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Perio 2 exam 2 > Sweep 1 > Flashcards

Sweep 1 Flashcards

1
Q

Fromatechnicalstandpoint,itisimpossible to —— a palatal flap.

A

apically position

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2
Q

Thinned palatal flap

A

Cut off gingiva above bone, scallop out gingiva near bone, close.

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3
Q

A distal wedge is a periodontal surgical procedure for removing excessive soft tissue

A

distal to a terminal tooth

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4
Q

• A term “wedge” refers to a process for —— by removal of a

A

internal thinning

block of tissue

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5
Q

Typical sites for wedges

\

A
  • Maxillary tuberosity

* Mandibular retromolar area • Edentulous ridges

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6
Q

Distal wedge advantages
• Provide access to ———
• Allow internal thinning of ———
• It is possible to obtain ——— of the wound after reduction of bulky tissue

A

bone and furcations

bulky tissue

primary closure

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7
Q

Distal wedge Triangular:

A

least difficult, least invasive
• Square: provides best access
• Linear: most effective at preserving keratinized gingiva

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8
Q

Distal wedge

• Square:

A

provides best access

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9
Q

Distal wedge

• Linear:

A

most effective at preserving keratinized gingiva

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10
Q

Conservative Flap Designs
• Intended to minimize —–
• Good for ——–

A

recession

maxillary anterior teeth

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11
Q

Conservative flap designs

A

-Modified Widman Flap

– Flap curettage (open flap debridement

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12
Q

Modified Widman Flap

A
  • A scalloped, replaced mucoperiosteal flap accomplished with an internal bevel incision
  • Provides access for root planing
  • Conservative design permits primary closure of the flap
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13
Q

modified Widman flap is elevated only

A

2 to 3 mm apical to the alveolar crest

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14
Q

With conservative flaps, there is little or no ——-. The flap is adapted to obtain primary closure

A

bone resection

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15
Q

Interrupted sutures

A

 Simple loop modification  Figure 8 modification

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16
Q

 Sling sutures

A

 Single sling suture

 Continuous sling suture

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17
Q

Sutures should be inserted through the ——– first

A

more mobile flap

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18
Q

Sutures should be placed no closer than —– mm from the edge of the flap

A

2-3

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19
Q

 In the interdental papilla, should enter and exit the tissue at a point located below the line that forms the

A

base of the triangle of the interdental papilla

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20
Q

Periodontal dressings

A
  • To protect the wound postsurgically
  • For patient comfort
  • To obtain and maintain a close adaptation of the mucosal flaps to the underlying bone
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21
Q

 Post operative plaque control

A
  • 0.12% chlorhexidine (Peridex, Periogard)
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22
Q

 Maintain good postsurgical wound stability

A
  • adequate suturing technique

- protection of wound from mechanical trauma during healing

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23
Q

Suture removal

A
  • Use mouthrinse to clean the wound
  • Cut the suture close to the tissue as possible to avoid dragging bacteria into the wound
  • When removing continuous sutures, each section should be cut and pulled out individually
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24
Q

Annual rate of Attachment Loss = 0

A

.22 mm

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25
Q

SURGICAL THERAPY

• ADVANTAGES

A

– Direct vision while working on root surface – Easier manipulation/removal of tissues

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26
Q

Surgery • DISADVANTAGES –

A

Morbidity

– Esthetic compromises – Cost (?)

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27
Q

Gingivectomy

A

– External bevel

– Exposed tissue during healing

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28
Q

Flap

A

– Internally beveled
– Provides access to bone
– Tissues not exposed during healing

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29
Q

Perio flaps contexts for use

A

Contexts for use:
– Resection (removal of hard or soft tissue) – Conservative (for access only)
– Regeneration (new periodontal support)
• Flaps preserve keratinized gingiva • Flaps can be closed by suturing

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30
Q

Elevation past the ——- will fully reflect the flap

A

mucogingival junction

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31
Q

Elevation is very difficult if the primary incision does not extend to the

A

bone

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32
Q

• Exostoses require special attention to

A

direction of elevation

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33
Q

Partial-thickness flaps

A
  • Also known as “split-thickness flaps”
  • Periosteum remains on bone, protecting it from resorption
  • Requires sharp dissection
  • Technique is relatively difficult
  • Facilitates an increase in the width of keratinized gingiva
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34
Q

