CLASSIC LIT COMBINED x2
............... et al. 2009 (11) • 39 patients with implants exhibiting signs of peri-implant disease studied over 5-year period o Excess dental cement associated with signs of peri-implant disease in .......% of the cases studied o These signs became absent in .........% of the test implants after removal of this excess cement
Wilson 81% 74%
What effect does dental cement have around implants?
Wilson 2009 - Excess dental cement was associated with peri-implantitis in 81% of peri-implantitis cases in a private practice
Who studied Compliance with maintenance therapy in private practice? What percent of patients completely complied with recall?
Wilson/Glover 1984 - 16% patients complied with maintenance recall - Follow-up study to improve compliance 1993: improved to 32%
Sugarman
With SCTG, get new CT attachment with parallel fibers, new bone and new cementum.
........................ et al 1981, Determine the prevalence of Mx incisor palatogingival grooves and their association with localized periodontal disease o They were only recorded if the grooves were at or extended past the CEJ • Prevalence was ...........% of people (............% of teeth) • .................% of the grooves were in maxillary laterals • No differences in groove presence based on sex or race • Results of GI and PI showed that groove is ..................... with poorer periodontal health and more plaque accumulation • Paper also discusses possible methods of tx: o Flattening by grinding, amalgam restoration, flap to remove granulation tissue/irritants, or extraction o Prognosis of therapy appears to be ............... and most frequently recommended treatment is ...................
Withers 8.5% 2.33% 93.8% associated poor extraction
Palato-radicular grooves are most commonly found on which tooth?
Withers 1981 - 94% of PRGs found in *Maxillary Lateral incisors*
............ 1992 o Retention of hopeless teeth does not affect the adjacent proximal periodontium by looking at hopeless teeth and it adjacent (PD, BL, and PDL space). o As long as you treat the hopeless teeth they can be MTN. o Periodontal therapy may inhibit further bone loss on adj proximal peridontium. • Summary: hopeless teeth does not lead to increased perio destruction as long as it can be maintained.
Wojcik
B36. According to Eke (2015) periodontitis prevalence was highest in all of the following groups EXCEPT: women smokers Hispanics Widowed individuals
Women
How does healing compare in terms of alveolar crest reduction following full vs. partial thickness flaps?
Wood 1972 - Partial thickness flap crest reduction: 0.98 mm - Full thickness flap crest reduction: 0.62 mm (partial thickness flaps healed slower)
Which author is known for ENAP?
Yukna - excisional new attachment procedure (precursor to LANAP procedure with the laser)
What are the 4 modes of calculus attachment?
Zander 1953 - Secondary cuticle - Microscopic irregularities in cementum - Mechanical undercuts - Penetration into cementum refuted by *Canis* 1979
........................ in 1953, described the calculus mode of attachment to the tooth. 1. .................................: the dental cuticle is believed to be remain on cementum when the epithelial attachment migrates apically. 2. Microscopic irregularities of the cementum surface: the previous location of Sharpey's fibers. 3. Penetration of microorganisms making up the calculus matrix into the cementum (later turned out to be not existing). 4. ..........................................
Zander, secondary cuticle, mechanical interlocking
What is the ideal particle size of periodontal bone grafting material?
Zaner 1984 - Ideal size: 380μm
Novel technique for coronally advanced flap using Oblique submarginal incisions
Zucchelli 2000
Sonic: uses ....... pressure for mechanical vibration (frequency of ................. to ....................Hz) Limitations and comparisons. The motion of the tip is either elliptical or orbital Ultrasonic: uses ................... current and change it into mechanical vibration, accompanied by a stream of water. Frequency range of .................. to ....................... Hz and an amplitude range of 10-100µm. with two different types: ............................. and ........................
air 2000 to 6000 electrical 18000-45000 Piezoelectric and magnetostrictive
C23. Under normal probing forces, the probe tip stops ___ the junctional epithelium on teeth affected by periodontitis apical to coronal to at the middle third of
apical
Nabers
apically repositioned flap - increases width of attached gingiva, partial thickness
What is the intermediate bifurcation ridge?
cementum extending from the mesial to the distal of a furcation opening on a mandibular molar. Its existence can hamper effective plaque control (and compromise effective SRP) by the patient or the dentist.
