Perio Flashcards
Re-evaluation falls under _________ phase
Non-surgical Phase
Re-evaluation _________ weeks after initial therapy
Re-evaluation 4-8 weeks after initial therapy
_________ is generally considered the
initiating factor of periodontal disease.
Microbial plaque
- Probing pocket depth (PPD)—from __________ to ______
- Clinical attachment loss (CAL)—from ______ to ______
- Bleeding on probing (BOP)—best measure of _________
in periodontal tissues
- Probing pocket depth (PPD)—from gingival margin to base of pocket
- Clinical attachment loss (CAL)—from CEJ to base of pocket
- Bleeding on probing (BOP)—best measure of inflammation in periodontal tissues
CAL= ______+________
CAL= PPD + recession
Miller Classification (Mobility)
- Class 0 normal physiologic mobility
- Class 1 slightly more than normal
- Class 2 moderately more than normal (≤1mm)
- Class 3 severely more than normal (>1mm) and
can be vertically depressed in socket
Certain factors can predispose a tooth to
furcation involvement:
– Short root trunk
– Short roots
– Narrow interradicular dimension
– Cervical enamel projection
Hamp Classification (Furcation)
- Class 0 no furcation involvement
- Class 1 horizontal furcation involvement <3mm
- Class 2 horizontal furcation involvement >3mm
- Class 3 through-and-through furcation
involvement
Glickman Classification (Furcation)
- Class 1 pocket formation into the FLUTE, incipient
- Class 2 pocket formation into the FURCA, cul-desac
- Class 3 through-and-through furcation lesion
- Class 4 through-and-through furcation lesion that
you can see through
Nabers probe is used in
Hamp Classification (Furcation)
- Normal distance from CEJ to alveolar crest is
____mm
2 mm
Infrabony Defects
* 1 wall
* 2 wall
* 3 wall
* 4 wall
Infrabony Defects
* 1 wall hemiseptal
* 2 wall crater (most common)
* 3 wall trough
* 4 wall circumferential (extraction socket)
Partial root coverage is seen in __________ class of recession- millers classification.
3
Plaque-Induced Gingival Diseases
* Modified by systemic factors
- Modified by medications
- Modified by malnutrition
Plaque-Induced Gingival Diseases
* Most common
* Result of interaction between plaque bacteria and
inflammatory cells of host
* Modified by systemic factors
– Endocrine changes (puberty, pregnancy, diabetes)
– Blood dyscrasias (leukemia)
* Modified by medications
– DIGE with CCBs, dilantin, and cyclosporine
– Oral contraceptives
* Modified by malnutrition
– Vitamin C deficiency (scurvy)
Periodontal Disease (Severity)
Slight
Moderate
Severe
Periodontal Disease (Severity)
Slight
* 1-2mm CAL
Moderate
* 3-4mm CAL
Severe
* ≥5mm CAL
- Pseudomembrane
- Fetid breath
- Blunted papillae represents ______ periodontitis
Necrotizing (ANUG, ANUP)
Aggressive Periodontitis
Localized version has _________
presentation
first molar/incisor
Dental Plaque Composition
