Perio II Flashcards
What Probe measures vertical depth?
What Probe measures horizontal depth?
Periodontal probe
Nabers Furcation probe
Maxillary Molar furcation measurements:
Facial 4 mm
Mesial 3 mm
Distal 5 mm
Maxillary Bicuspid furcation measurement:
Mesial 7 mm
Distal 7 mm
Mandibular Molar furcation measurements:
Facial 3 mm
Lingual 4 mm
What is the average root trunk length on the Facial of a Mb 1M?
3 mm
How often are there root concavities on the Mandibular molars?
neary 100%
_____ is present in 73% of mandibular molars
Bifurcation ridge
*bulge coming down from roof
What is the difference between Hamp and Glickman’s furcation classification systems?
No class IV in Hamp
A Glickman’s Class I furcation is incipient bone loss in the _______
Is it radiographically evident?
furca opening
No
Glickman’s Class II furcation involvment can be a _____ or ______ cul de sac.
Is it radiographically evident?
Shallow / Deep
May or may not appear on radiographs
Glickman’s Class III furcation:
Radiograph:
Through and through covered by gingiva
Usually radiographically evident
Glickman’s Class IV furcation:
Radiograph:
Through and through exposed
Almost always show
Hamp Class I:
Class II:
Class III:
less than 2 mm
greater than 2 mm
through and through
T/F
The furcation entrance is often more narrow than the standard curette in first molars
True
T/F
Cervical enamel projections are graded I-III depending on how far they go toward the furcation
True
____% of mandibular molars with furcation involvement also have CEP’s
(cervical enamel projections)
90%
There is a ____% association between a CEP and a furcation involvement
50%
CEP’s are present on ____% of Mandibular Molars and ___% of Maxillary Molars
28.6%
17%
Enamel pearls are present on 1.1% to 5.7% of permanent molars and ____% on third molars
75%
Accessory canals in the roof of the Furca
____% of Maxillary 1st molars
____% of mandibular 1st molars
___% of mandibular 2nd molars
___% of maxillary 2nd molars
36%
32%
24%
12%
T/F
Abscess blowouts happen in the furca zone with pulpitis/non-vital teeth
True
T/F
There is a very strong association between initial furcation involvement and losing teeth
True
Describe the pattern of tooth likelihood to be lost:
More root surface, more likely to lose
*multi-rooted teeth more difficult to clean
Concerning Molars, you are more likely to lose _____ teeth than _____.
Maxillary
Mandibular
Trauma from Occlusion is defined as damage to the ______ caused by opposing jaw
It is considered to be ______
Periodontium
Pathologic
T/F
Direction, Magnitude, Duration, and Frequency of force are variables that relate occlusal trauma to periodontal disease
True
What 3 parts of the Peridontium are affected by Occlusal Forces?
Cementum
PDL
Alveolar Bone
***gingiva/junctional epithelium NOT affected
Occlusal trauma will thicken the
PDL
Occlusal slide in centric relation or centric occlusion is a symptom of occlusal trauma
True
What is a tremulous vibratory movement of a tooth when teeth are in functional contact
(detected by finger palpation)
Fremitus
With occlusal trauma, there is an initial _____ in PDL width, loss of fiber orentation, hemorrhage, bone resorption, and then widening of PDL
(compression side)
decrease
What side has an initial increase in PDL space
Tension side
What happens to Cementum on the Tension Side?
Cemental Tearing
Describe Primary Occlusal Trauma:
Excessive occlusal forces
Normal alveolar bone support
Describe Secondary Occlusal Trauma:
Occlusal forces Normal or Excessive
Alveolar bone support reduced
Occlusal Hyperfunction is ____ increase in occlusal force
It is ______, not ______.
Slight
Physiologic, Pathologic
What happens to the PDL in occlusal hyperfunction?
What happens to the alveolar bone?
increase width, fiber bundles
Increased density/thickness
(also osteosclerosis)
A lack of physiologic stimulation leads to a mild weakeing of supporting structures and is called…
Occlusal Hypofunction
Occlusal Hypofunction is considered physiologic or pathologic?
It can only be diagnosed by…
Physiologic
Histology
The PDL fibers have _____ orientation in Hypofunction
normal
Total removal of occlusal forces is considered physiologic (not pathologic) and is called…
Disuse Atrophy
What happens to the PDL in Disuse Atrophy?
Tooth mobility?
