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    Topic Dental Decks Part 2 2016 Periodontics Flaps and Grafts and Surgery Questions

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    Victor Fan

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    ee CeIn Card #1 (of 18) ‘Topic: Dental Decks Part ll 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery All of the following statements concorning an autogenous free gingival graft ‘are true EXCEPT one. Which one is the EXCEPTION? + It can be placed to prevent further recession +I can be used to eflectively widen the attached gingiva ‘It retains its own blood supply and is not dependent on the bed of recipient blood vessels ‘The greatest amount of shrinkage occurs within the first 6 weoks ‘Its also useful for covering monpathologic dehiscences and fenestrations PERIODONTICS eee ee eta Answer + Htrctais its own blood supply and is not dependent onthe bed of recipient blood vessels Asogeanis gingiva rts (FG) nen noe of ter cn bod supply an ae tcl dependent on tea ‘ecient Mo wesc Ia sme foesces, it can be weed to cour a ant safc with arow denain. The proces ys igh egies of sucess rls whe sed fr aceasig ihe wit af the ataebe apne The se gal gra tesedtherapeaticalyto widen the pogo ater ecenon has coed. Hany be sed ro event recenhor where th ban of png iv arow ado thin, elon conse. The fie saga ea is an autogenous graf of igiva tat is placa on a ible connective asc bo cll cn te ene) wit ily, boca rll aca eas ses [9 st ese dao om whieh healt ‘ste deals eon oi palatal arena tuberosity, The rat epblun uderzoes depuration aie ‘isplucedTacatsleughs he pti sessed i about a week yh hace etch and probe ton of surviving don ts ell In 2 mee the issb appears have lord at atrton st complted {asi 10% 16 wes, Tere required is proporiorl ete ick fe wa (he Kal hicks fe FOG 8 ip 1S wm Note Tos Fee anal rat eee sats ow he ialecommeetie sue ed. “Te proce mayor may aot lek sccesfl esl wh ned bt an coversg; theresa hy rite in ue csc. The rfl maybe ato cnet localized nano cess lls butt ep wide reenfons. A croollyposions! fp might be dine ss scored prcedie afer ree pngval pa wo cover meee 1 The ice gngial raf bso be deft to pei diision nd vsculay ota) 2. The fe sng raf ic ls xtc ele th coanective eae ra 5. Wea he ee peal gra is placed deel) onthe ae thas 1510 2 nes es siakage than when ‘ts paca ona comectne tsb bd 2 elaaeaton syste fr recession: Che I: arial one rceion dos texted to he meinen Ther oon of bone rv ‘Hate he nena ren Weaa be mao wide ‘Clas: gia ns econo extends oor been tbe macogngul nin, There it aless of bose or elmer ees. can be wide oO magna tae recon extend ar yond te macopingial anton. There ie bone and sof Tissue sine or mapostioing ote wot 1 Clas IV: surgi anc recon eae to or bead he macnn jaction. Thee in severe bac an ‘of nue loiter er severe woth pion In grerah the progotifcloes Land Is good oerctent wheres for lass cape, Cut V haa very poor propros. nly paral coverage cn bo BEC ag card #2 (of 18) ‘opie: Dental Decks Part Il 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery ‘Most root amputations involve the: + Mandibular first and second premolars + Maxillary first and second molars + Maxillary canines ‘+ Mandibular molars with buccal and lingual class If or II fureation involvements PERIODONTICS a eu In Answer + Maxillary first and second molars ‘Root amputation refers to the separation ofan individual oot from the erovm structure of the tooth, Burs and diamond stones are uilized to sever the crown and root prior to extraction by root tip forceps. At the completion of the root amputation, the remaiming apical area ofthe erown and furcation region ae recontonred similar to the shape ofa poatic so that maximl acess is provided. {or oral hygiene methods. Most root amputations involve the maxillary first and second molars (these teeth are commonly involved periodontal ste), Root amputations or hem sections almost ala’ result ireversible pulpal damage that demands endosontic therapy: Mealy, the endo is dene fist, which ensures patent comfort. Sometimes the eval forthe mamber of bony walls and for defost morphology (doth atd width aa) Defect morphology: 1 The dep and narrow defet iste most enable o regeneration. Many dire techniques and mater fais are salable wo tet attachment ose + If the ossous defect s wide and deep, andthe toth i of importance in the ach, regenerative torts shoul be considered. Compromised results may be expected compared tothe deep and narow defect +The potential enefit ot regeneration is minimal wih shallow efets, For beth narrow shallow an \welshallow defects consider ap deiement, pally poston fp with or without oseons resection Malntenmce therapy may be watered ‘Number of remaining bony walls The preter the mavber of remaining wal, the grestr the preditbilty of regencration A space making defect creates a favorable station in regeneration, 1Walldsfst—2Walldelect Wall defect Wo 2 Treatment: A barier membrane and bone graf ae used together or independ to sailize the Hod clot and maintain space dng healing The GTR pocedhre allows forth selective repopulation of periodontal defect: Bone and PDL cells ae selectively permed to grow In am area sepurte) fom eter tisner by a barre, or membrane. The ‘nonabsorbable mater st often wed is expanded polytrafuarethyiene(e-PTFE, of Goxe- Tex") and the ‘most often used absrtube barets ee often polymrs of payete aid or ace butletate. Bone grate ‘rested om the sme stdividol ar aed auograRs. Common donor ses inl the antevor mnie, ‘aviary betes an msondular rus, Allogratis and xenograft bone sliminates doer site morbidity. Undecaltidfteen- died bone allografts (FDBA), decalcified feeze-red bone allografts (DFDBA), and bovine xenograft (BioOss) ate common examples od ene ae Card # 11 (of 18) ‘Topic: Dental Decks Part l 2016 - Periodontics - Flaps/Grafts/Surgery flaps/graftsisurgery ‘The primary reason for the failure of a free gingival autograft is: * Disruption of the vascular supply before engraftment + The formation of sear tissue pio caese7 asta PERIODONTICS De ee eee UT answer + Disruption of the vascular supply before engraftment "34 Ths second most common rasan is infection ‘Techniques used to inerease the width of attached gingiva include the fee gingival autograt, free connective tise atgraf and the apically pestioned lp, These echnigues ate used for widening the attached gingiva peal 1 the aea of recession. Techniques used for gingival augmentation eoromal 10 the recession (root coverage) incide the free gingival and eannectve tissue autograt, 36 well as peilcle autografts laterally and coronally positioned aps), the sibeptheial connective tissue graft (Langer, and guided tissue regeneration. Free gingival autografts involve