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Advanced Periodontology > Quiz Ch 14 Perio > Flashcards

Quiz Ch 14 Perio Flashcards

1
Q

What is the incisional surgery commonly called

A

Periodontal flap surgery

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2
Q

Periodontal flap surgery is the choice when what cannot be performed for pocket reduction

A

excisional periodontal surgery

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3
Q

this procedure is called flap surgery becasue

A

the tissue are pushed away from the underlying tooth roots and alveolar bone, much like the flap of an envelope

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4
Q

The usual incisional technique for pocket reduction with flap surgery is called

A

The apically positioned flap

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5
Q

Why is it called the apically positioned flap

A

Because the flap is sutured at a more apical location on the tooth roots to reduce pocket depth

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6
Q

what has fewer contraindications than gingivectomy , so incisional procedures are the most common type of surgery performed by periodontists

A

Flap surgery

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7
Q

what are the primary indication for incisional surgery

A

deepened periodontal pockets

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8
Q

What kind of pockets are best treated by flap surgery

A

suprabony pockets

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9
Q

Flap surgery also allows access to

A

infrabony pockets

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10
Q

what are the few contraindication for periodontal flap surgery

A

*gingival tissues must be wide and thick enough to allow proper incision, often the incision must be modified to preserve as much keratinized tissue as possible

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11
Q

What are special modifications of pocket reduction surgery include

A

combinations of incisional and excisional techniques, such as distal wedge surgery and internal beveled gingivectomy.

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12
Q

what does the distal wedge procedure permits

A

adequate plaque control on the distal surface of the last tooth in the mandibular arch

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13
Q

the goal of access flap procedures is to what

A

provide access to the root surfaces for debridement and to create conditions for reattachment of the gingival tissue to the root

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14
Q

what is the modified Widman flap

A

the excisional new attachment procedure, and open flap curettage

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15
Q

What uses three incisions to separate the pocket lining from the tooth in a controlled manner, whereas the excisional new attachment procedure usually does not involve elevating the flap past the mucogingival junction

A

modified Widman flap

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16
Q

what are the goal for access flap procedures

A

to gain access to the root surface for plaque biofilm and calculus removal, including scaling and root planning.

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17
Q

pocket reduction by apical positioning is not the goal of what

A

access flap procedures

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18
Q

what is access flap procedures are used to treat

A

periodontal pockets in aesthetically sensitive areas or where pocket reduction is not desired or indicated

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19
Q

That procedure is when incisions are made through thee crest of the gingiva, and the gingival tissues are reflected only far enough to allow the clinician to see the root surfaces and the crest of the alveolar bone

A

Access flap techniques

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20
Q

what is the major goal of access flap techniques

A

is to reattachment of the connective tissues to the root surface during healing or creation of a long junctional epithelium resulting in increased attachment for the teeth.

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21
Q

contraindications for access flap procedures

A

pt should understand that pocket depths may continue to be greater than 3 or 4mm after therapy

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22
Q

by definition involves attachment loss of the connective tissue to the root surface of the tooth and loss of alveolar bone

A

Periodontitis

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23
Q

What does bone loss create around the tooth

A

osseous defects

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24
Q

what makes healing unpredictable and result in gingival architecture that is difficult for the pt to maintain with acceptable plaque biofilm control and difficult for the hygienist to maintain with periodic scaling and root planning

A

osseous defects

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25
Q

what is ostectomy

A

if the alveolar bone that contains periodontal fibers that support the tooth is removed

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26
Q

what is osteoplasty

A

if only bony ledges or nonsupporting bone are removed

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27
Q

what is the primary indications for osseous defects

A

when periodontal pockets that extend below the level of the osseous crest, or infrabony pockets.

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28
Q

this is a indication for osseous defects

A

thick bony ledges

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29
Q

what is a type of bone loss in which the interproximal bone is apical to the facial and lingual bone (the reverse of the configuration in health), permits periodontal pockets to re-form during healing

A

Reverse alveolar bony architecture

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30
Q

Areas of serve bone loss are often best treated by what

A

reducing pocket depths and performing frequent maintenance care

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31
Q

recession is a common finding among pts with

A

periodontal disease

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32
Q

recession can lead to extension of the periodontal pockets beyond the mucogingival junction so that no attached gingiva exists on the tooth surface, what are these areas called

A

mucogingival defects and have been implicated in the spread of periodontal disease into deeper tissues , although this role remains controversial

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33
Q

mucogingival defects may be developed by what

A

orthodontic tx

forceful toothbrushing

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34
Q

this includes a variety of periodontal plastic surgery procedures to augment the thickness of keratinized tissues, increase the zone of attached gingiva, improve gingival aesthetics by covering root surfaces, or augment edentulous spaces

A

Mucogingival surgery

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35
Q

how are the areas of recession tx

A

pedicle grafts or free mucosal grafts, althrough connective tissue grafts have been increasingly used

