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Perio Diagnosis Update > Perio Diagnosis Update > Flashcards

Perio Diagnosis Update Flashcards

1
Q

There are 2 main categories of terms in the perio diagnostic system, what is the first one?

Which 3 categories all under the main category?

A
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2
Q

What is the second main category of periodontal diagnosis in the new system?

What 4 categories are contained within it?

A
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3
Q

What be the terminology when describing this scenario?

A

Clinical Gingival Health on an Intact Periodontium

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4
Q

The new diagnosis system contains this term where as the previous did not…what terminology would you use to describe this case?

A

Clinical Gingival Health on a Reduced Periodontium

(stable periodontitis patient)

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5
Q

What terminology would you use to describe this scenario?

A

Clinical Gingival Health on a Reduced Periodontium (non-periodontitis patient)

  • No history of periodontitis
  • No bone loss radiographically
  • Generalized recession and clinical attachment loss (or a reduced periodontium) mostly confined to the facial surfaces
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6
Q

The diagnosis system outlines 4 levels of Periodontal Health…What are they?

A
  1. Pristine Periodontal Health
  2. Well maintained clinical periodontal health with a structurally sound/intact periodontium
  3. Periodontal disease stability with a reduced periodontium
  4. Periodontal disease remission/control with a reduced periodontium
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7
Q

Describe pristine periodontal health…

A
  • Rare (not likely to be observed clinically), but realistic
  • No attachment loss, no BOP, no PD > 3 mm
  • No erythema, swelling/edem, or suppuration
  • Associated with physiologic immune surveillance, not pathological inflammation
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8
Q

Describe a well-maintained clinical periodontal health patient with a structurally sound/intact periodonium…

A
  • Clinically health = tissue that has absence of or very low levels of clinical indicators of inflammation (i.e. no BoP)
  • Radiographically intact lamina dura, no evidence of bone loss in furcations, 2mm from most coronal portion of alveolar crest to CEJ
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9
Q

Describe the 3rd level of Periodontal Health named Periodontal disease stability with a reduced periodontium…

A
  • Periodontitis has been successfully treated (by control of local and systemic factors)
  • Minimal BoP, improvements in PD and attachment levels
  • Lack of progressive destruction
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10
Q

Finally we are the 4th level of periodontal health which is called Periodontal diseaes remission/control with a reduced periodontium…can you describe this?

A
  • Reduction of inflammation and improvement in PDs, but may not be fully resolved
  • Lack of optimal control of local and/or systemic factors
  • If local/systemic factors not controlled, then may result in progressive attachment loss
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11
Q

What are the Indicators of Periodontal Health?

A
  • Minimal to no BoP: absence of BoP at repeated exams is a reliable indicator for periodontal stability
  • Shallow pockets or deep “healthy” pockets: unless in the presence of BoP and radiographic bone loss
  • Minimal to No Radiographic Bone Loss: intact lamina dura, no furcal bone loss, 2mm distance from CEJ to alveolar crest
    • Periodontal health can occur on a reduced periodontium (history of bone loss) but cannot be diagnosed with radiographs alone
  • Physiologic tooth mobility < 0.2 mm - unless associated with widened PDL, then likely a sign of occlusal trauma
    • Increased tooth mobility (no widened PDL) may be associated with a healthy reduced periodontium due to the loss of alveolar support
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12
Q

PERIODONTAL HEALTH and GINGIVAL HEALTH

What are 3 determinants of Clinical Periodontal Health?

A
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13
Q

Is periodontal disease a simple bacterial infection?

A

No!

  • Multifactorial disease process that involves:
    • Subgingival microorganisms
    • Host immuno-inflammatory response
    • Environmental modifying factors
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14
Q

What causes a patient to go from sound periodontal health to a gingivitis patient?

A
  • Once the 3 determinants of health (bacteria, host reponse, and environmental factors) exceed a certain threshold (which varies between individuals), you will see a transition from ehalth to a state of gingivitis
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15
Q

What is the 2nd category in the Periodontal Health, Gingival Diseases, and Conditions category?

A
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16
Q

GINGIVITIS: BIOFILM-INDUCED

What factors can influence systemic or local factors?

A
  • Biofilm induced gingivitis is primarily associated with the bacterial biofilm. This type of gingivitis can be modified (or exacerbated) by several different factors such as:
    • Sex steroid hormones
    • Hyperglycemia
    • Leukemia
    • Smoking
    • Malnutrition
    • Priminent Subgingival Restorations
    • Hyposalivation
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17
Q

What are 3 categories of drugs that can cause Drug-Influenced Gingival Enlargment?

