Perio Final Flashcards
1
Q
4 mechanic causes of gingival recession
A
Traumatic brushing, flossing
Ortho Tx
Trauma
Parafunctional habit
2
Q
Generalized vs. localized causes of biological gingival recession (2 of each)
A
G: tissue biotype
Oral hygiene
L: anatomy
Defective restoration
3
Q
Brushing abrasion commonly affects _ in young adults
A
Premolars
4
Q
Miller classification of recession
A
1- no interprox bone loss Recession doesn’t extend to MGJ 100% Root coverage 2- No interprox bone loss Recession to or past MGJ 100% root coverage 3-Interprox bone loss May pass MGJ Partial root coverage 4-Interprox bone loss PAST level of recession No root coverage
5
Q
Perio-ortho interrelationships
A
S
6
Q
Who has a higher increase in plaque after ortho?
A
Adults. Adolescents have higher baseline and it doesn’t increase that much
7
Q
After ortho, subgingival pathogens __. Several months later they _
A
Temporarily increase
Return to pretreatment levels
8
Q
_ % of people have gingival enlargement that remains after ortho tx
A
30%. 50 start, 100 end tx, 80% after 3-12 mo.
9
Q
What do normally erupting teeth look like at time of eruption
A
Developing root and 3/4 final root length complete
10
Q
Unerupted teeth have a more _ than erupting teeth
A
More completely developed root
11
Q
Order of frequency of impacted teeth
A
3rd molars Maxillary canine Man 1st PM Man 2nd PM Man Canine Max premolars
12
Q
Most impacted max canines are _ impacted
A
Palatal
13
Q
Buccally impacted canines are associated with _ deficiency
A
Arch length
14
Q
Local causes of tooth impaction
A
Failure of deciduous roots to resorb Abnormal position Supernumerary tooth Tooth crowding Dentigerous cyst Thickened soft tissues Soft/hard tiss. Pathology Premature extraction of primary tooth
15
Q
3 Systemic factors that can cause impaction
A
Childhood diseases
Hereditary factors
Genetic syndromes
16
Q
Problems that can follow canine impaction
A
Malpositioning of impacted tooth Migration of neighboring teeth Internal/external resorption Dentigerous cyst formation Referred pain
17
Q
Surgical aims for impacted teeth (not extraction)
A
Provide conditions for normal, unimpeded eruption
Provide access for ortho appliances
18
Q
Open eruption vs closed eruption
A
Open: cut a window, let it erupt
Closed: cut flap, ortho appliance, close flap
19
Q
Advantage/disadvantage of closed and open eruption
A
Open: more pain, hard to eat, if ortho breaks, don’t need surgery
Closed: more comfortable, but if ortho breaks, need surgery again
20
Q
ANUG starts where
A
Papilla then moves to gingiva
21
Q
Characteristics of advanced ANUG
A
Lack of deep pockets
Papillary and marginal involvement
STINKS
Necrosis causing craters
22
Q
4 microbes that cause ANUG
A
Treponema
Selenomonas
Fusobacterium
Prevotella
23
Q
Treatment of ANUG
1st
2nd
3rd
A
- History
Removal of necrotic tissue
Emergency tx
1/2 rinse with H2O2
- Evaluation
Scaling
Emergency
Confirm home hygiene - No more rinses
Plaque control
Counsel on hygiene
SRP repeated if needed
24
Q
4 types of abscesses, causes of each
A
Gingival - Trauma
Pericoronal - Trauma
Periodontal - Infection
Periapical - Infection
25
Antibiotics are contraindicated for which abscess
Gingival
26
Perio abscesses most often happen on which teeth and under what condition
Molars
| PD ≥ 5mm
27
Causes of perio abscesses
Periodontitis
| Non-perio, acute infection from another source
28
Treatment of perio abscesses
```
Drainage through pocket retraction or incision
SRP
Perio surgery
Extraction
Antibiotics if systemic complications
```
29
Types of mucogingival defects
```
Gingival recession
Lack of gingival keratinization
Lack of attached gingiva
-high frenum attachment
-shallow vestibule
Recession with abrasion
```
30
Etiology of gingival recession can be divided into two categories _
The first has 4 types
The second has 2 types
```
Mechanic/biological
M:
Traumatic brushing/flossing
Ortho
Trauma
Parafunctional habit
B:
Generalized (tissue type, oral hygiene)
Localized (anatomy, defective restoration)
```
31
Miller classifications for recession
I: no interprox bone loss, recession does NOT extend to MGJ
II: no interprox bone loss, recession extends to MGJ. Full root coverage
III: interprox bone loss, recession may reach MGJ. Partial root coverage (to level of interprox bone)
IV: interprox bone loss beyond level of recession. No root coverage
32
5 flap options for treating recession
```
Coronally advanced flap
Tunnel
Lateral sliding flap
Double papilla
Semilunar
```
33
Mucograft:
Xenograft porcine collagen I and III
34
Indications and disadvantages of free gingival graft
I: increase KG/attached gingiva
Increase vestibular depth
Achieve root coverage
D: not predictable for root coverage
Color doesn’t match
Complications at donor site
35
3 phases of healing of free gingival graft
Initial phase 0-3d
Revascularization 2-11d
Tissue maturation 11-42d
36
4 classifications of labial frena, definitions
Mucosal - frenum ends in mucosa or at MGJ
Gingival - frenum ends in gingiva
Papillary - frenum ends at papilla
Papillary penetrating - frenum ends at papilla and penetrates to palate
37
Main syndrome associated with prominent max frenum
Ellis van Creveld syndrome
38
Genetic syndromes (2) associated with absence of max labial frenum
Ehlers-Danlos
| Holoprosencephaly
39
3 types of tissues make up frena
Ortho and parakeratinized ep.
