perio midterm.txt

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perio midterm.txt
2013-02-13 00:51:00
Perio 202 midterm

perio 202 midterm kelley
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  1. What movement causes pocket formation?
    • coronal movement of gingival margin
    • apical movement of junctional epithelium
    • destruction of CT
    • bone loss
    • plaque, inflammation
  2. What are approximate depths of sulcus subgingival penetration of traditional means of oral hygeine?
    • .5-.9mm manual
    • 1.3-1.7mm power driven
    • .2mm mouthwash
  3. What are the modes of pocket elimination?
    • repair: adapt ging to tooth surface w/ LONG JUNCTIONAL EPITHELIUM via SR/P, flap surgery
    • resection: eliminate pocket wall->gingival recession via gingivectomy, apical flap
    • regeneration
    • extraction
  4. What are the advantages of SR/P?
    • predictable up to 5mm depth
    • little recession
    • limitations: posterior (access, furcations), deep or vertical defect pockets
    • why: OHI improvement, definitive therapy, facilitates surgery (tissue mgt, hemostasis, anesthetic)
  5. When should you re-evaluate results of S/RP?
    3 weeks, assess OH, pocket depth
  6. What are advantages for flap surgery for access?
    • predictable for >6mm
    • posterior access
    • least aggressive surgery
    • limitations: recession
  7. What are advantages of gingivectomy?
    • simple, quick easy, good for gingival enlargement(pseudo-pockets)
    • limitations: no access to bone, healing 2ndry intention, no conservation of keratinized tissue, painful
  8. What are some causes of gingival enlargement?
    • cyclosporine
    • nifedipine(Ca2+ channel blocker)
    • dilantin (phenytoin): antiepileptic
  9. What is the process of apically positions flap w resective osseous surgery?
    apical displacement of gingival margin with bony recontouring to acheive physiologic osseous profile
  10. What is positive osseous architecture?
    • proximal bone is more coronal than buccal and lingual
    • What are 2 ways to resstablish positive bone architecture?
    • regrow or reshape(osteoplasty, ostectomy)
  11. What are indications for surgery?
    • deep pockets
    • furcations
    • root anatomy
  12. What should always be done pre-operatively (before surgery)?
  13. When is surgery containdicated?
    • poor OH, small pockets,
    • poor prognosis (systemic), HTN, CV, clotting, diabetes
  14. What are adv & disadv of open socket extractions?
    • adv: simple, mucogingival junction maintained, w or w/o flap
    • disadv: graft inc infection risk, increased bone width loss
  15. What are adv & disadv of closed flap extractions?
    • adv: more predictable bone growth, maintain ridge width, hemostasis
    • disadv: more complete technique, may change mucogingival juntion, narrow application
  16. How does goretex affect closed flap surgeries?
    • minimizes width (height) loss especially if not exposed
    • maximizes socket fill
    • same results w/ resolut(resorbable membrane)
  17. How does BMP affect periodontal socket changes?
    • less change in height,
    • change in width 75% socket length none 1.65 BMP 2.68
  18. What is the most widely used flap surgery?
    modified widman flap
  19. What is the process of modified widman flap?
    • sulcular or reverse bevel incision to create full thickness (includes mucoperiosteum) flap
    • debride, remove granulation tissue, (S/RP), suture
  20. What are goals for flaps?
    thin & close to bone
  21. What is osteoplasty & ostectomy?
    • osteoplasty: reshaping non-supportive bone to give physiological contours
    • 1. interdental grooving
    • ostectomy: remove supporting bone for positive architecture
  22. What are the goals of osseous surgery?
    • calculus removal
    • pocket reduction
    • + architecture
    • furca protection
    • OH acess
    • granulation tissue removal
    • apical positioning of gingiva
    • crater elimination
    • harmony of gingiva and bone
    • process 1. gingivectomy 2. mucoperiosteal flap 3. osseus surgery + arch 4. apical flap
  23. What is the consequence of negative bone architecture?
    • soft tisse contours that are unstable and have post-surgical pocket formation and gingival inflammation
    • negative: facial bones coronal to interproximal
  24. What defines positive architecture?
    • periradicular bone apical to interproximal
    • mid-facial bone is apical to interproximal
  25. What is the palatal approach to osseous surgery?
    • more emphasis on bone reduction(ostectomy on the palate than buccal
    • reduce risk of removing too much healthy bone in buccal furcation
    • leads to soft tissue healing that gives palatal access to besial and distal furcations for interproximal plaque removal by patient
  26. How should a flap be positions with respect to mucogingival junction?
    beyond to allow movement
  27. What kind of incision is used on the palatal?
    reverse bevel since there is no free movement
  28. With respect to an upper molar where are the pockets located?
    • mesial and distal
    • mesial edentulous: mesial wedge technique with parallel incisions over ridge to expose bone defects and root surfaces
    • distal wedge technique: vertical inicisions at most distal portion, incisions to expose bone defects and root surfaces