Vertical incisions
• Provide access without ——-
• Help with ——-
• Must be made ——– near line angles (never over a root prominence)
• Should ——- apically for vascular integrity

A

flap extension to adjacent areas

flap positioning

interproximally

diverge

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35
Q 
Flap positioning
• ---------- positioned
– For regeneration or root coverage
• Replaced
– For -------- (minimal recession)
• Apically positioned
– For -------
A

Coronally

conservative flaps

pocket elimination or crown lengthening

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36
Q

Gingivectomy Indications

A

-hyperplastic tissue -suprabony pockets

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37
Q

Gingivectomy Contraindications

A

-osseous involvement -mucogingival involvement -furcation involvement

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38
Q

Gingivoplasty

A

-reshaping of the gingiva -recreating physiological contours

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39
Q

—— are typically used for gingivoplasty

A

Diamond burs

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40
Q

Phases of Postsurgical Healing

A
  • Inflammation
  • Fibroblastic granulation
  • Matrix formation and remodeling
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41
Q

Healing immediate response

A
  • Formationofbloodclotbetweenmarginsof wound and between flap and tooth or bone
  • Clotincludesfibrin,neutrophils,platelets, red cells, cell debris, and capillaries at the edge of the wound
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42
Q

Healing: first 24 hours

A
  • Neutrophils infiltrate the connective tissue

* Epithelium begins to migrate from the wound margins

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43
Q

Healing: 1-3 days

A
  • Space between the flap and tooth or bone narrows

* Epithelial cells migrate over the border of the flap, contacting the tooth

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44
Q

Healing: 3-7 days

A
  • Epithelialmigrationcontinues
  • Neutrophilsarereplacedbymacrophages,which eliminate dead/damaged cells
  • Bloodclotisreplacedbygranulationtissue
  • Revascularizationbegins
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45
Q

Healing: 1 week

A
  • Epithelium attaches to the root
  • Blood clot is replaced by granulation tissue derived from gingival connective tissue, bone marrow and/or periodontal ligament
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46
Q

Healing: 2 weeks

A
  • Collagen fibers are oriented parallel to tooth surface (nonfunctional)
  • Union of flap to tooth is weak • Collagen fibers are immature
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47
Q

Healing: 1 month

A
  • Inflammatory cells are mostly gone
  • Fibroblasts proliferate, synthesize collagen
  • Revascularization process regresses
  • Gingival crevice is fully epithelialized
  • Epithelial attachment is well defined
  • Functional arrangement of supracrestal fibers
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48
Q

Healing: 2 months

A
  • Collagenhasremodeledandcross-linked

* Thewoundhasregainedmostofitsoriginal tensile strength

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49
Q

• When the bone is exposed by a full thickness flap, superficial bone necrosis occurs after

A

1 to 3 days

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50
Q

• Typically, —- of bone is lost when bone is exposed to the oral environment

A

1 mm

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51
Q

Healing by secondary intention exhibits:

A
  • A more vigorous inflammatory response
  • Formation of a larger volume of granulation tissue to fill the defect
  • More pronounced wound contraction during healing
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52
Q

The blood clot is a major initial source of

A

growth factors and cytokines.

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53
Q

PDGF:

A

induces fibroblast and macrophage migration, fibroblast proliferation and macrophage activation

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54
Q

• EGF:

A

induces epithelial proliferation

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55
Q

• TGF-ß:

A

induces migration of inflammatory cells and proliferation of fibroblasts

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56
Q

Growth factors released from the blood clot

A

PDGF
EDF
TGF-beta

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57
Q

Factors released by fibroblasts and macrophages

A

TNF, IL1beta

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58
Q

• TNF: activates

A

endothelium, induces neutrophil migration

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59
Q

• IL-1ß: activates

A

endothelium, induces neutrophil migration

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60
Q

• Repair:

A

damaged tissues are replaced by tissues that don’t duplicate the function or architecture or the original tissues.

