Perio Test 1

Front 1

indications of mucogingival surgery

Back 1

- progressive gingival recession
- inflamation after initial therapy
- around dental implants
- around RPD abutments
- esthetic considerations.

Front 2

establishing a peio tx. plan

Back 2

- medical and dental consultation or referral for tx. when appropriate
- surgical and non surgical periodontal and implant procedures to be performed.

- consideration of other dental consultation or tx.

- provision for ongoing re evaluation during therapy and throughout the maint. phase.

- consideration of dx. testing

- risk factors that play a role in dev., progression and mgmnt. of pero diseases.

perio maint. program.

Front 3

tx. procedures initial phase

Back 3

- pat. ed., training and counseling

- removal of supra and subg plaque via scaling and rp

- antibiotics

- re eval aat 4-6 weeks.

Front 4

tx. procedures - surgical phase

Back 4

- resective porcedures
- perio regenerative procedures
- perio plastic surgery
- occlusal therapy
- pre prosthetic perio procedures.

Front 5

eval. of therapy

Back 5

Upon completion of planned periodontal therapy, the record should document that:
The patient has been counseled on why and how to perform an effective daily personal oral hygiene program.
All indicated therapeutic procedures have been performed.
The patient‟s treatment objectives have been met.
A recommendation has been made for the correction of anything contributing to the periodontal disease process.
A periodontal maintenance program has been recommended to the patient for long-term control of his/her condition.

Front 6

factors modifying therapy results

Back 6

- pulpal perio problems
- advers eenv. influcences like smoking and stress
- occlusal dysfunction
- uncorrectable anatomic, structural or iatrogenic causalities.

Front 7

some main differences between chronic and aggressive perio tx.

Back 7

- systemic antibiotics!

- srp done in 4 days to one week in agg. perio.

- may want micro eval after initial phase in agg. perio tx. if all local factors are eliminated and the disease iis still persisting.

Front 8

when to use local drug delivery

Back 8

- isolated deep pockets with pocket depths > 5 mm.

- most commonly used is arrestin.

Front 9

how much pd and cal change after srp

Back 9

- initial pd is 1-3 mm
- loss of attachment
- no change in pd

- initial pd is 4-6 mm
- gain .5 mm attachment
- pd is reduced 1-1.5 mm

- initial pd >6 mm
- gain 1 mm attachment
- pd reduction 2 mm.

Front 10

GTR tx. outcomes

Back 10

- cortellini and tonetti
- avg. of cal gain = 72%
- meain gain oc CAL in gtr = 3.4 mm
- mean residual pd in gtr - 3.3 mm
- mean cal in opd - 1.8 mm

mellinig
- avg. % of bone fill = 60%

Front 11

systemic antibiotic tx. outcomes

Back 11

- systemically adm. ab's were better when used in comb. with srp than srp alone
- .24 mm gain in al in chronic patients with antibiotics and .718 in aggressive patients.

- sign. effects for tetracycline, metranidazole, borderling significance for metro/ amox comibination

- improvements are greater for aggressive vs. chronic perio.

Front 12

therapeutic goals of surgery

Back 12

- alter or eliminate the microbial etiology and contributing local risk factors

- arresting the progression of the disease

- preserving the dentition in a state of health, comfort and function

- maintenance of esthetics if possible.

- regerneration of perio tissue when indicated.

Front 13

indications for surgery

Back 13

- patients with active perio disease with signs of probing depths of 5 mm or more, attachemtn loss, BOP despite good oral hygeine (pi less than 30%)

- pt. with minimal attached gingiva )less than 1mm)

- patients with gingival recession.

- healthy patients who needs crown lengthening
- implatn placement.

Front 14

basic principles of surgery

Back 14

- patient is medically stable
- gentle flap reflection
- allow good blood supply to the flap.
- allow ease of retraction for access.
- avoid injury to flap and vital structures.

- aseptic technique.

- achieve hemostasis.

Front 15

types of perio surgery

Back 15

- explorative
- resective (health and disease)
regenerative (disease only)
- implant placement in health
- combination.

Front 16

objectives of perio surgery

Back 16

better access for scrp or removal of local risk factors like overhangs.