taking a section of attached gingiva from another atea ofthe mouth (sally the hard palate or an edenmuous exon) and sururing to the recipient sie, The secessGepende ‘on tho graft being immobilized atthe recipient site. Free gingival grafls ae wie to create a widened ‘00e of keratnized attached gingiva with the possibility of pining rast coverage aswell The dificalty Sn getting compete root coverage isi the Et that as avascular grate placed over a rot sree also devoid ofa bla spy. Nate: The ideal thickness or this graft is Ut 1.5 nm, The frve connective tissue autograft cchnigue is based onthe et thatthe connective tissue earries the genetic message fr the overlying epithelium to become kertinized. Therefore, only eannective tse from kersinized zone ean be wie 3s graf. The advantage of this technique i th the donor tse js obtained fom the undersurface ofthe palatal lp, which s sutured backin primary closure; therefore, healing is by frst intention. ‘The apically displaced Map: ths technique wses the apically positioned fap either partial thickness or full-thickness, to increase the zone of ketatinized gingiva Remember: Positioned Maps (ie, laterally positioned Nap, eoronally positioned Dap, and apically positioned fap are procedures in which the coronal portion of the fap is elevated from an are adjacent to the recipient site, and freed, but the base of the flap is sil comecte to the underlying donor site tissue. In these procedures, the vascular supply to the flap is maintained, as opposed to the free singival rat Important: There is ne necrotic slough of positioned aps because these lps take thelr vaselar supply with them. Ina free gingival graft, the healing involves revaseularizaton of the graft: The top layers of the graft are the lst tobe revascuarized therefore the epithelium des ff (degeneration) producing the necrtic slough, Brag ‘cara # 12 (of 18) ‘Topic: Dental Decks Part Il 2016 - Periodonties - Flaps/Gratts/surgery flaps/grafts/surgery Avariation of the laterally positioned flap is called: +A coronally positioned flap ‘A modified Widman flap +A double papilla fap + A free gingival flap PERIODONTICS Beer eke ag answer +A double papilla flap. Laterally (horizontally) displaced flap: this technique was the standard technique for ‘many years and is still indicated in some cases. The laterally positioned flap can be used to cover isolated, denuded roots that have adequate donor tissue laterally and vestibular depth, Sliding partial-thickness grafts from neighboring edentulous areas (pedicle grafts) can be used to estore attached gingiva on teeth adjacent to edentulous spaces with denuded roots and a small, vestibular fornix, often complicated by tension from a frenum. The “double papilla flap” attempts to cover roots denuded by isolated gingival defects with a lap formed by joining the contiguous halves of the adjacent interdenta! popillae. Results with this technique are often poor because blood supply is impaired by suturing the two flaps over the root surfuee. Indications include: + Trauma from incorrect toothbrushing (gingival recession) + Covering the exposed root surface with gingiva also helps fo reduce or eliminate the problem of hypersensitivity |. Deep periodontal poekets are often treated by flap surgery. These cases Notes) will often result in reduced pocket depth by formation of a long junction: elium (soft tissue reattachment), even if there is no change in the position of the gingival margins. The best indicator of suceess of periodontal flap procedure is postoper- ive maintenance and plaque control by the patient 3. One month after flap surgery, a fully epithetialized gingival creviee with a welldefined epithelial attachment is present, Functional arrangement of supracrestal fibers i initiated, end Card #13 (ot 18) ‘Topic: Dental Decks Part ll 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery All corners of a periodontal flap should be: + Sharp + Rounded + It doesn't matter whether the comers of a periodontal flap are sharp or rounded PERIODONTICS ee ag Answer + Rounded A.periodontal apis section of gicgiva andl mucosa suzy sept frome undeving tues to provide ‘sity of sed aecoss othe Sone ad oot sue The Ba alls he gingiva tobe dsploed to a diene lock tin x patents wth mteoggialvelvemert Periodontal faps ca bs easitid based ox the folowing: " Booeexpesire af lp seflesen: fehikaesscacepenescl ps al oft aves, ssn the peste are elle o expo the ‘djing aheolarbene. Darta-hckness (msosl aps: ony he eit ad a ayer ofthe urdrying conectve se ae fellected. Abo calle splitikow lp ‘Based o Mp scones afer sae: “ onepced fae we tel reac we sud tt nil poston. “espace fas: re laced apc, cxoellyo ten to he erga pesto, + Ras ox managenest of he pill convents! a nerds rapa spl beset he eat pot of the wo appeninating ee veal rete buccal ad Koes! Usp. papilla preservation fa iscorortes the ete papi neo he Naps. seas perform who teh ave ape catact al vt fer wber teeth ae to close ieroinally give mre eshte tel thas conenton] Maps whex itis pole perfoma “The Four asl Roles For Fy Desi: 1. The base of the Map shouldbe wider ha the tee agin order fo lod seen Mood ereletion toe te margin f te fp, 2 The mo a the lean st not be pice over sry defect the ane prevent debyed healing 5. aasioes tat traverse bony emlnenee (cece) sold e welded. Te wucosa covenag Sony emikenes ‘sie aed Releg slow ae may pest isan gly se freien. 5 Alleore ofthe Ap soul be unde, Sta ote wl delay eaing important Heal soil ike place witout complication hase surgi principles are fll * leasioos mace asso hat harbor uncontrolled Saletion ray cate rp sored ofthe inecon. Do tot do this Most peiodontl supa poeedurcs are perfomnod only after aatvafective tery has bees completed SEC ag ‘card #14 (of 18) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Flaps/Gratts/surgery flaps/grafts/surgery Which of the following has a relatively high degree of predictabi “workhorse” of periodontal therapy? * Coronally displaced (positioned) flap * Laterally displaced (positioned) lap * Double papilla lap + Apically displaced (positioned) lap PERIODONTICS ee na Answer ++ Apically displaced (positioned) flap An apclly displace (positions) ap (APF) i fille orpanabthicknes, mocoperosteal Mp. tas relatively high dere of preictabilty and ina “workhorse” of peradontsl therapy The objective ofthis ype of ap ist surgically eliminate degp pockets by postioning the ap apically wheeling the keotnined gingiva. Adio, surgical cess is and for stove ge, treatment of nrabony (tabony) poskts, and rot paring. 