A
  • Anti-Epileptic Drugs (phenytoin, sodium valproate)
  • Calcium Channel Blockers (nifedipine, amlodipine, verapamil, diltizaem, felodipine)
  • Immmunoregulating Drugs (cyclosporine, high dose oral contraceptives)
  • Appreciate biofilm in attached picture
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18
Q

GINGIVITIS: BIOFILM-INDUCED

What are the signs/symptoms of biofilm-induced gingivitis?

A
  • Inflammation confined to free and attached gingiva
    • BoP and gingival erythema/edema
  • Presence of high bacerial load (plaque)
  • Stable attachment levels
  • Tenderness to probing
  • Halitosis
  • PREREQUISITE for developemnt of periodontitis
  • REVERSIBLE with disruption of biofilm
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19
Q

What is the 3rd category in the Periodontal Health, Gingival Diseases, and Conditions?

A
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20
Q

GINGIVAL DISEASES: NON BIOFILM-INDUCED

What are 4 categories that fall under Gingival Diseases: Non Biofilm Induced?

A
  1. Genetic/Developmental Disorders
  2. Specific Infections
  3. Inflammatory and Immune Conditions
  4. Reactive Processes
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21
Q

GINGIVAL DISEASES: NON BIOFILM-INDUCED

What is an example of a genetic/developmental disorder?

A

Hereditary Gingival Fibromatosis

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22
Q

GINGIVAL DISEASE: NON BIOFILM-INDUCED

What are some examples of Specific Infections related to Gingival Diseases: Non Biofilm-Induced?

A
  • Bacterial: necrotizing periodontal disease, acute streptococcal gingivitis, neisseria gonorrhoeae, orofacial tuberculosis
  • Viral: coxsackie, HSV/herpetic gingivostomatitis, HPV, VZV
  • Fungal: candidosis, histoplasmosis, aspergillosis
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23
Q

GINGIVAL DISEASE: NON BIOFILM-INDUCED

What are some examples of Inflammatory and Immune Conditions related to Gingival Diseases: Non Biofilm-Induced?

A
  • Hypersensitivity reactions - contact allergy, plasma cell gingivitis, erythema multiforme
  • Autoimmune disease: pemphigus vulgaris, pemphigoid, lichen planus, lupus erythmatosis
  • Granulomatous Inflammtory Conditions: orofacial granulomatosis, Crohn’s disease, sarcoidosis
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24
Q

GINGIVAL DISEASE: NON BIOFILM-INDUCED

What are some examples of Reactive Processes (epulides) as they relate to Gingival Diseases: Non Biofilm Induced?

A
  • Fibrous epulis
  • Calcifying fibroblastic granuloma-ossifing fibroid epulis, peripheral ossifying fibroma
  • Pyogenic granuloma
  • Peripheral giant cell granuloma
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25
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What is this a picture of?

A

Fungal Infection

Candidosis associated with a maxillary implant retained denture

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26
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What is this a picture of?

A

Lichen Planus

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27
Q

GINGIVAL DISEASES: NON BIOFILM-INDUCED

What is this a picture of?

A

Pemphigus

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28
Q

GINGIVAL DISEASES: NON BIOFILM-INDUCED

What is this a picture of?

A

Pemphigoid

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29
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are 4 categories of the above mentioned topic?

A
  1. Neoplasms
  2. Endocrine, nutritional, metabolic disorders
  3. Traumatic lesions
  4. Gingival pigmentation
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30
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are some examples of Neoplasms as it related to the above category?

A
  • Premalignant: leukoplakia, erythroplakia
  • Malignant: SCC, leukemia, lymphoma
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31
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are some examples of endocrine, nutritional, and metabolic disorders as it relates to the above topic?

A

Vitamin deficiencies - i.e. Scurvy/vitamin C deficiency

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32
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are some examples of Traumatic Lesions as it relates to the above topic?

A
  • Physical/mechanical insults-frictional keratosis, toothbrushing induced gingival ulceration, factitious injury
  • Chemical (toxic) insults - etching, chlorhexidine, ASA, cocaine, hydrogen peroxide, dentifrices, paraformaldehyde or calcium hydroxide
  • Thermal insults - burns
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33
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are some examples of Gingival Pigmentation as it relates to the above category?

A
  • Melanoplakia due to drugs, heavy metals, genetics, endocrine disturbances, syndromes, post inflammatory
  • Smoker’s melanosis
  • Drug-induced pigmentation - antimalarials, minocycline
  • Amalgam tattoo
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34
Q

GINGIVAL DISEASES: NON BIOFILM INDUCED

What are these pictures of?

A
  • First picture is likely amalgam tatoo
  • Second picture is likely racial pigmentation
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35
Q

Under the category of Periodontitis, what 3 sub categories are there?

A
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36
Q

What are the 3 kinds of Necrotizing Periodontal Diseases?

