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Perio 2 final > Ultimate Guide > Flashcards

Ultimate Guide Flashcards

1
Q

Soft Tissue Grafting Indications/Rationale-

  • anything that causes —–
  • recession that is —–
  • esthetic concerns
  • ————- around teeth scheduled for full coverage restorations
  • ——— prior to orthodontic treatment- thicken with tissue graft
A

root sensitivity

progressing

limited soft tissue support

thin tissue biotype

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2
Q

Free gingival graft-

A

soft tissue graft completely detached from one site and moved to another

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3
Q

FGG Indications-

A

increase keratinized/attached gingiva, increase vestibular depth, achieve root coveraage

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4
Q

FGG Contraindications-

A

root coverage not predictable, esthetic concern (different color), complication at donor site; Can be submarginal to modify root coverage

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5
Q

Pedicle graft-

A

A soft tissue graft that is laterally positioned to correct an adjacent defect [base remains attached to the donor site], you still have to do SCTG

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6
Q

Pedicle graft Indications/Contraindications-

A

Connective tissue graft- detached connective tissue graft placed between partial thickness flap
Indications- thicken thin tissue for necessary procedures, esthetics
Contra- not enough tissue to do a split thickness flap

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7
Q

CAF + Connective Tissue Graft is most successful @

A

root coverage

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8
Q

CAF, SGCT, frenectomy, and vestibuloplasty are all

A

SPLIT THICKNESS FLAP

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9
Q

FGG techniques FGG-

A

bring soft tissue from donor site, apically position flap, add soft tissue from donor site to recipient site above the flap you just brought down; use some sort of template to know how much tissue to take

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10
Q

Pedicle technique-

A

leave base intact, cut flap and slide over; lateral sliding flap, double papilla flap

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11
Q

SGCT technique-

A

split thickness flap (or tunnel technique) with graft added and sandwiched between

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12
Q

Mucogingival deformities-

A

deviation from normal relationship between gingiva and alveolar mucosa

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13
Q

Gingival recession-

A

recession of attached/keratinized gingiva sometimes resulting in exposure of root surface

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14
Q

Mucogingival defect-

A

deviations from normal in relationship between MGJ and gingival margin, closer to gingival margin

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15
Q

What is sufficient zone of attached gingiva?

A

Don’t need an amount unless the pt cannot keep teeth clean, there is no ideal number, do surgery if there is attachment loss

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16
Q

Frenectomy-

A

surgical excision of a frenum- V shaped is most common, Z-plasty also an option

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17
Q

Frenotomy-

A

cutting of a frenum

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18
Q

Vestibuloplasty-

A

apically positioning flap to increase vestibular depth

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19
Q

Frenum-

A

A small band or fold of integument or mucous membrane that controls, curbs, or limits the movement of organ or part.

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20
Q

Aberrant Frenum-

A

Atypical/ abnormal insertion of labial, buccal, or lingual frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements.

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21
Q 
Classification of labial frenum?
Mucosal- 
Gingival- 
Papillary- 
Papillary penetrating-
A

attaches in alveolar mucosa

attached between MGJ and base of interdental papilla- MOST COMMON

attaches between base and top of interdental papilla

attaches in interdental papilla and penetrates to palatal aspect- more often in younger children

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22
Q

Etiology of aberrant frenum?

A

After eruption of centrals, labial frenum normally transpositions in an apical direction. Sometimes it is unable to migrate during alveolar growth. Tooth development also implicated.

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23
Q

Surgery before or after orthodontic treatment??

A

Surgery should be done AFTER ortho treatment because it can lead to scarring which would resist orthodontic movement

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24
Q

What is LASER?-

A

Light amplification by stimulated emission of radiation

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25
Q

Advantages/disadvantages of LASER tx-
Advantages——
Disadvantages-

A

hemostasis, rapid healing, accuracy, reduced inflammation, lack of scar tissue, low level of discomfort

technical difficulties, lack of precision in depth of cut, hazardous, tissue not available in histopathology, dispersal of virus particles in plume

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26
Q 
Gingivectomy
Implant uncover
Frenectomy 
Uncovering soft tissue 
Impactions
LANAP- adjunct to SRP
PDT- use of free radicals to break down plaque
A

Periodontal Applications in LASERS-

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27
Q

Recession Defects: Miller Classification
Class I- —– bone loss, recession ———-
Class II- —— bone loss, recession ———-
Class III- —— bone loss, recession ——–
Class IV- — bone loss extends past recession

