Perio Final Flashcards by Ariel Rose

driving force behind all major related disorders?

inflammaton

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___ of americans over 30 yos have PD

1/2

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3 aspects of pathogensis of PD and systemic diseaeas

infection

inflamma

adaptive immunity

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6 systemic links to PD

CV disease

respiratory

diabetes

osteoporoesis

pre term baby

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more likely to have diabetes if you ahve PERIODONTAL INFLAMMATION

TURE

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earlier have diabetes -> earlier have PD

why?

true

PD play a role in woresening glycemic control

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____ is significant predictor of PD and is independent of

age

smking

race

ethinicty

obesity

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which types of diabtetes increases the risk of PD?

But type I has a ___ and ___ inflammatory response to bac

I and II

type I has eariler and higher inflamm

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_____ mediates the relations bt obesitty and PD

insulin resistance

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___ of US americans are overweight

60%

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obesity

10x fold of being ____

3x fold of gettting ____

10x = diabetic

3x = PD

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___ and ___ which contribute to systemic hyperinflammation, increase hyperlipidemia and increase insulin resistance

IL 6 and TNF alpha

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Diabetic patients with severe PD has a ___worsening of glycemic control over 2 years

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HB1Ac

life of RBC

120 days

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if pt is above 7% of Hb

is 170 =?

high

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deep pockets = ____

in NON diabettics

impaired glucose tolerance

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Poor control diabetic patients have worse periodontal status than control subject, but well controlled diabetic patients have PD status similar to controls

true

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periodontal pathogens can contribute to atherolscerolsis

true

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pt with artificial heart valves are they at greater risk?

true

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smokers are ___ x faster bone loss than non smokers

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bruxers [occlusal factors] increases the rate of bone loss

debatable

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in healthy tissue pocket depth is

1 - 3 mm

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pseudopockets are created how?

are they reversible?

during gingivitis the coronal movment of the gingival margin creates these psudeopockets

yes reversible, remove inflamma and returns to normal

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___ is activated during the 2nd stage of PD and destroys CT fibers [attachment loss] and bone loss

osteoclast

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why do deeper pockets favor bioflim accumulation

cleansibiity of pt and for us to get in with instruments

4 ways to repair/ eliminate pockets repair resection regeneration extraction

repair

create LONG junctional epithelium

resection

excise the wall of the pocket trim the gingiva [soft tissue] DOWN to the level of the BONE GINGIVA, DOWN, BONE LEVEL

regeneration

REGROW bone to the level of soft tissue REGROW, BONE, SOF TISSUE

tx of PD [a ROOT SURFACE DISEASE , not in bone or soft tissue] invovles

complete ELIMINATion of clean surface = HAVE TO DO SRP

the most important factor for LONG TERM SUCCESS

OHI

repair SRP is better on atnerior teeth bc

1 root no furcation easy access

SRP is predicatble and effective in pockets up to

5 mm

epithelial cells [gingiva] - _____ - tooth surface

epi cells attach to desmosomes to tooth surface [LONG JUNCTIONAL EPI

2 WAYS ELIMINATE POCKETS WITH SRP

1. tissue shrinkage = gingival recession

2. adherence of gingiva [epithelial cells] via desmosomes to the junctional epithelium = long junctional epi

waht is the main purpose of periodntal surgery

enhance the surgeons ability to do SRP

deep pockets

greater tahn 5 mm and BOP

waht is the main reason we do perio surgery

1. access for SRP 2. pocket reduction

2nd reason we do periodntal surgery

easy env for maintanence control

3 reasons for doing gingivectomy

1. lots of keratinzed attached gingiva 2. no osseous defects 3. drug induced irregular gingival contour [overgrowth]

3 reasons NOT to do gingivectomy

1. little keratinized attached gingiva 2. has osseous defects 3. if pt HIGH RISK OF post-operative BLEEDING [taking plavix, coumadin, baby asprin]

how many days shoud peple taking baby asprin, coumadin, and plavix stop B4 perio surgery

4 - 7 das

if blood sugar for diabetic is b/t 150 -180 progronossi for healing is ? greater than 180?

