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Tim's Cards > Perio II > Flashcards

Perio II Flashcards

1
Q

What Probe measures vertical depth?

What Probe measures horizontal depth?

A

Periodontal probe

Nabers Furcation probe

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2
Q

Maxillary Molar furcation measurements:

A

Facial 4 mm

Mesial 3 mm

Distal 5 mm

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3
Q

Maxillary Bicuspid furcation measurement:

A

Mesial 7 mm

Distal 7 mm

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4
Q

Mandibular Molar furcation measurements:

A

Facial 3 mm

Lingual 4 mm

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5
Q

What is the average root trunk length on the Facial of a Mb 1M?

A

3 mm

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6
Q

How often are there root concavities on the Mandibular molars?

A

neary 100%

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7
Q

_____ is present in 73% of mandibular molars

A

Bifurcation ridge

*bulge coming down from roof

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8
Q

What is the difference between Hamp and Glickman’s furcation classification systems?

A

No class IV in Hamp

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9
Q

A Glickman’s Class I furcation is incipient bone loss in the _______

Is it radiographically evident?

A

furca opening

No

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10
Q

Glickman’s Class II furcation involvment can be a _____ or ______ cul de sac.

Is it radiographically evident?

A

Shallow / Deep

May or may not appear on radiographs

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11
Q

Glickman’s Class III furcation:

Radiograph:

A

Through and through covered by gingiva

Usually radiographically evident

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12
Q

Glickman’s Class IV furcation:

Radiograph:

A

Through and through exposed

Almost always show

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13
Q

Hamp Class I:

Class II:

Class III:

A

less than 2 mm

greater than 2 mm

through and through

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14
Q

T/F

The furcation entrance is often more narrow than the standard curette in first molars

A

True

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15
Q

T/F

Cervical enamel projections are graded I-III depending on how far they go toward the furcation

A

True

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16
Q

____% of mandibular molars with furcation involvement also have CEP’s

(cervical enamel projections)

A

90%

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17
Q

There is a ____% association between a CEP and a furcation involvement

A

50%

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18
Q

CEP’s are present on ____% of Mandibular Molars and ___% of Maxillary Molars

A

28.6%

17%

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19
Q

Enamel pearls are present on 1.1% to 5.7% of permanent molars and ____% on third molars

A

75%

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20
Q

Accessory canals in the roof of the Furca

____% of Maxillary 1st molars

____% of mandibular 1st molars

___% of mandibular 2nd molars

___% of maxillary 2nd molars

A

36%

32%

24%

12%

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21
Q

T/F

Abscess blowouts happen in the furca zone with pulpitis/non-vital teeth

A

True

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22
Q

T/F

There is a very strong association between initial furcation involvement and losing teeth

A

True

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23
Q

Describe the pattern of tooth likelihood to be lost:

A

More root surface, more likely to lose

*multi-rooted teeth more difficult to clean

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24
Q

Concerning Molars, you are more likely to lose _____ teeth than _____.

A

Maxillary

Mandibular

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25
Q

Trauma from Occlusion is defined as damage to the ______ caused by opposing jaw

It is considered to be ______

A

Periodontium

Pathologic

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26
Q

T/F

Direction, Magnitude, Duration, and Frequency of force are variables that relate occlusal trauma to periodontal disease

A

True

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27
Q

What 3 parts of the Peridontium are affected by Occlusal Forces?

A

Cementum

PDL

Alveolar Bone

***gingiva/junctional epithelium NOT affected

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28
Q

Occlusal trauma will thicken the

A

PDL

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29
Q

Occlusal slide in centric relation or centric occlusion is a symptom of occlusal trauma

A

True

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30
Q

What is a tremulous vibratory movement of a tooth when teeth are in functional contact

(detected by finger palpation)

A

Fremitus

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31
Q

With occlusal trauma, there is an initial _____ in PDL width, loss of fiber orentation, hemorrhage, bone resorption, and then widening of PDL

(compression side)

A

decrease

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32
Q

What side has an initial increase in PDL space

A

Tension side

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33
Q

What happens to Cementum on the Tension Side?

A

Cemental Tearing

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34
Q

Describe Primary Occlusal Trauma:

A

Excessive occlusal forces

Normal alveolar bone support

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35
Q

Describe Secondary Occlusal Trauma:

A

Occlusal forces Normal or Excessive

Alveolar bone support reduced

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36
Q

Occlusal Hyperfunction is ____ increase in occlusal force

It is ______, not ______.

A

Slight

Physiologic, Pathologic

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37
Q

What happens to the PDL in occlusal hyperfunction?

What happens to the alveolar bone?

A

increase width, fiber bundles

Increased density/thickness

(also osteosclerosis)

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38
Q

A lack of physiologic stimulation leads to a mild weakeing of supporting structures and is called…

A

Occlusal Hypofunction

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39
Q

Occlusal Hypofunction is considered physiologic or pathologic?

