Term
| In a stable periodontium probing depths should measure less than _____ mm and there should be (absence/presence) of bleeding? |
|
Definition
|
|
Term
| T/F. Phase 1 therapy (SRP) is indicated again even after a patient that has improved to a level where the disease is stable? |
|
Definition
| False, periodontal maintenance is indicated in a stable periodontium. |
|
|
Term
| What are the two options of personalized therapy for an unstable periodontium? |
|
Definition
|
|
Term
| T/F. Surgical Therapy is indicated for a patient with an unstable periodontium, due to either low compliance or the patient is medically compromised? |
|
Definition
| False. The patient should be placed on a 3-month periodontal maintenance, as the medical condition and poor plaque control preclude us from doing any type of surgery. |
|
|
Term
| T/F Surgical Therapy is indicated in patients whom have shown an increase in compliance, decrease in probing depths, but still some bleeding in isolated areas? |
|
Definition
|
|
Term
| What are the indications for surgical therapy in order? (5) |
|
Definition
Access
Guided Tissue/Bone Regeneration
Mucogingival Surgery
Retreatment
Preprosthetic surgery |
|
|
Term
| The chances of completely removing sub gingival plaque is (directly, inversely) related to pocket depth? |
|
Definition
|
|
Term
| T/F. Even in patients with gingivitis success rates of COMPLETE removal of sub gingival plaque are SIMILIAR to that of periodontitis? |
|
Definition
| False. See slide 9 Note Lecture 1-13-15 |
|
|
Term
| Four contraindications to surgical therapy? |
|
Definition
Noncompliant patient
Poor Oral Hygiene
Smoking
Uncontrolled systemic conditions |
|
|
Term
| Orban knife is typically used in what region of the periodontium? |
|
Definition
| Interdental Papillary to sever alveologingival fibers |
|
|
Term
| This type of incision is placed .5-2mm apical to the gingival margin and typically only used in crown lengthening procedures and apically positioned flaps? |
|
Definition
|
|
Term
| T/F. Internal bevel incision is placed inside the sulcus? |
|
Definition
|
|
Term
What fibers need to be severed if you objective is to remove the gingival collar of diseased tissues?
A. PDL
B. Dentogingival fibers
C. Alveologingival fibers |
|
Definition
| Dentogingival fibers and Alveologingival fibers only |
|
|
Term
| (Sulcular/Extra-sulcular) incisions sever dentogingival fibers? |
|
Definition
|
|
Term
| Orban knives are used to severe which gingival fibers specifically? |
|
Definition
| alveologingival fiber (interproximal) |
|
|
Term
| APF techniques uses ____ different incisions? |
|
Definition
| 3 (1-Extrasulcular, 2-Sulcular, 3-Orban Knife) |
|
|
Term
| The knife is used commonly to remove drug induced gingival overgrothw and removal of supra bony pockets? |
|
Definition
|
|
Term
| T/F Kirkland knives are directed coronally, while organ knives are always directed apically? |
|
Definition
|
|
Term
| T/F. Gingivectomys are commonly used to treat drug induced gingival hyperplasia? |
|
Definition
| False, tissue will just grow back, painful for patient, and large wound bed are present. |
|
|
Term
| Periosteal elevators are typically used for (Full/Split) thickness flaps? |
|
Definition
| Full (Sharp dissection is necessary to reflect partial thickness flap) |
|
|
Term
| Prichard Curettes are used for what purpose? |
|
Definition
| Wide spoon allows you to go deep to scoop out granulation tissues. |
|
|
Term
| T/F. there are no cutting edges on the Prichard curette? |
|
Definition
|
|
Term
| What do you think the Sugarman inter proximal file is used for? |
|
Definition
Duh. Interproximal filing.