1 the couse ofthis ap supery, after gaining aceess to the underying osseous tise and performing the reqsred therapy the Axpt stre mplie nf more apa lve, sometimes ‘xposingthe alveolar bone marain, When his is doe tional tached gingiva granaltes om the periodontal Igament and covers the barely expose hone. This aiiena fase joins the aniclly positioned tached gingiva to form a trondor 2000 of gingiva. Note: On the palatal terface ef mailer molars, you neni the lp margin to the proper Sagi droge procedure. Palatal Maps cannot be spicillyo¢ coronlly positioned (Mey camt be displaced Extnve thee is no mncogingival junction). Indications for APF nso: * Moderate o deep pockets + Rucation involved teeth + Grom lengtesing ‘An APF s contraindicated if pation is at sk for oot cans. Eyoosiv oo surfaces a often exposed afer performing sn mpialy postions fap APFs ae slo cntaindicted where tooth xpos would be unesthtis Remember: For al micogingival procedure, blood supply isthe most significant concer, ‘Blomodiieation ofthe root mares the oot surface o the poset can bs iret o improve ts chances of accepting the new attachment of gingival tists. Several substances have been proposed fo this purpose, chiding ee ai, fbonocin, etrasseime and EDTA. Othe gems {sed ince gow fctors tie, PDGF, IGE, BEG, BMP, nd TGP) and one enamel mains protein derivative obiained from developing porcine teh (rade name i Emdogai®) ee na Card # 15 (ot 18) ‘Topic: Dental Decks Part ll 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery A free mucosal autograft (subepitheli free gingival graft in that the transplant connective tissue graft) differs from a a free mucosal graft is: + Connective tissue with an epithelial covering + Connective tissue without an epithelial eovering + Epithelial tissue with its own blood supply + Epithelial tissue without its own blood supply PERIODONTICS Ce ee eee ag Answer + Connective tise without an epithelial avering ‘A te mucasl autora (aubepabelial conceive issue graft [CT differs fora fee gingival graft in ‘hat the tanspln: ina free mucosal graf is connective ssve without an epithelial covering Epithelial differentiation i induced by the undetying connective tease, so thal fee grafs of dense ceomneesve issue taken fom herainized areas ost i the formation of Keratnized Hsu even hen trancplanted fo nonkeratinzed zones, This procedure is somerwhat more dificult than free gingival trafting. This procedure is often wed on canines whete thee is ittlekcratinized gingiva to ercate @ thane of gingvasike tise. Note: CTG gives better ot coverage an beter esthetic rel in ters of color match to adacent tissue than FG. Remember: During healing, the epthebum of fce gingival rafts depencrotes (necrotic slough), and re-pitheiaization occurs by probferation of epithelial cells from adjacent tssue an! surviving basal calls of the graft tissue "Note: Fre gingival grafts are often usedin conjunction with a frenectomy to prevent reformation of high ‘ena atactiments Hesling ater lap sarge: “Tuamediatey afer suturing (yp 4024 hours): a connection between the Map and the tot or bone sutfice i extablished by a blood elt, +10 3 daysaftr surgery the space between the fp andthe tot or bone thinner, and pitti cells migrate ove te borer ofthe ap, usally contacting the tooth at ths ime: + Teck ale surgery: an epithelial etachmest tthe roothas been establish by eas of heailesno ‘somes and a basal Janina. The Blood clot i replaced by aramulation tissue derived fom the gingival ‘conacctive tissue, the bone marrow, and the periodontal game + 2 meek aftr singery: collagen fers begin fo appear paral to dhe tocth surface. Union of the Map ‘a the toot esl weak because of the presence of inmate collagen fibers. “A meonth after surgery ally eitlolied gingivl crevice witha well define epithe attachment Ss present Functional arangement of supracestal bers sinated. ‘Note: Fallthickness flaps, which denude the hon, result ina superficial bone necrosis at Ito 3 days osteoclastic resorption follows and reaches a peak a 196 days, declining theater This osu ina lost of bone of about | mm; bone loss greater fhe bone is thin. Important A spt thickness tap resus less bone Tor than fl hicks Aap. a iis a Card # 16 (of 18) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery Which ofthe following mucogingival surgical techniques is indicated in areas of narrow gingival recession adjacent to a wide band of attached gingiva that can bbe used as a donor site? + Free gingival autograft * Double papilla lap + Modified Widman flap + Laterally displaced (positioned) fap PERIODONTICS a i ag Answer + Lateraly displace (positioned) nap Fupar casa) anil aps wheat api uno a ud ig oi o ioe laps wash ar pac! acl cry or cl soa potion otal and paris apne plat, bt t,he sacl ma sly ‘spring bones srabing the och porns te gigs we male Hon {ob lps cack nano becin oftesivee cance ag 1. Apia pce fips sth nga aang ofprerins theosteporon a hero Ace) walla sttemcy tno staked pga Tito: eps econ dob ogtive flinitg th pockst ed inch wh of ti aah uve a 2 aterly Spite fap acini cra or preven ees viding rot conrage ad creng er bad f igi Km be lish anes eevee wc he ae a rae $e ig eal ppl atic he pal by paleo iag cnt sen inte too ery Peed ape brite sd vera inne Tlevizatl incon: adc anh margin of gia in a es or advil tion tera we fcen: o's dase es te in aan deed am et oe ‘becenoftncbone, Torin pant nb nga ein’ y water tea apa placed {C210 em et pl cnn ttle acre othe bo poche or med {tbe maditee Wirmn p(s than 02 man opal oe pal nt). Al ale eit incom sure te il tx the recon of he anon ip) 8 he eer bee ince (eontsbor sinsree davies fom tha of te ghetto "revel incinn ls enh ened cer) ade nebo the pocket the ct of teleer To cohaienol opr bord eniatrinpsnt cna eae aed he ‘stander oft ian an gal are htc hte al ho pcket ‘ves con cpt andthe cmon toe bere *oterdetal acon (dnc hae spate i af gingiva om he th hose thre nssoas allow tho removal ofthe gingiva around the toch andvisuaiation of te alvok bone Yertical or oblique releasing inesions can be used on ove o both ends ofthe horizontal nso, epandngon he parpos of th ap Tey sree he flap so be postioned palo erally ao ‘extend beyond the mucogiagival ite, reaching the lvclar coat allow forte leas of he Mao be ‘placed. Note Imo veil isision are mae, the Hpi cll as envelope ap, Fe oa Card #17 (of 18) ‘Topic: Dental Decks Part ll 2016 - Periodontics - Flaps/Grafts/Surgery flaps/grafts/surgery Positive and negative architecture refer to the relative position of interdental bone to radicular bone. The architecture is said to be “positive” if the radicular bone (facial and lingual) is to the interdental bone. apical coronal the same height + None of the above PERIODONTICS eee Answer pleat Mombologielly descriptive lam hese tas ll ele fa prcenceli tan of del esses Sm): ‘Positive aul negative architects sfer the seaive poston ofierdental boos to radicular Hone The architected be “postive ifthe race bo fea alin spc oe