Perio Flashcards
Loss of tooth substance by mechanical wear is \_\_\_\_\_. A. Abrasion B. Attrition C. Erosion D. Abfraction
A. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
The width of keratinized gingiva is measured
as the distance from the _____.
A. Free gingival margin to the mucogingival
junction
B. Cementoenamel junction to the mucogingival
junction
C. Free gingival groove to the mucogingival
junction
D. Free gingival margin to the base of the pocket
A. Keratinized gingiva extends from the free gingival
margin to the mucogingival junction. The attached
gingival extends from the free gingival groove to
the mucogingival junction.
Which of the following best distinguishes peri-
odontitis from gingivitis?
A. Probing pocket depth
B. Bleeding on probing
C. Clinical attachment loss
D. Presence of suppuration
C. Gingivitis is characterized by inflammation of the
gingival tissues with no loss of clinical attachment.
Periodontitis is characterized by inflammation with
loss of clinical attachment.
A 22-year-old college student presents with oral
pain, erythematous gingival tissues with blunt
papillae covered with a pseudomembrane,
spontaneous gingival bleeding, and halitosis.
There is no evidence of clinical attachment
loss. What form of periodontal disease does
this patient most likely have?
A. Gingivitis associated with dental plaque
B. Localized aggressive periodontitis
C. Generalized chronic periodontitis
D. Necrotizing ulcerative gingivitis
D. Because there is no loss of attachment, the diag-
nosis would not be periodontitis. The clinical
description of pain, erythema, blunt papillae,
pseudomembrane, and halitosis is consistent
with necrotizing ulcerative gingivitis.
Which of the following methods of radi-
ographic assessment are best for identifying
small volumetric changes in alveolar bone density? A. Bitewing B. Periapical C. Subtraction D. Panoramic
C. Radiographs must be taken in a standardized
format at repeated visits to be assessed for small
changes in bone density over time, using sub-
traction radiography. Radiographs are usually
standardized by using a bite registration block to
relocate the x-ray at the same place and angula-
tion each time.
What tooth surfaces should be evaluated for
furcation involvement on maxillary molars?
A. Palatal, facial, and distal
B. Mesial, distal, and palatal
C. Facial, palatal, and mesial
D. Facial, mesial, and distal
D. Maxillary molars usually have three roots (mesio-
buccal, disto-buccal, and palatal). Furcation
involvement can be assessed on these teeth from
the facial (bifurcation between the mesio-buccal
and disto-buccal roots), mesial (bifurcation
between the mesio-buccal and palatal roots) and
distal (bifurcation between the disto-buccal and
palatal roots).
What bacterial species are found in increased
numbers in the apical portion of tooth-
associated attached plaque?
A. Gram-negative rods
B. Gram-positive rods
C. Gram-positive cocci
D. Gram-negative cocci
A. Subgingival plaque can be in the cervical area
or more apical. In both areas it can be either
tooth-associated or tissue-associated. The apical
tooth-associated plaque is composed primarily of
gram-negative rods.
What are the major organic constituents of bacterial plaque? 1. Calcium and phosphorous 2. Sodium and potassium 3. Polysaccharides and proteins 4. Glycoproteins and lipids A. 1 and 2 B. 2 and 3 C. 3 and 4 D. 2 and 4
C. Calcium, phosphorous, sodium, and potassium
are inorganic components of dental plaque.
Polysaccharides, proteins, glycoproteins, and
lipids are organic components of dental plaque.
Although many plaque bacteria coaggregate,
which of the following bacteria is believed to
be an important bridge between “early coloniz-
ers” and “late colonizers” as plaque matures
and becomes more microbiologically complex? A. Porphyromonas gingivalis B. Streptococcus gordonii C. Hemophilus parainfluenzae D. Fusobacterium nucleatum
D. Fusobacterium nucleatum can be found in health
and disease. This bacterium is an important bridge
between early and late colonizers of the dental
plaque biofilm.
What features best characterize the predomi-
nant microflora associated with periodontal
health?
A. Gram-positive, anaerobic cocci and rods
B. Gram-negative, anaerobic cocci and rods
C. Gram-positive, facultative cocci and rods
D. Gram-negative, facultative cocci and rods
C. Periodontal health is characterized by a
microflora dominated by gram-positive, faculta-
tive cocci and rods.
- Which of the following microorganisms is fre-
quently associated with localized aggressive
periodontitis? A. Porphyromonas gingivalis B. Actinobacillus actinomycetemcomitans C. Actinomyces viscosus D. Streptococcus mutans
B. Porphyromonas gingivalis has been associated
with chronic periodontitis. Actinomyces viscosus
is usually associated with health or gingivitis.
Streptococcus mutans is associated with dental
caries. Actinobacillus actinomycetemcomitans
has been associated with localized aggressive
periodontitis.
Which of the following is the primary etiologic
factor associated with periodontal disease?
A. Age
B. Gender
C. Nutrition
D. Bacterial plaque
D. Although age, gender, and nutrition may have an
impact on periodontal disease, the accumulation
of the bacterial plaque biofilm is the primary ini-
tiator of the disease.
Inadequate margins of restorations should be corrected primarily because they \_\_\_\_\_. A. Cause occlusal disharmony B. Interfere with plaque removal C. Create mechanical irritation D. Release toxic substances
B. Inadequate or overhanging margins serve as a
nidus for dental plaque accumulation and make
plaque removal difficult.
Light smokers are likely to have less severe
periodontitis than heavy smokers. Former
smokers are likely to have more severe peri-
odontitis than current smokers.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
C. Individuals who smoke cigarettes are more likely
to have periodontal disease than are nonsmok-
ers. The number of cigarettes smoked and the
number of years of smoking affect the severity of
disease. Former smokers usually have less dis-
ease than do current smokers.
Well-controlled diabetics have more periodon-
tal disease than nondiabetics. Well-controlled
diabetics can generally be treated successfully
with conventional periodontal therapy.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
D. The extent and severity of periodontal disease
in a patient with well-controlled diabetes is
usually no more than the extent and severity of
disease in patients without diabetes. Patients
with well-controlled diabetes can usually
be treated with conventional periodontal
therapy.
Oral contraceptives can cause gingivitis. Oral
contraceptives can accentuate the gingival
response to bacterial plaque.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
D. Oral contraceptives can exacerbate the impact of
bacterial plaque on the gingival tissues. However,
they cannot cause gingivitis.
Which of the following cells produce anti-
bodies?
A. Neutrophils
B. T-lymphocytes
C. Macrophages
D. Plasma cells
D. Neutrophils are one of the primary defense cells of
the innate immune system. T-lymphocytes are
important activators of the adaptive immune sys-
tem. Macrophages are antigen-presenting cells.
Plasma cells produce antibodies.
Defects in which inflammatory cell have most
frequently been associated with periodontal
disease?
A. The T-lymphocyte
B. The mast cell
C. The plasma cell
D. The neutrophil
D. Although defects in any of the host defense cells
could impact periodontal disease susceptibility,
defects in neutrophils have been most frequently
described.
What is the major clinical difference between
the established lesion of gingivitis and the
advanced lesion of periodontitis?
A. Gingival color, contour, and consistency
B. Bleeding on probing
C. Loss of crestal lamina dura
D. Attachment and bone loss
E. Suppuration
D. The initial, early, and established lesions of gingivitis
do not have attachment loss associated with them.
Which interleukin (IL) is important in the acti- vation of osteoclasts and the stimulation of
bone loss seen in periodontal disease? A. IL-1 B. IL-2 C. IL-8 D. IL-10
A. IL-1 is important in the activation of osteoclasts
and stimulation of bone loss.
Scaling and root planing are used in which phases of periodontal therapy? 1. Initial (hygienic) 2. Surgical (corrective) 3. Supportive (maintenance) A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1 and 3 only E. 1, 2, and 3
E. Scaling and root planing are used in all phases of
periodontal therapy where there has been loss of
attachment through periodontitis.
