Perio II Flashcards
1
Q
What Probe measures vertical depth?
What Probe measures horizontal depth?
A
Periodontal probe
Nabers Furcation probe
2
Q
Maxillary Molar furcation measurements:
A
Facial 4 mm
Mesial 3 mm
Distal 5 mm
3
Q
Maxillary Bicuspid furcation measurement:
A
Mesial 7 mm
Distal 7 mm
4
Q
Mandibular Molar furcation measurements:
A
Facial 3 mm
Lingual 4 mm
5
Q
What is the average root trunk length on the Facial of a Mb 1M?
A
3 mm
6
Q
How often are there root concavities on the Mandibular molars?
A
neary 100%
7
Q
_____ is present in 73% of mandibular molars
A
Bifurcation ridge
*bulge coming down from roof
8
Q
What is the difference between Hamp and Glickman’s furcation classification systems?
A
No class IV in Hamp
9
Q
A Glickman’s Class I furcation is incipient bone loss in the _______
Is it radiographically evident?
A
furca opening
No
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
11
Q
Glickman’s Class III furcation:
Radiograph:
A
Through and through covered by gingiva
Usually radiographically evident
12
Q
Glickman’s Class IV furcation:
Radiograph:
A
Through and through exposed
Almost always show
13
Q
Hamp Class I:
Class II:
Class III:
A
less than 2 mm
greater than 2 mm
through and through
14
Q
T/F
The furcation entrance is often more narrow than the standard curette in first molars
A
True
15
Q
T/F
Cervical enamel projections are graded I-III depending on how far they go toward the furcation
A
True
16
Q
____% of mandibular molars with furcation involvement also have CEP’s
(cervical enamel projections)
A
90%
17
Q
There is a ____% association between a CEP and a furcation involvement
A
50%
18
Q
CEP’s are present on ____% of Mandibular Molars and ___% of Maxillary Molars
A
28.6%
17%
19
Q
Enamel pearls are present on 1.1% to 5.7% of permanent molars and ____% on third molars
A
75%
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%
21
Q
T/F
Abscess blowouts happen in the furca zone with pulpitis/non-vital teeth
A
True
22
Q
T/F
There is a very strong association between initial furcation involvement and losing teeth
A
True
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
24
Q
Concerning Molars, you are more likely to lose _____ teeth than _____.
A
Maxillary
Mandibular
25
Trauma from Occlusion is defined as damage to the ______ caused by opposing jaw
It is considered to be ______
Periodontium
Pathologic
26
T/F
| Direction, Magnitude, Duration, and Frequency of force are variables that relate occlusal trauma to periodontal disease
True
27
What 3 parts of the Peridontium are affected by Occlusal Forces?
Cementum
PDL
Alveolar Bone
***gingiva/junctional epithelium NOT affected
28
Occlusal trauma will thicken the
PDL
29
Occlusal slide in centric relation or centric occlusion is a symptom of occlusal trauma
True
30
What is a tremulous vibratory movement of a tooth when teeth are in functional contact
(detected by finger palpation)
Fremitus
31
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
32
What side has an initial increase in PDL space
Tension side
33
What happens to Cementum on the Tension Side?
Cemental Tearing
34
Describe Primary Occlusal Trauma:
Excessive occlusal forces
Normal alveolar bone support
35
Describe Secondary Occlusal Trauma:
Occlusal forces Normal or Excessive
Alveolar bone support reduced
36
Occlusal Hyperfunction is ____ increase in occlusal force
It is ______, not ______.
Slight
Physiologic, Pathologic
37
What happens to the PDL in occlusal hyperfunction?
What happens to the alveolar bone?
increase width, fiber bundles
Increased density/thickness
(also osteosclerosis)
38
A lack of physiologic stimulation leads to a mild weakeing of supporting structures and is called...
Occlusal Hypofunction
39
Occlusal Hypofunction is considered physiologic or pathologic?
It can only be diagnosed by...
Physiologic
Histology
40
The PDL fibers have _____ orientation in Hypofunction
normal
41
Total removal of occlusal forces is considered physiologic (not pathologic) and is called...
Disuse Atrophy
42
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
43
T/F
| Trauma in the absence of inflammation causes Gingivitis, Periodontitis, and Pocket Formation
False
*causes none of these
44
Bone loss from trauma alone is....
reversible
45
Periodontitis + occlusal trauma will show remarkable ______ if both issues addressed
regeneration
46
Occlusal discrepancies greatly affect ______
Periodontal disease progression
47
What is a common iatrogenic disease that degrades the Periodontium?
Crown/restoration contour
48
Gingival margin overhangs (due to faulty/iatrogenic restorations) are associated with what 3 things?
Gingival inflammation
Bone loss
Microbial plaque and calculus accumulation
49
Normal crown to root ratio:
1:1.5
50
Mucogingival surgery, aka...
Periodontal Plastic Surgery
51
Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa
Periodontal plastic surgery
| mucogingival surgery
52
What procedure is used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva.
The Pushback Procedure
53
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
54
How much keratinized and attached gingiva is enough to maintain health?