ited bors. Ts ‘ove ti ohne “negative” erchioctre te ede bore e moe ape an the racial bore. Flat sscutce the edition of theatre one othe su height steadier sone Noe: Osseots fmm ‘considered tb "ideal" wha ihe booe is conssetly more ora on he inerproanal sees into te ‘Gena inal suttoos. Thee form of hears bone bass wend gh, it dal cued slopes ere order 3eas. Process nd to erect ements defects tave een asf into arp Osteplast: eles fo eka the ote wiles eapoviegkabnpoeting one + Ostctamy (orescoecony) incisesthe real oftaeparing Sone oot: sigparrg Sones the bane at nd Shares fers ofthe PDL wert) *** Oncor ofthe prosedaves may be recent prodace th deed et Flowing oteciomy, peaks of ore ically rain the faa and irgealysel ine anos ofthe et (idow's pes} I ites aera removed, peiodoctlpocke car ees Ostectony oa postive areece regres the ‘moval of th ineangle easier (widow's peaks), a¢ wel a some of te fa, hopin alata ad {eerprennal pve, The et eles ofsonee atten x he all x aga rot ures bua fepogrphy tat mor elsely resembles sea” tose Terms that eo the thorougbcss ofthe osc reshaping eshsigesineade: Definitive scons rsapin:impis at frercaconsesaping wonld ot inpove te veal eat * Conpromised once reslaprg-neaes se pale: al ae be cprove thet isch oes removal tht woaldbe diet othe oveal reat Note: The retsonhipYetween the deph a coigration ofthe ony lesa) to soot manghatagy andthe Mjgcent feck determines the exe tat hone and atachientf fennved using resection. The tctnigee of tetris beat plied to tients wiley oor ore lou (3) wil: rere ngioot as Bat Tavs bony defo with one o fa wal, Thee sallowstnmorrae ory defeccam be eecvsly managed leopard etetony.Insone sual poses i sncesvary to lat inlrradivelar bn eapoe Tis "sally resis in bre los of soli consequence Remember: The goal of esos crgy st elniate the Tony components of the pockets aud o crete n psitve bony architecture. While some bony defes cam De sliminaled by eiving boas llr sits er ciated yang bane aegeertion ocalen). ae USea cara # 18 (of 18), ‘opie: Dental Decks Part ll 2016 - Periodontics - FlapsiGrafts/Surgery flaps/grafts/surgery ‘The most common osseous defects are: + One-wall intrabony defects + Two-wallintrabony defects (osseous craters) * Threeswall intrabony defects * Through-and-through furcation defects yi 6307 ea PERIODONTICS Od eee ere a Answer + Two-wallintrabony defects (osseous eraters) ‘Morini bo ss i he moet common perme bone ks in pesiedonal seas. The bre itraluea in height, ba ths be mers romaasapponimacly prpecicalr othe tod sarace The newest a ial end Nngal ples are aed bu tc neces) an ea deus woutdthe m0 ‘Verte or angular defies re hose tht our nan oblige diet, leaving ahoiowedout wou is the bone alangside the ot tebe oe def eet pelos suraunding bows mest isiances angular dace have aeompanying niabony pido pokes maby pokes, heuer ahrays hive an undying ang eect Angular dfs ae casi ce the basso mumber of osseous malls Angular dees may ave oe 0 F| the malls Tastanber f walls ate apical pasion th dec ey he acter as Ut ts pele pe sw cae the en "Sombie seo fet se Impertanks Surin expesie steely sae Way 1 de {ormite the presence nd oafgration of vercaloseeus ses. Note 8% 0 BPS of davai of Ue base as to ake ple beer bac loss ea star shows om te 9. The eltve degre of ees of prinoal ove aati srepored ovary ily wie mumbo bony walls fthedeet(vasalraed osous size ara) and iver With De suze reo the oot agi wich the gal ‘simple. Thu nar wal angular delet wally yes heron success, a orale fet he ext best ad oe-nalos deft he let | Oc fing tenis ol materi ined oncom conga, logos nt ol bo, aoe Sete) peso ia eet bone, creed bate allogral (FDBA, which eundccalie), decal Feezosed “Ss banealogat (DFDBA), FDBA or DIDBA combined with atogeous bone 2 Root soon ise most common side elt of osseous aa. 5. Aallogral awl ales om ons hana (eo apd placed i att tune (oi) ‘{Raahecene fs for of te bea o nga ba only tn rot por ooo eg to aren ner hy sot ase ly. Tn thre etc was signal allan sacs deignat all yrical dete. {The onewal verted alo called a hemp, 7 Tomallatabony defects escous xr) ae best crested by ecatousing ofthe flan lingaa ‘alls ost naa ited vcs. Acerater sa sao haps fet fs oor Doe on so intndetaly. 9: Gingival rors at corer by ftgvepasy. Oseous crates re comets hy casous econo Gat count for about one-third (35.25) ofall ones Geet. boy fect. The erst a ter ee Bee od card # 1 (of 21) ‘opie: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease ‘Wolinelia recta was formerly known as: + Bacteroides melaninogenicus + Campylobacter curvis + Campylobacter rectus + Bacteroides intermedius PERIODONTICS Bae answer + Campylobacter rectus ‘The purpose of this card is to hopefully elear up any confusion on the recent reclas fications of a number of periodontal pathogens. The bacteria have stayed the same, but the names have changed. Recent Reclassification of Periodontal Pathogens: vier Chinn SanaRaT Tac Rei eloai See ed es aiden Bases es Seamed etal oleae sisson Lee RU lace eu Eo Card # 2 (oF 21) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease ‘Smokers demonstrate more orange and red microbial complexes. ‘Smokers have an increase in Tannerella forsythia levels. + Both statements are true + Both statements are false ‘The first statement is true, the second is false The first statement is false, the second is true PERIODONTICS + Both statements are true ‘Mos invesiatons that evaluated the eect of smoking on nonsurgial therapy have demonstrated less redeeion in probing doth and small guns in utichment eves in smokers compare with mons, Depending on which eins! parameters ate use to assess peiodomisl disease, smokers ate 2.610 6 times more likely o develop periodontal dseae than nossmoker Important points Stoking is one ofthe most signieant sk factors curry available w pedi the development and progression of periadons Smokers: * Demensrate mor orange and ed microbial complenes “Have am intense in Tarmerellafsyhi levels “Have deprestedimmane ssn, smoking exe significant ogee fet on the protstv elem ‘ofthe immune syst. Stas show that smoking Bot only dampens tho response af host defense els, such as neurephis but als leads io inereased teense of ssuo-esinetive enzymes. 