perio midterm.txt

• coronal movement of gingival margin
• apical movement of junctional epithelium
• destruction of CT
• bone loss
• plaque, inflammation

• .5-.9mm manual
• 1.3-1.7mm power driven
• .2mm mouthwash

• 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

• 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)

3 weeks, assess OH, pocket depth

• predictable for >6mm
• posterior access
• least aggressive surgery
• limitations: recession

• simple, quick easy, good for gingival enlargement(pseudo-pockets)
• limitations: no access to bone, healing 2ndry intention, no conservation of keratinized tissue, painful

• cyclosporine
• nifedipine(Ca2+ channel blocker)
• dilantin (phenytoin): antiepileptic

apical displacement of gingival margin with bony recontouring to acheive physiologic osseous profile

• proximal bone is more coronal than buccal and lingual
• What are 2 ways to resstablish positive bone architecture?
• regrow or reshape(osteoplasty, ostectomy)

• deep pockets
• furcations
• root anatomy

S/RP

• poor OH, small pockets,
• poor prognosis (systemic), HTN, CV, clotting, diabetes

• adv: simple, mucogingival junction maintained, w or w/o flap
• disadv: graft inc infection risk, increased bone width loss

• adv: more predictable bone growth, maintain ridge width, hemostasis
• disadv: more complete technique, may change mucogingival juntion, narrow application

• minimizes width (height) loss especially if not exposed
• maximizes socket fill
• same results w/ resolut(resorbable membrane)

• less change in height,
• change in width 75% socket length none 1.65 BMP 2.68

modified widman flap

• sulcular or reverse bevel incision to create full thickness (includes mucoperiosteum) flap
• debride, remove granulation tissue, (S/RP), suture

thin & close to bone

• osteoplasty: reshaping non-supportive bone to give physiological contours
• 1. interdental grooving
• ostectomy: remove supporting bone for positive architecture

• 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

• soft tisse contours that are unstable and have post-surgical pocket formation and gingival inflammation
• negative: facial bones coronal to interproximal

• periradicular bone apical to interproximal
• mid-facial bone is apical to interproximal

• 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

beyond to allow movement

reverse bevel since there is no free movement

• 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

• 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

• 1. gingivectomy
• 2. labial & lingual flaps elevated for root planing and osseous surgery
• 3. apically positioned flaps sutured close to bone margins

• U-shaped: pulls tissue coronoally
• figure 8: pulls tissue closer to bone

• enter buccally, go around each tooth
• then wrap around last tooth then repeat lingual

mattress: 2 bites to hold tissue down better

double mattress, lingual and buccal to preserve papilla

• cementum
• PDL fibers
• bone

• histologically
• notch root in most apical margin of calculus

• 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

• bone from burring, collected with scraper
• mostly cortical
• contaminated(H2O oil)
• combined w/ osseous surgery
• leads to higer fill than curretage

cancellous, fresh vs frozen, morbitity at donor site

• 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

• donor age
• decrease: smokers

• periosteum
• polylactide
• polylactide-glycolide
• collagen(most common)
• CaSO4

• Porous HA (hydroxyapatite)
• goretex: polytetraflourethylene

• porcine collagen resorbable membrane
• smooth toward mucosa, rough under to facilitate cell growth

xenograft: bovine

• 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

• 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

• Emdogain: amelogenin from ameloblasts and reduced enamel epithelium of root sheaths
• enamel matrix derivative
• molecule from end of developing roots that stimulates bone formation

• roll up w/ probe
• tension test, pull on lips/cheeks, keratinized resists muscle pull
• should not blanch/move

• keratinized epithelium
• dense collagen

no esthetic problem, not adequate keratinized gingiva

• esthetic prolem & inadequate keratinized tissue
• also gingival graft and coronally repositioned flap

• esthetic problem & inadequate keratinized tissue
• also gingival graft for root coverage

esthetic problem, adequate keratinized tissue, recession less than 2mm

esthetic problem, adequate keratinized tissue, more than 2mm recession, and ADEQUATE adjacent donor site

estheic problem, adequate keratinized tissue, more than 2mm recession, inadequate adjacent donor site and ADEQUATE Palatal site

esthetic problem, adequate keratinized tissue, more than 2mm recession, inadequate adjacent or palatal site.