Test 3 Flashcards
What does CHG stand for?
Chlorhexidine Gulconate
What is CHG?
Chlorhexidine Gluconate is a bis-biguranide which are cationic, broad-spectrum antimicrobials effective for both gram-positive and gram-negative bacteria.
How is CHG used?
Predominantly used in prescription oral rinses, irrigation solutions, and controlled-realase products
When should CHG be prescribed?
To facillitate healing 4-6 weeks after perio surgery and in the DH clinic to aid in plaque reduction and gingivitis (gingival bleeding) with DD3 and DD4 clients. (Reeval visits)
How does CHG work?
Attaches to salivary proteins and prevents pellicle formation. Attaches to the bacterial cell wall and distrupts its ability to colonize
What is the dosage of CHG?
20mL dosage for 60 seconds twice daily
What are the disadvantages of CHG?
Brown staining
Increased calculus deposition
May cause allergic reaction
30 minutes between CHG and brushing to avoid interacion with the detergent (sodium lauryl sulfate) which deactivates the CHG
What are the contraindications for CHG?
Do not use for long periods of time
Anterior restorations
Allergies or hypersensitivites to chlorhexidine gluoconate, chlorhexidine compounds or other ingredients
What schedule category does chlorhexidine fall under?
Schedule 1
What is an example of a phenolic compound?
Listerine
What is the main reason that the level of reduction in plaque and gingivitis seen with chlorhexidine is greater than that noted for phenolic mouth rinses?
Superior substantivity of chlorhexidine - its binding lasts longer
Why did the authors exclude patients with systemic disease from the study?
To eliminate potential confounding factors that could interefere with the results
What is the evidence that proves professionally applied oral irrigation has limited clinic value?
Not retained in adequate concentrations for sufficient duration to have significant effects on periodontal disease
Some active ingredients such as chlorhexidine gluconate are deactivated by blood and proteins
Gingival crevicular fluid is replaced about every 90 seconds reducing the concentration of an antimicrobial agent that reaches the subgingival organisms
How should antimicrobials be used in the treatment of periodontal diseases?
To supplement mechanical debridement
What is the difference between local and systemic delivery methods?
Local - the antimicrobial agent is applied directly to the oral cavity or to a specific location within it
Systemic - ingested by the patient and delivered via the blood stream
What agent kills or prevents propagation of plaque microorganisms?
Antiseptic agents
What agent inhibits or kills specific or groups of bacteria, or modulates host inflammatory response?
Antibiotics
What agent alters structure and/or metabolic activity of bacteria?
Modifying agents
What agent interferes with the ability of bacteria to attach to acquired pellicles?
Anti-adhesives
What is the goal of professionally applied products?
Aimed at reducing pathogenic bacteria in diseased sites that have resisted healing
What are some pros of professionally applied products?
Controlled-release drug delivery
Does not require patient compliance
Non-invasive
Able to reach the base of the periodontal pockets
What are some cons of professionally applied products?
Active ingredients may not be retained in adequate concentrations for sufficient periods of time or may become deactivated by blood products
What is the main ingredient of Antridox?
Doxycycline hyclate 10%
How is Antridox delivered?
Gel polymer that flows to the pocket base and solidifies on contact with gingival crevicular fluid
What is the length of Antridox’s bacterial suppression?
7 days
What are the pros of Antridox?
Controlled release for 7 days
Reaches gingival crevicular fluid concentrations of over 1500mg/mL within hours
Absorbable by the body so does not require professional removal
What are the indications for Antridox?
Periodontal disease with deep pockets
What are the contraindications for Antridox?
Sensitivity/allergy to any drug in the tetracycline family
Pregnant women
Breast-feeding women
What is a Periochip?
Chlorhexidine chip with 2.5mg of chlorhexidine d-gluconate that is inserted into a 5 mm or greater periodontal pocket
What is the active ingredient in a Periochip?
Chlorhexidine d-gluconate 2.5mg
What is the length of Periochip’s bacterial suppression?
