Perio final volume 2 Flashcards
Is age a factor to implant success
no
What are the suitable graft materials for defects around implants
Allograft = Autograft > Alloplast
Bone healing rates
following injury to bone, initial response is resorption at 3-4 days which peaks at 8-10 days. Resorption and bone formation co-exists from 14-21 days with a predominance of bone formation at 3 weeks.
Pedicle grafts
o Lateral sliding graft
o Double papillae graft
o Split thickness or full thickness
o Base of the flap contains its own blood supply which nourishes the graft and facilitates the re-establishment of vascular union with the recipient site.
intraoral sources of autogenous bone graft
Osseous coagulum Bone blend Maxillary tuberosity Edentulous ridges *Extraction sites *Ramus/chin
What are some Growth Factors
Bone Morphogenic Protein/Osteogenin Epidermal Growth Factor (EGF)- Monocyte Derived Growth Factor (MDGF)- Tumor Necrosis Factor alpha and beta (TNF-)-- Platelet Derived Growth Factor (PDGF)*- Platelet Derived Growth Factor (PDGF)*- Platelet Derived Growth Factor (PDGF)*- Transforming Growth Factor (TGF)-
Branemark’s Classification of Bone Quality
1 - homogenous compact bone (typically found in anterior mandible)
2 - thick cortical bone with marrow cavities
3 - thin cortical bone with dense trabecular bone of good strength
4 - thin cortical bone with low density trabecular bone of poor strength (typically found in posterior maxilla)
Whats the average amount of bone removed during osseous respective surgery
average loss of .6mm circumferentially—most on 1 surface was 1.5 mm
Why use a lingual approach for Man osseous respective surgery
Tibbets–used for pocket elimination in the mandible, bone ramped toward lingual
more vestibular depth on the lingual
teeth tilted 20 degrees toward lingual, lingual embrasures wider
easier access to defects, which are usually located apical to contact point, which is toward lingual
more attached ging. on lingual
What is alloderm
Allogenic soft tissue graft
What is the post op antibiotic regimen for GTR
- Doxycycline 100mg x 14, 2 tabs bid first day then 1 tabs qd till gone
- can also use Amoxicillin for 1 week post surgery (500 mg qid X 7 days)
Which is better–connective tissue attachment or long junctional epithelium?
In animals a LJE was equally resistant to breakdown as a CT attachment
Why is it a faulty to assume that body will establish its own bio width
it is difficult to “turn off’ bone resorptive inflammatory stage of the process, that visual signs of inflammation are usually present and may be unesthetic.
Cementum healing rates
cementum formation can be detected as early as 3 weeks but up to 6 months are required for maturation.
Seibert class 1 defect
Buccolingual loss of tissue with normal ridge height apicocoronally.
What is a miller class 1 recession
Recession not exceeding the MGJ; no loss of interproximal soft tissue or bone. 100% root coverage is anticipated.
How did wilsons compliance numbers change
32% compliant
48% erratic
20% non compliant
Def of hemisection
The surgical separation of a multirooted tooth, esp. a mandibular molar, through the furcation in such a way that a root and the associated portion of the crown may be removed.
Types of coronally positioned flaps
o Coronally positioned flap without autogenous grafts or GTR
o Tarnow’s semilunar coronally positioned flap
Def of root resection
The separation of a root that may or may not include the retention of that root or the removal of the root with accompanying odontoplasty
Bone fill def
The clinical restoration of bone tissue in a treated periodontal defect
What are indications to return to active therapy from maintenance status
Bleeding on Probing > 20% Evidence of radiographic bone loss Increase in pocket depth Increase in mobility Main reason for treatment failure Inadequate home care by patient Other reasons for treatment failure Inadequate root planing poor surgical technique
What is ENAP
(a gingival curettage with a knife)
sulcular epith. Removed (Although histologically it is not likely we remove all pocket epithelium, furthermore, it is not necessary to remove all pocket epithelium.)
