3Rd Bds Perio Notes

Front 1

Miller's Recession Classification

Class I
(2)

Back 1

Recession coronal to mucogingival junction.
No loss of bone/ soft tissue interdentally

Front 2

Miller's Recession Classification

Class II
(2)

Back 2

Recession apical to mucogingival junction
No loss of bone/ soft tissue interdentally

Front 3

Miller's Recession Classification

Class III
(2)

Back 3

Recession at or beyond mucogingival junction
Loss of interdental tissue coronal to marginal recession

Front 4

Miller's Recession Classification

Class IV
(2)

Back 4

Recession at or beyond mucogingival junction
Loss of interdental tissue = marginal recession

Front 5

1999 Classification

Categories
(8)

Back 5

1 - Gingival diseases (A,B)
2 - Chronic Periodontitis (A,B)
3 - Aggressive Periodontitis (A,B)
4 - As a manifestation of Systemic Disease (A,B,C)
5 - Necrotising Perio disease (A,B)
6 - Periodontal Abscess (A,B,C)
7 - Perio w/ endo lession (A)
8 - Developmental/ Acquired conditions (A,B,C,D)

Front 6

1999 Classification

Sub-classifications (classes 1,2,3)
(2)

Back 6

A = Localised
B = Generalised

Front 7

1999 Classification

Sub-classifications (class 4)
(3)

Back 7

4A - Haemological
4B - Genetic
4C - Others

Front 8

1999 Classification

Sub-classifications (class 5)
(2)

Back 8

5A - NUG
5B - NUP

Front 9

1999 Classification

Sub-classifications (class 6)
(3)

Back 9

6A - Gingival
6B - Periodontal
6C - Pericoronal

Front 10

1999 Classification

Sub-classifications (class 8)
(4)

Back 10

8A - Tooth-related factors
8B - Mucogingival Deformations
8C - Mucogingival Deformations (Edentulous)
8D - Occlusal Trauma

Front 11

Recession

% of pts with ≥1mm recession?

Back 11

50%

Front 12

Recession

Epidemiology
(2)

Back 12

M>F
Buccal most common

Front 13

Recession

Aetiology
(10)

Back 13

Developmental Absence
Frenal pulls
Piercings
Habits
Disease
Smoking
Orthodontic Rx
Abrasion
Dentures
Malocclusion

Front 14

Miller's Mobility Index

Classify
(4)

Back 14

0 - ≤0.2mm
I - 0.3 → 1mm
II - >1mm
III - vertical movement

Front 15

1989 AAP Classification

Disadvantages
(3)

Back 15

Lack of gingival disease
Age based, not disease based
Overlapping Categories

Front 16

1989 AAP Classification

Categories
(5)

Back 16

1) Early Onset Perio (A,B,C)
2) Chronic Adult Perio (>35yo)
3) Necrotising Ulcerative Perio
4) Refractory Perio
5) Perio associated w/ systemic disease

Front 17

1989 AAP Classification

Class 1 subcategories
(3)

Back 17

1A) <7yo
1B) 8-12yo
1C) 13-35yo

Front 18

Basic Periodontal Exam

Changes in adolescents?
(3)

Back 18

Quadrants not sextants
Only central incisors and first molars used
Only in children >12yo

Front 19

Periodontal Probes

CPTIN Probe
Acronym stands for?

Back 19

Community Periodontal Treatment Index Need

Front 20

Periodontal Probes

CPTIN Probe
Alternative name?

Back 20

WHO probe

Front 21

Periodontal Probes

CPTIN Probe
Markings and tip?
(3)

Back 21

Ball end (0.5mm)
3.5→5.5mm = black
8.5→11.5 = black

Front 22

Periodontal Probes

CPTIN Probe
Use?

Back 22

BPE

Front 23

Periodontal Probes

CP12 Probe
Markings and tip?

Back 23

Blunt end
3→6mm = black
9→12mm = black

Front 24

Periodontal Probes

CP15 Probe
Difference from CP12 Probe?

Back 24

Extra marking at 15mm length

Front 25

Periodontal Probes

TPS Probe
Benefit over CP12 Probe?

