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BDS4 Periodontology > Step 3 > Flashcards

Step 3 Flashcards

1
Q

What is S3 quality level

A

evidence and consensus based guidelines
uses sytematic review & representative guideline groups

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2
Q

What does step 1 consist of

A
  • control of local and systemic risk factors
  • PMPR
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3
Q

What should we look at when re-evaluating step 1

A
  • adherence and PPD >3mm means that we can progress to step 2
  • lack of adherence means repeat step 1
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4
Q

What happens in step 2

A
  • step 1 plus
  • subgingival instrumentation in some cases with adjunctive measures
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5
Q

What adjunctive measures can be used in step 2

A

local/systemic AB
CHX rinse

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6
Q

What should we re-evaluate after step 2

A
  • pocketing
  • are there any residual pockets?
  • if no, proceed to step 4
  • if pockets >4mm, proceed to step 3
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7
Q

What do we do in step 3

A
  • step 1 and 2 in residual pockets
  • plus periodontal surgery
  • only in cases with suitable px, tooth and defect factors
  • in certain cases, repeated subgingival instrumentation
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8
Q

What do we re-evaluate at the end of step 3

A
  • did we achieve our end point
  • PPD </= 4mm with no BOP
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9
Q

What is step 4

A
  • supportive care
  • risk adapted intervals 3-12 months
  • continous monitoring of local and systemic risk factors
  • PMPR
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10
Q

When should systemic AB be used in periodontal tx

A
  • not first line tx
  • used in selected cases
  • only allowed once combined with mechanical disruption of biofilm
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11
Q

What is the tx protocol for prescribing AB

A
  1. OH
  2. supragingival and subgingival PMPR of all sites indicated in pocket chart as quick as possible, within one week
  3. start antibiotic regimen on first morning of PMPR visit
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12
Q

What is the antibiotic regimen

A

400mg metronidazole TID for 7 days
can also give it with amoxycillin 500mg TID 7 days

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13
Q

Who is metronidazole contraindicated in

A
  • warfarin - increases anticoag effect
  • alcohol
  • pregnancy
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14
Q

What are the advantages of local antimicrobials

A

reduced systemic dose
high local concentration
superinfection unlikely
drug interaction unlikely
site specific
px compliance not an issue as applied by health care provider
can utilize agents which cant be utilized systemically

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15
Q

What are the disadvantages of local antimicrobials

A
  • expensive
  • still require RSD or biofilm disruption
  • limited indications
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16
Q

What are the indications for using local antiseptics such as periochip or chlorhexidine gel

A
  • only persisting pockets >5mm
  • always with RSD
  • only in isolated pockets
  • in cases of periodontal abscess - after evacuation of pus and RSD
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17
Q

What are examples of local antibiotic

A
  • arestin - 1mg micocycline
  • artidox - doxycycline
  • elyzol - 25% metronidazole
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18
Q

What is open flap debridement

A
  • intracrevicular incision made through base of gingival pocket and entire gingivae
  • mucoperiosteal fullthickness flap used
  • remove granulation tissue and instrument root surface
  • flap replaced in original position
  • no attempets to reduce preop depth of pockets
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19
Q

What is the post-op care for periodontal surgery

A
  • reinforce mechanical plaque control
  • post-op soft toothbrush for operated area
  • CHX mouthwash 1-2 wks
  • analgesia for a few days
  • AB if indicated
  • remove sutures after 1 wk
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20
Q

What is the purpose of gingivectomy

A
  • reduction of gingival excess to facilitate plaque control, restorative dentistry and improve appearance
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21
Q

Why is it important to control causative factors of ginival enlargement prior to surgery

A

*will recur

22
Q

What drugs are implicated in gingival hyperplasia

A

calcium channer blockers
phenytoin (anti-epileptic)
cyclosporin (antirejection drug)

23
Q

What are the indications for gingivectomy

A
  • gingival enlargement or overgrowth
  • idiopathic gingival fibromatosis
  • falls pockets
  • minor corrective procedures
  • procedure done during lengthening of crowns for prosthetic tx
24
Q

