Surgical Perio Final

What 3 parts make up the 3mm rule?

-"3mm rule": the final restoration margin should be at least 3mm from the crestal level (1mm sulcus depth + 1mm JE + 1mm CT)

What is the actual amount of bone reduction that is actually being removed during crown lengthening?

-"3mm rule": the final restoration margin should be at least 3mm from the crestal level (1mm sulcus depth + 1mm JE + 1mm CT)

What are some different ways in which crown lengthening can be accomplished?

-"A surgical procedure designed to increase the extend of supra gingival tooth structure for RESTORATIVE or ESTHETIC purposes by apically positioning the gingival margin, removing supporting bone, OR both. May be accomplished by orthodontic tooth movement."

What is the definition of crown lengthening?

-"A surgical procedure designed to increase the extend of supra gingival tooth structure for RESTORATIVE or ESTHETIC purposes by apically positioning the gingival margin, removing supporting bone, OR both. May be accomplished by orthodontic tooth movement."

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, what was the #1 cause of failure/ extraction?

-#1 = Restorative (secondary caries, repeated dislodgment of crowns)= 35.2%

What are the two types of sinus lift procedures?

-2 Procedures: Transcrestal approach and the Lateral Window Sinus Lift -The Lateral Window Sinus Lift is more invasive; if we have ≤4mm bone hieght, we do the lateral window sinus lift. If we have ≥5mm, we can do the transcrestal approach, which can achieve 4-5mm of bone gain.

Of the study radiographically evaluating 26 patients for development of radiographic furcation lesions in 5 years, what were the results?

-40% of the test teeth developed radiographic furcation lesion at 5-yr. -All the test teeth with an initial CDF < 4 developed the lesion. None of the teeth with initial CDF > 4 mm showed furcation involvement.

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, what & of the total number of teeth were RCT + post/core + crown?

-414 Teeth with functional CLP & had at least 1 yar f/u -62% (258/4140 had RCT + post/core + crown

What is the prevalence of severe periodontitis?

-8.5% of adults develop severe periodontitis

What is the definition of anatomic spaces?

-A compartment bounded by anatomical barriers, such as muscle or fascial layers, separated in health only by a small amount of fluid lubrication or loose connective tissue -Not really a "space" per se. Only become separated in instances of infection or disease. They don't exist as true spaces in health.

What is s three-wall defect?

-A defect in which three walls are remaining, and one has a defect -Can be ideal for regenerative procedures for the treatment of periodontal disease

What is the definition of the active tip area, and what size does it range from?

-Active tip: portion of the tip capable of doing work -Typically ranges from 2-4 mm in length (water comes out from the area BEFORE the tip to BATHE the tip and cool it, NOT through the tip)

How should you adjust the lavage settings on the magnetostrictive unit? (3)

-Adjusts the amount of water exiting the insert tip -Adjust the "Lavage" setting to create a fine mist (a halo effect) -Minimize the formation of aerosols outside of the mouth

What is the only factor contributing to a gummy smile that can be treated with esthetic crown lengthening?

-Altered passive eruption → ONLY one that can be treated with esthetic crown lengthening

What is the critical temperature for irrigation for implant placement?

-Ample irrigation/coolant. Critical temperatures 47˚C (117˚F) 1 minute or 40˚C (104˚ F) for 7 minutes.

What is the importance of ample irrigation/coolant for site preparation under clean/STERILE environment + as atraumatic as possible?

-Ample irrigation/coolant. Critical temperatures 47˚C (117˚F) 1 minute or 40˚C (104˚ F) for 7 minutes.

What is the definition of a surgical "complication"?

-An unanticipated problem that arises following, and is a result of, a procedure, treatment, or an untreated/improperly treated illness.

Anatomy - Where is the sublingual space located?

-Anatomy: Superior to the mylohyoid muscle

What is the anterior apico-coronal dimension needed from a restorative margin?

-Anterior = ~3-4mm from restorative margin

What type of flap can be used in both esthetic and functional crown lengthening?

-Apically position flap + Osseous

What is a hyperactive upper lip and what is it supposed to be on average?

-Avg. lip mobility from repose to full smile is 6-8 mm

What are some reasonings for taking a lingual approach to osseous surgery? (5)

-Avoids buccal furcation exposure -Avoids shallow buccal vestibule -Base of defect is located lingually due to lingual inclination of molars -Wider embrasure, greater access -Natural cleansing action via tongue

What are some reasonings for taking a palatal approach to osseous surgery? (6)

-Avoids buccal furcation exposure -Avoids shallow buccal vestibule → hard to plan out incisions -Adequate keratinized gingiva on palatal aspect → makes it easier -Wider embrasure, greater access -Natural cleansing action via tongue -More cancellous bone on palate so less post-op resorption

What is biological width?

-BW is the old term coined by Walter Cohen in 1962

What is the surgical armamentarium for crown lengthening?

-Back action chisel -Sugarman file -Ochsenbein chisel -Round bur -End cutting bur

What instrument does Dr. Lim usually use for the facial side for crown lengthening?

-Back end chisel

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, what were the main causes of failure/ ext between 5-10 years vs 10-15 years?

-Between 5-10 yrs. tooth fracture= 36% -10-15 yrs- restorative caries (50%) -Endo/perio complication occur relatively consistent throughout time

What are post-surgical complications? (4)

-Bleeding (refer to "Bleeding" section in Intra-surgical Complications) -Pain -Infection -Other Complications

Why is it not possible to achieve 100% osseointegration?

-Bone is a dynamic tissue that is always undergoing a remodeling process. -Implant may also be contacted by non-mineralized tissues (i.e. CT, vessels, etc.).

What is the crown lengthening procedure workflow for esthetic crown lengthening?

-Bone sounding -Diagnostic wax-up -(Surgical stent) -Full thickness flap with or without osseous recontour -Soft tissue only-4-6 weeks for healing (i.e. gingivectomy) -If osseous 4-6 months for healing -(Restorative procedure) if the patient needs a veneer or crown on their anterior teeth

What is required of analog conventional surgical templates?

-Both require communication between the restorative and surgical team members. -Please, please, please! Take your surgical guide seriously. The restorative doctor should be telling the surgeon the ideal location of gingival margin and angulation of tooth. Will improve your clinical skills as you review anatomy.

What are some other patterns of bone defects other than horizontal and vertical bone defects? (4)

-Bulbous bony contours/exostosis -Ledges -Negative/ reverse architecture -Furcation invasions

What is the formula for static computer aided surgical implant placement?

-CBCT (DICOM) + CAD/CAM Scanner (STL) → Registered files in Treatment Planning Software → 3D Printing Resin Surgical Guide

Should we use CBCT scans for treatment planning and implant placement? If so, when should you use them?

-CBCT scans obtained prior to tooth extraction is an important aid for treatment planning when considering immediate implant placement in all quadrants of the mouth.

What are the primary maxillary spaces? (3)

-Canine space -Buccal space -Infratemporal space

What is the gingival zenith position for the maxillary CI, LI, and canine with regard to the vertical bisected midline of the clinical crown?

-Central incisor: 1.1 mm -Lateral: 0.4 mm -Canine: 0 mm

What commonly used post-surgical antibiotic if the patient has a penicillin allergy?

-Clindamycin 150-300 mg, q6h → if they are allergic to penicillins

What is the purpose of static/ conventional surgical templates?

-Conventional Surgical templates = Prosthetically driven treatment plan

What types of probing are used for diagnosis and evaluation of osseous defects?

-Conventional probing- linear measurement of probing depth -Transgingival probing- Bone sounding (under anesthesia) provides topography information of defect in vertical and horizontal direction -What we learned form this is that our diagnosis and evaluation of osseous defects should be a combination of probing and radiographic imaging

What is inverse piezoelectricity?

-Conversely, if you pass electricity through the piezoelectric crystal, such as quartz, the crystals squeeze themselves by vibrating back and forth (Inverse Piezoelectric Effect)

What are the objectives/rationale behind osseous surgical procedures? (5-6)

-Create bony contours that will parallel gingival contours after healing with shallow pocket depths -Create cleansable gingival contours -Reshape the marginal bone to resemble the alveolar process undamaged by periodontal disease -Permit easier wound closure by thinning the bone and allowing better flap approximation -Expose additional clinical crown for proper restoration (crown lengthening) -Recreate a physiologic bony base through osteoplasty and ostectomy that the gingival tissues will adapt to and remain without significant gingival rebound → No reoccurrence of pocket depth

How should you minimize intrasurgical bleeding when it comes to bleeding from bone?

-Crushing nutrient canals with a hemostat -Direct pressure over an exposed marrow space

What is periodontal bone loss, and how does it manifest?

-Damage from periodontal disease manifests in variable destruction of the tooth-supporting bone. Bone resorption is not uniform; The resorptive process results in an osseous form with sharp, uneven marginal deformities & irregularities

What should you use on Day 2 to manage swelling?

-Day 2: neither ice or heat should be used.

When does swelling start to decrease post-surgery?

-Day 3 and 4: starts to decrease

What should you use on day 3 to manage swelling?

-Day 3: application of heat may help to resolve the swelling

How should you minimize intrasurgical bleeding when it comes to bleeding from soft tissue?

-Direct pressure for 5 minutes → #1 is compression of the site! -Ligation

What are factors to Consider in Immediate Implant Placement in the Posterior Sextants (3)

-Distance from the root apex to vital structures (i.e. inferior alveolar nerve bundle, mental nerve, maxillary sinus, etc.) -Presence or absence of a periapical radiolucency -Thickness of the labial (buccal) plate

What are the 2 types of implant surgical tecniques?

-Dynamic = Navigation (newer) -Static -Static computer aided implant surgery (3D printed) -Convention surgical guides (Vacuum form) -Free hand

What are the indications for osseous resection? (5)

-Elimination of shallow interproximal defects ≤ 3mm -Grade I and shallow grade II furcation involvement -Correction of reverse or flat bone architecture -Reduction of thick ledges and exostoses -Bone contouring in conjunction with root resection, crown lengthening procedures

With magnetostrictive scalers, what planes of the tip of the instrument move against the tooth?

-Elliptical pattern means that multiple planes of the tip of the instrument moves (the back, face, and the two lateral surfaces of the tip)

Outside of overlapping, multi-directional strokes, what other movements should we make, and why?

-Ensures "gentle tapping" (to chip away at the deposits) and "sweeping" motions (to remove the bacteria and detoxify the surface)

By what day should swelling be resolved by post-surgically?

Day 7

What type of defect is especially hard to see on radiographs?

Difficult to identify bone loss extended in the buccal-lingual dimension due to 2-D aspect of radiographs

How are fascial spaces classified?

Direct odontogenic involvement vs indirect odontogenic involement

Who is the father of modern osseous resection?

Dr. Schluger

What is the definition of ecchymosis?

Ecchymosis: Escape of blood from damaged blood vessels into the subcutaneous tissue

What is considered a high (steep) vault?

High (steep) vault: 17 mm from CEJ of molars and premolars

How can we improve implant stability? (4)

Increasing surface area, but how? Increasing surface area → Increasing stability Options: 1. Implant taper: parallel and taper at the bottom, taper from top to bottom 2. Channels 3. Thread pitch: distance between one thread to another 4. Vent holes

What are the indications for using a gingivectomy for crown lengthening?

