Ortho/Perio- Gillone Flashcards
1
Q
Ortho: Pretreatment Considerations
A
- Oral Health
- Oral Hygiene
- Caries
- Gingivitis/perio
- Mucogingival considerations
- Patient attitude
- Compliance
2
Q
What are the steps to control inflammation
A
- OHI (modifications)
- SRP
- Caries Control
- Re-eval
- Surgical Interventions
- Maintenance:
- Re-eval
- instrumentation
- motivation
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
4
Q
Timing of ortho treatment
A
Before starting ortho
- 3-6 months of perio stability
- inflammation control
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
6
Q
Periodontal Regeneration
A
- regenerate periodontal tissues
- reduces PD
- used for:
- 3 wall defects
7
Q
Extrusion with Periodontium
A
- SLOW
- Bone & supporting soft tissue move vertical
- gingival margin moves coronal
- Mucogingival jxn: unchanged
- Bone & supporting soft tissue move vertical
- 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
*
- 1 & 2 wall defects
- single tooth extraction before dental implants
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
- Forced eruption + gingival Fiberotomy
- Primary Indications:
- Crown-root fracture
- Deep sub-g caries
- Esthetic concerns
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
- Increase attachment
- Plaque-infected teeth:
- angular bony defects form
- Increase attachment loss
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
- Changes:
- causes:
- Results in:
- angular bone defect disappear
- Levels bone crest
- Does NOT modify peridontium
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
- Changes:
- causes:
- FOR Mesial tipped molars
- angular bone defect disappear
- Levels bone crest
- Does NOT modify peridontium
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)
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
14
Q
Circumferential Supracrestal Fiberotomy (CSF)
A
- Unknown mechanism
- releases all supra-crystal gingival fibers
- supra-alveolar & transeptal
- 30% decrease in ortho relapse
15
Q
What two periodontal components affect the stability of ortho corrected rotated teeth?
A
- Principle fibers of PDL
- Supra-alveolar gingival fibers
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
- Location of unerupted tooth
- Flap Design:
- Open Eruption Technique: Tooth not covered
- Window/Excision uncovering
- Apically Positioned flap
- Closed Eruption technique: Tooth covered
- Repositioned flap
- Open Eruption Technique: Tooth not covered
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)
- Buccal & Lingual corticotomies b/w roots
- 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
*
- Thicken Gingiva to decrease susceptibility to trauma, inflammation, & recession
- recommend for:
- Pre-ortho gingival augmentation
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
- labial/lingual: through cortical bone
25
Mini Screws
* Ortho Anchor
* Used for:
* Space Closure
* Tooth intrusion
* Anterior open bite closure