7-10 days
What are the pros of Periochip?
Suppression of subgingival bacterial flora is evident for up to 11 weeks
Self-retentive
Self-resorbs requiring no professional removal
Safe for pregnant women
No potential to develop bacterial resistance
Treatment can be repeated after 3-6 months
Delivery method of Periochip?
Place chip subgingivally
What is the contraindication for a Periochip?
Allergyy to chlorhexidine
What is the main ingredient of Arestin?
Minocycline hydrochloride 1mg
How is Arestin delivered?
As microsphere in a dry powder via a syrgine like handle with narrow tip to be inserted subgingivally
What is the length of Arestin’s bacterial suppression?
20 days
What are the pros of Arestin?
It well exceeds MIC levels within hours and remains effective for over 20 days
Resorbs and doesn’t require professional removal
What are the contraindications of Arestin?
Sensitivity or allergy to minocyclin or tetracyclines
Breat feeding women
Pregnant women
WHen would you use Atridox, Periochip and Arestin?
Isolated pockets
Before systemic antibiotics are applied
What is periowave?
A painless, non-invasive photo-disinfection procedure that can significantly improve treatment outcomes when combined with scaling and root planing
How is periowave applied?
A cold low-power diode laser as the activating light
What is the main goal of periowave?
Pathogen eradication
Are antiseptics and antimicrobials the same?
Yes
CHG rinses reduce plaque by how much?
16-45%
CHG rinses reduce gingivitis by how much?
27-80%
What is term referring to the prolonged adherence of an antiseptic to the oral mucosa/tooth and slow release of the effective dose?
Substantivity
What are antimicrobial and anti-gingvitis agents that reduce plaque accumulation and inflammation?
Phenolic compounds
What are components of plants that contain phenolic compounds that destroy microorganisms?
Essentil oils
True or False: professionally applied subgingival irrigation with various antrimicrobials has limited clinical value.
True
What size is a Periochip?
4 x 5 mm and 0.35 mm thick
Chemotherapeutics for self-applied delivery systems are typically used more often
at home with lower concentrations of active ingredients
Dental lasers are classified according to
Wavelength
Delivery system
Emission modes
Tissues absorption
Clinical applications
How do the lasers work?
Energy absorption will cause the target tissue to react in four ways: warm up, cogualte, vaporize or melt and recrystallize.
True or False: there has been very little research conducted with other adjunctive periodontal laser therapies so there is a low level of certainty regarding their use.
True
What are the primary objectives of periodontal surgery?
- Reduction in pocket depths
- Gain access for calculus and bioflim removal
- Regenerate periodontal tissue
- Arrest disease progression
- Create maintainable oral environment
How is clinical success measured for periodontal surgery?
Attainment of stable or improved clinical attachment levels, minimal inflammation and BOP, and reduced and stable probing depths.
What are the indications for peridontal surgery?
- Pocket elimination/reduction
- Correction of mucogingival defects
- Improve aesthetics
- Creating favourable restoration environment (crown lengthening)
- Placement of dental implants
- Icision and drainage of a gingival or periodontal abscess
- Regeneration of destroyed attachment apparatus
What are the contraindications for periodontal surgery?
- Systemic diseases that cannot be controlled by medications
- Systemic diseases that are associated with excessive bleeding
- Client taking blood thinners
- Clients taking inravenous or oral bisphosphonates
- Clients who are noncompliant with plaque control
- Concern for cosmetic outcome
- Treating teeth that have a hopless prognosis
- High risk for dental caries, sme surgeries expose root surface (relative contraindication)
When should a re-eval be completed?
4-6 weeks after initial NSPT is completed
After initial NSPT is completed, what should be done fo active periodontitis?
Refer to periodontist
What is the role of the dental hygienist pre-op periosurgery?
Removal or hard and soft deposits
Reinforcement of oral hygiene self care
Discuss the advantages and disadvantages of surgical treatment
What is the role of the dental hygienist post op perio surgery?