A

no IP, does not extend to MGJ

no IP, may extend to or past MGJ

IP, may or may not extend past MGJ

IP

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28
Q

Complete root coverage expected in —–defects, partial coverage expected in — defects, none in—–

A

I and II

III

IV

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29
Q

Healing Phases of Gingival Grafting
Initial Phase- 0-3 days; —-
Revascularization Phase- 2-11 days; ——
Tissue Maturation Phase- —–

A

“plasmatic circulation” from recipient bed, avascular

anastomoses between the blood vessels of the recipient bed and those in the grafted tissue; capillary proliferation; re-epithelization

11=42 days

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30
Q

Which teeth usually impacted?-

A

max canine> mand 1st premolar > mand 2nd premolar > mand canine > max premolars

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31
Q

Incidence of max canine impaction?-

A

2%

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32
Q

General location of impacted max canine?-

A

66-85% are palatally impacted

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33
Q
  • failure of deciduous tooth roots to fully resorb
  • abnormal position (eruption path)
  • supernumerary teeth
  • crowding
  • dentigerous cyst
  • thickened oral soft tissues
  • oral soft tissue pathology
  • hard tissue pathology
  • premature extraction of deciduous teeth
  • childhood diseases
  • genetic syndromes
  • hereditary diseases
A

Etiology of impacted tooth?

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34
Q
  • palatal or labial malposition of impacted tooth
  • migration of impacted teeth
  • internal root resorption
  • external root resorption
  • dentigerous cyst formation
  • referred pain
  • any combination of above
A

Site Effects of impacted tooth?

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35
Q

Open techniques-

A

window or apically positioned flap

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36
Q

Closed techniques-

A

flap is opened ortho appliance applied, and then flap is closed (better healing, less discomfort).

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37
Q

Periodontal Abscess- treatment includes

A

drainage and SRP and sometimes amoxicillin for 3 days

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38
Q

NUP-

A

Necrotic lesion of the papilla initially then progressing to gingival margin. Punched-out appearance; spontaneous and painful-

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39
Q

NUP Microbiology-

A

Treponema sp., Selenomonas sp— treated by lowering microbial load and removing necrotic tissue

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40
Q

Pericoronitis-

A

surrounds crown of partially erupted tooth

41
Q

Gingival abscess-

A

marginal gingiva or interdental papilla, less painful

42
Q

Pericoronal abscess-

A

surrounding crown of partially erupted tooth, less painful

43
Q

Periodontal abscess -

A

tissues adjacent to periodontal pocket, PA

44
Q

Periapical abscess-

A

involving pulp remnants and tissue surrounding apex of tooth, PA

45
Q

When do we prescribe systemic antibiotics for periodontal problems?

A
  • Poor response to initial therapy and continued attachment loss
  • Pts with biofilm tests positive for P. gingivalis and A.a.
  • Severe cases with generalized deep pocket depths
  • Periodontitis with secondary systemic involvement
  • Aggressive periodontitis
46
Q

• Amox-

A

bactericidal

47
Q

• Metro-

A

bactericidal

48
Q

• Tetracyclines-

A

bacteriostatic, inhibits collagenase

49
Q

• Clinda-

A

potent bacteriostatic activity (alternative to amox)

50
Q

• Macrolides-

A

anti-inflamatory, bactericidal

51
Q

• Aggressive periodontitis/Severe chronic periodontitis

antibiotics

A

o Amox 500mg 3x/day with Metro 250mg 3x/day for 8 days

o Azithromycin 500mg starting dose, 250 mg per day for 4 days; Metro 500mg 3x/day 7 days

52
Q

When do we prefer local delivery of antibiotics instead of systemic antibiotic prescription?

A

• Localized slight to moderate chronic periodontitis pt with limited amt of sites that are unresponsive to non-surgical therapy; adjunct to SRP for limited sites with greater than 5mm probing depths

53
Q

Advantages/Disadvantages for both local delivery and systemic antibiotic usage.

A

• Local dis- allergies to specific antimicrobial reagent, several sites/mouth with residual periodontal pockets following SRP, applications without performing SRP

54
Q

Surgical Periodontal Therapy

Indications?