Indications -Adequate band of KG (3-4 mm KG left AFTER gingivectomy) -Bone crest is 2-3 mm apical to restorative margin or fracture

What are the indications and contraindications for using a gingivectomy for crown lengthening?

Indications -Adequate band of KG (3-4 mm KG left AFTER gingivectomy) -Bone crest is 2-3 mm apical to restorative margin or fracture Contraindications -Inadequate zone of KG -Bone crest <2mm apical to restorative margin

What are the indications for using an apically positioned flap only for crown lengthening?

Indications -Inadequate band of KG to proceed with gingivectomy -Bone crest is 2-3 mm apical to restorative margin or fracture

What are the indications and contraindications for using an apically positioned flap only for crown lengthening?

Indications -Inadequate band of KG to proceed with gingivectomy -Bone crest is 2-3 mm apical to restorative margin or fracture Contraindications -Bone crest <2mm apical to restorative margin

What are the indications for using an apically positioned flap + osseous resection for crown lengthening?

Indications -Inadequate band of KG to proceed with gingivectomy -Bone crest is <2-3 mm apical to restorative margin or fracture

What is another term for secondary fascial spaces?

Indirect Odontogenic Involvement

What is the lavage therapy function of the coolant?

Lavage Therapy: constant flushing of debris from the site being debrided

What type of ultrasonic scaler is the Dentsply Cavitron?

Magnetostrictive

What type of ultrasonic scaler is characterized by a tip that has all sides working, an elliptical and non-linear motion of the insert tip, and motion against hte tooth in a "banging" or "hammering" motion?

Magnetostrictive scaler

What is the mechanical aspect of successful implant placement?

Mechanical = resists non-axial or excessive force & distributes to surrounding bone w/o fracture

What are the indications for using a medium power setting? (2)

Medium -Gross debridement -Large supragingival calculus removal

What is considered a medium vault?

Medium vault: 12 mm from CEJ of molars and premolars

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, when looking at teeth of the same tooth type, what teeth had a higher rate of failure?

Of the same tooth type, Maxillary teeth had slightly higher failure rate vs. mandibular teeth (18% vs 16.2%) but not statistically significant

What is the definition of osseointegration?

Osseointegration = mechanical retention of implant to bone microscopically.

What type of stability is osseointegration?

Osseointegration = mechanical retention of implant to bone microscopically. -Mechanical retention of the root form implant by intimate contact of bone and titanium as viewed with a light microscope.

What is another name for a transcrestal approach to a sinus lift?

Osteotome sinus lift

What type of radiograph reveals the existence of angular bone loss in the interproximal space?

PAs and Bitewings

What is the most common diagnostic tool we use in the diagnosis of osseous defects?

PAs/Bitewings

What are some ways to control bleeding? (3)

Prevention: atraumatic surgery -Clean incision -Gentle management of flaps Removal of granulation tissue Identification of bleeding site

What is the definition of primary stability?

Primary: stability of the implant at the stage of surgical placement (mechanical)

What are the contraindications for crown lengthening (4)?

-Non-restorable tooth (non-ideal crown-root ratio) -Functionally OR esthetically compromise the adjacent tooth (avoid exposing furcations) -Surgery results in compromising the remaining periodontal support and/or expose furcation -Financial consideration

What is Norco 5/325?

-Norco 5/325- 5 mg hydrocodone and 325 mg acetaminophen

Can you detect the presence of a maxillary sinus septum via 2-D radiography?

-Note: A 2-D panoramic radiograph is not sensitive enough to detect the presence of a maxillary sinus septum -Note: CBCT scans provide a 3-dimensional view of the sinus and gives the clinician more information regarding the anatomy of the sinus

What is the oscillation frequency of ultrasonic scalers?

-Oscillation frequency: 20,000 Hz- 45,000Hz (Frequency = the number of times the insert tip moves/second) -Frequency is the same between the Magnetostrictive and Piezoelectric

What are the different treatment options for osseous defects (5)?

-Osseous Re-contouring -Osteoplasty/Ostectomy -Regeneration/GTR -Root Resection with osseous resection -Maintenance of the pockets -Extraction (last resort)

What is the difference between osteoplasty and ostectomy?

-Osteoplasty- Reshaping the bone without removing the tooth-supporting bone (-plasty = reshaping) -Ostectomy- Includes removal of tooth supporting bone (bone where the fiber attachments are)

What are the minimum requirements for interocclusal, between implants, between teeth, and from vital structures for implants

-Overall, you want a minimum of 7mm interocclusally, 3-4mm between implants, 1.5-2mm between tooth, and then a safety zone of 2mm from any vital structures.

What are commonly used Post-surgical antibiotics? (4)

-Penicillin V 500 mg, qid -Amoxicillin 500 mg, tid -Cephalosporin 500 mg, qid -Clindamycin 150-300 mg, q6h → if they are allergic to penicillins

What is Percocet?

-Percocet - 5 mg oxycodone and 325 mg acetaminophen

What is Percodan?

-Percodan - 4.88 mg oxycodone and 325 mg aspirin

What results when there is invasion of the tissue attachment? (5)

-Persistent inflammation, bleeding, tenderness -Further attachment loss, deep probing depth -Furcation involvement around the molars -"Self-correcting" recession -Compromise esthetic & function

What does the physiologic dentogingival unit made up of?

-Physiologic dentogingival unit: gingival margin, sulcus, junctional epithelium, connective tissue attachment (Gargiulo, 1961)

What is the physiologic dentogingival unit?

-Physiologic dentogingival unit: gingival margin, sulcus, junctional epithelium, connective tissue attachment (Gargiulo, 1961)

What are some other applications in periodontology for the piezoelectric scaler?

-Piezo Block Graft Procedure for future implant placement -Piezo Sinus Lift Procedure for gentleness on the tissues

When odontogenic infections spread to soft tissue, where do they go?

-When odontogenic infections spread into soft tissue, they follow the path of least resistance→ opens (stretches out) the anatomic space→ result: violation of the anatomic space.

What is the purpose of dynamic implant surgery?

-Why? Reduction in deviation from planned implant locations via the use of surgical navigation system instead of a surgical stent

What are the indications for universal scaling tip from the piezoelectric scaler?

-Wide diameter tip -To be effective, the tip must be oriented tangentially to the surface being treated and must be moved in a back-and-forth sweeping motion without excessive lateral pressure -Precise control of power and irrigation is a guarantee of better efficiency -Set power knob within the blue band -Set lavage so that a halo of water (a mist) is coming out of the tip (we don't want a drip) -Indicated for gross supragingival scaling

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, what was the cumulative survival rates for: 0-5 years 5-10 years 10-15 years

0-5 years: 88.3% 5-10 years: 78.4% 10-15 years: 68.1%

What is the width/length ratio again for the ideal tooth?

0.75-0.8

What is the ideal material thickness for vacuum form matrices?

0.75mm

What does Chu's Aesthetic Proportion Gauge follow the rule of?

0.78 W/L ratio

What leads to the formation of immature bone/woven bone? When does it occur?

1 week = unorganized immature bone, woven bone. -Lead by mesenchymal cells differentiated into osteoblasts. Start forming cell-rich unorganized immature bone, woven bone.

What occurs 1 week after implant placement?

1 week = unorganized immature bone, woven bone. -Lead by mesenchymal cells differentiated into osteoblasts. Start forming cell-rich unorganized immature bone, woven bone.

When does formation of woven bone occur?

1 week = unorganized immature bone, woven bone. -Lead by mesenchymal cells differentiated into osteoblasts. Start forming cell-rich unorganized immature bone, woven bone.

Summary comparison between esthetic crown lengthening vs functional restorative crown lengthening

1) Esthetic -Increased coronal tooth structure -Improved esthetic -Address the periodontal inflammation 2) Functional/restorative -Achieve better retention & resistance form -Facilitate impression taking -Improved function

What are the 5 best ways to prevent post-surgical infections?

1) Excellent oral hygiene 2) Preoperative mouth rinse 3) Aseptic surgical technique 4) Thorough wound debridment → do not leave diseased tissue in the area 5) Limit the extent of surgical procedure → keep surgical time short

For Anterior Teeth and Facial/Lingual Surfaces of Posterior Teeth, how should the magnetostrictive tip be directed?

1) For Anterior Teeth and Facial/Lingual Surfaces of Posterior Teeth: Direct the "point" apically and slide the insert tip into the sulcus so that the lateral surface is parallel with the surface being debrided -The lateral surface of the insert tip is parallel to the tooth surface during instrumentation for access and to protect the tooth and gingival tissues -The Cavitron insert tip should be aligned with the long axis of the tooth similarly to how a diamond bur is oriented during a crown prep

What is the location of the most apical free gingival margin location?

1mm supracoronal for the lateral incisor in comparison to the central incisor and canine -central incisor and canine level is about in line, the lateral incisor is just 1mm coronal to it

Pain usually doesn't persist more than _____ days after surgery

2 days

What occurs 2 hours post-op from implant placement?

2 hours post-op = clot stabilization/ blood/fibrin clot (containing RBCs, platelets, neutrophils, monocytes, etc.) next to implant surface

When does clot stabilization occur after implant placement?

2 hours post-op = clot stabilization/ blood/fibrin clot (containing RBCs, platelets, neutrophils, monocytes, etc.) next to implant surface

What is the process of implant healing?

2 hours post-op = clot stabilization/ blood/fibrin clot (containing RBCs, platelets, neutrophils, monocytes, etc.) next to implant surface 4 days = fibrinolysis of clot. -Deposition of highly vascular granulation tissues (mesenchymal cells, matrix, angiogenic vessels → angiogenesis). -Provisional CT matrix has been established. 1 week = unorganized immature bone, woven bone. -Lead by mesenchymal cells differentiated into osteoblasts. Start forming cell-rich unorganized immature bone, woven bone. 2 weeks = clearly differentiated woven bone. 6-12 weeks = mineralized lamellar bone. -Woven bone converted to mineralized lamellar bone. Greater organization. -Lamellar bone: regular parallel alignment of collagen fibers. Replaces the original strength of the bone & is more organized.

What occurs 2 week after implant placement?

2 weeks = clearly differentiated woven bone.

When does woven bone become clearly differentiated after implant placement?

2 weeks = clearly differentiated woven bone.

What is a transmandibular/transosseous implant?

2) Transmandibular/ transosseous: -Penetration through inferior border of the mandible. Invasive. -Frame work: U-shaped + Transalveolar pins

What is the goal of resective microdesigns?

2. Resective (subtractive processes that remove material from the surface) -Goal: Enhance rate of osseointegration. i.e. machining, acid etching, blasting or combination

An ice pack shouldn't be used for more than....

24 hours

When is the peak of pain typically for post-surgical pain?

24-48 hours after surgery

On a CBCT and placement of an implant, how far does it need to be away from the IAN at a minimum?

2mm at a minimum

What is an endosseous implant?

3) Endosseous: (Everyday implants). What we use now. -Penetration of alveolus without penetration of inferior border of mandible.

How much bone loss needs to occur for it to be visible on radiographs?

