Periodontics Ii Exam 2 Oucod Spring 2008

Front 1

where are vertical incisions made

Back 1

at line angles to preserve interdental papillae

Front 2

vertical incisions should do what as they aproach the base of the flap and why

Back 2

should be divergent so the blood supply to the flap is not compromised

Front 3

any flap which is not elevated beyond the MGJ is called what

Back 3

gingival flap

Front 4

any flap elevated beyond the MGJ, involving both the gingiva and alveolar mucosa is known as what

Back 4

mucogingival flap

Front 5

any flap where the MGJ is returned to its former pre-op position upon closure is known as what

Back 5

replaced flap

Front 6

the palatal flap and modified widman flap are examples of: gingival, mucogingival, replaced, or displaced flaps

Back 6

replaced flaps

Front 7

any flap where the MGJ is shifted away from its former preop position at the time of flap closure is known as what

Back 7

displaced flap

Front 8

can a palatal flap be apically positioned

Back 8

no

Front 9

a gingivectomy incision is directed at what angle to the tooth surface

Back 9

45 degrees

Front 10

what is the purpose of gingivectomy

Back 10

to eliminate a subrabony pocket by excising the gingival wall where there is an adequate firm, fibrous tissue wall

Front 11

what is the purpose of gingivoplasty

Back 11

to create physiologic contours and improve esthetics by reshaping gingival tissue

Front 12

what are the contraindications for gingivectomy

Back 12

where access to bone is required, where the base of the pocket is apical to the mgj, and where frenum or muscle attachments are in the field of surgery

Front 13

resective techniques are most commonly considered with what conditions

Back 13

dilantin hyperplasia, chronic inflammatory hyperplasia, hereditary fibromatosis

Front 14

what are the indications for flap surgery

Back 14

when initial therapy and resective techniques are not adequate, pockets at or beyond MGJ, infrabony pockets, or soft tissue defects

Front 15

what are the surgical techniques aimed at achieving new attachment

Back 15

excisional new attachment procedure, modified ENAP, modified widman

Front 16

what is the purpose of the excisional new attachment procedure

Back 16

removal of a periodontal pockets ulcerated epithelial lining and adjacent chronically inflamed CT using a surgical blade

Front 17

what are the indications for the ENAP

Back 17

pockets 5 mm or less in an area without osseous defects and with adequate keratinized tissue (anterior teeth, esthetics)

Front 18

where is the incision for ENAP made

Back 18

from gingival margin to root just apical to the junctional epithelium with removal of the epithelial attachment and pocket lining, with interdental incisions made between the teeth to allow for slight flap reflection

Front 19

where is the incision for modified ENAP made

Back 19

incision from gingival margin to crest of bone

Front 20

describe the modified widman flap

Back 20

an extention of the modifed ENAP into a full thickness ginigval flap by exposing 1-2 mm of alveolar bone

Front 21

what are the indications for the modified widman flap

Back 21

provides great acess to roots and allows for management of minor bony defects and maintain attachment levels over time

Front 22

what are the indications for the wedge procedure

Back 22

surgical elimination of pockets distal to the last tooth in an arch, or pcokets on lone standing teeth

Front 23

what are some common postoperative complicaions

Back 23

pain, excessive bleeding, infection, lost dressing/sutures, root sensitivity, increased mobility, and herpetic ulcers

Front 24

what are the 5 signs of infection

Back 24

tense swelling, severe pain, purulence, fever, and malaise

Front 25

should probing be done at 3 week post operative tx? should polishing and supragingival scaling be done?

Back 25

no probing but yes to polishing and supragingival scaling

Front 26

when is the earliest time period to consider restorative procedures

Back 26

6 week POT

Front 27

at what POT would you establish a recall schedule

Back 27

12 week POT

Front 28

during the initial postsurgical period what should be done regarding commercial mouthrinses

Back 28

they should not be used, instead a prescription mouthrinse should be used

Front 29

what is the most labile tissues of the periodontium

Back 29

alveolar bone

Front 30

what is the term for a deformity in the alveolar bone adjacent to one or more teeth

Back 30

periodontal osseous defect

Front 31

classification of a bony defect is based on the number of missing bony walls T/F

Back 31

false: remaining bony walls

Front 32

what are the tx options for periodontal osseous defects

Back 32

osseous resection, orthodontic tooth movement, regeneration, root resection, compromised maintenance, and extraction

