rationale for perio surgery

Question 1

what were the findings on Periodontitis progression by the Loe et al study in 1978?

(theres 3 key points)

Answer 1

• annual attachment loss = 0.22mm
• average tooth root length = 17mm

** complete tooth loss by age 77

Question 2

what were the 3 different groups of the Loe study on periodontitis progression?

Answer 2

1) RP group (rapid perio)
– 5mm

2) MP group (moderate perio)
- AL < 2 mm any time, any mesial

3) NP group
- neither RP nor NP

Question 3

what was the progression of periodontitis in the RP group?

Answer 3

RP group ages 25-39:
- Annual rate of Attachment Loss = 0.91 mm

• Complete tooth loss in 19 years
• Edentulous by 35 years of age

Question 4

What happens if we do not do any treatment on patients with rapid or moderate periodontitis?

Answer 4

TOOTH LOSS

in susceptible individuals

Question 5

what are the advantages of surgical therapy for periodontitis?

Answer 5

– Direct vision while working on root surface

– Easier manipulation/removal of tissues

Question 6

what are the disadvantages of surgical therapy for periodontitis?

Answer 6

– Morbidity
– Esthetic compromises
– Cost (?)

Question 7

In the Badersten study, pocket depths of ______ showed the lowest reduction of probing depths following NON-surgical periodontal therapy.

Answer 7

sites with depths less than, or equal to, 3.5mm

Question 8

what was the average pocket depth reduction for pockets greater than 7mm following NON-surgical therapy? how about pockets 3.5-6.5 mm?

Answer 8

pockets of 7mm or more: reduced 3mm

pockets 3.5-6.5 mm: reduced 1.5mm

Question 9

what was measured during the Caffesse study of 1986? what were the groups of the study

Answer 9

• measured the % of surfaces with residual calculus
• there were 3 groups:
  1) No treatment
  2) Closed SRP (non-surgical)
  3) open SRP (full-thickness flap) = surgery

Question 10

how did Closed SRP, and open SRP (surgery), compare in the Caffesse study of calculus removal?

Answer 10

Probe depth of 1-3mm: no difference between them

Probe depths of 4-6mm: surgery removed 40% more

probe depths of 7mm or more: surgery removed 20% more

Question 11

what were the main findings of the Caffesse study?

comparing closed vs open SRP at removing calculus

Answer 11

• Residual calculus more often in deeper pockets
• SRP closed: more calculus on smooth surfaces
• SRP open: calculus on surface concavity (+ CEJ)
• FLAP APPROACH REDUCES CALCULU

Question 12

the Buchanan & Robertson study found that residual calculus is found in what regions following CLOSED SRP?

Answer 12

Residual calculus more often in:
– deeper pockets
– posterior teeth
– proximal surfaces

Question 13

what 3 studies support the idea that the Flap approach is more effective at reducing calculus?

Answer 13

• Caffesse et al 1986 JCP
• Buchanan & Robertson 1987 JP
• Fleischer et al 1989 JP

Question 14

the Sherman study found that Gingival healing response (cumulative bleeding) related to what factor?

Answer 14

clinically detectable residual calculus

Question 15

to summarize the Sherman study, Less calculus = less __________

Answer 15

less inflammation

Question 16

the Van Der Velden study found that _________________ was a risk factor for disease onset (periodontitis onset)

Answer 16

the amount of subgingival calculus

Question 17

the Lindhe and Nyman study found that more _____________ remain after SRP

Answer 17

More deep pocket (> 7 mm) sites remain after SRP

Question 18

the Kaldahl study found that _____________ (a therapy) resulted in the largest reductions of pocket depths in pockets >7mm

Answer 18

Osseous surgery with apically positioned flap (OS)

reduced pockets by 3.5mm after TWO YEARS

Question 19

what was the main finding of the Kaldahl study?

Answer 19

Surgical therapy resulted in greater, and sustained, Pocket Depth reduction

Question 20

T/F: the Kaldahl study found that the Incidence of periodontal breakdown was greater in deeper sites

Answer 20

True

Question 21

Osseous surgery treated sites have the least incidence of ___________________

Answer 21

periodontal breakdown

Question 22

The Harrel and Nunn study found that Teeth that receive no treatment or just SRP, compared to teeth that receive surgical treatment, show significant worsening of:

(hint: theres 4 things that worsened)

Answer 22

• probing depths
• furcations
• prognosis
• mobility

Question 23

what are the 2 predicting factors of attachment loss?

Answer 23

• Increasing mean probing depths (1 yr)

- Multiple residual probing depths > 6 mm at re-evaluation (3 months after SRP)

Question 24

what study linked residual pockets of >6mm AFTER SRP as a predictor for attachment loss?

Answer 24

Claffey & Egelberg

Question 25

what were the 2 findings of the Serino study?

Serino compared surgical to non-surgical in terms of DISEASE PROGRESSION

Answer 25

– provides better short and long-term pocket reduction

– may lead to fewer subjects needing additional treatment

Question 26

which study was a SYSTEMATIC REVIEW of studies comparing surgical therapy to non-surgical therapy?

Answer 26

Heitz-Mayfield et al

• was done in 2002 (more recent)

Question 27

the Heitz-Mayfield study found that: In the treatment of deep pockets (PPD > 6 mm) surgical (open flap) debridement results in what?

(2 major conclusions/findings)

Answer 27

– greater PPD reduction

and

– clinical attachment gain

Question 28

Surgical Regeneration Therapy led to retention of ____% of hopeless teeth scheduled for extraction

Answer 28

92%

Question 29

T/F: after regenerative surgery, retained teeth were clinically-stable (periodontal parameters), comfortable and functional for only 3 years after treatment

Answer 29

FALSE

they were still good after 5 years (the length of the study)