What is the most objective clinical indicator of inflammation? A. Gingival color B. Gingival consistency C. Gingival bleeding D. Gingival stippling
C. Although changes in gingival color and consis-
tency and loss of gingival stippling can be indica-
tors of gingival inflammation, bleeding on
probing is the most objective clinical indicator.
A 25-year-old patient presenting with general-
ized marginal gingivitis without any systemic
problems or medications should be classified with which periodontal prognosis? A. Good B. Fair C. Poor D. Questionable
A. Marginal gingivitis not complicated by systemic
problems or medications usually can be treated
successfully with phase 1 therapy, and a patient
with this diagnosis would have a good prognosis.
Instrumentation of the teeth to remove plaque, calculus and stains is defined as \_\_\_\_\_. A. Coronal polishing B. Scaling C. Gingival curettage D. Root planing
B. Polishing is used to remove plaque and stains
from the teeth. Gingival curettage is used to
remove the epithelial lining of a periodontal
pocket. Root planing is used to create a smooth
root surface through the removal of calculus and
rough cementum. Scaling is used to remove
plaque, calculus, and stains from the tooth.
Scalers are used to remove supragingival
deposits. Curettes are used to remove either
supragingival or subgingival deposits.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Scalers, with their pointed ends and back, are
designed for supragingival instrumentation;
curettes, with their rounded ends and back, can
be used for both supragingival and subgingival
instrumentation.
Which of the following is not a characteristic of
sickle scalers?
A. Two cutting edges.
B. Rounded back.
C. Cutting edges meet in a point.
D. Triangular in cross section.
E. Used for removal of supragingival deposits.
B. Scalers have a pointed back; curettes have a
rounded back, making them suitable for subgin-
gival instrumentation.
The modified Widman flap uses three separate
incisions. It is reflected beyond the mucogingi-
val junction.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
C. Three incisions are made in the modified Widman
flap—internal bevel, crevicular, and interdental. It
is designed to provide exposure of the tooth roots
and alveolar bone. However, the flap is not
reflected beyond the mucogingival junction.
The free gingival graft technique can be used to
increase the width of attached gingival tissue.
Apically displaced full-thickness or partial-
thickness flaps can also be used to increase the
width of attached gingiva.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Surgical techniques designed to increase the
width of attached gingiva include free gingival
grafts and apically repositioned flaps.
Miller Class I recession defects can be distin-
guished from Class II defects by assessing the
_____.
A. Location of interproximal alveolar bone
B. Width of keratinized gingiva
C. Involvement of the mucogingival junction
D. Involvement of the free gingival margin
C. The Miller classification system for mucogingival
defects takes into consideration the degree of
recession (whether or not it extends to the
mucogingival junction) and presence or absence of
bone loss in the interdental area. Both Class I
and Class II defects are characterized by no loss
of bone in the interproximal areas. In Class I
defects, the marginal tissue recession does not
extend to the mucogingival junction. In Class II
defects, recession does extend to or beyond the
mucogingival junction.
The reshaping or recontouring of nonsupport-
ive alveolar bone is called _____.
A. Ostectomy
B. Osteoplasty
C. Osteography
D. All of the above
B. Ostectomy is the removal of supporting alveolar
bone. Osteoplasty is the reshaping or recontouring
of nonsupporting alveolar bone.
An interdental crater has how many walls? A. One wall B. Two walls C. Three walls D. Four walls
B. An interdental crater has two bony walls remain-
ing. These walls are usually the facial and lingual
walls.
- During the healing of a surgically treated intra-
bony (infrabony) pocket, regeneration of a new
periodontal ligament, cementum, and alveolar
bone will only occur when cells repopulate the
wound from which of the following sources?
A. Gingival epithelium
B. Connective tissue
C. Alveolar bone
D. Periodontal ligament
D. Cells from the periodontal ligament are pro-
posed to allow for regeneration of the periodontal
tissues.
Which of the following is least likely to be suc-
cessfully treated with a bone graft procedure?
A. One-walled defect
B. Two-walled defect
C. Three-walled defect
D. Class III furcation defect
D. Through-and-through (Class III) furcation defects
are least likely to be treated with bone graft
procedures.
When osseointegration occurs, which of the fol-
lowing best describes the implant–bone inter-
face at the level of light microscopy following
osseointegration? A. Epithelial attachment B. Direct contact C. Connective tissue insertion D. Cellular attachment
B. When evaluated by light microscopy, there
appears to be direct contact at the bone-implant
interface.
The most effective topical antimicrobial agent currently available is \_\_\_\_\_. A. Chlorhexidine B. Stannous fluoride C. Phenolic compounds D. Sanguinarine
A. Chlorhexidine is the most effective antimicrobial
agent currently available.
What is the active ingredient in PerioChipTM? A. Doxycycline B. Tetracycline C. Metronidazole D. Chlorhexidine
D. PerioChip® is a biodegradable local delivery agent
for chlorhexidine.
How many days does it usually take for surface
epithelialization to be complete following a gin-
givectomy?
A. 3–7
B. 5–14
C. 14–18
D. 20–27
B. Epithelial cells migrate approximately 0.5 mm/day.
Following a gingivectomy, it takes 5 to 14 days for
surface epithelialization to be complete.
The most obvious clinical sign of trauma from
occlusion is increased tooth mobility. The most
obvious radiographic sign of trauma from
occlusion is an increase in the width of the
periodontal ligament space.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A. Increased tooth mobility is the most common
clinical sign of trauma from occlusion. Increased
periodontal ligament width is the most common
radiographic sign.
Trauma from occlusion refers to \_\_\_\_\_. A. The occlusal force B. The damage to the tooth C. The injury to the tissues of the periodontium D. The widened periodontal ligament
C. The term trauma from occlusion refers to the tis-
sue injury that occurs when occlusal forces
exceed the adaptive capacity of the tissues. An
occlusion that produces such an injury is called a
traumatic occlusion. The tooth may become
damaged as a result of excessive occlusal forces.
The periodontal ligament also may become
widened as a result of the force.
Which of the following is the primary reason for splinting teeth? A. For esthetics B. To improve hygiene C. For patient comfort D. As a preventive measure
C. Teeth are usually splinted to improve patient
comfort during mastication.
In the treatment of an acute periodontal abscess, the most important first step is to \_\_\_\_\_. A. Prescribe systemic antibiotics B. Reflect a periodontal flap surgery C. Obtain drainage D. Prescribe hot salt mouth washes
C. Establishment of drainage is the first step in treat-
ing an acute periodontal abscess. The patient may
then use self-applied mouth rinses and be
prescribed antibiotics if there is evidence of sys- temic involvement (e.g., fever, lymphadenopathy).
A flap would be reflected in a subsequent
appointment if the abscess did not resolve and
became a chronic problem.
Which of the following medications often result
in overgrowth of gingival tissues?
A. Penicillin, calcium channel blockers, phenytoin
B. Calcium channel blockers, phenytoin, and
cyclosporin
C. Cyclosporin, penicillin, and cephalosporins
D. Ampicillin, tetracycline, and erythromycin
B. Calcium channel blockers, cyclosporin, and
phenytoin often result in overgrowth of gingival
tissues.
Which of the following is the most important
preventive and therapeutic procedure in peri-
odontal therapy?
A. Professional instrumentation
B. Subgingival irrigation with chlorhexidine
C. Patient-administered plaque control
D. Surgical intervention
C. Patient cooperation and effectiveness in removing
bacterial plaque is of primary importance in main-
taining a healthy periodontium.
How many hours after brushing does it usually
take for a mature dental plaque to reform?
A. 1–2
B. 5–10
C. 12–24
D. 24–48
D. Mature dental plaque usually reforms on the
teeth within 24 to 48 hours after effective plaque
removal.
