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Classic Lit Fall 2021 > Perio Plastics III > Flashcards

Perio Plastics III Flashcards

1
Q

What is included in “1st generation” treatment for root coverage?

A

Pedicle flaps w/ or w/o autologous CTG

GTR based root coverage procedures

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2
Q

What is included in “2nd generation” root coverage procedures?

A

Pedicle flaps w/ CTG substitutes (ADM/CM)

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3
Q

What is included in “3rd generation” root coverage procedures?

A

pedicle flaps w/ tissue-engineered biomaterials: EMD/PDGF/PRP/Cell Therapy

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4
Q

What are pros/cons of ADM/CM?

A

no donor site
less time
unlimited amount

Long term instability/rebound
CTG better
NO CREEPING ATTACHMENT

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5
Q

What are pros/cons of 3rd generation treatments?

A

no donor site
may promote regeneration

less results
less predictable
expensive

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6
Q

What are the 3 (broad) procedures that can be used to correct soft tissue defects?

A

Mucogingival procedures (pedicle flaps)
Soft tissue grafts (xCTG, FGG, ADM)
GTR (resorbable or non-resorbable)

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7
Q

What pair coined the term “compartmentalization” and what was the new term? What was the evolution?

A

McCulloch et al. 1987 (with Melcher)

Melcher said compartmentalization just with PDL

McCulloch said PDL/Cementum/Bone Cells (Open Compartmentalization)

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8
Q

Who first used GTR for recession coverage?

A

Tinti & Vicenzi 1990

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9
Q

What kind of membrane did they use in the first GTR for recession coverage?

A

ePTFE

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10
Q

How does GTR w/ non-resorbable membrane compare to mucogingival surgeries for root coverage?

A

Pini Prato et al. 1992 (RCT) & 1996 (4yr follow up)
GTR w/ ePTFE vs FGG then CAF

NSSD in root coverage
Stable over 4 years

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11
Q

What are advantages of Collagen Membranes in GTR for Root Coverage?

A 
Wang et al. 2012
(BiG CHeeSe)
Biocompatible
Gingival Thickness 
Chemotactic
Hemostatic
Semi-permeable (gas and nutrient exchange)
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12
Q

How does CAF compare to CAF+XCM?

A

Jepsen et al. 2013

RCT-Split Mouth

Root coverage: NSSD
Complete root coverage: NSSD

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13
Q

How does CAF+CTG compare to CAF+XCM?

A

Tonetti et al. 2018

RCT - 187pts

CM+CAF: Shorter surgery, 2days shorter healing
CAF+CTG: OR for CompleteRC=4.0 vs CM+CAF

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14
Q

What articles can you use to support an opinion of mucogingival surgery > GTR for root coverage?

A

Al-Hamdan et al. 2003

Cairo et al. 2014

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15
Q

Would you consider performing a GTR for a recession defect instead of other recession coverage procedures?

A

NO!

Al-Hamdan et al. 2003 (Dr. Wang)

Meta-Analysis: GTR vs Conventional Mucogingival Surgery (CMGS) for root coverage

Recession reduction: CMGS > GTR
CRC: CMGS > GTR
KG gain: CMGS > GTR

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16
Q

Cairo et al. 2014

A

CAF + GTR: No benefit vs CAF alone

CAF + CTG: superior clinical outcomes - more CRC vs CAF+EMD, CAF+GTR, CAF+CM

17
Q

How does cGTR compare to CAF?

A

Lee et al. 2002

NSSD Clinical outcomes
CAF had more KT increase

GTR had more New Attachment at CT in histology

DID NOT MEASURE GT!!! - Necessary for success

18
Q

What types of ADM are there?

A 
Freeze-Dried (FDADM)
Solvent Dehydrated (SDADM)
19
Q

how is FDADM made?

A

Epidermis removed using buffered saline solution
Non-denaturing detergent used to dissolve cell types within dermis
Cryo-preservant used to prevent crystal formation when tissue is freeze dried

20
Q

How is SDADM made?

A

Osmotic, Oxidative, and Alkaline treatments
Tissue placed in gradients of Acetone (solvent dehydration)
Limited-dose gamma irradiation to sterilize

21
Q

How does CAF + FDADM compare to CAF + SDADM?

A

Wang et al. 2014/2015

NSSD 1yr outcomes

22
Q

How does ADM compare to sCTG for root coverage?

A

Network Meta-analysis
Barootchi et al. 2021

Root Coverage: CTG > ADM > CM
GT: CTG > ADM = CM
KTW: FGG > ADM > CM > APF

23
Q

What examples are there for tissue scaffold (citations)

A

Milinkovic et al. 2015 - Fibroblast seeded scaffold

McGuire & Nunn 2005 - human fibroblast derived dermal substitute

24
Q

McGuire & Nunn 2005

A

Allograft cell + Scaffold had similar outcomes to FGG

FGG 1-2mm > KTW

25
Q

Milinkovic et al. 2015

A

Autologous Fibroblast Cell Culture (AFCC) + Collagen matrix + CAF

Recession coverage, KTW, CAL NSSD
KTW greater in CTG

26
Q

What types of tissue enginering are there?

A

Passive

Active

27
Q

What is an example of “passive” tissue engineering?

A

No Cells

ADM
Collagen
GTR based (ePTFT/Collagen/Periostium)

28
Q

What are the implications of PASSIVE tissue engineering?

A

No cells

so NO Creeping attachment
NO KG
Cannot tolerate exposure

29
Q

What is a strip graft?

A

use of things like ADM as a wound dressing material

30
Q

What is “active” tissue engineering?

A

“Living Cell Construct” - McGuire

31
Q

What is “living cell construct?

A

ADM/Dermis
Collagen
GTR base

WITH - cells impregnated

32
Q

What is the prevalence of recession in older populations? (Citation)

A

88% of people 65yrs and older

Kassab & Cohen 2003

33
Q

How can you grow papilla orthodontically?

A

Move 2 teeth! Not just 1
Moving just 1 doesnt change the interproximal papilla
Moving 2, then implant, bone is higher for papilla

34
Q

After performing a CTG - what how do you get it to express KG?

A

Remove epithelial covering after 8-10 wks (Karring 1975)

35
Q

How thick does the tissue have to be for GTR based root coverage? Citation

A

Harris et al.
<0.5mm 26% coverage
>0.5mm 96% coverage

Hwang & Wang: >1mm

36
Q

What is the average root coverage for GTR based root coverage?

A

75%

37
Q

What types of root conditioning is there?

A

Citric Acid
Tetracycline (pH 1-3)
EDTA (pH 7.2-7.6)

38
Q

What is the problem with Citric acid or Tetracycline?

A

Its more acidic - causes constriction of the blood vessels/coagulation

39
Q

What 3 factors should be considered for root coverage studies?

A

GT
KTW
Bone level of adjacent teeth

Classic Lit Fall 2021 (29 decks)

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