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Classic Lit Fall 2021 > Reattachment and Osseous > Flashcards

Reattachment and Osseous Flashcards

1
Q

Repair

A

Healing that does not restore original ARCHITECTURE, FORM, or FUNCTION

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2
Q

Regeneration

A

Healing that restores original ARCHITECTURE, FORM and FUNCTION

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3
Q

Gingival Curettage

A

Removal of inflamed soft tissue lateral to the pocket wall

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4
Q

What is the goal of osseous surgery? Citation

A

Establish minimal or physiologic probing depth and create a gingival contour compatible with good self-performed oral hygiene (Barrington 1981)

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5
Q

What are the New Attachment procedures?

A

Gingival Curettage
ENAP
Modified ENAP
Modified Widman’s Flap
LANAP

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6
Q

How does Curettage impact clinical results? Citation

A

Echeveirra & Caffesse 1983

Split mouth - SRP and 4wks later Curettage

Did not improve - No additional benefit

AAP no longer considers it a treatment

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7
Q

What does ENAP stand for?

A

Excisional New Attachment Procedure

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8
Q

How do you perform ENAP? What is it similar to?

A

Internal bevel from FGM to just below the pocket
Remove with curette
Root plane exposed cementum
Approximate wound
Sutures and PERIO DRESSING

Gingival curettage with a scalpel

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9
Q

Citations for ENAP

A

Yukna 1976
Fedi & Rosenfeld

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10
Q

How does ENAP heal? Citation

A

Long Junctional Epithelium (Yukna 1976)

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11
Q

Fedi & Rosenfeld

A

ENAP modification

Instead of incising to just below the pocket - to bone crest

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12
Q

What is the goal of MWF?

A

Expose root suface for instrumentation - NOT pocket reduction

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13
Q

When is MWF indicated?

A

Esthetic zone
PD > 6mm
No pocket elimination needed

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14
Q

How do you perform a MWF? How does it change in esthetic zones? How is it modified on the palate? (Citation)

A

Primary incision: PD >2mm: 0.5-1mm from GM directed at alveolar crest - PD <2mm/Esthetic zone: Intrasulcular

Secondary incision: intrasulcular to detach the tissue

Tertiary incision: horizontal along the crest to remove the tissue

Palatally - directed more palatally to help with flap adaptation

Ramfjord & Nissle 1974

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15
Q

Healing after MWF? Citation

A

Caton 1980

LJE

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16
Q

What are the 3 incisions termed for MWF?

A

Primary/Internal bevel

Secondary/Crevicular

Tertiary/Interdental

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17
Q

What is LANAP?

A

Laser Assisted New Attachment Procedure

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18
Q

What is the wavelength of Nd:YAG?

19
Q

What are the first and second pass settings in LANAP?

A

1965mJ/mm^2

1st: 4W; 100µs pulse duration; 20Hz
2nd: 4W; 600µs pulse duration; 20Hz

20
Q

What is the objective of the first pass?

A

De-epithelialize the pocket (sparing CT)

Killing pigmented bacteria

21
Q

What is the objective of the second pass?

A

formation of a dense fibrin clot for periodontal regeneration

22
Q

What are the steps for LANAP?

A

1st pass

piezo

2nd pass

occlusal adjustment

23
Q

Citations for LANAP

A

Nevins et al. 2012

Dortaj et al. 2021

24
Q

Does LANAP result in regeneration? Citation

A

Some say yes

Nevins 2012 found 5/9 of LANAP teeth had regeneration

25
Q

How does LANAP compare to other treatments?

A

Dortaj et al. 2021

NSSD between SRP alone

26
Q

When is osseous resective surgery indicated? Citation

A

Whenever the infra-osseous defect depth is <4mm or when a 1wall defect is present

(Ochesenbein 1986)

27
Q

Osetoplasty goal/function

A

To create a physiologic form without removing supporting bone

Helps tissue adaptation

28
Q

Osteoctomy goal

A

Elimination of intrabony pockets

29
Q

What situations would you use osteoplasty?

A

Small buccal/lingual bony ledges

Incipient furcation involvement

30
Q

When would you use osteoctomy?

A

shallow intrabony or hemiseptal defects

To remove reverse architecture

31
Q

What is the difference between Infra/Intrabony defect? Citation

A

Goldman & Cohen 1958

Infrabony can be subdivided into intrabony (only 1 root surface involved) and crater (2 adjacent roots involved)

31
Q

What is the most common defect?

A

Crater

Becker and Becker

32
Q

What kind of defects are there?

A

Supra-bony (horizontal)

Infra-bony (vertical)

Inter-radicular (furcation)

33
Q

Where are craters most commonly found? Why? Citation

A

posterior teeth

interdental area collects plaque

McGugh 1971

34
Q

What is a circumfrential defect?

A

one that includes more than 1 tooth surface

35
Q

Who is the father of osseous surgery?

36
Q

What instrument should you use for osteoctomy?

A

Hand instruments (Ochsenbein Files)

Ochsenbein 1958

37
Q

What are the rules of osseous surgery?

A

1: Full thickness flap should be raised

2a: Scallop should aniticipate underlying bone contour
2b: Scalloping should reflect patient’s healthy gingiva
2c: Tissue/bone scalloping is reduced as interproximal space increases due to boneloss

3: Osteoplasty precedes ostectomy
4: Whenever possible - create positive architecture
5: no high speed next to teeth
6: final bone contour should reflect expected gingival contour

38
Q

Steps for osseous recontouring

A

vertical grooving

Radicular blending/Flattening interproximal bone

Gradualizing marginal bone

39
Q

What is the palatal approach?

A

Ochsenbein & Bohannan 1963

wider embrasure from divergence of palatal roots

40
Q

Lingual approach?

A

Tibbets eet al. 1976

Defects in mandible tend to happen beneath contact which is lingually displaced

Buccal bone is usually higher - causes excessive removal of buccal bone to get to lingual

41
Q

Classify craters

A

Small: 1-2mm

Med: 3-4mm

Deep: _>_5mm

42
Q

Classify root trunk

A

Ochsenbien

Maxilla:
Short: 3mm
AVERAGE: 4mm
Long: 5mm

Mand:
Short: 2mm
Average: 3mm
Long: 4mm

43
Q

What is palatal ramping?

A

in craters 2-3mm

reduce palatal side to 10˚ from base of crater

Classic Lit Fall 2021 (29 decks)

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