Placing the toothbrush bristles at a 45-degree
angle on the tooth and pointing apically so the
bristles enter the gingival sulcus describes
which brushing technique?
A. Charter
B. Stillman
C. Bass
D. Roll
C. The Bass technique of brushing is designed to
direct the bristles of the brush toward the gingival
sulcus.
Dental wear caused by tooth-to-tooth contact is \_\_\_\_\_. A. Abrasion B. Attrition C. Erosion D. Abfraction
B. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
Occlusal loading resulting in tooth flexure,
mechanical microfractures, and loss of tooth
substance in the cervical area is _____.
A. Abrasion
B. Attrition
C. Erosion
D. Abfraction
D. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
The distance from the CEJ to the base of the pocket is a measure of \_\_\_\_\_. A. Clinical attachment level B. Gingival recession C. Probing pocket depth D. Alveolar bone loss
A. The periodontal examination includes probing pocket depth (distance from the gingival margin
to the base of the pocket) and clinical attach- ment level (distance from the CEJ to the base of
the pocket). Both of these measures are made
using a periodontal probe. Gingival recession can
be measured as the distance from the CEJ to the
free gingival margin. Alveolar bone loss is meas-
ured radiographically.
Your examination reveals a probing pocket
depth of 6 mm on the facial of tooth 30. The free
gingival margin is 2 mm apical to the CEJ (there
is 2-mm recession on the facial). How much
attachment loss has there been on the facial of
this tooth?
A. 6 mm
B. 2 mm
C. 8 mm
D. 4 mm
C. When the free gingival margin is apical to the
CEJ, recession has occurred. Attachment loss is
the measure from the CEJ to the base of the peri-
odontal pocket. With the free gingival margin 2
mm apical to the CEJ and the probing pocket
depth measurement 6 mm, there has been 8 mm
loss of attachment.
In general, what species are predominant in
supragingival tooth-associated attached plaque?
A. Gram-negative rods and cocci
B. Gram-negative filaments
C. Gram-positive filaments
D. Gram-positive rods and cocci
D. Supragingival plaque is either tooth-associated or
outer layer. Tooth-associated is composed pri-
marily of gram-positive cocci and short rods.
The inorganic component of subgingival plaque is derived from \_\_\_\_\_. A. Bacteria B. Saliva C. Gingival crevicular fluid D. Neutrophils
C. Saliva is the source of inorganic components
(calcium, phosphorous) for supragingival plaque.
Gingival crevicular fluid is the source of inorganic
components of subgingival plaque.
What are the characteristics of the primary
(initial) bacterial colonizers of the tooth in
dental plaque formation?
A. Gram-negative facultative
B. Gram-positive facultative
C. Gram-negative anaerobic
D. Gram-positive anaerobic
B. Streptococcal and Actinomyces species are ini-
tial colonizers of dental plaque. They are gram-
positive, facultative micro-organisms.
Which of the following is an important constituent of gram-negative microorganisms that contributes to initiation of the host inflammatory response? A. Exotoxin B. Lipoteichoic acid C. Endotoxin D. Peptidoglycan
C. Endotoxin or lipopolysaccharide is an important
constituent of the gram-negative outer mem-
brane that contributes to initiation of the host
inflammatory response.
Calculus is detrimental to the gingival tissues because it is \_\_\_\_\_. A. A mechanical irritant B. Covered with bacterial plaque C. Composed of calcium and phosphorous D. Locked into surface irregularities
B. Calculus is calcified dental plaque. It is always
covered by a layer of uncalcified plaque, which is
detrimental to the gingival tissues.
Restoration margins are plaque-retentive and
produce the most inflammation when they are
located _____.
A. Supragingival
B. Subgingival
C. At the level of the gingival margin
D. On buccal surfaces of teeth
B. Supragingival margins are least detrimental to
the gingival tissues; subgingival margins are the
most detrimental due to the accumulation of
dental plaque.
Which of the following are cells of the innate immune system? a. Neutrophils and monocytes/macrophages b. T cells and B cells c. Mast cells and dendritic cells d. Plasma cells A. a and b B. a and c C. b and d D. b and c
B. Cells of the innate immune system include neu-
trophils, monocytes/macrophages, mast cells,
and dendritic cells. Cells of the specific (adap-
tive) immune system include T cells, B cells, and
plasma cells.
Which of the following are antigen-presenting cells? A. Neutrophils B. T-lymphocytes C. Macrophages D. Plasma cells
C. Neutrophils are one of the primary defense cells
of the innate immune system. T-lymphocytes are
important activators of the specific (adaptive)
immune system. Macrophages are antigen-
presenting cells. Plasma cells produce anti-
bodies.
Which of the following are the most important
proteinases involved in destruction of the
periodontal tissues?
A. Hylauronidase
B. Matrix metalloproteinases
C. Glucuronidase
D. Serine proteinases
B. Matrix metalloproteinases are the most impor-
tant proteinases involved in the destruction of
periodontal tissues.
The predominant inflammatory cells in the periodontal pocket are \_\_\_\_\_. A. Lymphocytes B. Plasma cells C. Neutrophils D. Macrophages
C. Neutrophils are the predominant inflammatory
cells in the periodontal pocket and have mig-
rated across the pocket epithelium from the
subgingival vascular plexus.
Which of the following are part of Preliminary Phase therapy? a. Treatment of emergencies b. Extraction of hopeless teeth c. Plaque control d. Removal of calculus A. a, b, and c B. b, c, and d C. a and b only D. b and d only
C. Preliminary Phase therapy is used to treat emer-
gencies and remove hopeless teeth.
Polymorphisms in which of the following genes have been associated with severe chronic periodontitis? A. IL-6 B. IL-1 C. TNF D. PGE2
B. Polymorphisms in the IL-1 genes have been asso-
ciated with severe chronic periodontitis.
Given the same amount of attachment loss and
same pocket depth, a single-rooted tooth and a
multirooted tooth have the same prognosis. The
closer the base of the pocket is to the apex of the
tooth, the worse the prognosis.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is false.
D. First statement is false. Second statement is true.
D. Single-rooted teeth have a poorer prognosis than
do multirooted teeth with comparable loss of
attachment. Loss of attachment that extends to
the apex of the root alters the crown-to-root ratio
and makes the prognosis worse.
Which of the following is most important in determining the prognosis for a tooth? A. Probing pocket depth B. Bleeding on probing C. Clinical attachment level D. Level of alveolar bone
C. The amount of clinical attachment loss is most
important in determining the prognosis. Deep
pocket depths and bleeding on probing can be
found in both gingivitis and periodontitis.
Although the level of alveolar bone is usually con-
sistent with the amount of clinical attachment
loss, there are circumstances under which these
two measures are not comparable.
Offset angulation is a characteristic feature of \_\_\_\_\_. A. Sickle scalers B. Universal curettes C. Area-specific curettes D. Chisels
C. Sickle scalers and universal curettes do not have
offset angulation of the blade. The working ends
of area-specific curettes are offset at a 60-degree
angle relative to the terminal shank. The working
ends of sickle scalers and universal curettes are
not offset—they are at a 90-degree angle relative
to the terminal shank.
Patients with which of the following should not be treated with ultrasonic instruments? A. Deep periodontal pockets B. Edematous tissue C. Infectious diseases D. Controlled diabetes
C. Patients with active infectious diseases should
not be treated with ultrasonic instruments
because of the aerosol that is created when using
this type of instrument.
What is the most important procedure to perform
during the initial postoperative visits following
periodontal surgery?
A. Plaque removal
B. Visual assessment of the soft tissue
C. Periodontal probing
D. Bleeding index
A. Plaque removal during the initial postoperative
visits following periodontal surgery is essential to
healing of the periodontal tissues.
When performing a laterally repositioned flap,
which of the following must be considered
relative to the donor site?