Has narrow tip and is used in a push pull facing to remove residual inter proximal granulation tissue and flatten osseous crystal deformities. |
|
|
Term
| T/F. Ochsenbein chisels have cutting edges on both the lateral sides and at the tip? |
|
Definition
|
|
Term
| These instrument is used to remove (widow) peaks of the alveolar bone at line angles? |
|
Definition
|
|
Term
| T/F Ochsenbein chisels are used in a push and pull motion? |
|
Definition
| False, only pushing. Push it real good.... |
|
|
Term
| What motion is a Rhodes back action chisel used to remove bony peaks at line angles? |
|
Definition
|
|
Term
| Where are the cutting tips for a Rhodes Back action Chisel? |
|
Definition
| Only at the tip. Yep, thats right just the tip. |
|
|
Term
| These are used to help better grasp thinner sutures compared to conventional needle holders and have quick and easy release? |
|
Definition
| Castroviejo needle holder |
|
|
Term
| Black silk, EPTFE, and nylon are all examples of what type of sutures? |
|
Definition
|
|
Term
| plain gut and chromic gut are all examples of what type of sutures? |
|
Definition
|
|
Term
| Vicryl is an example of what type of suture? |
|
Definition
|
|
Term
| A simple interrupted loop technique, does the needle pass the lingual papilla, inside-out or outside-in? |
|
Definition
|
|
Term
| T/F For the figure 8 technique the suture need passes outside in for both facial and lingual papilla? |
|
Definition
|
|
Term
| When is an interrupted loop suture indicated vs a figure 8? |
|
Definition
Interrupted loops are indicated for primary closure
Figure 8 are used where there is a gap between flap margins, when it is difficult to obtain precise approximation of the buccal and lingual papilla. |
|
|
Term
| T/F. Interrupted sling technique does not engage the lingual papilla? |
|
Definition
True.
Mesiofacial (outside-in)
Sling distally
Distofacial (outside-in)
Sling back around medially and tie |
|
|
Term
| This suturing technique allows separate positioning for lingual and facial flaps? |
|
Definition
|
|
Term
| Regeneration can only occur from cells derived from the ____ space? |
|
Definition
| PDL (multipotent stem cells) |
|
|
Term
| The typical healing réponse of the periodontium would be classified as, (regeneration or repair)? |
|
Definition
|
|
Term
| Differentiate between regeneration healing and repair healing? |
|
Definition
Regeneration restores both architecture and function
Repair does not fully restore original architecture and function |
|
|
Term
| What typically prevents regeneration healing? |
|
Definition
|
|
Term
| How fast does epithelium travel during healing? |
|
Definition
.5-1 mm daily
Connective tissue is .5
Bone is 50 microns |
|
|
Term
| ____ are used to prevent repair healing, and help induce regeneration of the periodontium after surgery? |
|
Definition
|
|
Term
| This term is defined as, reunions of epithelial and connective tissues with root surfaces and bone? |
|
Definition
|
|
Term
| Another definition of _____, is restoration of functional attachment apparatus composed of cementum, PDL, and alveolar bone? |
|
Definition
|
|
Term
| Definition: Union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus? |
|
Definition
|
|
Term
| Definition: Clinical restoration of bone tissue in a treated periodontal defect? |
|
Definition
|
|
Term
| Definition: New bone formation derived from viable undifferentiated cells or osteoblasts residing within the graft? |
|
Definition
|
|
Term
Definition: Stimulation of host cells to differentiate and form new bone. Graft materials may release osteoinductive substances such as bone morphogenetic protein (BMP) resulting in new bone
? |
|
Definition
|
|
Term
| Definition: Formation of new bone by host cells where the graft merely provides a scaffold for growth? |
|
Definition
|
|
Term
| What are the differences in species for Autograft, allograft, xenograft, and alloplast? |
|
Definition
Autograft
Tissue transferred from one position to another from the same individual
Allograft (Homograft)
Graft between genetically dissimilar members of the same species
Xenograft (Heterograft)
Graft taken from a donor of another species
Alloplast
Synthetic graft or inert foreign body implanted into tissue |
|
|
Term
| ___ ____ is used to achieve pocket reduction, restoration of lost alveolar process, or to regeneration of functional attachment? |
|
Definition
|
|
Term
| T/F. Osseous grafting is typically entirely predictable? |
|
Definition
| False. "These aren’t entirely predictable. You can do the best technical procedure in these areas, and everything is done well, and the patient comes back in 3 months or in 6 months, and you take a radiograph and it doesn’t look any different than what it did previously. " |
|
|
Term
| What is by far the most important factor influencing success of Osseous Grafting? |
|
Definition
| Patient selection (Non-smoker, Optimal oral hygiene) |
|
|
Term
| Can you list the 6 primary factors influencing success of bone grafts? |
|
Definition
Patient Selection
Defect Morphology (Horizontal/Vertical, # of bony walls)
Type of graft
Patients repair potential
Maintenance program
Skill of practitioner |
|
|
Term
| Horizontal/Vertical bone loss have better outcomes when trying to regenerate bone? |
|
Definition
|
|
Term
| One can expect about ____ percent of bone fill after grafting? |
|
Definition
|
|
Term
| Why is horizontal bone loss harder to regenerate? |
|
Definition
| Less vascular supply as compared to vertical defect, that supplies sources of cells from bone marrow or PDL |
|
|
Term
| How many walls would the most ideal bony defect have? |
|
Definition
|
|
Term
| T/F A circumferential defect has a more regeneration potential than a 3 wall defect? |
|
Definition
|
|
Term
| Why do 3 wall osseous defects have better potential than 1 wall defects? |
|
Definition
| The more walls, the more vascular supply |
|
|
Term
| T/F. The patients repair potential is relatively predictable? |
|
Definition
False.