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61
Q

• Regeneration:

A

damaged tissues are replaced by tissues that duplicate the structure and function of the original tissues.

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62
Q

• Thin bone =

A

horizontal bone loss •

63
Q

Thick bone =

A

vertical bone loss

64
Q

• Bone formation always occurs in areas of bone

A

resorption

65
Q

Increased resorption in the presence of

A

normal or increased bone formation

66
Q

• Decreased formation in the presence of

A

normal resorption.

67
Q

• Increased resorption combined with

A

decreased formation.

68
Q

Central buttressing bone

A

Central –occurs within the jaw

69
Q

Peripheral buttressing bone

A

Peripheral- occurs on the external surface of the jaw
• Creates a deformity in the overlying mucosa • Looks like a ledge
• Severe plaque trap

70
Q

Horizontal bone loss •

A

Suprabonypocket

71
Q

• Angular bone loss (vertical, infrabony, angular) •

A

Infrabonypocket

72
Q

Osseous surgery

A

Full thickness flap, Apically positioned flap

73
Q

• Regenerative surgery

A

Full thickness flap, Coronally positioned flap

74
Q

Physiologic architecture

A

When the crest of the interdental gingiva or bone is located coronal to its midfacial or midlingual margins

75
Q

Reverse architecture

A

When the crest of the interdental bone or gingiva is located apical to its mid- facial and mid-lingual margins

76
Q

Ostectomy-

A

Removal of bone that is attached to the tooth

77
Q

Ostectomy

Indications

A
  • Sufficient remaining bone for establishing physiologic contours without attachment compromise
  • No esthetic or anatomic limitations
  • Elimination of interdental craters
  • Intrabony defects not amenable to regeneration
  • Horizontal bone loss with irregular marginal bone height
  • moderate to advanced furcation involvement
  • Hemisepta
78
Q

Ostectomy

Contraindications

A
  • Insufficient remaining attachment
  • Unfavourably affect adjacent teeth
  • Anatomic limitations
  • Esthetic limitations
  • Effective alternative treatment
79
Q

Ostectomy

Advantages

A
  • Predictable pocket elimination
  • Physiologic gingival and osseous architecture
  • Favorable prosthetic environment
80
Q

Ostectomy

Disadvantages

A
  • Loss of attachment
  • Esthetic compromise
  • Increased root sensitivity
81
Q

Osteoplasty

A

Reshaping of the alveolar process to achieve a more physiologic form without removing alveolar bone proper

82
Q

Osteoplasty

Indications

A
  • Tori reduction
  • Intrabony defects adjacent to edentulous ridges
  • Incipient furcations
  • Reduction of thick heavy ledges or exostoses
  • Shallow osseous craters
83
Q

Tissue regeneration in periodontics

A
  • Bone grafts

* Guided tissue regeneration

84
Q

Guided tissue regeneration (GTR)- Definition

A

• Procedures allowing the repopulation of a periodontal defect by cells capable of forming new connective tissue attachment and alveolar bone.

85
Q

Materials used in GTR

• 1st:Non-Resorbable –

A

ePTFE

86
Q

• 2nd:Resorbable

A

– Cross-linked collagen membranes
– Calcium sulfate
– Poly-lactic/poly galactic acid (PLA/PGA) – Doxycycline 4%

87
Q

• 3rd: Stem cells,

A

functionally graded membranes

88
Q

e-PTFE

A

• Expanded Poly Tetra Fluoro Ethylene
• Non-resorbable
• Second stage surgical procedure required
• Remove4-6weekspostop – Use small incision
– Do not disturb tissue
– Cover new tissue with flap

89
Q

PLA/PGA

A

– Polylactic acid + citric acid ester – Degradation: 4-6 weeks
– One-stage surgery

90
Q

Collagen

A

– Cross linked

– Adding zinc prevents breakdown of collagen – Bovine or porcine source

91
Q

Osteogenesis –

A

Viable cells

92
Q

• Osteoinduction

A

– Uncommitted CT cells induced

93
Q

• Osteoconduction

A

– Non viable scaffold

94
Q

Autogenous grafts

– Advantages

A

• ‘Gold standard’-predictable results- Marx 1994 • Osteogenic

95
Q

Autogenous grafts

– Disadvantages

A

• Secondsurgicalsite
• Insufficient material
• Membranousbone(IO)vascularizesfasterthanendochondral(EO)
-Kusiak 1985
• IO bone resorbs slower than EO - Smith 1974, Zins 1983