It can only be diagnosed by…

A

Physiologic

Histology

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40
Q

The PDL fibers have _____ orientation in Hypofunction

A

normal

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41
Q

Total removal of occlusal forces is considered physiologic (not pathologic) and is called…

A

Disuse Atrophy

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42
Q

What happens to the PDL in Disuse Atrophy?

Tooth mobility?

PDL fiber orientation?

bony trabeculae?

A

Decrease PDL width

increase mobility

Loss of orientation

decrease - localized osteoporosis

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43
Q

T/F

Trauma in the absence of inflammation causes Gingivitis, Periodontitis, and Pocket Formation

A

False

*causes none of these

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44
Q

Bone loss from trauma alone is….

A

reversible

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45
Q

Periodontitis + occlusal trauma will show remarkable ______ if both issues addressed

A

regeneration

46
Q

Occlusal discrepancies greatly affect ______

A

Periodontal disease progression

47
Q

What is a common iatrogenic disease that degrades the Periodontium?

A

Crown/restoration contour

48
Q

Gingival margin overhangs (due to faulty/iatrogenic restorations) are associated with what 3 things?

A

Gingival inflammation

Bone loss

Microbial plaque and calculus accumulation

49
Q

Normal crown to root ratio:

A

1:1.5

50
Q

Mucogingival surgery, aka…

A

Periodontal Plastic Surgery

51
Q

Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa

A

Periodontal plastic surgery

mucogingival surgery

52
Q

What procedure is used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva.

A

The Pushback Procedure

53
Q

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?

A

Pushback Procedure

54
Q

How much keratinized and attached gingiva is enough to maintain health?

A

At least 2 mm

55
Q

Tooth position that pushes out of alveolar bone can lead to ______ or ______.

A

fenestration

dehiscence

56
Q

Gingival recession may be caused by a thin…

A

biotype

57
Q

T/F

Keratinized tissue is always attached

A

False

58
Q

T/F

Gingival recession defects are treated to increase the width of the keratinized attached gingiva or for root coverage

A

True

59
Q

What are the 3 treatment options for increasing the width of the Attached Gingiva?

A

APF - Apically positioned flap (full thickness)

FGG - Free autogenous gingival graft

CTG - Subepithelial connective tissue graft

60
Q

What are the 3 treatment options for Obtaining Root Coverage?

A

CTG - subepithelial Connective Tissue Graft

Tarnow Procedure - Semi-lunar incision + coronal positioning

LPF - Lateral pedicle flap

61
Q

Describe the APF:

A

Cut top of margin, bring down, suture, new gingiva grows above

*apically positioned flap

62
Q

What is the FGG (free autogenous gingival graft) most often used for?

A

Increase amount of keratinized gingiva

even though first used for root coverage

63
Q

The FGG increases the width of the attached gingiva, removes ______, deepens oral vestibule, or augments _____.

A

abnormal frenulum

ridge

64
Q

What are 3 advantages to the FGG

A

Not technically demanding

partial or full-thickness flap works

Many applications

65
Q

What are 4 disadvantages to the FGG

A

Poor blood supply

Esthetics (looks like tire patch b/c of keratinization)

2 intraoral sites required

Donor site problems (bleeding, pain, slow healing)

66
Q

The CTG (subepithelial Connective Tissue Graft) is indicated to widen _____

to deepen _____

to remove ______

to cover _____

or:

A

attached gingiva

oral vestibule

frenulum

root surface

esthetics (color match)

67
Q

The CTG is most often used for ______

A

esthetic purposes

68
Q

What are 5 advantages to the CTG

A

Predictable

Good blood supply

Donor site (palatal) can be closed

Color match

multiple teeth

69
Q

What are 2 disadvantages to the CTG?

A

Technically demanding

Gingivoplasty often need post (decrease thickness)

70
Q

In the CTG, there is bleeding on both sides and the mucosa is induced to being

A

keratinized

71
Q

Using the CTG technique, re-establishing root coverage is possible provided…

A

There is no bone loss

*blood supply

72
Q

What is an inferior option when using the CTG:

A

Acellular dermal matrix from a cadaver

73
Q

What is used for maxillary anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva?

A

Semi-lunar incision with coronal positioning

Tarnow Procedure

74
Q

The Tarnow procedure can be complimentary after others (FGG, CTG, GTR) were used to obtain…

A

Root coverage

75
Q

What are some (6) advantages to the Tarnow Procedure (semilunar w/ coronal positioning)?

A

No tension coronally

good esthetics

papillary height preserved

simple

minimal discomfort

multiple teeth

76
Q

What are 4 disadvantages to the Tarnow Procedure (semilunar w/ coronal positioning)?

A

Can’t use if greater than 2 mm recession

requires 3-5 mm keratinized tissue

contraction b/c secondary intention

2nd procedure often required

77
Q

If dehiscence/fenestration is revealed in a Tarnow procedure, what should be done?