- pocket depth reduction to eliminate diseased tissue
- facilitate oral hygeine
- facilitate maintenance therapy.
- elimination of infrabony defects with resective tx. (osseous surgery)
- bone grafting (GTR) for attachment gain.

- perio plastic surgery
- (gingivoplasty, increased attached gingiva, root coverage, ridge augmentation, aberrant frenum.

- crown lengthening
- implant placement

Front 17

suturing

Back 17

- provides wound closure
- position tissues
- controls bleeding
- helps reduce post op pain.

Front 18

classification of flaps design

Back 18

- envelope vs. relaxed

Front 19

cass. of flaps placement

Back 19

- replaced = repositioned (RF
- apically positioned (af)
- coronally positioned (cpf
- laterally positioned (Lpf
distal or proximal wedge (D/PW)

Front 20

classification of flaps width

Back 20

- full thickness = mucoperiostial
- partial (split thickness
- combinations.

Front 21

envelope vs. relaxed flap

Back 21

- envelope - scallops around the tooth with no vertical relaxer
- adv. faster haleing with less post op pain.
- esthetic areas
- conservative tissues
- easier primary closure

disadv.
- limited axes to bone
- limited flap mobility.

RELAXED flap - has vertical releasing incisions
- adv.
- access, tissue position allows for smaller surgical field.

- disadv.
- delayed healing due to decreased blood supply
- more post op pain.

Front 22

envelope flap design considerations

Back 22

- horizontal (parallel to occlusal plane)
- sulcular
- extrasulcular with internal and external bevel.

Front 23

relaxed flap designs

Back 23

- vertical incisions perp. to occlusal plane and parallel to long axis of the tooth
- placed at line anbles and extend beyond the MJG.

Front 24

replaced or repositioned flap

Back 24

- sulcular, envelope, full thickness, replaced mucogingival flap.

Front 25

cornally positioned flap

Back 25

- sulcular
- relaxed
- split thickness
- coronally positioned
- mucogingival flap.

Front 26

full thickness flap

Back 26

- include reflection of the periosteum conn. tissue and epithelium to expose the alveolar crest

- used ofr osseous resective or regenerative surgery.

Front 27

partial thickness flap

Back 27

- perio plastic surgery

Front 28

summary of important distinctions for flap incisions

Back 28

- laterlly positioned flaps - full thickness and partial thickness but oNLY relaced flap design, no envelope allowed.

- distal or proximal wedge - full thickness with NO vertical releasing incisions.

Front 29

FTAPMGF without ostectomy; advantages over replaced flap

Back 29

- more probing depth reduction in..
- areas with thin radicular bone
- areas with narrow facial/lingual witdth
- areas with suprabony pockets
- areas of horizontal bone loss.
disadv.

- potential for increased root exposure leading to dentinal hypersensitiviity
- slower interproximal healing
- more post op discomfort

- poor flap adaptation in the presence of thick bony ledges.

Front 30

osseous resection

Back 30

- still used today
- most predictable
- stable pocket reduction.

Front 31

rationale for osseous resection

Back 31

- eliminate perio pockets
- create shallow gingival sulci
- achieve maintainabe perio anatomy.
- re establish natural physiologic bony architecture.

Front 32

what determines bone defect shape/ type

Back 32

- thickness of bone
- thick bone/ exostoses = vertical defect
- thin bone - horizontal defect

2. plaque
3. root anatomy, inclination, position
- root trunk length, furcation
- root proximity

Front 33

sphere of influence

Back 33

- sphere of influence and thin buccl plate yield a 1-2 wall defect

Front 34

to asses and diagnose osseous defects

Back 34

- probing attachments.
- xray - high positive predictability and low negative predictability.

Front 35

terminology of osseous defects

Back 35

- suprabone defects
- horizontal bone loss
- JE coronal to AC

Front 36

infrabony defects

Back 36

- vertical bone loss
- JE apical to AC

Front 37

infrabony has two types

Back 37

- intrabony (1 tooth)
- crater (2 teeth)

Front 38

interradicular defects

Back 38

furcations

Front 39

horizontal component

Back 39

- class 1 - 3

Front 40

vertical component

Back 40

- subclass A - C
-

Front 41

negative osseous architecture

Back 41

- lower IP bone reshaped to positive osseous architecture (higher IP bone, meaning more apical) done via resective surgery.

