Sweep 2 Flashcards by Tyler Brown

• Annual rate of Attachment Loss =

0.22 mm

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– Modified Kirkland flap (MKF) • uses ——– incisions

Sulcular incisions

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Flap

– —— beveled

Internally

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Exposed tissue during healing

gingivectomy

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Pocket depth, amount of keratinized gingiva and intended position of the flap are essential

pre-treatment considerations

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——– scalpel blades and handle for flap

Bard-parker

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• Elevation past the —— will fully reflect the flap

mucogingival junction

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• Coronally positioned

– For

regeneration or root coverage

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• Replaced

– For

conservative flaps (minimal recession)

Pretty much removing interior, placing exterior back where it was.

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• Apically positioned

– For

pocket elimination or crown lengthening

Same as replaced, but removed from alveolar bone, moved down.

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Creation of bleeding points as Gingivectomy

knife reference points for primary incision

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Thinned palatal flap

like a cross between gingivectomy and internal bevel. Cut gingiva down low, bevel, reattach at bone margin

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Mod widman Initial incision has ——- scallop, but may also be ——-

0.5 to 1 mm

intrasulcular

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With conservative flaps, there is little or no —-

bone resection

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 Simple loop modification  Figure 8 modification

Interrupted sutures

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 Single sling suture

 Continuous sling suture

Sling sutures

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Cut the suture —— as possible to avoid dragging bacteria into the wound

close to the tissue

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Phases of Postsurgical Healing

Inflammation
Fibroblastic granulation
Matrix formation and remodeling

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

Healing: immediate response

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Neutrophils infiltrate the connective tissue

* Epithelium begins to migrate from the wound margins

Healing: first 24 hours

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Space between the flap and tooth or bone narrows

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

Healing: 1-3 days

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Epithelialmigrationcontinues
Neutrophilsarereplacedbymacrophages,which eliminate dead/damaged cells
Bloodclotisreplacedbygranulationtissue
Revascularizationbegins

Healing: 3-7 days

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

Healing: 1 week

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

Healing: 2 weeks

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* 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

Healing: 1 month

* Collagenhasremodeledandcross-linked | * Thewoundhasregainedmostofitsoriginal tensile strength

Healing: 2 months

When the bone is exposed by a full thickness flap, superficial bone necrosis occurs after 1 to 3 days • Osteoclastic resorption follows, peaking at

4 to 6 days.

PDGF: induces

fibroblast and macrophage migration, fibroblast proliferation and macrophage activation

• EGF: induces

epithelial proliferation

• TGF-ß: induces

migration of inflammatory cells and proliferation of fibroblasts

gingival inflammation extends along

collagen fiber bundles

gingival inflammation follows course of

course of blood vessels

gingival inflammation can enter maxillary sinus, leading to

[thickening of sinus membrane

Bacterial plaque in a radius of ------m to bone will lead to resorption Angular defects if interdental septum is ------

1.5-2.5mm >2.5mm wide (Tal)

Bone Loss due to Periodontal Disease can be due to

Increased resorption in the presence of normal or increased bone formation. • Decreased formation in the presence of normal resorption. • Increased resorption combined with decreased formation

• Bone forms during periods of

remission

Osseous surgery Full thickness flap, ----- positioned flap • Regenerative surgery Full thickness flap, ------- positioned flap

Apically Coronally

Osseous surgery Generally ------ incision but sometimes sulcular incision only (if keratinized tissue is limited) Additional vertical incisions if needed to apically position

scallop

Regenerative surgery ------- incision | Additional vertical incisions if needed to coronally position

Sulcular

Reverse architecture

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

Reverse architecture is the opposite of

physiological architecture

Osteoplasty | Reshaping of the alveolar process to achieve a more physiologic form without removing --------------

alveolar bone proper

Class I crater :

2-3mm deep, thick facial and lingual walls. •

Class I crater Manage by

palatal ramping

Class II crater :

4-5 mm deep, thinner facial and lingual walls.

Class II crater - Manage by

facial and palatal ramping

• Class III crater :

6-7 mm deep, thin walls, sharp drop to base.

Class III crater - Manage by

facial and palatal ramping

• Class IV crater :

Variable depth, very thin walls.

Class IV crater - Remove

both walls

remove e-PFTE -------- weeks post op

4-6

Functionally graded membranes

core, outer, inner layers for specific purpose

Reinforce the membrane • Create a

``` scaffold • Using tenting screws • Using fillers – Bone – Bone substitutes – Collagen sponge incorporated with growth factors ```

• Osteogenesis –

Viable cells

• Osteoinduction | –

Uncommitted CT cells induced

• Osteoconduction

– Non viable scaffold

Enamel Matrix Derivative (Emdogain®) | • Action:

formslayerofextracellularmatrixontheroot surface that promotes selective cell colonization (enhances mesenchymal cell adhesion and inhibits epithelial cell adhesion)

Human Platelet-Derived Growth Factor in Tri-calcium Phosphate (GEM 21S ®) • Action:

PDGF stimulates migration and proliferation of osteoblasts, fibroblasts and cementoblasts, leading to formation of new bone, PDL and cementum

Max molars root concavities

* Maxillary Molars | * 94% mesiobuccal roots • 31% distobuccal roots • 17% palatal roots

Incidence of enamel pearls:

1.1% - 9.7%

• Trauma from occlusion may cause inflammation and tissue destruction within the

interradicular area of a multirooted tooth

Bone ramps into the furcation to

enhance plaque control

Sequence of treatment at RSR

* Endodontic treatment * Provisional restoration * RSR * Periodontal surgery * Final prosthetic restoration

Tunneling | for grade---- furcation

III

Hemisection for

* Mandibular molars | * Grade III furcation

For hemisection, • Soft tissue positioned

below level of pulp chamber

Root Separation | • Root separation involves the

sectioning of the root complex and the maintenance of all roots

GTR for furcation defects only doable for

grade II

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

1 to 2

Lateral incisor gingival line should be ------ more coronal than for central incisors and canines

0.5 mm

Dentogingival complex (DGC): -------------- • epithelial attachment (junctional epithelium) • connective tissue attachment

• gingival sulcus

• From sound tooth structure to alveolar crest: (allowance to drop margin during prep): – Textbook: general rule- at least

4 mm

Internal (inverse) Bevel – Scalloped (submarginal incisions) as if to ------- – Removes tissue without -----------

raise a flap exposing wound during healing

Apically Positioned flap with Osseous Resection • Performed when ------------ is needed to establish a biologic width: – Prevents ------- rebound – Maintains integrity of --------

osseous resection gingival attachment apparatus

• Two options for lengthening clinical crown with osseous surgery:

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

After osseous resection and suturing, biologic width re-established: ----- from gingival margin to bone

>3 mm

Time to wait after Crown lengthening for Restoration | • If correct procedure for crown lengthening was done, at least

6 weeks

Management of mucogingival | problems

* Subepithelialconnectivetissuegraft • Freegingivalgraft | * Vestibular extension

Ridge Augmentation Procedures | METHODS:

* Soft tissue augmentation only * Hard tissue augmentation only * Soft and hard tissue augmentations

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Sweep 2 Flashcards

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