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Classic Lit Fall 2021 > Principles of Periodontics > Flashcards

Principles of Periodontics Flashcards

1
Q

What are the indications for periodontal surgery? Citation

A

Barrington 1981

BIIIRRD CRAP

Biopsy
Improve contour for better OH
Improve esthetic
Improve prognosis
Remove disease
Regenerate
Drain abscess

Correct MGDeformaties
Restorative access
Access
Pocket elimination

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2
Q

Critical probing depths

A

Lindhe 82
Critical PD for non-surgical: 2.9mm
Critical PD for surgical: 4.2mm

Heitz-Mayfield 2013
Critical PD for surgery indicated: 5.4mm

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3
Q

Citations for Why not just do SRP and no surgery?

A

Stambaught 1981

Caffesse 1986

Waerhaug 1978

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4
Q

how deep can a curette clean? whats its limit? Citation

A

3.7mm + 0.97mm
6.21mm

Stambaught 1981

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5
Q

What are major findings of Pihlstrom 1983

A

MWF Maintained pocket reduction in deep pockets (7+) for 6.5yrs vs SRP’s 3yrs

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6
Q

What does flap improve vs SRP? other than access - Citation

A

Caffesse 1986

Greater reduction of residual calculus with flap vs SRP

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7
Q

How much do we clean sub-G? Citation

A

Waerhaug SRP - Caffesse SRP - Caffesse Flap

Shallow : 83% - 86% - 86%
Mod : 38% - 43% - 76%
Deep : 11% - 32% - 50%

Waerhaug deep = >5mm
Caffesse 1-3, 4-6, 7+

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8
Q

What might complicate anterior implant placement? Citation

A

Mraiwa 2004

Nasopalatine on average 7.4mm from labial surface of unresorbed ridge (Range 3-14mm)
Big range - might be no space

Average width: 4.6mm

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9
Q

Where is the infraorbital nerve located?

A

9mm from infraorbital margin

30mm from midline

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10
Q

What articles research GP location?

A

Reiser 1996

Yu et al 2014

Tavelli et al. 2018

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11
Q

How does palatal vault impact GP N/A location? Where is the thickest tissue? Citation

A

Reiser 1996

Shallow: 7mm

Average: 12mm

High: 17mm

Between mesial of first molar and distal of canine (in the premolar region)

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12
Q

What paths does the GP artery take? Citation

A

Yu et al 2014

Type I - Lateral branch gives of Medial and Canine branch after the Bony Prominence (40%)

Type II - Lateral Branch gives of Medial branch before the Bony Prominence - Mb runs on Medial aspect of the BP (33%)

Type III - Lateral Branch gives off Canine Branch immediately after exiting the GPF (15%)

Type IV - Lateral Branch gives off Medial Branch immediately after exiting GPF (8%)

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13
Q

What is the average location of the GPN/A from different teeth? Where is the GPF located? Citation

A

Tavelli et al. 2018

M2 - 13.9 + 1
M1 - 13 + 2
P2 - 13.8 + 2
P1 - 11.8 + 2
C - 9.9 + 3

Mid-palatal aspect of 3rd molar (57%)

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14
Q

how large is the maxillary sinus?

A

15oz

35mm height

35mm width

45mm length

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15
Q

Articles for sinus

A

Cho et al. 2001

Chan et al. 2013

Monje et al. 2016

Pommer 2012

Rosano 2011

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16
Q

What anatomical factors influence perforation risk in sinus? Citation

A

Angle of floor (Cho 2001)

Location of PNR (Chan 2013)

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17
Q

Cho 2001

A

Higher perforation risk when elevating narrow sinus floor

<30deg = 62.5%

>60deg = 0%

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18
Q

Chan 2013

A

PNR higher/sharper in PM (14mm) lower/wider at 2M

more frequent in 2PM area

Angle <90 and location <15mm from crest = higher risk of perf

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19
Q

How thick is the schneiderian membrane?

A

CBCT: 1.33mm

Histo: 0.48mm

CBCT is 2.5x that of histology

Monje 2016

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20
Q

What is the prevalence of sinus septae?
Where are they located?
Orientation?