"This is the unknown—the patients repair potential. That’s where you have to look at things like this. Other things—like is the patient systemically healthy? " |
|
|
Term
| Fact: The maintenance program is a factor influencing success of bone grafts and simply means how willing the patient is to come back and follow up after surgery. |
|
Definition
|
|
Term
| What is the most important step of surgical technique when placing a bone graft on a vertical defect with root exposure? |
|
Definition
| Root instrumentation/debriding |
|
|
Term
| T/F. Cortical bone is osteogenic? |
|
Definition
| False. Cortical bone contains osteocytes, not osteoblasts. Its osteoconductive, but most likely not osteogenic. |
|
|
Term
|
Definition
| A mixture of autogenic and aloo/xenogenic graft material. |
|
|
Term
| What is the hope in demineralizing bone before grafting? |
|
Definition
| Releasing some inductive proteins like BMP |
|
|
Term
| T/F. You have some bone fill after an open flap debridement procedure. |
|
Definition
|
|
Term
| Processing of demineralized bone has been show to kill infectious diseases, even HIV. Fact |
|
Definition
|
|
Term
| T/F. Alloplast have been histologically proven to aid in bone regeneration? |
|
Definition
|
|
Term
| 1982 study showed that ___ was the critical probing depth at which root planning resulted in a gain of attachment? |
|
Definition
|
|
Term
| At what clinical probing depth would open flap surgery likely result in attachment loss? |
|
Definition
<4.2mm (Loss)
>4.2 mm (results in gain) |
|
|
Term
| Gingivectomy, apically positioned flap, and osseous surgery are what types of pocket reducing surgeries? |
|
Definition
|
|
Term
| Whats the difference between reattachment and new attachment? |
|
Definition
| Im not really sure I just think this might be a good question. |
|
|
Term
| Following surgery, a periodontal wound will be repopulated by what 4 cells? |
|
Definition
Epithelial
Connective Tissue
Bone
PDL |
|
|
Term
| What happens to a healing site if (1) epithelial cells (2) connective tissue cells (3) bone (4) PDL cells arrive to cementum first. |
|
Definition
1. Long junctional epithelium
2. CT adhesion and root resorption
3. Root resorption and ankylosis
4. New connective tissue attachment
Slide 13 of 47 |
|
|
Term
| T/F. Bone grafts with membranes showed higher percentage of bone fill? |
|
Definition
|
|
Term
| T/F. Even with regenerative approaches such as membranes, Class III furcations still show a 90% resolution? |
|
Definition
|
|
Term
| T/F. Bone grafting is indicated for defects surrounding implants? |
|
Definition
|
|
Term
| Major contraindication for regenerative procedures, and many other periodontal surgeries? |
|
Definition
|
|
Term
| Name 4 contraindications for regenerative procedures? |
|
Definition
Flap perforation
Horizontal defect
Smoking
Technical Error |
|
|
Term
| When adapting membranes to a bone graft, one should overlap margins ---- mm? |
|
Definition
|
|
Term
| How long after surgery are non-resorbable membranes removed if no signs of infection occur? |
|
Definition
|
|
Term
| What is used at home to cleanse surgical sites for the first 7-10 days? |
|
Definition
| Chlorhexadine twice a day. |
|
|
Term
| How often should you see patients for follow up if you use a membrane? |
|
Definition
|
|
Term
| How long must you wait to probe areas that have received periodontal surgery? |
|
Definition
|
|
Term
| T/F. Non resorbable membranes should have a slight exposure to the oral cavity at the DEJ to allow for migration of cells to constitute regeneration? |