A
  1. Necrotizing Gingivitis
  2. Necrotizing Periodontitis
  3. Necrotizing Stomatitis
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37
Q

Describe what is going on here…

A

Necrotizing Gingivitis

  • Necrosis/ulcer of papillae, gingival bleeding, pain
  • Halitosis, pseudomembranes, lymphadenopathy, fever, sialorrhea
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38
Q

What is going on here?

A

Necrotizing Periodontitis

  • Necrosis/ulcer of papillae, gingival bleeding, pain
  • Halitosis, pseudomembranes, lymphadenopathy, feber, sialorrhea
  • Rapid bone loss
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39
Q

What is going on here?

A

Necrotizing Stomatitis

  • Soft tissue necrosis extending beyond the gingiva
  • Bone denudation through alveolar mucosa
  • Osteitis, bone sequestrum
  • Severely systemically compromised patient
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40
Q

What type of bacteria is associated with all 3 various stages of the Necrotizing Periodontal Diseases?

A

Spirochetes

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41
Q

What are some predisposing factors for Necrotizing Periodontal Diseases?

A
  • Compromised host immune response
  • HIV/AIDS
  • Malnutrition
  • Psychologic stress
  • Lack of sleep
  • Inadequate OHm pre-existing gingivitis, previous history of NPD
  • Tobacco, alcohol use
  • Young age, Caucasian
  • Winter months
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42
Q

NECROTIZING PERIODONTAL DISEASES

Describe the category of Necrotizing periodontal disease in chronically, severely compromised patient…

A
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43
Q

NECROTIZING PERIODONTAL DISEASES

Describe Necrotizing Periodontal disease in temporarily and/or moderately compromised patients…

A
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44
Q

Describe the definition of a Periodontitis patient…

A
  • Interdental CAL at > or equal to 2 non-adjacent teeth
  • Buccal or lingual CAL > or equal to 3 mm with pocketing > 3 mm detactable at > or equal 2 teeth
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45
Q

When describing a periodontitis patient, the CAL CANNOT be ascribed to…

A
  • Gingival recession of traumatic origin
  • Dental caries on cervical aspect of tooth
  • Presence of CAL on distal of 2nd molars due to malposition/extraction of 3rd molars
  • Endo lesion draining through marignal gingiva
  • Vertical root fracture
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46
Q

Describe the 4 stages of Periodontitis?

A
  • Stage I: Initial periodontitis
  • Stage II: Moderate periodontitis
  • Stage III: Severe periodontitis with potential for additional tooth loss
  • Stage IV: Severe periodontitis with potential for loss of dentition
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47
Q

Describe the Extent and Distribution of Perionditis diagnosis…

A

Extent and Distribution

  • Localized (<30% of teeth involved)
  • Generalized
  • Molar-incisor distribution
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48
Q

Describe the 3 Grades as they relate to Periodontitis diagnosis…

A

Grades

  • Grade A: Slow rate of progression
  • Grade B: Moderate rate of progression
  • Grade C: Rapid rate of progression
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49
Q

Describe Stage I of Periodontitis…

A
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50
Q

Describe Stage II as it relates to Periodontitis Diagnosis…

A
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51
Q

Describe Stage III as it relates to Periodontitis…

A
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52
Q

Describe Stage IV is relates to Periodontitis diagnosis…

A
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53
Q

How does a clinician arrive at the proper stage for Stage I periodontitis?

A
  • Mild Disease
  • Patient’s will have PD < or equal 4
  • CAL < or equal 2 mm
  • Horizontal bone loss
  • Require NON SURGICAL TREATMENT
  • No post treatment tooth loss is expected
  • Case has a good prognosis going into maintenance
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54
Q

How does a clinician arrive at a Stage II periodontitis diagnosis?

A
  • Moderate disease
  • Patients will have PD < or equal to 5 mm
  • CAL < or equal to 3-4 mm
  • Horizontal bone loss
  • Will REQUIRE NON SURGICAL AND SURGICAL treatment
  • No post-treatment tooth loss is expected
  • Good prognosis going into maintenance
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55
Q

How does a clinician arrive at a Stage III Periodontitis diagnosis?

A
  • Severe Disease
  • PD > or equal to 6 mm
  • CAL > or equal to 5 mm
  • May have vertical bone loss and/or furcation involvement of Class II or III
  • Will REQUIRE SURGICAL and possibly REGENERATIVE TREATMENTS
  • There is potential for tooth loss from 0 to 4 teeth
  • The complexity of implant and/or restorative treatment is incrased
  • Overall case ha a fiar prognosis going into maintenance
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56
Q

How would a clinician arrive at the Stage IV periodontitis diagnosis?