Citation

A

Pommer 2012
28%
25 - 55 - 20 (Retro M - M - PM)

~90% Transverse (Buccal/Palatal)

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21
Q

What artery do we need to be aware of with the sinus? How can we evaluate its location? Citation

A

Rosano 2011

47% seen on CBCT
Mean 11.25mm from crest
55% <1mm - 40% 1-2mm - 5% 2-3mm

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22
Q

Location of the mental foramen? Anomolies? Citation

A

Neiva 2004

Between 1st and 2nd PM 58%

Apical to 2nd PM 42%

Anterior loop 88% - Bilateral 75% - Extends 4.1mm anterior

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23
Q

What is the course of the lingual nerve vertically? Citation

A

Chan et al 2010

Vertical distance from mid-lingual CEJ
2M: 9.6mm
1M: 13mm
2PM: 14.8mm

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24
Q

What is the course of the lingual nerve horizontally? Citation

A

Chan et al. 2010

Turning point:

2ndM: 33%
1M: 42%
2ndPM: 25%

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25
Q

How prevelant is an undercut in the posterior mandible?

A

Chan et al. 2011

Convex (C)
Parallel (P)
Undercut (U)

Lingual concavity undercut 66% (most prevalent U)

26
Q

Where is the most risk for lingual perf duuring implant prep?

A

2nd Molar (31%) are high risk

27
Q

Who developed Gingivectomy?

A

Goldman 1951

28
Q

What are the different flap designs discussed and their creators?

A

Original Widman Flap (Widman 1918)
Neumann Flap (Neumann 1920)
Kirkland Flap/Modified Flap Operation (Kirkland 1931)
Gingivectomy (Goldman 1951)
Apically Repositioned Flap (Nabers 1954)
Modified Widman Flap (Ramfjord & Nissle 1974)
Papilla Preservation Flap (Takei et al. 1985)

29
Q

Which flaps are for pocket elimination?

A

Original Widman
Neumann Flap
Gingivectomy
Apically Repositioned Flap

30
Q

Which flaps are NOT meant for pocket ELIMINATION? What ARE they meant for?

A

Kirkland Flap (Access/Regeneration/Esthetics)
Modified Widman Flap (pocket REDUCTION)
Papilla Preservation Technique (Regenration/Esthetics)

31
Q

What was the first flap? Aim? How to?

A

Original Widman 1918

Flap elimination - to remove pocket epithelium and inflamed CT and facilitate optimal cleaning of the roots

1 - Two vertical Releases - Connect with reverse bevel/scalloped (can be buccal and lingual)
2 - FTMPF to expose 2-3mm of bone
3 - Removetissue collar
4 - SRP
5 - Osteoplasty recommended
6 - Reposition flap at level of crest w/ interrupted sutures (interproximals often healing by secondary intension)

32
Q

What was the FIRST modified widman flap? Describe it

A

Neumann 1920 (The Neumann Flap)

1 - Intrasulcular incision
2 - Curettage inside of flap
3 - SRP
4 - Osteoplasty
5 - Trim flap and place on crest

33
Q

Describe the Kirkland flap and its use

A

Kirkland 1931

Open - Clean - Close

Originally created for Periodontal Pus Pocket (perio abscess)

1 - Intrasulcular incision with M and D extension
2 - Flap reflected to expose diseased root
3 - Remove granulation tissue/calculus
4 - Reposition flap at original position

34
Q

How to perform an Apically Repositioned Flap?

A

Vertical release
Reverse bevel at a pocket depth distance from the margin
FTMPF
Remove tissue collar
Osseous
Flap positioned at newly recontoured alveolar bone

35
Q

Contraindications for gingivectomy

A

narrow/absent attached gingiva

infrabony pockets

Exostoses

36
Q

advantages of Widman Flap vs Gingivectomy

A

Less post op discomfort (primary healing)

Access to contour alveolar bone

37
Q

What are advantages of the Kirkland flap?

A

Bone regeneration potential

Can be used in esthetic zone

38
Q

Advantages of ArPF?

A

Pocket elimination

minimal post op bone loss

Controlled positioning of the gingival margin

Maintain entire mucogingival complex

39
Q

Disadvantages of ArPF?

A

Esthetics

Root sensitivity problems

40
Q

Advantages/Disadvantages of MWF?

A

Soft tissue closely adapted to root
Minimal trauma to CT and bone
Better aesthetics
Less sensitivity

Chance for remaining pockets

41
Q

Furcation Classifications

A

Class 1 / 2 / 3

Hamp 1975
<3mm
_>_3mm but not through/through
through/through

Lindhe 2008
>⅓ but not through/through
through through

42
Q

Vertical defect classifications

A

Grade A / B / C

Tarnow & Fletcher 1984
_<_3mm
4-6mm
_>_7mm

Tonetti et al. 2017
Coronal third of root
Middle third of root
Apical third of root

43
Q

Studies on post op infection

A

Powell 2005

Abu-Ta’a 2008

44
Q

Powell 2005

A

Retrospective of 400patients

NSSD of post op infection w/ vs w/out ABx

CHX did lower infection

45
Q

Abu-Ta’a 2008

A

JCP RCT

NSSD when proper asepsis perameters.