At least 2 mm
55
Tooth position that pushes out of alveolar bone can lead to ______ or ______.
fenestration
dehiscence
56
Gingival recession may be caused by a thin...
biotype
57
T/F
| Keratinized tissue is always attached
False
58
T/F
| Gingival recession defects are treated to increase the width of the keratinized attached gingiva or for root coverage
True
59
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
60
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
61
Describe the APF:
Cut top of margin, bring down, suture, new gingiva grows above
*apically positioned flap
62
What is the FGG (free autogenous gingival graft) most often used for?
Increase amount of keratinized gingiva
| even though first used for root coverage
63
The FGG increases the width of the attached gingiva, removes ______, deepens oral vestibule, or augments _____.
abnormal frenulum
ridge
64
What are 3 advantages to the FGG
Not technically demanding
partial or full-thickness flap works
Many applications
65
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)
66
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)
67
The CTG is most often used for ______
esthetic purposes
68
What are 5 advantages to the CTG
Predictable
Good blood supply
Donor site (palatal) can be closed
Color match
multiple teeth
69
What are 2 disadvantages to the CTG?
Technically demanding
Gingivoplasty often need post (decrease thickness)
70
In the CTG, there is bleeding on both sides and the mucosa is induced to being
keratinized
71
Using the CTG technique, re-establishing root coverage is possible provided...
There is no bone loss
*blood supply
72
What is an inferior option when using the CTG:
Acellular dermal matrix from a cadaver
73
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
74
The Tarnow procedure can be complimentary after others (FGG, CTG, GTR) were used to obtain...
Root coverage
75
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
76
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
77
If dehiscence/fenestration is revealed in a Tarnow procedure, what should be done?
FGG or CTG after coronal positioning of flap
78
Describe the LPF (lateral pedicle flap) procedure:
lateral flap cut halfway (not to bone) and flapped over
79
3 Drugs that induce gingival enlargement:
Phenytoin (Dilantin)
Cyclosporine (Sandimmune)
Nifedipine (Procardia)
80
2 Types of Leukemia that can cause a gingival enlargement:
Acute lymphocytic
Acute myelocytic
81
Classifications of Inflammatory Gingival Hyperplasia:
Acute/Chronic
Localized/Generalized
Slight, moderate, severe
82
Name 3 Hormonally induced types of gingival enlargement:
Pregnancy
Pyogenic Granuloma
Puberty
83
Manadione is an essential nutrient for ______
P. intermedia
84
Menadione = Methyl-maphthalenedione
Progesterone = ________
Napthoquinone
*P. intermedia substitutes
85
What bacteria is associated with Pyogenic Granuloma Formation?
P. intermedia
86
What is Phenytoin (Dilantin) prescribed for?
Epilepsy (and trauma induced seizures)
Severe depression
Severe cluster headaches
87
What is the incidence of Phenytoin (Dilantin) induced gingival enlargement?
When does it begin?
50%
1-3 months
88
T/F
There is a positive correlation between Dilantin, gingival enlargement, and poor OHI
T/F
The initial lesion involves gingival papillae
True
True
89
The incidence and severity of gingival enlargement associated with Dilantin has no correlation with what 3 factors?
Dosage
Plasma levels
Duration
90
Gingival overgrowth incidence by drug: Carbamezepine:
Phenytoin sodium:
Phenytoin sodium + Sodium valporate:
Phenytoin sodium + Carbamazepine:
Phenytoin sodium + Carbamazepine + Phenobarbital:
0%
52%
56%
71%
83%
91
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)
92
T/F
| Dilantin can cause gingival enlargement in the endentulous and under partial dentures and around implants
True
93
Histologically speaking, Dilantin produces epithelial _______ elongation
rete ridge
94
Dilantin causes the accumulation of 2x the amount of _______ and less ______ than normal
Type III collagen
Type I collagen
95
Aside from increasing the amount of collagen, Dilantin increases the volume and density of ________
non-collagen protein matrix
96
What is the most important Ca++ Channel blocker to know?
Nifedipine (Procardia)
97
What is Nifedipine (Procardia) prescribed for?
| two things
Angina pectoris
Post-myocardial syndrome
98
What is the mechanism of Nifedipine (Procardia)?
Blocks influx of Ca++ into heart cells thereby reducing oxygen demands
99
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
100
What condition is Cyclosporine (Sandimmune) prescribed?
Major organ transplantation (immune suppression)
101
How does Cyclosporine (Sandimmune) suppress the immune system?
Suppresses CD8 specifically
mildly all B-lymphocytes
102
WHO claims 1 Billion people will be on Cyclosporine (Sandimmune) for what 5 conditions?
Rueumatoid Arthritis
Sarcoidosis
Malaria
Psoriasis
MS
103
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
104
Describe the epithelial rete ridges in Nifedipine (Procardia)/Cyclosporine (Sandimmune) hyperplasia:
Describe the collagen composition:
Elongated
Normal
105
If Nifidipine/Cyclosporine doesn't alter the collagen composition, what is increased?
matrix macromolecules by fibroblasts
106
What are the 2 types of Leukemic gingival Enlargement?
Acute lymphocytic
Acute myelocytic
107
What chromosome is associated with Hereditary Gingival Fibromatosis?
What gene is mutated?
2p21
SOS1
108
Activation of the SOS1 gene in Hereditary Gingival Fibromatosis results in overproduction of protein which signals the _____ pathway
ras
109
The ras pathway prompts cells do what 3 things?
Grow
Differentiate
Apoptosis
110
A false gingival enlargement is a buccal _____
tori
111
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
