Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Periodontics > Surgical Periodontal Therapy 2 > Flashcards

Surgical Periodontal Therapy 2 Flashcards

1
Q

What is a periodontal flap?

A

A section of gingiva and/or mucosa that is surgically separated from underlying tissues to provide for the visibility and accessibility to bone and root surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can periodontal flaps be classified? (3)

A

Based on:

  1. bone exposure after flap reflection
  2. placement of flap after surgery
  3. management of papilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are flaps classified based on bone exposure after flap reflection? (2)

A
  • full-thickness (mucoperiosteal)
  • partial-thickness (mucosal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are flaps classified based on placement of flap after surgery? (2)

A
  • nondisplaced flaps - returned to and sutured in original position
  • displaced (repositioned) flaps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 types of displaced flaps? And when are they used?

A
  • apically displaced- pocket therapy
  • coronally displaced- recession
  • laterally displaced - recession
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are flaps classified base on the management of papilla? (2) Explain both

A
  • conventional flap: interdental papilla is split beneath the contact point of the 2 approximating teeth (splits B and L - causes shrinkage)
  • papilla preservation flap: incorporates the entire papilla in one of the flaps (L pushed completely to B, avoids shrinkage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is it important to use papilla preservation flap?

A

anteriors (aesthetic zone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is open flap debridement (OFD)? aka replaced flap, access flap, open flap debridement

A

to improve visibility and accessibility for subgingival instrumentation of both soft and hard root surface deposits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the OFD procedure. Give 4 main aspects and 2 optional.

A
  1. Intra-sulcular incision and full thickness mucoperiosteal flaps (B and L/P)
  2. Removal of granulation tissue and thorough root surface debridement
  3. Replacement of flap margins to original position and place sutures
  4. Complete coverage of alveolar bone at end of surgery

Optional: papilla preservation for anteriors, vertical relieving incisions to improve access by allowing movement but can reduce blood supply and stability of the flap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is purpose of the Modified Widman Flap (MWF)? (2)

A
  • historically designed as an access flap with removal of inflamed pocket epithelium
  • aims to excise marginal tissue cuff to facilitate direct postoperative PD reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main disadvantage of the Modified Widman Flap?

A

recession and black triangles due to loss of soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Outline the MWF technique. (6)

A
  1. initial scalloped IBI 1mm from gingival margin and parallel to long axis of tooth
  2. second intra-sulcular incision to bone crest
  3. removal of soft tissue collar (infected tissue)
  4. removal of granulation tissue and planing of the root surface
  5. optional: bone re-contouring
  6. replacement of flap and suture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the purpose of an Apically repositioned flap?

A

Reduce the pocket, maintaining an adequate zone of attached gingiva by displacing the flap with the whole complex of the soft tissue (gingiva and mucosa) in an apical direction → what was pocket becomes attached gingiva

can be full or partial thickness flap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the Apically repositioned flap technique. (4)

A
  1. IBI and SI as in MWF to remove collar tissue
  2. Vertical release incisions extending to mucogingival junction
  3. Exposure of bone margins and possible bone reshaping
  4. Repositioning of flaps at the apical level and secure its position with adequate suturing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the outcome of the Apically repositioned flap technique?

A

pocket reduction and increase in attached gingiva

although there may be residual pocketing in areas of greater bone loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the issue with treating furcation involved multi rooted teeth with non-surgical perio therapy?

A

respond less favourably + reduced prognosis

(due to limited operator and pt access)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain the 3 grades of furcation involvement.

A

Grade I: incipient, catch in furcation

Grade II: bone loss not through and through (cul de sac)

Grade III: bone loss through and through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the periodontal pocket in a furcation lesion influenced by?

A
  • soft tissue anatomy (thick or thin)
  • bone loss (horizontal or angular)
  • inter-radicular anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 2 categories of surgical treatment for furcation involved multi rooted teeth?

A
  1. resective surgery
  2. regenerative surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the types of resective surgery? Which is most conservative?

