Test 2 Flashcards
What are the 4 modifying factors of furcation involvement
Anatomic, Supervised neglect, difficult cleansibility, restorations
What are 5 examples for anatomic modifying factors of furcation involvement
Cervical enamel projections, enamel pearls, accessory canals, root anatomy, root trunk length
What factors affect root anatomy 4
Form proximity grooves and concavities bifurcation ridges
exposed roots are more or less sussectable to caries
more
Longer trunks roots are harder to clean but are less or more susceptible to caries
less
Short root trunks are easy to clean but are more or less susceptible to carries
more
Root trunk distances for the facial maxillary molar and Mandibular molar
Facial molar is 4mm long while the mandibular is 3 mm
Root trunk distances for the mesial surfaces of maxillary bicuspid, molar
3mm for maxillary molar
7mm for maxillary bicusbid
Root trunk distances for distal surfaces of maxillary molar and bicusbid
5mm
7mm
What is the lingual distance of a mandibular molar
4mm
Premolars have a good prognoses with furcation involvement because of the root trunk length T of F
false the have a poor prognosis
Bifurcating ridges within the furcations are present 73% of what molars
mandibular and they are convex on both sides
entry of probe for maxillary teeth are from what angles
Mesial palatal, distal and facial right angled.
What type of probe is used for maxillary molars
naber’s probe
Glinkmans classifications go to what number
1-4
What describes Glinkmans class 1 furcation
not evident on radio graph, incipient bone loss
Hamp classification involves 3 classes but are different than the Glinkmans classifications.
false they are the same
Where is the incipient bone loss for class 1
opening of the furcation, detectable upon examination but not by radiograph
Glinkmans class 2 furcation involvement is
partial bone loss, with a culdelsac like appearnce, not through and through and may or may not show up on a radiograph
Class two of glinkmans can either be what or what
deep or shallow, deep may go all the way to the middle and stop at the mesial root
Class 3 glinmans furcation involvement is
through and through and will definitively show up on a radiograph, inter radicular bone is completely absent
Class 4 glinkmans furcations involve a
through and through with a furcation exposure due to gingival recession
Hamp classes go to what number and explain each number
1 2mm
3 through hand through
What is the average width of a currette
1.25
58% of fucations are less than
.75mm
81% of furcations are
1.0mm
untreated furcations progress to the next stage every
class one year 1
Class two year 4
Class three year 6
Enamel projections are separated into 3 grades what is grade one
Distinct change in to the CEJ tha tprojects toward the furca
Enamel projections are separated into 3 grades what is grade two
CEP approaching the furcation
Enamel projections are separated into 3 grades what is grade 3
CEP at the roof of or into the furcation
T or F gingiva will not bind to the enamel and will cause a deep PD,
T
The commonality of cervical enamel projects are
28.6% of mandibullar molars
17% of maxillary molars
CEPs in ____ of isolated mandibular molars with furcation involvement
> 90% and usually 50% of all CEP involves the furcation
If you get a random deep pocket depth you should associate that with CEP
TRUE
what is the likely hood of getting a enamel pearl
1.1% to 5.7% of permanent molars
74% of 3rd molars
Accessory canals that exit in the roof of furcation
36% of maxillary 1st molars
32% of mandibular 1st molars
24% of mandibular 2nd molars
12% of maxillary 2nd molars
In non vital teeth or those with pulpits accessory canals are often associated with
abscess blow outs of furcal bone
What were the percentages of advanced disease in 600 patients in Hirshfeld L Wasserman study
76%
What was the percentage of those who lost 0-3 teeth 4-9 teeth and 10-23 teeth
0-3 teeth were 83%
4-9 teeth was 13%
10-23 teeth were 4%
What teeth are less likely to be lost to perio
single rooted teeth
What trends of lost teeth do you find with teeth loss
Maxillary are lost before mandibular except for central incisors
the pushback procedure is used to establish a wider
keratinized tissue
what were some reasons for stopping the pushback proceedure
exposure of denuded bone during healing resorption of crestal bone stormy post surgery healing poor esthetic results poor long term results of infra-bony lesion are not adequately treated
Wennstrom is described as how attached gingiva
at least 2 mm of attached keratinized
What is the Etiology of Gingival recession
Chewing tobacco use Malposed teeth Factitial injury Eruption patterns Frenulum attachment Parafunctional habits Chronic inflammation toothbrushing technique thin biotype Iatrogenic Discrepancy in facial-lingual width of tooth vs that of the alveolus
