perio1 Flashcards
Which statement regarding an autogenous free gingival graft is true? Select all that apply.• it can be placed to prevent further recession• it can be used to effectively widen the attached gingiva• it retains its own blood supply and is not dependent on the bed of recipient blood vessels• the greatest amount of shrinkage occurs within the first 6 weeks• it is also useful for covering nonpathologic dehiscences and fenestrations
• it can be placed to prevent further recession• it can be used to effectively widen the attached gingiva• the greatest amount of shrinkage occurs within the first 6 weeks• it is also useful for covering nonpathologic dehiscences and fenestrations
the donor site of an autogenous free gingival graft from which the graft is taken is ?
an edentulous region or the palatal area
The graft epithelium undergoes ? after it is placed. Then it sloughs, the ‘epithelium “ is reconstructed in about ? by the adjacent epithelium and proliferation of ?. In 2 weeks the tissue appears to have reformed, but maturation is not completed until ? weeks
• degeneration • a week • surviving donor basal cells• 10-16
The free gingival graft receives its nutrients from the ?
viable connective tissue bed
The graft may be used to correct ? but not ?
localized narrow recessions or cleftsdeep, wide recessions
Miller classification system for marginal tissue recession:
• Class I: no extension to the mucogingival junction• Class II: extension to or beyond the mucogingival junction + no loss of bone or soft tissue in the interdental areas• Class III: extension to or beyond the mucogingival junction + loss of bone or soft tissue in the interdental areas OR malpositioning of the tooth• Class IV: There is severe bone and soft tissue loss interdentally or severe tooth malposition
the prognosis for classes I and II is ?; whereas for class III, ?. Class IV has ?
• good to excellent• only partial coverage can be expected• a very poor prognosis
Hemisection is most likely to be performed on:• mandibular first and second premolars• maxillary first and second molars• maxillary canines• mandibular molars with buccal and lingual class II or III furaction involvements
mandibular molars with buccal and lingual class II or III furaction involvements
Hemisection has been called ? because it changes the molar into two separate roots.
bicuspidization or segaration
? refers to the separation of an individual root from the crown structure of the tooth.
Root amputation
Most root amputations involve ?
the maxillary first and second molars
Root amputations or hemisections almost always result in irreversible pulpal damage that demands endodontic therapy. Ideally, when the endo is done ?
first
The? pontics have convex undersurfaces, which makes them easiest to clean. The ? designs have concave surfaces, which are more difficult to access with dental floss
sanitary and ovateridge-lap and modified ridge-lap
the ideal pontic form?
ovate pontic (The alveolar bone must be a minimum of 2 mm from the most apical portion of the pontic)
The main goal of osseous recontouring (surgery) is:• to cure periodontal disease• to eliminate the existing microflora• to eliminate periodontal pockets• to change the existing microflora
eliminate periodontal pockets — to reshape the marginal bone to resemble that of the alveolar process undamaged by periodontal disease
The most critical factor in determining whether a tooth should be extracted or have surgery performed on it is ?
the amount of attachment loss
Material to be grafted can be obtained from the same individual (?), from a different individual of the same species (?), or from a different species (?).
autograftsallograftsxenografts
• osteogenic potential of bone grafting materials• osteoinductive potential of bone grafting materials• osteoconductive potential of bone grafting materials
• ability to induce the formation of new bone by cells contained in the graft• (ability of molecules contained in the graft to convertneighboring cells into osteoblasts• ability of the graft material to serve as a scaffold that favors outside cells to penetrate the graft and form new bone
All of the following statements regarding periodontal flaps are true EXCEPT one. Which one is the EXCEPTION!• full-thickness periodontal flaps involve reflecting all of the soft tissue, including the periosteum, to expose the underlying bone• the partial-thickness periodontal flap includes only the epithelium and a layer of the underlying connective tissue• both full-thickness and partial-thickness periodontal flaps can be displaced • flaps from the palate are considered easier to be displaced than those from any other region• flaps should be uniformly thin and pliable
flaps from the palate are considered easier to be displaced than those from any other region (palatal flaps cannot be displaced)
a full thickness flap will be used where the attached gingiva is ?, and a partial-thickness flap may be used when the attached gingiva is ?
thin (2 mm or less in width)thick (2 mm or more)
There are various distal flap approaches used for retromolar reduction. The simplest is the:• gingivectomy • apically positioned flap• distal wedge• laterally positioned flap
distal wedge (sometimes called proximal wedge procedures)
indications to gingivectomy include ?
• elimination of gingival enlargements• Elimination of suprabony pockets, regardless of their depth, if the pocket wall is fibrous and firm• Elimination of suprabony periodontal abscesses
The following factors should be considered when electing to perform a gingivectomy rather than a periodontal flap:• Pocket depth (?)• Need for access to bone (?)• Amount of existing attached gingiva (?)
• if base of pocket is located at the mucogingival junction or apical to the alveolar crest, do not perform gingivectomy• if osseous recontouring is needed, do not do gingivectomy• if inadequate, do not do gingivectomy
A gingivoplasty is directed toward reshaping the gingiva and papilla of a tooth for correction of ?. The overall objective is not to eliminate periodontal pockets but, rather, to provide a ?
• deformities and to provide the gingiva with normal and functional form• more,physiological tissue contour
which procedure is commonly used to correct the tissue contours that result from ANUG
gingivoplasty
The primary objective and advantage of surgical flap procedures in the treatment of periodontal disease is:• reduce or eliminate periodontal pockets• to provide access to root surfaces for debridement• regrowth of alveolar bone• maintenance of biological width• establishment of adequate soft tissue contours
to provide access to root surfaces for debridement (choices are goals but not a primary objective)
The modified Widman flap:• in addition to improving accessibility for instrumentation, removes the pocket wall, thereby reducing or eliminating the pocket• facilitates instrumentation but does not attempt to reduce pocket depth• improves accessibility and eliminates the pocket, but does the latter by apically positioning the soft tissue wall of the pocket• none of the above
facilitates instrumentation but does not attempt to reduce pocket depth
The reduction or elimination of pocket depth is the main purpose of two flap techniques?
