Non surgical + TFO

Question 1

How long may sensitivity after ScRD last

Answer 1

2 weeks.

Salt water rinse, apply sensodyne sensitivity relief at cej

Question 2

How Long does it take for long je to form after ScRD

Answer 2

7-14 days Caton and Zander 1979

Question 3

When does maturation of connective tissue complete after ScRD

Answer 3

Week 4-8 Biagini et al 1988

Question 4

Teeth with constant bop during recalls had __ times higher risk for future tooth loss compared to teeth without BOP

Answer 4

46 schatzle et al 2004

Question 5

Average clinical improvement baseline <3mm

Answer 5

0. 03mm Pd reduction
   - 0.34mm CA gain

Cobb 2002

Question 6

Average clinical improvement baseline <4-6mm

Answer 6

1. 29mm Pd reduction
2. 55mm ca gain

Cobb 2002

Question 7

Average clinical improvement baseline <6mm

Answer 7

2. 16mm Pd reduction
3. 19mm ca gain

Cobb 2002

Question 8

Treatment outcome statistics for pocket and patient

Answer 8

35% of baseline pathological pockets did not reach endpoint success Wennstrom et al 2005

39% of patients reached end point success of probing depths ≤5mm van dear Weijden et al 2019

Question 9

Can you leave calculus behind

Answer 9

Clinically acceptable levels of gingival wound healing can occur despite microscopic aggregates of residual calculus Nyman et al 1986

Reduction of gram negative bacterial load is more crucial, periodontal healing possible on calculus as long as subgingival plaque removed from root surfaces

Question 10

How does tfo result in mobility

Answer 10

Jiggling forces, multidirectional heavy loading, gradually increase in width of PDL on both sides of the teet. Pdl space increase, active bone resorption, increase mobility

Bone resorption induced by tfo is reversible (in a healthy periodontium)

Question 11

If occlusal forces are too great and PDL unable to adapt to occlusal forces

Answer 11

Inflammation is pushed down into zone of co destruction, move down PDL space, connective tissue attachment loss.

There is bone resorption due to occlusal forces and bone resorption due to periodontal inflammation

Angular bone defect, widened PDL space. Occlusal adjustments —> no improvement in attachment level because lost by bacteria

Question 12

How does tfo accelerate progression of periodontitis

Answer 12

Glickman: trauma causes bacteria to enter zone of co destruction, further ingress into pdl space

Question 13

TFO does or does not aggravate gingivitis associated with plaque in a healthy periodontium

Answer 13

Does not

Does not CAUSE periodontitis, only accelerate progression

Question 14

When does tfo cause intrabony defect/further connective tissue loss and bone loss

Answer 14

If there is subg plaque in addition to heavy occlusal loading

Question 15

What to check when diagnosing TFO

Answer 15

MI and lateral excursion

Question 16

Important signs and symptoms to diagnose tfo + key radiographic feature

Answer 16

Increased tooth mobility, fremitus

Pathogenic tooth migration

Tenderness of muscles of mastication/TMD dysfunction

Craze and crack lines

Widened PDL space

Question 17

Can diagnosis of TFO be made from hypermobility alone

Answer 17

Ramfjord and ash 1981
Increasing tooth mobility found over series of repeated measurements but cannot be made from hypermobility alone

Need other signs eg widened PDL space

Question 18

Management of TFO

Answer 18

Occlusal adjustments

Selective grinding (not equilibration, just adjust tooth with heavy occlusal contact)

Removable/fixed appliances eg bite splint

Ortho treatment to adjust occlusion

Question 19

Occlusal equilibration vs selective grinding

Answer 19

Equilibration: to reshape occluding surfaces to create harmonious contact relationship

Selective grinding: alter occlusal forms to decrease/redirect occlusal forces

Question 20

How thick is shi stock

Answer 20

0.005 inch

Question 21

ScRP result in __ reduction in HbA1c

Answer 21

0.4%, equivalent to action of 1 oral medication Hngebretsson and Kocher 2013 (Falcao and Bullon 2019 found this controversial)

Chapple et al 2013 reduced severity of perio disease —> reduced pro inflammatory TNFa —> increased glucose uptake by cells

Question 22

Effectiveness of OH with no ScRD

Answer 22

25% reduction in bleeding

Can resolve signs of inflammation associated with gingivitis Badersten et al 1984

Westfelt et al 1998: 8% of such sites had further attachment loss, 5% unchanged at end of study

Brushing alone has limited effect on subgingival microflora and infiltrate in deeper pockets

Question 23

Efficacy of poor OH with ScRD

Answer 23

Pockets return to baseline at end fo two months due to reestablishemnt of microbiological profile

Question 24

Efficacy of good oh with scrd van dear weijden et al 2002

Answer 24

Significant reduction in % of deep pockets >6mm from 11% to -.3% after.3 years

Question 25

Critical probing depth to benefit from surgery

Answer 25

Only probing depth 5.5mm and above would benefit from benefit from additional surgical therapy Heinz Meyfield et al 2002

5.4mm critical probing depth

Question 26

Surgical intervention should only be considered after ___

Answer 26

Non surgical perio therapy and good plaque control

Surgery in plaque infested dentition —> recurrence of disease, ineffective to prevent recurrence of periodontitis Nyman et al 1977

Question 27

Critical probing depth Lindhe et al 1982 for nspt and spt

Answer 27

Nspt: loss of attachment when clinical probing depth ≤2.9mm

Spt: loss of attachment when clinical probing depth ≤4.2mm. Above this value there is clinical attachment gain