30-40% minimum

What occurs 4 days post-op of implant placement?

4 days = fibrinolysis of clot. -Deposition of highly vascular granulation tissues (mesenchymal cells, matrix, angiogenic vessels → angiogenesis). -Provisional CT matrix has been established.

When does deposition of highly vascular granulation tissue occur?

4 days = fibrinolysis of clot. -Deposition of highly vascular granulation tissues (mesenchymal cells, matrix, angiogenic vessels → angiogenesis). -Provisional CT matrix has been established.

When does fibrinolysis of the clot occur?

4 days = fibrinolysis of clot. -Deposition of highly vascular granulation tissues (mesenchymal cells, matrix, angiogenic vessels → angiogenesis). -Provisional CT matrix has been established.

When is a provisional CT matrix established?

4 days = fibrinolysis of clot. -Deposition of highly vascular granulation tissues (mesenchymal cells, matrix, angiogenic vessels → angiogenesis). -Provisional CT matrix has been established.

What is the healing time for soft tissue and osseous for crown lengthening surgery in the esthetic zone?

4-6 months

What is the healing time for soft tissue only with crown lengthening surgery?

4-6 weeks

Typically, when does swelling reach its peak post-surgery?

48-72 hours

What is the healing time for soft tissue and osseous for crown lengthening surgery in the non-esthetic zone?

6 weeks

What occurs 6-12 week after implant placement?

6-12 weeks = mineralized lamellar bone. -Woven bone converted to mineralized lamellar bone. Greater organization.

When does the mineralization of lamellar bone occur after mplant placement?

6-12 weeks = mineralized lamellar bone. -Woven bone converted to mineralized lamellar bone. Greater organization.

What is considered successful in terms of vertical bone loss after an implant's 1st year of service?

<0.2 mm annually

How often does post-surgical infection occur after periodontal surgery?

<1%

According to the study: Crown lengthening is related to development of furcation involvement following the placement of the full crown when the critical distance from the furcation is ....

<4 mm.

What did the study aimed to radiographically evaluate the outcome of crown lengthening procedure and to determine as the "critical distance from the furcation" in mandibular teeth?

<4mm

In what patients is post-surgical bruising most common?

>50 years old

What is the magnetostrictive scaler internal anatomy?

A = hand piece which is hollow, attaches to the unit by way of water tubing and detaches for sterilization B = the tip which is carried on a removable insert C = Ferromagnetic stack which transforms electromagnetic energy into mechanical energy needed to move the insert tip

What is a two-wall defect?

A defect in which two walls are remaining, and the other two have a defect

What is defined by macrodesign?

Adaptation to the alveolus: Types (according to shape and jaw attachment)

What are 5 medications that increase bleeding tendency?

Aspirin -Used as blood thinner/ inhibition of cyclooxygenase pathway reduce the production of thromboxane A2 which is responsible for platelet aggregation. Anticoagulants -Used as blood thinner/ pts with myocardial infarction or pulmonary embolism, prosthetic heart valves or venous thrombosis to prevent intravascular coagulation. Coumadin (warfarin) inhibits the Vit K participation in the process of coagulation factors. Antibiotics -Destroys intestinal microflora that makes Vitamin K → decrease Vit K production → decreased hemostasis. Vit K is necessary for the liver to produce adequate quantities of coagulation factor (II, VII, IX and X → liver-derived coagulation factors) Alcohol -Consuming large amount of alcohol for long duration may have liver cirrhosis- ↓ production of liver dependent coagulation factors. Anticancer

What are the aspects of ridge dimensions needed for implant placement? (4)

B-L width M-D width Interocclusal Apico-coronal

What is considered a shallow (flat) vault?

Shallow (flat) vault: 7 mm from CEJ of molars and premolars

What are the classifications of severity in terms of a classic crater angular defect?

Shallow: 1-2mm Moderate: 3-4mm Deep: >5mm

What type of piezoelectric tip is indicated for fine supragingival scaling AND subgingival scaling, and also indicated for scaling tight interproximal spaces?

Slim (diameter) tip

What are the different types of subgingival tips for cavitrons?

Slim diameter- straight -Subgingival deposits -Low power Slim diameter- curved -Subgingival deposits -Interproximal root surfaces -Line angles -Low power

What are the different types of intrasurgical complications? (4)

Soft Tissue Injury (i.e. flap perforation, necrosis) Hard Tissue Injury (i.e. improper osseous resective surgery, surgical complications arising during block grafting) Injury to Adjacent Structures -Nerve (paresthesia, anesthesia, etc.) à can be temporary or it can be permentant damage -Vessel (hemorrhage) -Sinus (maxillary sinus perforation) -Tooth (iatrogenic damage to tooth structure) Bleeding

What is a combination defect?

Some portion of the walls will still be present, and you cannot completely classify them. Resorption is not very uniform an can proceed in any form, any morphology!

What is stage I of passive eruption?

Stage I -The sulcus & JE are on enamel (teeth reaching plane of occlusion)

What is stage II of passive eruption?

Stage II -The sulcus is on the enamel, JE is on enamel and cementum

What is stage III of passive eruption?

Stage III - The sulcus is on CEJ, JE is on cementum

What stages of passive eruption are our patients typically in?

Stage III and Stage IV

What is stage IV of passive eruption?

Stage IV -The sulcus and JE are apical to the CEJ (totally on cementum) -portion of the root may or may not be clinically exposed → we usually see these 2 on our patients

What type of magnetic field is created with magnetostrictive scalers?

The electrical current creates a circular magnetic field around the ferromagnetic rod.

What part of the magnetostrictive scaler is responsible for transforming electromagnetic energy into mechanical energy to move the insert tip?

The ferromagnetic stack

What is the vertical maxillary excess supposed to be on average?

The middle 3rd of the face should approx. equal to the lower 3rd of the face

What is the definition of gingival zenith?

The most apical location of the free gingival margin.

Which tip has graduated bands, and what are they for?

The piezo microtip -The two graduated bands are used to evaluate the periodontal pocket depths while debriding the root

What are the classifications of altered passive eruption?

Type 1 → ≥ 2mm KG -Subtype A is when the bone is at 1.5-2mm below the CEJ -1A Tx: gingivectomy (too much tissue, bone ok) -Subtype B is when the bone is at the CEJ -1B Tx: gingivectomy + osseous Type 2 → < 2 mm of KG (insufficient) -Subtype A is when the bone is at 1.5-2mm below the CEJ -2A Tx: apically positioned flap -Subtype B is when the bone is at the CEJ -2B Tx: apically positioned flap and remove the bone

What are the two types of access perforations for the maxillary sinus lift?

Two types -Round bur- create a window with a bone island that you can keep or remove -No bone island → the type depends on the brand of instruments that you use

How is Type 1 different from Type 2 for altered passive eruption?

Type 1 → ≥ 2mm KG -Type 2 → < 2 mm of KG (insufficient)

What physical signs do we look for as post-surgical signs of infection? (3 categories)

Vital signs -Blood pressure -Pulse rate -Respiratory rate -Temperature Extra-oral exam -Patient's general appearance -Facial asymmetry -Swelling -Lymph nodes Intra-oral exam -Swelling -Erythema -Palpation

What is the purpose of creating microdesigns for implants?

Why create microdesigns or surface roughness? -Modifications don't to the surface of the implant that influence the tissue response to enhance osteogenesis through: -Aid in surface wetting + cellular migration/attachment. -Aid in retention of the fibrin clot.

What tip should you use for gross debridgement?

beavertail

What appearance/discoloration does conversion of hemoglobin to bilirubin cause?

blue-green appearance/discoloration

What appearance/discoloration does release of hemoglobin cause?

blue-red appearance/discoloration

What causes the golden-brown appearance/discoloration on the skin during post-surgical bruising?

conversion of bilirubin to hemosiderin

What causes the blue-green appearance/discoloration on the skin during post-surgical bruising?

conversion of hemoglobin to bilirubin

What does a diagnostic wax-up involve for crown lengthening?

establishes the desired end result of periodontal and restorative treatment

Is passive eruption and esthetic or functional indication for crown lengthening?

esthetic

What are 2 other names for anatomic spaces?

fascial spaces potential spaces

What is another term for osseointegration?

functional ankylosis

What is the cause of bleeding complications?

Problems with the clotting mechanism -History of previous problem with bleeding -Family history of bleeding -Systemic diseases -Alcoholic liver cirrhosis → the liver produces coagualation factors; scar tissue -Hepatitis -Bleeding disorders Medications

What type of bone is more organized, woven bone or lamellar bone?

lamellar bone

When the current flows over the quartz crystal, it squeezes the crystal toward the ________ axis of the hand piece

longitudinal

What appearance/discoloration does conversion of bilirubin to hemosiderin cause?

golden-brown appearance/discoloration

What should the power knob be set at for a slim (diameter) tip with the piezoelectric scaler?

green band (low power)

What should the power knob be set on with a microtip piezoelectric scaler?

green band (low power)

What is used for resective microdesigns?

i.e. machining, acid etching, blasting or combination

The electromagnetic field created around the ferromagnetic stack in a magnetostrictive scaler will cause what type of movement by the tip?

induce torsional oscillation of the tip

Regardless of flap design, what type of incision should we be using with crown lengthening?

inverse bevel incision

If we are selecting a tip for an ultrasonic scaler, what type is it?

magnetostrictive

When it comes to vital anatomic structures that can create surgical complications, are there more in the maxilla or mandible?

mandible

What types of angular defects are the primary focus of osseous resective procedures?

one-wall and two-wall defects

What power setting do you use subgingival scalers on?

only low

Which includes removal of tooth-supporting bone: osteoplasty or ostectomy?

ostectomy

Which tips require wrenches to put on?

piezoelectric scaler tips

What is the most common cause of delayed healing?

post-surgical infection

Why do we incorporate the use of radiopqaue materials into the diagnosis and evaluations of osseous defects?

radiopaque materials can aid in determining the defect depth and contour

What causes the blue-red appearance/discoloration on the skin during post-surgical bruising?

release of hemoglobin

What do you make from your diagnostic wax-up in surgical crown lengthening?

surgical stent -help you identify during the procedure how much gingiva you want to apically display or trim away using the gingivectomy

How long can COVID remain viable in aerosols and survive up to on surfaces at room temperatures?

survive up to 3 days

In order for piezoelectric tips to be effective, they must be oriented....

tangentially to the surface being treated, and must be moved in a back-and-forth sweeping motion without excessive lateral pressure

What instruments are used in the interproximal area for crown lengthening?

the end cutting bur and the Sugarman file

What type of piezoelectricity do we want with our ultrasonic scalers?

the inverse piezoelectric effect

Why do we need to wait for the final restorative procedure after crown lengthening?

tissue rebound 0-1 mm: 1.42mm rebound vs. >3 mm: 0.14 mm rebound) tissue (FGM) stability -No change over ±1 mm in 85% of the sties between 6 wk -6 mo. -HOWEVER, 12% of sites showed 2-4 mm recession, while 33% shifted 1-3 mm coronally during this time

Rank the piezoelectric scaler tips from largest to smallest

universal > slim > microtip

What causes the angle of the mandible to shift to the opposite side in terms of violations of fascial spaces?

violation of the buccal space

Oftentimes, during the 1st year after implant placement, bone remodeling is ....