* Supragingival= ________ organisms
– Tooth=
– Outer surface of plaque=
* Subgingival= anaerobic
– Tooth= _________ coronal and ____apical
– Epithelium= _______
Dental Plaque Composition
* Supragingival= aerobic
– Tooth= G+
– Outer surface of plaque= G-
* Subgingival= anaerobic
– Tooth= G+ coronal and G- apical
– Epithelium= G-
Supragingival components derive from _________,
subgingival components derive from _______
Saliva
GCF
- Pellicle Formation
– Within _______
– Consists of _________
and other molecules that serve as __________
sites for bacteria
- Pellicle Formation
– Within seconds
– Consists of glycoproteins, proline-rich proteins,
and other molecules that serve as attachment
sites for bacteria
- Adhesion and Attachment of Bacteria
– Within _________
– Initial adhesion is due to _________ and _______- forces
– Firm attachment is due to ____ irreversible
interactions between _________
molecules and __________ receptors
- Adhesion and Attachment of Bacteria
– Within minutes
– Initial adhesion is due to weak reversible van der
Waals and electrostatic forces
– Firm attachment is due to strong irreversible
interactions between specific bacterial adhesin
molecules and host pellicle receptors
- Colonization and Plaque Maturation
– Within _________ hours
– Firmly attached primary colonizers provide new
receptors for attachment of other bacteria in a
process called ___________
- Colonization and Plaque Maturation
– Within 24 to 48 hours
– Firmly attached primary colonizers provide new
receptors for attachment of other bacteria in a
process called coadhesion
- Quorum sensing refers to
Quorum sensing refers to communication among
bacteria in a biofilm to encourage growth of beneficial
species and discourage growth of competing species
- Red complex is associated with _______ and __________
- Red complex is associated with BOP and deeper
pockets
– P. gingivalis
– T. denticola
– T. forsythia
- Orange complex precedes presence of red
complex supporting sequential nature of _________
maturation
- Orange complex precedes presence of red
complex supporting sequential nature of plaque
maturation
– Fusobacterium
– Prevotella intermedia
– Campylobacter rectus
A. Actinomycetemcomitans ______ periodontitis
* Protease that cleaves ____
Aggressive periodontitis
IgG
P. Gingivalis __________ periodontitis
- Chronic periodontitis
- Fimbriae
- Capsule
- Gingipain
present in
P. Gingivalis
- Actinomyces -
- S. mutans -
- S. salivarius -
- Pseudomonas, Staph -
- Actinomyces - healthy gingiva, root caries
- S. mutans - coronal caries
- S. salivarius - most common oral bacteria,
resides on tongue - Pseudomonas, Staph - implants
F. Nucleatum induces apoptosis of ________ and release of tissue-damaging substances from ___________
Induces apoptosis of leukocytes and release of tissue-damaging substances from leukocytes