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36
Q

what should be considered for tissue-grafting

A

area of recession that significantly reduce the width of the keratinized gingiva or have progressed beyond the mucogingival junction

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37
Q

what is the most quoted idea for attached gingival tissue

A

3mm

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38
Q

what are some other indications for surgical intervention to control mucogingival problems

A

broad labial or lingual frenum attachments near the gingival margin that may result in unsightly diastemata and a shallow vestibular depth that must be deepened to improve the fit and retention of removable dental prostheses

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39
Q

what are the most common procedures for mucogingival defects

A

lateral pedicle gingival graft
free autogenous gingival graft
subgingival connective tissue graft

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40
Q

what type of graft is sliding of gingival tissue from an adjacent tooth or papilla, has been suggested as the best technique to attempt to cover exposed root surfaces bec it bring their blood supply with them

A

Lateral Pedicle Grafts

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41
Q

what are the limitations to pedicle grafts

A

depend largely on the availability of an adequate source of donor tissue adjacent to the area that needs augmentation

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42
Q

another important limitation to pedicle grafts is

A

risk of causing gingival recession to the donor site, particularly if the alveolar bone housing is thin or bony dehiscences are exposed during the surgical procedure

43
Q

this grafts have donor sites located somewhere in the mouth away from the site that requires grafting

A

Free gingival graft

44
Q

what is the most common donor site for free gingival graft

A

the palate, but edentulous areas are also used edentulous areas are also used

45
Q

How long should the free gingival graft tissue be immobile for

A

the first week after surgery to allow for the establishment for circulation to the grafted tissue

46
Q

what is generally not included as part of the donor tissue for free gingival graft

A

palatal rugae

47
Q

includes a variety of surgical techniques that attempt t restore the periodontal tissues lot through disease

A

Regeneration surgery

48
Q

by definition, periodontal regeneration is

A

the formation of new alveolar bone, new cementum, and new periodontal ligament on a tooth root surface that was previously diseased

49
Q

this category of surgery is reserved for procedures that increase the predictability of the growth of new tissues of the attachment apparatus

A

regeneration surgery

50
Q

what is created from donor bone from the pts own body. Bone may be taken from intraoral sites, such as tori, the maxillary tuberosity, or bone removed during osteoplasty

A

Autografts

51
Q

created from bone that comes from another person. Cadaver bone, obtained from bone banks accredited by the American Association of Tissue Banks, is the most common source of bone allografts used in periodontics

A

Allografts

52
Q

this graft uses a variety of synthetic bone materials.

A

Alloplasts

53
Q

this graft is made out of hydroxyapatite material or ceramics, such as plaster of Paris and tricalcium phosphate

A

Alloplasts

54
Q

these are created from bone taken from another species, such as bovine (cow) or porcine (pig) bone

A

Xenografts

55
Q

the most successful use of this materials has been had been as fillers for large osseous defects, using graft materials with all organic tissue chemically removed

A

Xenografts

56
Q

indications for bone grafts is

A

defects with sufficient osseous walls to promote healing, ideally three-wall defects

57
Q

what are some other defects indications for bone grafts

A

furcation defects, particularly mandibular molar buccal furcation of grade 2 (not through and through)

58
Q

Are they any contraindication for bone fill procedures

A

NO

59
Q

what is guided tissue regeneration

A

healing by selected cell repopulation

60
Q

what appears to be the best candidates for guided tissue regeneration

A

infrabony defects and furcation’s

61
Q

what are the most promising sites for guided tissue regeneration

A

osseous lesions that are likely to respond well to other forms of bone fill or grafting

62
Q

what is the procedure for guided tissue regeneration

A

Flaps are reflected and after debridement of the intraosseous lesion, a membrane is placed over the opening in the bone or furcation and fastened to the tooth by suturing or other stabilizing methods

63
Q

when the epithelium is closed over the membrane in the guided tissue regeneration procedure how long is the wound allowed to heal for

A

a period of 30 to 60 days

64
Q

how long does it take for the polylactic acid material resorbs through hydrolysis

A

within 6 to 12 months

65
Q

what is required to close the periodontal surgical wounds and to secure grafts into position

A

sutures

66
Q

What type of sutures does periodontal surgeons generally use

A

Braided black silk sutures

67
Q

when does the sutures have to be removed

A

7 to 14 days

68
Q

what is the infection called resulting from sutures retained too long

A

stitch abscess

69
Q

at least __ or __ mm of suture “tail” should be left beyond the knot

A

2 to 3 mm

70
Q

what must be documented in the chart

A

the location and number of sutures placed

71
Q

this is sometimes placed over the sutures to hold the flaps tightly to the teeth and underlying bone when pocket reduction surgery has been performed

A

periodontal dressing or pack

72
Q

what is the most common type of pack

A

consists of a paste mixture that sets chemically to a firm, rubbery consistency,

73
Q

postoperative procedures include

A

prescription for an analgesic and possibly an antibiotic

74
Q

what type of mouthwash may be used to freshen the mouth and inhibit plaque during primary healing in the first week or two after surgery