PDL fiber orientation?
bony trabeculae?
Decrease PDL width
increase mobility
Loss of orientation
decrease - localized osteoporosis
T/F
Trauma in the absence of inflammation causes Gingivitis, Periodontitis, and Pocket Formation
False
*causes none of these
Bone loss from trauma alone is….
reversible
Periodontitis + occlusal trauma will show remarkable ______ if both issues addressed
regeneration
Occlusal discrepancies greatly affect ______
Periodontal disease progression
What is a common iatrogenic disease that degrades the Periodontium?
Crown/restoration contour
Gingival margin overhangs (due to faulty/iatrogenic restorations) are associated with what 3 things?
Gingival inflammation
Bone loss
Microbial plaque and calculus accumulation
Normal crown to root ratio:
1:1.5
Mucogingival surgery, aka…
Periodontal Plastic Surgery
Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa
Periodontal plastic surgery
mucogingival surgery
What procedure is used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva.
The Pushback Procedure
What procedure, used Pre-1965, exposes denuded bone during healing, resorbs crestal bone, has a stormy healing phase, poor esthetics, and poor long term results if infrabony lesions aren’t adequately treated?
Pushback Procedure
How much keratinized and attached gingiva is enough to maintain health?
At least 2 mm
Tooth position that pushes out of alveolar bone can lead to ______ or ______.
fenestration
dehiscence
Gingival recession may be caused by a thin…
biotype
T/F
Keratinized tissue is always attached
False
T/F
Gingival recession defects are treated to increase the width of the keratinized attached gingiva or for root coverage
True
What are the 3 treatment options for increasing the width of the Attached Gingiva?
APF - Apically positioned flap (full thickness)
FGG - Free autogenous gingival graft
CTG - Subepithelial connective tissue graft
What are the 3 treatment options for Obtaining Root Coverage?
CTG - subepithelial Connective Tissue Graft
Tarnow Procedure - Semi-lunar incision + coronal positioning
LPF - Lateral pedicle flap
Describe the APF:
Cut top of margin, bring down, suture, new gingiva grows above
*apically positioned flap
What is the FGG (free autogenous gingival graft) most often used for?
Increase amount of keratinized gingiva
even though first used for root coverage
The FGG increases the width of the attached gingiva, removes ______, deepens oral vestibule, or augments _____.
abnormal frenulum
ridge
What are 3 advantages to the FGG
Not technically demanding
partial or full-thickness flap works
Many applications
What are 4 disadvantages to the FGG
Poor blood supply
Esthetics (looks like tire patch b/c of keratinization)
2 intraoral sites required
Donor site problems (bleeding, pain, slow healing)
The CTG (subepithelial Connective Tissue Graft) is indicated to widen _____
to deepen _____
to remove ______
to cover _____
or:
attached gingiva
oral vestibule
frenulum
root surface
esthetics (color match)
The CTG is most often used for ______
esthetic purposes
What are 5 advantages to the CTG
Predictable
Good blood supply
Donor site (palatal) can be closed
Color match
multiple teeth
What are 2 disadvantages to the CTG?
Technically demanding
Gingivoplasty often need post (decrease thickness)
In the CTG, there is bleeding on both sides and the mucosa is induced to being
keratinized
Using the CTG technique, re-establishing root coverage is possible provided…
There is no bone loss
*blood supply
What is an inferior option when using the CTG:
Acellular dermal matrix from a cadaver
What is used for maxillary anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva?
Semi-lunar incision with coronal positioning
Tarnow Procedure
The Tarnow procedure can be complimentary after others (FGG, CTG, GTR) were used to obtain…
Root coverage
What are some (6) advantages to the Tarnow Procedure (semilunar w/ coronal positioning)?
No tension coronally
good esthetics
papillary height preserved
simple
minimal discomfort
multiple teeth
What are 4 disadvantages to the Tarnow Procedure (semilunar w/ coronal positioning)?
Can’t use if greater than 2 mm recession
requires 3-5 mm keratinized tissue
contraction b/c secondary intention
2nd procedure often required
If dehiscence/fenestration is revealed in a Tarnow procedure, what should be done?