  29. What is the trap-door approach?
    • 2 parallel inceision run distally to allow elevation of trap door or distal flap of tissue
    • Used when bone graft materials are to be placed in distal intrabony defects
  30. What is the technique for hyperplastic gingival tissues?
    • 1. gingivectomy
    • 2. labial & lingual flaps elevated for root planing and osseous surgery
    • 3. apically positioned flaps sutured close to bone margins
  31. What are the choices for an interrupted suture?
    • U-shaped: pulls tissue coronoally
    • figure 8: pulls tissue closer to bone
  32. What is the technique for the continuous sling suture?
    • enter buccally, go around each tooth
    • then wrap around last tooth then repeat lingual
  33. What technique do you use for palatal suturing?
    mattress: 2 bites to hold tissue down better
  34. What is the papilla preservation technique?
    double mattress, lingual and buccal to preserve papilla
  35. What tissues are targets of regeneration?
    • cementum
    • PDL fibers
    • bone
  36. What is the only way to evaluate regeneration?
    • histologically
    • notch root in most apical margin of calculus
  37. What is the gold standard of bone grafts?
    • autogenous bone
    • adv: no rejection, disease, cost, commercial sponsor
    • disadv: quantity availability small, min data, limited clinical results
    • study: better probing depth, clinical attachment, defect fill
  38. What is osseous cagulum?
    • bone from burring, collected with scraper
    • mostly cortical
    • contaminated(H2O oil)
    • combined w/ osseous surgery
    • leads to higer fill than curretage
  39. What are the features of hip marrow graft?
    cancellous, fresh vs frozen, morbitity at donor site
  40. What are the types of allografts?
    • 1. decalcified freeze-dried w/ alloplasts (HA fom coral)
    • variable osteogenic capacity, viral particles killed, limited success in furcations, particles & putty
    • 2. calcified freeze-dried
  41. What factors seem to increase success of new bone formation in grafts?
    • donor age
    • decrease: smokers
  42. What are the types of resorbable membranes?
    • periosteum
    • polylactide
    • polylactide-glycolide
    • collagen(most common)
    • CaSO4
  43. What increases efficacy of goretex membrane?
    • Porous HA (hydroxyapatite)
    • goretex: polytetraflourethylene
  44. What is Bio-Gide?
    • porcine collagen resorbable membrane
    • smooth toward mucosa, rough under to facilitate cell growth
  45. What is Bio-Oss?
    xenograft: bovine
  46. What bioactive molecules aid bone reformation in platelet rich proteins?
    • PDGF: polypeptide stim protein synth in bone, resoption, collagen and matrix production and angiogenesis
    • TGF-beta: polypeptide (3) stim angiogenesis collagen, ground substance and fibronectin production. Inhibits osteoclasts, stimulates osteoblast division
    • PDEGF: stim keratinocyte & fibroblast proliferation
    • PDAF: stim new blood vessel production
    • IGF-1: stim cartilage, bone matrix production & osteogenic stem cells
    • PF-4: chemoattractant for fibroblasts and PMNs
  47. What is BMP?
    • aka osteogenin
    • Bone Morphogenetic proteins: TGF-B subgroup
    • BMP1 not part of superfamily is procollagen protease.
    • BMP induce osteoprogenitor cell formation
    • Most bound to carrier of bovine type I collagen sponge
    • ideal carrier still not found
    • discovered 1965 UCLA at URIST
    • BMP7 not effective in sinus elevation
    • BMP2 & 7 > BMP5
  48. What is amelogenin?
    • Emdogain: amelogenin from ameloblasts and reduced enamel epithelium of root sheaths
    • enamel matrix derivative
    • molecule from end of developing roots that stimulates bone formation
  49. What are tests for adequate keratinized gingiva?
    • roll up w/ probe
    • tension test, pull on lips/cheeks, keratinized resists muscle pull
    • should not blanch/move
  50. What layers of tissues does a graft include?
    • keratinized epithelium
    • dense collagen
  51. When is gingival graft used?
    no esthetic problem, not adequate keratinized gingiva
  52. When is gingival graft for root coverage used?
    • esthetic prolem & inadequate keratinized tissue
    • also gingival graft and coronally repositioned flap
  53. When is gingival graft and coronally repositioned flap used?
    • esthetic problem & inadequate keratinized tissue
    • also gingival graft for root coverage
  54. When is Coronally Repositioned Semi-Lunar Flap used?
    esthetic problem, adequate keratinized tissue, recession less than 2mm
  55. When is lateral sliding flap used?
    esthetic problem, adequate keratinized tissue, more than 2mm recession, and ADEQUATE adjacent donor site
  56. When is connective tissue graft used?
    estheic problem, adequate keratinized tissue, more than 2mm recession, inadequate adjacent donor site and ADEQUATE Palatal site
  57. WHen is coronally repositioned flap with membrane or emdogain used?
    esthetic problem, adequate keratinized tissue, more than 2mm recession, inadequate adjacent or palatal site.