albrektson 1986
clinical mobility radiographic peri-implant radiolucencies >0.2mm annual bone loss after first year pain, infection, paresthesia, or mandibular canal violation
Bernimoulin
coronally positioned graft (2 stage): FGG, wait 2 months, then coronally position graft by 0.5-1mm good for mandibular anteriors
Raetzke
covering localized recession with CTG + envelope technique without vertical release or suturing
Adipose tissue can produce ......................... As we know, cytokines produce a hyper-inflamed state. ..................... et al 2012 found that overall obesity and central adiposity are associated with an ............... hazard of periodontal disease progression in men.
cytokines Gorman increased
Goal of maintenance: • To prevent ....................................... • To prevent/reduce ...................... • To locate other .............................. in a timely manner
disease recurrence tooth loss oral diseases
Robinson
distal wedge - linear, square, triangular, trapdoor
Romanos
double lateral bridging flap
Cohen and Ross
double papilla repositioned flap in periodontal therapy
Is an extracellular matrix ....................... and it is abundant in healing sites. It has been found to promotes the attachment of .................. to root surfaces (.......................... et al. 1986). As showed earlier by Alger study, The tetracycline-HCl and fibronectin treated group had a mean reattachment of ........... mm, no new cementum was observed. They concluded that the addition of fibronectin to tetracycline treated teeth did not enhance connective tissue attachment, and appeared to inhibit it (................. et al. 1990)
glycoprotein fibroblasts Terranova 0.17 Alger
Reattachment
healing of a periodontal wound by the reunion of the connective tissue and roots where these two tissues have been separated by incision or injury but not by disease
A review of the literature concerning the influence of surface roughness on supra and subgingival plaque formation concluded that teeth with a rough surface had ........... plaque accumulation (.................. et al 1995). On the other hand, some other studies concluded the opposite. In a study by ....................., they found no correlation between roughness resulting from instrumentation with manual curettes and cavitron of hopeless teeth up to 232 days with plaque accumulation. And no statistically significant differences in mean plaque scores or mean inflammatory indices were seen between the experimental groups (................ et al. 1976).
higher Quiryne Rosenberg Rosenberg
Comparisons between monozygotic (MZ or ....................) twins and dizygotic (DZ or ..................) twins are conducted to evaluate the degree of genetic and environmental influence on a specific trait. MZ twins are the same sex and share ...........% of their genes.
identical fraternal 100
A.50 According to the 2015 AAP Commissioned Review, the function of neutrophils, monocytes and macrophages is ____ in patients with diabetes compared to healthy controls exacerbated similar impaired
impaired
A.50 According to the 2015 AAP Commissioned Review, the function of neutrophils, monocytes and macrophages is ____ in patients with diabetes compared to healthy controls - exacerbated - similar - impaired
impaired
Grupe + Warren
lateral sliding flap
It has been shown that after SRP, tissue heals by means of ................................... Which histologically resembles the same junctional epithelium but longer (repair) (............. et al 1979).
long junctional epithelium Caton
Reddy et al. 2003 Periostat Sub-antimicrobial dose doxycycline (SDD) 20mg tab BID Systemic host modulator
low dose doxycycline will inhibit MMP and interleukin 1 + scavengers for superoxide American Academy of Periodontology Consensus Report Level of Evidence: strong There is evidence supporting the use of SDD as an adjunct to conventional therapy in the management of chronic periodontitis the evidence indicates that in patients with chronic periodontitis, the adjunctive use of SDD combined with conventional therapy does not result in significant adverse events
Ramfjord and Nissl
modified Widman flap
Pollack
modified distal wedge (adjacent to edentulous areas)
Azithromycin Mascarenhas et al. 2005
n Broad spectrum; bacteriostatic; bind 50s ribosome subunit n Effective against gram (+, -); aerobes, anaerobes n One of the safest macrolids n Higher tissue concentration (100X higher than serum concentration) n Effective as an adjunct to Sc/RP for smokers n Associated with increased risk of death for those with heart problems
Agranulocytosis is a condition where the absolute ................... count is less than ...... per microliter of blood. It can be serious and even life-threatening. Untreated, it can lead to death from the blood infection called septicemia.