~1.2mm

What component of the supragingival tissue attachment has more variation? Less variation?

"Supracrestal tissue attachment" is the new term proposed in the 2017 AAP workshop (use this!) -Consists of JE + CT: 2.04 mm on average → value you want to remember -JE: more variation between person to person -CT: most consistent

What does the supracrestal tissue attachment consist of?

"Supracrestal tissue attachment" is the new term proposed in the 2017 AAP workshop (use this!) -Consists of JE + CT: 2.04 mm on average → value you want to remember -JE: more variation between person to person -CT: most consistent

What is the supracrestal tissue attachment?

"Supracrestal tissue attachment" is the new term proposed in the 2017 AAP workshop (use this!) -Consists of JE + CT: 2.04 mm on average → value you want to remember -JE: more variation between person to person -CT: most consistent

What are the pre-surgical considerations we have to look at with functional crown lengthening? (8)

#1 Restorability -Restorative and periodontally/ post, core, crown, endo Pt's MH, dental history Plaque control, tooth mobility, caries risk Amount of KG -Gingival phenotype Exposure of anatomical features -Position of furcations, root length & morphology Esthetic zone? Residual tooth structure? -Extent of caries, Restoration plan and selected material Favorable crown: root ratio? Interarch distance

What are some key points you want to keep in mind when it comes to functional crown lengthening? (4)

-Establish the future restorative margin pre-surgically whenever possible -This may involve doing all the caries removal first to see where the margin will be -Extent and degree of osseous scalloping is determined by tooth anatomy -Crown lengthening will involve adjacent teeth to some extent -Restorative procedure following the surgery should not extend more than 0.5 mm sub-gingivally. Use supragingival margins whenever possible!

What is the etiology of a violation of the canine space?

-Etiology: Infection from the maxillary anteriors, canine, maxillary 1st and 2nd premolars, and sometimes mesiobuccal root of maxillary 1st molars

What are the cons of dynamic implant surgery?

-Expensive -Relatively new technology → little evidence -Learning curve. -Large equipment/ space-occupying -Requires intra-operative calibration. -Must revert to freehand if extraoral clip is lost.

What is involved in the provider factors of preventing surgical complications? (3)

-Experience level -Technique abilities -Membrane exposures -Sinus perforations etc. -Professional judgment

Failure to follow the M-D width suggestions will lead to...

-Failure to follow this rule = prosthetic + biological compromises.

What is gradualizing marginal bone, and what step is it of the osseous resective technique?

-Final step -Ostectomy step -Minimal bone removal -Necessary to provide a sound, regular base for the gingival tissues to follow

Who first discovered the maxillary sinus? Describe its shape and borders

-First described by Nathaniel Highmore in 1651. -AKA Antrum of Highmore -Pyramid shaped with the base pointed medially towards the lateral wall of the nose as well as its apex towards the zygomatic bone laterally.

Describe the process of a maxillary augmentation/ sinus lift

-First described by Tatum, in 1976, and was subsequently published by Boyne & James, in 1980 -Remove the wall, create a window in the bone, then lift the maxillary sinus membrane all the way up and put in the bone graft marerial to integrate with the native bone. Will give you enough vertical hieght for an implant.

What is vertical rooting, and what step is it of the osseous resective technique?

-First step -Rotary instruments (image on the right is an osteoplasty, so only non-supporting bone shown) -To reduce the thickness of the alveolar housing and provide relative prominence to the radicular aspect of the teeth -It also provides continuity from the interproximal space onto the radicular space.

What should you do to manage a perforation in the maxillary sinus? (6 steps)

-First, regain your composure (and don't say oops) -Elevate around the perforation -Fold a piece of resorable collagen membrane to cover "torn" membrane and to reestablish the inner wall of the sinus compartment -Place bone graft material into the new compartment -Place a second piece of resorable collagen membrane over the bone graft / outer surface -Obtain primary closure! → treatment depends on the size of the perforation

Explain post-surgical flap placement after osseous resection

-Flap may be replaced to their original level to cover the new bony margin, OR they may be apically positioned -2020 Shin: idea is if you replace the flap at the original level, even though there is an apically positioned flap margin, the flap itself is NOT considered apically displaced in the photo because the body of the flap is not apically positioned. The margin itself is lower due to excited tissue collar. Flap is still considered a "repositioned flap" despite the margin being considered an apically positioned flap margin. -Placement within 3mm of the alveolar crest results in PDs ≤ 3mm -Need to consider the super-crestal tissue attachment

What are the indications for using a bevertail supragingival tip?

-For moderate-to-heavy plaque/calculus deposits located supragingivally: -Broader tip, larger diameter -Use for gross debridement, removal of ortho cement, moderate-to-heavy supragingival calculus -Never use sub-gingivally -Use on Medium power setting

What are the indications for using a universal supragingival tip?

-For small-to-medium plaque/calculus deposits located supragingivally: -Curved shank and tapered tip -Use with caution when instrumenting subgingivally (the diameter of the tip may be wider than the pocket orifice) -Use on low-to-medium power setting

What are the indications for using a triple bend supragingival tip?

-For small-to-medium plaque/calculus deposits located supragingvally: -Shank bends for access to proximal surfaces and line angles -Used to remove small-to-medium supragingival calculus or staining -Use subgingival if tissue allows (shallow pockets) -Use on low-to-medium power setting

How do you adjust the frequency of the cavitron tip?

-Frequency is automatically tuned to peak performance when the insert tip is loaded against the tooth surface àyou cannot control the frequency setting -No operator flexibility in controlling the frequency setting

What are the maxillary anatomic considerations? (2)

-Greater Palatine Neurovascular Bundle (NVB) Contents: -Greater Palatine Nerve -Greater Palatine Artery

What is the definition of trismus?

-Limitation in opening of the mouth as the result of inflammation involving the muscles of mastication

What are the components of an esthetic smile?

-Healthy gingiva with filled interdental space -Teeth in correct anatomy & proportion -Proper color and shade -Symmetric display and harmony between maxillary gingival line and upper lip -Harmony between anterior and posterior segments -Lower lip parallel to the incisal edges of the maxillary anterior teeth -Dental midline is aligned -Harmony of occlusal plane to incisal edge -Harmonious gingival margin, gingival zenith

What does high power look like with the magnetostrictive unit?

-High "Power" → Longer, more powerful stoke -Warning: the insert tip will wear down faster and generate significant frictional heat (pulp irritation)

Why does bleeding occur in the oral cavity? (3)

-Highly vascularized tissue -Mobile tissue (tongue) -Salivary enzymes can lyse the blood clot

What is the definition of horizontal bone loss?

-Horizontal Bone Loss- Bone is reduced in height but the margins remains approximately perpendicular to the tooth surface

How do you measure an angular defect?

-How to measure: measure from the highest level of bone to the bottom of the defect **DOESN'T have anything to do with the gingival margin or the CEJ -Shallow: 1-2mm Moderate: 3-4mm Deep: >5mm

What should be used for the prevention and management of swelling?

-Ice pack can be used immediately after surgery → reduces temp and causes vascoconstriction -Ice pack should be kept on the surgerized area for 15-20 min and then left off for 15-20 min.

With what frequency should an ice-pack be used post-surgery?

-Ice pack should be kept on the surgerized area for 15-20 min and then left off for 15-20 min. -Ice pack shouldn't be used more than 24 hours

What is the ideal B/L width of ridge dimensions for implant placement?

-Ideal: Implant shoulder is ~1mm from point of greatest contour of adjacent teeth.

What is the implant fixure (body)?

-Implant fixture (body). -Surgical screw. -Alloplastic material (i.e. Ti, Ti/Zr, Zr). -Placed surgical beneath the periosteum within the alveolar housing or within the bone for functional, therapeutic, or esthetic purposes

When is implant weakest post-operatively?

-Implant is weakest 2 weeks post-operatively. Implant should be placed with good initial stability

What happens if you place an implant too close to another implant or tooth?

-Implant placed too close will have resorption and loss of interdental papilla; black triangles

What is the M/D width for implants from implants?

-Implant teeth = 3.0 mm

Describe what happens to these anatomic spaces when disease occurs

-In disease the orofacial infection "spreads" to these potential spaces ... -Inflammatory infiltrate (pus and blood) spreads and accumulates in these spaces and the spaces "open up" ... -Clinical signs of swelling and facial asymmetry

How much tooth structure is needed for functional crown lengthening? How is this amount of tooth structure measured?

-In general, should have 3-4mm of sound tooth structure from crest of bone to the future restorative margin

What is the engineering principle behind ultrasonic scalers?

-In ultrasonic, a transducer converts electrical energy into extremely rapid mechanical vibrations -Electrical energy → Mechanical vibrations

What is a sign of infection when it comes to swelling post-surgery?

-Increased swelling after the 3rd day may be a sign of infection

What are the general contraindications for use of ultrasonic instruments? (10)

-Individuals with pacemakers (electromagnetic interferences from the magnetostrictive unit) -Communicable diseases or immunocompromised patients (TB, HIV) -Patients with difficulty in swallowing -Patients who easily gag -Demineralized enamel -Porcelain crowns, veneers, resins, and titanium implants (→ Use plastic for titanium) -Sensitive teeth -Children (large pulp chambers, in which the heat and vibrations from the ultrasonic can cause damage) -Individuals who present with 1-3 mm, minimal inflammation, and minimal plaque/calculus deposits (excessive tx for minimal problems) -Pregnant women(?) - err on the side of caution

What are the clinical features of a violation of the submandibular space? (4)

-Indurated swelling of the submandibular region -Swelling of the floor of the mouth -Dysphagia -Difficulty in breathing ***all symptoms of Ludwig's angina)***

What are the clinical features of a violation of the submental space? (4)

-Indurated swelling of the submandibular region -Swelling of the floor of the mouth -Dysphagia -Difficulty in breathing (all symptoms of Ludwig's angina)

When is bleeding most profuse? Why?

-Initially bleeding is more profuse due to the presence of highly vascular diseased granulation tissue -Bleeding is reduced significantly once the granulation tissue has been removed

What are the components of the piezoelectric ultrasonic scaler?

-Insert tips- screwed into the hand piece with a wrench -Hand piece- contains quartz crystal transducer -Instead of the ferromagnetic stack like the Magnetostrictive

What is the importance of intermittent drilling technique for site preparation under clean/STERILE environment + as atraumatic as possible?

-Intermittent drilling technique. Pumping action to increase irrigation and allowing for heat dissipation.

If bleeding occurs during a sinus lift, where is that blood usually coming from?

-Intraosseous branch of the posterior superior alveolar artery

What are the characteristics of ideal gingival architecture? (3)

-Knife-edged margins -Interdental grooves -Cone-shaped papilla

What is the pattern of lamellar bone?

-Lamellar bone: regular parallel alignment of collagen fibers. Replaces the original strength of the bone & is more organized.

What are the procedural steps for osseous resective surgery? (4)

-Local Anesthesia -Conventional Flap- Sulcular / Internal bevel incision (depends on amount of keratinized gingiva and how the vestibule in the area is) -no papilla preservation here -Full thickness flap Reflection → because you want to see the underlying bone so we need to reflect the periosteum -Thorough soft and hard tissue debridement (hand or ultrasonic instruments)

What are the indications for using a slim diameter - curved tip?