- Motile, gram-negative rod
- Polar flagellum
C. Rectus
Penetrates epithelium and connective tissue
T. Denticola
T. Denticola ___________ periodontitis
ANUG/ANUP
T. Forsythia protease that cleaves __________ and
______________
Protease that cleaves immunoglobulins and
complement factors
T. Denticola protease that can degrade __________
- Protease that can degrade collagen,
immunoglobulins, and complement factors
Pregnancy gingivitis caused by
P. Intermedia
Precipitation of mineral salts into plaque usually occurs within _________ days
1-14 days
Materia Alba is a
Soft white cheeselike unorganized
accumulation of bacteria, salivary proteins,
desquamated epithelial cells, and occasional
food debris
Extrinsic Stains
* Orange=
* Brown=
* Dark brown and black=
* Yellow-brown=
* Black=
* Green and yellow=
* Bluish-green=
Extrinsic Stains
* Do not contribute to gingival inflammation and are
primarily an esthetic concern
* Orange= usually on anterior teeth, poor OH
* Brown= drinking dark-colored beverages, poor OH
* Dark brown and black= tobacco
* Yellow-brown= CHX and stannous fluoride
* Black= thin lines on cervical third, found in healthy
mouths, consumption of iron
* Green and yellow= usually on anterior teeth, poor OH
and chromogenic bacteria
* Bluish-green= occupational exposure of metallic dust
Subgingival Margins
* Even when not faulty they are associated with
_____________, __________, and _________.
Subgingival Margins
* Even when not faulty they are associated with
plaque accumulation, gingival inflammation,
and deeper pockets
First line of defense _______ cells
Neutrophils
MMP-8 (neutrophil collagenase)= most important proteinase
involved in destruction of __________, inhibited by ___________
MMP-8 (neutrophil collagenase)= most important proteinase involved in destruction of periodontal tissues, inhibited by tetracyclines
They internalize bacteria via _________ and kills them using “biologic bleach” of ______ and _________
They internalize bacteria via phagocytosis and kills them using “biologic bleach” of myeloperoxidase and oxygen radicals
Defective neutrophil chemotaxis leads to
________
aggressive periodontitis
Neutrophil abnormalities include __________
neutropenia, Chediak-Higashi syndrome, Papillon-Lefevre syndrome, and LAD-1 and LAD-2
Macrophages
* Antigen-presenting cells (APCs) like __________
and__________ cells
* Regulate immune response via cytokine
release like ______
Macrophages
* Antigen-presenting cells (APCs) like monocytes
and dendritic cells
* Regulate immune response via cytokine
release like IL-8
Mast Cells
fun:
* Ig_______
Mast Cells
* Vascular permeability and dilation
* IgE
Lymphocytes
* B cells become ________ cells and make
_________
* T helper cells (CD4) help in
___________
* T cytotoxic cells (CD8) kill
* NK cells are T cells that can recognize
and kill ________ and _________ cells
Lymphocytes
* B cells become plasma cells and make
antibodies
* T helper cells (CD4) help in
communication
* T cytotoxic cells (CD8) kill intracellular
antigens
* NK cells are T cells that can recognize
and kill tumor and virally-infected cells
Proinflammatory Mediators
- IL-1= bone resorption
- IL-6
- PGE2
- TNFa= macrophage activation
- MMPs= collagen destruction
Anti-inflammatory Mediators
- IL-4
- IL-10
- TIMPs
Pathogenesis of Gingivitis
* Stage 1,
* Stage 2,
* Stage 3,
* Stage 4,
- Stage 1, Initial Lesion—2 to 4 days, neutrophil
infiltration, increased GCF - Stage 2, Early Lesion—4 to 7 days, T lymphocyte
infiltration, increased collagen loss, BOP - Stage 3, Established Lesion—14 to 21 days, B
lymphocyte infiltration including mature plasma
cells, collagen loss, clinical changes in color,
contour, and consistency - Stage 4, Advanced Lesion—transition to
irreversible damage of periodontitis
Periodontal re-evaluation (pocket depths, inflammation) should occur ________ weeks after the completion of