96
Q

Allografts

A 
Advantages
– Availability
– No donor site
– Reduced surgical time – Fewer complications
Disadvantages
– Antigenicity
– Longer healing – Less volume
97
Q

Alloplasts and xenografts

A
  • Hydroxyapatite
  • Bovinederivedanorganicbonematrix
  • Tricalciumphosphate
  • Syntheticbonematerial(eg.Osteogen)
  • Coralline
  • Hard tissue replacement polymer
  • Bioactiveglass
98
Q
  • Enamel matrix proteins

* rhBMP -recombinant human bone morphogenetic protein

A

Biological mediators

99
Q

Root Trunk

Represents the

A

undivided region of the root.

The height of the root trunk is the distance between the CEJ and the separation line between two root cone

100
Q

Fornix:

A

the roof of the furcation

101
Q

Mand molars

A

100%,99% mesial and distal root depressions/concavities

102
Q

Cervical Enamel Projections

A

• 13% of molars have CEPs
• May favor the onset of periodontal lesions in the affected furcation
• Incidence of enamel pearls:
1.1% - 9.7%
• Maxillary 2nd molar found near the CEJ extending into molar bifurcations

103
Q

Glickman

Class 1:

A

early, catch in the probe, NO radioluscency

104
Q

Glickman

• Class 2:

A

varies from catch to deep penetration, radiographically visible, cul-de- sac or ‘blind alley’

105
Q

Glickman

• Class 3:

A

through and through

106
Q

Glickman

• Class 4:

A

clinically visible

107
Q

Pulpal pathosis may some times cause a lesion in the

A

periodontal tissues of the furcation

108
Q

Trauma from occlusion may cause inflammation and tissue destruction within the —- area of a multirooted tooth

A

interradicular

109
Q

Osseous Surgery

• Most effective in grade —– furcation

A

II

110
Q

Osteoplasty and ostectomy techniques
• Remove the lip of defect to reduce ——
• Bone ramps into the ——- to enhance plaque control
• Reduce ——–

A

horizontal depth

furcation

probing depths

111
Q

Root Resection done for

A

grade II, III

112
Q

Root Resection

Contraindications

A 
Inadequate bone support
• Fused roots
• Inoperable
endodontically
• Patient considerations
113
Q

Sequence of treatment at RSR

A
  • Endodontic treatment
  • Provisional restoration
  • RSR
  • Periodontal surgery
  • Final prosthetic restoration
114
Q

Hemisection

A
  • Mandibular molars
  • Grade III furcation
  • Need widely separated roots
  • Soft tissue positioned below level of pulp chamber
115
Q

Tunneling

A
  • Grade III furcation
  • Permits plaque removal
  • Root caries (4% stannous fluoride)
  • 25% failure rate at 5 years
  • Recurrent periodontitis
116
Q

Guided tissue regen for furcation defects - only effective with degree

A

II

117
Q

Periodontal problem zones with fixed replacements

A

1- Supragingival crown margins (if possible) with precise marginal adaptation 2- Open interdental spaces, crown contour follows natural tooth contour
3- Point- or line-shape contact of pontic with tissue
4- Occlusion, articulation

118
Q

All subgingival margins should be placed within —— mm apical to the free gingival margin whenever possible

A

1 to 2

119
Q

Avoid ————– cantileveredpontic

A

distally extending

120
Q

Smoking • Causes

A

peripheral vasoconstriction— Decreases tissue perfusion

121
Q

Restorative perio indications

A

INDICATIONS:
• Pocketsadjacenttoedentulousregions…
- To establish a healthy gingival sulcus
- To eliminate extraneous mucosal tissue to permit adequate vertical space for the replacements
-To provide a firm, healthy mucosal base for placement of saddles or pontics

122
Q

• Esthetic Crown lengthening:

A

Excessive gingival display or lack of gingival line symmetry

123
Q

• Functional Crown Lengthening:

