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.
Using FGG over graft sucess
66%
Diabetes and implants
Too few patients (5) in the study to conclusively demonstrate a correlation to implant failure
Type 2 diabetes patients had 92.2% implant survival rate vs 93.2% for non-diabetic patients. It was determined that diabetes was a marginal risk to long-term survival
What will bio width violation result in
marginal/alveolar inflammation
attachment loss
gingival recession
distance needed from restorative margin to bone to not violate Biologic width according to Ingber
3mm
Prichard denudation
Works well in 2- and 3-walled defects, resulting in 2-4mm of bone fill within the defects.
Required Steps
Removal of gingiva to margins of bony walls of defect
Removal of transseptal and alveolar crest fibers, and granulation tissue
Removal of all calculus (Prichard did no root planing)
Use of surgical dressing
Optional Steps
Use of an antibiotic
Occlusal adjustment
No presurgical scaling
Limitations of alloplast
No inductive potential
May be difficult to handle
Primarily a space filler
Haven’t enjoyed very good success in the literature
GTR incisions
Sulcular incisions, full thickness flaps, preserve interdental papillae
-tissue augmentation prior to surgery if needed
Vertical release incisions as needed
-more than one tooth beyond defect
Surgical considerations in implant tx planning
B-L dimension: 6mm (4 for implant with 1mm of bone surrounding implant)
2mm from any anatomical structures
What is the michigan study
Maintenance study
Patients treated with surgical or nonsurgical therapy then seen every 3 months for SPT
Maintained for long periods of time despite non-ideal home care
Regardless of therapy, SPT works
Maynord and Wilson say you need this much keratinized tissue to place a margin subgingivally
5mm, 2 free and 3 mm attached
Autogenous Bone graft
GOLD STANDARD
Tissue taken from one site and placed into another site in the same individual
Whats the biggest reason for failure in resection
root fracture
Lateral pedicle graft concern
might cause recession at donor site
Types of hard tissue graft
Autogenous
Allografts
Alloplasts
Xenografts
Alloplast wound healing
Alloplasts tend to heal with fibrous encapsulation of the material
Minimal or no bone formation apparent in most histologic studies
Primary function: Act as biocompatible space fillers
Clinical results similar to osseous grafts and GTR procedures
Osteoconduction def
Formation of new bone by host cells where the graft merely provides a scaffold for growth
What are the furcation tx options
Regeneration
Resection
Clean out procedures
Are allografts safe?
Processing of DFDBA renders it safe for use (Mellonig, 1992)
Exclusionary techniques
Defatting and viral inactivation with 70% ethanol
Decalcification in 0.6N HCL
Disadvantages of using autogenous extra oral source
Additional surgical site Has caused root resorption Increased patient morbidity Additional expense Technique sensitive
Whats the AAP def of mucogingival surgery
Periodontal surgical procedures used to correct defects in the morphology, position and/or amount of gingiva.
What type of closure is needed for gtr
primary
- interrupted or mattress sutures
- don’t suture flaps too tightly
Delayed implant placement
Placement of dental implants 4-6 months after extractions
WHAT ARE CONSIDERATIONS FOR NON RESORBABLE MEMBRANE REMOVAL
Remove after 4-8 weeks
Minor flap elevation
Gentle dissection of membrane
De-epithelialize inner surface of flap
Do not disturb newly regenerated tissue—will usually look “beefy” red
Complete closure over newly regenerated tissue
what is the stability of gingival margin after can lengthening
Thus, in posterior sites, typical minimal 6 weeks of healing is sufficient for restorative tx, but in esthetic areas, changes may occur even past 6 months! However, if the gingival margin is placed at 3 mm above the osseous crest at the time of surgery (establishing biologic width), earlier stability may result.
What are the most predictable procedures in class 2 furcations
- Combination of ePTFE with DFDBA
- Combination of composite graft with ePTFE
- GTR with ePTFE alone
- Iliac grafts
- Alloplast
Repair definition
Healing of a wound by tissue that does not fully restore the architecture or function of the part.
Osteoinduction def
Stimulation of host cells to differentiate and form new bone.
Smooth v rough implants
When one looks at overall success rates of smooth versus rough implants, they are pretty much the same. However, as Cochran’s research shows, when implants are placed in less desirable sites (i.e. posterior maxilla, sites with poor quality bone, immediate extraction sites where there will be a gap between the implant surface and healing extraction site….) it may be beneficial to use a surface other that smooth titanium (such as TPS, HA, etched, TiUnite [NobleBiocare’s new surface—reportedly an increased titanium oxide layer], or ITI’s SLA surface [sand-blasted, acid attacked/etched]). Also, rough surface implants provide earlier integration; thus, allowing immediate and delayed immediate implant placements as well as immediate and delayed immediate implant loading possible.