-Longer, thinner tip compared to Universal insert -Easier access to interproximal root surfaces and at line angles -Designed for subgingival deposit removal -Use at low power setting

What are the indications for using a slim diameter - straight tip?

-Longer, thinner tip compared to Universal insert -Similar to a periodontal probe -Designed for subgingival deposit removal -Use at low power setting

What are the disadvantages of osseous bone resection? (4)

-Loss of attachment -Esthetics compromised (particularly in maxillary anterior sites) -Risk for root caries -Root hypersensitivity

What does low power look like with the magnetostrictive unit?

-Low "Power" → Shorter, less powerful stroke -Ideal for subgingival scaling

What are some limitations of using CBCTs for diagnosis and evaluation of osseous defects? (4)

-Low Dose but excessive if unlikely to improve outcome of treatment provided -3-7x more than a pano and the same amount of radiation as an FMX. Case selection -Equipment size and cost -CBCT assessment technically more difficult -Beam hardening effects (metal artifacts) from amalgams or crowns

What are the two main types of ultrasonic scalers?

-Magnetostrictive -Piezoelectric

What are the characteristics of post-surgical pain?

-Main characteristics of post-surgical pain: -Usually not severe -The peak of pain occurs about 24-48 hours after surgery -Pain usually doesn't persist more than 2 days after surgery

What are the secondary fascial spaces? (7)

-Masseteric -Pterygomandibular -Superior and deep temporal -Lateral pharyngeal -Retropharyngeal -Prevertebral -Parotid

What is the material of choice for implants?

-Material of Choice: Titanium -Light-weight, biocompatible, chemically inert (does not corrode readily), mechanically strong

What are the contraindications for osseous resective surgeries?(5)

-Maxillary anterior sites (due to aesthetic compromise, EXCEPT crown lengthening procedures) -Isolated, deep intrabony defects ≥ 4mm -Excessive, severe bone loss -Root hypersensitivity, high caries risk -Presence of local anatomic factors → limit the ability to do surgery -Ascending ramus -External oblique ridge -Maxillary sinus -Very shallow palate

What is the overall MOA of ultrasonic instrumentation (4)?

-Mechanical action/ vibration -Lavage/ flushing action -Cavitation (bubbles) -Heat

How do you determine osseointegration?

-Mechanical retention of the root form implant by intimate contact of bone and titanium as viewed with a light microscope.

What does medium power look like with the magnetostrictive unit?

-Medium "Power" → ideal for supragingival scaling

Describe the oscillation pattern of the magnetostrictive scaler pattern

-Micromovement of the tip: 360 ° activation of the tip (all sides working) -Elliptical, non-linear motion of the insert tip -Motion against the tooth is similar to a "banging" or "hammering" motion -Oscillation frequency: 20,000 Hz- 45,000Hz (Frequency = the number of times the insert tip moves/second) -Frequency is the same between the Magnetostrictive and Piezoelectric

What is the detailed oscillation pattern of the piezoelectric scaler?

-Micromovement of the tip: Only two sides of the tip work -Linear motion of the insert tip -Motion against the tooth is similar to a "sweeping" or "back-and-forth" action -Oscillation frequency: 20,000 Hz- 45,000 Hz -Linear pattern means the tip of the instrument moves in one plane- forwards and backwards.

What is the importance of sharp drills for site preparation under clean/STERILE environment + as atraumatic as possible?

-Minimizes operator fatigue → if drills are dull, you need to put more pressure. Reduces heat generation. -More efficient preparation of the site. Reduces excessive apical force being applied to the alveolar bone during preparation. -Starting with a small drill, gradually move to a larger drill. -Minimize trauma and heat generation by irrigating with lots of saline; good infection control

What are the conclusions regarding osseous resection? (6)

-Most Predictable in thick phenotype with 5-6mm PDs, referral to periodontist early (if indicated) -In severe bone loss circumstances, osseous resection will be compromised -Deep Intrabony defects best treated by regenerative approaches -Be judicious in amount of bone removal; retain 1mm thickness at crest to prevent buccal bone resorption -Long term benefits of Osseous resection include better PD reduction -However, compliance and maintenance is most critical for long term success

How much swelling is expected post-surgery?

-Most of surgical procedures result in a certain degree of swelling -Reaches its maximum 48 to 72 hours after surgery. -Day 3 and 4: starts to decrease -Day 7: resolved -Increased swelling after the third day may be a sign of infection

What is involved in the comprehensive treatment plan of preventing surgical complications?

-Must include treatment planning of ALL disciplines -Treatment Options: RPD, fixed bridge, implant-supported bridge???? → Lack of interocclusal space when the patient bites down - need to address. Probably osteectomy

What is the M/D width for natural teeth from implants?

-Natural teeth = 1.5 mm

Is it possible to achieve 100% osseointegration with an implant?

-Never = 100%. Average contact = 25-75%

What is piezoelectricity/piezoelectric effect?

-Piezoelectricity (also called the piezoelectric effect) is the appearance of an electrical potential (a voltage, in other words) across the sides of a crystal when you subject it to mechanical stress (by squeezing it) -In other words, if you mechanically squeeze a piezoelectric crystal, such as quartz, you can make electricity flow through them (Direct Piezoelectric Effect) -Our goal is mechanical movement, NOT the Direct Piezoelectric Effect

When should you place a healing abutment?

-Place healing abutment if insertion torque >15 Ncm and no need to addition augmentation.

What is involved with implant surgical protocols? (4) - detailed

-Pre-operative antibiotics -Implant is sterile and biocompatible material. -Material of Choice: Titanium -Light-weight, biocompatible, chemically inert (does not corrode readily), mechanically strong -Site preparation under clean/STERILE environment + as atraumatic as possible. -Sharp drills. -Minimizes operator fatigue → if drills are dull, you need to put more pressure. Reduces heat generation. -More efficient preparation of the site. Reduces excessive apical force being applied to the alveolar bone during preparation. -Starting with a small drill, gradually move to a larger drill. -Minimize trauma and heat generation by irrigating with lots of saline; good infection control -Ample irrigation/coolant. Critical temperatures 47˚C (117˚F) 1 minute or 40˚C (104˚ F) for 7 minutes. -Intermittent drilling technique. Pumping action to increase irrigation and allowing for heat dissipation. -Place healing abutment if insertion torque >15 Ncm and no need to addition augmentation. -Implant is weakest 2 weeks post-operatively. Implant should be placed with good initial stability

What are the requirements of implant surgical protocols? (4)

-Pre-operative antibiotics -Implant is sterile and biocompatible material. -Site preparation under clean/STERILE environment + as atraumatic as possible. (Sharp drills, Ample Irrigation/coolant, Intermittent drilling technique) --Place healing abutment if insertion torque >15 Ncm and no need to addition augmentation.

What are the advantages of osseous bone resection? (3)

-Predictable results (if done properly) and long lasting for compliant patients -Minimal waiting period for healing- 8 to 12 weeks → regenerative procedures need to wait about 6 months -Pocket reduction allows good plaque control

What is primary stability influenced by? (3)

-Preparation technique i.e. surgical technique -Bone quality (Misch) i.e. mechanical characteristics of bone (quality and quantity) -Implant type i.e. thread, pitch, macrodesign

What are the local anatomical factors present that could lead to contraindication for resective osseous procedures? (4)

-Presence of local anatomic factors → limit the ability to do surgery -Ascending ramus -External oblique ridge -Maxillary sinus -Very shallow palate

How is post-surgical bruising prevented and managed?

-Prevention and Management: same as management of postop swelling.

How do we manage surgical complications?

-Prevention of complication is the best way to manage surgical and/or nonsurgical complications

What is osseous surgery?

-Procedures by which changes in the alveolar bone can be accomplished to rid it of deformities induced by periodontal disease or other related factors.

What is the internal anatomy of the quartz crystal in the piezoelectric ultrasonic scaler?

-Quartz crystal is sandwiched between two metal plates. -When current flows over the quartz crystal, it squeezes the crystal toward the longitudinal axis of the hand piece.

How are osseous defects diagnosed and evaluated? (2)

-Radiographs- periapical/ bite wings/ CBCT -Clinical- conventional probing/ transgingival probing (bone sounding)

what is the ratio of the maxillary central incisor supposed to be in terms of length: width?

-Ratio of Mx. central incisor (Length:width = 2:1)

What are the regenerative predictability factors for osseous defects?

-Regenerative predictability -Deep Defect > Shallow Defect -3 wall defect > 2 wall defect > 1 wall defect -Narrow defect > Wide defect

What is the crown lengthening procedure workflow for functional crown lengthening?

-Removal of defective restoration or caries removal; RCT, provisional restoration -Full thickness flap with osseous recontour -6-8 weeks of healing - refers more to posterior; if it is in the esthetic zone, you'll want to wait longer -Restorative procedure

What can we use during diagnosis/evaluation of osseous defects using PAs and bitewings?

-Reveal the existence of angular bone loss in the interproximal space -Radiopaque materials can aid in determining the defect depth and contour -Provides only 2-D information -Can often underestimate the amount of bone loss -Early changes are usually not detected (30-40% mineral loss) -Difficult to identify interdental craters → or bone loss extending in the buccal lingual dimension; related to the 2-D limitation

What are some reminders (2) for analog conventional surgical templates?

-Review wax up with Prosth and Perio prior to fabrication of vacuum form matrix. -Material at least 0.75 mm for rigidity.

What is radicular blending,, and what step is it of the osseous resective technique?

-Second step -Rotary instruments -To gradualize the bone over the entire radicular surface - Provides a smooth, blended surface for good flap adaptation i.e. you join the groove you initially made, remove the bone, and provide a smooth surface

Where does the greatest osseous scalloping typically occur?

-The greatest osseous scalloping is around the maxillary anterior teeth and flattens out around the posterior teeth (Gargiulo et al. 1961)

What is the technique used for piezoelectric scalers?

-Select the appropriate insert tip indicated for scaling -Using the colored wrench, gently tighten the insert tip into the handpiece until you hear a "click" sound (this "click" sound indicates that the insert tip is locked into the handpiece) -Adjust the power control and lavage control to their appropriate settings -Operate the piezoelectric scaler using the same methods and techniques used when operating the magneto-strictive scaler -When not using the piezometric scaler, cradle the handpiece back onto the instrument tray and make sure to cover the insert tip with the colored wrench so as to avoid any iatrogenic exposures

What should the lavage be set on for piezoelectric ultrasonic scalers?

-Set lavage so that a halo of water (a mist) is coming out of the tip

What should the power knob be set at for piezoelectric universal scalers?

-Set power knob within the blue band

What are the esthetic indications for crown lengthening? (2)

-Short clinical crown -Excessive gingival display

What are the factors related to post-op infections? (4)

-Size of bacterial infection → bacterial load -Extent and time of surgery → the duration of surgery is important beucase the longer the sit is open the more likely to infect -Presence of foreign body -Level of host resistance → are they immuno-comprimised

Which tip for the ultrasonic is similar to a periodontal probe?

