Periodontics Flashcards
What findings should you search for in a perio exam?
Pocket Depth BOP Calculus Plauqe index Furcation Mobility Vitality test (if suspect perio-endo lesion)
What are the 5 major categories of what to look for when checking radiographs for perio disease?
Remaining bone support Bone loss Calculus Crown/Root morphology Evidence of Endo involvement
When looking examining a radiograph for bone loss on radiographs, what features should you look for?
Size
Extent/progression (in order this is):
- Breakdown of lamina dura
- Wedge shaped lesion on mesial/distal aspect of interdental septum
- Loss of interdental septum bone height
- Crater formation in interdental septum (cupping effect)
- Disparate buccal/lingual height of cortical plate
- Vertical bone loss
- Furcation involvement
- Formation of two distinct margins due to difference in height of buccal and lingual cortical plate
Shape:
- Vertical (infrabony)
- Horizontal (suprabony)
- Hemiseptal (3 wall), 2 wall, 1 wall, cup shaped
When checking for crown/root morphology for perio disease on radiographs, what should you search for?
- Crown: root ratio
- Crown/root fractures
- Interproximal spacing (can be influenced by convexity of crown/greater convexity=greater spacing)
- Size, shape, position of root
- Signs of resorption
- Convergence/divergence of roots
- Length of root trunk
- Any remaining root fragments
When looking for evidence of endo involvement in perio disease on radiographs, what should you look for?
- Widening of PDL (though this could indicate occlusal trauma)
- Pulpal anatomy/evidence of pathology
What are the grades of mobility? What is the normal range for tooth mobility?
Grade I: up to 1mm of movement in horizontal direction
Grade II: up to 2mm of movement in horizontal direction
Grade III: greater than 2mm-3mm movement in horizontal and vertical direction
Elasticity of bone and PDL allows 0.2mm of movement in normal/healthy person, varies throughout day
What can cause mobility, and how can it be managed?
Occlusal trauma:
- Widening of PDL space
- Mobility evident with no bone loss due to rigidity of PDL fibres
- Can treat by adjusting occlusion/lowering tooth surface to reduce load (may be done to natural tooth or restorations)
Bone loss: Splint teeth, options include: -Removable acrylic splint -Wire splint (semi-rigid) -Composite resin splint (rigid, risk of ankylosis/ tooth fusion to bone occurring)
What is can cause furcation involvement?
- Periodontal bone loss
- Cervical projections/enamel pearls
- Iatrogenic endo damage
- Endodontic lesion with accessory canals into furcation area
What are the management options for furcation?
Class I, II, III:
Non-invasive approach:
-OHI re. use of tufted brush to clean furcation area
-Scaling/cleaning of area
Class II or higher
- Tunnel prep (change furcation from class II to III to allow easier access)
- Furcation plasty: smooth the surfaces involved in furcation with a bur to allow easier cleaning
- Guided tissue regeneration
- Gingivectomy: surgical removal of a portion of gingiva to allow access for cleaning
- Root resection: Remove a root to allow for easier access, particularly if that root has heavy bone loss
- Hemisection: For lower molars, divide the tooth in half and convert it into two premolars
- Replacement with implant
What are the grades of furcation?
Class I: Probe can be inserted up to 1mm into furcation
Class II: Probe can be inserted 2mm or more into furcation but can not pass all the way through
Class III: Probe can pass straight through furcation (through and through destruction)
True or false: furcation involvement has both horizontal and vertical components
T
What are the considerations for root resection?
- Vitality of tooth
- Size and length of root (if small don’t bother)
- Remaining bone support on other roots
- If heavily restored crown
- Convergence/divergence of roots
What are the indications for root resection?
- Heavily restored crown (depending on situation)
- If remaining roots have good bone support
- Root fracture
What are contra-indications for root resection?
- Heavily restored crown (depending on situation)
- Difficult endo on remaining roots/tooth still vital
- Fused roots
- Heavy bone loss on remaining roots
- Cost
- Small roots
What is meant by a 3-walled defect, and what is it’s prognosis vs 1 walled defect?
3-walled defect means the lesion is surrounded by bone on 3 sides, far better prognosis than 1 wall defect
What are some issues with the old studies involved in perio disease? (in particular with epidemiology)
- Considered perio to be inevitable progression of gingivitis without considering susceptibility of pt
- Considered perio would worsen with age
- Considered tooth loss inevitable without treatment
What improvements have been made with modern studies of perio epidemiology? What issue still remains?
- Consider gingivitis and periodontitis separately and takes into account susceptibility of patient
- Measures actual attachment loss rather than using an index
- Correlates clinical findings with radiographs and histories
- However considers perio to the be the cause of all attachment loss
What can cause attachment loss other than periodontitis?
Over-eruption of teeth: if radiograph will find bone is completely intact
In terms of periodontic aeitology, what is a necessary cause and what is a sufficient cause?
Necessary cause: Necessary to cause the disease but will not cause disease on its own, in this case the bacteria
Sufficient cause: Enable to the necessary cause to cause disease, in this case host resistance/susceptibility and environmental factors