A

FGG or CTG after coronal positioning of flap

78
Q

Describe the LPF (lateral pedicle flap) procedure:

A

lateral flap cut halfway (not to bone) and flapped over

79
Q

3 Drugs that induce gingival enlargement:

A

Phenytoin (Dilantin)

Cyclosporine (Sandimmune)

Nifedipine (Procardia)

80
Q

2 Types of Leukemia that can cause a gingival enlargement:

A

Acute lymphocytic

Acute myelocytic

81
Q

Classifications of Inflammatory Gingival Hyperplasia:

A

Acute/Chronic

Localized/Generalized

Slight, moderate, severe

82
Q

Name 3 Hormonally induced types of gingival enlargement:

A

Pregnancy

Pyogenic Granuloma

Puberty

83
Q

Manadione is an essential nutrient for ______

A

P. intermedia

84
Q

Menadione = Methyl-maphthalenedione

Progesterone = ________

A

Napthoquinone

*P. intermedia substitutes

85
Q

What bacteria is associated with Pyogenic Granuloma Formation?

A

P. intermedia

86
Q

What is Phenytoin (Dilantin) prescribed for?

A

Epilepsy (and trauma induced seizures)

Severe depression

Severe cluster headaches

87
Q

What is the incidence of Phenytoin (Dilantin) induced gingival enlargement?

When does it begin?

A

50%

1-3 months

88
Q

T/F
There is a positive correlation between Dilantin, gingival enlargement, and poor OHI

T/F
The initial lesion involves gingival papillae

A

True

True

89
Q

The incidence and severity of gingival enlargement associated with Dilantin has no correlation with what 3 factors?

A

Dosage

Plasma levels

Duration

90
Q

Gingival overgrowth incidence by drug: Carbamezepine:

Phenytoin sodium:

Phenytoin sodium + Sodium valporate:

Phenytoin sodium + Carbamazepine:

Phenytoin sodium + Carbamazepine + Phenobarbital:

A

0%

52%

56%

71%

83%

91
Q

Dilantin, mechanism of Gingival Enlargement:

Suppresses 3

Increases 2

Interferes with 1

A

Suppresses: MMP-1, TIMP-1, cathepsin B/L (lysosomal cystein proteinase)

Increases: gycosaminoglycan, PDGF-beta

Interferes: Folic Acid (affecting tissue w/ high turnover rates)

92
Q

T/F

Dilantin can cause gingival enlargement in the endentulous and under partial dentures and around implants

A

True

93
Q

Histologically speaking, Dilantin produces epithelial _______ elongation

A

rete ridge

94
Q

Dilantin causes the accumulation of 2x the amount of _______ and less ______ than normal

A

Type III collagen

Type I collagen

95
Q

Aside from increasing the amount of collagen, Dilantin increases the volume and density of ________

A

non-collagen protein matrix

96
Q

What is the most important Ca++ Channel blocker to know?

A

Nifedipine (Procardia)

97
Q

What is Nifedipine (Procardia) prescribed for?

two things

A

Angina pectoris

Post-myocardial syndrome

98
Q

What is the mechanism of Nifedipine (Procardia)?

A

Blocks influx of Ca++ into heart cells thereby reducing oxygen demands

99
Q

What are 2 components of the pathogenesis of gingival enlargement caused by Nifedipine?

A

Genetic predisposition (must have “responder” fibroblast phenotype - produces more collagen/matrix)

Collagenolysis is Ca++ dependent

100
Q

What condition is Cyclosporine (Sandimmune) prescribed?

A

Major organ transplantation (immune suppression)

101
Q

How does Cyclosporine (Sandimmune) suppress the immune system?

A

Suppresses CD8 specifically

mildly all B-lymphocytes

102
Q

WHO claims 1 Billion people will be on Cyclosporine (Sandimmune) for what 5 conditions?

A

Rueumatoid Arthritis

Sarcoidosis

Malaria

Psoriasis

MS

103
Q

What are 2 theories concerning the mechanism of Cyclosporine (Sandimmune) induced gingival enlargement?

A

Genetic predisposition

increased PDGF (platelet derived growth factor), which increases fibroblast proliferation

104
Q

Describe the epithelial rete ridges in Nifedipine (Procardia)/Cyclosporine (Sandimmune) hyperplasia:

Describe the collagen composition:

A

Elongated

Normal

105
Q

If Nifidipine/Cyclosporine doesn’t alter the collagen composition, what is increased?

A

matrix macromolecules by fibroblasts

106
Q

What are the 2 types of Leukemic gingival Enlargement?

A

Acute lymphocytic

Acute myelocytic

107
Q

What chromosome is associated with Hereditary Gingival Fibromatosis?

What gene is mutated?

A

2p21

SOS1

108
Q

Activation of the SOS1 gene in Hereditary Gingival Fibromatosis results in overproduction of protein which signals the _____ pathway

A

ras

109
Q

The ras pathway prompts cells do what 3 things?

A

Grow

Differentiate

Apoptosis

110
Q

A false gingival enlargement is a buccal _____

A

tori

111
Q

T/F

If there’s no Fremitis there’s no occlusal trauma

A

False

*fremitis is a sign but not necessary for occlusal trauma to be present

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