Back 25

Markings to show correct probing force

Front 26

Periodontal Probes

Which type is electronically pressurized, very accurate and mostly used for research?

Back 26

Florida Probe

Front 27

Root Surface Instrumentation

Indications?
(4)

Back 27

True Pockets
PD ≥4mm
BoP
Adequate Oral Hygiene

Front 28

Root Surface Instrumentation

Outcome

Back 28

Long Junctional Epithelium
(Epithelial cells with hemi-desmosomal attachments to root surface)

Front 29

Root Surface Instrumentation

Benefits of successful treatment?
(3)

Back 29

Less inflammation
Gain in attachment
Improved tissue resistance

Front 30

Root Surface Instrumentation

Rate of epithelial re-attachment?

Back 30

~1mm day⁻¹

Front 31

Bleeding on Probing

% of sites which progress to LOA?

Back 31

30%

Front 32

Bleeding on Probing

Why is this used as an indicator of disease?

Back 32

95% of sites w/o BoP do not progress to LOA

Front 33

Loss of Attachment

Define

Back 33

ACJ ↔ Base of pocket

Front 34

Gingivitis

Clinical finding

Back 34

No LOA but ↑PD

Front 35

Periodontal Probes

Probe used for detecting subgingival calculus?

Back 35

Cross Calculus Probe

Front 36

Dentine Hypersensitivity

Presenting complaint
(3)

Back 36

Short, sharp pain
May be episodic
Can be spontaneous or in response to stimuli resulting in a fluid outflow from tubules

Front 37

Dentine Hypersensitivity

Diagnostic Criteria
(2)

Back 37

Symptoms fit
Other pathology excluded

Front 38

Dentine Hypersensitivity

Epidemiology
(3)

Back 38

~15% of population
F>M (and younger)
20-50yo

Front 39

Dentine Hypersensitivity

Teeth most commonly affected
(6)

Back 39

3, Canines
4, First Premolars
1, Central Incisors
2, Lateral Incisors
5, Second Premolars
6,7,8 Molars

Front 40

Dentine Hypersensitivity

Surface most commonly affected

Back 40

Buccal Cervical

Front 41

Dentine Hypersensitivity

Causes of dentinal exposure
(5)

Back 41

Attrition
Abrasion
Abfraction
Erosion
Periodontal Disease

Front 42

Dentine Hypersensitivity

Absi et al's SEM results
(2)

Back 42

Sensitive dentine has 8x the number of open tubules
Open tubules had double the mean diameter

Front 43

Dentine Hypersensitivity

Current theory of dentinal pain conduction?

Back 43

Hydrodynamic theory

Front 44

Dentine Hypersensitivity

Does all exposed dentine cause pain? Why?
(3)

Back 44

No
Unknown but potentially due to smear layer or CaPO₄ deposits
Evidence to suggest size and number of open tubules is important

Front 45

Dentine Hypersensitivity

Two main categories of treatment?

Back 45

Inhibition of sensory nerve activity
Tubule Occlusion

Front 46

Dentine Hypersensitivity

Indirect action of treatments containing K⁺ ions
(2)

Back 46

K⁺ stimulates NO release from odontoblasts
NO exerts an analgesic effect on the Aδ fibers

Front 47

Dentine Hypersensitivity

Why is K⁺ now thought to work indirectly rather than directly in nerve inhibition?
(4)

Back 47

K⁺ requires direct contact with the nerve
K⁺ ions would need to travel against the fluid flow
NO is freely diffusible
NO can produce effects at greater distances from the nerve

Front 48

Dentine Hypersensitivity

Tubule Occlusion Treatments
(4)

Back 48

Di-potassium Oxalate 30% (Sensitrol)
Silica abrasion (Toothpastes)
Resins/ GI (Seal & Protect)
F⁻ Varnishes (Duraphat)

Front 49

Dentine Hypersensitivity

Dietary and toothbrushing advice
(3)

Back 49

Reduce acid
Brush teeth 30 mins prior to eating
Ensure correct brushing force and technique