Periodontal dressing removal
Post surgical biofilm removal
Follow-up wound care and home care istructions
How do you know if the client has peri-implantitis or mucositis?
Peri-implant mucositis has damage to the soft tissue only while peri-implantitis has damage to the soft tissue and surrounding bone.
What are the characteristics of peri-implant mucositis?
Reversible
Plaque related
BOP
Erythema
Inflammation
Suppuration
Can lead to perio-implantitis
The clinical manifestations of retrograde peri-implantitis are
Pain
Inflammation
Fistula formation
Swelling
Possible implant mobility
What surgical procedure is done to remove/excise gingival tissue including gingiva that may be attached to the tooth to treat gingival disease or created better esthetics?
Gingivectomy
What surgical procedure is done to reshape the surface gingiva without removal of any gingiva attached to the tooth typically to improve appearance back to its natural form?
Gingivoplasty
What are the indications for gingivectomy and gingivoplasty?
Eliminate gingival/suprabony pocket with horizontal bone loss
Eliminate gingival elargements, medication induced gingival overgrowth, gingival hyperplasia, pseudopockets
Improve esthetics
Better access for self care
Increase length of teeth in preparation for cosmetic procedures
What are the contraindications for gingivectomy and gingivoplasty?
Slower healing
Long in the tooth appearance
No access to underlying bone
Removal of keratinized tissue
Why do gingivectomies have a reduced role today?
Tissues can grow back, slower wound healing, increased post op discomfort and bleeding, failure to conserve keratinized tissue to maintain esthetics
What are gingivectomies primarily used for today?
Correct deformaties caused by periodontitis
How long does gingivectomy and gingivoplasty take to heal?
4-5 weeks but looks healed in 2 weeks
What surgery is a procedure where an incision is made in the gingiva, alveolar mucosa, or periostium to allow for separation from underlying root and alveolar bone?
Periodontal flap surgery
What is the most common periodontal surgical procedure?
Periodontal flap surgery
What are the indications for perio flap surgery?
- To gain access to the tooth root and alveolar bone to complete debridement, correct irregular bony contours, treatment deep pockets.
- Required as a first step to other perio surgeries (root resection, crown lengthening)
What are the three periodontal flap incision techqniues?
- Internal bevel (1mm from GM)
- Sulcular/crevicular - through base of pocket
- Interdental - removed collar of the bone
What type of technique is B?
Sulcular/crevicular
What type of technique is C?
Interdental
What type of technique is A?
Interdental bevel
How are flaps classified?
Based on tissue components included in the flap and the positioning of the flap at the end of the procedure
Which type of flap gives complete access to the underlying bone?
Full thickness flap
When is a full thickness flap indicated?
For open flap debridement or flap currettage
Is there a change to pockets with a full thickness flap?
Only if the flap is apically placed
Which type of flap involves the elevation of the epithelium and thin layer of the underlying connective tissue?
Partial thickness flap
What are the indications for a partial thickness flap?
Pocket reduction
Guided tissue regeneration - implant placement
What is an apically positioned flap used for?
Elininating moderate to deep pockets, lengthening the crown for restorative/esthetic procedures or increasing the zone of attached gingiva
What is a coronally positioned flapp used for?
To attempt to cover the surigcal site, often used when a bone graft is placed
What is a modified wipman flap also known as?
Flap for Access
When is a modified widman flap used?
For better visualization of the area to gain access to root surfaces for improved periodontal debridement and reduction in inflammation and pocket depths
Is a modified widman flap displaced or non-displaced?
Non-displaced
What is the indication for a modified widman flap?
Better adaptation of connective tissue to root
How does healing from flap surgery occur?
By formation of a long junctional epithelium
What is a periodontal pack?
A post op surgical dressing
How long is periodontal pack left on for?
1 week
What are the peridontal pack’s purposes?