Collagen fibers
Chronic inflammatory infiltrate
40
4 indications for frenectomy
Recession
Interference with oral hygiene procedures
Diastema
Denture fabrication
41
Frenotomy vs frenectomy
Otomy: cutting of frenum, esp release of ankyloglossia
Ectomy: total removal of a frenum
42
4 surgery options for a frenectomy
V shaped
Z-plasty
Lasers
Electrosurgery
43
Do ortho before or after frenectomy
Before unless really wide and thick
44
1st
1st
45
6 factors determining LASER interactions with tissues
```
Wavelength
Energy level
Waveform
How focused the beam is
Duration of exposure
Tissue characteristics
```
46
Disadvantages of laser use
Technical difficulties
Less precise
Hazardous
Can disperse viral particles in plume
47
LANAP:
How does it work
Laser assisted new attachment procedure
Remove sulcular epithelium
Modify root surface
New attachment will occur
48
How does photodynamic therapy work
Sensitizer is injected, absorbed by tissues. Light targets only sensitized tissue, kills whatever is absorbed
49
4 indications for perio surgery
Failure to resolve inflammation by SRP (hard to reach areas)
Regeneration of periodontium
Cosmetic improvements to periodontium
Resorative needs
50
Two purposes of perio surgery
Access and regeneration
51
T/F open flap debridement is statistically significant in its effect
TRUE
52
3 types of healing
Repair - doesn’t restore function
New attachment - CT + root surface, deprived of original attachment
Regeneration - new cementum, PDL and bone to reconstitute lost part
53
T/F surgical tx is necessary to arrest inflammatory progress of disease
TRUE
54
T/F surgical access to root surface is least common surgical treatment to arrest periodontal disease
FALSE - it is the most common
55
T/F Regenerative surgery is rapidly changing the way perio disease is managed
TRUE
56
Biologics are generally comparable to _ and _ and superior to _ in improving clinical parameters in treatment of intrabony defects
Demineralized freeze-dried bone allograft AND GTR
OFD
57
In the infrabony defects meta-analysis, clinical outcomes appear most influenced by _ rather than by tooth and defect characteristics
Patient behaviors and surgical approach
58
T/F periodontal regeneration in intrabony defects is impossible on previously diseased root surfaces
FALSE
59
T/F surgical treatment is necessary to arrest inflammatory progress of disease
TRUE
60
_ is the most common surgical treatment to arrest periodontal disease
Surgical access to root surfaces
61
The two most frequent causative factors for gingival recessions
Toothbrushing trauma
| Bacterial plaque
62
What is the bilaminar technique, why use it
Coronally advanced flap covering a connective tissue graft
Use of graft increases the likelihood of achieving complete root coverage (especially long term)
63
Tooth loss is _ proportional to perio maintenance therapy
Inversely
64
3 therapeutic goals of PMT
Prevent recurrence and progression of perio disease in patients treated ja
Prevent tooth loss by monitoring teeth
Increase probability of treating other diseases in mouth
65
Ideal frequency of PMT
3 months
66
What requires retreatment during maintenance
```
Continued inflammation (surgery)
Aloss (SRP + antibiotics or surgery)
```
67
2 species of bacteria around teeth/implants with inflamed tissues
Prevotella intermedia
| Pophyromonas gingivalis
68
In maintenance of implants, what 3 things are we looking at
Tissue health
Crevicular fluid
Mobility and occlusion
69
```
Soft tissue healing:
First day
1-3 days
3-4 days
Week 1
Week 2
Week 4-6
```
Day 1: blood clot/coagulin
1-3d: fibrinolysis
3-4: mesenchymal cells, replacement of coagulum by gran tiss.