A
  • furcation plasty (most conservative)
  • hemi-section, root resection, bicuspidisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is furcation plasty and its expected outcome? (2)

A

changing shape of furcation area for improved access for self-care and supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What specific procedures may be involved in furcation plasty? (3)

A

odontoplasty

osteoplasty

gingivoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Outline the steps of furcation plasty? (4)

A
  1. flap to access to inter-radicular area
  2. odontoplasty to widen furcation entrance
  3. osteoplasty to reduce/eliminate intrabony defect and bone thickness
  4. positioning of flap at level of alveolar bone crest
24
Q

What aspect of furcation plasty should be done cautiously with regards to teeth?

A

aggressive odontoplasty should be avoided on vital teeth due to risk of hypersensitivity

25
Q

An alternative to furcation plasty’s are tunnel preparations - what are they and which teeth are they done on?

A

Prep goes completely B to L bone to get better cleaning access.

Done in deep grade 2 or 3 furcation defects in md molars to delay the need for extraction.

(not mx molars which don’t have straight access)

26
Q

What is the rationale behind hemi-section, root resection and bicuspidisation procedures? What needs to be done before or after the surgery?

A

= complete elimination of the furcation defect is only possible if the roots are sectioned to remove the ‘furcation’ itself

  • need to do endo before surgery to preserve tooth or part of it
  • sometimes decision to resect tooth is made during surgery in which case endo done along with surgery
27
Q

What is hemi section and its indications? (1,2)

A

Sectioning tooth into 2 and removing half of it

Indications:

  • severe bone loss around 1 root
  • perforations during endo
28
Q

What is root resection aka. root amputation? (1) Which teeth can it be done on? (1)

What are the indications? (1)

A

removal of 1 or 2 roots while keeping rest, endo required, only on mx molars

similar indications to hemi-section (when there are issues with 1-2 roots)

29
Q

What is bicuspidisation?

A

splitting tooth into 2 and retaining BOTH sections

(i.e. keeping tooth without furcation)

30
Q

Outline the overarching steps of hemi-section, root resection and bicuspidisation. (4)

A
  1. Mucoperiosteal flap to expose furcation area
  2. Sectioning of tooth with straight line cut
  3. Careful removal of root (root resection) or tooth section (hemisection) selected for extraction. None for bicuspidisation.
  4. Re-positioning of flaps at level of bone crest
31
Q

What should be given before bicuspidisation (1)

A

remaining root(s) should have adequate bone support

32
Q

What are bicuspidisation failures usually due to and what should be done properly

A

non-perio complications

care should be taken to ensure sound endo therapy and balanced occlusion

33
Q

What does regenerative surgery involve? (3 tissues)

A

regeneration of all tissues destroyed by periodontal disease:

cementum

new attached periodontal fibres

new bone

34
Q

How can you verify true regeneration? What might be the clinical finding post surgery?

A

only by histologic evaluation with re-entry surgery, which can measure bone fill but cannot ascertain if new cementum or periodontal fibres have formed

(only been done in very limited research contexts)

clinically, can result in decreased PD but this may due to tightly adapted gingiva with long JE

35
Q

What are the 4 types of pocket outcomes possible after perio tx and which is mostly associated with regenerative surgery?

A
  1. long JE
  2. connective tissue adhesion and root resorption
  3. root resorption and ankylosis
  4. new connective tissue attachment (REGEN - mainly done with bone grafts)
36
Q

What are the indications (4) and contraindications (4) of bone grafting?

A

Indications:

  • 2 or 3 walled infra/intrabony defects
  • grade 2 furcation involvement
  • preparation of site for implant placement (GBR)
  • in combo with GTR procedures

Contraindications:

  • horizontal bony defects associated with teeth
  • lack of soft tissue coverage
  • patients with poor plaque control
  • systemic issues e.g. smoking or poor general health
37
Q

Name the 4 types of bone grafts. (Ordered from best to worst in achieving regeneration).