phase _____ therapy to allow for ______ and formation of ______
Periodontal re-evaluation (pocket
depths, inflammation) should occur
4-8 weeks after the completion of
phase I therapy to allow for healing
and formation of JE
Reduce or eliminate periodontal pockets in _____ phase
- surgical phase
- Periodontal therapy, including placement of
implants - Endodontic therapy ______ phase
2
Risk Determinants are
Genetic factors
* Age
* Gender
* Socioeconomic status
Risk Indicators are
HIV/AIDS
* Osteoporosis
* Infrequent dental visits
* Stress
Risk Markers
- Previous history of periodontal disease
- BOP
- CAL
Risk Factors
- Smoking
- Diabetes
- Pathogenic bacteria
- Microbial tooth deposits
_________ is the most important factor in determining the prognosis!
CAL
prognosis Local Factors
Local Factors
* Plaque and calculus
* Subgingival restorations
Sickle Scalers
* For_________l calculus
* _______ cutting edges
* __________ in cross section
Sickle Scalers
* For supragingival calculus
* Two cutting edges
* Triangle in cross section
Curettes
* For __________ calculus
– _____cutting edges
– __________ in cross section
* Gracey curettes adapt to specific areas of the mouth
– _______-cutting edge
– _________ in cross section
Curettes
* For subgingival calculus
* Universal curettes can be used in any area of the mouth
– Two cutting edges
– Semicircle in cross section
* Gracey curettes adapt to specific areas of the mouth
– One cutting edge
– Semicircle in cross section
gracey curretes numbers and surfaces
– Gracey 1-2 and 3-4—anterior
– Gracey 5-6—anterior and premolars
– Gracey 7-8 and 9-10—posterior, facial and lingual
– Gracey 11-12—posterior, mesial
– Gracey 13-14—posterior, distal
agitation observed in fluids by mechanical vibrations
that disrupts bacterial cell walls
Acoustic turbulence
mechanically removes deposits and debris
Vibrations
vacuum air bubbles collapse and release energy to flush debris
Cavitation
- When initially inserting a curette into the pocket, angulation between the blade and the tooth should be ____ degrees (closed-angle) and when scaling and root planing, this angulation is changed to ________ degrees (open-angle)
- When initially inserting a curette into the pocket, angulation between the
blade and the tooth should be 0 degrees (closed-angle) and when scaling
and root planing, this angulation is changed to 45-90 degrees (open-angle)
light to moderate pull stroke used for final smoothing
- Root planing
short, strong pull stroke to remove hard deposits
- Scaling
Prophy Jet uses:
remove extrinsic stains and soft deposits
- Vertical releases at
line angles
- Split or partial thickness (mucosal) flap
– Used for _________ surgery because
exposing the bone is unnecessary - Full thickness (mucoperiosteal) flap
– Used for ________ surgery and periodontal
regeneration to permit ______ closure as
well as in _________ flaps - Whenever alveolar bone is exposed like in
full thickness flaps, expect about _____mm of
bone resorption and remodeling
- Split or partial thickness (mucosal) flap
– Gingiva/mucosa, submucosa
– Used for mucogingival surgery because
exposing the bone is unnecessary - Full thickness (mucoperiosteal) flap
– Gingiva/mucosa, submucosa, periosteum
– Used for osseous surgery and periodontal
regeneration to permit primary closure as
well as in apically repositioned flaps - Whenever alveolar bone is exposed like in
full thickness flaps, expect about 1mm of
bone resorption and remodeling
Full Thickness Flap
* Involves _____ horizontal incisions, and they are
Full Thickness Flap
* Involves three horizontal incisions:
– Internal or reverse bevel—about 1mm from
the gingival margin, removes pocket lining
yet conserves outer gingiva
– Sulcular or crevicular—through base of
pocket to alveolar crest
– Interdental or interproximal—removes the
collar of tissue around the tooth you
created with the first two incisions
three incisions and provides access to subgingival
areas for debridement with the goal of new
attachment
Modified Widman flap
pocket reduction with additional vertical releasing incisions
Apically repositioned flap
Periodontal Pack
* Usually consists of _____
* Leave in place for _______ week
* Packs are placed to protect the
* Packs do NOT enhance ________
Periodontal Pack
* Usually consists of ZOE
* Leave in place for 1 week
* Packs are placed to protect the surgical
wound, minimize discomfort, maintain tissue
placement, and help prevent post-op bleeding
* Packs do NOT enhance healing
Gingival surgery healing is by _____ intension
secondary
Pocket reduction ________ incision in maxilla and mandible
parallel, V-shaped
- Free gingival graft=
- Connective tissue graft=
- Frenectomy=
- Frenotomy=
- Vestibuloplasty=
- Free gingival graft= widen
