Sweep 1 Flashcards
mucogingival defect
Gingival recession
Lack of gingiva (Keratinization)
Gingival recession with abrasion
Recession - generalized - due to
Tissue biotype, oral hygiene
Recession - localized - due to
Anatomy, defective restoration
Brushing and recession - in young adults —- most involved
premolars
Hx of hard brush use
•Positive association with
% receded surfaces
Miller class 1 when there is no
interproximal bone loss and the recession does not extend to mucogingival junction. 100% root coverage can be anticipated in miller class I recession defects.
Miller class II When there is no
interproximal bone loss and the recession extends to or beyond mucogingival junction. 100% root coverage can be anticipated in miller class II recession defects.
Miller class III there is
interproximal bone loss and the recession may or may not extend to mucogingival junction. Only partial root coverage up to the level of interproximal bone can be anticipated in miller class III recession defects
Miller class IV there is
interproximal bone loss beyond the level of recession No root coverage can be anticipated in miller class IV recession defects.
CAF - coronally advanced flap -
most predictable outcome. Full thickness, coronally positioned. Two vert incisions.
Tunnel -
no incision, raise flap through sulcus, tunnel to underlying bone, insert graft
Lateral sliding flap -
single tooth recession. Remove epi layer and slide flap from donor side over. Partial thickness, if concern for recession on donor side use collagen.
Double papilla -
like lateral sliding from two sides
SGCT -
Subepithelial connective tissue graft
increase tissue thickness at site.
Allograft
• Recovered from
human donor skin
• Mucograft
• Xenograft porcine collagen type I and III
• Emdogain
– an extract of enamel matrix and contains amelogenins
—– provides best outcome for root coverage
SGCT, CAF
Free gingival graft INDICATIONS
• To increase ——-
• To increase —– depth
• To achieve ——-
KG/attached gingival
vestibular
root coverage
Free gingival graft - DISADVANTAGES
• Not predictable to achieve —–
• Esthetic concern: —— at recipient site
• Complications at —–
root coverage
color discrepancy
donor site
FGG healing - Initial phase (0-3 days) –
“Plasmatic circulation
FGG healing - —— phase (2-11 days)
Revascularization
FGG healing - ——- phase (11-42 days)
Tissue maturation
Frenulum (frenum)
A small band or fold of ——– that controls, curbs, or limits the movement of organ or part
integument or mucous membrane
Aberrant Frenum
Atypical/abnormal insertion of ——- frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements.
labial, buccal, or lingual
Inability of —————- has been implicated in the persistence of aberrant frenum
frenum to migrate apically during alveolar growth and tooth development
Classification of labial frenum
Mucosal
Gingival
Papillary
Papillary penetrating
Mucosal frenum
Insertion of frenum ends in
mucosa or, at the most, at mucogingival junction.
Gingival frenum
Insertion of frenum ends in the
gingiva, between mucogingival junction and base of the interdental papilla
Papillary frenum
Insertion of frenum ends at the
interdental papilla, but does not penetrate to the palatal aspect of the tissues
Papillary penetrating frenum
Insertion of frenum ends at the
interdental papilla, and penetrates to the palatal aspect of the tissues.
Ellis-van Creveld syndrome Orofacial-digital syndrome associated with
Prominent/Aberrant max frenum problems
Ehlers-Danlos syndrome Holoprosencephaly
Genetic Syndromes are associated with absence of maxillary labial frenum
Studies of excised frena agree on presence of :
both orthokeratinized and parakeratinzed epithelium.
collagen fibers.
chronic inflammatory infiltrate
With excised frena - Presence of ——- is inconsistent
muscle fibers
Aberrant labial frenum
Can be associated with:
Frenal tension
Interference with oral hygiene procedures
Gingival Recession
Midline Diastema
Recession Interference with oral hygiene procedure Trauma Plaque retention Diastema Denture fabrication
Indications of frenectomy
Frenotomy: the cutting of a frenulum, especially the release of ———.
ankyloglossia
Frenulectomy (frenectomy): the
excision (total removal) of a frenulum.