Front 33

what is the term for the shaping of osseous structures to a more physiologic contour without removing bone that provides attachment for the tooth

Back 33

osteoplasty

Front 34

what is the term for removal of bone that is part of the supporting apparatus of the tooth

Back 34

ostectomy

Front 35

describe a healthy positive bony architecture

Back 35

the normal scalloped osseous configuration in which the bone directly overlying the roots is at a more apical level than the bone in the adjacent interproximal spaces

Front 36

describe a reverse negative bony architectures

Back 36

an osseous configuration in which the bone directly overlying the roots is at a more coronal level than the bone in the adjacent interproximal spaces

Front 37

what are the objectives of osseous resective surgery

Back 37

provide a healthy positive osseous architecture, permit primary wound closure, facilitate restorative procedures (crown lengthening)

Front 38

what specific types of osseous defects are corrected by osseous resective surgery

Back 38

very wide 3 wall defects, craters (2 wall defects), one wall defects, and furcation involvement

Front 39

what is the most common interproximal bony defect in posterior sextants

Back 39

craters (2 wall defects)

Front 40

what is a one wall defect where the remaining bony wall is along a proximal root surface

Back 40

hemiseptum

Front 41

what are the contraindications for osseous resective surgery

Back 41

attachment/bone loss so severe that further osseous reduction would jeopardize the support of the tooth, extreme root sensitivity, high caries index, inadequate oral hygiene, inability to provide adequate maintenance, esthetic considerations, medically compromised, or potential anatomical limitations due to proximity: maxillary sinus, external oblique ridge, shallow palate, close root proximity, dehiscences and or fenestrations, and furcations

Front 42

what is the order of wound healing in osseous resective surgery

Back 42

osteoclastic phase (2-14 days), epithelialization (1 week), CT attachment (2 weeks), osteoblastic phase (3-4 weeks), and maturation (6 months)

Front 43

what is the physiologic zone of attached tissues between the base of the sulcus and the alveolar crest

Back 43

biologic width

Front 44

ct attachement is 1 mm typically, the junctional epithelium is 2 mm T/F

Back 44

1st is true, 2nd is false: junctional epithelium is typically 1mm

Front 45

impingement on biologic width will lead to what

Back 45

to bone resorption in an effort to recreate these dimensions

Front 46

what comprise the biologic width

Back 46

CT attachment and junctional epithelium

Front 47

osteoblasts are not heat sensitive T/F

Back 47

false: they are heat sensitive

Front 48

when using a low speed handpiece with steel or carbide bur for ostectomy what size bur should be used

Back 48

largest bur which will fit the area

Front 49

when planning the final osseous contours how much additional bone will be lose due to osteoclastic activity during wound healing

Back 49

.5 mm

Front 50

what is the ultimate goal of periodontal therapy

Back 50

regeneration of a complete functioning attachment apparatus (reestablishment of cementum, a functional pdl, and supporting bone on a previously diseased root surface

Front 51

bone lost due to periodontal disease is restored by cells derived from what

Back 51

adjacent viable osseous walls and pluripotential cells with the pdl

Front 52

what are contraindications for osseous regeneration

Back 52

wehn simpler techniques would achieve the desired result, poorly motivated pts with respect to oral hygiene and or maintenance, medical complications, and heavy cigarette smokers

Front 53

place the relative predictability of success of osseous regenration based on defect morphology from most predictable to least

Back 53

narrow 3 wall defect, wide 3 wall defect, 2 wall defect, crater, 1 wall defect, furcation defect, and crestal apposition

Front 54

what is the term for a graft taken from one site and transplanted to antoher site in the same individual

Back 54

autograft (same species, same genes)

Front 55

what is the term for a graft taken from a member of one species and transplanted to another member of the same species

Back 55

allograft (same species, different genes)

Front 56

what is the term for a graft material taken from a member of one species and transplanted to a member of a different species

Back 56

xenograft

Front 57

what is the term for synthetic materials used as a graft

Back 57

alloplast

Front 58

a material is said to be _____ when vital cells within the graft istelf produce new bone

Back 58

osteogenic

Front 59

a material is said to be ______ when graft acts to stimulate or to induce new bone formation

Back 59

osteoinductive

Front 60

a material is said to be ______ when graft acts passively as scaffold or template to assist in bone formation