|
Definition
| False, exposure will result in infection and/or microbial contamination |
|
|
Term
| Gore Tex, ePTFE and dPTFE are examples of _____ membranes? |
|
Definition
|
|
Term
| Biomend (zimmer) and Bio Gide (osteohealth) are examples of ____ membranes? |
|
Definition
|
|
Term
| T/F. Emdogain has been proven to regernate cellular cementum, periodontal ligament, and alveolar bone? |
|
Definition
| False. Acellular cementum, not cellular |
|
|
Term
| 4 major factors affecting treatment outcomes for osseous grafts? |
|
Definition
1 Bacterial contamination
2 Wound healing potential (smoking; genetics; age; diabetes
3 Site characteristic (walled defect; anatomy; morpholgy; occlusion)
4 Surgical procedure (operator skill; approach; root preparation) |
|
|
Term
| Which mandibular molars are the root trunks the shortest? Why is that important to know? |
|
Definition
1st molar
If both molar have clinical attachment loss of 5. You are more likely to have furcal involvement on 1st molars since the root trunks are shorter. |
|
|
Term
| Which root on the maxillary molars generally has a longer root length? Mandible molars? |
|
Definition
Palatal - Max.
Mesial - Mandibular |
|
|
Term
| T/F. Palatal root of maxillary molars typically has the most surface area of the three roots? |
|
Definition
| False. Mesial 25%, Palatal 24% |
|
|
Term
| If you are resecting the root of a maxillary molar, which root is preferred to be removed? |
|
Definition
|
|
Term
| If you are resecting the root of a maxillary molar, which root is preferred to be removed? |
|
Definition
|
|
Term
| ___ can interfere with measuring horizontal attachment loss by preventing through and through instrumentation. The treatment is "tunneling"? |
|
Definition
| Intermediate Bifurcational Ridge |
|
|
Term
| T/F. Entrance to furcation can be apical to the roof of the furcation? |
|
Definition
| True. Some reports should 63% of mandibular molars and 55% of maxillary molars have external bifurcation ridges. |
|
|
Term
| When probing the maxillary molars with a nabers for furcation involvement. Where does one expect the furcation for the (1) Palate/Distal root (2) Palatal/mesial (3) mesial/buccal |
|
Definition
1. Midpoint buccal lingually on the distal
2. 2/3 towards the palate buccal lingually
3. Midpoint mesial buccally, on the mesial |
|
|
Term
| Glickman's classification defined furcation involvement with ____ grades? |
|
Definition
4
Grade 1: Incipient bone loss, interradicular bone is intact
Grade 2: Extends into furcation but not completely with bone loss
Grade 3: Through and Through with bone loss
Grade 4: Clinical visible through and through |
|
|
Term
| Hamps degree of furcation involvement classified degrees 1,2,3 as? |
|
Definition
1. Horizontal loss of Less than 3 mm
2. Horizontal loss of More than 3 mm, but not through and through
3. Through and through |
|
|
Term
| Clinically visible through and through furcation would be classified as a Grade ____, degree ____? |
|
Definition
|
|
Term
| Grade B vertical attachment classifications suggest how many mm of bone loss of interradicular bone? |
|
Definition
|
|
Term
| T/F. Furcation arrows show a strong reliability, as a diagnostic tool of furcation involvement in degree 1 to 3? |
|
Definition
| False, it is not very predictive, with the highest reliability of 55% for degree 3. |
|
|
Term
| Clinical findings are confirmed in about 50% of cases with furcation involvement. For the remaining 50%, is FI underestimated or overestimated clinically? |
|
Definition
|
|
Term