Previous periodontist and implants
Immediate implants placed at previous periodontitis sites were 2.3 times more likely to fail (8.2% vs. 3.7%)
Rate of bone loss around Brånemark implants (0.09mm) not influenced by progression of periodontitis around remaining teeth (0.48mm)
309 implants in partially & fully edentulous jaws of patients with a history of aggressive periodontitis. Success rates: 97% (mand) & 98% (max).
What is emdogain
Absorbable enamel matrix protein derivative including amelogenin, derived from porcine origin
Applied to root surfaces during periodontal surgery
Only material indicated in 1 wall osseous defect
Some studies indicate regeneration including cementum
What is the tucson study
Untreated patients tooth mortality = 0.36 teeth/pt/year Treated, but not maintained patients tooth mortality = 0.22 teeth/pt/year Treated and maintained patients tooth mortality = 0.11 teeth/pt/year Best results or least tooth mortality seen with treated and maintained patients
Regeneration definition
reproduction or reconstitution of a lost part such as a fully functional PDL, cementum or alveolar bone
Osteogenesis def
New bone formation derived from viable undifferentiated cells or osteoblasts residing within the graft.
Seibert class 2 defect
Apicocoronal loss of tissue with normal ridge width buccolingually.
What areas are regeneration less successful and less predictable
Less success in mesial or distal maxillary furcations
Unpredictable results in grade III defects
What method of regeneration is most predictable
Combination of bone graft + membrane most predictable
Less recession, greater horizontal attachment gain with Guidor vs. Gore Tex
Properties of an ideal alloplast
Biocompatible Induce osteogenesis Readily obtainable Convenient Inexpensive Radiopaque Sterilizable Resorbable
How does defect morphology affect regenerative sucess
Vertical defects work best: 3-walled > 2-walled > 1-walled
Furcations: Variable results Grade II > Grade III, Buccal > Lingual > MB=DB
Horizontal defects: Worst
Peri implantitis
Infection of the peri-implant epithelium and connective tissue potentially resulting in marginal bone loss and implant failure (Berman, 1989). A term used to describe inflammation around a dental implant and/or its abutment. (AAP Glossary of Terms, 2001) -an inflammatory process affecting the tissues around an osseointegrated implant in function that results in loss of supporting bone. Bone loss is typically circumferential (“saucerization”)
What is the AAP World Workshops opinion on root biomodification
Its shit
Indications for crown lengthening
fractured teeth
subgingival caries
wear
esthetics—(i.e. incomplete passive eruption (altered passive eruption))
root perforations or root resorption needing repair
surpaeruption for pros restoration
Biointegration
Osseointegration in which a direct biochemical implant interface occurs that is confirmed at the electron microscope level (Meffert, 1987). Meffert associates this type of integration with “bioactive materials” such as calcium-phosphate or ceramic materials. A bonding of living bone to the surface of an implant which is independent of any mechanical interlocking mechanism. (AAP Glossary of Terms, 2001)
Is sex a factor in implant sucess
no
What are the types of maintenance
- Preventive
Accomplished in periodontally healthy patients
To prevent inception of disease - Trial
To maintain borderline conditions over a period of time while assessing the need for corrective therapy.
Not sure if patient needs surgery - Compromise
Slow the progression of disease in patients unable to receive needed corrective therapy
Patient needs surgery, but can’t receive it due to health, finance, inadequate home care, etc. - Post-Treatment
Intended to prevent recurrent disease and maintain health achieved during therapy
What are the indications for ressection
Severe bone loss affecting one or more root
Grade II or III furcation involvements
Unfavorable root proximity with adjacent teeth
Root fracture, perforation, caries or resorption of root
When required endo treatment of a particular root can’t be performed
What are allografts
grafts between genetically dissimilar members of the same species
Gem 21s
contains -TCP, and rhPDGF-BB
Advantages of using extra oral source for bone graft
Most predictable (i.e. most research to support)
Greatest induction potential
Potential for osteogenesis
Sufficient quantities
May be stored
Easy to handle
No potential for disease transmission or antigenicity
What did the scandinavian studies show
SPT every 2 weeks for 2 years vs. no SPT for 2 years
All patients treated surgically by a variety of surgical modalities
test group maintained health
control group lost attachment
Treatment without SPT does not last
Flap curettage and regeneration
Variable amount of new connective tissue attachment, bone fill and new cementum formation.
Clinically have PD reduction and AL gain, however, this is primarily due to healing by long junctional epithelium formation.