first incision goes to the base of the pocket
Contraindications for root ressection
Its stupid
Insufficient bone supporting remaining roots
Unfavorable anatomic situations (long root trunk, fused roots)
Unable to perform endo treatment in remaining roots
Lack of usefulness of remaining roots
Large discrepancies in adjacent proximal bone heights
Expense or time constraints
Inadequate oral hygiene
Nonrestorability of remaining roots
Bisphosphonate use (especially IV) this is true for most periodontal surgeries
Biologic Width (Cohen 1962 Gargiulo 1961))
connective tissue attachment 1.07mm (most consistent)
epithelial attachment 0.97mm (most variable)
sulcus depth 0.69mm
Total (- sulcus) 2.04mm (remember this number is a mean of a mean)
What did wilson change in his compliance studies in 93
accommodating patient’s schedule
training hygienists at general dental office
scheduling appointments before patient left
telephone and postcard reminders
notification of failed appointments
SPT compliance records
educating staff and patients of importance of SPT
identifying possible noncom pliers early and increasing positive reinforcement
Conective tissue healing rates
up to 4 days, primary healing response within CT is inflammation by macrophages under the polyband (in the clot) to clear necrotic cells.
Fibroblasts have the greatest mitotic activity at 3-4 days, with greatest collagen formation at 7-21 days and completion of maturation at 3-4 weeks
Biological seal
The area between regenerating crevicular epithelium of the gingiva and the implant surface (McKinney, 1985).
Bone resorption facts following surgery
thick bone exhibited less resorption than thin bone
cancellous bone exhibited less resorption than cortical bone
root surfaces showed more bone resorption than interproximal areas (less cancellous bone)
Advantages of osseous respective surgery
visualization of osseous defects
minimal treatment time
simplicity
elimination of additional surgical sites (to obtain autogenous grafting materials)
end up with shallow probe depths which tend to break down less (especially furcations) and are easily maintainable by patient and therapist
Restorative consideration in implant tx planning
A-C restorative dimension: 7mm minimally from the gingiva of the edentulous space to the opposing cusps
M-D restorative dimension: 7mm (4mm for implant with 2mm distance from adjacent teeth)
extra oral sources of bone graft
Iliac crest bone marrow or anterior tibia
Def Maintenance therapy
Maintenance Therapy is an extension of periodontal therapy that is performed at selected intervals to assist the patient in maintaining health. Also known as preventive maintenance, supportive periodontal therapy, recall maintenance.
What were the 84 compliance stats
16% compliant
49% erratic
34% never returned for recall
Miller class 4 recession
Recession to or beyond MGJ with severe loss of interproximal tissues and/or malpositioning of teeth. No root coverage is anticipated.
Militations of osseous respective surgery
length and shape of roots location and dimensions of defects width of bone root prominence relationship of bony defects to adjacent teeth and other anatomic features—i.e. furcations
Def of root amputation
The removal of a root from a multirooted tooth.
What are the average root trunk lengths for max/man molars
max molars-4mm
man molars 3mm
Definition of Ostectomy
removal of supporting bone (bone with PDL attached)
Connective tissue graft facts
o Langer and Langer (coronally positioned flap with connective tissue graft)
o Raetzke pouch
o Tunnel technique (Pat Allen)
What types of procedures yield new attachment
Any flap surgery where the flaps are either replaced or coronally positioned
Modified Widman flaps
Excisional New attachment procedure (ENAP)
Modified ENAP (incision goes to crestal bone)
Anterior Curtain Procedure
Scaling and root planing
What is an Anterior Curtain
used when mid facial pocket depths not >4mm
pockets accessed from palatal aspect
either step back or sulcular incision on the palate for access
facial incisions only to release papilla, but the facial portion of the papilla remains not reflected, and this is referred to as the “curtain”
Why use a palatal approach for max osseous respective surgery
Ochsenbein-used for pocket elimination in the maxilla, bone ramped toward palate
more keratinized tissue on the palate
better surgical access
less bone resorption due to greater amt. Of cancellous bone on palate
defects ramped toward the palate were less likely to expose furcations
Seibert class 3 defect
Combination defect; loss of normal ridge height and width.