neutrophil 100
In a study to evaluate repeated instrumentations Vs. single instrumentation in pts with severely advance periodontitis. In a split mouth design Single Vs. Repeated instrumentation were carried using ultrasonic. The results showed that There are .......................... in clinical results when comparing single versus repeated instrumentation (Badreston et al. 1984)
no differences Badreston
In later human studies by the same group evaluated effect of ethylenediaminetetraacetic acid (EDTA) gel applied during surgical periodontal therapy on probing depth and CAL gain. They reported ........................ difference when using EDTA gel in surgical and non-surgical treatment in terms of pocket depth, CAL, gingival recession or probing bone levels when compared to controls (..................... et al. 2000 I) (.................... et al. 2000 II).
no significant Blomlöf Blomlöf
...............................: a spreading invasive gangrene chiefly of the lining of the cheek and lips that is usually fatal and occurs most often in persons severely debilitated by disease or profound nutritional deficiency.
noma
Junctional epithelium: A unique squamous, .................... epithelium that forms the base of the gingival sulcus and adheres to both tooth and the underlying lamina propria at the base of the gingival crevice. The cells of the junctional epithelium attach to these structures by .................................. via the internal (tooth) and external basal laminas (connective tissue). Historically, this structure was referred to as the ........................................
nonkeratinized hemidesmosomes epithelial attachment
In a monkey study looking at the resilience of such LJE compared to normal length, it was found that long junctional epithelium barrier against plaque infection is ....................... to that provided by a dentogingival epithelium of normal length. In the study 4 monkeys received elastic ligatures to induce periodontal tissue breakdown and treated with flap surgery (........................ et al. 1983).
not inferior Magnusson
With three patterns of re-colonization (Slots et al. 1978):
o Rapid reduction followed by slow return ; spirochetes o Rapid increase followed by slow return ; cocci, A. viscosus o Rapid reduction followed by rebound return ; Gram -ve, Anaerobe, Fusobacterium
Pennel
oblique rotated flap
prichard 1983
pano underestimate small defects and overestimate large ones
Corn
pedicle graft
What are the radiographic and clinical indications currently used for trauma from occlusion? 1- ..................................... 2- unfavorable crown/ root ratio 3- ...................................... 4- crown and root fractures 5- ........................................ 6- angular bone loss 7- alterations in root morphology
recession of gingiva ncreased tooth mobility widened pdl space
rodriguez 1980
remove amalgam overhang during periodontal therapy --> reduces gingival inflammation
41. According to the 2017 AAP/EFP World Workshop, women taking current formulations of oral contraceptives have ____ levels of gingivitis compared to the control group increased similar decreased
similar
Kwok and Caton 2007 (11) • Aim: To propose a new periodontal prognostication system using periodontal stability as the primary outcome • Proposed Classification system: o Individual tooth prognosis is based on the predictability of future ...................................................................... • General Factors that affect prognosis: o Patient compliance Primary factor for periodontal breakdown = .................................... So, pt must adhere to professional maintenance program in order for stability to be maintained o Cigarette smoking o Diabetes mellitus o Other systemic conditions Neutrophil dysfunction - usually manifests as severe breakdown AIDS and leukemia - can also predispose to periodontal breakdown Other: Interleukin-1 genotype, stress, nutrition, hormones, obesity, osteoporosis, and alcohol • Local Factors that affect prognosis: o Deep PD/CAL o Other plaque-retentive factors Furcation involvement, enamel pearls, CEPs, PG grooves, tooth malposition/crowding, open contacts, overhanging restorations o TFO/parafunction o Mobility Conclusion: Systems using tooth loss as an endpoint may not be predictable or useful in patient management (more useful in epidemiological studies). This system, which is based on stability and evidence-based modification factors, may be more predictable and facilitate communication between clinicians and patients
stability of the supporting tissues plaque-induced infection and inflammation
Bragger
surgical crown lengthening biologic width 3 mm
Murphy
systematic review GTR with bone graft more efficient than OFD in tx of furcations
Karring
the role of gingival CT in determining epithelial differentiation
New attachment
the union of a pathologically exposed root with functionally oriented connective tissue or epithelium
Laurel
use of bioresorbable matrix barrier in GTR (case series) -> reduced probing depths, pronounced gain of clinical attachment, low incidence of gingival pathology/recession/device exposure (but no control)
Friedman
(1995) - describes osteoplasty and ostectomy
What are the criteria for a successful dental implant?