What is creeping attachment
o a phenomenon of additional root coverage during healing which my be observed between one month and one year post-grafting of up to 1.2 mm of coronal creep at one year with free autograft procedures
Technique and rationale for using EDTA for root modification
Neutral EDTA – (PrefGel) commonly used with Emdogain. Removes smear layer with no antibacterial effect. Place for 2 minutes.
Rationale
removes smear layer
neutralizes endotoxin
opens dentinal tubules for CT ingrowthexposes dentinal matrix and growth factors located there
roughens surface preventing epith. migration
bactericidal
prevents collagenase production by the host (TCN)
binds to Ca (TCN)
What biomodification can be considered in procedures where flaps are replaced against prev diseased root surfaces
citric acid or tetracycline (TCN) may be considered
Whats a modified widman flap
three incision technique (“step back”, sulcular, connecting)
tissue reflected to the mucogingival junction
papillae typically sutured in a mattress suture technique, although interrupted is perfectly acceptable
Indications of osseous respective surgery
to correct pockets in areas of bony ledges
to correct shallow pockets 4-6mm deep in posterior areas
to be used with apically positioned flaps for pocket elimination or esthetic crown lengthening
Limitations of allografts
Poor success in furcations Antigenicity (?) Disease transmission: 1/8,000,000 Unpredictable Possible long resorption time
What is the glickman classification
Grade I: Pocket formation into flute of furca. Bone intact
Grade II: Pocket formation and bone loss of varying depths into furca. Does not go completely through furcation
Grade III: Complete loss of interradicular bone. Probeable to opposite side of tooth
Grade IV: Loss of attachment and recession resulting in clinically visible furca
Advantages of Allografts
Adequate material for large defects Osteoinductive - DFDBA Osteoconductive – DFDBA, FDBA Ease of procurement Can be used as an expander for autogenous bone Easy to handle
What must be done to the bone in GTR
- ¼ or ½ round bur for perforation of cortex
- allows cells from bone marrow origin to repopulate wound
What is biomed
Resorbable bovine collagen membrane (Type I)
Lacks spacemaking qualities
Good membrane to suture
Completely absorbed in 4-8 weeks
How to use tetracycline for root mod
use tetracycline at 50mg/ml but <100mg per ml
take a 250mg capsule, empty contents into dappen dish, add 5cc of sterile water, mix and use supernatant
Immediate implant placement
Placement of dental implants at the time of extractions
Disadvantages of intraoral bone graft sources
Limited quantity of material
Need for second surgical site
Have deep can the craters be and still be eliminated by resection
craters 1-3mm deep can be eliminated by resection
deeper craters must be partially eliminated (compromised tx>) or can be grafted for regeneration
root trunk lengths and furcations limit the amount of bone that can be removed by osseous
resection
Esthetic considerations in implant tx planning
Implant to tooth distance: 2mm to maintain interproximal papillae
Implant to implant distance: 3 mm to maintain interproximal papillae
Immergence profile: implant platform placement at 3mm from gingival margin (or adjacent teeth CEJ)
Fibro osseous integration
A tissue to implant contact with inter-position of healthy dense collagenous tissue between implant and bone (AAID Terms, 1986).
Alloplast def
Implant of inert material
Smoking and implants
Smokers have twice the implant failure (11.28%) of non- smokers (4.76%), though success rates still high
Implant failures pre loading was 9% in non-smokers and 26% in smokers
Implant failure in smokers was 14.9% vs 7.5% in non-smokers using Core-Vent implants. HA-coated failed 4.8% of the time in smokers, 2.4% in non-smokers while non-cated implants failed 11.7% in non-smokers and 16% in smokers. Preop antibiotics decreased failure rate to 4.7% for both smokers and non-smokers
Smoking had no significant impact on the marginal bone loss around Brånemark implants
Smokers had less success than non-smokers (84.2% vs. 98.6%). Heavy smokers had the most failures vs. moderate smokers vs. light smokers (HS = 30.8%, MS = 12%, LS = 9.1%)
Average furcation entrance depths for max man molars and max bicuspids
max molars M-3.6mm, B-4.2mm, D-4.8mm
man molars B-4mm, L-5mm
Max bicuspids M-7mm
GBR def
Procedures attempting to augment alveolar ridge or bone around implants
What is the post op care regimen for GTR
Monitor patient closely
-weekly for 4 weeks, biweekly until membrane removal (6-8weeks)
Maintain meticulous plaque control
Avoid brushing/flossing of area for 4-8 weeks
No probing for 6 months
What is goretex
Expanded polytetrafluoroethylene (ePTFE)
Highly negative fluorine atoms form protective sheath, leading to polymer that is inert and stable
Lower surface energy leads to non-sticking surface
Resistant to even the most corrosive chemicals
Forms: tubes, sheets and filaments
Expansion produces microstructure of solid nodes and fine fibrils which can be varied in length
What is the camp classifications
Degree I: Horizontal loss of periodontal tissue support < 3mm
Degree II: Horizontal loss of support >3mm but not encompassing the total width of the furcation
Degree III: Horizontal through-and-through destruction of the periodontal tissue in the furcation
Perimucosal seal
A seal at the base of the sulcus produced by junctional epithelium and dense circumferential bands of connective tissue
What are the regenerative techniques
Flap curetage
Epithelial exclusion
Hard tissue grafting
GTR
What must be done to root prior to membrane placement
Meticulous debridement of root and defect
Furcation clean out procedure description
Open flap debridement with or without osseous modification
-Consider use of chemical root biomodification for new attachment
Unlikely to close furcation
Difficult maintenance
Blood vessels healing rates
revascularization takes place as early as 3-4 days after surgery and continues for 10-15 days
Miller class 3 recession
Recession to or beyond the MGJ combined with some loss of interproximal bone or soft tissue and/or malpositioning of teeth. Partial root coverage is anticipated.