Front 42

osseous resection procedures (2)

Back 42

- osteoplasty - removal of non supporting bone

- ostectomy - removal of alveolar bone proper/ PDL

Front 43

regenerative procedures

Back 43

- bone graft
- GTR

Combinations - resect until 3 wall defect remains.

Front 44

osseous defect treatment

Back 44

shallow, wide 1 wall defect
- less protected (non confined)

- osseous resection most predictable.

Front 45

osteoplasty

Back 45

- interdental fluting
- reduction of crater wall
- base of interproximal crater

Front 46

indications for an osseous surgery inconjunction with an apically positioned flap

Back 46

- mild horiz. bone loss
- shallow 1,2, wall bone defecs
- 1-3 mm

- mild to moderate - pochet depth of 4-6 mm with CAL of 1-3 mm.

Front 47

relative contraindications for osseous surgery

Back 47

- advanced horizontal bone loss

- deep 1,2,3 wall vertical defects > 4 mm.

advanced
- pocket depth >7 mm
- CAL > 4mm

mobility
high caires rate
esthetic zone

Front 48

indications for crown lengthening

Back 48

- maintain biologic width (JE +CT)
- increase the retention of crowns
- improve esthetics (hard adn soft tissue removal)
- to access carious lesions, fracture lines, restorations margins.

- combinations.

Front 49

biologic width normal levels

Back 49

- epithelium + CT attachment = 2.04 mm

- sulcus+JE+CT attachment = 2.9 mm

Front 50

things to evaluate before CL

Back 50

- crown to root ratio
- furcation involvement.

Front 51

soft tissue crown legthening can

Back 51

access carious lesions.

Front 52

what happens if we impinge on the biologic width

Back 52

- expect uncrontrolled inflammation process

- gingival margin inflammation with subsequent bone loss (uncontrolled bone loss)
- the inflammation process will make it impossibl for proper oral hygeine -->periodontitis

- in somd cases the inflammation rocess will be followed by gingival recession

Front 53

crown lengthening vs. orthodontic forced eruption

Back 53

- esthetics (high smile line)
- crown to root ration
- ortho tx is more time consuming.
- requires communication between perio and ortho.

Front 54

crown lengthening contraindications

Back 54

- non strategic
- non restorable
- esthetics
- compromised periodontal condition

Front 55

melchers wisdom

Back 55

- the cell type which repopulates the root surface after surgery determines the type of attachment that will form.

Front 56

variations in wound healing

Back 56

- new attachment - the union of conn. tissue or epithelium with a root surface that has been deprived of its original attachment apparatus.

- repair - healing of a wound by tissue that doesn't fully restore the original architecture

- regeneration - the formation of new bone, cementum and PDL on a previously diseased root surface.

Front 57

definitions -

Back 57

autograft - a tissue graft transferred from one position to another in the body of the same individual.

- allograft - a tissue from same species but of non identical DNA
- mineralized and demineralized freeze dried bone (puros)

- alloplast - a synthetic bone graft material; a bone graft substitute
- B tricalcium phosphate/ OH apatite

- Xenograft - a tissue bone graft between members of a different species.

Front 58

implant vs. transplant

Back 58

- implant implies non living tissue.

Front 59

osteoinduction

Back 59

- process in which new bone is induced to form through the action of factors contained within the bone graft, such as proteins or growth factors.

- osteoconduction - process in which graft acts as a trellis or scaffold over which new host bone can form. but doesn't have ability to induce new bone.

Front 60

indications for regeneration

Back 60

- deep intraosseous defects
- moderate defects in esthetic sites
- furcation defects
- class 2 buccal/ lingual

- extraction sockets - implant site prep and ridge preservation.

- around implants - after immediate extraction and placement (gaps > 1.5 mm)

- support for critical teeth - with some type of vertical defect.

Front 61

bone graft material

Back 61

autograft - bone from patient is osteoinductive, intraoral pulled from extraction sockets and exostoses
- extra oral pulled from iliac crest and tibia.