band of keratinized tissue - Connective tissue graft= root
coverage - Frenectomy= complete
removal of frenum - Frenotomy= incision of
frenum - Vestibuloplasty= deepen the
vestibule
Ideal thickness of graft is _________ mm
1-1.5mm
revascularization from the recipient bed ______ graft
FGG
________ is most common donor site for both
FGG and CTG
Palate
- Ostectomy= removal of __________ bone
- Osteotomy= removal of ___________ bone
- After ostectomy, peaks of bone often remain at
the__________ called _______
- Ostectomy= removal of supporting bone
- Osteotomy= removal of non-supporting bone
- After ostectomy, peaks of bone often remain at
the line angles called widow’s peaks
Wound Healing
* These cells populate a wound area during the
healing process from fastest to slowest:
– Epithelial cells (1)
– CT cells (2)
– PDL cells (4)
– Bone cells (3)
Root Surface Treatment
* Chelating agents like_____ and _______can
expose the collagen fibrils through
demineralization and may improve new
attachment
EDTA and citric acid
- Autograft=
- Allograft=
- Xenograft=
- Alloplast=
- Autograft= from yourself
- Allograft= from another human, usually cadaver
- Xenograft= from another animal, usually cow
- Alloplast= synthetic or inorganic
- Osteoconductive=
- Osteoinductive=
- Osteogenic=
- Osteoconductive= scaffold
- Osteoinductive= convert neighboring progenitor
cells into osteoblasts - Osteogenic= make bone
- Barrier membrane is the “tank”—
- Bone graft is the “damage”—
- Biologic agent is the “healer”—
- Barrier membrane is the “tank”—prevents soft tissue
downgrowth and permits hard tissue ingrowth - Bone graft is the “damage”—osteoconductive,
osteoinductive, and/or osteogenic - Biologic agent is the “healer”—creates an environment
conducive to tissue formation
Antibiotics
* Should only be used as an adjunct to
phase _________
* _________ and _________ periodontitis
(1) Antibiotics
* Should only be used as an adjunct to
mechanical debridement during phase I
* Aggressive and refractory periodontitis
Local Delivery Antibiotics (LDA)
drugs:
When localized recurrent and/or residual PD
________mm with inflammation are still present
following conventional therapies
When localized recurrent and/or residual PD
≥5mm with inflammation are still present
following conventional therapies
* Arrestin= Minocycline
* Atridox= Doxycycline
* PerioChip= Chlorhexidine gluconate
Host Modulation Therapy
* Should only be used as an adjunct to
mechanical debridement during phase _____
* _________- periodontitis
- Should only be used as an adjunct to
mechanical debridement during phase I - Chronic periodontitis
Subantimicrobial Dose Doxycycline (SDD)
* Inhibits ________
* ______mg twice daily for ______ months (Periostat)
Subantimicrobial Dose Doxycycline
(SDD)
* Inhibits MMPs (collagenases)
* 20mg twice daily for 3-9 months (Periostat)
Periostat-
Periochip-
Subantimicrobial dose doxycycline is periostat- 20 mg twice daily for 3-9 months
PerioChip= Chlorhexidine gluconate-Local Delivery Antibiotics (LDA)
Locally Administered Host-Modifying
Agents
* These surgical adjuncts may also influence
_________ regeneration
Locally Administered Host-Modifying
Agents
* Emdogain= enamel matrix proteins
* PDGF= GEM 21S
* These surgical adjuncts may also influence
periodontal regeneration
- Primary occlusal trauma= caused by excessive
forces on a _________l periodontium - Secondary occlusal trauma= caused by normal
occlusal forces on a _______ periodontium - Fremitus=
- Primary occlusal trauma= caused by excessive
forces on a normal periodontium - Secondary occlusal trauma= caused by normal
occlusal forces on a reduced periodontium - Fremitus= vibration of teeth upon closing
coronoplasty is
- Occlusal adjustment (coronoplasty)= selective
reshaping of occlusal surfaces
Replace brushes every ______ months
3
Periodontitis most common to least common
most common in _______ descent
Chronic > LAP > GAP > Refractory
males of African descent
Calculus contains _____ amounts of viable bacteria than plaque.
lower
Smokinghas been shown to____________ the inflammatory response of gingival tissues, ___________probing depths
Smokinghas been shown todecrease the inflammatory response of gingival tissues, Increased probing depths
Dental plaque starts as a pellicle and a few early colonizers and takes around ____ days to mature.
1-2 days
What should clinicians initially assume for grading?
Grade- B
This time frame allows for histologic healing of the periodontal tissues, which includes _____ weeks for the long junctional epithelium and __________ weeks for connective tissue.
This time frame allows for histologic healing of the periodontal tissues, which includes 2 weeks for the long junctional epithelium and 4-6 weeks for connective tissue.
