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Perio > Surgery In Periodontal Disease_23rd April 2018_8am > Flashcards

Surgery In Periodontal Disease_23rd April 2018_8am Flashcards

1
Q

What are the types of periodontal surgerY?

A
  • Resective
  • Access flap
  • Periodontal regeneration (previously known as guided tissue regeneration)
  • Mucogngival
  • Implant
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2
Q

What does periodontal regeneration invovle?

A
  • Placing a barrier into the defect
  • Barrier prevents growth of epithelial or gingival CT into defect
  • Allows bone, PDL and cementum to repopulate defect instead
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3
Q

What sort of bony defects can guided tissue regeneration be done in?

A
  • Angular defects (the more walls the defect has the better the prognosis)–>3 wall good, 2 wall decent, 1 wall hopeless
  • Can not be done in horizontal defects as these are pretty much zero wall defects

-Also dependant on size of defect, technical difficulties (e.g. if 7/8 affected), predictability (e.g. medically compromised elderly patient)

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4
Q

Which type of cementum can regenerate?

A

AEC

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5
Q

What is the turnover rate of:

  • Epithelial cells
  • Gingival Ct cells
  • PDL cells
  • Bone cells
A
  • Epithelial cells: hours to days
  • Gingival Ct cells: days to weeks
  • PDL cells: days to weeks
  • Bone cells: weeks to months
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6
Q

What are the outcomes when the following are the main cell types proliferating into a periodontal defect?

  • Gingival CT
  • Epithelial cells
  • Alveolar bone
  • PDL
A
  • Gingival CT: root resorption
  • Epithelial cells: long junctional epithelium (happens after normal scale/clean)
  • Alveolar bone: ankylosis (if lots of bone)
  • PDL: Tissue regeneration
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7
Q

What features do you aim for in the periodontal healing response?

A
  • Shrinkage of pocket
  • New collagen formation in gingiva
  • Long junctional epithelium or if very deep periodontal regeneration
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8
Q

Define:
Repair
Reattachment
New attachment

A

Repair: healing by resorption and ankylosis

Reattachment: Reunion of previous existing fibres that have been torn (e.g. replanting tooth evulsed by trauma, keep it in milk and reattach within 24 hours)

New attachment: (true regeneration) formation of new collagen fibres that embed into newly formed cementum

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9
Q

What materials are used for periodontal regeneration?

A

Bone grafts: Facilitates formation of new bone
*Bone grafts purpose is to achieve osteoinduction (causes alterations in molecular biology which results in new cell formation depositing new bone). However, whether what is formed really is bone is up for debate–>confirmed with Kaur in person

Membranes: covers the defect after putting bone graft in to prevent the granules from coming out, also plays a role in regeneration by creating a barrier, thus causing defect area to be repopulated with bone, PDL and cementum NHrather than epithelial cells

Growth factors: Consist of stem cells that facilitate bone growth

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10
Q

What are the different types of bone grafts?

A
  • Autogenous: harvested from patient
  • Autollogous: harvested from same species
  • Alloplastic: Bioactive glasses (Perioglas, Biogran)–>not often used anymore
  • Xenografts: Bovine bone (Bio-Oss)–>has shown very good results
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11
Q

How is periodontal regeneration carried out?
What is the protocal re. membrane and graft usage?
How long should you wait before probing or scaling area?

A
  1. Anaesthetise
  2. Open flap
  3. Clean the area + remove granulation tissue
  4. Condition root surface with Pref-gel
  5. Take Bio-Oss and mix with patient’s blood and Emdogain (25mins 20 seconds)
  6. Place it into defect
  7. Place membrane (cut biogide into shape of defect)
  8. Suture
  9. Keep two weeks before removing sutures
  • Wait 6 months before probing or scaling
  • Membranes always used (for guided bone regeneration)
  • Graft used with non-reinforced membranes
  • Reinforced membranes do not require graft (GTAM Goretex does not require graft 24mins 25 seconds)
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12
Q

What type of membranes are there?

A

Note: Resorbable and non resorbable available

Xenograft: made from porcine (pigs) (Bio-gide)–>most commonly used, resorbable

Synthetic: Polyglycolic, polyactic (Vicryl)–>not used anymore

Gor-tex (GTAM): has reinforced wire, can be bent, but requirse a second surgery to remove as non-resorbable and risk of exposure to oral cavity even after very good packing which causes instant failure. However, as reinforced does not require use of graft

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13
Q

What are the different types of growth factors available?

A

Xenograft: Enamel matrix protein derived from porcine (Emdogain)–>most commonly used, comes with PrefGel which is used to condition bone beforehand

Autogenous: Platelet rich plasma, rich in PDGF–>not used often

Synthetic: rhBMP-2–>not used often

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14
Q

What are the expected clinical results (in terms of attachment, tissue gain and healing) with:
Perioglas/Bioglas
Bio-Oss/Biogide
Emdogain

A

Perioglas/Bioglas:
Attachment: 2mm decrease in PD/2mm gain in attachment
Tissue: No or little cementum, mostly long junctional epithelium and some CT attachment
Healing: 3-6 months for resorption, can improve up to 1 year

Bio-Oss/Biogide:
Attachment: 4mm decrease PD/3-4mm attachment gain
Tissue: Cementum, CT attachment, bone formed as well as long junctional epithelium
Healing: 12-18 months for graft to resorb, can improve up to 2 years

Emdogain:
Attachment: 4mm decrease PD/ 3-4mm attachment gain
Tissue: Cementum, CT attachment, bone formed as well as long junctional epithelium
Healing: Can improve up to 2-3 years

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15
Q

What is the difference between periodontal regeneration and guided bone regeneration?

A

-Periodontal regeneration tries to form PDL, cementum and bone (in areas where there is a tooth)

Bone regeneration only aims to form bone in bone deficient areas (normally for edentulous areas for pros)

However both use the same materials

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16
Q

What are the classifications of bone defects in edentulous areas?

A 
class I: bucco lingual deficiency (dip on the buccal or lingual side, but height is preserved)
class II: Vertical deficiency
class III: combination
17
Q

Define:
Osteoinduction
Osteoconduction

A

Osteoinduction: Recruitment of immature cells to differentiate into preosteoblast to form new bones

Osteoconduction: Formation of scaffold which permits bone growth on surfaces or pores (e.g. formation of bone on implants screws), bone formed is slightly different from osteoinduction in the senes that it forms a scaffold

*Bone grafts purpose is to achieve osteoinduction (causes alterations in molecular biology which results in new cell formation depositing new bone). However, whether what is formed really is bone is up for debate–>confirmed with Kaur in person

18
Q

What does tissue engineering involve?

A

-Stimulation of stem cells to produce new tissue

19
Q

What is the cost cost of one jar of bio oss?

A

$500

20
Q

What is the cost of membranes?

A

$450

21
Q

What is socket preservation?

A

After extraction of tooth, place a block into the socket to facilitate bone healing

Only use for “clean” sockets (i.e. not for endodontically treated teeth as always have some residual infection)

22
Q

What are some other methods other than guided bone regeneration for repairing defects?

A

-Inlay/onlay grafts
(removal of bone from tuberosity, symphysis area and build in height)

  • Ramus grafting (take out bone and mix with patient’s bone)
  • Sinus grafting
  • Rib grafting
  • These procedrues must be done under GA, whereas GBR can be done chairside

Perio (5 decks)

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