| T/F Cervical enamel projections can lead to isolated furcation involvement? |
|
Definition
|
|
Term
| If one were to believe isolated furcation involvement can occur due to traumatic occlusion. Which teeth would be most pre-disposed to isolated furcation involvement? |
|
Definition
| Teeth closets to the fulcrum, as they receive the greatest stress. |
|
|
Term
| Describe the 3 grades of cervical enamel projections? |
|
Definition
Grade 1- change in contour of enamel
Grade 2- CEP is approach furcation
Grade 3 - CEP is within the furcation |
|
|
Term
| T/F. One study found that 90% of isolated furcation involvement on mandibular molars were related to cervical enamel projections. |
|
Definition
|
|
Term
| Accessory canals can lead to isolated furcation involvement, especially when no clinical signs of furcation involvement are present. Fact. |
|
Definition
|
|
Term
| T/F. Ross and Thompson should that even for molars with poor or questionable prognosis, a large majority can be saved with SRP, occlusal adjustment, and periodontal surgery with OHI? |
|
Definition
|
|
Term
| What instrument would be sent home with a patient whom has a Grade 1 furcation involvement, and is used to reduce inflammation? |
|
Definition
|
|
Term
| Minocycline HCL may be indicated for pocket elimination in grade ____ furcation involvement? |
|
Definition
|
|
Term
| T/F. In grade II, degree II, closed SRP is indicated to reduced horizontal bone loss? |
|
Definition
| False, 58% of furcation entrances are smaller than .75mm. Open flap surgeries are indicated for access. You can do SRP it is just better to do open. |
|
|
Term
| T/F Ultra sonics are more effective in narrow furcations? |
|
Definition
|
|
Term
| What two procedures are contraindicated for Grade II, degree II furcations? |
|
Definition
Tunneling
Osteoectomy and osteoplasty |
|
|
Term
| T/F. CEP are detrimental to guided tissue regeneration? |
|
Definition
|
|
Term
| T/F. All CEPs are completely composed of enamel? |
|
Definition
| False. Approximately 45% had cementum on the surface. |
|
|
Term
| T/F. Tunneling procedures have been shown to have considerably good outcomes and should be considered as valid treatment for Grade III furcations? |
|
Definition
|
|
Term
| What anatomical feature of roots "might" contraindicate a tunneling procedure? |
|
Definition
| Intermediate Bifurcation Ridge, must maintain certain distance from the pulp 3.5mm |
|
|
Term
| How should one suture after a tunneling procedure? |
|
Definition
| Continuous with stitch running through furcation to disallow granulation tissue formation within the furcation. |
|
|
Term
| T/F Root resection and implants should similar results in the treatment of isolated furcation invasion? |
|
Definition
|
|
Term
| Retention Considerations? (5) |
|
Definition
Is the disease process affecting other teeth?
2. Discomfort?
3. Strategic, abutement tooth?
4. Plaque control
5. Systemic conditions? |
|
|
Term
| The greatest width of attached gingiva is where? |
|
Definition
| Anterior (Maxillary>Mandibular) |
|
|
Term
| Location of the least width of attached gingiva? |
|
Definition
|
|
Term
| Lang and Loe suggest the minimum amount of attach gingiva to withstand mastication is _____ mm and minimum keratinized mucosa is ____ mm? |
|
Definition
|
|
Term
| Deep rete pegs are a histologic feature of (attached gingiva/alveolar mucosa) |
|
Definition
|
|
Term
| Differentiate between the actual and apparent position of gingival recession. |
|
Definition
Actual is a measure of recession in regards to the junctional epithelium.