1w: vascular networks formed
2w: socket covered w/ new conn. Tiss with blood vessels and inflammatory cells
4-6w: soft tissue keratinization
70
Hard tissue healing:
4-6 weeks
4-6 months
6mo+
4-6w: woven bone in alveolus
4-6m: lamellar bone on woven
6mo+: bone deposition continues, won’t reach coronal bone level of neighboring teeth
71
More resorption occurs in the _ of the max and mand
Buccal aspect of alveolus
72
Resorption occurs more on _ (type) alveoli and in the presence of _ or _ or after the formation of a _ following healing
Thin, cortical, knife edged facial alveoli
Dehiscence or fenestration
Buccal concavity
73
Bone loss in the first 6 months-1 yr occurs more in _ direction
Horizontal
74
Following extraction, what 3 things can affect the amount of residual bone
Surgical trauma
Elevation of a flap
Age of the patient
75
Class I-V bone defects
I: extraction sockets
II/III: dehiscence defects
IV: horizontal defects
V: vertical defects
76
ARP:
Definition
Purpose
Diff b/t GBR
Alveolar ridge preservation at time of extraction.
Control resorption
GBR targets regeneration of already resorbed/lost bone
77
When to do ARP
When immediate implant placement isn’t possible
78
3 contraindications for ARP
Infection
Indication for immediate implant placement
Soft tissue limitation
79
Bone grafting materials can be either _ (scaffold) or _ (stimulates resident cells)
Osteoconductive
| Osteoinductive
80
Which materials are osteogenic, osteoinductive, osteoconductive
Autogenous grafts: all 3
Allografts: OI/OC
Xenografts: OC
Synthetics: none. Just fillers
81
Synthetic grafts can be absorbable or non-absorbable. Examples of each
A: plaster of paris, calcium carbonate
NA: bioglass, HA, PMMA
82
Where is autogenous bone graft material taken from
Iliac
| Max tuberosity, extraction site, osseus coagulum
83
3 types of allogenic bone grafts
Frozen iliac cancellous bone
Freeze-dried bone allograft (mineralized/demineralized)
(D)FDBA w/ autogenous bone
84
What is the role of the barrier in the ARP
Type of tissue in a space is determined by what cells have access. Block off unwanted cells
85
6 types of membranes
```
Millipore filter
ePTFE (w/ or w/o titanium)
Cross-linked bovine collagen barrier
Bioabsorbable polymer: polylactic acid base
Autogenous conn. Tiss membranes
```
86
4 things affecting outcome of ARP
Blood supply
Space maintenance
Membrane stability
Tension in flap closure (want none)
87
In mature bone, implants should have _ mm on all sides
At least _ mm of interocclusal distance is needed from top shoulder of implant to occlusal of opposing tooth
At least _ mm space b/t two adjacent implants and _ mm b/t implant and adjacent tooth
1
7
3, 2-3
88
3 types of mandible shapes, best one for implants
C P U
| C is best, U is worst (concave)
89
4 implant placement types based on timing
Immediate
Early
Late
Conventional
90
Immediate implant placement
Advantages
Disadvantages
A: less surgeries, less treatment time, optimal use of bone
```
D: site morphology needs to be good
Tissue biotype needs to be good
Need keratinized mucosa for flap
Adjunctive surgeries may be necessary
Technique sensitive
```
91
Immediate implant placement may not prevent _ that follows tooth extraction
Physiologic modeling/remodeling
92
Early implant placement has two advantages
Easier flap adaptation
Allows resolution of local pathology
93
Disadvantages of early implant placement
```
Bad site morphology
Longer treatment time
Bone resorption at socket walls
May need adjunctive surgery
Technique sensitive
```
94
At least _ mm of bone height is needed apically to the socket for immediate and early implant placement
3
95
_ biotype is indicated for early implant placement
Soft
96
Early/immediate implants need _ walls and no _)
3/4 walls and no dehiscence or fenestration of buccal
97
Advantages for late implant placement
Clinically healed ridge
Mature soft tissues, easy flap management
98
Disadvantages of late implant placement
Treatment time
Adjunctive procedures
Large variation in available bone (more bone loss with longer wait time)
99
New bone formation is decreased after
3-4 months
100
Indications for early implant placement of a single-rooted tooth
```
Good extraction (preserve bone)
Thick biotype soft tissue
Manageable gap following placement
Root length (mand ant., max lat)
```
101
Contraindications for immediate/early placement of implant of single rooted tooth
```
Oval shaped socket
Rotated tooth
Malocclusion
Esthetic zone
Anatomical landmarks
Long root length (canines)
```
102
Indications/contraindications of early implant placement for a multi-rooted tooth
I: large intact septum b/t divergent roots
Non-esthetic area
CI: multiple sockets
Lack of soft tissue
Heavy occlusal forces
Anatomy
103
T/F Immediate implant placement is best
T
104
Why wouldn’t immediate implant placement be done (2 reasons)
Infection
| Soft tissue issues
105
_ implant placement is done unless _ or _,
in which case _ is done until _ can be done, unless _
In which case _ will be done and delayed implant placement will be done.
