OPTEC- periodontal considerations

Question 1

What do we need to achieve before begining reconstructive treatment and why?

Answer 1

We need to achieve periodontal stability for at 3-6 months prior to reconstructive treatment .

An unhealthy or inflamed gingivae will bleed during procedures and be unstable in its apico-coronal position (it will move causing recession or swelling)

Question 2

What is the supracrestal attachment?

Answer 2

This is the distance from the junctional epithelium to the supracrestal connective tissue. It should be 2mm.

Question 3

What happens if your restoration impinges on the supracrestal attachment?

Answer 3

This will cause:

• Persistent inflammation
• Loss of attachment (with pocketing and gingival recession)

This is thought to be the gingiva trying to obtain the supracrestal attachment again.

Question 4

What do we use the temporary restorations for?

Answer 4

As a practice run of the final restoration to check :

Margins- Do they look good, are they impinging on the supracrestal attachment.

Material- is it the appropriate thickness?

Question 5

How do overhanging restorations cause periodontal problems.

Answer 5

They cause more inflammation which results in bone loss

Question 6

How does the restoration contour cause periodontal problems?

Answer 6

You want it to the restoration to be the natural shape of teeth. If the contacts are too long then it is uncleansable.

Question 7

Compare the damaged caused by crowns and bridges to the damage from RPDs

Answer 7

Crowns and bridges:

• Plaque retention due to
  
  • Location and fit of restoration margins
  • Contour of retainers and pontics.
• Unfavourable transmission of occlusal forces.
• Pulp damage

RPD

• Plaque retention due to:
  
  • Gingival margin coverage
• Direct trauma from the components
• Unfavourable transmission of forces (occlusal, insertion and removal)

Question 8

What is the least damaging prothodontic option from a periodontal perspective?

Answer 8

A fixed prosthesis.

Question 9

What problems are caused by using a fixed prosthesis?

Answer 9

The use of an abutment tooth will make the existing periodonitits worse and loosen the tooth.

Question 10

What is the gingival zenith?

Answer 10

This is the highest point of the gingival curvature running from the central incisor to the canine.

This line is paralell to the incisal edge.

Question 11

How do we treat a gummy smile?

Answer 11

A gingivectomy where we move the gingival margin. This is done by decreasing the gap between the gingival margin and bone.

But we still need to maintain the supracrestal attachment width.

This shows more of the tooth and less of the gums

Question 12

How do we treat gingival overgrowth ?

Answer 12

We cut away the gums that have overgrown.

Question 13

How do we increase the clinical crown height?

Answer 13

You need to remove some bone (to maintain supracrestal attachment) as well as increasing length of tooth exposed (cutting back & manipulating the gingival margin)

Question 14

How can we camoflauge gingival recession?

Answer 14

We can use an acrylic gingival veneer- but this has a high risk of plaque retention so cannot be constantly worn.

Question 15

Compare orthodontic to occlusal forces.

Answer 15

Orthodontic forces are sustained movement in the same direction (The teeth are tipping in the same way)

Occlusal force is a jiggiling force. This causes the teeth to move back and forward.

Question 16

Compare the excessive occlusal force and the occlusal trauma. Link these.

Answer 16

Excessive occlusal force is the occlusal force that pushes the reparative capacity of periodontal attachment aparatus.

THIS RESULTS IN

Occlusal trauma- which is the injury resulting in tissue changes within the attachment apparatus including (PDL, supporting alveolar bone and cementum due to the occlusal forces)

Question 17

Compare Primary and Secondary occlusal trauma.

Answer 17

Primary occlusal trauma- injury caused by tissue changes due to excessive occlusal forces applied to a tooth with normal periodontal support (no perio disease/no bone loss)

Secondary occlusal trauma- injury resulting in tissue changes due to occlusal forces applied to a tooth with reduced periodontal support. The tooth is less able to adapt to the occlusal forces.

(There is attachment loss and bone loss)

Question 18

In response to occlusal trauma the PDL can adapt, compare the two types of adaption.

Answer 18

Pathological- The demand of occlusal forces is too great or the PDL has reduced adaptive capacity.

The PDL width continues to increase (doesn’t stabilise)

Physiological- The PDL width increases until the forces are adequately dissapted allowing stabilisation.

When the demand is reduced, the PDL width returns to normal .

Question 19

How does the occlusal trauma affect the tooth histologically?

Answer 19

Zones of tension and pressure occur with the adjacent periodontium.

Pressure causes increased vascularisation and permeability, hyalinization/ necrosis of the PDL, Haemorrhage, thrombosis, bone resorption, root resorption and cemental tears.

On the side of tension- there is elongation of the PDL fibres and apposition of alveolar bone and cementum.

Question 20

What can cause tooth mobility?

Answer 20

Width of PDL

Height of PDL

Inflammation

The number/shape and length of the roots.

Increased width of PDL space.

Decreased alveolar bone density.

Question 21

What can tooth mobility reflect?

Answer 21

Pathology

Succesful adaptation of the periodontium to functional demands.

The nature of the remaining attachment .

Question 22

When do we intervene with tooth mobility?

Answer 22

If the tooth is getting more mobile (causing symptoms or difficulties with restorative treatment)

When we see radiographic evidence of increased PDL size.

When we feel fremitus on clinical examination.

When wear facets are present (from tooth grinding)

Tooth migration (e.g. splaying) 
If the force is causing (fracturing, root resorption, thermal sensitivity)

Question 23

Discsus the co-destruction of the gingival attachment?

Answer 23

If a patient has both gingival inflammation causing bone resorption and excessive load on the the teeth,

We get greater attachment loss.

Question 24

How does occlusal trauma affect Periodontal therapy.

Answer 24

The hygiene phase therapy is not as succesful. (a smaller improvement in the clinical attachment loss)

Over time there will be increased clinical attachment loss.

Question 25

When do we use splinting in periodontal treatment?

Answer 25

When the teeth are mobile due to advanced loss of attachment

If mobility is causing discomfort or difficulty chewing

To stabilise teeth prior to debridment.

Question 26

What are the disadvantages of using splinting in periodontal treatment.

Answer 26

It does not influence the rate of PDL destruction.

It may create hygiene difficulties.

*used as a last resort**

Question 27

Why do teeth splay?

Answer 27

Reduced periodontal support and bone to hold the teeth in place.

Question 28

How do we manage splaying teeth?

Answer 28

Treat the periodontitis and correct the occlusal relations.

then

• accept the position of the teeth and stabilise them.
• move the teeth orthodontically and stabilise them.