A. Presence of bone on the facial
B. Width of attached gingiva
C. Thickness of attached gingiva
D. All of the above
D. Laterally positioned flaps should only be per-
formed when there is adequate bone and ade-
quate width and thickness of attached gingiva on
the facial of the donor site.
Which class of bony defect responds best to regenerative therapy? A. One-walled B. Two-walled C. Three-walled D. Shallow crater
C. Three-walled defects respond best to regenera-
tive therapy.
The most common clinical sign of occlusal trauma is \_\_\_\_\_. A. Tooth migration B. Tooth abrasion C. Tooth mobility D. Tooth attrition
C. Although tooth migration can be a sign of
occlusal trauma, tooth mobility is the most com-
mon clinical sign.
For most periodontitis-affected patients, what is the recommended interval for maintenance appointments? A. 1 month B. 3 months C. 6 months D. 1 year
B. The majority of patients who have been treated for
periodontitis should be seen at 3-month intervals
for supportive periodontal therapy (maintenance).
Controlled diabetes has same perio problems as those who don’t have diabetes:
TRUE
What is not true regarding patient with diabetes and perio? either increase of crevicular fluid or increase of sugar in crevicular fluid
increase of crevicular fluid
QUESTION: Patient with diabetes, which finding is not consistent?
Increase collagenase in crevicular fluid
Increase glucose in crevicular fluid
Increase gram negative in crevicular fluid
Decrease in thickness of basilar lamina of blood vessels in periodontium
Increase gram negative in crevicular fluid
Diabetic patients have more of the following except: higher glucose levels in gingiva, increased anaerobic bacteria in pockets,
increased IL-1, increased collagenase
increased anaerobic bacteria in pockets,
Diabetics are more prone to perio and are less resistant to the effects of bacteria.
Both statements are true.
By recent studies, which one has a correlation with periodontitis?
Diabetes - diabetics are 15x higher at risk.
Pt presents with aggressive bone loss, bleeding gums, mobile teeth. What condition?
- uncontrolled diabetes
- non-Hodgkin’s lymphoma
• uncontrolled diabetes
ASA III:
uncontrolled diabetes
Periodontal disease is associated with what systemic diseases?
Diabetes and HIV
Which ethnic group has the most chronic periodontitis?
Black males
syndromes assoc with periodontitis
papillon-lefevre
chediak-higashi
ehlers-danlos
down
Red complex has 3 bacteria’s:
P. Gingivalis, Tannerella forsythia, Treponema denticola
what is red complex responsible for
BOP, deep pockets
which complex is earlier, red or orange
orange
what is orange complex responsible for
plaque formtaion and maturation, precedes red complex
orange complex bacteria
fusobacteria, prevotella, campylobacter
Which cells are predominant in sulcular fluid?
PMN’s
What cells predominate in established gingivitis?
plasma cells
Which of the following species is a usual constituent of floras that are associated with periodontal health?
Streptococcus gordonii
What bacterial species is not associated with periodontal disease?
A. Actinomyces species
B. P. gingivalis
C. Capnocytophaga
A. Actinomyces species
Bacteria that is not in chronic periodontitis? Actinomyces viscosus C. rectus T. forsytiaas P. gingivalis.
Actinomyces viscosus
Which is related to periodontal disease?
Gram negative bacteria
What is the 1st step in bacterial plaque formation on a tooth?
Pellicle formation (glycoproteins, enzymes, proteins,
phosphoproteins) .
- 2nd step is adhesion and attachment of bacteria
- 3rd step is colonialization and plaque maturation
Which is not part of plaque formation? Host antigen, extracellular bacterial polymers, bacterial interactions
Host antigen
Most plaque retentive thing –
calculus
Gingival recession, other than plaque amount, is related to – age, tobacco, etc
age
Plaque index is used for what? track gingivitis progression track disease activity to know plaque amount patient motivation
patient motivation
Which one is not a periodontal risk factor? Smoking, oral hygiene, malnutrition, diabetic mellitus
malnutrition
Which of the following things are associated w/ periodontal disease? Atheroschlerosis, Diabetes Mellitus, Low birth weight of
babies
Diabetes Mellitus
Difference between primary and secondary occlusal trauma?
Periodontal support/healthy periodontium in primary
normal bone level, normal attachment level, but excessive occlusal forces
Healthy patient, probing shows bleeding, what could this be due to?
Gingivitis
Which is least likely to occur with occlusal trauma?
Gingivitis
Gingival index/perio index. Know their flaws:
Perio index flaws are that the gingival recession was not taken into account.
Gingival index: each of the 4 gingival areas of the tooth is given a score from 0 (normal) to 3 (severe inflamed), mostly based on color.
Score is totaled per tooth or added all together/ (total teeth #) to give GI person score.
- GI doesn’t consider PD, degree of bone loss or any other qualitative changes in periodontium.
What is Gingival Plaque Index?
a. Nominal
b. Ordinal
c. Interval
d. Ratio
ordinal
a. Nominal like mild, moderate, severe
b. Ordinal include numbers: like furcation involvement 1,2,3
c. Interval like Celsius degree
d. Ratio e.g. Kelvin degree, or BP measurement (cannot be zero), length (cannot be negative), weight
What is CPITN?
Community Periodontal Index of Treatment Needs
What is predominant in plaque 2 days after prophy?
Gram (+) cocci and rods
- gram + cocci and rods normally present, gingivitis transition includes Gram (–) rods and filaments followed by spirochetal and motile
organisms.
With the development of gingivitis, the sulcus becomes predominantly populated by
a. gram-positive organisms.
b. gram-negative organisms.
c. diplococcal organisms.
d. spirochetes.
a. gram-positive organisms.
QUESTION: Supragingival calculus main crystals
main crystals are hydroxylapatite 58%
Chronic periodontitis has which bacteria
G (–) anaerobes.
Chronic periodontitis: has which bacteria
P. gingivalis (gram -)
Fusobacteria nuceatum has what specific characteristic?
Bridging microorganism between early & late colonizers of dental plaque
All syndromes are associated w/ periodontal problems except
a. Stevens-Johnson syndrome
b. Pap-lefev syndrome
c. down syndrome
d. hypophosphatasia
e. acrodynia
Stevens-Johnson
a. Stevens-Johnson syndrome (target lesions - conjunctiva and genital problems)
b. Pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
c. down syndrome (related)
d. hypophosphatasia (bone disease similar to rickets, premature loss of primary teeth)
e. acrodynia (pain, discoloration of hand/feet, chronic heavy metal
Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque
plaque
Which of the following causes bone loss?
a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase
Interleukin
What cytokine responsible for osteoclasts? IL-1, IL-8, IL-5, IL-3
IL-1
Stress long term cause problem in periodontium b/c
it increases cortisone and cortisone and brings immune system down
fenestration in perio
isolated areas where root is denuded of bone and root surface is covered by gingiva and periosteum, but marginal bone is intact
dehiscence in perio
denuded areas extend through marginal bone
What is it called when you have a hole in the bone that exposes the root?
Fenestration
QUESTION: Dehiscence:
Loss of buccal or lingual bone overlying a tooth root, leaving the area covered by soft tissue only
which side is dehiscence usually on and what shape
facial, lingual is rare
characteristic oval shape
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION? A. A trough B. A dehiscence C. A hemiseptum D. An interdental crater
B. A dehiscence
Biological width is
2 mm.
Biological width is from
the alveolar crest to the base of the sulcus.
Biologic width definition: junctional epithelium and _______ attachment to the tooth above the alveolar crest (at least 2mm)
a. gingival sulcus
b. epithelial attachment
c. connective tissue
c. connective tissue
How to determine attachment loss?
From CEJ to sulcus (depth of pocket)
Which of the following factor is most critical in determining the prognosis of periodontal disease?