Appart position is in relation to the free gingival margin |
|
|
Term
| Gingival margin is typically (range) mm coronal to the CEJ? |
|
Definition
|
|
Term
| Total recession is a sum of what two categories of recession? |
|
Definition
|
|
Term
| Which miller classification states Marginal tissue recession, which extends to or beyond the MGJ. There is no periodontal loss in the interdental area? |
|
Definition
|
|
Term
| At what miller classification do teeth began to become malposition? |
|
Definition
|
|
Term
| Which type of papilla is ideal, which is the least ideal for mucogingival surgery? |
|
Definition
Type A is most ideal
Type C is least ideal |
|
|
Term
| Papilla that fills the embrasure space. There is no interdental recession and complete root coverage is attainable. The papillae is less than 3 mm wide at the CEJ of the tooth (teeth) to be grafted are said to be what type? |
|
Definition
|
|
Term
| Tissue Barrier Concept state what? |
|
Definition
| Attached gingiva withstands inflammation much better than alveolar mucosa |
|
|
Term
| T/F. Exposing bone to increase the zone of keratinized gingiva is contraindicated? |
|
Definition
|
|
Term
| T/F. When an adequate zone of attached keratinized gingiva exists, vestibular depth is not a factor? |
|
Definition
|
|
Term
| How thick is a typical free gingival graft? |
|
Definition
|
|
Term
The advantages of this surgery include, One surgical site
Good vascularity of the pedicle flap
Ability to cover a denuded root surface? |
|
Definition
| Laterally positioned pedicle flap |
|
|
Term
| 4 contraindications to lateral pedicle graft? |
|
Definition
Presence of deep interproximal pockets
Excessive root prominence
Deep or extensive root abrasion or erosion
Significant loss of interproximal bone height |
|
|
Term
| Neurovascular bundles are more proximal to the CEJ of molars in (low/high) arched palates? |
|
Definition
|
|
Term
| Donor sites for grafts need to typically be how big? |
|
Definition
| 1-1 1/2 tooth wider than the recipient site. |
|
|
Term
| What allergy should we be concerned with while placing Alloderm grafts? |
|
Definition
|
|
Term
| T/F. Alloderm grafts are orientation dependent grafts when used to cover recession defects? |
|
Definition
| False. They are only dependent for bone defects. Only the connective tissue side absorbs blood. |
|
|
Term
| The physiological purpose of the ____ is thought to act as a guide to the developing fetal and infant dentition. |
|
Definition
Frenum.
Probably not a question but a good fact to know |
|
|
Term
| T/F. In adulthood the frenum serves no purpose? |
|
Definition
|
|
Term
| What is an aberrant frenum? |
|
Definition
| One that causes diastemas or recession |
|
|
Term
| What are the three parts of the dentogingival complex? |
|
Definition
Gingival sulcus
Junctional epithelium
Connective tissue attachement |
|
|
Term
| Apical movement of the soft tissue is referred to as ____ eruption? |
|
Definition
|
|
Term
| Hallmark of Altered Active Eruption? |
|
Definition
| Crest of bone is at the CEJ. |
|
|
Term
| Stages of Passive eruption - 1-4? |
|
Definition
1. Gingival Sulcus (GS) and junctional epithelium (JE) are on enamel
2. GS is on enamel, JE is on enamel and cementum
3. GS is at CEJ, JE is on cementum
4. GS and JE are on cementum |
|
|
Term
| What are the different subgroups of altered eruption A and B main attributes? |
|
Definition
A is bone is alveolar crest is 1.5-2mm from the CEJ
B, alveolar crest is at the CEJ. |
|
|
Term
| Which type of altered passive eruption show a larger band of gingiva that allow crown lengthening by gingivectomy? |
|
Definition
|
|
Term
| Type ____ altered eruption teeth allow more gingivectomy, whereas type _____, require apical positioned flaps? |
|
Definition
|
|
Term
| Lateral incisors in relation to the central incisors are _____ mm shorter, and the gingival line is ____ mm shorter than the central incisors? |
|
Definition
|
|
Term
Gingival height of convexity is located on what third?
1. Central Incisor
2. Lateral Incisor
3. Canine? |
|
Definition
1. Distal third
2. Middle third
3. Distal third |
|
|
Term
| T/F. When performing a gingivectomy premolar to premolar one must make an extrasulcular incision, reflect full thickness flap, except for papilla region should be partial? |
|
Definition
|
|
Term
| _____ are recommended when raising a flap and bone levels are altered. |
|
Definition
|
|
Term
| Gentle brushing can begin ____-____ days post crown lengthening? |
|
Definition
|
|
Term
| Temporary restorations can be reshaped _____ weeks post crown lengthening, but permanent restorations should not be placed until ______ weeks after? |
|
Definition
|
|
Term
| What would a periodontist use Chu's gauge to measure? |
|
Definition
| Clinical crown lengths and widths simultaneously |
|
|
Term
| The periodontium of altered ____ eruption is typically of thick biotype, whittle the peridontium of altered ____ eruption is of thin biotype? |
|
Definition
|
|
Term
| Altered eruption Type 1 is different from Type 2 in what way? |
|
Definition
Type 1: MGJ is apical to alveolar crest and gingival dimension is wider than normal
Type 2: MGJ is at the CEJ and normal gingival dimension width |
|
|
