Periodontal Flap Procedures (Part I)

Question 1

Regeneration =

Answer 1

New alveolar bone, cementum & PDL

Question 2

Describe new attachment in tissue attachment-healing:

Answer 2

The union of connective tissue with a root surface

Question 3

The union of connective tissue with a root surface that has been deprived of its original attachment apparatus:

Answer 3

New attachment

Question 4

Give an example of new attachment seen in tissue attachment-healing:

Answer 4

reunion of connective tissue with the root surface which has been pathologically exposed

Question 5

The reunion of connective with a root surface which has been pathologically exposed:

Answer 5

New attachment

Question 6

The reunion of connective tissue with a root surface on which viable periodontal ligament tissue is present:

Answer 6

Reattachment

Question 7

Example: where biologic width (now termed supracrestal tissue attachment) existed before a flap was reflected, and when the flap is replaced, reattachment occurs with the intact connective tissue fibers:

Answer 7

Reattachment

Question 8

New name for biologic width:

Answer 8

Supracrestal attachment

Question 9

We reflect a flap, stitch it back down, and over time it heals back to normal. This is an example of:

Answer 9

Reattachment

Question 10

The healing of a wound that does NOT fully restore the architecture or function of the part:

Answer 10

Repair

Question 11

What is the primary example of repair:

Answer 11

Healing by a long junctional epithelium

Question 12

Healing by a long junctional epithelium:

Answer 12

Repair

Question 13

Provide a term for the following definitions:

1. Reproduction or reconstitution of a loss or rendered part
2. The union of connective tissue with a root surface that has been deprived of its original attachment apparatus:
3. The reunion of connective tissue with a root surface on which viable PDL tissue is present:
4. The healing of a wound that does not fully restore the architecture or function of the part

Answer 13

1. Regeneration
2. New attachment
3. Reattachment
4. Repair

Question 14

Scar formation is an example of:

Answer 14

Repair

Question 15

Why is scar formation an example of repair?

Answer 15

Scar formation closes that area effectively but does not fully restore architecture or function

Question 16

When you have root planed an area, and the 10mm pocket is now 3mm, the 7mm difference is due to:

Answer 16

repair

Question 17

When ALL soft tissue including the periosteum is reflected exposing the underlying bone:

Answer 17

Full thickness flap

Question 18

The most commonly used flap:

Answer 18

Full thickness flap

Question 19

A full thickness flap may also be called:

Answer 19

Mucoperiosteal flap

Question 20

A mucoperiosteal flap is another name for:

Answer 20

Full thickness flap

Question 21

When epithelium and SOME connective tissue is reflected, leaving periosteum and some connective tissue overlying the bone:

Answer 21

Partial thickenss flap

Question 22

A partial thickness flap may also be called:

Answer 22

Split thickness flap

Question 23

A split thickness flap may be used to describe:

Answer 23

A partial thickness flap

Question 24

When creating a flap, the incisions should always:

Answer 24

be down to the bone

Question 25

List the principles of tissue attachments: (5)

Answer 25

1. Preparation of soft tissue wall 2. Preparation of root surface 3. Debridement of bony defects 4. Adaptation of soft tissue to root surface 5. Control of etiology pre- & post- surgery

Question 26

List the root changes hindering tissue attachment: (4)

Answer 26

1. foreign body nature of exposed diseased root surfaces (presence of endotoxin) 2. Endotoxin absorbed on & into cementum 3. Pathologic changes in root surface (hypo- & hypercalcification areas) 4. Decreased organic material in exposed cementum (loss of fibers and alterations in the organic material related to endotoxin)

Question 27

T/F: The presence of endotoxin will aid in tissue attachment

Answer 27

False- hinders tissue attachment

Question 28

It is crucial _____ is removed from the root surface to ensure good healing

Answer 28

Endotoxin

Question 29

A functional, comfortable, healthy dentition with stable probing attachment levels:

Answer 29

Therapeutic endpoint: success

Question 30

What are the factors to consider when determining what procedures to use?