A
  • Very severe disease
  • PD > or equal to 6 mm
  • CAL > or equal to 5 mm
  • May have vertical bone loss and/or furcation involvement of class II or III
  • Less than 20 teeth may be present and there is the potential for tooth loss of 5 or more teeth
  • Advanced surgical treatemnt and/or regenerative therpy may be required
  • Very complex/restorative treatment
  • Overall case has a questionable prognosis going into maintenance
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57
Q

Describe Grade A in regards to the Periodontitis patient…

A
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58
Q

Describe Grade B in regards to the Periodontitis patient…

A
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59
Q

Describe Grade C in regards to the Periodontitis patient…

A
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60
Q

What is the intent of staging and grading?

A
  • Do not help arrive at a diagnosis
  • Staging and grading help clarify extent, severity, and complexity of the condition
  • Also help clarify rate of disease progression, predicted reponse to standard therapies, and potential impact on systemic health
  • Also include pattern of bone loss, tooth loss, furcation status, treatment difficulty
  • Prognosis for tooth loss
  • Degree of restorative difficulty and complexity
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61
Q

Can I use a stage for each quadrant or sextant like I did with a severity-based diagnosis of slight, moderate, or severe?

A
  • No
  • Stagging is designed to give information about the whole mouth relative to the severity and complexity, including prognosis
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62
Q

Does the area with the most severe destruction determine the stage?

A
  • Yes
  • The staging system is designed to highlight the patient’s most sever areas of destruction
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63
Q

Can the stage change for a periodontitis patient?

A
  • The stage typically does not regress or move to a lower stage
  • Exception
    • If Stage III due to presence of vertical defect > 3 mm or Class II furcation involvement and those sites are successfully regenerated such that the CAL throughout the dentition is not 3-4 mm, the furcation involement is a Class I or not clinically detectable, and PD are < or equal to 5 mm, the stage could change from Stage III to Stage II
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64
Q

Why do I need to utilize grading?

A
  • Grading provides the likelihood of post-treatment disease progression
  • The disignations recommended are A, B, or C, signifying slow or no progression, moderate progression, and rapid progression
  • The assessment is baed on past progression, presence of risk factors such as diabetes and/or smoking, and the systemic impact of periodontitis
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65
Q

How should I use grading?

A
  • Only one grade is assigned to the patient
  • Based on either direct or indirect evidence of the rate of disease progression and risk for future progression
  • Grade modifiers include smoking and diabetes
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66
Q

Describe the 4 step approach to Staging and Grading…

A
  1. Initial Overview of Case
  2. Fine-tune the stage
  3. Determine Grade
  4. Diagnose
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67
Q

In your journey of arriving to a Periodontitis diagnosis, describe Step I…

A
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68
Q

In your journey of arriving to a Periodontitis diagnosis, describe what you’re doing during Step 2…

A
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69
Q

During your journey in arrive to a Periodontitis diagnosis, what are you doing during Step 3?

A
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70
Q

What is the default Grade?

A

Grade B!

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71
Q

Finally, in arriving to a diagnosis of your Periodontitis patient, what are you doing during Step 4?

A
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72
Q

Can you name the 3rd category under Periodontitis?

A
73
Q

Have there been any notable changes in the Periodontitis as a Manifestation of Systemic Disease category?

A

No!

74
Q

What are some diseases associated with immunologic disorders?

A
  • Down syndrome
  • Leukocyte adhesion deficiency
  • Papillon-Lefevre syndrome
  • Haim-Munk syndrome
  • Severe neutropenia
  • Primary immunodeficiency diseases
  • Cohen syndrome
75
Q

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

What are some diseases affecting connective tissue?

A
  • Ehlers-Danlos syndrome
  • Angioedema
  • Systemic lupus erthematosis
76
Q

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

What are some metabolic and endocrine disorders?

A
  • Glycogen storage disease
  • Gaucher disease
  • Hypophosphatasia
  • Hypophosphatemic rickets
  • Hajdu-Cheny syndrome
  • Diabetes mellitus
  • Obesity
  • Osteoporosis
77
Q

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

What is going on in these pictures?

A

Agammaglobulinemia

78
Q

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

What is going on in this picture?

A

Leukocyte Adhesion Deficiency

79
Q

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

What is going on in this picture?

A

Leukocyte Adhesion Deficiency

80
Q

What are some examples of Acquired Immunodeficiency Diseases?

A
  • Acquired Neutropenia
  • HIV Infection
81
Q

What are some examples of Inflammatory diseases that affect the periodontium?

A
  • Rheumatoid arthritis
  • Osteoarthritis
  • Inflammatory bowel disease
  • Epidermolysis bullosa acquisita
82
Q

What are some Systemic disorders that can result in loss of periodontium INDEPENDENT of periodontitis?

A
  • Neoplasms
    • Odontogenic Tumors
  • Langerhans cell histiocytosis
  • Giant cell granulomas
  • Hyperparathyroidism
83
Q

There are 5 sub categories below “Other Conditions Affecting the Periodontium”…can you name all 5?