1. Mest systemic dicases nd conions tht may fst peiodanal diseases generally shor host, ‘Notes barterand bos: defense mechanisms Although many conions case gingival nMamation znd COS ees, wot all people develop peiodoaal dines. Crain factors put iva higher sk SSS than oiers. Those fecors ar called “Risk Factors", They donot case the dees by themssves bur thoy ean make dhe progression of the disease wore 2. Osteoporosis (loss of tone density) hss doch asseclsted with periodontal isssse in post- ‘menorsusal women. Theo is some evidence thi smn eaten fbr oscoporss, such 3s S- ‘phosphonstes, may duce bone ss, inclaing the bony troctres tht suppor the tet, However, bisphosphonates at also assisted wih bone neetoss a he Jans especialy the TV foams 3-Autoimmune conditions (6¢..Cobn disess,eumstoid ants, ips erythematosus, CREST. ‘yaukome) have boen associate wis higher ncdence of peiodonial disease. £1 Smolka taiseco sxe has sen ssocited wth oral eshoplakis an carnora ovtever. m0 gencrlzed effects on pexedonal dca progression seem w occ eer ths localized sch. ‘nt oss and rceston athe sie of tbo product semen 5, Patients receiving radiation therapy chow peviodontl attachment lss and toth Joss 0 be ‘arcater onthe radaced side compared with the oa inadated side. Periodontal hea shouldbe established prorto beginning radiction theropy. Periodontics - Gingivitis/Periodontal Disease card #3 (of 21) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal/disease Mediators produced as a part of the host response that contribute to tissue all of the following EXCEPT one. Which one is the EXCEI + Free radicals + Proteinases + Prostaglandins + Cytokines: nde tbe? Dea PERIODONTICS Periodontics - Gingivitis/Periodontal Disease Answer + Free radicals ‘Matrix metalloproteinases (IMPs) are considered to be primary proteinases involved in periodontal tissue destruction by degradation of extracellular matrix molecules. MMPS ate a family of proteolytic enzymes found in neutrophils, macrophages, fibroblasts, epithelial cells osteoblasts, and osteoclasts that degrade extracellular matrix molecules, such as collagen, gel- atin, and elastin, MMP-8 and MMP-t are both collagensses; MMP-8 is released by infil- trating neutrophils, whereas MMP-1 is expressed by resident cells, including fibroblasts, ‘monoeytes/macrophages, and epithelial cells. Note: MMPs are also precuced bay periodontal pathogens P. gingivalis and A. aetinomycetemeomitans, Cytokines are important signaling molecules released fiom cells. Interleukin] (IL-1), IL-8, and tumor necrosis factor alpha (TNFa), appear to have a central role in periodontal tissue destruction. The properties of these cytokines that relate to tissue destruction involve stimulation of bone resorption and induction of tissue-degrading proteinases. IL-1 is a potent stimulant of osteoclast proliferation (bane resorption), differentiation, and activation. IL-8 is {important in atracting inflammatory cells, and TNFa has similar effects as IL-1 bot is much Jess potent thau IL-1. Iis also important i activating moerophages. Note: Monocytes/macrophages ate very important in regulating the immune response through the release of cytokines, Macrophages are recruited to the area of inflammation and are activated (by binding to LPS) to produce prostaglandins (c.., prosiaglandin Es, PGE). Prostaglandins are biochemically synthesized from the fatty acid, arachidonic acid of cells membranes in response to cy- clooxygeneses (COX-1 and COX-2). Cox-2 is upregulated by IL-1, TNF, and bocterial LPS, and it appears to be responsible for generating the prostaglandin (PGE,) that is associated with inflammation. Note: The primary cells responsible for PGE production in the periodontium are macrophages and fibroblasts. Induetion of MMPs and osteoclastic bone resorption is induced by PGE. Fe ee eco card #4 (of 21) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal/disease Inflammation, bleeding on probing, and pocket depths are the most important diagnostic aids or signs of gingival or periodontal disease. ‘The presence or absence of stippling is not diagnostic. + Both statements are true «= Both statements are false The first statement is true, the second is false The first statement is false, the second is true PERIODONTICS Periodontics - Gingivitis/Periodontal Disease answer + Both statements are true Jntaxsmtion, bleeding on probing, aad posketdepls are the most portant diagposte as or signs of singival or perodomal disease. Giaaiva may or Ray not bo stipled Whatber healthy oF invlamed. The presence or absence of tipping sna diagnostic. Clinica eriteria wed for diagnosing gingvitit * Color: aormalgivgival cole ranges fora cor pink to vain stages of pigmentation ‘Erythema tefers wo an inet rd car Probably the moat comnom solr change noted wih atonal disease is eyanoss (uishpurpe hue) + Contour: besa rnge of norte This isin uenced by misig eth, positon of wet, et. Papila sboald ‘le incepronial specs. Gingival mexpns oud be scalloped i fem. + Tone (or Consistney tbe nocmaleovsstency ofthe gingival tissue should be relent an bot in ‘ature frm he ee gingival groove apical tote mucopingival seion Texture, sipplingof te atached singivn (he socalled orange ped appearince) may of may not be preset. 1 Sle: the besity gingival sex shouldbe wel contre to the uiderlying osseous ashitece with the foe gingival margin being of rach thiatss wallow fora "knife edge” thickness ate demopigiva magia + Plague, calcul: the best way teva the ant a dstsbation of plage i by the wilization of disclosing solution. Remember: Without bacterial lagu, there would be no gigiv Tmportant: The impact of nuttin on prion disease - here as no autional deicienies that by themasves can ease ging vis or periodontitis However, nioral deficiencies eam affect the eonliion ofthe peniodaatin. + Vitamin A deficiency: vitamin A may play on imporem role in roecting aginst miro nveon by ‘imiaiing epithelial iter. A etctensy cam enput the Brier fuetin of epithelia cel + Vitamin D deficiency: vt D is eset fo the absorption of cli rom the Gl tata fr the ‘alcium-posphous balance, No huanan studies demnonstate a relaioaship between vitamin D deficiency and periodoataldscase Note: Vitamin D defcieasy cau conbute wo osteoporosis of alveolar boa in poume dogs 2 Vital Recomplex decency: vitamin B complex icles thiamin, sioftavin, alain, pysidoxin, ‘oss, fle seid, apd coblamin, DeSciency of hes asa group may covtbute 0 gingivitis + Vitamin C detcleney: severe defciecy of viamia Cress ia sary. Bleeding, svollea pina, and Ivovened teeth oe common eats of sr Bee ee card # 8 (of 21) ‘opie: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease In a clinically healthy periodontium, the microbial flora is largely composed of: + Gram-negative ebligate mieroorganistns + Gram-negative facultative microorganisms + Gram-positive obligate microorganisms + Gram-positive fucultative microonganisms PERIODONTICS Periodontics - Gingivitis/Periodontal Disease Answer + Gram-positive facultative microorganisms ‘The gingival crevice ators bers int eal and dnc, [a lincally healt petiodtam, the micrbih fora agsly cmpoaed of gram-penve facultative coce and roc, penal speci of genera such as ‘Atinongce se Streplocctns Gren-agstine species and spc fre alo may be il hey se = ‘Sealy prevalent or over