Perio Midterm Flashcards
What are 5 therapeutic goals of periodontal therapy?
- Resolve Inflammation
- Arrest Disease Progression
- Regenerate lost periodontium
- Deter recurrent disease
- Establish and maintain comfort, function and esthetics
What are 4 therapeutic endpoints to periodontal therapy?
- Plaque control compatible with health
- Shallow sulci (3mm or less pocket)
- Eliminate / minimize BOP and inflammation
- Establish physiologic architecture of soft / hard tissue
When does surgical periodontal therapy normally come into play in periodontal therapy?
After PIOE, diagnosis, scale and root plane 4 quadrants, and eval of intiial therapy
What is included in initial therapy phase for perio?
- Medical consults
2 .OHI - Occlusal adjustments
- Scaling and root planing
What is done at the end Evaluation of Initial Therapy (EIT)?
- Evaluate tissue response
- Evaluate oral hygiene
- Repeat exam and charting
- Determine next treatment options
For scaling and root planing (Sc/RP) effectiveness, what is a general rule?
The deeper the pocket, the less effective
1-3 mm, get 86% calculus free
4-6mm, get 43% calculus free
>6mm get 32% calculus free
With a 4-6mm probing depth, what improvement can be expected with Sc/RP therapy?
1mm improvement (0.96 decrease probing depth and 0.23 increase in attachment)
For 7mm and greater probing depth, what improvement can be expected with Sc/RP therapy?
2mm improvement (2.2mm decrease probing depth and 0.91mm increase in attachment)
For the initial probing depths and their intended outcomes, what is the remaining consideration about the periodontium after therapy?
There is still a probing depth
Incomplete removal of subgingival plaque and calculus results in what two things?
- Persistent infection
2. Continued loss of attachment
What is considered periodontal health with minimal probing depths at EIT?
Up to 4mm probing depth
What is EIT with up to 5mm probing depth?
Periodontal health with residual moderate to severe probing depths
What are 3 treatment options at EIT?
- Periodontal maintenance
- Continue initial therapy (Sc/RP again, systemic antibiotics, local antibiotics)
- Surgical Periodontal treatment
What is the term for surgical manipulation of periodontal soft tissues, tooth roots and bone with the primary goal to create an oral environment that is conducive to maintaining the patient’s dentition in health, comfort, and function?
Periodontal surgery
What are 5 objectives for periodontal surgery?
- Provide access to debride root and bone
- Modify osseous architecture
- Repair / regenerate the periodontium
- Pocket reduction
- Establish acceptable soft tissue contours
What are 5 surgical options for the treatment of periodontitis?
- Open flap debridement
- Osseous resective surgery (pocket elimination)
- Regeneration (guided tissue regeneration)
- Root resection
- Extraction and replace root with implant
What are 5 MORE objectives of surgery?
- Arrest inflammation and disease
- Improve pocket depth and attachment
- Modify osseous architecture
- Establish acceptable tissue contours
- Repair / regenerate the periodontium
At what point is surgical treatment planned?
At EIT
What are findings that indicate a need to continue from initial therapy or maintenance therapy into surgical therapy?
- Deep probing depths
- Increasing probing depths
- Continued BOP
- Suppuration
- Abscess
What are treatment approaches that would allow the goals of stopping disease progression, allowing access to root surface, improving pocket depth and increasing attachment levels, modifying the osseous architecture, and establish acceptable tissue contours?
- Open flap debridement
- Osseous resection (flap and osseous surgery)
- Regeneration
- Mucogingival augmentation
What are 3 types of wound healing following periodontal surgery?
- Reattachment
- New attachment
- Regeneration
What is the term for healing of a wound by reconnection of tissue that has been surgically repaired?
Reattachment
Reattachment would normally occur in what areas after periodontal surgery?
In areas where teeth were not periodontally involved
What is the term for the union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus?
New attachment
What types of connections constitute new attachment after periodontal surgery?
- Epithelial adhesion
- Connective tissue adaptation / attachment
- New cementum
Can new attachment be considered regeneration?
No because there is no new bone
What is the term for formation of new bone, new cementum, and new periodontal ligament about a tooth root surface previously exposed to bacterial plaque?
Regeneration
What are the three requirements for healing to be considered regeneration?
- New bone
- New cementum
- New PDL
What are 3 surgical methods to get a shallower pocket?
- Surgery giving new attachment = open flap debridement
- Surgery giving regeneration = freeze-dried bone and membrane
- Osseous resection
What must be attained before any surgery?
Informed consent
What must a patient have after periodontal surgery?
Escort
What is an anxiolytic that can be prescribed to take 90 minutes before the procedure?
2mg Ativan
For IV sedation, what is the desired drug?
Long acting (valium, versed (barbiturates)) and demerol (opiod)
What is key for the surgical site to ensure an aseptic technique?
Copious irrigation
Are antibiotics indicated prophylactically for periodontal surgery?
Treating post op infection
Which has a higher post-op infection rate: quadrant surgery or sextant surgery?
Quadrant surgery
What are 4 parts of the aggressive treatment of post op infections?
- Debridement
- Drainage
- Culture and Sensitivity
- Antibiotics
What are 3 antibiotics common for treatment of post op infections?