A

7mm+ pockets, in advanced periodontitis pts

55
Q

Ostectomy

A

(sufficient remaining bone or 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);

56
Q

osteoplasty-

A

reshaping of the alveolar process to achieve a more physiologic form without removing alveolar bone proper, tori reduction, intrabony defects adjacent to edentulous ridges incipient furcations, reduction of thick heavy ledges or exostoses, shallow osseous craters

57
Q

Crown lengthening-

A

not enough space for the fixed prosthesis, potential violation of biologic width, to help with removable prostheses

58
Q

What is a forest plot?-

A

Forest plot is a way of charting study results. Horizontal lines show confidence interval at 95%. Vertical line marks zero effect and the dot shows effect estimate and weight for each study

59
Q

describe rationales for periodontal maintenance.

A

-tooth loss inversely proportional to PMT frequency; reduced risk of future attachment loss despite incomplete plaque removal; monitoring; plaque removal

60
Q

analyze rationale for duration and frequency of maintenance therapy.

A

-In patients with a history of periodontal disease, every 3 months, appointments around an hour long to cover everything; extend to 6 mo if they are doing well with OH or don’t have history of disease

61
Q

evaluate differences between implant and tooth periodontal maintenance.

A

-implants need just as good or better care than real teeth

62
Q

Areas of periodontal breakdown may need additional treatment.

A

–poor plaque control = no surgical treatment, clean and OHI
–single site = nonsurgical treatment
–continued inflammation = surgical treatment
–attachment loss = S/RP + antibiotics or surgery
–Increasing mobility = occlusal adjustment

63
Q

Office visits for implants-

A typical maintenance visit should include:

A

–Probe implants w/ plastic probe
–Assess soft tissue. Look for BOP and suppuration
–Examine prosthesis- May have to remove
–Occlusal exam. Look for wear, loosened screws or cylinders, broken abutments, screws or implants
–Evaluate stability Remove any plaque and calculus
–Use plastic curette, and rubber cup w/ polishing paste
–Can also irrigate w/CHX–Check/modify OH Radiographs
–Monitor bone with vertical BW or PA at least once a year

64
Q

Discuss the rationale for pre-implant surgical procedures.

A

-preserve ridge dimensions and contour when immediate implant placement not possible
-wound stability and space maintenance need to be paid attention to- membrane, grow bone in socket
•

65
Q

Non-resorbable membranes-

A

for space maintenance, but will require second surgery, sticks through; worried about dehiscience, thick gingival biotype

66
Q

• Resorbable membranes-

A

less surgery, thinner

-contraindicated if infection, implants can be placed immediately, and soft tissue limitations

67
Q

Endosseous dental implant-

A

interfaces with bone

68
Q

Implant abutment-

A

connects to the endosseous dental implant, serves as base for crown

69
Q

Abutment Screw-

A

holds together abutment and implant

70
Q

Osseointegration-

A

intergrating with bone

71
Q

Risk factors/indicators for implant failure:

A

periodontitis, thin tissue biotype, resorbed ridges

72
Q

Autogenous (from patient)-

A

osteogenesis, osteoconduction, osteoinduction

73
Q

Allograft (from human donor)-

A

Osteoconductive and osteoinductive

74
Q

Xenograft-

A

osteoconductive (basically scaffold)

75
Q

Synthetics-

A

just filler

76
Q

Role of barrier- space maintenance (don’t allow wrong tissue type to invade) and wound stability

A
  • e-PTFE
  • Titanium reinforced e-PTFE
  • Cross-linked collagen barrier
  • Polylactic acid based membranes
  • Subepithelial connective tissue graft
  • Free gingival graft
77
Q

Minimal flap elevation especially in

A

esthetic region (if possible)- FULL THICKNESS

78
Q

ARP- Generally successful in preventing alveolar bone height loss. •Does not eliminated alveolar ridge width loss (approximately —– width loss with socket preservation, nothing we can do). •Presence of residual material following healing.

A

2.5 mm

79
Q

Immediate-

A

implant placed immediately following extraction

  • less surgery and less overall treatment time
  • optimal use of existing bone
  • site morphology and tissue type could complicate optimal use of existing bone
  • may not have enough keratinized epithelium for flap
  • technique sensitive procedure
  • metal surface of implant may become visible due to buccal resorption
80
Q

Early-

A

implant placed where soft tissue has healed and covers socket

  • easier implant placement
  • allows for resolution of local pathology
  • site morphology may complicate optimal treatment
  • longer treatment time
  • varying amount of bone resorption at socket walls
  • technique sensitive
81
Q

—– OF FOUR SOCKET WALLS MUST BE INTACT FOR THESE FIRST TWO

A

THREE

82
Q

Late-

A

placed after substantial amounts of new bone have formed (typically over 16 weeks later)