A

Exposure of sound tooth structure for restoration

124
Q

Crown Lengthening to Treat Excessive Gingival Display

• Indicated if not

A

enough of the anatomic crown of the tooth is exposed (altered passive eruption)

125
Q

Crown Lengthening to Treat Excessive Gingival Display

• Contra-indicated if problem is

A

hypermobile lip or skeletal problem (vertical maxillary excess)

126
Q

Dentogingival complex (DGC):

A
  • gingival sulcus

* epithelial attachment (junctional epithelium) • connective tissue attachment

127
Q

From sound tooth structure to alveolar crest: (allowance to drop margin during prep):

A

– Textbook: general rule- at least 4 mm

– Others state from at least 3 mm to as much as 5.25 mm

128
Q

External Bevel

A

– Leaves gingiva as an open wound that must heal by secondary intention (granulate in)

129
Q

External Bevel

– Indications:

A
  • Adequate keratinized tissue

* adequate biologic width after surgery

130
Q

External Bevel

– Contraindications:

A

• Inadequate keratinized tissue • Biologic width invasion

131
Q

Electro-cautery (ElectroSurg)
• Limited to cauterizing soft tissue that interferes with impression taking
• Contraindicated if encroaches on biologic width: risk of

A

bone necrosis

132
Q

Apically Positioned Flap without osseous resection
– Preserves ——-
– However tissues may ——–

A

keratinized tissue

rebound

133
Q

Two options for lengthening clinical crown with osseous surgery:

A

– Submarginal (scalloped) incisions- if adequate keratinized tissue
– Sulcular incisions and apical positioning- if limited keratinized tissue

134
Q

Management of mucogingival

problems

A 
• Lackofkeratinizedand/orattachedgingiva - abutment teeth
- edentulous site
• Shallowvestibulardepth
- for partial removable denture
- for total removable denture
135
Q

If correct procedure for crown lengthening was done, wait at least

A

6 weeks

136
Q

Ridge Augmentation Procedures

INDICATIONS:

A

• Tocorrecttheexcessivelossofalveolarbonethat occurs due to:

  • advanced periodontal disease, - periapical lesion,
  • traumatic tooth extractions,
  • external trauma
137
Q

Ridge Augmentation Procedures

A
  • Placementofathickmucosalautograftobtainedfrom palate or the tuberosity
  • Placementofaconnectivetissuegraftbeneathafullor partial thickness flap or in a “tunnel” created by a lateral incision
  • Therolltechniquewhichconsistsofelevatingaflapover the deformed area, de-epithelizing its terminal half, and rolling it under the flap
  • Guidedboneregeneration
138
Q

GTR materials 3 classes

A

resorbable, nonresorbable, stem cells

139
Q

Layer facing bone - SL - bone side

A

, hydroxyapatite encorporated

140
Q

Layer facing bone - facing epithelium

A

metronidazole incorporated to prevent infection

141
Q

Core layer

A

protein in the middle of surface layers

142
Q

Space maintenance

A

Reinforces the membrane, create a scaffold with tentings crews, fillers (bone, bone subs, collagen)

143
Q

Mechs of graft integration

A

oteogenesis
Osteoinductive
osteoconductive

144
Q

Osteogenesis –

A

Viable cells

145
Q

• Osteoinduction

–

A

Uncommitted CT cells induced

146
Q

• Osteoconduction

A

– Non viable scaffold

147
Q

Autograft

A

conductive, inductive, genic

148
Q

Allograft

A

conductive, maybe inductive, not genic

149
Q

Alloplast/xenograft (bovine bone, synthetic stuff)

A

conductive, not inductive, not genic

150
Q

Allografts problems

A

antigenicity, longer healing, less volume.

151
Q

—– return at best for grafts (especially for allografts)

A

70%

152
Q

Allograft benefits:

A

Availability
– No donor site
– Reduced surgical time – Fewer complications

153
Q

Biological mediators in grafts

A
  • Enamel matrix proteins

* rhBMP -recombinant human bone morphogenetic protein

154
Q

Easiest root to remove

A

DB root

Perio 2 exam 2 (5 decks)

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