Immediate, infection, soft tissue issues
Socket preservation until early placement
Not enough bone, guided bone regeneration
106
5 steps in drilling sequence for implant
```
Round bur
Pilot hole
Parallel pin (radiographs)
Widen hole
Final diameter
```
107
Advantages/disadvantages of ONE STAGE implant placement (3/2)
A: no 2nd surgery to uncover implant
Better evaluation of wound healing
Early temporization
D: Exposure to oral cavity during osseointegration
Difficult to control loading
108
Contraindications for one stage implant placement
Torque value less than 35 Ncm
Smokers
Thin tissue (soft and hard) biotype
109
All _ problems should be solved prior to any types of implant placement surgery
Periodontal health related
110
The implant shoulder should be placed _ to CEJ of adjacent teeth in patients without gingival recession
2 mm apical to CEJ
111
Implant pre-op procedures to control bacteria and prep for surgery
Antibiotic prophy
Chlorhexidine rinse
NSAIDS
Prep for sedation
112
The incision for an implant is where
Mid-crestal or slightly lingual
113
What happens in post op visits
7-10d post op
1 mo post op
7-10:
- chlorhexidine rinse
- review OHI
- remove sutures if necessary
1 mo:
-check that implant is covered still
BOTH:
Check for signs of infection
114
At least _ mm bone thickness b/t two implants
3mm
115
It is harder to create alveolar bone _ than _
Height than width
116
T/F inter-implant papillae can be predictable re-established
FALSE
117
3 ways dentures can be supported by implants
Ball attachments
Bar and clips
Hybrid (fixed implant supported denture)
118
Lateral vs vertical bone augmentation
Lateral is predicable and achievable
Vertical is difficult
119
Multiple anterior implants should be aligned _ with _ between each other
Parallel
| 3mm
120
Three components of an implant
```
Implant fixture (first part in)
Abutment (screws into fixture)
Restoration
```
121
Infection indicator that is more common on implants than teeth
Suppurations
122
Peri-implantitis vs peri-implant mucositis
PI- Inflammation and loss of supporting bone around implant in function
PIM- gingivitis around implant
123
Ailing vs. failing vs. failed implant
A: PI mucositis
Failing: P-implantitis
Failed: P-implantitis, hopeless, non-functional, pain
124
Peri-implantitis is almost always _ shaped
Cup
125
3 goals in treating failing implants
Resolve inflammation
- plaque debridement
- improve oral hygiene
- adjunctive antibiotics
Correct pseudo pockets by flap surgery/gingivectomy
Re-osseointegration (decontaminate implant, GBR)
126
How to treat peri-implantitis
Class I
II
III/IV
I: repositioning of flaps
Cleaning implant surface
Implantoplasty if needed
II: same as one
GTR if vertical with 3+ walls
1/2 walls = osteoplasty/bone leveling
III/IV: GBR
127
Active ingredient in infuse
| What does it do, when do you use it
Recombinant human bone morphogenic protein-2
Stimulates bone formation
Regeneration after peri-implant bone defect
128
Why perio before restorative? (4)
No inflammation means ideal tooth access and prep ability
More stable, less Aloss
Better esthetics
129
6 steps in treatment sequence
1. Etiologic phase (faulty rest.s)
2. Pre-prosthetic surgery (preservation, augmentation)
3. Restoration design
4. Pre-implant surgery
- sinus lift
5. Post-prosthetic surgery
- tissue deformities/gummy smile
6. Maintenance
130
When is perio necessary before ortho
When there is inflammation/perio problems
131
When can you do ortho in perio patients
Reduced but healthy and stable periodontium
Active perio with ortho will have problems
132
Pre-ortho, what perio procedures can help with ortho (5)
```
Tooth exposure
Root coverage
Frenectomy
Perio accelerated ortho
Implants for anchorage
```
133
Post/during ortho, what perio procedures can help with ortho
Fiberotomy
Frenectomy
Gingivectomy
Root coverage
134
Adjunctive ortho can help what perio problems (4)
Diastemas
Gingival margin discrepancies
Intrabony defects
Implant site development (space/ridge development)
135
Clinical data doubles ever _
18 months
136
3 types of gingival grafting
Free gingival graft
Pedicure (lateral)
Sup-epithelial connective tissue graft
