Perio Flashcards by Dan Hibbert

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

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What is Fremitus

Tooth moves in occlusion

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What are the radio graphic signs of occlusal trauma

Widening of PDL

Crescent shaped bone loss

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What is direct trauma

Trauma direct to periodontal tissues

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What is indirect trauma

Trauma through teeth applying trauma to tissues

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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

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What happens when forces occlude blood flow

Necrosis of PDL
Osteoclasts appears sub surface
Undermining or indirect resorption

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What happens if the occlusion is adjusted in a tooth with PDL widening

PDL with restores as well as mobility

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What happens in occlousive forces. Adaptive and excessive in a perio patient.

Adaptive forces cause no further advancement in resorption but excessive accelerate resorption

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What is abfraction

This is wedge like cervical lesion thought to result from excessive occlousal froces

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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

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What are the stages of perio therapy

Initial - OHI PFS Remove plaque
Corrective - perio endo or restorative treatment
Supportive - indexes reinstrumentation etc

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What is non surgical treatment

Sub gingival PMPR

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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

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What is the aim of surgery.

Control of disease
Eliminate pockets of >5
Regeneration

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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

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Who would have perio surgery

Deep pockets not shallow ones

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What are the classifications of furcation

Class 1 - 3mm horizontal loss
Class 2 - more than 3mm horizontal loss
Class 3 - through and through

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What furcation defects affect the prognosis of a tooth

Class 2&3

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What is the aim of regenerative surgery for furcation involved teeth.

Turn only class 2 defect into class 1 defect

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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