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week 87 > Ortho/Perio- Gillone > Flashcards

Ortho/Perio- Gillone Flashcards

1
Q

Ortho: Pretreatment Considerations

A
  • Oral Health
  • Oral Hygiene
  • Caries
  • Gingivitis/perio
  • Mucogingival considerations
  • Patient attitude
  • Compliance
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2
Q

What are the steps to control inflammation

A
  1. OHI (modifications)
  2. SRP
  3. Caries Control
  4. Re-eval
  5. Surgical Interventions
  6. Maintenance:
    1. Re-eval
    2. instrumentation
    3. motivation
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3
Q

Periodontitis effects on Ortho Movement

A

IMPORTANT: Manage Inflammation when done with ortho. Especially perio patients

  • Rapid Destruction of Periodontium
    • inflammation + ortho forces +occlusal trauma (vs inflammation ONLY)
    • Angular Bony defects + Inflammation
      • if SubG inflammation resolved before→no tooth movement
  • No loss of attachment (No effect)
    • Adults w/reduced but healthy periodontium
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4
Q

Timing of ortho treatment

A

Before starting ortho

  • 3-6 months of perio stability
  • inflammation control
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5
Q

Osseous Surgery

A
  • Reshape Bone Defects (1 & 2 walls) to reduce PD
  • Indications:
    • pts response to SRP
    • Location of defects
    • Predictability of defects w/Nonsurgical maintenance during ortho
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6
Q

Periodontal Regeneration

A
  • regenerate periodontal tissues
    • reduces PD
  • used for:
    • 3 wall defects
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7
Q

Extrusion with Periodontium

A
  • SLOW
    • Bone & supporting soft tissue move vertical
      • gingival margin moves coronal
      • Mucogingival jxn: unchanged
  • Maintains relationship b/w CEJ & Bone crest
  • Indications:
    • single tooth extraction before dental implants
      • Primary use
      • improves marginal bone levels
    • Shallow bone Defects:
      • 1 & 2 wall defects
        *
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8
Q

Extrusion out of Periodontium

A
  • Rapid
    • Forced eruption + gingival Fiberotomy
      • reduces coronal movement of bone & gingiva
    • Increases Clinical Crown Length
      • creates resistance & retention form for final restoration
  • Primary Indications:
    • Crown-root fracture
    • Deep sub-g caries
    • Esthetic concerns
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9
Q

Intrusion

A
  • Indications:
    • Horizontal Bone Loss
    • Infrabony defects
    • esthetics of Maxillary gingiva margin level before restoration
      • align gingival margins of adjacent teeth
  • Periocompromised teeth:
    • controversial benefits
  • Healthy Periodontium
    • Increase attachment
      • New cementum formation
      • CT attachment
  • Plaque-infected teeth:
    • angular bony defects form
    • Increase attachment loss
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10
Q

Molar Uprighting

A
  • For MESIAL TIPPED MOLARS
  • Disto-occlusal movement
    • causes:
      • Tension on PDL collagen fiberss
      • Shallower alveolar crests
      • No change in CT attachment
        • Changes:
          • PD
          • Crown:root ratio
  • Results in:
    • angular bone defect disappear
    • Levels bone crest
    • Does NOT modify peridontium
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11
Q

Molar Uprighting

A
  • Disto-occlusal movement
    • causes:
      • Tension on PDL collagen fiberss
      • Shallower alveolar crests
      • No change in CT attachment
        • Changes:
          • PD
          • Crown:root ratio
  • FOR Mesial tipped molars
    • angular bone defect disappear
    • Levels bone crest
    • Does NOT modify peridontium
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12
Q

Interproximal Reduction (IPR)

A
  • Interpoximal spaces
  • > 0.05 mm
    • cancellous bone
    • Lamina dura
  • < 0.5 mm
    • no cancellous bone
    • Fused Lamina Dura
  • < 0.3 mm
    • No bone
    • Roots connected by PDL (fused roots)
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13
Q

What are the different periodontal procedures for Ortho?

