Perio Flashcards
What are the Indicators of occlusal trauma
Wear facets Mobility Root resorption Occlusal discrepancies Discomfort Fremitus TMJ pain Hypertrophy Radio graphic signs Tooth migration Fractured tooth Thermal sensitivity
What is Fremitus
Tooth moves in occlusion
What are the radio graphic signs of occlusal trauma
Widening of PDL
Crescent shaped bone loss
What is direct trauma
Trauma direct to periodontal tissues
What is indirect trauma
Trauma through teeth applying trauma to tissues
What happens if the pressure doesn’t occlude PDL blood flow
Increased vascularisation Increased vascular permeability Vascular thrombosis Disorganisation of cells and collagen Direct bone resorption
What happens when forces occlude blood flow
Necrosis of PDL
Osteoclasts appears sub surface
Undermining or indirect resorption
What happens if the occlusion is adjusted in a tooth with PDL widening
PDL with restores as well as mobility
What happens in occlousive forces. Adaptive and excessive in a perio patient.
Adaptive forces cause no further advancement in resorption but excessive accelerate resorption
What is abfraction
This is wedge like cervical lesion thought to result from excessive occlousal froces
What are the goals of perio treatment
Reduction of gingivitis to no more than 20-40% BOP
Reduction of PPD to 5 or less
Absence of pain
Satisfactory aesthetics and function
What are the stages of perio therapy
Initial - OHI PFS Remove plaque
Corrective - perio endo or restorative treatment
Supportive - indexes reinstrumentation etc
What is non surgical treatment
Sub gingival PMPR
What are predictors of further breakdown
Pt level - sites above 6mm Treated without la %BOP Tooth level - furcation involvement, mobility, limited residual support, overhanging restorations Site Level - BOP
What is the aim of surgery.
Control of disease
Eliminate pockets of >5
Regeneration
Suitable candidate for surgery
Highly motivated Compliance with OHI and apps PFS >70% on more than one occasion Non smoker No medical conterindecations Non surgical therapy completed
Who would have perio surgery
Deep pockets not shallow ones
What are the classifications of furcation
Class 1 - 3mm horizontal loss
Class 2 - more than 3mm horizontal loss
Class 3 - through and through
What furcation defects affect the prognosis of a tooth
Class 2&3
What is the aim of regenerative surgery for furcation involved teeth.
Turn only class 2 defect into class 1 defect
What needs to be considered with root resection/hemisection
Support for roots to be kept
What is a gingivectomy
Reduction in excessive gingival overgrowth
What are the bands of tissue around the roots of the teeth called from gingival margin to apex
Free gingivae
Keratinised mucosa -attached gingivae
Mucogingival junction
Oral mucosa
That’s is the function of the oral mucosa
Not keratinised not meant to be gingivae
What is the role of keratinised mucosa
More robust
What are bio types
You have thick and thin bio types responsible for the type of gingiva
What are the bio type appearances
Thin and thick and recession is more common in thin bio type because it is harder to maintain
What causes recession
Trauma
Tooth position
Poor OH
Ortho
What is a frenal pull
This is where the frena are attacked to the gingivae causing tissue to blanch around teeth when pulled
What is EMD
Enamel matrix derivative which is responsible for periodontal attachment to the cementum
How can you promote regeneration
Polish root surfaces
EMD placed in dry root surface
Making the wound stable post op so no frenal lull
What are the Miller classifications if recession
1 does not cross MG line
2 extends to it crosses MG line but ID papillae in tact
3 slight loss of interdental hard and soft tissues
4 significant loss of interdental hard and soft tissues and interdental bone
What Miller class would you expect to see 100% recovery
Class 1&2
Positives and negatives of FGG free gingival graft
Fast and predictable
Poor colour match
Palate sore
What are pros and cons of a connective tissue graft.
CT harvested from palate but epithelium left and then graft placed under epithelium at donor site so looks more natural
What are complications of mucogingival grafts
Damage to GP artery Necrosis Pain and bleeding Swelling Bruising
What is a pedicel flap
Flap moved from adjacent site
What’s mucograft
Collagen matrix that’s used insisted but this is not as effective gold standard is CT grafting
What is resection
Removing pocket shifting gingival pocket more apically
Okay hat is a suprabony defect
This is where the base of the pocket is more coronal than the bone
What is an lnfrabony pocket
This is where the pocket is more apical than the bone
Autograft?
Graft from patient to another place on body
Xenografts?
Graft from animal
Allogenic?
Taken from another person
Alloplastic?
Not human or animal may be plant or man made
What are the benefits of EMD
Restricts epethelial growth and connective tissue growth
Increased bone growth PDL growth Cementum growth and it restricts bacterial growth
What is important about flap design
Papilla must be kept to increase success and must be minimally invasive only exposing 1-2mm if cerestial bone
What patients are unsuitable for periodontal therapy
Haemophiliac Antiocoagulants Bisphosphonates Poorly controlled diabetics Poorly controlled hypertension Immunocompromised
What defect types are suitable for surgery.
Only Infrabony defects
What is an ninfrabony crater
This is where you have buccal and lingual bone but the part between the teeth is deficient/resorbed
