Periodontal Health Considerations Flashcards by jackie calderon

What is a benefit of correcting crowding and uprighting malposed teeth in periodontal patients?

Alignment of malposed teeth to facilitate access for plaque removal

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What tissue benefit is provided by uprighting teeth?

Reduces/corrects soft/hard tissue defects

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What occlusal benefit does uprighting provide?

Improves occlusal relationships

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What happens to occlusal forces after posterior tooth loss?

Occlusal forces are no longer directed down the long axis of the tooth

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What becomes more likely due to posterior tooth loss?

Food impaction is likely

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What does selective coronoplasty during uprighting help prevent?

Additional destruction of supporting tissues

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What type of prosthetic treatment is likely after uprighting?

Fixed prosthetic treatment

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What happens to occlusal forces after fixed prosthetic treatment?

Occlusal forces again directed down the long axis of the tooth

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What are examples of pathologic migration?

Extrusion, labial flaring, rotation of anterior teeth

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What is pathologic migration associated with?

Traumatic occlusion and loss of attachment/bone

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What may pathologic migration also be associated with?

Loss of posterior tooth support

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What is the first step in the sequence of treatment for pathologic migration?

Periodontal therapy to treat the inflammatory component

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What is the second step in the sequence of treatment for pathologic migration?

Orthodontic therapy to correct pathologic migration

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How can a periodontal pocket lead to a periapical lesion?

By infecting the pulp through an accessory canal

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What is one type of perio-endo lesion involving fistulization?

Endodontic problem with fistulization from the tooth’s apex

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How can pulpal infection spread in perio-endo lesions?

Through accessory canals along the root surface, including the furcation

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How can a periodontal pocket secondarily involve the pulp?

By deepening to the apex

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What happens when two independent lesions coexist?

Periapical and periodontal lesions can eventually fuse

What are the characteristics of an Endo lesion?

Pain: Yes

Pocket: No

Oral Swelling: Maybe (apex)

Sinus Track: Maybe

Vital Pulpal Test: No

Radiolucency: Maybe (apex)

What are the characteristics of a Perio lesion?

Pain: Maybe

Pocket: Yes

Oral Swelling: Yes (gingiva)

Sinus Track: Maybe

Vital Pulpal Test: Yes

Radiolucency: Maybe (anywhere along root)

What are the characteristics of a Perio-Endo lesion?

Pain: Yes

Pocket: Yes

Oral Swelling: Yes (anywhere along root)

Sinus Track: Maybe

Vital Pulpal Test: No

Radiolucency: Maybe (anywhere along root)

Is endodontic therapy for combined perio-endo lesions predictable?

Yes, highly predictable

What does prognosis depend on in combined perio-endo lesions?

Ability to manage the periodontal defect

What effect does a chronic periodontal component have on prognosis?

Decreases prognosis

What effect does an acute periodontal component have on prognosis?

Increases prognosis

What is the first step in treating combined perio-endo lesions?

Endodontic therapy

What is the next step after endodontic therapy in perio-endo lesions?

Removal of plaque and calculus (non-surgical or surgical)

What must be done after plaque and calculus removal in perio-endo lesions?

Evaluate the tooth

What happens if a residual pocket or bony defect is present in perio-endo lesions?

Periodontal therapy Osseous resective surgery Regeneration (bone grafting, barrier membrane)

What happens when supra-crestal tissue attachment (STA) is infringed?

Inflammation and loss of periodontal supporting tissue

Why is the supra-crestal tissue attachment important?

It is essential for preservation of periodontal health

What is the approximate total measurement of supra-crestal tissue attachment?

2 mm

When is surgical crown lengthening necessary?

When subgingival restorations impinge on the supra-crestal tissue attachment (STA)

Why is surgical crown lengthening important?

Ensures long-term periodontal health

What does surgical crown lengthening allow?

Reestablishment of STA at a more apical position

When does violation of STA occur?

When the restorative margin encroaches the biological width

What does STA violation result in?

Inflammation, potential pocket formation, and attachment/bone loss

What is the recommended restorative margin placement?

Supragingival whenever possible Subgingival extension up to 0.5 mm (Nevins and Shurow, 1984)

What can excessive occlusal force cause?

Injury within the attachment apparatus surrounding teeth

What does “excessive” occlusal force depend on?

Tooth anatomy and position Force duration, direction, and frequency

What conditions are present in primary occlusal trauma?

Normal bone levels Normal attachment levels Excessive occlusal forces

What is primary occlusal trauma?

Injury from excessive occlusal forces on teeth with normal support

What conditions are present in secondary occlusal trauma?

Bone loss Attachment loss Normal or excessive occlusal forces

What is secondary occlusal trauma?

Injury from normal or excessive occlusal forces on teeth with reduced support