Fenistratins and dishissence may have pathology yes or no
no
Tooth osition relative to ______or_______ may result in bony fenestration and dehiscence
facial or lingual
_______ when combined with bony dehiscence or fenestration is likely to result in gingival recession
Biotype for thin gingiva
Other causes for recession include
plaque malposed tooth, calculus frenulum trauma toothbrushing piercings
what equals attached gingiva
the width of keratinized tissue - PD
to determine the keratinized tissue one can use what two things
a probe, disclosing solution
tissue fenestration is when you have a hole in what
mucosa
why would you want to treat recession
To increase the width of keratinized tissue and attached gingiva
For root coverage
Why increase the keratinized and attached gingiva
prosthetic concerns
Orthodontic concerns
prevent progressive recession
Root coverage is important in order
help esthetics
dentinal sensitivity
prevention of root caries
How to increase the width of attached gingiva
APF Apically positined flap, full thickness flap
Free autogenous gingival graft FGG
Subepitheilial connective tissue great CTG
What are the options for obtaining root coverate
CTG,
semilunar incision+ coronal positioning Tarnow procedure
Lateral pedicle flap LPF
APF need to check on
Thickness of the alveolar bone
amount of pocket reduction required
length of the root run average 3mm
Clinical crown length
APF is used to increase what and how is it done
It is used to increase the karitinized tissue, and is done by cutting the tissue and moving it up, used for multiple teeth
the FGG is importantt to use for
increase attached gingiva remove abnormal frenulum deepen oral vestibule ridge augmentation procedures rarely to cover exposed roots
What are the advantages of using a FGG
Not technically demanding
may be accomplished with partial or full thickness flap reflections
FGG disadvantages
poor ability to provide blood supply to graft for root coverage
esthetic results are compromised due to scarring during healing resulting in poor color match
surgery required at two intramural sites
Donor site may present problems with bleeding pain and slow healing
CTG, more often used for
for covering exposed root surface
What advantages are there to using a CTG technique
High predictability
graft receives abundant blood supply
palatal wound can be surgically closed for rapid healing
Good color match
applicable for recession on multiple teeth
Disadvantages for CTG
The subepitheilial connective tissue graft is technically demanding, gingivoplasty may be necessary after healing to obtain better tissue contours and to decrease thickness
Semilunar incision with coronal positioning requires what
Maxillary anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva
A complimentary procedure for small areas of gingival recession remaining after other procedures were used for root coverage
Advantages to Tarnow procedure aka semi-lunar incision with coronal positioning are
no tension on coronal positioned flap no narrowing of oral vestibule good esthetics due to color match papillary height is preserved simple surgical procedure minimal post operative discomfort applicable to minimal gingival recession across multiple teeth
disadvantages of Tarnow procedure is
Not applicable in cases of moderate to advanced gingival recession greater than 2mm
requires 3-5 mm of thick keratinized tissue
Healing is by secondary intention and therefore some contraction may occur
may require a second procedure depending on occurrence of tissue contraction
osseous dehiscence or fenestration exists apical to the gingival recession area a FGG or CTG should be performed after coronal positioning of the semi lunar flap
Trauma from occlusion is considered to be
pathologic
forces of occlusion that exceed the adaptive capacity of the periodontium is considered to be what type of trauma
occlusal trauma
what are the variables of force in occlusal trauma
direction of force
magnitude of force
duration of force
frequency of occurrence
What re the effected sections of the periodontium affected by occlusal forces
cementum
PDL
Alveolar Bone Proper
The gingiva and junctional epithelium are not affected by occlusal forces
What are the clinical symptoms of occlusal trauma
mobility of affected teeth
radiographic evidence of PDL
positive HX of clenching or bruxism
What are some more clinical symptoms of occlusal trauma
evidence of working on occlusal interferences
evidence of occlusal slide in centric relation or centric occlusion
evidence of occlusal inter terence in protrusive mandibular movement
What is Fremitus
A movement of tooth when teeth come into functional contact
Trauma from compression side causes
initial decrease in PDL space