• the undisplaced flap (most frequently performed type of periodontal surgery) [=internal bevel gingivectomy]• the apically displaced flap
the two techniques that surgically remove the pocket wall?
the.undisplaced flap and the gingivectomy
A soft tissue graft that is rotated or otherwise repositioned to correct an adjacent defect is called a:• free gingival graft• pedicle graft• connective tissue graft• frenectomy
pedicle graft (The base of the graft remains attached tothe donor site to maintain the blood supply) (designed for repair of isolated not generalized recession)
What is guided tissue regeneration?• a soft tissue graft used to correct mucogingival junction involvement• placement of nonresorbable barriers or resorbable membranes and barriers over a bony defect• a free gingival graft used to increase the amount of attached gingiva• placement of an autograft to treat a bony defect
placement of nonresorbable barriers or resorbable membranes and barriers over a bony defect
The primary reason for the failure of a free gingival autograft is:• infection• edema• disruption of the vascular supply before engraftment• the formation of scar tissue
disruption of the vascular supply before engraftment (The second most common reason is infection)
A variation of the laterally positioned flap is called:• a coronally positioned flap• a modified Widman flap• a double papilla flap• a free gingival flap
a double papilla flap
Techniques used to increase the width of attached gingiva include ? These techniques are used for widening the attached gingiva apical to the area of recession
the free gingival autograft, the connective tissue autograft, the apically positioned flap
Techniques used for gingival augmentation coronal to the recession (root coverage) include ?
• the free gingival and connective tissue autograft, • pedicle autografts (laterally and coronally positioned flaps), • the subepithelial connective tissue graft (Langer), • guided tissue regeneration
The ideal thickness for the free gingival graft is ?
1 to 1.5 mm
There is no necrotic slough of positioned flaps (?) because these flaps take their vascular supply with them
laterally, coronally, and apically positioned flap
Deep periodontal pockets are often treated by flap surgery. These cases will often result in reduced pocket depth by ?, even if there is no change in the position of the gingival margins
formation of a long junctional epithelium (soft tissue reattachment)
The best indicator of success of a periodontal flap procedure is ?
postoperative maintenance and plaque control by the patient
how long after flap surgery, a fully epithelialized gingival crevice with a well-defined epithelial attachment is present? Functional arrangement of supracrestal fibers is initiated
One month
All corners of a periodontal flap should be:• sharp• rounded• it doesn’t matter whether the corners of a periodontal flap are sharp or rounded
rounded
Which of the following has a relatively high degree of predictability and is a “workhorse” of periodontal therapy?• coronally displaced (positioned) flap• laterally displaced (positioned) flap• double papilla flap• apically displaced (positioned) flap
apically displaced (positioned) flap
indications of apically displaced (positioned) flap?
• Moderate or deep pockets• Furcation-involved teeth• Crown lengthening
contraindications of apically displaced (positioned) flap?
• a patient is at risk for root caries• tooth exposure would be unesthetic
For all mucogingival procedures, what is the most significant concern?
blood supply
the root surface of the pocket can be treated to improveits chances of accepting the new attachement of gingival tissues. Several substances have been proposed for this purpose, including ?
citric-acid, fibranectin, and tetracycline. Other agents used include growth factors and one enamel matrix protein derivative obtained from developing porcine teeth (trade name is Emdogain).
Which of the following mucogingival surgical techniques is indicated in areas of narrow gingival recession adjacent to a wide band of attached gingiva that can be used as a donor site?• free gingival autograft• double papilla flap• modified Widman flap• laterally displaced (positioned) flap
laterally displaced (positioned) flap
A free mucosal autograft (subepithelial connective tissue graft) differs from a free gingival graft in that the transplant in a free mucosal graft is:• connective tissue with an epithelial covering• connective tissue without an epithelial covering• epithelial tissue with its own blood supply• epithelial tissue without its own blood supply
connective tissue without an epithelial covering (often used on canines where there is little keratinized gingiva to create a band of gingiva-like tissue)
the epithelium of free gingival grafts degenerates (necrotic slough), and re-epithelialization occurs by ?
• proliferation of epithelial cells from adjacent tissue • surviving basal cells of the graft tissue
Full-thickness flaps,,which denude the bone, result in ?
a superficial bone necrosis (a loss of bone of about 1 mm; bone loss is greater if the bone is thin.)
Which of the following terms refers to reshaping the bone without removing tooth-supporting bone?• ostectomy• osteoplasty• positive architecture• negative architecture
osteoplasty
The most common osseous defects are:• one-wall intrabony defects• two-wall intrabony defects (osseous craters)• three-wall intrabony defects• through-and-through furcation defects
two-wall intrabony defects (osseous craters)
The architecture is said to be “positive” if the radicular bone is ?
apical to the interdental bone.
Flat architecture is ?
the reduction of the interdental bone to the same height as the radicular bone
Osseous form is considered to be “ideal” when ?
the bone is consistently more coronal on the interproximal surfaces than on the facial and lingual surfaces
Angular defects are classified on the basis of ?
the number of osseous walls (one, two, or three walls)
? is the only sure way to determine the presence and configuration of vertical osseous defects
Surgical exposure
? is the most common side effect of osseous grafting
Root resorption
A dehiscence is ?
a loss of the buccal or lingual bone overlaying the root portion of a tooth, leaving the area covered by soft tissue only