-Slim Diameter Straight subgingival tip

Describe the spread of infection seen with an invasion of the submandibular space

-Spread of infection: may spread to the contralateral space and/or into the sublingual space and/or submental space

What are the stages of passive eruption?

-Stage I -The sulcus & JE are on enamel (teeth reaching plane of occlusion) -Stage II -The sulcus is on the enamel, JE is on enamel and cementum -Stage III - The sulcus is on CEJ, JE is on cementum -Stage IV -The sulcus and JE are apical to the CEJ (totally on cementum) -portion of the root may or may not be clinically exposed → we usually see these 2 on our patients

What are the types of static implant surgery? (3)

-Static computer aided implant surgery (3D printed) -Convention surgical guides (Vacuum form) -Free hand

what are the functional and restorative indications for crown lengthening? (6)

-Subgingival caries -Deep subgingival margin existing - issue taking a good impression -(Hz) crown/root fracture below gingival margin -Tooth needing restoration w/o adequate retention and resistance form -Tooth needing restoration w/o adequate interocclusal space -Excessive gingival display

What are the primary mandibular spaces? (3)

-Submandibular space -Sublingual space -Submental space

What are the general indications for use of ultrasonic instruments? (7)

-Supragingival and subgingival scaling -Deep Furcation Access -Removal of stains -Gross debridement (prior to oral surgery) -Removal of orthodontic cement -Removal of overhangs on restorations -Patients who present with periodontitis and/or have moderate-to-heavy plaque/calculus deposits → wouldn't use it for light calculus because you're going to have to scale anyway so just use hand instruments

What is the definition of secondary stability?

-Surface roughness + Chemistry (fluoride-coated implants) -Healing capacity i.e. how your body and bone is biologically responding to the implant surface

What are some other complications that may be signs of post-surgical infection?

-Swelling -Bruising -Trismus

What are the clinical features of a violation of the buccal space? (3)

-Swelling of the cheek, lower eyelids -Angle of the mouth shifted to opposite side -Swelling in the cheek

What are the clinical features of a violation of the canine space? (3)

-Swelling of the cheek, lower eyelids -Edema of the lower eyelid -Swelling of the upper lip

What does the power setting on a magnetostrictive unit adjust?

-The "Power" setting adjusts the Stroke Amplitude of the insert tip

What is the definition of stroke amplitude, and what is it adjusted by?

-The "Power" setting adjusts the Stroke Amplitude of the insert tip for a magnetostrictive unit -Stroke Amplitude is the range or distance the insert tip moves in one cycle -Analogy: swing→ push harder= swing moves further

What instrument is used to lift the sinus membrane?

-The Sinus Currettes are uses to lift the sinus membrane

What is the short upper lip, and what is it supposed to be on average?

-The approx. repose upper lip length in young adult: -Female: 20-22 mm -Male: 22-24 mm

What does primary stability determine?

-The degree of primary stability at the bone-to- implant interface during initial healing is of utmost importance in achieving good secondary stability.

during esthetic crown lengthening, which side of the gingiva is typically operated on?

-The facial side -You're not really touching the interdental or lingual palatal side

Via the model demonstration for osseous resection, what are the steps that occur

-The yellow lines show the marginal bones and red areas are where the defect is present -First step was bulk reduction by making the vertical grooves in the interdental sites on the buccal and lingual 1. The marginal bones and defect walls are not touched yet in this step -Then you move to the removal of the crater walls and you get thinning of the radicular bone for anticipated amount of scallop 1. The base of the defect is not modified 2. The base of the defect forms the new peak so you get ideal positive architecture -After that, we resect radicular bone and we can use hand instruments to do so. We already made our scallops and now we have to make the area more smooth. The yellow peaks of bones at line angles are removed with hand instruments. -Failure to remove widow's peaks allows tissue to rise to a higher level than the baes of the bone loss in the interdental area (lead to deep pockets forming again) OVERALL: we never touch the base of the defect (new highest point)

What are the indications for slim scaling tip from the piezoelectric scaler?

-Thin diameter tip -To be effective, the tip must be oriented tangentially to the surface being treated and must be moved in a back- and-forth sweeping motion without excessive lateral pressure -Precise control of power and irrigation is a guarantee of better efficiency -Set power knob within the green band (low power) -Set lavage so that a halo of water (a mist) is coming out of the tip -Indicated for fine supragingival scaling ANDsubgingival scaling. Also indicated for scaling tight interproximal spaces

What are the indications for microtip scaling tip from the piezoelectric scaler?

-Thinner diameter tip -To be effective, the tip must be oriented tangentially to the surface being treated and must be moved in a back-and-forth sweeping motion without excessive lateral pressure -Precise control of power and irrigation is a guarantee of better efficiency a) Set power knob within the green band (low power) b) Set lavage so that a halo of water (a mist) is coming out of the tip -Indicated for fine subgingival scaling -The two graduated bands are used to evaluate the periodontal pocket depths while debriding the root

When is a transcrestal approach for a sinus lift indicated?

-This approach is usually done when there is 5mm or more remaining bone in the area

Describe the process of the transcrestal approach to a sinus lift

-This approach is usually done when there is 5mm or more remaining bone in the area -Prepare an osteotomy site like you would for an implant and lift the membrane through that -Tap and break through the bone. Elevate the membrane and place the bone graft material and you can simultanously place the implant in that area. -Note: patients can sometimes experience headaches from tapping on the mouth

What is involved in the preoperative assessment of preventing surgical complications? (2)

-Thorough medical history **Risk of infection: 2.09%, with or without antibiotics -Updated, diagnostic radiographs

What is the right hand rule for Magnetostrictive scalers?

-Thumb - points in the direction of the electrical current (I) -Fingers - curl in the direction of the magnetic field (B or H) -Palm - points in the direction of the magnetic force (F)

What is the issue if the B/L width is too thick?

-Too thick/ too far palatal = increased risk of palatal placement + ridge lap design (plaque trap)

What is the issue if the B/L width is too thin?

-Too thin/ too far buccal= increased risk of resorption, recession and thread exposure = increased risk of complications

What is transgingival probing?

-Transgingival probing- Bone sounding (under anesthesia) provides topography information of defect in vertical and horizontal direction

What are the two most common frequency inserts?

-Two most common frequency inserts are 25k (kHz) and 30k (kHz)

Compare and contrast the two most common frequency inserts

-Two most common frequency inserts are 25k (kHz) and 30k (kHz) -30k tips are smaller and lighter than 25k tip -The higher the frequency: -the greater the frictional heat -the shorter the active tip (30 kHZ- 4.2 mm vs. 25kHz- 4.3 mm)

What is Tylenol #3?

-Tylenol #3 - 30 mg Codeine and 300 and 300 mg Acetaminophen

What is the effect of ultrasonic scalers on root surfaces?

-Ultrasonic scalers create microscopic irregularities and roughness on the root surface -Need to root plane with hand instruments! - WILL BE TESTED ON

What does the osseous morphology look like under normal and healthy circumstances?

-Under normal and healthy circumstances: the osseous morphology always present parallels to the CEJ around the tooth. -The greatest osseous scalloping is around the maxillary anterior teeth and flattens out around the posterior teeth (Gargiulo et al. 1961)

What are the names of the tips for piezoelectric scalers?

-Universal -Slim tip -Microtip

What is post-surgical infection most commonly caused by?

-Usually caused by the indigenous bacteria -Primarily aerobic & anaerobic gram-positive cocci, and anaerobic gram-negative rods

In what direction does vertical bone loss occur in?

-Vertical Bone Loss/Angular- Bone loss occurs in an oblique direction, leaving a hollowed-out trough in the bone alongside the root.

What is the definition of vertical bone loss?

-Vertical Bone Loss/Angular- Bone loss occurs in an oblique direction, leaving a hollowed-out trough in the bone alongside the root.

What is Vicodin 5/500?

-Vicodin 5/500 - 5 mg hydrocodone and 500 mg acetaminophen

What is Vicoprofen?

-Vicoprofen - 7.5 mg hydrocodone and 200 mg ibuprofen

What is used for additive microdesigns?

-i.e. inorganic mineral coating, plasma spraying, growth factors, calcium phosphates, sulfates, carbonates, hydroxyapatite. -Results in a rougher surface to increase osseointegration

For Posterior Interproximal sites, how should the magnetostrictive tip be directed?

1) For Posterior Interproximal Sites: Direct the insert tip apical to the interproximal contact so that that the lateral surface is parallel to the proximal surface -Direct the insert tip apical to the interproximal contact so that that the lateral surface of the insert tip is parallel to the interproximal surface

What is the basic instrumentation technique for using a magnetostrictive device?

1) Light modified pen grasp, light stable intraoral/extraoral fulcrums, and light lateral pressure! -Let the ultrasonic do the job! (no "Working Stroke" necessary) -Increasing lateral pressure may minimize the mechanical vibrations which diminishes the "chipping" action of the ultrasonic instrumentation and ultimately the effectiveness of the device

What parts of the ultrasonic tip should be touching the tooth, and which ones should not be?

1) Never direct the point of the tip perpendicular into the tooth surface -Point: generates the most energy → not used on tooth (used on deposit) -Face (concave)- 2nd most powerful; do not adapt to tooth -Back (convex surface)‐ less energy then face/point; can be adapted to tooth -Lateral surfaces: (sides)‐ least amount of energy 1. Used directly on tooth recommended by all power instruments

Why should we be releasing the foot pedal periodically when using the ultrasonic?

1) Release foot pedal periodically to allow for aspiration of water, debris, and blood and to increase patient comfort (avoid drowning the patient)

What 3 things are involved with site preparation under clean environment + atrauamatic as possible?

1) Sharp drills. -Minimizes operator fatigue → if drills are dull, you need to put more pressure. Reduces heat generation. -More efficient preparation of the site. Reduces excessive apical force being applied to the alveolar bone during preparation. -Starting with a small drill, gradually move to a larger drill. -Minimize trauma and heat generation by irrigating with lots of saline; good infection control 2) Ample irrigation/coolant. Critical temperatures 47˚C (117˚F) 1 minute or 40˚C (104˚ F) for 7 minutes. 3) Intermittent drilling technique. Pumping action to increase irrigation and allowing for heat dissipation.

What is a subperiosteal implant?

1) Subperiosteal: -Intimate adaptation to underlying bone without penetration of the bone.

What are the 3 types of implants?

1) Subperiosteal: -Intimate adaptation to underlying bone without penetration of the bone. 2) Transmandibular/ transosseous: -Penetration through inferior border of the mandible. Invasive. -Frame work: U-shaped + Transalveolar pins 3) Endosseous: (Everyday implants). What we use now. -Penetration of alveolus without penetration of inferior border of mandible.

The resective technique can be broadly categorized in 4 steps:

1) Vertical grooving 2) Radicular blending 3) Flattening interproximal bone 4) Gradualizing marginal bone

Reminder: what are the steps you should do prior to using the ultrasonic device? (4)

1. 0.12% chlorohexidine gluconate rinse for 30 seconds → reduces bacterial levels in oral cavity and aerosol → CDCA recommends that all patients do this to reduce viral loads 2. Flush out the unit for 1-2 minutes→ clears out the stagnant water and reduces the biofilm in the tubing 3. Select proper insert tip 4. Set power to lowest effective setting 5. Adjust coolant spray (lavage setting) to create a halo effect - KEY

What are some steps we want to do prior to the use of an ultrasonic device?