To protect the surgical site
To maintain tissue placement
To prevent post op bleeding
To minimize discomfort
What are the types of healing seen with periodontal flap surgery?
Formation of long junctional epithelium
Inflammation resolved
Regeneration
What involves root debridement and the removal of the diseased lining of the soft tissue pocket wall, including the JE and the underlying CT?
Subgingival curettage
True or False: The benefits of soft tissue curettage are helpful and as a separate procedure offers justifiable application during active therapy for chronic periodontitis.
False. The benefits of soft tissue curettage are questionable and as a separate procedure has no justifiable appliction during active therapy for chronic periodontitis.
What type of bone loss is equal on both side of adjacent teeth?
Horizontal
What type of pocket has the base coronal to the alveolar crest?
Suprabony
What type of bone loss is more on one side of a tooth?
Vertical
What type of pocket that has the base of the defect apical to the crest of the alveolar bone?
Infrabony
How can the type of infrabony defect be determined?
By surgical entry only
What is the objective of osseous resective surgery?
To correct alveolar bone irregularities caused b periodontal disease. Also to reshape bone to have the contours of healthy bone, optimal physiologic contours.
What is the goal of osseous resective surgery?
To eliminate infrabony and peridontal pockets.
What are the indications for osseous resective surgery?
Mild-moderate periodontitis
What are the contraindications for osseous resective surgery?
Clients with severe bone loss, esthetics, furcations, location of pertinent anatomic structures
What procedure involves the removal of tooth-supporting bone?
Ostectomy
What procedure involves reshaping the surface of bone contours without removing tooth-supporting bone?
Osteoplasty
What is the goal of ostectomies?
Eliminate the periodonal pocket and form a more natural bone contour
What is the drawback of ostectomies?
Results in loss of attachment/small amounts of alveolar bone
True or False: Most resective surgeries use a combination of osetecomy and osteoplasty?
True
What procedure is performed to expose more tooth structure for the purpose of properly restoring a tooth?
Crown lengthening
What are the indications for crown lengthening surgery?
A tooth that is fractured close to the gingival margin and/or alveolar crest
Subgingival caries
Esthetic reasons
What is biological width?
The soft tissue attachment from the base of the sulcus to the crest of alveolar bone
True or False: biologic width is necessary for periodontal health.
True
What is the removal of a root while leaving the crown on a multirooted tooth?
Root resection or amputation
What is the surgical sectional and removal of one root?
Hemisection
Where is root resection usually done?
Mandibular molars
What is the sectioning, separation of the mandibular molar in half, creating two separate teeth?
Bicuspidization
True or False: endo treatment must be done before root resection.
True
Is long-term survival/prognosis of root resected teeth predictable?
No
What surgery is a surgical procedure that corrects/eliminates deformities in the gingival or alveolar bone and improves esthetics?
Periodontal plastic surgery
What older term is used to describe procedures that correct defects in the morphology, position and/or amount of gingiva?
Mucogingival surgeries
What are examples of mucogingival surgeries?
Frenectomy
Crown lengthening
Autograft CT
Free soft tissue graft
What are the indications for mucogingival surgery?
Sites with inadequate width and thickness of attached gingiva that exhibit persistent inflammation (bleeding)
Sites that show progressive gingival recession
Sites of inadequate attached gingiva with subgingival restoration or ortho
Elimination of frenum and muscle pull at or near the gingival margin of a tooth
Base of periodontal pocket extends to or beyond the mucogingival junction
To deepen the buccal vestibule (for dentures or resto)
Esthetic reasons
Modification of edentulous ridges prior to prosthetic reconstruction
What is the apical position of the free gingival margin onto the root surface?
Gingival recession
What are the classes of gingival recession?
Class I - do not extend to the mucogingival line and no loss of interdental bone. Complete coverage can be achieved.
Class II - extends to or beyond the mucogingival line and there is no loss of interdental bone. Complete root coverage can be achieved.