*Albrektsson* 1986 - No mobility - No radiographic evidence of peri-implant radiolucency - <0.2 mm/year vertical bone loss after 1 year loading - No signs/symptoms of pain, infection, or neuropathies
In patients who have periodontal disease, how many teeth will be lost per patient per year with and without periodontal treatment and maintenance?
*Becker* 1979 - No treatment, no maintenance: 0.36 teeth/pt/year lost *Becker* - With treatment, No maintenance: 0.22 teeth/pt/year *Becker* 1984 - With treatment and maintenance: 0.11 teeth/pt/year lost
Mucosal thickening of the maxillary sinus membrane. When should a referral to an ENT be considered?
*Carmeli* 2011 - Mucosal thickening is irregular and > 5 mm - Circumferential thickening is present - Complete sinus fill
Name the Italian authors that wrote extensively on Guided Tissue Regeneration. What were their principle findings?
*Cortellini* *Tonetti* - Demonstrated radiographic bone fill using GTR - More bone fill with more bony walls: 95% fill of 3 wall defects. 82% fill of 2 wall. 39% fill of 1 wall (Cortellini 1993)
How does Tooth mobility affect the predictability of periodontal therapy?
*Fleszar* 1980 - Clinically mobile teeth don't respond to perio therapy as well as stable teeth - Mobility disrupts stability of fibrin clot
List the main different Furcation classification systems
*Hamp* 1975 - Degree I: <3 mm - Degree II: ≥3 mm - Degree III: through and through *Glickman* - Grade I: initial - Grade II: significant - Grade III: through and through *Tarnow* - vertical subclassification of furcations - Subclass A: 1-3 mm - Subclass B: 4-6 mm - Subclass C: >6 mm
Are radiographic Furcation arrows a good indicator for clinical furcation involvement?
*Hardekopf* 1987 - First author to describe the furcation arrow. Presence predicts clinical furcation however absence of furcation arrow doesn't mean it is not clinically present *Deas* 2006 - Furcation arrow predicts clinical furcation 70%. Clinical furcation appears as a furcation arrow 40%
Human studies on association between occlusion and periodontitis
*Jin, Cao* 1992: no significant difference in PD, AL, and bone level between teeth with and without abnormal occlusal contacts *Harrel, Nunn* 2001: strong association between occlusal discrepancies and progression of perio disease
Who are the main authors for the comparative studies between SRP, MWF, and Osseous surgery? List the location for each group of authors.
*Knowles*: Michigan group - No difference in PD reduction or CAL gain *Becker*: Arizona group - No difference between the 3 treatments *Olsen*: Washington group - More disease recurrence in OFD group. Osseous superior in terms of PD *Kaldahl*: Nebraska group - Osseous → greatest PD reduction over 7 years - MWF → greatest CAL gain over 7 years
Pro and con article for Adequte amount of keratinized tissue (KT) necessary for gingival health
*Lang* 1972: 2 mm of KT (1 mm attached) is necessary to maintain gingival health *Freedman* 1992: No recession was found over 18 years follow-up at sites with no KT (dental students with great oral hygiene)
How often does a patient need to brush to prevent gingivitis?
*Lang* 1973 - Every 48 hours in patients with perfect oral hygiene *Freitas/Pinto* 2016 - Brushing every 48 hours results in more inflammation and plaque compared to 12 or 24 hours (no difference between 12 and 24)
Is Bleeding on Probing (BOP) a reliable indicator for disease progression?
*Lang* 1990 - Absence of BOP is a good indicator of perio health. - Presence of BOP is not a good indicator of disease progression - However, in this study, BOP positive sites were re-instrumented at every follow-up appointment
Which general types of bacteria are more associated with periodontal disease? What is the progression of the bacterial flora from health to disease?
*Listgarten* 1978 - Spirochetes and motile bacteria *Health → Disease* - Coccoid → Spirochetes - Non-motile → Motile - Gram positive → Gram negative - Aerobic → Anaerobic
Retention of periodontally "hopeless" teeth and its effect on proximal teeth
*Machtei* 2007 - With perio treatment, retention of "hopeless" teeth is possible with no impact on adjacent teeth - Without perio treatment, retained hopeless teeth caused significant bone loss on adjacent teeth (1989) *Davore* 1988 - With treatment, hopeless teeth had no effect on adjacent teeth
The long term results after resective periodontal surgery depends on what main factor?