A
  1. Systemic Diseases/conditions affecting the periodontal supporting tissues
  2. Periodontal Abscesses and Endo-Perio Lesions
  3. Mucogingival Deformities/Conditions
  4. Traumatic Occlusal Forces
  5. Tooth and Prosthesis Related Factors
84
Q

SYSTEMIC DISEASE/CONDITIONS AFFECTING THE PERIODONTAL SUPPORTING TISSUES

What are some diseases/conditions that influence the course of periodontitis?

A
  • Diabetes mellitus
  • Leukocyte adhesion deficiency
  • Hypophosphatasia
  • Papillon-Lefevre syndrome

**Significant overlap with periodontitis as a manifestation of systemic diseases category

85
Q

SYSTEMIC DISEASE/CONDITIONS AFFECTING THE PERIODONTAL SUPPORTING TISSUES

What are some diseases/conditions that affect ther periodontal supporting tissues INDEPENDENT of plaque biofilm?

A
  • Diseases that cause periodontal breakdown that can mimic the clinical presentation of periodontitis
    • SCC
    • Langerhans Cell Histiocytosis

**Significnat overlap with periodontitis as a manifestation of systemic diseases category

86
Q

What is going on in this picture?

A

Langerhans Cell Histiocytosis

87
Q

What is the 2nd category under “Other Conditions Affecting the Periodontium”?

A
88
Q

What is a Periodontal Abscess?

A
  • Common dental emergency requiring immediate management
  • Rapid destruction of periodontium, negatively affecting the prognosis of the tooth
  • Possible severe systemic involvement
  • Bacterial invasion leading to localized collection of PNs and other inflammatory mediators
  • Most common pathogen: P. Gingivalis
89
Q

What are some signs and symptoms of a periodontal abscess?

A
  • Pain, tenderness of gingiva
  • Swelling or tooth “elevation”
  • Suppuration on probing, deep opcket, BoP
  • Increased tooth mobility
  • Radiographic bone loss
  • Facial swelling
  • Elevated body temperature
  • Malaise
  • Lymphadenopathy
90
Q

What are the new 2 sub groups of Periodontal Abscesses?

A
  1. Periodontal abscesses in periodontitis patients
  2. Periodontal abscesses in non-periodontitis patients
91
Q

What are som etiologic factors related to Periodontal abscesses in periodontitis patients?

A
92
Q

What are some etiologic factors associated with Periodontal abscesses in non-periodontitis patients?

A
93
Q

What are some possible pathways for Endo-Perio Lesions?

Are there major differences between the microbiology of a perio lesion and a perio lesion?

A
  • Apical radicular foramina
  • Accessory/lateral canals
  • Dentinal tubules
  • No!
94
Q

What are some signs of an Endo/Perio Lesion?

A
  • Fistula/sinus tract
  • History of endo treatment, possible trauma
  • Loss of pulp vitality with periodontal pocket to the apex of the tooth
  • Radiographic evidence of root resorption or fracture
95
Q

What are the 2 sub categories of Endo/Perio Lesions?

A
  • Endo-Perio lesion WITH root damage
  • Endo-Perio lesion WITHOUT root damage
96
Q

If there IS root damage with an endo/perio lesion, what is the likely etiology?

A
  • Root fracture or cracking
  • Root canal or pulp chamber perforation
  • External root resorption
97
Q

If you have an endo/perio lesion WITHOUT root damage, you can further classify this with what 2 types of patients?

A
  • Endo-Perio lesion in PERIODONTITIS patients
  • Endo-Perio lesion in NON PERIODONTITIS patients
98
Q

If you have an endo/perio lesion in a patient that has periodontitis, what are the 3 grades?

A
  1. Grade 1: narrow deep perio pocket in 1 tooth surface
  2. Grade 2: wide deep perio pocket in 1 tooth surface
  3. Grade 3: deep perio pocket in > 1 tooth surface
99
Q

If you have an Endo/Perio lesion in a non periodontitis patient, what are the 3 grades?

A
  1. Grade 1: narrow deep perio pocket in 1 tooth surface
  2. Grade 2: wide deep perio pocket in 1 tooth surface
  3. Grade 3: deep perio pocket in > 1 tooth surface
100
Q

In the new perio diagnostic system, what is the 3rd category under “Other Conditions Affecting the Periodontium”?

A
101
Q

What are the diagnostic categories in Mucogingival Deformaties/Conditions?

A
  • Gingival phenotype
  • Gingival/soft tissue recession
  • Lack of gingiva
  • Decreased vestibular depth
  • Aberrant frenum/muscle position
  • Gingival excess
  • Abnormal color
  • Condition of the exposed root surface (NCCLs)
102
Q

Instead of the word “biotype” - the new word is…

A
103
Q

What are the 3 Periodontal Phenotypes?