fa mc eller aber he desclopment of gts occur in parallel wth 4 weniendoin incense manors bacteria pent in ‘lage A distin’ Shi athe basal conpostoa ofthe plage ao cee, wih increasing proportions of Fame negative anaerbes. Note: Te host espns opaque bats is fundancialy a lammatry respons Despie a emarte dvciy of bara und in th eso icc, only few species have ban asc ated with priate inches *orkgronces sight ‘+ Febacterian mele ‘Taner ory + Actnokaeis artnonystemsomians ) {pvt otrosia + Peposuepossces 8 + Cenpylmactar ret ‘Treponema detent *eeereltscorodens Important: Dacrsses inte poalene al mabers oF gags, Torey, aT demclasce asec ith sicerfl lin aeotnet Of dee Netspeife Plaque Hypottes: csins tat penal dase est mn the “elaboration of roo poe {an bythe etre plage loli tis pnt compet ented of pertentl acme pes ‘an conzel fhe amow of plague accumsan. This hype comalieed by te fining te some pts ‘wine plague have severe psoas ‘Specie Plague Hypothest ihe never aypothess tats tht aly era plaque is pagel,ad is pogeiity depends cm tie presence of o increse fa spel miertorgnime, area le onganized in ota layer called “Biofilm” Tas agar the bons let wnbed he ere pathogen types of hts hates. Ts cones pedis ta plague hate spesie Lover pathogens ress in a parodental disease bess these ors Produce substance ha mast he deseo Fat suse. Notes Acexpance fs hypoihesi war pared By ‘he recgnison ofA acnonycelemcomtan a patogen in loealied aggresive periodonti |The red complex of acti ia groapof baste tt ha ow deni ia severe periodontist ‘Notes conse of treponem deco, nner fay, and Popyomenae gingival 1 Aeimebaclssctacnncetecomitns abe grees compe ocean sis ih ‘agree peiodanit Periodontics - Gingivitis/Periodontal Disease Card # 6 (of 21) ‘Topic: Dental Decks Part ll 2016 - Perlodonties - Gingivitis/Periodontal Disease gingivitis/periodontal disease Endotoxins are the lipopolysaccharide component of the cell wall of: + Gram-positive bacteria + Gram-negative bacteria + Both gram-positive and gram-negative bacteria + Neither gram-positive and gram-negative bacteria PERIODONTICS Fa eee Ma Dec! Answer + Gram-negative bacteria “The cel wall of gram-negative bacteria consists ofa lipopolysaccharie (LPS) has, also known ss endotoxin, that has significant pathogens potential. Typically, LPS-containing gram-negative cell wall exacts ae cape of promoting bone resorption, inhibiting osteogenesis chemotaxis of oui, and other events astoeated with ative patiodontis, Important facts: ‘Free endotoxin is present in deta plague an ina gingiva + Plague accumulation has direct effect on the severity of pinaivitis| + Plaguetsctria produce enzymes (hyaluronidase collagenase, chondo rasa and proteases) hat may initiate periodontal disease 1. Collagenase (ich is produced by Bacteroides spacis) catalyzes the degradation (hydrolysis) f collagen. 2 Hyaluroniase (which is produced by Sweptocoeeus mitans and salivarits) and chondroitin slFstase (sich is produced by Diphtheroids) amy lead to the desiuction of the amorphous ground substance. + Antibodies or immunoglobulins ae produced by plasma cells in response to oral octeria or their by-produets. The most numerous are HgG, which act io neutaze bacterial toxins by cahancingphogoovtosis + The most likely source of bacteria found in diseased periodontal tissue plague + The ikelinod tat bacteria endotoxins play a major role in gingival inflammation is evidenced by the following 1.Areduetion in inflammation bythe removal of pagus, 2. Aedueton of the in lsmory sate wth antibiotic weatment sulfa, subgingival Important: Gingivitis is more common than periodontitis. Gingivitis affects the gingival tissue only. Periodontitis affects the gingival tissue and the tachment apparatus (bone comentum and PDL), Deen rtd cara #7 (of 21) ‘Tople: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease Which of the following clinical signs and symptoms is characteristic of necrotizing ulcerative gingivitis (NUG)? + Minimal bleeding + “punched-out” papilise + Painless + Periodontal pocket formation PERIODONTICS eee eI eau Answer +*punched-out” papillae Two forms of necrotizing ulcerative periodontal diseases are necrotizing ulcerative gine givitis (NUG) and necrotizing ulcerative periodontitis (NUP). These conditions represent acute forms of periodontal destruction typically associated with some form of hast com- promise. ‘The essential components of NUG are: * Interdental gingival necrosis: often described as “punched-out” papillae = Pain * Bleeding ** Variable features include a fetid ors (offensive odor), lymphadenopathy, fever, and malaise. Predominant organisms associated with NUG include P. intermedia, Fusobacterium species, and spirochetal microorganisms. Note: EM stucies of NUG reveal a zone of tissue infiltration of spirochetal microorganisms in advanee of the region of tissue necrosis. NUG is usually associated with predisposing host factors, ineluding stress, smoking, immunosuppression (as seen with HIV infection), and malnutrition, [NUP is distinguished from NUG by the loss of elinieal attaettment and bone in affected sites, but the elinical presentation and etiologic factors are similar to that of NUG in the absence of systemic disease, In the presence of systemic immunosuppression, exempli- fied by HIV infection, NUP may result in rapid andl extensive necrosis to the tissues and ‘underlying alveolar bone. ‘The treatment of NUG or NUP includes debridement, hydrogen peroxide (or eblorkex- {dine) rinses, and antibiote therapy (Pen. V) if there is systemic involvement (manifested by fever, malaise, and lymphadenopathy). Important: Patients with HIV-associated NUG require gentle debridement and antimicrobial rinses. Pee ee Net ur ec Card # 8 (of 21) ‘Topic: Dental Decks Part Il 2016 - Pertodonties - Gingivitis/Periodontal Disease gingivitis/periodontal disease In a healthy sulews, which of the baeteria below are most abundant? + Actinobacillus actinomycetemeomitans and tanerel Zorsythus + Streplococeus and actinomyces species ‘+ Treponema and eapnocytophaga species + Provotella intermedia and porphyromonas gingivalis cht 6207 atta PERIODONTICS eC Oran ace! Answer + Streptococcus and actinomyces species *** Gram-positive cocei (Streptococci) and filamentous bacteria (Actinomyces) are ‘most abundant in a healthy sulcus. Normal inhabitants of the oral cavity: Gram-negative: #Veillonella * Corynebacterium + Actinomyces Campylobacter + Peptostreptocoveus + Fusobacterium + Lactobacillus + Eikenella ‘** Viridans streptococci consist ofa variety of alpla-hemolytic streptococci, includ- ing S. salivarins, mutans, sanguis, and mitis, all eommon oral flora, Important information 1, The oral cavity is usually sterile at birth, Microorganisms appear about 10-12 hours after