s10 - non surgical therapy

Question 1

What is the primary goal of Phase I periodontal therapy?

Answer 1

To remove pathogenic biofilms/calculus and reestablish a biologically acceptable root surface.

Question 2

List the 5 steps in the sequence of Phase I therapy procedures.

Answer 2

*1) Plaque control instruction,
* 2) Supra/subgingival debridement,
* 3) Restoration recontouring,
* 4) Caries management,
* 5) Tissue re-evaluation.

Question 3

Why is Phase I therapy considered “cause-related”?

Answer 3

It targets microbial etiology and contributing factors to halt disease progression.

Question 4

What is the rationale for removing contaminated cementum during root planing?

Answer 4

Bacterial endotoxins in cementum prevent PDL attachment and perpetuate inflammation.

Question 5

How does Phase I therapy contribute to systemic health in periodontal patients?

Answer 5

By reducing oral inflammation linked to systemic conditions (e.g., diabetes, CVD).

Question 6

Define “regeneration” in periodontal healing.

Answer 6

Growth of original tissue types (e.g., PDL, bone, cementum) to restore lost structures.

Question 7

How does “repair” differ from “regeneration”?

Answer 7

Repair forms long junctional epithelium/scar tissue without restoring original architecture.

Question 8

Why does epithelium migrate faster than connective tissue during healing?

Answer 8

Epithelium has higher mitotic activity, CT relies on slower angiogenesis.

Question 9

What are the 4 requirements for predictable periodontal regeneration?

Answer 9

1) Infection control,
2) Epithelial migration control,
3) Recruitment of PDL/bone cells,
4) Biocompatible root surface.

Question 10

Why is long junctional epithelium (LJE) considered a weak attachment?

Answer 10

Non-keratinized, permeable to bacteria, lacks functional PDL fibers.

Question 11

Name one protective role of junctional epithelium despite its weaknesses.

Answer 11

Basement membrane restricts bacterial penetration; high turnover rate.

Question 12

What is the primary objective of scaling?

Answer 12

Remove calculus, bacteria, and toxins from crown/root surfaces.

Question 13

How does root planing alter the root surface for healing?

Answer 13

Removes contaminated cementum, smoothens surface to discourage plaque retention.

Question 14

Why is subgingival curettage controversial?

Answer 14

Proper scaling/RP often resolves inflammation without needing curettage.

Question 15

What is the “smear layer,” and why is it problematic?

Answer 15

Incomplete calculus/organic debris acting as a barrier to new attachment.

Question 16

Why is deep pocket debridement challenging without surgery?

Answer 16

Limited visibility, root irregularities, and instrument access constraints.

Question 17

List 3 ways pocket reduction occurs post-scaling/RP.

Answer 17

1) Tissue shrinkage (edema reduction),
2) LJE formation,
3) CT reattachment.

Question 18

How does gingival inflammation affect probe penetration depth?

Answer 18

Inflamed tissue is more penetrable, leading to overestimation of pocket depth.

Question 19

What is the primary goal of biofilm disruption in non-surgical therapy?

Answer 19

Expose bacteria to host defenses/chemotherapeutic agents.

Question 20

Why is endotoxin removal critical during root planing?

Answer 20

Endotoxins trigger host inflammation and inhibit PDL cell adhesion.

Question 21

Name 3 indications for non-surgical therapy.

Answer 21

1) Shallow/moderate pockets, 2) Pre-surgical prep, 3) Medically compromised patients.

Question 22

How does non-surgical therapy aid pre-surgical tissue management?

Answer 22

Reduces edema/bleeding, improves surgical visibility/outcomes.

Question 23

Why might non-surgical therapy alone suffice for some patients?

Answer 23

Dramatic improvement in pocket depth/inflammation may eliminate need for surgery.

Question 24

What is the role of oral hygiene in maintaining non-surgical therapy results?

Answer 24

Prevents plaque recurrence and disease progression.

Question 25

What are the two main categories of periocentrics?

Answer 25

Antimicrobial therapy and host modulating therapy.

Question 26

What is the primary goal of antimicrobial therapy?

Answer 26

To reduce bacterial challenge and harmful bacterial byproducts.

Question 27

What is the key mechanism of chlorhexidine?

Answer 27

Positively charged molecules bind to negatively charged bacterial cell walls, causing membrane disruption.

Question 28

List 3 disadvantages of chlorhexidine use.

Answer 28

Tooth staining, calculus formation, and taste alterations.

Question 29

What makes local delivery antimicrobials (LDA) superior to mouthrinses for periodontal pockets?

Answer 29

LDAs maintain high drug concentrations at the site for extended periods.

Question 30

Name the 5 FDA-approved LDAs.

Answer 30

Tetracycline fiber, doxycycline polymer, chlorhexidine chip, minocycline ointment, metronidazole gel.

Question 31

How long does tetracycline fiber (Actisite) release medication?

Answer 31

10-14 days.

Question 32

What is unique about doxycycline polymer (Atridox) delivery?

Answer 32

It's syringe-applied and biodegradable, requiring no removal.

Question 33

What is the main advantage of systemic antibiotics over topical antimicrobials?

Answer 33

Ability to reach bacteria in deep pockets, furcations, and extra-dental sites.

Question 34

List 3 disadvantages of systemic antibiotic use.

Answer 34

Adverse reactions, antibiotic resistance, and uncertain patient compliance.

Question 35

What is the purpose of host modulation therapy?

Answer 35

To reduce tissue destruction and promote periodontal stabilization/regeneration.

Question 36

Give two examples of host modulatory agents.

Answer 36

Sub-antimicrobial dose doxycycline (SDD) and NSAIDs.

Question 37

How do matrix metalloproteinase (MMP) inhibitors work?

Answer 37

They inhibit collagenase activity to prevent connective tissue breakdown.

Question 38

What is the primary limitation of mouthrinses as antimicrobial delivery?

Answer 38

Poor subgingival penetration beyond 2-3mm.

Question 39

Why is irrigation alone insufficient for periodontal therapy?

Answer 39

Rapid clearance by GCF/blood flow and inability to maintain effective drug concentrations.

Question 40

What are the three ideal characteristics of chemotherapeutic agents?

Answer 40

Bactericidal effect, ability to reach infection sites, and sustained activity.

Question 41

Why is biofilm a challenge for antimicrobial therapy?

Answer 41

Extracellular matrix protects bacteria and limits drug penetration.

Question 42

What are two methods to deliver antimicrobials subgingivally?

Answer 42

Controlled-release devices (e.g., chips/fibers) and professional irrigation.

Question 43

Why might a periodontist choose local over systemic antimicrobials?

Answer 43

To avoid systemic side effects and target specific sites.

Question 44

What is the biggest limitation of non-surgical therapy for deep pockets?

Answer 44

Inability to completely debride root surfaces without surgical access.

Question 45

How does diabetes affect periodontal treatment outcomes?

Answer 45

Impaired healing and increased inflammation complicate therapy.

Question 46

Why is patient compliance critical after non-surgical therapy?

Answer 46

To prevent plaque recurrence and disease progression.

Question 47

What is the main reason for periodontal disease recurrence?

Answer 47

Inadequate plaque control and failure to maintain supportive therapy.

Question 48

What are two key factors in long-term success of non-surgical therapy?

Answer 48

Patient oral hygiene and regular professional maintenance.