A
  1. Thin Scalloped
  2. Thick flat
  3. Thick scalloped
104
Q

Describe thin scalloped phenotype…

A
  • Slender triangular crown
  • Subtle cervical convexity
  • Interproximnal contact close to incisal edge
  • Narrow zone of KT
  • Clear thin delicate gingiva
  • Thin alveolar bone
105
Q

Describe the thick flat phenotype…

A
  • Square shaped crowns
  • Pronouonced cervical convexity
  • Large interproximal contact located more apically
  • Broad zone of KT
  • Thick fibrotic gingiva
  • Thick alveolar bone
106
Q

Describe the thick scalloped phenotype…

A
  • Thick fibrotic gingiva
  • Slender teeth
  • Narrow zone of KT
  • Pronounced gingival scalloping
107
Q

Define Recession…

A

Apical shift of the gingival margin with respect to the CEJ; associated with attachment loss and exposure of root surface

108
Q

What are some predisposing factors to recession?

A
  • Thin periodontal phenotype
  • Absence of attached gingiva
  • Ideally 2 mm of KT and 1 mm of attach gingiva for health, but NOT necessary to prevent attachment loss in presence of good OH
  • Reduced thickness of alveolar bone
  • Incorrect toothbrushing (inconclusive evidence)
  • Intracrevicular restorative margins - augmentation recommended if minimal/no gingiva at these sites
  • Ortho-augmentation indicated prior to ortho in areas with <2mm of gingiva
109
Q

What is the new recesion system called?

A

Cairo Recession Classification

110
Q

How would you classify this recession?

A

Cairo Recession Type I

  • Recession with NO LOSS of interproximal attachment
  • Interproximal CEJ clinically non-detectable
  • Overlaps with Miller Class I and II
  • 100% root coverage anticipated/predictable
111
Q

How would you classify this recession?

A

Cairo Recession Type 2

  • Recession WITH LOSS of interproximal attachment < or equal to buccal CAL
  • Overlaps with Miller Class III
  • 100% root coverage can be achieved by not in every case
112
Q

What type of recession is this?

A

Cairo Recession Type 3

  • Recession with loss of interproximal attachment > buccal CAL
  • Overlaps with Miller Class IV
  • 100% root coverage is NOT achievable
113
Q

What is the new classificaiton called for NCCLs?

A

Pini-Prato Classification

114
Q

What is the difference between a Pini-Prato Class A and Class B?

A
  • Class A you can still detect the facial CEJ
  • Class B the CEJ has CEJ has been worn away
115
Q

What does the + and - mean in the Pini-Prato classificaiton system for NCCLs?

A
  • The + indicates a step is present
  • The - indicates that there is a smooth transition
116
Q

How would you classify these?

A
  • Pini-Prato Class A-
  • Pini-Prato Class A+
117
Q

How would you classify these?

A
  • Pini-Prato Class B -
  • Pini-Prato Class B+
118
Q

MUCOGINGIVAL DEFORMITIES CONDITIONS

How would you describe this picture?

A

Excess Gingival Display

119
Q

MUCOGINGIVAL DEFORMITIES/CONDITIONS

How would you describe this?

A

Aberrant Frenum Position

120
Q

MUCOGINGIVAL DEFORMITIES/CONDITIONS

How would you describe this?

A

Lack of Keratinized Tissue

121
Q

What is the 4th diagnostic category under “Other Conditions Affecting the Periodontium”?

A
122
Q

What are some indicators of occlusal trauma?

A
  • Fremitus
  • Mobility
  • Occlusal discrepancies
  • Wear facets
  • Tooth migration
  • Fractured tooth
  • Thermal sensitivity
  • Discomfort/pain on chewing
  • Widened PDL space
  • Root resorption
  • Cemental tear
123
Q

What is the definition of Excessive Occlusal Force?

A

Occlusal force exceeds reparative capacity of periodontal attachment apparatus which leads to occlusal trauma, excessive tooth wear or loss

124
Q

What is the definition of Occlusal trauma?

A
  • Injury resulting in tissue changes to PDL, supporting alveolar bone and cementum
  • Occurs in an intact periodontium or in a reduced periodonium
125
Q

How would you define Primary Occlusal Trauma?

A
  • Injury resulting in tissue changes on a tooth/teeth with a NORMAL, healthy periodontium
  • Normal CAL, normal bone levels and excessive occlusal force
126
Q

How would you define Secondary Occlusal Trauma?

A
  • Injury resulting in tissue changes on a tooth/teeth with a reduced periodontium
  • CAL, bone loss and normal/excessive occlusal force
127
Q

How would you define Fremitus?

A
  • Palpable or visible tooth movement when subjected to occlusal forces
128
Q

How would you define Bruxism?

A
  • Habit of grinding/clenching/clamping of teeth
  • Has the potential to damage the periodontal attachment apparatus
129
Q

Can traumatic occlusal forces lead to periodontal disease?