A
  1. autogenous graft (self)
  2. allograft (human)
  3. xenograft (animal)
  4. alloplast (synthetic)
38
Q

Explain the osteogenic, osteoinductive and osteoconductive categories of bone grafts. State which types of grafts fall into each category.

A

Osteogenic (best): provide appropriate cellular elements which survive transplantation and synthesise new bone at recipient site → autografts

Osteoinductive: graft sends signals to attract, proliferate and differentiate early-lineage cells capable of forming bone → allografts

Osteoconductive: graft serves as scaffold which bone can attach, migrate, grow and/or divide → allografts and some xenografts

i. e
osteogenic: has cells required for bone formation
osteoinductive: molecules that encourage cells to produce new bone
osteoconductive: need host cells to get into scaffold to lay down new bone

39
Q

Circle the best regenerative procedures.

A

bone derived vs non-osseous

40
Q

What is an autogenous graft (autograft)? (2) Why is it the ‘gold standard’? (1)

A

tissue from self, blocks or chips scraped off bone surface (depending on how much you want - e/o or i/o)

best because most compatible

41
Q

What are 3 points differentiating using extra vs intra oral sites for harvesting autografts?

A

Extra-oral:

  • larger quantity
  • increased morbidity (under GA)
  • theatre cost

Intraoral:

  • limited quantity
  • lesser morbidity (LA)
  • surgical expertise
42
Q

Name the common sites for extra-oral autograft hravesting. (4)

A

Iliac crest

ribs

fibula

tibia

43
Q

What are the 2 forms of allografts?

A
  • Freeze-dried bone (DFBD)
  • Decalcified freeze-dried bone (DFBD)
44
Q

Name the common sites for intra-oral autograft harvesting. (6)

A
  • extraction sites
  • md retromolar area
  • md ramus
  • md symphysis
  • maxilllary tuberosity
  • tori

(areas that have enough cortical bone and marrow underneath)

45
Q

What is the particle size of DFDBA?

A

250-710 microns

46
Q

Outlines the steps for creating DFDBA. (5)

A
  1. 100% ETOH (to reduce lipid content)
  2. HCl acid (for decalcification)
  3. Washed and buffered to pH 6.8-7
  4. Lyophilized
  5. Stoppered under vacuum
47
Q

How is a xenograft made? (2 key points)

Name one commercially available xenograft product. (1)

A

protein extracted from bovine bone to produce porous bone mineral hydroxyapatite

e.g. Bio-Oss (de-proteinised bovine bone with alkali at 300oC for 15h then sterilised)

48
Q

What is GTR and what concept does it rely on?

A

Selective repopulation

Involves placing a membrane on the bone surface up to the epithelium and connective tissue (which would normally grow back first), blocking them off and preventing these unwanted cells from growing , allowing only bone and PDL cells to repopulate

This allows for true regeneration.

49
Q

Which two procedures are the only ‘true regenerative’ procedures?

A
  • bone grafts
  • GTR/GBR
50
Q

What type of procedure are Non-resorbable membranes mainly used in?

A

GBR

(implant site prep)

51
Q

Name 2 non-resorbable membranes.

A

polytetrafluoroethylene (PTFE) membrane → Goretex

titanium-reinforced PTFR → Cytoplast

52
Q

Name 2 disadvantages of Non-resorbable membranes.

A
  • need 2nd surgery to remove
  • exposure can lead to infection (should be under flap but sometimes exposed once healed)
53
Q

Name 3 types of resorbable membranes. (3)

Which is most commonly used? State its brand name (2)

A

collagen (main) → Bio-Gide (porcine)

polyactic acid

polyglycolic acid

54
Q

What are the advantages of resorbable membranes (4)

A
  • elimination of need for 2nd surgery
  • more tissue-friendly
  • enhance tissue coverage
  • resist or prevent microbial colonisation (minimal even if exposed)
55
Q

What are the disadvantages of resorbable membranes? (2)

A
  • may elicit immunologic or inflammatory reaction (rare)
  • time of resorption cannot be controlled (very subject and cannot know if resorbed or not)

Periodontics (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions