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Spring 2018 > Perio 2 Test 2 > Flashcards

Perio 2 Test 2 Flashcards

1
Q

What happens if we don’t do any tx to perio?

A

Tooth loss in susceptible individuals

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2
Q

What happens if we don’t do surgery?

A

Less reduction in probe depths

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3
Q

What happens if we do surgery?

Why?

A

Greater and sustained probe depth reduction

Flap approach reduces calculus, less calculus less inflammation

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4
Q

Advantages and disadvantages of surgical therapy (cutting open gums to work on perio)

A

A: direct vision
Easier manipulation and removal of tissues

D: moribidity
Esthetics
Cost

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5
Q

What are the short term vs long term benefits of surgery?

A

Surgery has better short term and long term pocket reduction

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6
Q

Benefit of regenerative surgery?

A

Favorable outcomes on even hopeless teeth (92% retention)

Stable 5 years after tx

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7
Q

Gingivectomy vs gingivoplasty

A

Ectomy: excision of the soft tissue wall of a perio pocket

Plasty: reshaping the gingiva to recreate physiological contours

Plasty is a step in a gingivectomy procedure

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8
Q

2 indications for gingivectomy

3 contraindications

A

Hyperplastic tissue
Suprabony pockets

Osseus involvement
Minimal attached gingiva/mucogingival involvement
Furcation involvement

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9
Q

Steps in gingivectomy

A
  1. LA
  2. Pocket depth marks (Bleeding Pts)
  3. External bevel
  4. Tissue removal
  5. Excision of tissue tags
  6. Gingivoplasty
  7. Application of surgical dressing
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10
Q

Complete healing after gingivectomy takes _ weeks

A

7

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11
Q

Gingivectomy vs. flap

A

Gingivectomy:
Cuts at 135˚ to tooth
External bevel
Exposed tissue during healing

Flap:
Leaves gap b/t leftover tissue and tooth
Internally beveled
Provides access to bone
Tissues not exposed during healing
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12
Q

Purpose of perio flaps

3 contexts for use

A

Provide access to bone and furcations

  1. Resection (removal of tissue)
  2. Conservative (access only)
  3. Regeneration (new perio support)
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13
Q

Flaps preserve _

A

Keratinized gingiva

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14
Q

Surgical access facilitates what 3 things

A

Calculus removal
Elimination of perio pockets
Perio regeneration

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15
Q

Other than calculus removal, 5 other applications for perio flaps

A 
Surgical extractions
Biopsies
Exploratory surgery
Clinical crown lengthening
Pre-prosthetic surgery
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16
Q

Blade used for primary incision

A

15

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17
Q

Steps of full thickness flap

A
  1. LA
  2. Incisions
  3. Flap elevation
  4. Removal of soft tissue
  5. Osseus surgery
  6. Flap placement
  7. Sutures
  8. Dressing
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18
Q

3 pre-flap-surgery essential considerations

A

Pocket depth
Amount of keratinized gingiva
Intended position of flap

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19
Q

3 problems that can occur with flap elevation

A
  1. Difficult if 1st incision doesn’t extend to bone
  2. tearing of flap with excessive force or improper direction of elevation
  3. Exostoses require special attention
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20
Q

Why place a wedge

A

Access to bone and Furcations
Internal thinning of bulky tissue
Closure and primary healing after reduction

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21
Q

2 conservative flap designs

A

Modified wild man

Flap curettage

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22
Q

A widman flap is 3 things

A

Scalloped
Replaced mucoperiosteal
With internal bevel incision

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23
Q

6 goals of suturing

A
  1. Tension that’s adequate enough for wound closure, but loose enough to prevent ischemia and necrosis
  2. Hemostasis maintained
  3. Primary intention healing permitted
  4. Post-op pain reduced
  5. Bone exposure prevented (faster healing)
  6. Proper flap position
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24
Q