FGG or CTG after coronal positioning of flap
Describe the LPF (lateral pedicle flap) procedure:
lateral flap cut halfway (not to bone) and flapped over
3 Drugs that induce gingival enlargement:
Phenytoin (Dilantin)
Cyclosporine (Sandimmune)
Nifedipine (Procardia)
2 Types of Leukemia that can cause a gingival enlargement:
Acute lymphocytic
Acute myelocytic
Classifications of Inflammatory Gingival Hyperplasia:
Acute/Chronic
Localized/Generalized
Slight, moderate, severe
Name 3 Hormonally induced types of gingival enlargement:
Pregnancy
Pyogenic Granuloma
Puberty
Manadione is an essential nutrient for ______
P. intermedia
Menadione = Methyl-maphthalenedione
Progesterone = ________
Napthoquinone
*P. intermedia substitutes
What bacteria is associated with Pyogenic Granuloma Formation?
P. intermedia
What is Phenytoin (Dilantin) prescribed for?
Epilepsy (and trauma induced seizures)
Severe depression
Severe cluster headaches
What is the incidence of Phenytoin (Dilantin) induced gingival enlargement?
When does it begin?
50%
1-3 months
T/F
There is a positive correlation between Dilantin, gingival enlargement, and poor OHI
T/F
The initial lesion involves gingival papillae
True
True
The incidence and severity of gingival enlargement associated with Dilantin has no correlation with what 3 factors?
Dosage
Plasma levels
Duration
Gingival overgrowth incidence by drug: Carbamezepine:
Phenytoin sodium:
Phenytoin sodium + Sodium valporate:
Phenytoin sodium + Carbamazepine:
Phenytoin sodium + Carbamazepine + Phenobarbital:
0%
52%
56%
71%
83%
Dilantin, mechanism of Gingival Enlargement:
Suppresses 3
Increases 2
Interferes with 1
Suppresses: MMP-1, TIMP-1, cathepsin B/L (lysosomal cystein proteinase)
Increases: gycosaminoglycan, PDGF-beta
Interferes: Folic Acid (affecting tissue w/ high turnover rates)
T/F
Dilantin can cause gingival enlargement in the endentulous and under partial dentures and around implants
True
Histologically speaking, Dilantin produces epithelial _______ elongation
rete ridge
Dilantin causes the accumulation of 2x the amount of _______ and less ______ than normal
Type III collagen
Type I collagen
Aside from increasing the amount of collagen, Dilantin increases the volume and density of ________
non-collagen protein matrix
What is the most important Ca++ Channel blocker to know?
Nifedipine (Procardia)
What is Nifedipine (Procardia) prescribed for?
two things
Angina pectoris
Post-myocardial syndrome
What is the mechanism of Nifedipine (Procardia)?
Blocks influx of Ca++ into heart cells thereby reducing oxygen demands
What are 2 components of the pathogenesis of gingival enlargement caused by Nifedipine?
Genetic predisposition (must have “responder” fibroblast phenotype - produces more collagen/matrix)
Collagenolysis is Ca++ dependent
What condition is Cyclosporine (Sandimmune) prescribed?
Major organ transplantation (immune suppression)
How does Cyclosporine (Sandimmune) suppress the immune system?
Suppresses CD8 specifically
mildly all B-lymphocytes
WHO claims 1 Billion people will be on Cyclosporine (Sandimmune) for what 5 conditions?
Rueumatoid Arthritis
Sarcoidosis
Malaria
Psoriasis
MS
What are 2 theories concerning the mechanism of Cyclosporine (Sandimmune) induced gingival enlargement?
Genetic predisposition
increased PDGF (platelet derived growth factor), which increases fibroblast proliferation
Describe the epithelial rete ridges in Nifedipine (Procardia)/Cyclosporine (Sandimmune) hyperplasia:
Describe the collagen composition:
Elongated
Normal
If Nifidipine/Cyclosporine doesn’t alter the collagen composition, what is increased?
matrix macromolecules by fibroblasts
What are the 2 types of Leukemic gingival Enlargement?
Acute lymphocytic
Acute myelocytic
What chromosome is associated with Hereditary Gingival Fibromatosis?
What gene is mutated?
2p21
SOS1
Activation of the SOS1 gene in Hereditary Gingival Fibromatosis results in overproduction of protein which signals the _____ pathway
ras
The ras pathway prompts cells do what 3 things?
Grow
Differentiate
Apoptosis
A false gingival enlargement is a buccal _____
tori
T/F
If there’s no Fremitis there’s no occlusal trauma
False
*fremitis is a sign but not necessary for occlusal trauma to be present