1. 0.12% chlorohexidine gluconate rinse for 30 seconds → reduces bacterial levels in oral cavity and aerosol → CDCA recommends that all patients do this to reduce viral loads 2. Flush out the unit for 1-2 minutes→ clears out the stagnant water and reduces the biofilm in the tubing 3. Select proper insert tip 4. Set power to lowest effective setting 5. Adjust coolant spray (lavage setting) to create a halo effect - KEY

What is the goal of additive microdesigns?

1. Additive (coat or add material to the surface) -Goal: enhance chemical bonding with host cells. -i.e. inorganic mineral coating, plasma spraying, growth factors, calcium phosphates, sulfates, carbonates, hydroxyapatite. -Results in a rougher surface to increase osseointegration

How do we create microdesigns for implants?

1. Additive (coat or add material to the surface) -Goal: enhance chemical bonding with host cells. -i.e. inorganic mineral coating, plasma spraying, growth factors, calcium phosphates, sulfates, carbonates, hydroxyapatite. -Results in a rougher surface to increase osseointegration 2. Resective (subtractive processes that remove material from the surface) -Goal: Enhance rate of osseointegration. i.e. machining, acid etching, blasting or combination

What are the therapeutic determinants for treatment planning for osseous defects?

1. Depth of the defect → most important 2. Width of the defect 3. No. of remaining bony walls 4. No. and configuration of the adjacent root surfaces

What are some hemostatic agents used to minimize intrasurgical bleeding? (4)

1. Gelatin sponge 2. Oxidized cellulose (surgicel) 3. Topical thrombin -Thrombin bypasses all steps in the coagulation cascade and helps to convert fibrinogen to fibrin enzymatically, which forms a clot. 4. Collagen -Plug (collaplug) -Tape (collatape)

What is the sequence of conventional implant surgery? (7)

1. Impression 2. Wax-up - ideal restorative location with occlusion 3. Vacuum template (ideally 0.75mm) 4) Trim to height of contour on all teeth except prosthetic tooth for implant and adjacent teeth. 5. Radiographic material + CBCT 6. Plan implant position in software to estimate position. 7. Use template for initial osteotomies and angulation checks. Implant placement/ contour augmentation with template.

KNOW THIS What is the crown lengthening surgical sequence?

1. Inverse bevel incisions → IF only soft tissue, this is IT 2. Full thickness flap reflection, soft tissue debridement 3. Ostectomy to establish 3-4mm of sound tooth structure apical to restoration/ caries/fracture 4. Osteoplasty to improve bone contours for better flap adaptation 5. Recement the temporary crown 6. Reposition or replace the flap suture 7. Apply periodontal dressing as needed **For cases requiring FACIAL bone removal = the rest

What is the sequence of post-surgical bruising? (6)

1. Local trauma causing extravasation 2. Escape of Red Blood Cells into the soft tissue 3. Macrophages phagocytose Red Blood Cells 4. Release of Hemoglobin (blue-red appearance/ discoloration on the skin) 5. Conversion of Hemoglobin to Bilirubin (blue-green color appearance/discoloration) 6. Conversion of Bilirubin to Hemosiderin (golden-brown appearance/discoloration)

What are the 5 categories that we focus on when it comes to preventing surgical complications?

1. Preoperative assessment -Thorough medical history -Radiographs 2. Comprehensive treatment plan 3. Provider factors 4. Anatomical considerations → don't just do surgery make sure you do a consult to get to know the patient well so you know their history 5. Surgical considerations

What are the disadvantages of the high power settings? (5)

1. Requires more water to lavage the tooth and to cool the insert tip 2. Produces contaminated aerosol (greater splash back of the coolant toward the direction of the operator) 3. Greater potential of iatrogenically damaging the tooth and/or the attachment apparatus 4. May increase patient discomfort due to greater stroke amplitudes of the insert tip 5. Medium "Power" setting is as effective as high "Power" setting in removing deposits

What are factors that contribute to a gummy smile? (4)

1. Vertical maxillary excess -The middle 3rd of the face should approx. equal to the lower 3rd of the face 2. Short upper lip -The approx. repose upper lip length in young adult: -Female: 20-22 mm -Male: 22-24 mm 3. Hyperactive upper lip -Avg. lip mobility from repose to full smile is 6-8 mm 4. Altered passive eruption → ONLY one that can be treated with esthetic crown lengthening

The ________ in a magnetostrictive device induces torsional oscillation of the insertion tip A. Ferromagnetic Stack B. Quartz Crystal C. Dilithium Oxide chamber

A. Ferromagnetic Stack

What is the definition of positive bony architecture?

A. Positive Bony Architecture- Radicular bone is apical to the interdental bone

What are the 3 types of bony architecture?

A. Positive Bony Architecture- Radicular bone is apical to the interdental bone B. Flat Bony Architecture- Reduction of the interdental bone to the same height as the radicular bone C. Negative Bony Architecture- Interdental bone is apical to the radicular bone → this is what you see in periodontitis and is one of the most common indication for osseous resection to reduce pocket depths

What is the definition of a dental implant?

AAP ~ " A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge."

Anatomy - Where is the submental space located?

Anatomy: Superior to the mylohyoid muscle

Anatomy - Where is the buccal space located?

Anatomy: between the buccinator muscle and the skin of the cheek.

Anatomy - Where is the submandibular space located?

Anatomy: mandibular lingual cortical plate laterally and mylohyoid medially

Anatomy - Where is the infratemporal space located?

Anatomy: posterior to the maxilla, between the lateral pterygoid plate of the sphenoid bone medially and the base of the skull (think "medial to the temporalis muscle)

What is the definition of flat bony architecture?

B. Flat Bony Architecture- Reduction of the interdental bone to the same height as the radicular bone

-If a patient is complaining of sensitivity while being scaled with an ultrasonic scaling device, all of the following actions will be appropriate to counter this problem EXCEPT 2. Which two are inappropriate? A. Proceeding to another tooth then returning to sensitive area later B. Moving the instrument slower C. Adjusting water spray D. Using less pressure

B. Moving the instrument slower

What are the basic rules of osseous surgery? (4)

Basic Rules of Osseous Surgery (2021 NEW SLIDE) 1. A full-thickness mucoperiosteal flap should be raised 2a. The scalloping of the flap should anticipate the final underlying osseous contour, which is more prominent anteriorly & decreases posteriorly 2b. The scalloping of the flap should reflect the patient's own healthy gingival architecture 2c. The degree of tissue and bone scalloping is reduced,a s the interproximal area becomes broader as a result of bone loss.

What are the 3 categories for supragingival tip selection?

Bever-tail → think strong -Moderate to heavy plaque deposits -Gross debridement, removal of ortho-cement -Never use sub-g -Medium power setting Triple Bend -Small to medium plaque/calculus -Sub-g if the tissue allows -Low-medium power Universal -Small to medium plaque/calculus deposits -With caution sub-g -Low-medium power

What is the biologic aspect of successful implant placement?

Biologic = functional relationship of osseointegration maintained bwn implant substrate and host

Which category of success criteria does osseointegration fall under?

Biologic = functional relationship of osseointegration maintained bwn implant substrate and host

-Ultrasonic instrumentation is accomplished with a: A. heavy touch and light pressure, keeping tip perpendicular to the tooth and in constant motion B. Light touch and heavy pressure, keeping the tip parallel to the tooth surface and stationary C. Light touch and light pressure, keeping the tip parallel to the tooth and constantly in motion D. heavy touch and heavy pressure, keeping tip perpendicular to the tooth and stationary

C. Light touch and light pressure, keeping the tip parallel to the tooth and constantly in motion

What is the definition of negative bony architecture?

C. Negative Bony Architecture- Interdental bone is apical to the radicular bone → this is what you see in periodontitis and most common indication for osseous resection to reduce pocket depths

-Each of the following describes the modes of action for Cavitrons EXCEPT one. What is the exception? A. Cavitron B. Lavage C. Piezo movement D. Vibration

C. Piezo movement

82% of the time, what is considered the esthetic tooth dimensions for width of the CI, LI, and canine?

CI = 8-9mm LI = 6-7mm canine=7-8 mm

Anatomy - Where is the canine space located?

Canine space is the region between the anterior maxilla and the overlying tissues of the upper lip

When looking at the retrospective study at the UM SOD evaluating long-term success of crown lengthening, what were the main causes of failure/ ext?

Causes of failure/ ext -#1 = Restorative (secondary caries, repeated dislodgment of crowns)= 35.2% -Tooth fracture=29.6 -Endo failure= 23.9% - Perio origin= severe loss of supporting periodontium furcation involvement, mobility =11.3%

What is the cavitation effect of the coolant?

Cavitation Effect: as the coolant contacts the vibrating tip, it forms millions of little liquid bubbles -Bubbles ricochet off the vibrating tip and hit the tooth at high speed

What is the primary mechanism of action of the ultrasonic when it is removing debris and calculus?

Cavitation Effect: as the coolant contacts the vibrating tip, it forms millions of little liquid bubbles -Bubbles ricochet off the vibrating tip and hit the tooth at high speed -When bubbles hit the tooth, they collapse and release bursts of energy with rupture the bacterial cell wall and disrupt the subgingival microbial environment

What is the most commonly seen type of two-wall defect?

Classic crater: buccal and lingual walls are present, and the adjacent proximal walls are absent.

What are the clinical features of a violation of the infratemporal space? (4)

Clinical features: -Extraoral swelling over the sigmoid notch area -Intraoral swelling in tuberosity area -Trismus -Infection will spread via the pterygoid plexus of veins and enter the cavernous sinus→ cavernous sinus thrombosis

What are the clinical features of a violation of the sublingual space? (4)

Clinical features: -Indurated swelling of the submandibular region -Swelling of the floor of the mouth -Dysphagia -Difficulty in breathing (all symptoms of Ludwig's angina)

What is the 1st thing you do for crown lengthening procedures, regardless of whether it is for esthetic or functional purposes?

Consultation (intraoral and radiographic exams)

What are the contraindications for using an apically positioned flap + osseous resection for crown lengthening?

Contraindications -Bone crest 2- 3mm apical to restorative margin

What are the contraindications for using an apically positioned flap only for crown lengthening?

Contraindications -Bone crest <2mm apical to restorative margin

What are the contraindications for using a gingivectomy for crown lengthening?

Contraindications -Inadequate zone of KG -Bone crest <2mm apical to restorative margin

What is the cooling effect of the coolant?

Cooling Effect: cools down the activated insert tip and dissipates frictional heat

What are the 3 purposes of coolant

Cooling Effect: cools down the activated insert tip and dissipates frictional heat Lavage Therapy: constant flushing of debris from the site being debrided Cavitation Effect: as the coolant contacts the vibrating tip, it forms millions of little liquid bubbles -Bubbles ricochet off the vibrating tip and hit the tooth at high speed -When bubbles hit the tooth, they collapse and release bursts of energy with rupture the bacterial cell wall and disrupt the subgingival microbial environment

What is the cosmetic aspect of successful implant placement?

