, erythrocytes, platelets, debris of injured cells, and capillaries at the edge of the wound.

Answer 11

primary

Question 12

primary intention

Within 24 hrs: Neutrophils infiltrate the _

_ migrates from the wound margin and begins to cover the wound.

Answer 12

neutrophils infiltrat connective tissue.

Epithelium migrates

24 hours

Question 13

primary retention

1 to 3 days:

The space between the flap and the tooth or bone _.

Epithelial cells migrate over the border of the flap, usually contacting_

Answer 13

bone thins

the tooth. 1-3 days

Question 14

primary intention

_ days Epithelial migration continues. Neutrophils are replaced by macrophages, which eliminate dead or damaged tissue elements.
The incision space begins to fill with granulation tissue. Revascularization is underway.

Answer 14

3 to 7 days:

Question 15

primary intention

_ days An epithelial attachment to the root forms by means of hemidesmosomes and a basal lamina.
The blood clot has been replaced by granulation tissue derived from the gingival connective tissue, the bone marrow, and the periodontal ligament.

Answer 15

1 week:

Question 16

primary intention

_ days Collagen fibers begin to appear parallel to the tooth surface.
The union of the flap to the tooth is weak because of the immaturity of the collagen fibers.

Answer 16

2 weeks:

Question 17

primary intention

_ days Inflammatory cells are mostly gone.
Fibroblasts proliferate and collagen accumulates.
The revascularization process regresses.
A fully epithelialized gingival crevice with a well-defined epithelial attachment is present.
The supracrestal fibers begin to assume a functional arrangement.

Answer 17

1 month:

Question 18

primary intention

_ days The wound gains tensile strength.

Answer 18

h) Within 6 to 8 weeks:

Question 19

primary intention

Full thickness flaps which denude the bone, result in _ after 1 to 3 days;

osteoclastic resorption follows and reaches a peak at _ days , declining thereafter.

This results in a loss of bone of about _ mm. The loss is greater if the bone is thin.

Answer 19

superficial bone necrosis 1-3 days

osteoclastic - 4 to 6 days

Question 20

during primary intention, full thickness flap results in _

Answer 20

about 1mm of bone loss

Question 21

Healing by secondary intention (e.g., extensive cell/tissue loss due to gingivectomy).
This differs from healing by primary intention as follows: a) Since there is more necrosis, the _ response is more intense.
b) More _ forms to fill the larger defect.
c) Wound _ is much more pronounced

Answer 21

inflammatory response is more intense.

More granulation tissue

Wound contraction is much more pronounced

Question 22

Summary of wound healing events

a) The wound is debrided by _.
b) _ cells regenerate.
c) _ and _ tissue cells migrate and proliferate.
d) Extracellular matrix proteins (e.g., collagen) are _.
e) Connective tissue and parenchymal components remodel.
f) The wound gains strength.

Answer 22

debridged by inflammatory cells

b) Parenchymal cells regenerate.
c) Parenchymal & connective tissue cells migrate and proliferate.
d) Extracellular matrix proteins (e.g., collagen) are synthesized.
e) Connective tissue and parenchymal components remodel.
f) The wound gains strength.

Question 23

Outcomes of wound healing after periodontal surgery
_ Damaged tissues are replaced by tissues that do not duplicate the original function or architecture of the original tissues.
This is the usual outcome of therapy.

Answer 23

Repair

Question 24

Outcomes of wound healing after periodontal surgery
_Damaged tissues are replaced by tissues duplicate the structure and function of the original tissues. Ideally, this should involve the formation of new cementum, periodontal ligament, and alveolar bone.

Answer 24

Regeneration:

Full regeneration is comparatively rare, but is the most desirable outcome of periodontal therapy. Development of techniques to maximize regeneration is an active area of periodontal research.

Question 25

Factors that make periodontal _ unpredictable
1. The surgical wound is contaminated by many types of bacteria.2. Regeneration requires the concerted action of many specialized types of cells, including cementoblasts, osteoblasts, fibroblasts, junctional epithelial cells, and endothelial cells. 3. Regeneration requires the formation of several specialized junctional complexes (e.g., attachment of epithelium to tooth, PDL to tooth, gingival connective tissue to tooth). 4. The root surface is avascular and can’t contribute to the formation of new blood vessels. 5. Regeneration requires complex interactions between the extracellular matrix and cells.

Answer 25

regeneration unpredictable