Perio Final

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  1. Perio emergencies- Do they generally require systemic antibiotic treatment?
  2. Which tooth is most likely to develop periocoronitis during eruption?
    Mand. 3rd molars
  3. Emergency appt. initial treatment of NUG what 2 things do you do at the first appt?
    • Debridement
    • Patient education
  4. What is the major objective of perio flap surgery?
    • Tissues are reflected away from roots to provide access for debridement.
    • Purpose is to eliminate or minimize pocket depths
  5. What causes a psuedopocket?
    Edema or inflammation
  6. If I am doing perio surgery and you flap back and see the root sticking through it's called what?
    • Dehiscence
    • (cleft like defect extending from bone margin, exposing the root, more common) v shape.
  7. Perio surgery where you reshape alveolar bone
    using a hand instrument what is it called?
    Osseous Re-contouring
  8. Perio surgery where I cut off a piece of keratinized tissue completely away from its source and sew it on another place, it is a
    graft. What kind of tissue is it?
    Free gingival graft; soft tissue autograph
  9. Free gingival graft; where is the most likely
    site to get the tissue from?
    Hard palate
  10. What is the worst most absolute contraindication for perio surgery?
    • Non compliant patient.
    • If home care is inadequate…… this is NOT a candidate for surgery!!
  11. What is an auto graft?
    Tissue taken from the same patient’s body
  12. What is an Allo-graft?
    Tissue taken from another individual of the same species.
  13. What is a Xenograft?
    Tissue taken from another species (usually bovine)
  14. What is necessary in guided tissue regeneration that is not used in older forms of perio surgery?
    Barrier membrane
  15. What is the purpose of the Barrier membrane?
    To prevent the growth of soft tissue attachment
  16. Give a positive and negative about Black Silk
    • Most common 
    • Absorb bacteria 
    • Can cause inflammation after 7-10 days
  17. Give a positive and a negative about Absorbable Gut Sutures?
    • “gut” –stiff, difficult to use 
    • Synthetic – stronger, more flexible 
    • Patient does not return for removal of sutures
  18. Nylon, polyester, Gore-Tex Sutures
    • Very thin good for delicate tissue
    • Non-absorbable
    • Might be hard to find to remove
  19. Osteogenesis
    The potential for new bone cells and new bone to form after grafting
  20. Osteoconductive
    Grafting materials that form a framework for new bone cells to inhabit
  21. Osteoinductive
    Grafting materials that have actual bone-forming cells
  22. Emdogain
    • Enamel matrix derivative (EMD) 
    • Taken from the reduced enamel epithelium of embryonic pigs
  23. Biological Enhancement Materials
    • Platelet derived growth factor (PDGF) 
    • Stimulates creation and growth of PDL fiber cells and bone cells
  24. What are dental implants made of?
  25. What is Osseointegration?
    • Direct contact of bone to the dental implant 
    • No PDL! 
    • Successfully osseointegrated implants are more rigid than natural teeth
  26. Fibrointegrated implants are what?
    • If connective tissue grows between the implant and the bone.
    • It may not be stable
  27. What are the best means for assessing implants?
    Radiographs and mobility
  28. What are the three types of implants?
    • Endosseous 
    • Subperiosteal 
    • Transossteal (“staples”)
  29. Endosseous Implants
    • Most common 
    • Most predictable 
    • Placed directly in the bone 
    • Titanium 
    • Various shapes: 
    • Hollow cylinder 
    • Threaded
  30. Subperiosteal Implants
    • Custom made cast metal framework 
    • Fits over the bone like a saddle 
    • UNDER  the periosteum 
    • For patients with severely resorbed alveolar ridge or traumatic injury/cancer reconstruction.
  31. Transosteal Implants
    • "staples” 
    • Placed all the way through the mandible in the chin area 
    • Last resort!
  32. Which vitamin is most important for collagen
    Vitamin C
  33. What are gingival fibers made of?
  34. Where on the root would you find the highest number of living cells and what are they called?
    • They are cementoblast and they are on the apical third
    • *So the cervical third has the most non living cells
  35. What is the average biologic width?
  36. What is Fenestration?
    Window-like defect in the bone
  37. What is the Col?
    • Area between facial and lingual surfaces of the papilla, just beneath contact area
    • Shaped like a pup tent
  38. Nonkeratinized Tissues of the Periodontium
    • Sulcular epithelium 
    • Interdental col tissue 
    • Junctional epithelium
    • *Surfaces of the gingiva exposed to the oral cavity are keratinized.