A

chlorhexidine or essential oil

75
Q

what are some postoperative instructions

A

physical activity should be limited
soft diet
avoid smoking
homecare plaque

76
Q

when should the pt return for a postoperative visit

A

1 week after periodontal surgery

77
Q

the area if surgery shouldn’t be probe for how long

A

1 month

78
Q

Relative Contraindications to Periodontal Surgery

A
  1. Patients with certain systemic diseases/conditions
    A. Uncontrolled hypertension
    B. Recent history of myocardial infarction
    C. Uncontrolled diabetes
    D. Certain bleeding disorders
    E. Kidney dialysis
    F. History of radiation to the jaws
    G. HIV infection
  2. Patients totally non-compliant with self-care.
  3. Patients with a high risk for dental caries.
  4. Patients with unrealistic expectations.
79
Q

what is root SENSITIVITY cause by

A
  1. Exposure of root surfaces (previously covered by gingiva) to the oral environment.
  2. Apically positioned periodontal flaps,
  3. Gingival shrinkage during healing,
  4. Root planning with cementum removal
  5. Dentinal tubules exposed to the oral environment and hydrodynamic forces.
80
Q

Treatment of Tooth Sensitivity:

A

Home Fl gels/rinses for 1 month post operatively (containing potassium nitrate)
At Office- application of topical desensitizing agents containing potassium oxalate or ferric oxalate
Sensitivity usually diminishes in 1-2 months

81
Q

what can cause the tooth to become mobile

A

periodontal surgery as the result of swelling of the periodontal ligament.
OR Removal of calculus bridge.

82
Q

Healing After Periodontal Surgery

A

Blood clot forms at the surgical site.
The blood clot acts as a matrix or scaffolding.
Should be thin.
Firm pressure helps thin the clot, decrease bleeding, and approximate the edges of the flap.

83
Q

Four Potential Sources of Cells in a Healing Periodontal Surgical Wound

A

Gingival Epithelium
Gingival Connective Tissue
Bone Cells
Periodontal Ligament Cells

84
Q

what are the 4 Categories for healing

A

Repair
Reattachment
New Attachment
Regeneration

85
Q

In the category of repair what does not form

A

new bone, new cementum, or PDL during the healing process.

86
Q

what category is Healing of a periodontal wound by the reunion of the connective tissue and root surface where they have been separated by incision or injury – NOT by disease.

A

reattachment

87
Q

Describes the union of a pathologically exposed root with connective tissue or epithelium (where periodontitis had previously destroyed this attachment.)

A

new attachment

88
Q

this results in the regrowth of the precise tissues that were present before the disease or damage occurred. (ie. Reformation of lost cementum, lost PDL, and lost alveolar bone.)

A

Healing by regeneration

89
Q

Can be accomplished with modern periodontal surgical procedures but cannot be regenerated predictably in all sites.

A

regeneration

90
Q

what are the 3 forms of healing

A

Primary Intention
Secondary Intention
Tertiary Intention

91
Q

what form of healing is this Wound margins and edges are closely adapted to each other. Heals Quickly
(Ex. Flap surgery-incisional flap)

A

primary intention

92
Q

what type of graft Obtain their nutrients by diffusion for the first 2 weeks after surgery from the prepared site.

A

free gingival graft

93
Q

Wound margins are not close to each other.
Heals more slowly
A large clot must form over the entire surface
Epithelial cells must migrate long distances.
Can result in more post-operative pain.
(Ex. Gingivectomy-Excisional removal of tissue.)

A

secondary intention

94
Q

Wound temporarily left open with the intention of closing at a later date.

A

Tertiary Intention

95
Q

Window-like openings in the alveolar bone over a root surface

A

Fenestration

96
Q

Root is denuded of bone and portions of the root surface are covered only by soft tissue. Characterized by a long, narrow defect of bone.

A

Dehiscence

97
Q

refers to a fissure in the gingival tissues and may be caused by abnormal frenula, trauma from occlusion, or pierce related trauma.

A

Gingival cleft

98
Q

a severe abscess or multiple boil in the skin, typically infected with staphylococcus bacteria.

A

Carbuncle

99
Q

what are the 2 techniques for removal of aberrant fremun

A

frenoectomy

frenectomy

100
Q

this refers to the complete removal of the frenum, including its attachment to the underlying bone

A

frenectomy

101
Q

this is the incision of the frenum, it usually is done to relocate the frenal attachment so as to create a zone of attacked gingiva between the gingival margin and the frenum

A

frenoctomy

102
Q

is a specializeddentalprocedure, whereby one rootis removed from a multi-roottooth. The tooth is then stabilized and rendered fully functional with a crown or filling.

A

Root amputation

103
Q

This procedure may be successful to maintain teeth where bone loss has exposed the furcation. Treatment also involves treating the pulp of the tooth with root canal therapy and placement of a crown.

A

Root amputation

Advanced Periodontology (6 decks)

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