- Probing depth
- Mobility
- Class 3 furcation
- Attachment loss
- Attachment loss
Attachment loss:
loss of connective attachment w/ apical migration of the JE away from the CEJ
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is the attachment loss:
2 mm
If recession is 2 mm and probing is 1 mm, how much attachment loss?
3 mm
If you have 1 mm recession and can probe 3 mm, how much attachment loss is there?
4mm
Perio treatment sequencing for mild-moderate chronic periodontitis?
Plaque control, Sc/Rp, caries control, perio surgery
When is the perio prognosis that poor?
Class 2 mobility
deep class 2 furcation
deep probing with suppuration
deep probing with suppuration (indicates tooth fracture)
Which teeth commonly relapse after perio tx (poor long-term prognosis)?
maxillary molars due to furcation anatomy
Where perio Tx is more difficult?
Maxillary molars due to trifurcations.
Which tooth is most commonly lost due to long term care in periodontal patients? max molar, max pm, man molar, man pm
max molar
QUESTION: If you have a through-and-through furcation involvement (class III furcation) on a tooth with 5 mm of root left in the bone, what do you do? Extract the tooth Splint Place Implant
Extract the tooth (preferred treatment)
QUESTION: Patient with class III furcation and 3 mm exposure?
Extract
If you have a grade III furcation, you can do all of the following except
a. Section it and crown both as PFMs
b. Tunneling procedure
c. GTR
GTR - Better for Class II, least successful for class III
Tx option: Class 2 almost class 3 furcation?
Main goal of tx on class 2 is converted to class 1 furcation by doing GTR
Recommended treatment for a Class II that is almost a class III:
- convert class II to a class I by doing GTR
- tunneling
- extraction
- convert class II to a class I by doing GTR
Most likely shape of furcation is?
Wide but still not very accessible to dental tools,
When you have a through and through furcation (Grade 3 at least),
a. It’s wide enough and you can clean it
b. It’s wide enough and the curette is too big to clean it
c. It’s narrow enough and you can’t clean it
d. Its narrow enough and the currete is too small to clean it
b. It’s wide enough and the curette is too big to clean it
Root amputation of MB root –
cut at furcation and smoothen for patient to keep clean
What is most common periodontitis in school-aged children: aggressive PD, ANUG, marginal gingivitis
marginal gingivitis
Which therapy in which adding antibiotic + debridement have minimal effect for? anug, Localized aggressive, chronic periodontitis
chronic periodontitis
How do you treat gingivitis in puberty:
debridement and OHI
Percentage to be considered generalized perio?
> 30%
Diagnosis for 40-year-old female w/ generalized bone loss, localized vertical bone defect, and gross calculus:
Chronic periodontitis
Which of the following PDL disease causes rapid destruction of alveolar bone?
- Periodontal abscess
- ANUG
- Chronic periodontitis
- Periodontal abscess
Two patients, old and young person w/ same perio. Which has better prognosis?
Older patient (b/c younger pt had shorter time frame to get to the same condition so more aggressive in nature)
Which of these is reversible with tooth movement? • Tooth mobility • Bone resorption • Crestal bone • Gingival recession • Attachment loss
• Tooth mobility
Best for interproximal plaque removal in teeth without contacts: floss, waterpick, interproximal brush
interproximal brush
QUESTION: What is not able to reach the interproximal?
Toothbrush
Best brushing technique to clean periodontal pockets:
A. Charters
B. Sulcular
C. Whitman’s
. Sulcular (another name for modified Bass)
Least effective for crevicular plaque? Water irrigating device (waterpik), nylon, toothbrush
waterpik
- Water irrigation removes debris (not plaque)
Which of the following is likely to be abrasive after osseous surgery? Water pik, toothbrush, toothpick, rubber gum stimulator
Water pik,
Class 2 furcation, which instrument is the worst to clean a class II furcation? Tooth brush, floss, waterpik, rubber stimulating tip
rubber stimulating tip
- Rubber tip is for interdental papilla
Toothbrush and floss, how much can it reach in perio pocket?
Toothbrush 0 mm, floss 2-3 mm
Toothbrush 2-3 mm, floss 0mm
Toothbrush = 1 mm, floss = 2-3 mm
Toothbrush = 1 mm, floss = 2-3 mm
What can make teeth green? Bacteria, gingival hemorrhage, medications or hyperbilirubinemia
(ALL of them)
QUESTION: Green and orange stains on maxillary incisors can usually be attributed to A. drugs. B. diet. C. poor oral hygiene. D. fluoride consumption E. Genetics
C. poor oral hygiene.
What are proper ways to reinforce OHI: verbal and written in the dental office, verbal only, video tape
verbal and written in the dental office,
What is most difficult to maintain oral hygiene with home preventive care?
- pit and fissure
- proximal smooth surface
- facial smooth surface
- lingual smooth surface
• proximal smooth surface
Why don’t you use Acidulated Fluoridated Toothpaste?
Ruins Polish of Crown
How does Listerine act?
Antiseptic mouth rinse is a broad-spectrum antimicrobial & kills bacteria associated with plaque and
gingivitis by disrupting the bacterial cell wall.
- bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides.
Action of Listerine?
Uncharged phenolic compound
What daily oral rinse would you give to a medically compromised child for plaque control? CHX, Listerine, Nystatin, stannous
fluoride, sodium fluoride
CHX
The role of chlorohexidine is cause:
Substantivity (anti-plaque)
Action of chlorhexidine:
binds to cell wall à cell membrane disruption/rupture à fluid leaks out, cell lysis (CHX bursts membranes)
Use of chlorhexidine à
reduce plaque accumulation
- broad spectrum against gram positive and negative bacteria and fungi – Positively charged
What does sodium pyrophosphate do?
Plaque removal
- removing crystals of Ca+ and magnesium, inhibits mineralization of biofilm/staining (inhibits Ca+ phosphate from binding)
charge on listerine
uncharged
charge on chlorhexidine
+
Why are inorganic pyrophosphates in anti-tartar toothpaste? I
t acts as a tartar control agent, serving to remove calcium and
magnesium from saliva and thus preventing them from being deposited on teeth (chelating + abrasion)
Why is inorganic pyrophosphate in tooth paste? prevent calcium phosphate crystals, decrease number of bacteria growth
prevent calcium phosphate crystals
Periostat:
2x daily 20 mg has doxycycline, which works by inhibiting collagenase/protein synthesis
Periostat’s mechanism of action: inhibits collagenase, inhibits ribosome 50s, periochip,
inhibits collagenase,
- Reduces elevated collagenase activity in gingival crevicular fluid of patients with adult periodontitis; no antibacterial effect reported at
this dose
Doxycycline use?
Intramicobial which inhibits MMP (matrix metaloprometase)
- Sub-antimicrobial dose doxycycline (SDD, periostat) inhibits matrix metalloproteinase (MMP)
Root surface tx with what agents?
Use citric acid, fibronectin and tetracycline
Which is least complicating for OH? Fixed bridge, rheumatoid arthritis, open contact
open contact
from which side better to probe furcations
better access to facio-mesial furcation from facial
Best way to detect furcation – curve perio probe, curette, straight perio probe
curve perio probe (naber probe)
Best angle to place curette on root is
45- 90 degrees for working strokes.
What edge of curette do you want to be in contact at line angle?
Lower 1/3
Curette, which third adapts tooth? Apical Third, Middle Third
Apical Third
Which part of instrument do you place on line angle of tooth:
middle third
third including tip
third closest to handle or entire edge
third including tip
Which gracey curette is used for the mesial surface of distal root in max tooth?
11-12
What is not the initial treatment for gingivitis? s/rp, OHI, corticosteroids
corticosteroids
Sc/RP removes
diseased cementum
Just did Sc/RP on pt w/ recession. What’s the best way to prevent sensitivity to newly exposed root surface?