What are some guys findings on respective success
Fugazzotto (2001): 96.8% after 13-15 years
Carnevale et al (1998) 93% after 10 years
Carnevale et al (1991): 94% after 3-11 years
Buhler (1988): 68% after 10 years
Erpenstein (1983): 79% after 3 years
Langer et al (1981): 62% after 10 years
Hamp et al (1975): 100% after 5 years
What to do to the membrane before placement
Select proper shape and size
- trim to fit
- extend 3mm beyond edges of defect
- remove sharp angles or corners
- material should lay passively without collapsing into defect (therefore may require bone graft)
- can presuture membrane prior to grafting
- if using resorbable collagen membrane, use a template first in order to get proper size
Recommendation: indications for root coverage surgery
o Esthetics
o Sensitivity
o Progressive recession
o Localized inflammation
GTR def
Procedures attempting to regenerate lost periodontal structures through differential tissue responses.
What to do if membrane becomes exposed in gtr
- maintain with Peridex cleaning—either rinse or swab with cotton-tipped applicator
- consider early removal
- membrane stays occlusive for 4 weeks (Gore-Tex)
- may have less regenerated tissue
What are the most predictable procedures for regenerating intrabony defects
- GTR with ePTFE alone
- Combination of ePTFE and DFDBA
- DFDBA alone
- Insufficient evidence to evaluate resorbable barriers
def of root separation
Splitting of a mandibular molar with the retention of both fragments (i.e. bicuspidization).
Procedures for crown lengthening
gingivectomy (if adequate attached gingiva present)
apically positioned flaps
ostectomy/ostectomy with apically positioned flaps
orthodontic forced eruption, followed by crown lengthening
almost always have to include osseous surgery
Criteria for GTR success
Resolve etiologic considerations -eliminate occlusal trauma -reduce inflammation and infection Good patient oral hygiene a must Prefer non-smokers, or smoke less than 10 cigs/d Prefer stable tooth
What are the types of resection
i. Root Amputation
- Usually for maxillary molars
ii. Hemisection
- Usually for mandibular molars
iii. Root Separation
- Treatment of grade III furcations with adequate bone support around both roots
iv. Tunneling
- Create a grade IV furcation
- Requires horizontal bone loss and divergent roots
What is osseoguard
Resorbable bovine collagen membrane (Type I)
Lacks spacemaking qualities
Excellent membrane for GBR
Resorbed in 6-8 months
What is positive bony architecture
facial scalloping with interproximal areas as high or higher that the facial bone
This is what we strive for.
In posterior sites, a more flat architecture is acceptable.
Advantages of alloplast
Readily available
Unlimited quantity
Sterilizable
Biocompatible
Why are furcations difficult to manage
- Attachment loss tends to progress despite non-surgical therapy.
- 25% of furcation sites with continued attachment loss vs. 10% of molar flat sites.
- Anatomy of area limits access
- 81% of furcation diameters < 1mm wide
- 93% residual deposits after closed scaling/root planing
where are regenerative procedures best
Best in facial or lingual grade II furcations associated with an intrabony component
Def of osteoclasts
reshaping of the alveolar process without removal of supporting bone
Advantages of intraoral bone graft sources
Ease of procurement
Rapid technique
Osteoinductive/osteoconductive/OSTEOGENIC!!
Easy to handle
No potential for disease transmission or antigenicity
What are the design criteria for GTR materials
Biocompatible Cell-occlusive Spacemaking Tissue integration -Wound stabilization -Epithelial inhibition Clinically manageable
Miller class 2 recession
Recession to or beyond the MGJ; no loss of interproximal soft tissue or bone. 100% root coverage is anticipated.