  • clinically healed ridges and mature soft tissue
  • increased treatment time
  • large variation in bone volume available (longer waiting time increases bone loss)
83
Q

Conventional-

A

implant placed in fully healed ridge

  • extraction site lined with keratinized mucosa on dense cortical bone
  • rate of new bone formation decreases after 3-4 months
84
Q

Bone Defects- Classification I

A

Extraction sockets [5-wall defect]
Dehiscence defects [4-wall defect]
Horizontal defects [2-3 wall defect]
Vertical defects [1-wall defect]

85
Q

Alveolar Ridge Defects- Classification II

A

Horizontal (B-L) loss only
Vertical (C-A) loss only
Loss in both vertical and horizontal directions

86
Q

—– minimal bone thickness for surrounding bone (for osseointegration to occur)
—– minimal bone thickness on the buccal aspect (for both bone/soft tissue integrity and for restorative reasons)
——- minimal distance between a tooth and an implant
—— minimal distance between two implants
Implant has to be placed —— apical to adjacent CEJ in patients with no attachment loss (2-5 mm is the working range)
—— interocclusal (interarch) distance for the crown (regular implant-supported screw-retained crown)

A

1 mm

2 mm

2 mm

3 mm

2 mm

7 mm

87
Q

Cover screw vs healing abutment-

A

cover screw is flat and can be healed over, healing abutment then put on so gingiva can heal around it

88
Q

If placing more than one implant…..

A
  • Importance of a good surgical stent (guide)
  • Parallelism
  • Angulation
  • Spacing (mesial-distally, buccal-lingually but also amount of penetration into bone [apical-coronally])
  • Vertical bone augmentation is difficult to achieve
  • Inter-implant papillae cannot predictably be re-established.
89
Q

Per-implant disease-

A

pathology must be noted after loading (already has a crown) and not related to placement complications

90
Q

Peri-implant mucositis-

A

analogous to gingivitis- reversible, no bone loss

91
Q

Peri-implantitis-

A

analogous to periodontitis- loss of peri-implant bone

92
Q

Per-implant disease diagnosed on…

A 
Bleeding on probing around the implant
Suppuration around the implant
Probing depth around the implant
Mobility of the implant 
Radiographic evidence of bone loss around the implant
93
Q

Failing Implant-

A

progressive alveolar bone loss, pocket formation, bleeding on probing, or suppuration
Failed Implant-
-hopeless and nonfunctional implant requiring removal
–may exhibit loss of osseointegration, mobility, or pain

94
Q

Treating Failing Implants- need to do ——- to get rid of grooves

  • resolve ———
  • correct ————
  • re-osseointegration- ———
A

implantoplasty

inflammation (debride plaque, improve oral hygiene, adjunctive antibiotics as indicated)

unfavorable soft tissue morphology by flap surgery or gingivectomy

decontaminate implant surface with citric acid solutions, guided bone regeneration

95
Q

Peri-implant defects and treatments

Class I- \

A

Slight horizontal bone loss with minimal peri-implant defects
Treatment- Surgical reduction of pocket depth, thinning of mucosal flaps and apical repositioning of flaps at a bone edge level, using the corresponding suture technique. The implant surface is cleaned and decontaminated. Implantoplasty is only performed if threads are exposed.

96
Q

Peri-implant defects and treatments

Class II-

A 
Moderate horizontal bone loss with isolated vertical defects
Treatment- Similar to class 1, but repositioning is performed more apically, leaving more implant surface exposed, thus requiring an implantoplasty. If local vertical resorption has three or more walls, this bone defect is restored using classical GTR techniques. In cases where the defect involves one or two walls, osteoplasty or bone leveling is performed to favor soft tissue repositioning, to fulfill self-cleaning criteria.
97
Q

Peri-implant defects and treatments

Class III-

A

moderate to advanced horizontal bone loss with broad, circular bony defects
Treatment-Presence of vertical defects almost always requires GTR techniques.

98
Q

Peri-implant defects and treatments

Class IV-

A

advanced horizontal bone loss with broad, circumferential vertical defects, as well as loss of the oral and/or vestibular bony wall
Treatment- Same as III

99
Q

How do you sequence treatment?

A
  1. Etiologic phase of treatment (correct faulty restorations
  2. Prepros surgery (crown lengthening, mucogingival procedures, ridge augmentation)
    a. Something you can do for a denture
  3. Restoration design
  4. Pre-implant surgery
  5. Post prosthetic surgery
  6. Maintenance

Perio 2 final (2 decks)

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