Keep root surface free
of plaque
After you do Sc/RP, how does new attachment form?
Long junctional epithelium
Direction of root planing?
From base of pocket to CEJ
What kind of gingiva is favorable for S/RP?
More edematous gingiva
QUESTION: Best results from S/RP will be from a patient who has: edematous gingiva, fibrotic gingiva, loss of attachment
edematous gingiva
What do you do if after S/RP, there are 2 probing sites of 6 mm?
Perio Surgery
Pt had SRP & they came back for perio maintenance but there are still 5-6 mm pocket. What do you do?
Open debridement
Why do you check occlusion in pts with perio abscess?
- many perio lesions are caused by occlusion
- edema can cause teeth to supra erupt
- some other choices were pretty good to, but I can’t remember what they were
edema can cause teeth to supra erupt
What’s the FIRST thing you do in maintenance appointment (recall)?
Update medical history
QUESTION: What do you not do at the perio maintenance apt.?
SRP pockets of 1 – 3mm
What happens after the periodontal re-eval, what should the recall interval be set as? The recall interval is set but may be changed
if the patient’s situation changes, should be less to motivate pt, should be more to motivate pt
The recall interval is set but may be changed
if the patient’s situation changes
The normal recall appointment between periodontal treatment:
3 months
Best time for supportive periodontal therapy? 1, 3, 6, 9, months post s/rp
3
How you determine perio maintenance recall –
different for each patient
Pt is on a periodontal recall system. What best denotes good long term prognosis? BOP, Plaque, Deep pockets
BOP (bleeding)
BOP most indicative of what?
Inflammation
How long does it take to form mature plaque after removal?
24-36 hours
Mature plaque in • 1-2 hrs. • 6-8 hrs. • 10-12 hrs. • 24-48 hrs.
• 24-48 hrs.
How many hours until plaque accumulation (after brushing or eating?)?
1 hour
Which part of dental anatomy on a central collects the most plaque? Facial surface, lingual surface, cingulum, mamelon,
gingivopalatal groove
lingual surface
Magnetostrictive instrument:
elliptical vibration pattern, all sides of tip are active (4 sides total)
Piezoelectric instrument:
linear vibration pattern, 2 sides are more active
contraindication to ultrasonics
pacemaker, communicable diseases, titanium implants (use plastic tip), kids
QUESTION: Each of the following is a mode of action of an ultrasonic instrument EXCEPT one. Which one is this EXCEPTION? A. Lavage B. Vibration C. Cavitation D. Sharp cutting edge of tip
D. Sharp cutting edge of tip
Mode of action of ultrasonic:
Vibration in elliptical (magnetostrictive), sonics is linear
what kills bacteria in sonic instruments
water and air
serum response in localized aggressive
robust. IgG-2
serum response in generalized aggressive
poor
bacteria in localized aggressive
Aa, capnocytophaga
bacteria in generalized aggressive
Aa, sometimes P. gingivalis
Localized aggressive periodontitis show bone loss on
first molars and incisor.
Where are the most teeth lost in local aggressive periodontitis?
Max molars
What kind of bone loss do you see in aggressive periodontitis? Vertical, horizontal, mesial distal, interprox.
Vertical
Reason pts get aggressive periodontitis?
Host can’t fight off
What are two things in common among generalized aggressive periodontitis & chronic periodontitis?
Distribution among the teeth
Classical sign of aggressive periodontitis? T
ooth mobility & deep pockets with lack of inflammation are initial signs of LAP.
What is not a characteristic of localized aggressive periodontitis (LAP)?
Severe bone loss in anteriors
Deep probing depths for first molars
Generalized gingival inflammation
Generalized gingival inflammation
Which of the following is not true about local aggressive periodontitis? Affect less than 30% Tx is scaling & systemic antibiotic Genetic component Gingival inflammation
Gingival inflammation
What is not associated with LAP (Localized aggressive periodontitis):
Calculus
Initial tx for Localized aggressive periodontitis Sc/RP Antibiotics Sc/RP and Antibiotics Antibiotics for 1 week and then Sc/RP
Sc/RP and Antibiotics
Best way to treat localized aggressive periodontitis?
a. chlorhexidine
b. H2O2 rinse
c. systemic antibiotic
c. systemic antibiotic
- Localized aggressive perio, treat with tetracycline
18-year-old female w/ > 5 mm pocket on central and 1st molars?
Localized aggressive Perio
bacteria in ANUG
anaerobic fusobacteria + spircohetes (Prevotella intermedia)
tx for ANUG
For ANUG: Normally, you don’t give antibiotic. You only do debridement, rinse, and oral hygiene. But if the patient has a fever or
systemic indications like HIV, give metroniadozle.
For NUG or ANUG, which microorganisms predominate?
Spirochetes
Patient comes in with gingivitis, no pocketing, pseudomembranous coating that’s gray on gingiva?
ANUG
Patient has interpapilla damage, periodontal condition, what could this be due to?
ANUG
Cratered gingiva
l = ANUG (NUG) – punched out papilla
Which of the following is the most appropriate initial treatment for a patient with HIV-associated necrotizing ulcerative gingivo-
periodontitis?
A. Debridement and anti-microbial rinses
B. Definitive root planning and curettage
C. Administration of antibiotics
D. Gingivectomy and gingivoplasty
A. Debridement and anti-microbial rinses
Tx for NUG pt with no systemic involvement?
Debridement, chlorhexidine, OHI
First step in initiation treatment of HIV necrotizing ulcerative gingivitis? debridement and antibacterial rinse, antibiotics,
gingivectomy
debridement and antibacterial rinse,
Pregnancy gingivitis has
altered metabolism of progesterone.
Pregnant women have more gingivitis why?
Hormones (progesterone)
Which one of these bacteria are associated with pregnancy?
P. intermedia
Pregnancy gingivitis caused by?
hormones (progesterone) & P intermedia
Pregnant patient, you should not give what meds?
Tetracycline, metronidazole, gentamicin and vancomycin should be avoided
Bacteria most associated with puberty?
P. Intermedia
Picture of gingival hyperplasia on 14-year old girl –
hormonal-induced
meds associated with gingival hyperplasia
anticonvulsants (phenytoin, valproate, carbamazepine)
calcium channel blockers (dipines, verapamil, diltiazem)
immunosuppressants (cyclosporine, tacrolimus)
QUESTION: Patient’s interpapilla gingiva is
swollen -
anticonvulsant meds
Dilantin/phenytoin
What’s the #1 cause of medication
induced gingival hyperplasia?
Anti-convulsant meds Dilantin (30% of all drug induced)
All the following drugs cause gingival enlargement (hyperplasia) except? a. phenytoin b. cyclosporin c. nifedipine d. digoxin
d. digoxin
All of the following drugs cause gingival hyperplasia except? Verapamil, diltiazem, phenytoin
(Dilantin), nifedipine and cyclosporine
—all do.
diltiazem is CCB!
Patient is on calcium blockers, picture show gingival hyperplasia, what do you do?
Tell them to see their doctor to switch meds
When pt is on immunosuppressant’s for transplanted liver, what happens in the mouth?
CT overgrowth & hyperplasia à
cyclosporine will lead to gingival hyperplasia
Modified Widman flap:
Internal bevel incision & instrumentation for root therapy, not pocket depth reduction but removes pocket lining
& pocket shrinks after healing.
Displaced flap:
PD reduction. Excisional procedure of gingiva = gingivectomy. Internal bevel gingivectomy but also reverse bevel. Final
placement of flap determined by first incision.
Apical positioned flap:
Internal bevel incision for pocket elimination (by apical position) and/or increases width of attached gingiva. Best
position is 2 mm apical to alveolar crest.
Distal wedge =
cut to removal of excessive soft tissue distal to a terminal tooth. It’s to treat
pockets through internal thinning to gain access to bone on the distal aspect of terminal
teeth.