  39. Which fibers brace the free gingiva against the tooth?
  40. Demographics (epidemiology) which population has the greatest risk factor for developing periodontal disease?
    Low education level
  41. What causes periodontal disease; current theory?
    • “Host-Bacterial Interaction Theory”
    • Bacterial infection with pathologic bacteria + host response to bacteria (or lack of response) = PERIODONTAL DESTRUCTION
  42. Most significant risk factor for periodontal disease?
    Smoking (modifiable)
  43. Where does the mineral content of subgingival calculus come from?
    Derived from Serum
  44. Where does the mineral content of supragingival calculus come from?
    Derived from Saliva
  45. This is a small notch in the cervical enamel of the tooth caused by flexing forces?
  46. Iatrogenic
    • Caused by medical/dental treatment 
    • Poorly contoured restorations 
    • Overhangs 
    • Open contacts 
    • Over/under contoured
  47. True or False: absence of bleeding indicates there is no inflammation
  48. List 3 demographics, who may experience hormone related gingivitis?
    • Post-menopausal women taking hormone replacements
    • Teens going through Puberty
    • Pregnant Women
  49. What kind of drugs cause gingival overgrowth?
    • Ca+ Chanel Blockers
    • Anticonvulsant
    • Immunosupressive
  50. Name 2 Ca+ Chanel Blockers?
    • nifedipine 
    • verapamil
  51. Name the immunospressive drug that causes gingival hyperplasia?
  52. What is the name is of the anticonvulsant drug that causes gingival overgrowth? Brand & Generic
    • Brand: Dilantin
    • Generic: phenytoin
  53. T or F: perio screening and recording can take the place of probing and charting for every patient.
  54. Necessary elements of informed consent. What do you have to do?
    • Explain Disease process
    • Explain all treatment options
    • Consequences of no treatment vs treatment
  55. What is another word for consistency?
  56. What do you assess furcations with?
    A Nabors probe
  57. What is the Furcation classification for when the probe can enter the furcation, but not go all the way through?
    Class 2
  58. How much attachment is necessary to not have a mucogingival defect?
  59. What would the grade of mobility be if the tooth can be depressed in the socket?
    Grade III
  60. How do you calculate the width of attached gingiva?
    • Measure from gingival margin to mucogingival junction, then 
    • Subtract probing depth
  61. Calculating Clinical Attachment Level (CAL)
    • If recession is present:
    • Recession + Probing depth=
    • If margin is swollen apical to CEJ: 
    • Probing depth minus distance from CEJ to margin
  62. Which type of x-rays are best for measuring bone loss in a perio assessment?
    Vertical Bitewings
  63. What is an early radiographic sign of perio destruction?
    Loss of lamina dura
  64. Horizontal bone loss
    • Most common type of bone loss 
    • Suprabony pockets
  65. Vertical bone loss
    • Uneven resorption of alveolar bone 
    • Forms trenches or craters in the bone 
    • Infrabony pockets
  66. What is the theory for sensitivity?
  67. Around which teeth would you see the most obvious bone loss with aggressive periodontitis?
    1st molars and incisors
  68. Is it necessary to perform root planning for a glassy smooth root surface
  69. What is the prescription med taken systemically to slow perio destruction?
  70. Chlorhexidine gel inserted into the sulcus is what?
    Perio Chip
  71. Minocycline microspheres that are syringed?
  72. Where does the mineral content of subgingival calculus come from?
    Derived from Serum
  73. Where does the mineral content of supragingival calculus come from?
    Derived from Saliva
  74. Primary objective or most important thing to
    evaluate following perio therapy is?
    Making sure the inflammation has not returned
  75. Endotoxins
    • Potent destructive substance 
    • Found in the outer cell walls of gram-negative bacteria 
    • Released when cell dies
  76. Actinobacillus actinomycetemcomitans
    • Associated with aggressive disease 
    • Found in family members of persons with aggressive disease
  77. Tannerella forsythus (Bacteroides)
    • Found in deep periodontal pockets 
    • Assoc. with chronic periodontitis
  78. Porphyromonas gingivalis
    Primary organism associated with gingivitis and periodontitis
  79. What bacteria is associated with hormone changes like with pregnancy?
    Prevotella intermedia
  80. Which bacteria is mostly associated with ANUG and not with any other disease?
    • Treponema denticola 
    • A spirochete
  81. What is the main difference between gingivitis and periodontitis?
    • Gingivitis 
    • Reversible tissue damage 
    • Periodontitis 
    • Permanent tissue damage 
    • Loss of attachment
  82. Which immune cell is the first to arrive at the
    site of inflammation?
    PMN's (neutrphils)
  83. Name of a body chemical that mediates inflammation?
    • Cytokines (Interleukin-1)
    • Prostaglandins
  84. This immune cell can develop into a plasma cell.
    B lymphocyte
  85. What is the body process that causes immune cells to come to the site of a bacterial invasion?
  86. What is the complement system?
    • Series of proteins in the blood 
    • Complement reacts in a cascading (chain reaction) way when stimulated by bacteria or other antigen.
  87. Prostaglandins
    • Powerful inflammatory mediators 
    • Associated with PAIN 
    • Main producer are the PMN’s & macrophages 
    • Increase vascular permeabilityà EDEMA 
    • Trigger osteoclastic activity 
    • Promote overproduction of matrix metalloprotein enzymes (MMP’s)
  88. What are MMP's and where do they come from?
    • Matrix metalloproteins
    • Major producers are neutrophils and fibroblasts 
    • Produced by many cells in response to bacterial endotoxins
  89. What is an active ingredient for desensitizing?
    Potassium nitrate
  90. Treatment Planning
    • Initial treatment (non-surgical)-phase I 
    • Reassessment**essential!!! 
    • Surgical phase (possible) – phase II 
    • Restorative therapy – phase III 
    • Maintenance – phase IV 
  91. Actisite
    Tetracycline fibers
  92. Atridox
    Doxycylcine gel syringed into sulcus
Card Set:
Perio Final
2013-07-31 05:52:36
final exam

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