150 - 180 = good +180 = BAD **tissue wont heal**

open wound is bad for gingivectomy bc

1. possible post operative bleeding 2. possibly post operative discomfort

3 things periodontal flaps do

1. provide access to root and osseous defects 2. eliminate pocket 3. primary closure [minimize trauma and more comfort to pt]

beveled incisions are usually used for

gingivectomy

reversed bevel for

sulcular incisions flap surgery

advantage of vertical incison

1. increase access 2. increased flap mobility

vertical incisors would you rather split a papilla incise over a radicular root surface [prominent root surface]

radicular surface

vertical incisors disadvantage 1. severe neurovascular bundeles 2. compromised blood suppy

greater palatine artery [distal to the 1st molar max] lingual nerve [distal to the lwer 1st molar] mental nerve [mesial to the lower 2nd pm] 2. flap necrosis and delayed wound healing

long narrow flap margin \> base

vertical incisons

flap fundamentals i.e. CS

incison elevation coaptation suturing

elevations full thickness flap aka

mucoperiosteal flap

full flap thickness = mucoperiosteal flap partial thickness = split thickness flap

flap coaptation non displaced flap apicall displaced flap

non displaced flap

bone defect within the attached kera gingiva: 1. can do a scallop incision 2. reposition witout displacement

apically displaced flap

bony defect beyond the mucogingival junction: 1. flap apically displaced 2. preserve keratinized tissue

incisions that are staying close to the tooth as much as possible

submarginal incison

what type of flaps if you are looking at bone = if you are looking at tissue =

bone = full thickenss flap = non displaced flap or apically displaced flap tissue = partial thickness flap = apically dispalced flap

where is the tissue thinnest

mucogingival junction

when you make a vertical incision over the radicular part of the root [root prominence] there is a lot of tension and can result in what? also if you make and incson in the mucosa you can get this as well

scarring

indications for distal flap

distal angular defects distal furcation

3rd molar extractions is a good example of waht type of flap technique

distal falp

waht type of flap techniques is when you make an incision and the two incisions meet

distal wedge flap

for distal wedge incisions should be made how far apart?

1/2 - 2/3 distal probe depth NEVER BEYOND THE LINE ANGLE

for horizontal inscisons: how do you know where to make the incison

1/2 - 2/3 the probe debth

4 reasons to do INTERNAL bevel incision

1. rid inflammed pocket 2. conserve kera tissue 3. primary closure is mini trauma and reduce discofmromt [primary healing] 3. SHARP, thin flap margin

modified distal wedge

do a vertical incison to merge the to incisons

for edentulous areas its better to do waht type of suture

simple

distal flap procedure wrap around the tooth

figure 8 suture

simple suture figure 8 suture anchor suture continous sling suture

continuous sling suture - suture the buccal then lingual falp and anchored around the tooth

tf continus sling suture needs only one knot since it is continuous

true

how far does the suturing have to be from the flap margin

at least 3 mm

normal week 1 healing

swelling = edema erythmea NO tissue NECROSIS

if there is tissue necrosis waht does that mean? and waht does that indicate clinically

immune system suppressed = POOR WOUND HEALING

how long does it take for tissue necrosis to heal

4 weekq

2 types of regenerative

papilla preservation flap conventional flap

indications for papilla preservation flap for regneration

1. need interdental space LARGE ENOUGH for push back [if not tissue necrosis] 2. scallop incision on the palatal side 3. push whole papilla back in

what is papilla preservation used mostly for?

esthetic areas

further therapy = perio surgery 1. esthetic areas 2. non esthetic areas

esthetics: 1. perioscopy 2. conservative surgery [but tend to stay away] non esthetic: 1. resective 2. regneration