loss of fiber orientation
rupture of capillaries and hemorrhage into PDL perivascular spaces
Resorption of alveolar bone proper to widen PDL
Root resorption may occur
What are two symptoms of trauma seen on a slide for compression side
Surface resorption of bone and compacting of PDL at compression side of tooth
Tension side trauma of occlusion creates
stretching of fibers increase PDL
Rupture of PDL fiber bundles
compression of PDL capillaries and hemorrhage
Apposition of new alveolar bone proper follwwed by decrease PDL
Cemental tearing
Primary occlusal forces are Increased and excessive the bone support is
normal
Forces are or are not on the long axis of the tooth during excursive primary occlusal truama
not on the long axis
Secondary occlusal trauma occur ______ and the amount of alveolar bone support is _______
normal or excessive
reduced
Occlusal hyperfuncion is caused by
slight increase in occlusal force
considered to be a physiologic adaptation and not a pathologic entity
What clinically will you see with occlusal hyperfunction
Increase in number and diameter of collagen fire bundles in PDL
increased width of PDL
Increased density and thickness of alveolar bone proper Lamina dura
Radiographic evidence of oseosclerosis of alveolar bone with PDL insertions
slight or undetectable tooth mobility
Occlusal Hypofunction
a mild weakening of tooth supporting structures due to lack of physiologic stimulation
Considered to be physiologic adaptation and not a pathologic entity
can only be dianosed by histology
decrease in number of PDL fiber bundles Normal orientation
decreased physiologic turnover and remodeling of alveolar bone
narrowing of PDL space
no change in tooth mobility
Difuse atrophy
total removal of occlusal forces resulting in lack of the level of physiologic stimulation required to maintain mnormal form and function, consderd to by physiologic not patholgic
Difuse atrophy can be seen with
decreased width of PDL
increased tooth mobility is always present
absence of occlusal antagonist
loss of orientation of the principle bundle
Significant decrease in number of bony trabecular
Trauma from occlusal forces do no cause
gingivitis
increased PD
Periodontitis
Even though there is occlusal trauma with perio, it doesn’t mean that
the removal of the occlusal trauma will make it better
Occlusal trauma with perio does produce more bone loss than with perio alone t or f
true
iatrogenic disease
the creation of additional problems or complications as a result of treatment
Contour of crowns and gingival margins of crowns and restorations are important determinants of what
periodontal health
Gingival margin overhangs of inter proximal restorations
are associated with periodontal pockets that are significantly deeper
Gingival inflammation and plaque retention scores show significant decreases following removal of the overhang
significant decreases following removal of the overhang
Gingival margin overhangs are associated with
gingival inflammation
bone loss and
microbial plaque and caluculus accumulation
X-rays can show
periodontal ligament
trabecular of cancellous bone
lamina dura
What are causes of alveolar bone loss
Chronic periodontitis
aggressive periodontitis
Necrotizing ulcerative periodontitis
Interproximal caries will typically
occur below the contact point
follow direction of the enamel odds
cone shaped radiolucency
spreads along the DEJ
BW radiographs check for , what is important not to do in order to find this
have overlap on the BW
1/2 enamel penitration,
A incipeint lesion
does no pass more than half way of the enamel
a moderate lesion
passses mor than half way
what is most likely penitrated the dentin incipient or moderate
moderate
How much of the actual decay can be seen on a radiograph,
70%
Through and through lesion has penitrated
past the DEJ and visualized in the dentinal layer
Base of triangle on enamel then
base of triangle at dej
Root caries involves what
dentin and cementum
generally root caries are initiated in areas of
food impaction
Root caries commonly are found in
surgical patients for periodontal disease
Root caries are what shaped
saucer shaped
Is enamel envolved in root caries
no
Interpretation or root caries must be what before diagnosis
confirmed clinically due to cervical brunout
How efficient are our diagnostic tools
they are good at only seeing changes and not good at early preventive detection, best is home hygiene
half of what go undetected by explorers
proximal lesions
X-rays are ____ senisitive in the diagnosis of proximal caries
60%
Caris detection by radiographic examination requires
very through clinical examination
flawless radiographic technique
experience in radiographic interpretation
Why have root coverage
esthetic concerns
dentinal sensitivity
prevention of root caries