Front 50

Sensitrol

Active agent

Back 50

30% Di-potassium Oxalate

Front 51

Sensitrol

pH

Back 51

4.3

Front 52

Sensitrol

POI (Post Op Instruction)

Back 52

Avoid acid for 24h

Front 53

Sensitrol

Mode of action
(2)

Back 53

Tubule Occlusion
Calcium Oxalate crystal formation

Front 54

Dentine Hypersensitivity

Management of generalised hypersensitivity
(3)

Back 54

Dentifrice advice
Dietary prevention
F⁻ Mouthwash OD

Front 55

1999 AAP Classification

Is periodontal disease secondary to poorly controlled diabetes class IV?

Back 55

No - diabetes is a modifier of periodontal disease

Front 56

Recession

How does a frenal pull contribute to localised recession?
(2)

Back 56

Impedes plaque removal
Directly pulls tissue away

Front 57

Recession

What tissue biotype is most likely to exhibit recession?

Back 57

Type 1

Front 58

Recession

How does smoking affect recession?

Back 58

It increases, even when there's no periodontal disease

Front 59

Antibiotics

What does LDA stand for?

Back 59

Locally Delivered Antimicrobials

Front 60

LDA in Periodontics

Are these a stand-alone treatment?

Back 60

No, only as an adjuct

Front 61

LDA in Periodontics

Indications
(4)

Back 61

Long standing lessions
Deep pockets
Failure to respond to Rx [non-surgical]
Adequate OH

Front 62

LDA in Periodontics

Ideal properties as defined by Goodson et al. 1985
(3)

Back 62

1) Must reach the base of pocket
2) Must deliver biologically active concentrations
3) Must maintain the concentration for sufficient time

Front 63

LDA in Periodontics

Depth of pocket after which mouthwashes do not reach?

Back 63

>5mm

Front 64

LDA in Periodontics

Does CHX irrigation with a syringe reach the base of pockets?

Back 64

Not predictably

Front 65

LDA in Periodontics

Increase in concentration required to affect a biofilm compared to planktonic bacteria?

Back 65

500x

Front 66

LDA in Periodontics

Advantages compared to systemic?

Back 66

Site Specific.
Locally high concentrations.
Prolonged exposure with slow release systems.
Lower systemic side effects.(Low plasma concentration.)
High patient compliance.
Lower risk of super-infection.

Front 67

LDA in Periodontics

Main categories of drug?
(3)

Back 67

Chlorhexidine (Antiseptic)
Tetracyclines (Bacteriostatic antibiotic)
Metrinidazole (Bacteriocidal antibiotic)

Front 68

LDA in Periodontics

Constituents?
(2)

Back 68

Active ingredient
Carrier

Front 69

LDA in Periodontics

Tetracycline Overview
(3)

Back 69

Broad Spectrum
High resistance (~25%)
Inhibits bone resorption and collagen breakdown (MMP and PMN inhibition)

Front 70

LDA in Periodontics

Categories of LDA?
(2)

Back 70

Antimicrobial slow release gels
Antiseptics

Front 71

LDA in Periodontics

Antimicrobial slow release gels
(2)

Back 71

Dentomycin (Minocycline)
Elyzol Dental Gel (Metronidazole)

Front 72

LDA in Periodontics

Antiseptic Preparations

Back 72

PerioChip (Chlorhexidene)
Chlo-site (Chlorhexidene)

Front 73

Dentomycin

Active ingredient?

Back 73

2% Minocycline Gel
(Biodegradable)

Front 74

Dentomycin

Method of application?
(3)

Back 74

Apply with syringe
3-4 applications
14 day interval
≥5mm pockets

Front 75

Dentomycin and Elyzol

Perceived disadvantage

Back 75

MIC only maintained for 12-24h
(Minimum Inhibitory Concentration)

Front 76

Elyzol

Active ingredient?

Back 76

25% Metrinidazole Benzoate Gel
(Biodegradable)

Front 77

Elyzol

Method of application and regime?
(3)

Back 77

Apply with syringe
2 applications
7 days apart

Front 78

LDA in Periodontics

Why might antiseptic systems be preferable to antimicrobials?