A
  • Excessive occlusal forceds DO NOT initiate plauqe induced periodontal diseases or loss of periodontal attachment
  • Insufficient evidence to conclude that excessive occlusal forces result in abfraction or gingival recession
130
Q

How does ortho affect the periodontium?

A
  • Ortho forces can be detrimental to the periodontium if forces are non-controlled; however, evidence suggests there is minimal overall effect on the periodontium (especially with good OH)
131
Q

What is the 5th category under “Other Conditions Affecting the Periodontium”?

A
132
Q

What are some tooth related factors that affect the periodontium?

A
  • Tooth anatomic factors
  • Root fractures
  • Cervical root resorption
  • Cemental tears
  • Root proximity
  • Altered passive eruption
133
Q

What are some localized dental prosthesis-related factors that affect the periodontium?

A
  • Restoration margins placed within the supracrestal attached tissues
  • Clinical procedures related to indirect restorations
  • Hypersensitivity/toxicity reactions to dental materials
134
Q

What is the new term for Biologic Width?

A

Supracrestal Tissue Attachment

135
Q

What happens when restorative margins are placed within or encroaching upon the supracrestal tissue attachment?

A
  • Greater papillary bleeding index scores
  • Increased PDs
136
Q

What is Altered passive eruption?

A
  • Developmental condition resulting in abnormal dento-alveolar relationship
  • Gingival margin at a more coronal level than normal which leads to pseudopockets and shortened clinical crown heights
137
Q

How do Class II restorations with subgingival margins affect the periodontium?

A
  • Increased ginigval inflammation
  • Increased PDs
138
Q

When you have overhangs > 0.2 mm, how does this affect the periodontium?

A
  • Crestal bone loss
  • Increased BoP and PDs
  • Removal of overhangs during initial therapy improves parameters
139
Q

How can RDPs have a negative impact on the periodontium?

A
  • Increased prevalence of caries, gingivitis and periodontitis
  • Increased plaque levels and gingival inflammation
140
Q

RDPs can have a favorable periodontal prognosis if…

A
  • Periodontal disease is treated and controlled
  • Patient maintains OH
  • Patient compliance with maintenance
  • RDP has been correctly designed and maintained
141
Q

What are some tooth anatomical considerations that could lead to periodontal destruction?

A
  • Cervical Enamel Projections
  • Enamel Pearls
  • Developmental Grooves
  • Tooth Fractures
142
Q

How can CEPs and EPs affect the periodontium?

A
  • Increased risk of furcation involvement
  • Increased PD and CAL
  • CEP found in 82.5% of furcation involved molars
  • Prevalence of EPs = 1-5.7% of molars
143
Q

How can Developmental Grooves affec the periodontium?

A
  • Palatogingival groove on max lateral incisors
    • 1-8.5% prevalence
    • 43% do not extend > 5 mm apical to CEJ
  • Commonly present on the interproximal surfaces of other teeth
144
Q

Do tooth fractures always affect the periodontium?

A
  • If the tooth fracture = coronal to gingival margin
    • Not usually associated with gingivitis/periodontitis
145
Q

Describe the 3 grades of CEPs…

A
  • Grade I: distinct change in CEJ with enamel projecting toward the furcation
  • Grade II: CEP approaching furcation but not making contact with it
  • Grade III: CEP extending into furcation proper
146
Q

What is this?

A

Enamel Pearl

147
Q

What is this?

A

Palatogingival Groove

148
Q

What is the new diagnostic category regarding implants?

A

Peri-Implant Diseases and Conditions

149
Q

What is the first category under “Peri-Implant Diseases and Conditions”?

A

Peri-Implant Health

150
Q

What are the 4 categories under “Peri-Implant Diseases and Conditions”?

A
  1. Peri-Implant Health
  2. Peri-Implant Mucositis
  3. Peri-Implantitis
  4. Peri-Implant Soft and Hard Tissue Deficiencies
151
Q

Describe ideal Peri-Implant Health…

A

Absence of clinical signs of inflammation (erythema, edema) and no BoP

152
Q

The implant surface of peri-implant mucosa is comprised of what 2 distinct parts?

A
  • Coronal Portion: line by thin barrier epithelium (similar to JE) and sulcular epithelium; connective tissue has delicate vascular plexus with circumferential collagen fibers
  • Apical Portion: connective tissue in direct contact with implant surface (zone of connective tissue adhesion) with limited vascular structures
153
Q

Discuss what probing an implant in health looks like?

A
  • Probe fails to reach apical portion of epithelial barrier
  • PDs greater at proximal sites vs facial sites
  • Peri-implant PDs are greater than PDs at tooth sites
  • Soft tissue cuff around implants is less resistant to probing
154
Q

Is probing implants safe?

A

Yes!