birth 2. After | year, the following bacteria are present: + Streptococei - S. salivarius is most abundant ~ S. mutans and sanguis do not appear until teeth are present + Actinomyces + Fusobacterium 0 By the age of 45, the oral flora resembles that of an adult Periodontics - Gingivitis/Periodontal Disease card #9 (of 21) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease Early microbiologic studies of localized aggressive periodontitis (LAP) provided clear evidence of a strong association between disease and a unique bacteriat microbiota dominated by: + Tannerella forsythia + Prevotella intermedia + Porphyromonas gingivalis * Actinobacillus aetinomyeetemcomitans (aa) PERIODONTICS eS Ca uo ‘Answer + Actinobacillus actinomyeetemcomitans (aa) - also called aggrogatibacter actinomyceterncomitans Important: The new chiaton system of 1989 fer pericdnts iste descriptive znd not 2s tempor as wat the previous eysem. The terms a, juvenile, edly one, and propaberal have Deen replace with ‘rious fos of chronic end aggresive disse ‘The majority of patients with ehrnicperiodontis se sucesflly maasged with convent treataent regimens Howevr ssl peoportion of petits donot respond fo retmeat and demonstrate cation clinical poriodentat destruction. Thess ind dls ae flere to a: “etractary perodontis patients” [a ‘chronic pelodontite, the bacteria mort oft casted at high levels isle pingivalie, . fori Pislemeda Cros, ,comodens, F nucleatum, A. estaneyestemeonaiens (A), P mato, and Trp fend Enbacicum spotis. Dette levels of P gingival, F infermodie,T.fosythin,C. rectus end ‘A. estinomnyecteccomitens (Ma) are axsocieted with dsssse progression ead their elimtrtion by theepy is ‘soe wilbimproved hcl spon Note: Recess hve doen evxiaton beeen ebronic retiodcoitis an vir mictoogensms of the hepesvins groap most notably Epsin-Bir viru and human {jlomegatovirws The preseace ofthese subgingival viruses is ssocatd with patie hace po ges, inhoding pogivals, forthe, P itermaia, nT. deaticoa A primary chcntrnc of aggressive peat tat deems i fr cone eres i the rapa [progression of stachnen an tune ss thet evident. Agaesive pridomiis my be localized er genera {ned The esse for of heaved garessveperodoris as ily eared oe “priodonions” sad thea 1 "Toalized jvenle periodontitis” (LIP), Localized aggressive peiodonits (LAP) the new easiffation osgnatit place LIP. LAP is defined by sever dsingisingchameteriies- onset cand he ine of pet, aggresive pico {al desincton leads exclsivel tothe inciaone snd Ft molars, an fri ptier of eccrene ‘ais thedomimunt bacterin LAP, othe minooreniss that have ben sscited wit LAPinclde P ging vals FE. conodess, C.recns, Fuses, Ballas capil, Eubscterium baehy and Cepmoeytohage species tnspicehetes, Important: The one oustanding negate features therebtvesbseneofloel Hts pq) {oexphin the rove periodontal destuction Hh is present, Generazed aggressive pions (GAP) is diferencia from the lovin form by the exert of nv ‘me svound most of the pormanen eth, nd it ie considered to inch rpiy progresingpeiodoni athnte wih GAP ffequenly have subgingival gram-negetive rod, inciudiag P.gngislig and exit ‘suppressed scuwophilchemtess Note: Aggressive priodopiss considered gered wher the ate beet Toss tects test 3 permsncat cet ee han the Fst mols ead incor. Be aie Card # 10 (of 21) ‘Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease Diseases that present clinically as desquamative gingivitis inelude all of the following EXCEPT one. Which one is the EXCEPTION? * Lichen planus + Pemphigoid + Pemphigus vulgaris + Leukemia + Chronie ulcerative stomatitis + Lupus erythematosus PERIODONTICS Periodontics - Gingivitis/Periodontal Disease Answer vakemia ‘The following diseases also present as desquamative gingivitis: linear IaA disease, dermatitis hherpetitorm, and erytheme avaliforme Desquanatve gingivitis (DG) is only a elinial term that deseribes a peculiar lineal picture. This ‘erm isnot a diagnosis, nd once i is rendered, a series of Iaboraiory procedures should be used 10 amrive ata final diagnosis. [is important to be aware of this rare clinical entity s0 as o distinguish desquamative gingivitis om plaque induced gingivitis, which an extremely eomnmon eoudiion, casly recognized, sn treated daily by the dental practitioner, DG is characterized by Hery red, gzed, airophic or eroded-looking gingiva. There is loss of stippling and the gingiva may desquamate easly with minimal trauma. As opposed to plague- indeed gingivitis, DG is more common in middle-aged t elderly females, is pain, predominantly affects the buccaliaiel gingiva frequently spaces the marpioal gingiva but can involve the whole thickness ofthe attached gingiva, ad is elnical appearance i no significantly altered by traditional orl hygiene measures or conveotional periodontal therapy alone focus on dermatologic disease makes it imperative that clinicians develop dingnostic skills and good communication with physicians such a5 intemists and dermatologists. Because mleroscopie evaluation is the foundation for diagnosis of DG lesions, clinicians must take the responsibility to biopsy all esquamative lesions. ‘The majority of eases of DG are now known to be deo mucocutancous conditions, in particular lichen plamus, pemphigoid, and pemphigus. DG can be mistaken for ploque-induced ging!vitis, and this ean lead (o delayed diagnosis and inappropriate texxment of serious dermatolozical diseases such 28 pemphigoid or pemphigus, Remember: Histologically, where nooulerated areas ae found the stratified squamous epithelium is signifleanly atrophic. Rete pegs are shor or absent. Inflammatory cells, mainly plasma cells smay be found on the basal layer: Bee od card #11 (of 21) ‘opie: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease ‘Which of the following statements regarding periodontitis is incorrect? + Periodontitis does not always begin with gingivitis + Gingivitis and periodontitis canmot be induced without bacteria * There are no radiographic Features of gingivitis * The presence of pockets cannot be determined from radiographs * Chronic gingivitis does not always lead to periodontitis PERIODONTICS Pee ee Net ur ec Answer + Periodontitis does not always begin with gingivitis Peviodmii aways begins 2 gingiks, which cus de wo les acon, primi plagu, andthe {nlamatin then speeds from the sogiva and soft issues ito tbe underlying srucues. Gingivis md penodents cannot be induced withows Beers (paa). Peviodonitis is instammation that affecis and destroys the atschment ppt. The clinica extare thot ssunguises perodntts from gingivitis ithe presence of elinialy detectable attachment Iss. This en is accompanied by periodontal pocket formation and changes inthe dens snd height of subjeent alveolar ‘bone Important: The progress