V-shaped incision, Archer incision, diamond-shaped incision
Simplest procedure
Z-plasty incision
More demanding, less relapse
Lasers (CO2, others)
Better patient outcomes
Frenectomy can result in scar formation between central incisors, which can lead to resistance to ——
orthodontic movement.
Orthodontic treatment should be considered before
the frenectomy. - however, Wide and thick frenum may require removal prior to space closure
Ankyloglossia
“Tongue tie” Congenital oral anomaly characterized by an abnormally short lingual frenulum Partial or complete Incidence: 0.02 - 10.7%
Anatomic indications: for ankyloglossia removal
notching of the ———
inability of the tongue tip to contact the ——
restriction of ——- movement
restriction of tongue protrusion beyond the ——-
protruding tongue tip
maxillary alveolar ridge
lateral tongue
mandibular alveolus
Ankyloglossia
—– is a safe procedure
Treatment may improve ——-
Frenotomy
breastfeeding,
tongue mobility, and speech articulation
Laser: Common Components
ActiveMedium
ExcitationMechanism
HighReflectanceMirror
PartiallyTransmissiveMirror
ActiveMedium
solidcrystals(rubyorNd:YAG)
liquiddyes(gaseslikeCO2orHelium/Neon) semiconductorssuchasGaAs.
ExcitationMechanism
Excitation mechanisms pump energy into the active medium by one
HighReflectanceMirror
A mirror which reflects essentially 100% of the laser light.
or more of three basic methods; optical, electrical or chemical.
PartiallyTransmissiveMirror
A mirror which reflects less than 100% of the laser light and
transmits the remainder (this is the LASER beam).
Technical difficulties
Lack of precision in depth of cut
Tissue not available for histopathology
Hazardous
Dispersal of viable virus particles in the plume
disadvantages of lasers
Periodontal applications - laser Soft tissue surgery ------ ------- uncovery Frenectomy? Uncovering ------
Gingivectomy
Implant
soft tissue impactions
Lasers for tooth exposure
Indications
Soft tissue impactions
Hard tissue palatal impactions
Lasers for tooth exposure
Contra-indications
Hard tissue impactions with variable bone
thickness Esthetics
LANAP
Laser Assisted New Attachment Procedure
not a ton of evidence for this, most of their claims can be countered.
LANAP - Basic concept:
Remove sulcular epithelium
Modify root surface
New attachment will occur
Lanap - protocol
1 pass of laser, SRP x 3, pass 2 of laser, periostat one week before and 3 months after
Photo Dynamic Therapy (PDT) Advantages Useful for ----- ------ specific – since the photosensitizer can be formulated to target certain tissues (e.g. iodine-coupled dyes will target thyroid only) No ----- (for bacteria)
hard to reach areas (inject the sensitizer through
IV, then shine a light on the target tissue)
Tissue
antibiotic resistance
PDT Disadvantages
Wavelength of light is very narrow (630-700nm), so big ——–
Light source configuration is cumbersome (think rigid instrument in narrow spaces)
Photosensitivity can cause —– injuries
tumors (and deep pockets) cannot be penetrated
severe burn
PDT not
FDA approved
Peri-implantitis does not seem to be treatable by
non-surgical means
PMT =
Periodontal MaintenanceTherapy
Rationale for PMT • tooth loss ------- to SPT frequency • reduced risk of future attachment loss despite ------- • monitoring • plaque removal
inversely proportional
incomplete plaque removal
Components of PMT appointment
assessment of personal oral hygiene (cleaning more or less)
• active treatment (root planing, occlusal appliance, antimicrobials, surgery)
- communication
• planning
Frequency of PMT
• For most patients presenting with gingivitis but without history of attachment loss- performed on a —–
For patients with a history of periodontitis, PMT should be performed at intervals of less than — months - most commonly every ——.
semiannual basis
6
3 months
– poor plaque control =
no surgical treatment
– single site =
nonsurgical treatment
– continued inflammation =
surgical treatment