Back 78

No risk of resistance

Front 79

Periochip

Active ingredient and delivery mechanism?
(2)

Back 79

2.5mg Chlorhexidine Gluconate
Slow release from a biodegradable cross-linked hydrolysed gelatin polymer

Front 80

Periochip

Method of application?
(4)

Back 80

RSI of site
Dry site
Insert chip
Advise breakdown over 7-10 days

Front 81

Periochip

Why is its release profile preferable to the antimicrobial gels?
(3)

Back 81

It has a two phase release
Initially ~7x MIC
24h to one week it maintains 0.6-3x MIC

Front 82

Chlo-Site

Active Ingredients?
(2)

Back 82

0.5% Chlorhexidine digluconate
1% Chlorhexidine dihydrochloride

Front 83

Chlo-Site

Carrier and its benefits?
(3)

Back 83

Xanthan Gel
It adheres to the gingivae
Releases CHX slowly

Front 84

Chlo-Site

Why are there two forms of CHX?

Back 84

The digluconate produces high levels initially (7 days)
The dihydrochloride maintains MIC over days 7-15

Front 85

Chlo-Site

Method of application?
(3)

Back 85

RSI
Wash and dry sites (paper points)
Syringe application of gel

Front 86

LDA is Periodontics

Evidence for?

Back 86

Some short term improvement but very minor

Front 87

LDA in Periodontics

Evidence against?

Back 87

No long term improvements

Front 88

LDA in Periodontics

Disadvantages?
(3)

Back 88

Expensive
No long term gain
Potentially systemic effects

Front 89

Recession

What biotype is this and what are its features?
(4)

Back 89

Biotype 1
Long Papillae
Thin and scalloped gingivae
Predisposed to dehiscence and fenestrations
Susceptible to recession

Front 90

Recession

What biotype is this and what are its features?
(3)

Back 90

Short papillae
Thick and flat gingivae
Resistant to recession

Front 91

Recession

Which precursor to recession is shown?

Back 91

A Stillman's Cleft

Front 92

Recession

Which precursor to recession is shown?

Back 92

A McCall's Festoon
('rolled up' or swollen gingivae)

Front 93

Recession

Treatments
(2)

Back 93

S&P/ RSI (Prevent further)
Mucogingival Surgery

Front 94

Recession

Methods of monitoring progression?
(3)

Back 94

Serial Photographs
Serial Study Models
Recording of PD and LOA

Front 95

Furcation Involvement

Can a radiograph diagnose furcation involvement?

Back 95

No, the diagnosis is clinical.

Front 96

Furcation Involvement

Why does this reduce the tooth's prognosis?
(2)

Back 96

Harder to clean
May result in loss of vitality (accessory canals)

Front 97

Furcation Involvement

Rx for Hamp Class I Lesion?
(3)

Back 97

S&P
RSI
Furcationplasty

Front 98

Furcation Involvement

Rx for Hamp Class II lesions?
(6)

Back 98

Furcationplasty
Tunnel Preparation
Root Resection
XLA
GTR
EMD

Front 99

Furcation Involvement

Rx for Hamp Class III lesions?
(3)

Back 99

XLA
Tunnel Preparation
Root resection

Front 100

Furcation Involvement

Furcationplasty procedure
(5)

Back 100

Raise flap
Remove granulation tissue
RSI
Odontoplasty
Osteoplasty

Front 101

Furcation Involvement

How does a furcationplasty differ from a tunnel preparation?

Back 101

Tunnel preparations aim to leave the defect cleanable, furcationplastys aim to close the defect.

(query answer)

Front 102

Furcation Involvement

Complications of furcationplasty/ tunnel preparation?
(3)

Back 102

Loss of vitality
Root caries
Hypersensitivity

Front 103

Furcation Involvement

Root Resection Procedure
(4)

Back 103

RCT within 2 weeks (ideally before)
Retain most stable root when possible
Surgically remove resected root
Retrograde fill defect

Front 104

Furcation Involvement

Hamp Classification I

Back 104

Horizontal loss ≤⅓ tooth width

Front 105

Furcation Involvement

Hamp Class II

Back 105

Horizontal loss >⅓ <1 width of tooth

Front 106

Furcation Involvement

Hamp Class III

Back 106

Complete horizontal loss of tissues.