Front 62

allograft

Back 62

- human cadaver bone
- osteoconductive
- decalcified freeze dried bone allograft
- freeze dried bone allograft.

- alloplast - synthetics
- fille

Front 63

alloplast - synthetics

Back 63

fillers
- hydroxyapatite
- tricalcium phosphate
- bioactive glass (perioglass)

Front 64

xenograft (anorganic bovine bone)

Back 64

- osteoconductive
- bio oss, biogran.

Front 65

infrabony defect morphology and predictability of regeneration

Back 65

- horizontal bone loss and shallow wide intrabony defect are least predictable with 3 wall defect being the most predictable ... and a deep narrow intrabony defect is also most predictable.

Front 66

tx of crater defects

Back 66

- shallow defects - like 1-3 mm crest to base and osseous resection

- deep defects > 4mm crest to base you should consider regeneration like bone graft, GTR and combination.

Front 67

moderate to deep osseous defect tx.

Back 67

- 3 wall defects
- more protected and stable and confined
- most predictable regeneration.

- autograft from previous extraction sites
- highly osteoinductive 8-12 weeks post extraction.

Front 68

if we don't have a nice confined bony lesion

Back 68

- consider therapy combo.
- resection to get the multiwalled defect if possible.


- graft +GTR or biological to maintain space, immobilize teeth absolute primary closure
and weekly PO for 8 weeks.

Front 69

membranes - non resorbable and resorbable

Back 69

non = goretex
resorbable = synthetic alloplast
- allograft
- xenograft.

Front 70

relative contraindicaitions for regenerative surgery

Back 70

- any general surgical contraindications like brittle diabetic and high risk BONJ

- heavy smoker
- tooth mobility
- defect beyond apex
- fractured tooth
- grade 3 furcation
- oor plaque control.

Front 71

pure mucogingival problems

Back 71

- tooth erupting into prominence at or near the mucogingival junction so that little or no attached gingiva is present over the promincne of the fully erupted tooth. may be existing or future problems.

- mucogingival osseous problems
- caused by pockets so deepened with periodontitis that little or no attached gingiva remains. these problems have different etiologies. ant their tx. may differ.

Front 72

dehiscence

Back 72

- refers to the bursting through the bone of a root as the tooth erupts so that the bone does not extend to its normal proximity to the CEJ.

Front 73

fenestration

Back 73

- circumscribed defect that creates a window through the bone over the prominent root.

Front 74

recession defined

Back 74

- movement of the gingival margin apically from teh CEJ and can be localized or generalized and associated with one or more buccal or lingual surfaces.

Front 75

prevalence of gingival recession

Back 75

- frequency of gingival recession in subjects witha high standard of oral hygeine has been reorted to be more frequent at buccal than proximal or lingual surfaces.

Front 76

prevalence of gingival recession increases with

Back 76

age
- males vs. females
- recession is more prevalent and severe at buccal surfaces
african american vs. other races
- recession increases with tobacco consumption.

Front 77

etiology of gingival recession

Back 77

- lack of alveolar bone at the recession site
- development factors - fenestration and dehiscence of the alveolar bone, abnormal tooth position in the arch, path of eruption of the tooth and individual tooth shape

- acquired factors - ortho movement outside the lingual or buccal plate causing dehiscence.

- pathological factors - resorption of bone due to microbially induced perio disease.

Front 78

millers classification of gingival tissue

Back 78

- class 1 - marginal tissue recession tat doesn't extend to the MGJ

- class 2 - marginal tissue recession that extends to or beyond the MGJ with no periodontal attachment loss in the interdental area.

- class 3 - marginal tissue recession that extends to or beyond the MGJ with periodontal attachment loss in the interdental area or malpositioning teeth.

class 4 - same but with more severe bone loss.

Front 79

free gingival graft

Back 79

- indication - minimal or no attached / keratinized gingiva present.

Front 80

KG = distance from

Back 80

FGM/GM to MGJ

Front 81

Recession

Back 81

- distance from CEJ to FGM/GM

Front 82

attached gingiva

Back 82

- ag = (distance from FGM to the MGJ ) - sulcus or pocket depth