of periodontitis maybe ares with proper therapy. Remember: There ate na radiograph fstutes of gingvits. In perfodomtit,radhographlc changes are noted hich may Ince the folowing los of tmina dare “horizantl or versal bone resorgton “thickening (widening of the peniodontalHigsment space (Clinical signs ofinflammaton, such as changes in coor, contour, nd consistency and bleeding on probing. may not always be positive indicators of ongoing atichment less. However. the presence of eantinued bleeding en probing st sguental vss has proven to be 2 reliable incr ofthe presence of inlmumation snd the potntal for subsequent ataehment loss atthe bleeding sit 1-mportant: The presncsof pockets cannot be determined fom she evelsion of radiographs. NNotey) 2 Ginivis doesnot always lod to pericdontis. Chronic gngivis may est for ong pends ret thou advancing to periodontitis “SS 5 Severe periodontal disease may be sn inpsints with Chik Higashi sydome, Papillon Lefevre syndrome, Down syndtome (increased levels of Piguennedt have been found), Izy leukooye syndrome, and leoeye sheen dency (LAD) 41 Chronic stress appear to hve eflets onthe perodontia. I isk fictr for periodontl dbsease, while iteanno: cause the disease by il tean make the disease progres faster, The most nowble example is the documented relationship between sress and necrotizing ulcerative gingivitis SUG). 5 Hypophosphtisin, congener disease tealogy of Fall, and Fisenmenger gmdkome may beasicited wih incressed sever of erodoncl disease 6. Ingestion of heaey metas (ie, bismuth, led, and mercury) may suk in changes inthe periedoaism, ee dae eS Card #12 (of 21) Topic: Dental Decks Part Il 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease A.cuplike resorptive area at the erest of the alveolar bone is a radiographic finding of: + Gingivitis + Occlusal trauma * Barly periodontitis, + Acute necrotizing uleerative gingivitis, PERIODONTICS Periodontics - Gingivitis/Periodontal Disease Answer + Early periodontitis, Radiographic Changes in Peridontal Disease “Barly perlodontis seas of leslie erosion ofthe alveolar bone eres (bunting of the crs in ater for regions and a rocnding of the uncon between the ces and lamina dara i he postir regions). At- tachment foss0F 12 mm, + Movderateperiodontt: th dsirscion of alvolsr bone extends beyond early changes i the aveo- eres and may ined haccl or lngcal plas resorption, genralizad horizontal erosion or lealized ‘erica defects, aod posubesincl evidence of toth mobi, Achmet los of 3-4 + Advanced periodomtits: the hone loss 0 extensive tat he remaining tovth show excessive medi and ting andre in jeopardy of Being lost. There is usually extensive horlzonal bone os or extensive bony defects. tachment loss ofS er more mm. 1 In gingivitis the ndiogiphic epcerance ofthe bone wil be noma Notes) 2 Thecres ofthe alveolar bone isafecied in perodocal disease In health ies 12 men Below the level ofthe CEs of ad acon teth, This distance is where the gingiva attaches othe roc r= “SS! ce via jancsionl epithelium and connective tise, iis nown as the “Biologie Wide. {3A eduction of only 0 or 10 mim inthe thickness ofthe concl pe is sllcen to permit ‘dographi visualztin of desiruton ofthe intr cancellous tabecas. Important: Dishetes melts 8 an extremely important disease fom « perodadonialstemipoin. Is comidcted risk fotr for perodonstdserve Kiss complex metabolic dincae ciracerz by chronic Iyperlyecri. oiduas with dabees havea higher prevalence am seer of periodontal disease than do those withaxtdibetes Dibetes des not ease perodonal disease, bu statis shoe tha it alters the response of te perodons!tsnes to Bacterial pique, Poorly controled diabetes often have * Enlarged gingva, sesie of seduncuaied inal poly, polypoid gingiva proliferations, abscess for sation, and loosened teeth ‘= Polymorphonuclear lenkocyte defcences resin in tpsied chemotsis defective phagocytosis, of Sayed arenes * Thechronic hyperglgcemia adversely lets th syaesi rstutin, and mesntenaee of collagen nd ‘xuacelalar mas Numerous pocetos and matrix molecules undergo a noneazyntleglyconylation, ‘esvhing in aeamnlated glyeaton end prduets (AGES) This inerease in AGEs affects how eallagen normally repaired or replaced and may playa role the progression of pri-doral discuss. oe ee ar eae Card #13 (of 21) ‘Topic: Dental Decks Part II 2016 - Periodontics - Gingivitis/Periodontal Disease gingivitis/periodontal disease Which of the following is most significant in regard to the prognosis of a periodontally involved toot + Pocket depth + Attachment loss + Anatomical crown length “Bleeding on probing PERIODONTICS FT ea em MU att cd Answer + Attachiment loss ‘Attachment Joss is much more significant than periodontal pocketing (actually its the most significant fx because ith tachment loss, supportive structure are being destroyed Pocket depth he distance between the bose ofthe pocket andthe gingival margin. The level of attachment fon the other hand she distance between the base ofthe pocket anda fxd pin on the row sus the (CEJ. Changes inthe vel of atehment canbe caused nly by gin ot los of etachment an, this, provide 2 Detter indication o the degre of periodontal destrstion. Tmportant: The wo most erica parameters for the proguosl of peadonly involved tosh te attache ment os (ost crea) ad modi. In periodonics, firs oe considered in he generation ofa prognossnelude, but ate not Kmied wo, ooh |ype,fureation involvement, Hone less, pocket depth, wath mobility, eeclsal free pasiens home cate presence of stemic discs, and egarete snaking ‘The prognosis usally chisified as eveelent (no bone loss, gingival health, go0d patient cooperation, no secondary systemic orenvizoomenal fairs). good (adequate bone suppor, good patient cooperation, no ‘vironmental factors, an well contlled systemic fcton, fae (ess dan adeqiate bone siepon, moby, fgrue I fication involvement, good paint cooperation, and! Limited envizonmentl andr sywemic fey) poor (meder o advanced bone es, mobi, grado and If Frcation involvement, uescnabl pont ‘oopettion nd presence of environmental and/or systemic ctor), questionable advanced bone loss, grade Vand Il faction involvements, mobility. and presence of environmental andor systemic fers), and hopeless advanced bons oss, aby to exabsh mainisinable stanton, end che presence of uncortlled cviormentl ano sytemie ftrs —extraction(s)ivare hndiated) |. Pooketing cen increase or detese, depending on the smoun’ of inarumstion Without tiach- Notes) ment loss, On tho other hand, extensive attachment loss snd gingival recession may BE _3ccampaniad hy shallow pockes (poor prognosis of tot). 2 When the gingival margin is located on the anaiomie crown, the level of atchment is

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