Front 107

Akerly Classification

Class I

Back 107

Lower incisors impinge on palatal mucosa

Front 108

Akerly Classification

Class II

Back 108

Lower incisors impinge on palatal gingival margins

Front 109

Akerly Classification

Class III
(2)

Back 109

Lower incisors impinge on palatal gingival margins
Upper incisors impinge on lower labial gingival margins

Front 110

Akerly Classification

Class IV

Back 110

Lower incisors occlude with palatal surface of upper incisors

Front 111

Perio Treatment Planning

5 phases in Perio
(5)

Back 111

1) Initial exam & Pain relief
2) Cause related therapy (Clinical checks, advices and hands-on therapy)
3) Re-examination
4) Definitive treatment
5) Maintenance

Front 112

Perio Treatment Planning

At re-examination pt has ≤3mm PD and no BoP - next stage?

Back 112

Maintenance

Front 113

Perio Treatment Planning

At re-examination pt has >3mm PD and BoP - next stage?
(3)

Back 113

Determine cause
If treatable cause then phase 4 (Definitive Rx)
If not then palliative care

Front 114

Perio Treatment Planning

At re-examination pt has >3mm PD but no BoP - next stage?

Back 114

Review in 1/12 (Likely a slow healer)

Front 115

Perio Treatment Planning

Which stage for cured pts?

Back 115

Trick question - can't cure perio disease

Front 116

Periodontal Palliative Care

Usual treatment plan?

Back 116

3/12 S&P

Front 117

Perio Treatment Planning

Factors affecting phase 5 recalls
(2)

Back 117

General risk factors
Local risk factors

Front 118

Susceptibility to Periodontitis

Factors?
(4)

Back 118

Age
Oral hygiene levels
Severity of disease
Relationship of plaque scores to BoP

Front 119

Perio Treatment Planning

General factors affecting prognosis?
(6)

Back 119

Type of disease
Susceptibility
Systemic health
Treatment required
Oral hygiene
Availability for Rx

Front 120

Perio Treatment Planning

Local factors affecting prognosis?
(6)

Back 120

Degree of restorations
Crowding of teeth
Anatomy of teeth
Furcation involvements
Recession
Appliance wear

Front 121

Enamel Matrix Derivative

Trade name?

Back 121

Emdogain

Front 122

Enamel Matrix Derivative

Active ingredients
(2)

Back 122

Porcine derived
Amelogenins + other related proteins

Front 123

Enamel Matrix Derivative

Indications for use
(3)

Back 123

1,2,3 wall defects
Hamp II furcations
≥6mm PD and >3mm radiographic LOA

Front 124

Enamel Matrix Derivative

Storage and pre-operative care
(4)

Back 124

Store refrigerated
0.3ml/0.7ml syringes
Warm for 30mins pre-op
Use within 2 hours

Front 125

Enamel Matrix Derivative

Procedure
(8)

Back 125

0.12% CHX for 1 min
LA
Raise flap
RSI
'Root surface bio-modification'
Saline rinse
Place EMD
Close flap

Front 126

Enamel Matrix Derivative

What is 'Root surface bio-modification'?
(4)

Back 126

Removal of the smear layer by;
Citric Acid (pH1)/
Phosphoric acid (15s)/
24% EDTA gel (pH6.7 for 2 mins)

Front 127

Enamel Matrix Derivative

Post op instruction
(4)

Back 127

Paracetamol/ Ibuprofen if painful
CHX MW 2x daily
No mechanical cleaning for 3 weeks
No inter-proximal cleaning for 6 weeks

Front 128

Enamel Matrix Derivative

Antibiotic use?
(3)

Back 128

21 days of 100mg doxycycline
Begin one day pre-op
At clinician's discretion

Front 129

Enamel Matrix Derivative

Pharmokinetics
(6)

Back 129

Binds to hydroxyapatite and collagen
Coagulin fills defect
Carrier disappears after 12-24h
Days) Mesenchymal cells attach
Weeks) New CT develops
Months-Year) Resolution of defect

Front 130

Enamel Matrix Derivative

Where does new bone formation begin?