Evidence supports probing with light force is safe and important for complete evaluation

155
Q

What does the probe reach in disease regarding an implant?

A

Probe reaches apical base of inflammatory cell infiltrate

156
Q

How often should you probe an implant?

A
  • At least once a year
  • Peri-implant PDs should be < or equal to 5 mm (but not necessary fo healthy peri-implant tissue)
  • Increase in PD over time may indicate development of peri-implantitis
  • BoP should not be present in peri-implant health
157
Q

How often should you take x-rays of implants?

A
  • Baseline (with suprastructure in place) and annually thereafter
  • Changes of > or equal to 2 mm at any time point should be considered pathologic
158
Q

Do you need Keratinized Mucosa for implants?

A
  • Need for minimum amount of KM around implants is controversial
  • Some studies suggest that if peri-implant KM < 2 mm, there is increased PD and marginal inflammation
159
Q

What is Osseointegration?

A
  • Bone to implant contact on light microscopic level
  • Direct functional and structural connection between living bone and surface of a load-carrying implant
160
Q

What is the 2nd category under Peri-Implant Diseases and Conditions?

A

Peri-Implant Mucositis

161
Q

What is Peri-Imlant Mucositis?

A
  • Clinical signs of inflammation (may include erythema, edema, BoP, suppuration) WITHOUT loss of supporting bone or continual marginal bone loss
  • Inflammation is REVERSIBLE with plaque control
162
Q

What are some risk factors for developing Peri-Implant Mucositis?

A
  • Plaque accumulation
  • Smoking
  • Lack of compliance with maintenance
  • Implant prosthesis design over-contoured and submarginal restorative margins
  • Radiation
  • Further evidence needed for potential risk factors like diagetes, lack of KM and excess luting cement
163
Q

What is the third category under Peri-Implant Disease and Conditions?

A

Peri-Implantitis

164
Q

What is Peri-Implantitis?

A
  • Clinical signs of inflammation (may include erythema, edema, BoP, suppuration) WITH loss of supporting bone and/or progressive bone loss
165
Q

Which disease process is faster, Peri-Implantitis or Periodontitis?

A

Peri-Implantitis

166
Q

What disease process is going on here?

A

Peri-Implantitis

167
Q

What is Periapical (retrograde) peri-implantitis?

A
  • Radiolucency at apical portion of implant
  • Seen at 2-8 weeks post-implant placement (up to 4 years later)
  • With or without clinical signs of inflammation (edema, fistula, abscess)
  • Direct correlation between periapical peri-implantitis and existing adjaent periapical endodontic infection
168
Q

What is going on here?

A

Periapical (retrograde) Peri-Implantitis

169
Q

What are some risk factors for Peri-Implantitis?

A
  • History of Periodontitis
  • Smoking
  • Diabetes
  • Poor OH/Lack of Maintenance
170
Q

Currently there is not enough evidence to determine the risk of the following factors on the development of peri-implantitis…

A
  • Lack of KM
  • Excess cement
  • Genetic factors
  • Systemic conditions
  • Iatrogenic factors (inadequate restorative abutment seating, implant malpositioning, design of suprastructure)
171
Q

What is the 4th and final category below “Peri-Implant Diseases and Conditions”?

A

Peri-Implant Soft and Hard Tissue Deficiencies

172
Q

What are some factors that affect HARD TISSUE PRIOR to implant placement?

A
  • Tooth loss
  • Trauma from tooth extraction
  • Periodontitis
  • Endodontic Infections
  • Root fractures
  • General Trauma
  • Bone height in posterior maxilla (pneumatization of sinus post-extraction
  • Systemic Diseases
173
Q

What are some factors that affect Hard Tissue AFTER implant placement?

A
  • Defects in healthy situations
  • Malpositioning of implants
  • Peri-implantitis
  • Mechanical overload
  • Soft-tissue thickness
  • Systemic diseases
174
Q

What are some factors that affect SOFT TISSUE PRIOR to implant placement?

A
  • Tooth loss
  • Periodontitis
  • Systemic Diseases
175
Q

What are some factors that affect SOFT TISSUE DEFECTS AFTER implant placement?

A
  • Lack of buccal bone
  • Papilla height (2 adjacent implants leads to reduced papilla height)
  • Keratinized tissue (minimal KT may be associated with increased plaque and BoP)
  • Migration of teeth and life-long skeletal changes
176
Q

What is going on here?

A
  • Seibert Class I
  • Buccal-lingual loss
177
Q

What is going on here?

A
  • Seibert Class 2
  • Apico-Coronal Loss
178
Q

What is going on here?

A
  • Seibert Class 3
  • Combination
179
Q

What cateogry does the Seibert classification fall under in the new perio system?

A

Peri-Implant Soft and Hard Tissue Deficiencies

Perio Diagnosis Update (1 decks)

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