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DS4102 > W6 - Interdisciplinary Perio - Sharma > Flashcards

W6 - Interdisciplinary Perio - Sharma Flashcards

1
Q

What can perio therapy help achieve in multi-disciplinary approach (4)

A

Stable gingival margins before tooth prep

Adequate tooth length / Crown lengthening

Perio tx after ortho mvmt and restorations causing mvmt

Esthetic and implant procedures usually require specialized perio

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2
Q

What is Perio specialty’s role in preprosthetic surgery (4)

A

After control of active disease:

Mgmt of mucogingival problems

Preservation of ridge after exo

Crown lengthening

Alveolar ridge reconstruction

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3
Q

Example of preservation of ridge

A

GBR - not squeezing socket after exo, rather pack it to not lose anatomy

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4
Q

Describe how the resto margins are tolerated by perio tissues (3)

A

Supragingival: no effect on perio but unaesthetic in anterior

Equigingival- well tolerated

Subgingival - Can affect SCAT and lead to BL

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5
Q

What is SCAT (+ measurement)

A

Supracrestal attached tissues AKA biologic width

Junctional epithelium + connective tissue attachment

2.04 mm

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6
Q

How to evaluate if you violated SCAT + BEST way

A

Radiograph - can SUGGEST it

Pt discomfort when probing around resto margins

Histological evaluation is definitive (but not clinically possible)

BEST WAY: Bone sounding

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7
Q

What is bone sonding and what is it used to indicate

A

Probe is pushed through attachment tissues to underlying bone after LA

  • Can be done on healthy gingival tissues
  • <2 mm indicated SCAT violation
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8
Q

Management of SCAT violation (2)

A

Surgically removing bone away from proximity of resto margin (faster)

or

Ortho extrusion

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9
Q

Rules for managing clinical margin placement (3)

A

Rule 1: Sulcus is ≤ 1.5 mm, resto margin no more than 0.5 mm subgingival

Rule 2: Sulcus ≥ 1.5mm margin at half the depth of the sulcus

Rule 3: Sulcus >2mm, gingivectomy to create a 1.5mm sulcus, then use rule 1

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10
Q

Indications for surgical crown lengthening (3)

A

Subgingival caries or fracture

Inadrquate clinical crown for retetion

Unequal or unesthetic gingival heights

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11
Q

Why do we use crown lengthening? (2)

A

To expose adequate clinical crown to prevent margins impacting SCAT

At least 3 mm between the most apical extension of the restorative margin and alveolar bone.

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12
Q

Contraindication of surgical crown lengthening (3)

A

If surgery would create unaesthetic outcome

If deep caries or fracture would require excessive bone removal on adjacent teeth

Tooth has poor restorative prognosis

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13
Q

Guideline/rule for soft tissue crown lengthening vs osseous reduction CL

A
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14
Q

When is ortho extrusion necessary (2)

A

Violation is on interproximal side or is across the facial surface with ideal gingival tissue level

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15
Q

Slow force vs rapid force ortho extrusion

A

Slow force - takes months

  • Bone and teeth move
  • Surgical correction

Rapid force - weeks

  • Teeth only
  • Supracrestal fibrotomy
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16
Q

Interproximal tooth contact to bone distance relationship with Black triangles

A

≤ 5mm or less → papilla always fill space

6mm → 56% of papillae fill the space

7mm → 37% of the papillae fill the space

17
Q

Relationship between contact point and embrasure impacting papilla shape

A
  • Embrasure too wide, papilla flattens out, assumes a blunted shape.
  • Embrasure ideal width, papilla assumes a pointed form, normal sulcus
  • Embrasure too narrow, papilla grows out to the facial and lingual, and become inflamed.
18
Q

2 options for black triangles

A
  1. Tissue coloured ceramics to mimic papillae
  2. Resin - carry the interproximal contact apically towards papilla
19
Q

How can a good emergence profile be developed in pontic receptor site

A

Provisional prosthesis placed to develop the ovate pontic receptor site

  • Maintains interdental papilla
  • Develops the pontic receptor site
20
Q

Interdisciplinary treatment case objectives

A

Example

21
Q

Benefits of ortho tx in perio pts (6)

A

Fix crowding for better OH

Intrusion to improve osseous defects

Improve gingival margin esthetics

Crown lengthening fractured teeth

Corrected embrasures to regain lost papilla

Adjust adjacent tooth positions before implant

22
Q

What is pathologic tooth migration (PTM)

A

change in tooth position that occurs when there is a disruption of forces that maintain teeth in a normal relationship

Ex. Perio, occlusal forces, oral habits, soft tissues

23
Q

Major factors affecting tooth position (4)

A

Perio tissues

Soft tissues inc cheek, tongue, lips

Occlsual forces

Oral habits

24
Q

Example of ortho tx of osseous defects

A

Hemiseptal defects

  • One or two walled defects usually found in mesial tipped or supraerupted teeth
  • Treated by up righting or intrusion
  • Supra-erupted teeth managed by intrusion
25
Q

Indications for surgical crown lengthening (3)

A

Subgingival caries or fracture

Inadequate clinical crown length for retention

Unequal or unaesthetic gingival heights

26
Q

2 types of ortho extrusion and features

A

Rapid force - takes weeks, tooth movement only, supracrestal fibrotomy → releasing fibres with scalpel every few weeks as force is applied

Slow force - takes months, bone AND teeth move, need surgical correction after tx to remove excess bone

27
Q

When is alveolar ridge reconstruction done?

A

Prior to fixed prosthesis or implant therapy in the form of soft or hard tissue augmentation.

28
Q

How is papillary height established?

A

Contact area

Level of bone

Biological width

Form of gingival embrasure

29
Q

What is an osseous crater?

A

IP 2-wall defect that does not improve with orthodontic treatment—surgical reshaping is required

30
Q

How is a class III furcation defect commonly managed?

A

Hemisecting crown and root of tooth

Sequence: endo-perio-ortho-pros

31
Q

What is is the length of gingival sulcus + junction epithelium + connective tissue

A

3mm

32
Q

What is an example of when soft tissue augmentation is required?

A

May be used to correct black triangles

33
Q

Why can the papilla appear inadequate?

A

Bone loss or IP contact located too high coronally

34
Q

What is most common pontic?

A

Modified ridgelap

  • Used anteriorly and posteriorly
  • Balance of aesthetics and hygiene
35
Q

What is the issue with this patients dentition

A
  • Significant recession
  • Extrusion/supraeruption of teeth
  • Pathological migration
  • Multiple teeth missing
  • Open bite
36
Q

What are factors to consider for tx of fractured teeth (crown lengthening and forced eruption)?

A
  • Root length (fracture to level of bone, erupt at least 4mm)
  • Root form (broad and non-tapering)
  • Level of fracture (too deep from bone makes difficult)
  • Relative importance of tooth (pt age)
  • Aesthetics (high lip line)
  • Endo/perio prognosis (perio defect and vertical fractures have poor prognosis)
37
Q

What is required before orthodontics?

A
  • Perio assessment
  • Hx: prev perio disease, drug hx, systemic diseases
  • Clinical exam: BOP, mobility, thin fragile gingiva, pockets
38
Q

What happens when an extruded tooth with vertical bone defect is intruded with orthodontics?

A

Bone can fill in the defect (may need to do bone graft before ortho)

39
Q

What are some common ways ortho is a useful adjunct to perio management?

A
  • Managing vertical bone defect
  • Managing pathological tooth migration

DS4102 (37 decks)

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