- Advantages: close wound procedure (healing by primary intention), access to bond,
preserve zone of keratinized gingiva
The most common incision given by oral surgeons is?
a. envelope flap
b. y incision
c. Z incision
d. Semilunar incision
a. envelope flap
2 teeth anterior, 1 tooth posterior
Doing flap surgery on mandible, what structure do you watch for?
Mental nerve (If 3rd molar TE= Lingual)
Apical position flap are contraindicated in what location?
Maxillary palatal
An apically displaced flap is generally impossible in which of the following areas?
a. mandibular facial
b. mandibular lingual
c. maxillary facial
d. maxillary palatal
d. maxillary palatal
Where can you not do apical flap?
lingual of maxillary molars
When doing extrusion of canine, these flap techniques can be used except
1) Envelope flap
2) Semilunar flap
3) Apical repositioning flap
3) Apical repositioning flap
Where are you most likely to damage a nerve in vertical release of flap?
Lingual, Wharton’s duct and the sublingual gland
- avoid vertical incisions in lingual and palatal
Vertical or oblique flap, where do you make incision?
At line angles
QUESTION: Modified Widman flap can be characterize by all BUT? internal bevel incision,
replaced flap, reflected beyond mucogingival line
reflected beyond mucogingival line
- It is internal bevel incision and replaced/nonrepositioned flap.
- Flap reflection with the MWF approach is only 2-3 mm beyond the alveolar crest
and not beyond the mucogingival junction. (Mosby)
What type of incision for maxillary palatal tuberosity reduction? T, Y
Y
Which of the following statements about the flap for the removal of a palatal torus is correct?
A. The most optimal flap uses a midline incision which courses from the papilla between teeth #8 and 9 posteriorly to the junction of the hard
and soft palates.
B. The most optimal flap is a reflection of the entire hard palate mucoperiosteum back to a line between the 2 first molar teeth.
C. The most optimal flap uses a midpalatal incision that courses from the palatal aspect of tooth #3 across to the palatal aspect of tooth #14
D. The most optimal flap is shaped like a “Double-Y”, with a midline incision and anterior and posterior side arms extending bilaterally from
the ends of the midline incision.
D. The most optimal flap is shaped like a “Double-Y”, with a midline incision and anterior and posterior side arms extending bilaterally from
the ends of the midline incision.
Distal wedge contraindication?
On 3rd molars without attach gingiva
CI when using distal wedge technique:
Not enough keratinized tissue
Distal Wedge limited to:
• Formation of the ramus
• Long buccal nerve
• Mental nerve
• Formation of the ramus
A tooth had epithelium above CEJ, what flap would you use?
Undisplaced/Replaced flap
Long jxn epithelium is coronal to CEJ and margin is around CEJ, what type of flap would you use?
apical position flap, Widman flap, replace flap
apical position flap
What type of flap do you use in crown lengthening?
Apical Repositioning Flap
RCT w/ post and core and crown lengthening, why do crown lengthening?
Ferrule effect,
To expose a mandibular lingual torus of a patient who has a full complement of teeth, the incision should be…
a. Semilunar
b. Paragingival
c. In the gingival sulcus and embrasure area
d. Directly over the most prominent part of the torus
e. Inferior to the lesion, reflecting the tissue superior
In the gingival sulcus and embrasure area
If removal of torus must be performed to a patient with full-mouth dentition, where should the incision be made?
a. Right on the top of the torus
b. At the base of the torus
c. Midline of the torus
d. From the gingival sulcus of the adjacent teeth
From the gingival sulcus of the adjacent teeth
What has the biggest effect on the flap?
a. initial incision
b. extensiveness of reflection
c. post-op oral hygiene
d. final position of flap
d. final position of flap
During maintenance therapy, pt has recurrent 6mm pocket on M of #4 and D of #20. What is 1st tx option?
flap surgery
scaling root planning with local microbial administration
flap surgery
To prevent exposure of a dehiscence or fenestration, what kind of flap do you do?
partial or split
thickness flap
Split thickness flap involves what tissues? Mucosa (only) or submucosa, epithelium and CT
(submucosa)
epithelium and CT
(submucosa)
- surface mucosa (consisting of epithelium, basement mem brane, and connective tissue lamina propria
In a partial thickness flap, what do you cut through?
Epithelium, connective tissue, but NOT periosteum
Perio flap that expose bone -
Full thickness
Full thickness flap will result in bone atrophy (or loss) in: thin periradicular bone thick periradicular bone thick interproximal bone thin interproximal bone
thin periradicular bone
so do partial-thickness flap for this)
goal of gingivectomy
Eliminate suprabony pockets, eliminate gingival enlargements or eliminate suprabony periodontal abscess
DO NOT DO gingivectomy if osseous recontouring is needed, if pocket depth is apical to mucogingival junction, if there is inadequate
attached gingiva, or is esthetics is a concern.
osseous recontouring is needed, if pocket depth is apical to mucogingival junction, if there is inadequate
attached gingiva, or is esthetics is a concern.
Gingivoplasty:
Reshaping of gingival to create physiological gingival contours in the absence of a pocket.
Primary Intention healing –
tissue surface has been approximated/closed. Ex. stitch, flap, glue. Very little tissue loss
Secondary Intention healing –
extensive wound, considerable tissue loss, edges can’t be brought together. Ex. ulcer, Sc/RP, gingivectomy.
Repair time is longer, greater scarring, increased infection
Tertiary Intention Healing –
delayed/secondary closure, delayed suturing/wound closure. Ex. poor circulation or drainage to wound area
so wait, tissue grafts
What direction is the reverse bevel (internal bevel) incision?
axial toward bone
Know about internal bevel incision and where to cut:
apical to the base of the periodontal pockets, but coronal to the MGJ.
What is purpose of “bleeding incisions” in gingivectomy?
location of dehiscence
location of alveolar defects
guide for incision
guide for incision
Bleeding spots established in gingevectomy to?
outline incision line
How does a site heal after a gingivectomy?
Long junctional epithelium
secondary intention
QUESTION: Indications for gingivectomy –
hyperplastic gingiva & suprabony pockets
when not to do gingivectomy?
infrabony pockets, little attached gingiva, high smile line
Which is contraindicated in 2nd molar region to reduce deep pocket with limited attached gingiva?
Gingivectomy
Patient has very little keratinized gingiva, which of the following flaps should you not do:
gingivectomy
Pt has a PFM #18 molar with minimum keratinized gingiva with deep pocket depth. Which of the following way is not acceptable is
a way to minimize pocket depth?
Gingivectomy
Gingivectomy is contraindicated in:
when the sulcus is apical to gingival groove
sulcus is apical to convexity of tooth
sulcus is apical to the crest of alveolar bone
sulcus is apical to the crest of alveolar bone
Gingivectomy is contraindicated with?
Minimum attached gingiva
Gingivectomy is contraindicated when bottom of the pocket is
apical to alveolar crest (infrabony bony pocket)
also beyond mucogingival junction
What should be considered for gingivectomy?
level of attached gingiva
degree of attachment loss
level of attached gingiva
The base of the incision in the gingivectomy technique is located
A. in the alveolar mucosa.
B. at the mucogingival junction.
C. above the mucogingival junction.
D. coronal to the periodontal pocket.
E. at the level of the cementoenamel junction
C. above the mucogingival junction.
Gingivectomy incision:
Excisional (external bevel incision)
How many mm per day does epithelium grow over connective tissue? 0.5-1 mm, 1-2 mm, 2-3 mm
0.5-1 mm,
How does external bevel gingivectomy heal? Primary intention, secondary, tertiary, granular tissue formation
secondary
How does a gingivectomy heal?