Back 60

osteoconductive

Front 61

what is the common extraoral donor site for autograft

Back 61

bone marrow from iliac crest

Front 62

what are the common intraoral donor sites for autograft

Back 62

osseous coagulum (cortical bone particles collected when performing osteoplasty/ostectomy), bone blend (harvested bone particles, triturated to a homogenous, paste like mass), healing extraction socket, or cancellous bone

Front 63

when should bone be harvested from a healing extraction socket

Back 63

6-12 weeks after extraction

Front 64

what are the two major types of allograft materials

Back 64

freeze dried bone and decalcified freeze dried bone

Front 65

what size are bone particles ground to in allograft materials

Back 65

300-500 microns

Front 66

what makes decalcified freeze dried bone have an improved osteoinductive potential when compared to regular freeze dried bone

Back 66

when particles are decalcified bone morphogenic protein is exposed which improves osteoinductive potential

Front 67

allograft materials are antigenic T/F

Back 67

false: non-antigenic

Front 68

allografts are often combined with what to improve bone fill

Back 68

tetracycline powder and hydroxyapatite particles

Front 69

when is histologic evience of new bone formation seen in freeze dried bone grafts

Back 69

2 months

Front 70

when is histologic evidence of new attachment seen with freeze dried bone grafts

Back 70

3 months

Front 71

when is the bone graft material totally incorporated into new host bone with freeze dried bone grafts

Back 71

8 months

Front 72

when is a functional new attachment apparatus seen with freeze dried bone grafts

Back 72

8 months

Front 73

what is the graft material of choice when available

Back 73

autogenous bone

Front 74

when good surgical technique is followed, results from various studies have shown fill of the original intrabony defect of aboue what amount

Back 74

60-70%

Front 75

a 10-14 day regimen of tetracycline and chlorhexidine is used following bone graft procedure for what purpose

Back 75

plaque suppression

Front 76

what is an aread where the tip of a periodontal probe extends apical to the mgj (lacks a band of attached gingiva

Back 76

mucogingival involvement

Front 77

what is an area which probes apical to the mgj and requires therapy to correct or prevent pathology

Back 77

mucogingival defect

Front 78

what are surgical procedures designed to correct recession and other defects in the morphology, posiiton, and or amount of gingiva surrounding teeth or implants

Back 78

mucogingival surgery/ periodontal plastic surgery

Front 79

what is an adequate band of attached gingiva

Back 79

any width of attached gingiva that will allow the tissue to be maintained in a state of health

Front 80

what is apical migration of the free gingival margin exposing the CEJ and creating a longer clinical crown

Back 80

gingival recession

Front 81

what is the etiology of mucogingival involvement/defect and recession

Back 81

plaque, chronic irritation, trauma, and anatomic anomalies

Front 82

gingival defects and root exposure caused by recession can result in

Back 82

root sensitivity, esthetic concern to the pt, predilection to root caries, cervical abrasion, and difficulty creating an esthetic restoration

Front 83

in what locations is there found an inadequate band of attached gingiva most commonly

Back 83

facial of lower canines and premolars, lingual of lower incisors, mesiobuccal of upper and lower 1st molars, and facial of lower 2nd and 3rd molars

Front 84

what class of recession does not extend to the MGJ, has no interproximal loss of bone or soft tissue, can be narrow or wide, and has good prognosis

Back 84

class 1

Front 85

what class of recession is to or beyond MGJ, shows no interproximal loss of bone or soft tissue, can be narrow or wide, and has good prognosis

Back 85

class 2

Front 86

what class of recession is to or beyond MGJ, shows interproximal bone or soft tissue loss or tooth is malposed, and only partial coverage may be expected

Back 86

class 3

Front 87

what class of recession is to or byond MGJ, severe interproximal bone/tissue loss or sever malposition, and poor prognosis for coverage

Back 87

class 4

Front 88

how is the width of the attached gingiva determined

Back 88

by measuring the distance form the free gingival margin to the MGJ, and subtracting the depth of the gingival sulcus

Front 89

for a free gingival graft, an internally beveled incision should be made where

Back 89

1 mm coronal to the clinical MGJ

Front 90

what flaps are included under pedicle flaps

Back 90

laterally positioned, obliquely rotated, double papilla, coronally positioned, and semilunar coronally positioned