A
  • Circumferential Supracrestal Fiberotomy
  • Frenectomy
  • Surgical tooth Exposure
  • Accelerate Osteogenic Ortho
  • Gingivectomy and/or Gingivoplasty
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14
Q

Circumferential Supracrestal Fiberotomy (CSF)

A
  • Unknown mechanism
  • releases all supra-crystal gingival fibers
    • supra-alveolar & transeptal
  • 30% decrease in ortho relapse
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15
Q

What two periodontal components affect the stability of ortho corrected rotated teeth?

A
  1. Principle fibers of PDL
  2. Supra-alveolar gingival fibers
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16
Q

Frenectomy

A
  • Complete removal of the frenum
    • including attachment to bone
  • High maxillary frenum→ Midline Diastema
  • Hyperplastic Frenum→ obstructs diastema closure
17
Q

Frenectomy vs Frenotomy

A
  • Frenectomy:
    • complete removal
  • Frenotomy
    • relocate
18
Q

Surgical Tooth Exposure: Indications

A
  • Indications:
    • Failed tooth eruption
    • Diversion from normal eruption path
    • retained primary tooth impedes eruption
    • Insufficient space
    • Ankylosis
    • Idopathic
  • Surgical Considerations:
    • Location of unerupted tooth
      • labial vs palatal
    • Eruption Technique
      • open vs closed
    • Type & Amount of Tissue in site
      • keratinized vs mucosa
    • Path of Eruption
    • Able to Maintain Dry Surgical Field
  • Flap Design:
    • Open Eruption Technique: Tooth not covered
      • Window/Excision uncovering
      • Apically Positioned flap
    • Closed Eruption technique: Tooth covered
      • Repositioned flap
19
Q

Accelerated Osteogenic Orthodontics

A
  • AKA Wickodontics
  • Based on Regional Accelerated Phenomenon
    • physiological processes are accelerated in region adjacent to injury
  • Involves
    • Buccal & Lingual corticotomies b/w roots
      • combined w/alveolar augmentation (sometimes)
  • Promotes Rapid Ortho Movement
20
Q

Timing of Grafting

A
  • Prophylactic Tissue grafting
    • Pre-ortho gingival augmentation
      • recommend for:
        • thin soft tissue
        • anticipate Labial/Buccal movement
      • Goal:
        • Thicken Gingiva to decrease susceptibility to trauma, inflammation, & recession
          *
21
Q

What are the different types of Soft Tissue Grafts?

A
  • Free Gingival Graft (FGG)
  • Connective Tissue Graft (CTG)
  • Pedicle Graft
  • Soft tissue allograft
22
Q

Implants & ortho:

A
  • Assess the position of teeth before implant therapy
    • M-D width
    • interarch space
    • good spacing/position of teeth
    • Root Divergence
    • fix esthetic or functional concerns
  • osseointegrated implants
    • Must heal 4-6 months before ortho use
    • used as anchor and future abutment (crown or fixed bridge)
    • If not anchor, implant is placed after complete ortho tx
      • timing determined by restorative tx plan
23
Q

Implants: Restorative Dimension

A
  • Interarch space
    • distance from ridge of crest to occlusal table
    • 6-10 mm needed for restoration:
      • abutment
      • height for cement retention or prosthesis screw fixation
      • prosthesis
24
Q

Mucogingival Considerations:

A
  • Position of tooth eruption
  • Buccolingual tooth positioning
  • Width of Keratinized tissue
  • Thick vs thin tissues
  • Tooth movement
    • labial/lingual: through cortical bone
      • Thinning cortical plate→ Dehiscence
      • Soft tissue recession
        • Thin tissue + Labial Tooth Movement
    • minimal side effects when in the envelope of alveolar process
25
Q

Mini Screws

A
  • Ortho Anchor
  • Used for:
    • Space Closure
    • Tooth intrusion
    • Anterior open bite closure

week 87 (7 decks)

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