Types of adjuncts used in GTR
o ePTFE membranes o Collagen membranes o Polymer membranes o Emdogain o Gem 21
Relative contraindications for GTR
Prosthetic heart valves (depends on valve and membrane used)
Prosthetic devices
Heart defects, rheumatic heart disease
Uncontrolled diabetics
Bisphosphonates (IV especially), this is true for most periodontal surgeries
Flyers?
Types of allografts
Freeze Dried Bone or Demineralized Freeze Dried Bone (FDBA or DFDBA
New attachment definition
The union of connective tissue with a root surface that has been deprived of its original attachment. This can occur without the formation of new bone or cementum; can be CT attachment or JE
Epithelial regeneration rates
Grows at the rate of .5-1mm per day, takes place underneath the clot, begins in 6-12 hrs after surgery, once wound is covered, keratinization completed by 14-17 days.
Delayed immediate implant placement
Placement of dental implants 6-8 weeks after extractions
Albrektsso criteria
- no clinical mobility,
- no radiographic peri-implant radiolucencies,
- <0.2 mm annual bone loss following the implant’s first year of service and,
- lack of pain, infection, paresthesia or violation of the mandibular canal
What is bioguide
Resorbable bilayer porcine collagen membrane (Type I and III collagen)
Lacks spacemaking qualities
Excellent handling properties
Reportedly functions as an effective barrier longer than BioMend
Resorbed within 24 weeks
What type of healing is usually seen in new attachment
healing is predominately by long junctional epithelium
What are the 6 general principles of mucogingival surgery
- Flaps should be broad enough at their base to include major gingival vessels;
- A flap’s length to width ratio should not exceed 2:1;
- Minimal tension should be produced by suturing techniques and the tissue should be managed gently during the surgical procedure;
- Partial thickness flaps covering avascular areas should not be too thin so that more blood vessels are included in them; and,
- The apical portion of periodontal flaps should be full thickness when possible. Morman and Ciancio (1977)
- For connective tissue grafts, appropriate graft donor material should consist of keratinized tissue with a dense lamina propria. Studies by Karring, et al. (1975) found that the phenotypic expression of epithelial surface was determined by the underlying connective tissue.
Osseointegration
Contact established without interposition of non-bone tissue between normal remodeled bone and an implant entailing a sustained transfer and distribution of load from the implant to and within the bone tissue (AAID, 1986). A direct contact, on the light microscopic level, between living bone tissue and an implant. (AAP Glossary of Terms, 2001)
Xenografts
Tissue derived from another species
Reattachment definition
Reunion of connective tissue with a root surface on which viable periodontal tissue is present.
(As when a flap is placed replaced and no debridement is done).
What are some treatment precautions of complete resection
- Complete resection
Use explorers or take radiographs to assess complete resection through furcation
Would complicate restorative and maintenance procedures
Requires second surgical procedure to remove - Establishment of biologic width
Average distance from floor of pulp chamber to most coronal area of root separation is 2.70mm
Restoration may impinge on biologic width
Peri-implant mucositis
an inflammatory process distinguished from peri-implantitis by the lack of bone loss (reversible, similar to gingivitis)
two types of epithelial exclusion
Prichard denudation
Use of FGG over grafts
What is boomed extend
Resorbable bovine collagen membrane (Type I)
Lacks spacemaking qualities
Good membrane to suture
Completely absorbed in 18 weeks