Front 91

what are the objectives of free gingival grafts

Back 91

cover exposed root surfaces, increase zone of keratinized attached gingiva

Front 92

what are the advantages of free gingival grafts

Back 92

high predictability to increase keratinized attached tissue, and readily available donor tissue source

Front 93

what are the disadvantages of free gingival grafts

Back 93

wound at donor site is often painful when healing and esthetics are hard to match

Front 94

what is the total palatal soft tissue thickness

Back 94

3-5 mm

Front 95

what is the thickness of palatal epithelium

Back 95

.11-.62 mm

Front 96

what is the ideal graft thickness to increase the amount of keratinized attached gingiva

Back 96

.75-1.25 mm ( the graft should be slightly thicker to improve chances of root coverage, 1.5-2 mm)

Front 97

the success of the free gingival graft depends on what

Back 97

the survival of the graft CT

Front 98

what is a pathologic condition that has caused a loss of attachment in the intraradicular area of a multirooted tooth

Back 98

furcation involvement

Front 99

furcation involvement is best diagnosed how

Back 99

clinical exam with perio or nabors probe (can be radiographically but should confirm clinically)

Front 100

what is a grade 1 furcation

Back 100

loss of soft tissue attachment to the level of the furcation with minimal osseous destruction, probe enters furcation less than 1 mm

Front 101

what is a grade 2 furcation degree 1? degree 2?

Back 101

degree 1: 1-3 mm horizontal bone loss, degree 2: more than 3 mm horizontal bone loss but not through and through

Front 102

what is a grade 3 furcation

Back 102

extensive furcation bone loss that allows the nabors probe to pass through and through but still covered by soft tissue

Front 103

what is a grade 4 furcation

Back 103

through and through bone loss and the furcation opening is exposed allowing complete visualization through the furcation

Front 104

cervical enamel projections are present to some degree on the buccal aspect of _% of all molars

Back 104

25%

Front 105

what is the prognosis of specific teeth when they have furcation invovlement in order from best to worst

Back 105

mandibular 1st molar, mandibular 2nd molar, maxillary 1st molar, and maxillary first bicuspidq

Front 106

what are the tx options for furcation involvement

Back 106

hemisection, root amputation, furcation tunnel, and regenerative techniques

Front 107

what is the term for contact being established between bone and implant surface without the interposition of CT as discerned at the light microscope level

Back 107

osseointegration

Front 108

what is the absence of interposed CT between the implnt and bone at the light microscopic level and presence of a chemical bond between the implant and bone at the electron microscope level

Back 108

biointegration

Front 109

what is the best bone type for implant placement

Back 109

type II

Front 110

where is type I bone found

Back 110

anterior mandible

Front 111

type 1 bone has dense cortical plates with small medullary space and is not highly vascular T/F

Back 111

true

Front 112

what are the components of type II bone

Back 112

good cortical bone for anchorage and stability, and good medullar/cancellous bone with a good blood supply

Front 113

what is the worst bone for implant placement

Back 113

type IV bone

Front 114

where is type IV bone typically found

Back 114

posterior maxilla

Front 115

what are the components of an implant

Back 115

fixture, transmucosal abutment, and prosthesis

Front 116

when does periodontal maintenance therapy begin

Back 116

immediately following completion of active periodontal tx (phase 1 or phase 2)

Front 117

what are the objectives for periodontal maintenace therapy

Back 117

preserve health and prevent or minimize disease recurrence

Front 118

subgingival scaling alters the pocket microflora for relatively long periods T/F

Back 118

true

Front 119

what is the term that is that period between professional appts over which the pt remains stable.

Back 119

maintenance interval

Front 120

what is the most common interval following active periodontal therapy

Back 120

3 months

Front 121

what are the objectives of compromised maintenance therapy

Back 121

provide necessary care to slow and minimize further periodontal attachment loss in patients with residual disease activity who need periodontal surgery but where the surgery is not performed

Front 122

when would CMT be performed

Back 122

when perio surgery is indicated but plaque index is above 20%, inadequate financial resources, medical or psychological contraindications for surgery

Front 123

what is done at a typical CMT appt

Back 123

review med hx, past dental tx, px, and previous exam, do tissue exam, record probing depths, check bleeding sites, check tooth mobility, furcations, caries, radiographs, plaque evaluation, signs indicating periodontal disease recurrence, decide needs, do OHI, scaling, polishing, and provide adjuncts such as irrigation (chlorhexidine) and toical fluoride