Secondary intention
External bevel incision for a gingivectomy, where is the incision made?
apical to epithelial tissue
vascular bundle
Junctional epithelium
Junctional epithelium (apical to base of pocket (epithelial attachment))
Regeneration -
type of healing that completely replicates the original architecture & function. It involves the formation of a new cementum,
PDL, and alveolar bone.
- See PDL, bone, cementum
Repair -
replacement of loss apparatus with scar tissue, which doesn’t completely restore the architecture or the function of the part replaced.
End product is the establishment of long junctional epithelium attachment at the tooth-tissue interface.
- See long junctional epi, CT
Following flap surgery, new junctional epithelium can form on either cementum or dentin, junctional epithelium is reestablished as
early as one week.
First is False, second is true.
- Not on dentin, JE is reestablished in 1-3 weeks
After you perform a flap surgery, where you see regeneration?
Epithelial attachment via long junctional epithelium & connective
tissue adhesion.
The soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease is a E. collagen adhesion. F. reattachment by scar. G. long junctional epithelium. H. connective tissue attachment.
G. long junctional epithelium.
Periodontal regeneration involves –
Sharpey’s Fibers, Cementum and Alveolar Bone
Type of healing in S/RP and free gingival graft:
LJE and CT
What do you want from perio flap?
Regeneration of PDL, cementum & bone
After flap surgery, where does repair occur? PDL moves occlusally, apically, laterally
occlusally
After periodontal surgery, what type of healing is it most of the time?
Repair
3 things you need when doing GTR:
bone, Sharpey’s fibers, & cementum
Correction of an inadequate zone of attached gingiva on several adjacent teeth is best accomplished with a/an? a. apically repositioned flap. b. laterally positioned sliding flap. c. double-papilla pedicle graft. d. coronally positioned flap. e. free gingival graft.
e. free gingival graft.
How do you fix gingival recession in anterior region?
pedicle graft (laterally repositioned flap, never lose blood supply)
Purpose of lateral graft (Pedicle graft) à
For gingival recession
8-year-old with anterior crossbite, has recession on anteriors. What type of tx would you do?
a. chlorhexidine
b. lateral sliding graft
c. pedicle graft
c. pedicle graft
Free gingival graft: Which area can be affected: § Greater palatine nerve bundle § Nasopalatine nerve bundle § Nasopalatine artery § Greater palatine artery
§ Greater palatine nerve bundle
Most likely to be damage (complication) when you take tissue from gingival graft?
Damage to greater palatine neurovascular
bundle
What nerve is most likely injured when transferring donor tissue to area of free gingival graft (mucosal graft)?
Greater palatine
Mucosal graft epithelization by
connective tissue from underlying tissue (recipient site)
Where does the epithelial cells for a graft come from?
a. Donor epithelium
b. Donor connective tissue
c. Recipient epithelium
d. Recipient connective tissue
d. Recipient connective tissue
What has ultimate effect on the thickness of epithelium of free gingival graft?
a. Recipient epithelial tissue,
b. donor epithelial tissue,
c. donor CT
d. recipient CT
d. recipient CT
What is the disadvantage of a connective tissue graft?
Two surgical sites
You only have 4 mm of bone (alveolar ridge) above max sinus, how do you do bone graft?
fill graft towards sinus
fill graft towards alveolar ridge
fill graft towards mesial
fill graft towards sinus
- Don’t add to alveolar ridge, it’s not going to integrate so fill towards sinus
What graft is best for sinus lift?
Autogenous & alloplastic
Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were advised that she was going to need a
sinus lift procedure with placement of an autogenous bone graft. What is the definition of that graft?
A. The graft will use an artificial, bone-like material.
B. The graft uses bone from another human being.
C. The graft uses the patient’s own bone, taken from another site.
D. The graft uses bovine bone, or bone from another animal species.
C. The graft uses the patient’s own bone, taken from another site.
Which is the most predictable when restoring an edentulous mandibular ridge?
Autograft
What is a graft from a different species?
Xenograft
How to replace large chunks of mandible?
Autogenous graft
What is the most osteogenic?
ONLY autograft
alloplast
xenograft
allograft
autograft
conductivity, inductivity, genesis
alloplast + –
xenograft + –
allograft + +/- -
autograft + + +
Freezed dried cadaver bone is a type of what graft?
Allograft
Decalcified freeze dried bone allograft: has ____ )
bone morphogenetic proteins (BMP
Best allograft material:
dried freezed bone
Freeze dried bone has the advantage of having which protein:
bmp/pdgf (bone morphogenic protein, Platelet-derived growth
factor)
Which hormone is used to bone graft?
BMP (bone morphologic protein)
Which type of grafts causes bone growth? Osteoinductive, Osteoconductive
- OsteoINDuctive –> Allograft, autograft
contraindication to grafting procedure
mx canine
Least likely to need bone graft? one wall, two wall, three wall wide, three wall narrow
three wall narrow
- Wide & deep 3 wall defect = GTR,
narrow 3 wall defect = bone graft regeneration
Best prognosis for bone graft:
narrow 3 wall defect
Best prognosis for a guided tissue regeneration?
three walled defect
Recession of a single tooth, what do you do?
• Double papilla graft
• Free gingival graft
• Apical repositioning
• Free gingival graft
QUESTION: Facial recession on mandibular canine of 14-year-old à
graft not indicated? Reposition with ortho?
Least desirable place to place graft:
mandibular 1st premolar space
Tx for Class II furcation involvement (also called cul-de-sac)?
GTR
Class 3 furcation, which tx not an option?
GTR
- Class III furcations are least successful in GTR procedures.
The purpose of GTR is to prevent: Long J.E, migration of PDL cells, migration of CT cells
Long J.E,
also CT
want regeneration of attachment apparatus
The purpose of a barrier: Apical movement of PDL cells, coronal movement of PDL cells
coronal movement of PDL cells
Which tx is best for Class III furcation?
a. guided tissue regen
b. apical flap
c. hemisection
d. root amputation
- hemisection = mand molar, to treat Class II or III furcation invasions
- root amputation = max molars
In a through and through furcation lesion, which is the least appropriate treatment?
GTR
Contraindication for max molar with class II furcation?
hemisection w/ crown
How to treat an RCT mand molar that has Class III furcation involvement:
hemisection and place 2 crowns to act as 2 premolars.
Root amputation is for maxillary teeth.
Hemisection of mandibular molar, which has best prognosis:
• Furcation that is more coronal or apical
• Furcation that is more coronal
Furcation that is more coronal
QUESTION: Bony area between two premolars has no mesial, facial and lingual wall, what is it called?
Hemiseptum
Indication for periodontal/surgical dressing: Healing the tissue, Protect the wound
Protect the wound
Reverse architecture-
interproximal is lower than on facial and lingual
interdental bone is apical to crestal bone
After periodontal surgery, the dentist leaves interproximal bone apical to radicular bone. What
is this called?
negative architecture.
Most important issue that determines success after periodontal surgery?
Plaque control of the area
Sequence to close diastema in a child with low labial frenum:
1) wait for the canines to erupt
2) close the diastema with ortho
3) perform the frenum surgery
10 y/o kid has a thick upper buccal frenum with diastema between 8 & 9. Tx?
wait til upper permanent canines erupt
frenectomy
use elastics
wait til upper permanent canines erupt (then, do frenectomy)
If diastema is caused by a frenum, when should frenectomy happen? .
you don’t do a frenectomy until the canines have erupted
QUESTION: All of the following are risk for ortho treatment except? Frenal displacement, plaque management, bone loss,
resorption
Frenal displacement
Which of the following explains why the Z-plasty technique used in modifying a labial frenum is considered to be superior to the
diamond technique?
a. it is less traumatic
b. it is technically easier
c. it requires fewer sutures
d. it decreases the effects of scar contracture
e. it allows for closure by secondary intention
it decreases the effects of scar contracture
- improves the appearance of scars and purpose is to relax the frenum pull – less contracture
