Periodontal Considerations Flashcards
How long after periodontal treatment should we monitor the gingiva before placing definitive restorations and why?
monitor for 3-6months
gingival tissues recede after treatment so we need to achieve stability before they are placed.
how can poorly fitted crowns and bridges cause periodontal problems? (3)
Cause plaque retention if the fit/contours or pontics are incorrect
Create unfavourable transmission of occlusal forces
Cause pulp damage
how can poorly made RPD’s cause periodontal problems? (3)
Cause plaque retention if the gingival margin is covered
Cause direct trauma
Create unfavourable transmission of occlusal forces
why are fixed prosthesis preferred in terms of maintaining periodontal health? (3)
The provide effective tooth support
They allow clearance of gingival margins
They have rigid connectors
what does the biological width measure mm?
2mm (variable)
what are the supracrestal tissues composed of? (2)
junctional epithelium
supracrestal connective tissue
where should we place restoration margins in mm?
ideally the margin should be 3mm away from bone however If the margin is placed 0.5mm into the sulcus = still acceptable
however 80% of people have recession over 5 years later
what occurs if restoration margins encroach supracrestal attachment? (2)
There is persistent inflammation
There is loss of attachment i.e. pocketing and recession
describe Ante’s law. (1)
The combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth/teeth to be replaced.
what periodontal procedures can aid restorative dentistry? (3)
Gingivectomy
surgical crown lengthening = Removing gingival tissue and alveolar bone
Camouflage of gingival recession ‘to remove the black triangle’
What patients require surgery to increase crown height? (1)
Patients with wear
what are gingivectomies used to correct? (2)
Gummy smiles
Gingival overgrowth
describe the gingival margin heights in healthy tissues. (2)
The gingival margin of the lateral incisor should be 1mm below the gingival margin zenith.
This is the highest point – which is the margin of the canine
The gingival margin line across the incisors from the right canine to the left canine should run parallel to the interpapillary line.
Describe the force that causes periodontal problems? - name examples
Intermittent non orthodontic Horizontal loading i.e. jiggling from Parafunction, abnormal tooth loading and Clasps from dentures
define excessive occlusal forces.
When more force than the body can handle is applied and exceeds the reparative capacity of the periodontal attachment apparatus.
what are excessive occlusal forces caused by? (2)
trauma
parafunction
what are the outcomes of excessive occlusal forces? (2)
- Occlusal trauma
- Excessive tooth wear
Occlusal trauma = injury from occlusal forces that results in changes to the tooth attachment apparatus i.e. PDL, supporting bone and cementum.
what factors impact how mobile a tooth will be (4)
Increased width of PDL
Low height of PDL
Inflammation – in health there is a tight collar of fibrous tissue and collagen = restricted movement, swollen gingiva filled with inflammatory fluid = increased movement.
Morphology of roots: Number, shape and length = small, short root makes teeth more mobile
is tooth mobility always pathological? (2)
No
- it can indicate successful adaptation to functional demands
- physiologic adaption to allow the tooth to bounce and to spread the load.
when should tooth mobility be addressed/when should we intervene? (3)
- Progressively increasing
- Symptoms are present
- Creates difficulty with restorative treatment
how can we treat occlusal trauma and reduce mobility from the widened PDL? (3)
- Control plaque induced inflammation
- Correct abnormal occlusal relations
- Splinting healthy teeth to spread the load and allow the healthy teeth to support
define primary occlusal trauma.
Tissue changes from excessive occlusal forces on a dentition with normal periodontal support (no perio disease)
what are the outcomes of excessive occlusal forces on a healthy periodontium (primary OT) ? (2)
• creates a wider PDL space without the present of periodontal disease
- PDL width increases until forces are dissipated
- Width then stops increasing and stabilises when the force is adequately dealt with
- This is a successful adaptation
- Once the force is removed, the width should go back to normal = reversible - If excessive loading is more than the adaptive capacity
- Width increases until it becomes a functional problem = pathological problem
is inflammation associated with primary and secondary occlusal trauma?
NO - there is no loss/further loss of attachment
define secondary occlusal trauma.
Tissue changes from normal/excessive occlusal forces on a dentition with a reduced but healthy periodontium has less PDL and bone support.
- There is no plaque induced inflammation
- The trauma will not lead to further loss of attachment, just increased mobility
what is fremitus?
- Palpable or visible movement of a tooth when subjected to occlusal forces
How do we assess fremitus?
Put finger on the tooth and ask the patient to close = can feel the movement on the finger
what causes tooth migration/splaying teeth? (3)
- Loss of perio attachment
- unfavourable soft tissue profile
- Unfavourable occlusal forces
what occurs in plaque induced periodontal disease and excessive occlusal force and why? (4)
More bone and attachment loss than in a healthy periodontium.
Why is there more bone loss?
There are Zones of co-destruction;
- Bone resorbed from plaque induced inflammation
- Bone resorbed from excessive occlusal loading
When these happen at the same time = more attachment loss.
what causes horizontal bone loss?
(not related to the occlusal trauma)
When thin bone between two teeth resorbs in inflammation = horizontal bone loss
what causes vertical bone loss?
not related to the occlusal trauma.
When there is resorption caused by inflammation in thick bone with teeth further apart (from increased bone between) = vertical bone loss
does excessive occlusal forces cause gingival recession?
no
when is splinting used to reduce mobility? (3)
(last resort)
When there is mobility due to advanced loss of attachment
When mobility is causing discomfort/difficulty in chewing
If the teeth have to be stabilised before HPT