4 points of a suture needle

A

Swage
Radius
Body
Point

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25
2 types and subtypes of NON-resorbable sutures
1. Silk 2. Polyester A. Nylon B. PTFE
26
2 types and subtypes of resorbable sutures
1. Natural A. Plain gut B. Chronic gut 2. Synthetic A. Coated vinyl
27
Chromic gut | Pros/cons
Heals fast BUT Relatively weak Moderate tiss. Rxn
28
Coated vicryl pros/cons
Strong Minimal tissue rxn BUT 56-70 day hydrolysis resorption
29
Surgical silk pros/cons
2+ strength BUT Moderate tissue rxn Non-resorbable
30
ePTFE pros/cons
Strong Extremely low tissue rxn BUT Non-resorbable
31
2 types of interrupted sutures 2 types of sling sutures
I: simple loop Figure 8 S: single sling Continuous sling
32
Sutures inserted through _ first
More mobile flap
33
Distance from sutures to the edge of the flap
2-3 mm
34
3 phases of postsurgical healing
Inflammation Fibroblasts granulation Matrix formation/remodeling
35
``` Primary Intention healing at: 24 hrs (2) 1-3 days (2) 3-7 days (3) 1 week (1) 2 Weeks (2) 1 month (6) 2 months (2) ```
24 hrs - Neutrophils infiltrate - Epithelium starts to migrate from wound margins 1-3 days - Space b/t flap and tooth narrows - Ep cells migrate over border of flap 3-7 days - Neutrophils replaced by macrophages - Blood clot replaced by granulation tissue - revascularization 1 Week -Ep attaches to root 2 Weeks - Collagen fibers oriented parallel to tooth (non-functional, immature) - Union of flap to tooth is weak 1 Month - Inflammatory cells gone - Fibroblasts multiplying, making collagen - Less revascularization - Ging. Crevice is epithelialized - Ep attachment is well defined - Functional arrangement of supracrestal fibers 2 Months - Collagen remodeled and cross-linked - Wound regained tensile strength
36
How does exposed bone heal
Superficial bone necrosis (1-3 d) Osteoclastic resorption (4-6 days)
37
How much bone is lost if exposed to oral environment
1mm
38
4 things to do for best surgical outcome
Minimize tissue trauma Minimize wound desiccation (irrigate) Suture meticulously Address systemic health issues b4 surgery
39
Healing by secondary intention: | 3 things that are worse than primary
More inflammation More granulation tissue More wound contraction during healing
40
Where do growth factors and cytokines come from
Blood clot
41
3 growth factors released from the blood clot
PDGF- induces fibroblast and macrophage migration, proliferation and activation EGF-induces epithelial proliferation TGF-Beta - induces migration of inflammatory cells and proliferation of fibroblasts
42
What do TNF and IL-1B do and from where are they released
They activate endothelium and induce neutrophil migration Fibroblasts and macrophages
43
Epithelial healing requires _ days | Healing is complete in _
7-14 days | Complete in 6-7 weeks
44
What 3 things happen to cause alveolar bone loss
Gingival inflammation is extended Trauma from occlusion Systemic disorders
45
How does gingival inflammation extend? 4 ways
Extends along collagen fiber bundles Follows course of blood vessels Enters alveolar bone Enters max sinus
46
Angular defects happen if interdental septum is _ wide. If less than that, horizontal bone loss will occur.
>2.5mm
47
5 types of osseus defects
``` Horizontal bone loss Angular bone loss Ledges Reverse architecture Furcation involvement ```
48
Tx options for horizontal bone loss
SRP Gingivectomy Open Flap Debridement Osseus Surgery
49
Angular defect tx options
OS | GTR
50
Osseus surgery flap vs regenerative surgery flap
Both are full thickness FLAP: Osseus is apically positioned Regen is coronally positioned Incision: Osseus is usually scalloped but if keratinized tissue is limited, sulcular incision Regen is sulcular
51
Ostectomy
Removal of bone ATTACHED TO TOOTH
52
How to correct reverse architecture
Bring interdental bone up | Lower facial bone
53
4 requirements for ostectomy
1. Horizontal bone loss with irregular marginal bone height 2. Intrabony defects that we can’t regenerate 3. No esthetic or anatomic limitations 4. Sufficient remaining bone for establishing physiologic contours w/o attachment compromise
54
Contraindications for ostectomy
``` Insufficient remaining attachment Unfavorably affect adjacent teeth Anatomic limitations Esthetic limitations Effective alternative ```
55
Ostectomy vs osteoplasty
Ectomy: removal of bone attached to tooth Plasty: removal of bone not attached to tooth
56
Indications for osteoplasty
``` Tori Intrabony defects adjacent to edentulous ridges Incipient furcations Reduction of buttress bone or exostoses Shallow osseus craters ```