Back 130

At the treated root surface

Front 131

Enamel Matrix Derivative

Post operative supervision
(3)

Back 131

Bi-monthly recall for 6/12
6/12 to 1 year 3/12 recall
S&P and OHI as required

Front 132

Systemic Antimicrobials

Use in Refractory periodontal disease?

Back 132

Not indicated

Front 133

Systemic Antimicrobials

Adjunct to ANUG treatment dosage?
(4)

Back 133

Metrinidazole
200mg
tds
3 days

Front 134

Systemic Antimicrobials

Use in NUP?

Back 134

Indicated but no clear protocol

Front 135

Systemic Antimicrobials

Adjunct to Ag Periodontitis treatment?
(4)

Back 135

Amoxicillin 250mg
Metrinidazole 400mg
tds
7 days

Front 136

Systemic Antimicrobials

Dosage for perio abscess without drainage?
(4)

Back 136

Amoxicillin
250mg
tds
5 days

Front 137

Periostat

What is Periostat?
(4)

Back 137

Doxyciclin Hyclate 20mg
Sub-antimicrobial concentration
Taken bd 1 hour before food
3 month regimes, max 9 months

Front 138

Periostat

Mode of action?

Back 138

Inhibits Collagenases (Matrix Metalloproteinase enzymes)

Front 139

Periostat

Effects?
(3)

Back 139

Reduces collagen breakdown
Promotes repair and healing
Inhibits disease progression

Front 140

Periostat

Evidence for?

Back 140

Yes, ↓PD + ↑reattachment
Rebound effect can occur
More research required

Front 141

Periostat

Indication

Back 141

Generalised severe periodontitis

Front 142

Periostat

Contra-indications
(3)

Back 142

Allergy to Tetracyclines
Pregnancy / Breast-feeding
Children < 12 years old.

Front 143

Periostat

Warnings and interactions
(4)

Back 143

Warfarin (~↑INR)
Penicillin
Oral contraceptives
Photo-sensitivity

Front 144

Guided Tissue Regeneration

Ideal barrier properties
(5)

Back 144

Inert and bio-compatible
Act as a barrier to epithelial invasion
Allow tissue integration
Maintain space
Easily shaped, placed and trimmed

Front 145

Guided Tissue Regeneration

Most common barrier material

Back 145

Expanded Polytetraflourethylene
(e-PTFE)

Front 146

Guided Tissue Regeneration

Procedure
(5)

Back 146

Raise flap
Thorough RSI
Membrane placed (>3mm extensions)
Suture
Remove membrane after 4-6 weeks

Front 147

Guided Tissue Regeneration

Post-op instruction
(3)

Back 147

Avoid brushing site for 3 days
0.2% CHX MW for 4-6 weeks
Antibiotics 1-2 weeks

Front 148

Guided Tissue Regeneration

Factors affecting outcomes
(Patient)
(4)

Back 148

Smoker/ non-smoker
Plaque score <15%
Bleeding score <15%
Smaller bone defects

Front 149

Guided Tissue Regeneration

Factors affecting outcomes
(Operational)
(3)

Back 149

Correct membrane placement (no exposure)
Adequate flap
Flap design (Modified Papilla Preservation Technique [MPPT] is advised)

Front 150

Periodontal Surgery

Contra-indications
(5)

Back 150

Bleeding disorders
Significantly immunocompromised
Uncontrolled systemic disease
Smoking
Poor co-operation

Front 151

Periodontal Surgery

Procedures
(6)

Back 151

Gingivectomy
EMD
GTR
Root resection
RSI
Crown lengthening

Front 152

Splints

3 types of fixed splints

Back 152

Composite bonded
Orthodontic wire
Resin retained