- Amoxicillin 500mg, tid 7 days
- Clindamycin 300 mg qid, 7 days
- Metranidazol
What are 5 ways to atraumatically manage tissue during surgery?
- Crisp incision
- Sharp dissection
- Avoid flap tension
- Avoid flap compression
- Maintain tissue hydration
Where should a flap be widest?
At the base
The Pritchard curette, Young-Good 7/8 and the McCall 13-14 are all tissue curettes used for what? What order are they used in?
All used to debride soft tissue. Curette from larger to smaller. Start with Pritchard, then Younger-Good, then McCall
What is the term for a cut or surgical wound made by a knife, electrosurgical scalpel laser, or other such instrument?
Incision
What are 2 types of incisions?
- Sulcular
2. Inverse bevel / step-back
What is a surgical incision type that puts the blade in the sulcus?
Sulcular
What is an incision type where the first incision is away from the tooth in order to make a new gumline?
Inverse bevel / step-back
What type of incisions increase access, aide in avoiding healthy sites, minimized flap tension, and allows flap postioning?
Vertical-releasing incisions
When are vertical incisions contraindicated?
- Adjacent to osseous defects
- Over or near extraction site
- In area of membrane
- Over canine eminence
- Near mandibular PM to avoid mental nerve
What is an incision that leaves a layer of connective tissue over bone to provide a bed for a graft of gingiva?
Split thickness
Which arch has greater bleeding in surgery?
Mandibular
Is bleeding during surgery related to incision length or field size?
No
What is the average blood loss for a surgery of less than 2 hours?
134 mL
What is the desired INR for a patient on anticoagulation therapy for surgery?
INR 3 or less, 2.5 desired
What is the first line of defense to control hemorrhage?
Pressure
What are 4 local agents that can aide in hemorrhage control?
- Surgicel - oxidized cellulose
- Collacote, Avitene - microfiber collagen
- Gelfoam - gelatin sponge
- Thrombostat - topical thrombin
A blood loss greater than or equal to what mL requires fluid replacement?
Greater than or equal to 500 mL
If systolic pressure drops, how many mmHg indicates fluid replacement?
Greater than or equal to 20 mmHg
What diastolic pressure drop indicates a need for fluid replacement?
Greater than or equal to 10 mmHg
What suture material does perio use a lot?
Vicryl (polyglactin 910)
What suture needle does perio use a lot?
Reverse cutting needle
How many cutting edges does a reverse cutting needle have? Where is there no cutting edge?
3 cutting edges.
No cutting edge on the inside of the curve`
Should you use as many sutures as possible when closing a wound?
No. Use the least number of sutures necessary, in keratinized tissue if able.
Is a periodontal dressing intended for hemostasis?
No, should have hemostasis before placing dressing.
What are 4 purposes for a periodontal dressing?
- Protect wound
- Enhance patient comfort
- Flap stability
- Retain osseous graft material
How long after perio wound is the weak fibrin linkkage and clot adhesion starting?
0-1 days
How long after perio wound is the weak granulation tissue forming?
3 days
How long after perio wound is the moderately strong epithelial attachment and collagen adhesion forming?
14 days
How long after a perio wound is the strong maturation of connective tissue and cementum formation?
21 days
What are 2 types of periodontal dressing?
- Coe-pak
2. Barricaid (light cure resin that Dr Sabatini like for anterior)
What are the motrin prescriptions for post op analgesia?
800mg Motrin, 24 tabs, 1 q8h prn pain
400 mg Motrin, 40 tabs, 2 q8h prn pain
What is the opioid prescription for post op analgesia?
Tylenol #3, 18 tabs, 1 or 2 tabs q4-6 hrs prn pain
What rinse and instructions are used for post-op oral hygiene?
Peridex D.12%, swish 1/2 or bid for 30 seconds
Where is the distance from the inferior alveolar nerve to the apex of the tooth the shortest?
3rd molar
The opening of the mental foramen faces which directions?
Upward and distal
How many branches does the mental nerve divide into?
Three branches:
One to skin of chin
Two to skin and mucous membrane of lower lip and labial alveolar mucose
Do you ever do a flap or thin the flap on the lingual of the mandible and why?
No. The lingual nerve is in that tissue and laying a flap there would risk damage.
Does the lingual artery travel with the lingual nerve?
No
Which 2 arteries are direct branches of the external carotid artery?
- Lingual artery
2. Maxillary artery
The maxillary artery gives rise to what other branch?
Inferior alveolar artery
The inferior alveolar artery gives rise to what branch?
Mental artery
What is an anatomic region that is occupied by glandular and adipose tissue covered by unattached nonkeratinized mucosa?
Retromolar triange
What is a muscle that separates the sublingual space and the submandibular space which is a big consideration?
Mylohyoid muscle
What is a variant of normal that is a small soft tissue mound lingual of the mandibular cuspids that is only a development remnant and has no pathologic significance?
Retrocuspid papilla
What is the term for a sinus that expands around the roots of teeth?
Pneumatized sinus
What are 3 nerves that branch off CNV maxillary division?
- Greater palatine nerve
- Superior alveolar nerves
- Nasopalatine nerve
What is the main reason we do not do palatine flaps?
Greater palatine foramen in the area of 2nd and 3rs molar dumping out the greater palatine nerve
What branch of the external carotid crosses the external angle of the mandible?
Facial arteru