Answer 30

1. diagnosis 2. know your endpoint (regeneration, pocket elimination, pocket reduction) 3. know indications and contraindications 4. maintenance

Question 31

Removal of the connective and epithelial attachment circumferentially with a currette:

Answer 31

Curettage

Question 32

Curettage used to be used to treat:

Answer 32

Soft tissue

Question 33

Removal of the connective and epithelial attachment circumferentially with a scalpel:

Answer 33

ENAP

Question 34

The excision of the soft tissue wall of the periodontal pocket, the incision forms an external bevel or surface that is exposed to the oral cavity:

Answer 34

gingivectomy

Question 35

Gingival deformities are shaped and reduced to create a normal and functional form. The incision creates an external bevel:

Answer 35

gingivoplasty

Question 36

removal of the total piece:

Answer 36

-ectomy

Question 37

re-shaping the existing structure:

Answer 37

-plasty

Question 38

A pocket above the bone level:

Answer 38

suprabony pocket

Question 39

Elimination of SUPRABONY pockets which cannot be adequately debrided without tissue removal would indicate:

Answer 39

Gingivectomy

Question 40

Eliminatino of SUPRABONY pockets if the pocket wall is fibrous and firm and therefore will not shrink after non-surgical therapy would indicate:

Answer 40

Gingivectomy

Question 41

What procedure should be performed in the following scenario? Suprabony pockets which can't be adequately debrided without tissue removal:

Answer 41

gingivectomy

Question 42

What procedure should be performed in the following scenario? Suprabony pockets if the pocket wall is fibrous and firm and therefore will not shrink after non-surgical therapy:

Answer 42

gingivectomy

Question 43

What procedure should be performed in the following scenario? Needing access for restorative therapy in the presence of suprabony pockets:

Answer 43

gingivectomy

Question 44

What is the most common indication for gingivectomy?

Answer 44

elimination of gingival enlargements

Question 45

What procedure should be performed in the following scenario? Patient presents with gingival enlargement due to taking dilantin:

Answer 45

gingivectomy

Question 46

What procedure should be performed in the following scenario? Patient presents with assymetrical or unesthetic gingival topography

Answer 46

gingivectomy and/or gingivoplasty

Question 47

What procedure should be performed in the following scenario? Patient presents needing exposure of interrupted teeth when adequate keratinized tissue is present:

Answer 47

gingivectomy

Question 48

List the CONTRAindications for performing a gingivectomy:

Answer 48

1. access is needed for INFRAbony defects 2. base of pocket is apical to MG junction 3. keratinized tissue is inadequate 4. severely inflamed tissue 5. esthetics 6. anatomical preclusion

Question 49

Why would we NOT perform a gingivectomy in the following situation? -Keratinized tissue is INADEQUATE

Answer 49

A gingivectomy would remove all of the keratinized tissue (we don't want this to occur)

Question 50

Why would we NOT perform a gingivectomy in the following situation? -Severely inflamed tissue

Answer 50

Needs SRP instead

Question 51

Why would we NOT perform a gingivectomy in the following situation? -Anterior maxilla area

Answer 51

esthetics

Question 52

Why would we NOT perform a gingivectomy in the following situation? -Anatomical preclusion

Answer 52

In this case there is a lack of keratinized tissue

Question 53

The following are contraindications for: ______ -access is needed to infrabony defects -base of pocket is apical to MG junction -keratinized tissue is inadequate -anterior maxilla/esthetics -severly inflamed tissue -anatomical preclusion

Answer 53

Gingivectomy

Question 54

List the advantages to a gingivectomy;

Answer 54

Relatively simple and fast

Question 55

List the disadvantages to a gingivectomy:

Answer 55

1. limited applicability (suprabony defects) 2. longer healing period (4-5 weeks) 3. more post-op discomfort 4. less effective than flap surgery (no access to osseous defects)

Question 56

What type of pockets are necessary to perform a gingivectomy?

Answer 56

SUPRABONY defects

Question 57

How long is the healing period for gingivectomy?

Answer 57

4-5 weeks

Question 58

T/F: A gingivectomy is more effective than flap surgery

Answer 58

False- a gingvectomy is LESS effective than flap surgery because no access to osseous defects

Question 59

A gingivectomy does not allow for access to:

Answer 59

Osseous defects

Question 60

Gingivectomy technique invovles: 1. ____ of the pocket depth 2. ____ of the gingiva with incision starting ____ to the pocket base and externally beveled at a _____ angle

Answer 60

1. marking 2. resection; apical; 45 degrees

Question 61

During a gingivectomy, the incision should start ________ The incision should be externally beveled at a ______

Answer 61

apical to the pocket base 45 degree angle

Question 62

What should be AVOIDED during a gingivectomy?

Answer 62

bone exposure

Question 63

If possible during a gingivectomy, there should be:

Answer 63

complete removal of pocket

Question 64

When performing a gingivectomy thick tissue will require:

Answer 64

a more apical start of the incision

Question 65

During a gingivectomy what requires a more apical start of the incision?

Answer 65

Thick tissue

Question 66

T/F: With the gingivectomy technique it can be accomplished with an internal bevel incision, however it is more difficult with this approach

Answer 66

True- we typcially prefer an external bevel

Question 67

The 45 degree angle in the gingivectomy technique is located at:

Answer 67

Mucogingical surface