ABx lowered post-op pain

46
Q

Studies on pain after surgery

A

Burkhardt 2015

Vogel 1992

47
Q

Burkhardt 2015

A

Grafts between 1-2mm have significantly less post op pain (50% less)

Residual donor site >5mm = 60% less pain

48
Q

Vogel 1992

A

600mg Ibuprofen immediately AFTER delays onset of pain more than immediately before

49
Q

Studies on bleeding

A

Zigdon 2012 (JOP)
Baab 1977

50
Q

Zigdon 2012 + Baab 1977

A

Zigdon:

Minimal blood loss during perio procedures

Smokers bleed significantly more

Asprin NSSD?????

Baab:

Average: 134ml blood loss
Duration of surgery + Amount of anesthetic used significantly impacted blood loss

51
Q

How did Zigdon isolate blood from other fluids?

A

Fructosamine - first time used - separates blood from other fluids

52
Q

What citation for managing post op infection after GBR?

A

Fontana 2016

53
Q

What groups demarcate different response to surgical site opening during healing?

A

_<_3mm WITHOUT exudate

>3mm WITH exudate

Membrane exposure WITH exudate

No exposure WITH ABSCESS

54
Q

First group of infection management - how do you manage? Citation

A

Fontana 2016

_<_3mm exposure w/ NO exudate

Topical CHX gel 2x/day
Membrane left for maximum of 3-4wks

55
Q

Second group of infection management - how do you manage? Citation

A

Fontana 2016

>3mm exposure WITH exudate

Remove membrane immediately
If underlying graft NOT compromised - close/heal 4-5mo
ABX

56
Q

Third group of infection management - How do you manage? Citation

A

Fontana 2016

Membrane exposure w/ exudate

Membrane immediately removed
Curettage graft and removal of infected graft particles
ABX

57
Q

Final group of infection management - how do you manage? Citation

A

Fontana 2016

No membrane exposure - Abscess formation

Immediately remove membrane
Remove infected tissue
ABX

58
Q

Essentially - what is the procedure for treating exposure after GBR?

A

Anytime its infected - remove membrane and curette infected particles out - prescribe ABX

  • Exposure _<_3mm
    • CHX 2x/day and remove membrane after 3-4wks
  • Exposure >3mm
    • Remove membrane/assess graft
      • No infection?
        • Close/Heal 4-5mo
      • Infection? (Or exudate seen before membrane removed)
        • Curette graft/remove infected particles
        • ABX
  • No exposure but ABSCESS
    • Remove membrane/curette infection/ABX
59
Q

Patient presents after GBR - what do you do?

A
  • Assess healing
    • Exposure?
      • Yes
        • Size?
          • _<_3mm
            • CHX
            • Remove membrane in 3-4wks
          • >3mm
            • Remove membrane and assess graft
        • Infection?
          • Yes
            • Remove membrane
            • Remove infected particles
            • ABX
          • NO
            • Let heal 4-5mo
    • NO
      • Infection?
        • NO - good
        • Yes - Remove membrane/graft/ABX
60
Q

What is the difference between inFRA-bony defect and inTRA-bony defect?

A

According to Goldman & Cohen 1958

inFRA-bony - base of the pocket is located apical to the alveolar crest

inTRA-bony - base of the pocket is located within surrounding bone (3-wall defect)

Infra-bony is any vertical defect - Intra-bony is a contained defect

61
Q

How does pocket depth impact tooth prognosis?

A

Matuliene 2008

172pt 11yr Retrospective

Odds ratio for tooth loss compared to 3mm PD

5mm - OR 7.7
6mm - OR 11
7mm - OR 64.2

62
Q

What is the likelihood of closing based on their initial depth and single vs multirooted? How does smoking impact this?

A

Tomasi 2007

Multirooted reduces chance by ~20%

Non-Smokers
Single Rooted
7mm - 63%
8mm - 36%

Multi Rooted
7mm - 43%
8mm - 19%

Smokers have about 50% these numbers

Classic Lit Fall 2021 (29 decks)

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