57
Guided tissue regen:
Procedures that allow a perio defect to get cells that can form new connective tissue attachment and alveolar bone
58
3 principles of GTR
Exclude unwanted Protect wanted Hold the space
59
6 qualities of an ideal oral membrane
``` Absorbable Biocompatible Cell Occlusive Space Maintenance Tissue Integration Clinically Manageable ```
60
3 types of materials used for GTR
Non-resorbable Resorbable Stem cells, functionally graded membranes
61
Gore-Tex is otherwise known as _ which stands for _
e-PTFE Expanded Poly Tetra Fluoro Ethylene
62
Two types of resorbable membranes
Polylactic acid Collagen (bovine/porcine, need consent)
63
Graded membrane components
HA surface layer Two core (protein) layers Metronidazole epithelial layer
64
How is space maintained after extraction
Reinforcing the membrane Creating a scaffold (screws and fillers)
65
Cells in: Osteogenesis vs osteoinduction vs osteoconduction Which are Conductive, inductive, genic?
OG: viable bone cells OI: uncommitted CT cells induced OC: non-viable scaffold Autograft is all 3 Allograft is 1.5 Alloplast/xenograph is conductive only
66
3 things you use when doing a graft
Membrane Graft Mediator
67
What are 2 types of biological mediators
Enamel matrix proteins | rhBMP - recombinant human bone morphogenetic protein
68
What does an enamel matrix derivative (Emdogain) do
Helps grow bone, PDL, cementum and matrix
69
What does PDGF do?
Aids in formation of bone, PDL and cementum by stimulating osteoblasts, fibroblasts, and cementoblasts
70
3 reasons for GTR
Space maintainer Exclude epithelium Protect and promote bone and PDL growth
71
The Furcation transitional part? | The crotch?
Entrance | Fornix
72
Width of a blade of a new gracey curette
0.75mm
73
Order of Furcation sizes in max molar from biggest to smallest
Mesial Distal Buccal
74
Most often root concavities can be found where (which sides of which molars)
Almost always (94-100) - M/D of mandibular - MB of max Rare - DB (31) - Palatal max (17)
75
CEPs: What Frequency Main type
Cervical enamel projections 13% of molars Enamel pearl
76
Glickman vs Hamp, Nyman and Lindhe’s Classifications
``` G: 1-4 1-catch, not visible on r-graph 2-visible on r-graph, can be shallow or deep 3-through and through 4-clinically visible ``` HNL: 0-3 Basically same thing, but 3 is through and through, no 4
77
3 things a Furcation radiolucency could be: How to tell?
1. Perio 2. Drainage of infection from accessory canal from chamber (non-vital tooth) 3. Trauma from occlusion (won’t have deep probe depths)
78
Most effective way to treat grade 2 furcations
Osseus surgery (plasty and ostectomy)
79
Root resection is indicated when? Contraindications
Grade 2 severe, or grade 3 Furcation CI: inadequate bone support, fused roots, inoperable endo, patient considerations
80
Window to do root canal after root resection
2 weeks
81
If doing root resectioning, what is the sequence
``` Endo Provisional RSR Perio surgery Final prosthetic ```
82
When is hemisection indicated
Mandibular molar Grade III Furcation Widely separated roots Soft tissue below level of pulp chamber
83
Regen of Furcation defects works best on _ and is done by _
Type II furcations | GTR
84
Treatment of furcations: Class I Class II Class III
I- SRP II- open flap, SRP, osseus surgery, GTR, tunneling, root resection III-tunnel, hemisection, resection, extraction
85
Survival of treated furcated molars
70%
86
6 pre-prosthetic perio surgical procedures
``` Tooth prep to gingival margin Restorative in perio surgery Crown-lengthening Gingival grafting Ridge plumping Ridge reduction ```
87
T/F gingival retraction works on inflammed tissue
FALSE
88
Crown lengthening to treat excessive gingival display is indicated and contraindicated when
I: not enough of anatomic crown is exposed (altered passive eruption) CI: hypermobile lip Skeletal problem
89
Dentinogingival complex vs. biologic width
DGC: sulcus, JE, connective tissue BW: JE, Connective
90
Optimal distance from GM to alveolar crest From alveolar crest to tooth structure?
At least 3 2 for attachment, 1 for sulcus At least 4
91
How long do you need to wait after crown lengthening to do a restoration
6 weeks
92
2 indications to do mucogingival alteration not on a tooth 3 methods to alter it
Lack of keratinized/attached gingiva -For abutment teeth or edentulous site Shallow vestibular depth - for RPD - for complete denture 1. Subepithelial connective tissue graft 2. Free gingival graft 3. Vestibular extension

Spring 2018 (18 decks)

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