Cosmetic = papilla, margins, color, etc. correct M-D, apical, coronal, B-L position for esthetics.

Compare and contrast the crown lengthening procedure workflow between esthetic vs. functional crown lengthening

Esthetic -Bone sounding -Diagnostic wax-up -(Surgical stent) -Full thickness flap with or without osseous recontour -Soft tissue only-4-6 weeks for healing (i.e. gingivectomy) -If osseous 4-6 months for healing -(Restorative procedure) if the patient needs a veneer or crown on their anterior teeth Functional -Removal of defective restoration or caries removal; RCT, provisional restoration -Full thickness flap with osseous recontour -6-8 weeks of healing - refers more to posterior; if it is in the esthetic zone, you'll want to wait longer -Restorative procedure

What is the etiology of a violation of the infratemporal space?

Etiology: Infection from the maxillary 3rd molars and infection distal to the maxillary third molars

What is the etiology of a violation of the buccal space?

Etiology: Infection from the maxillary AND mandibular premolars and molars

What is the etiology of a violation of the submandibular space?

Etiology: infection from the mandibular 2nd and 3rd molars that perforate through the lingual plate

What is the etiology of a violation of the submental space?

Etiology: infection from the mandibular incisors or an anterior extension of the submandibular or sublingual spaces

What is the etiology of a violation of the sublingual space?

Etiology: infection from the mandibular premolars or mandibular 1st molars that perforate through the lingual plate

What reflection in intra-oral exam should you look for when it comes to the physical examination for post-surgical infection?

Extra-oral exam -Patient's general appearance -Facial asymmetry -Swelling -Lymph nodes

What is the fixed or removable dental prostheses?

Fixed or removable dental prosthesis. -Crown or RPD/CD. -Cemented, Screwed, "Screw-mentable".

What are the components of an implant? (3)

Fixed or removable dental prosthesis. -Crown or RPD/CD. -Cemented, Screwed, "Screw-mentable". Trans-mucosal abutment (includes internal or restorative screw). -"Seat for the Implant Crown" -Connection between restorative and surgical aspect of care. -Straumann platform switch connection. -Implant fixture (body). -Surgical screw. -Alloplastic material (i.e. Ti, Ti/Zr, Zr). -Placed surgical beneath the periosteum within the alveolar housing or within the bone for functional, therapeutic, or esthetic purposes

What is the frequency defined as when it comes to ultrasonic scalers?

Frequency = the number of times the insert tip moves/second) -Oscillation frequency: 20,000 Hz- 45,000Hz

What is the definition of frequency when it comes to ultrasonics?

Frequency is the number of times the insert tip moves per second (cycles per second)

What are some general recommendations when it comes to the potential transmission of COVID and using ultrasonic scalers?

General Recommendations: -Screening protocols -PPE -Minimize the use of ultrasonic instruments to reduce the risk of aerosols -Rubber dam -Pre-procedure mouthrinse to reduce coronavirus in saliva -Negative-pressure treatment rooms -Disinfect inanimate surfaces→ COVID can remain viable in aerosol and survive up to 3 days on surfaces at room temp.

What are the two types of flap designs we can use for crown lengthening when we are only trying to remove soft tissue?

Gingivectomy -Indications -Adequate band of KG (3-4 mm KG left AFTER gingivectomy) -Bone crest is 2-3 mm apical to restorative margin or fracture -Contraindications -Inadequate zone of KG -Bone crest <2mm apical to restorative margin Apically position flap only -Indications -Inadequate band of KG to proceed with gingivectomy -Bone crest is 2-3 mm apical to restorative margin or fracture -Contraindications -Bone crest <2mm apical to restorative margin

Who is responsible for the classification of angular defects? What is that classification system based off of?

Goldman and Cohen -Based on the number of osseous walls remaining

What are the 3 signs of normal alveolar bone morphology?

I. Interproximal bone is more coronal in position than the labial or lingual/palatal bone. II. The form of interdental bone is a function of tooth form & embrasure width. -More tapered tooth- pyramidal bony form/ accentuated scalloping (anterior) -Wider embrasure- flatter interdental bone/ flat scallop → usually in the posterior III. Position of the bony margins mimics the contours of the CEJ

What are the ideal parameters in which we should consider osseous recontouring as a treatment modality?

Ideal: ≥5mm PD and ≤3mm osseous defect ≤5mm PD: non-surgical management ≥3mm osseous defect: regeneration/GTR

What are some ways to minimize instrasurgical bleeding? (2)

Identification of bleeding site: -Bleeding from soft tissue: -Direct pressure for 5 minutes → #1 is compression of the site! -Ligation -Bleeding from bone -Crushing nutrient canals with a hemostat -Direct pressure over an exposed marrow space

What are the advantages of ultrasonic instrumentation? (8)

Increased patient comfort -More time efficient -Less operator fatigue -No cutting edges -No sharpening required -As effective as hand instrumentation -Bacteriocidal effects (cavitation effect and acoustic turbulence) -Better access to deep pockets and furcations -Delivery of antimicrobials (i.e. Chlorhexidine gluconate 0.12%)

What can an inflammatory reaction result in? (4)

Inflammatory Reaction can lead to [Cellulitis, Fistula, Bacteremia/septicemia, or Deep fascial pain]

What reflection in extra-oral exam should you look for when it comes to the physical examination for post-surgical infection?

Intra-oral exam -Swelling -Erythema -Palpation

What are the two stages o f surgical complications?

Intra-surgical complications post-surgical complications

In terms of invasions of fascial spaces, what can cause a cavernous sinus thrombosis?

Invasion of the infratemporal space -Infection will spread via the pterygoid plexus of veins and enter the cavernous sinus→ cavernous sinus thrombosis

An invasion of what fascial space presents with clinical features that are all symptoms of Ludwig's angina?

Invasion of the submandibular space, sublingual space, OR submental

What is selection of the proper ultrasonic tip size based on?

Location of plaque/calculus (supragingival vs subgingival) 2) Size of plaque/calculus (light vs. moderate vs. heavy) -Magneticstrictive

What are the indications for using a low power setting? (2)

Low -Less damage to attachment apparatus -More coolant to enter calculus

The clinical features of a violation of the submandibular space, sublingual space, and submental space are all symptoms of what?

Ludwig's angina

Should we be using CBCTs for routine diagnosis of intra-bony or fucation defects?

NO -Limited evidence to support the utilization of CBCT for routine diagnosis of intra-bony and furcation defects

What is the advantage of using high power setting?

NONE- Medium "Power" setting is as effective as high "Power" setting in removing deposits

What is the average contact seen with osseointegration?

Never = 100%. Average contact = 25-75%

What falls under success criteria for implants?

Non-mobile, ideal restorable position, BIC radiographically, non-symptomatic, limited BL. -Vertical bone loss < 0.2mm annually after the implant's 1st year of service. Oftentimes during 1st year, bone remodeling is ~1.2mm Biologic = functional relationship of osseointegration maintained bwn implant substrate and host Mechanical = resists non-axial or excessive force & distributes to surrounding bone w/o fracture Cosmetic = papilla, margins, color, etc. correct M-D, apical, coronal, B-L position for esthetics.

What tool is best used for removing the widow's peak?

Oschenbein chisel

What type of ultrasonic scaler is the HU-Friedy's Symmetry IQ?

Piezoelectric

Define gingivectomy

Removal of soft tissue only -it is usually for Type 1A altered passive eruption -indication: when there is an adequate amount of KG and the bone crest is 2-3mm apical to the restorative margin or the CEJ

What is flattening of the interproximal bone, and what step is it of the osseous resective technique?

Step 3 -Requires removal of very small amounts of supporting bone (ostectomy step) -Indicated when interproximal levels vary horizontally. This allows us to keep the interdental bone at a higher level vs. radicular bone. -When we work on crater reduction, we will incorporate the supporting bone around the tooth to flatten the interproximal bone.

What are the two types of osseous surgery?

Subtractive Osseous Surgery → focus of today -To restore the form of pre-existing alveolar bone to the level present at the time of surgery or slightly more apical to this level Additive Osseous Surgery -Procedures directed at restoring the alveolar bone to its original level

What types of angular defects are ideal for regenerative procedures?

Three-wall defects

Why is an ice-pack used post-surgery?

To manage swelling -helps reduce the temperature and cause vasoconstriction

What is the trans-mucosal abutment?

Trans-mucosal abutment (includes internal or restorative screw). -"Seat for the Implant Crown" -Connection between restorative and surgical aspect of care. -Straumann platform switch connection

What is Type 1 Subtype A for altered passive eruption? What treatment is proposed?

Type 1 → ≥ 2mm KG (sufficient) Subtype A is when the bone is at 1.5-2mm below the CEJ -1A Tx: gingivectomy (too much tissue, bone ok) -Subtype B is when the bone is at the CEJ -1B Tx: gingivectomy + osseous -Type 2 → < 2 mm of KG (insufficient) -Subtype A is when the bone is at 1.5-2mm below the CEJ -2A Tx: apically positioned flap -Subtype B is when the bone is at the CEJ -2B Tx: apically positioned flap and remove the bone

What is Type 1 Subtype B for altered passive eruption? What treatment is proposed?

Type 1 → ≥ 2mm KG (sufficient) Subtype B is when the bone is at the CEJ -1B Tx: gingivectomy + osseous

What is Type 2 Subtype A for altered passive eruption? What treatment is proposed?

Type 2 → < 2 mm of KG (insufficient) -Subtype A is when the bone is at 1.5-2mm below the CEJ -2A Tx: apically positioned flap

What is Type 2 Subtype B for altered passive eruption? What treatment is proposed?

Type 2 → < 2 mm of KG (insufficient) Subtype B is when the bone is at the CEJ -2B Tx: apically positioned flap and remove the bone

Do you need to do hand instrumentation if you are using ultrasonic instrumentation?

Ultrasonic instrumentation must be followed by hand instrumentation -Why? Because we need to root plane!

What type of piezoelectric tip is indicated for gross supragingival scaling?

Universal Scaling Tip

What types of strokes should you use with magnetostrictive ultrasonics?

Use overlapping multi-directional strokes (oblique, horizontal, and vertical) and always keep the insert tip moving when in contact with the tooth

What reflection in vital signs should you look for when it comes to the physical examination for post-surgical infection?

Vital signs -Blood pressure -Pulse rate -Respiratory rate -Temperature

What are the 3 main reasons why craters (classic craters) are present?

a. This is the area where plaque accumulates the most and it is the most difficult to access and leads to more bone loss b. The shape of this area is actually flat and the B/L concavity makes bone loss more prevalent in this area c. The vascular pattens in the area to the crest can be compromised and it causes crater formation

How is "supra-crestal tooth structure" measured?

from the crest of the bone to the future restorative margin

What types of ultrasonic scalers are in unit/internal, and which ones are external?

internal: piezo external: magnetostrictive

What type of piezoelectric tip is indicated for fine subgingival scaling only?

microtip

Most rotary instruments are used for ____________ and most hand instruments are used for ____________, but either can be used.

rotary instruments = osteoplasty hand instruments = ostectomy