Class III - extends to or beyond the mucogingival line with bone or soft tissue loss in the interdental area. Partial root coverge can be achieved
Class IV - extends to or beyond the mucogingival line with severe bone or soft tissue loss in the interdenal area. No root coverage can be expected
What is used to move gingiva from an adjaceent tooth or edentulous area with adequate amounts of gingiva to a prepared site with inadequate amounts of gingiva?
Pedicle graft/Lateral displaced flap
What is a double pappila flap?
Large bilateral interdental papilla are used as donor tissue in a v-shaped incision from either side of the tooth with recession and laterall positioned
What is a free gingival soft tissue graft?
Donor site is usually the palate, and placed to cover exposed root from recession
FGG’s most common site is the palate, but what other area can also be used?
Edentulous areas
What procedure is the procedure of choice for root coverage of single or multiple teeth?
Subeithelial connective tissue graft
During a subepithelial connective tissue graft, connective tissue is harvested from the palate while leaving
The epitheliu on the outside of the flap
What tissues are involved in regeneration?
Gingival epithelium
Gingival connective tissue
Periodontal ligament
Supporting alveolar bone
Cementum
What is the fastest growing tissue in cell regeneration?
Epithelium
For regeneration, cells capable of forming new cementum, PDL and supporting bone must
Migrate into the peridontal osseous defect and produce these tissues
What cells are involved with regeneration?
Osteoblasts
Fibroblasts
Cementoblasts
True or False: regeneration slows the apical migration of the JE and prevents the gingival connective tissue cells making contact with the root surface.
True
What type of graft is transferred from one location to another in the same person?
Autogenous graft
What type of graft is transferred between genetically dissimilar members of the same species?
Allogenic graft
What type of graft is taken from a donor of another species?
Xenogenic graft
What type of graft is an inorganic, synthetic, biocampatible bone graft substitute?
Alloplastic materials
What are specific factors obtained from the patient?
Growth factors
What are the classes of bone graft?
Osteogenesis
Osteoinduction
Osteoconduction
What is considered the gold standard of bone grafts?
Autgenous bone (bone from the host)
What are bone grafts and bone graft substitutes which induce the transformation of immature stem cells into bone producing osteroblasts?
Osteoinductive agents
What is an example of an osetoinductive agent?
Demineralized free-dried bone from cadavers
What type of bone graft acts as a scaffold to allow bone cells from the surrounding bone in the defect to lay down new bone but does not produce its own bone?
Osetoconductive material
What type of bone graft is harvested from one part of the body and grafted to another in the same person?
Autografts
What type of graft is bone material obtained from other individuals of the same species but genetically different?
Allografts
What type of bone graft is made of biocompatible, inorganic, inert materials including syntehtic hydroxyapetite, calcium sulfate, bioactive glass, tricalcium phosphate and collagen?
Alloplasts
What type of graft is made of a naural bone substitute derived from a genetically different species?
Xenograft
What class of bone graft are autografts?
Osteogenic
What class of bone graft are allografts?
Osteoinductive
What class of bone graft are alloplasts?
Osteoconductive
What class of bone grafts are xenografts?
Osteroinductive
What does a membrane do in guided tissue regeneration?
Blocks unwanted tissue, allowing ligament fibres and bone to grow
What is an example of a barrier membrane that is a biomaterial processed from human tissue and is placed into the defect, after complete debridement of defect and root surface?
Alloderm
What are absorbable sutures made from?
Material that is designed to dissolve harmlessly in the body fluids over time
What are non-absorbable sutures made from?
Material that does not dissolve in body fluids (silk)
What are the postoperate care considerations of periodontal surgery?
Discomfort
Swelling
Bleeding
Physical activity
Eating
Sutures
Periodontal dressing
Smoking
Homecare
What is done at the 7-10 post op appointment following periodontal surgery?
Area is cleaned with chlorhexidine
Dressing is removed
Sutures are removed
Cleanse the area again
Supragingival sacling to remove plaque/debris