What is false pockets

A

enlargement of gingival tissue without apical migration of the junctional epithelium attachmnet

25
Q

What are the aims of regenerative therapy

A
  • increase periodontal attachment in severely compromised teeth
  • dercease deep pockets to maintainable range
  • reduction of vertical and horizontal component of furcation defects
26
Q

What are the types of pockets/bone loss

A
  • horizontal bone loss
  • vertical bone loss
27
Q

What is horizontal bone loss also known as

A

supra bony pocket
base of the pocket is located coronally to the alveolar crest

28
Q

What is vertical bone loss also known as

A

infrabony pocket defect
apical end of pocket locaed below alveolar crest

29
Q

What is a crater defect

A

sits between two adjacent teeth

30
Q

Why are vertical defects hard to tx

A
  • narrow
  • poor visability
31
Q

What is the classification of intrabony deffect

A
  • one wall
  • two wall
  • three wall - best for regeneration tx
32
Q

What are the strategies for periodontal regeneration

A
  • space maintenance and clot protection
  • selective cell repopulation
  • provision of progenitor cells
  • use of signalling molecules
33
Q

What are the types of membranes that can be used in guided tissue regeneration

A
  • bioabsorbable
  • non-absorbable
34
Q

What are the objectives of bone grafts

A
  • space maintenance and clot protection
  • osteoconduction
  • osteoinduction
  • osteogenesis
35
Q

What is osteoconduction

A
  • the material acts as a scaffold
  • new bone grows onto the material
36
Q

What is osteoinduction

A
  • induces new bone growth via promotion of osteoblact activity

Osteoinduction is the process by which osteogenesis is induced. It is a phenomenon regularly seen in any type of bone healing process. Osteoinduction implies the recruitment of immature cells and the stimulation of these cells to develop into preosteoblasts.

37
Q

What is osteogenesis

A
  • osteoblasts persent in the graft
  • bone formation occurs
38
Q

What is grade I furcation involvement

A
  • early lesion
  • less than one third of horizontal attachment loss
39
Q

What is grade II

A
  • more than one third horizontal attachment loss but not through and through
40
Q

What is grade III

A
  • through and through
41
Q

What is the treatment aims of furcation involvement tx

A
  • elimination of the microbial plaque from the exposed surface of the root complex
  • establishment of an anatomy of the affected surface that facilitates proper self performed plaque control
42
Q

What are the different tx strategies for furcation involved tx

A
  • palliative - maintain plaque control
  • repair
  • regeneration
  • eliminate - resective treatmnet
43
Q

What is palliative treatment

A
  • non-symptomatic
  • functional
  • periodic debridement
  • periodontitis may progress a t slow rate
  • if reasonably firm and not too severe, the tooth can survive
  • because of access difficulties, non surgical tx is likely to be susccessful only in tx early graed lesions
44
Q

What are indications for periodontal regeneration in furcation defects

A
  • two and three proximal defects
  • graed II mandibular furcation deffects
  • grade II buccal maxillary furcation defects
45
Q

What is the technique for repair

A
  • small furcation
  • RSD
  • open flap debridement
46
Q

What are the difficulties with regenerative appraoches in furcation defects

A
  • furcation sites provide good space maintenace and clot protection
  • but they are difficult to adequately debride
  • they are relatively avascular
47
Q

What techniques can be used for regeneration of furcation defects

A

*guided bone regeneration

48
Q

How does open flap design compare with guided tissue regeneration when tx furcation defect

A
  • GTR results in greater vertical and horizontal bone fill
  • results are better in mandibular furcation
  • GTR + bone graft means even better results
49
Q

What are the different possible resective treatments

A
  • furcation plasty (mainly at buccal and lingual furcation
  • tunnel preparation to treat deep II and II furcation in mandibular molars
  • root resection/seperation/hemisection
50
Q

What are indications for extraction of teeth with furcation defects

A
  • recurrent symptoms
  • little remaining attachment
  • gross mobility
  • non functional teeth

BDS4 Periodontology (2 decks)

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