*Nyman, Lindhe, and Rosling* published a series of articles in favor of good OH and strict maintenance following surgery - High level of plaque control and periodontal maintenance are necessary for good perio surgery outcomes - Maintenance and good oral hygiene
Use of citric acid vs. saline in open flap debridement.
*Parodi* 1984 - The use of citric acid had no statistical benefit over saline solution *Mariotti* 2003 review article - Use of citric acid provides no clinical benefit in terms of PD and CAL in patients with chronic periodontitis
Can angular bony defects be closed by orthodontic tooth movement?
*Polson* 1984 (monkey study) - It is possible to close an angular bony defect by orthodontic tooth movement with no loss attachment with excellent oral hygiene. Defect closure by Repair (LJE), not regeneration
How does Nicotine affect PDL fibroblasts? How does smoking affect Neutrophils?
*Raulin* 1987 - Nicotine impairs PDL fibroblast proliferation, attachment, and chemotaxis *MacFarlane* 1992 - Neutrophils in smokers with refractory perio disease showed decreased phagocytosis
The effect of root roughness on plaque accumulation and gingival inflammation
*Rosenberg* 1974 - Root roughness not significantly related to mean inflammatory index or to supragingival plaque accumulation
How does enamel matrix derivative (EMD) affect periodontal pathogens?
*Spahr* 2002 - EMD has an inhibitory effect on Gram-negative perio pathogens while having no effect on gram-positive microbes
What is the significance of the width of keratinized gingiva on the perio status of teeth with submarginal restorations?
*Stetler* 1987 - A Subgingival crown with narrow keratinized tissue (<2 mm) will elicit a greater inflammatory gingival response.
Should a membrane be placed over a lateral window sinus lift?
*Tarnow* 2000 - Barrier membrane increases vital bone formation - Increases implant survival
At what probing depth is SRP not effective?
*Waerhaug* 1978 - In pockets ≥5 mm, total plaque removal occurred in 11% of cases *Rabbani* 1981 - SRP does not result in effective removal of subgingival calculus in pockets >5 mm *Stambaugh* 1981 - Not possible to remove all plaque and calculus by one episode of SRP in pocket depths ≥5 mm
How is prognosis assigned with the McGuire & Nunn prognosis scheme? What is the reliability of this prognosis scheme
- *Good*: adequate periodontal support - *Fair*: 0-25% attachment loss and/or class I furcation - *Poor*: 25-50% attachment loss and/or class II furcation - *Questionable*: >50% attachment loss and/or class III furcation, and/or mobility class II - *Hopeless*: Inadequate attachment, recommended EXT - 5-8 year prediction accuracy of 80%. Prediction accuracy reduced to 50% when the good prognosis category was removed
How is prognosis assigned with the Kwok and Caton scheme?
- Favorable: tooth can be stabilized with perio treatment - Questionable: tooth is influenced by local/systemic factors that may or may not be controlled - Unfavorable: tooth influenced by local/systemic factors that cannot be controlled - Hopeless: must be extracted
How does a neutrophil travel to an infected site?
- Margination: line up at the vascular wall - Diapedesis: pass through vascular wall - Chemotaxis: movement toward the high concentration gradient
List the main Prognosis schemes
-*McGuire & Nunn* (good, fair, poor, questionable, hopeless) -*Kwok & Caton* (favorable, questionable, unfavorable, hopeless) -*Miller/McEntire* (prognostic factors evaluated and score given) -*Hirschfeld & Wasserman* (well-maintained, downhill, extreme downhill)
AAP position paper 1999 diabetes
-More attachment loss -Less collagen production -Reduced PMN function -increase susceptibility to infection -vascular changes -poor wound healing
Graber HG, Conrads G, Wilharm J, and Lampert F. Role of Interactions Between Integrins and Extracellular Matrix Components in Healthy Epithelial Tissue and Establishment of a Long Junctional Epithelium During Periodontal Wound Healing: A Review. J Periodontol 1999:70:1511-1522
...Regeneration after barrier techniques
Gargiulio - Healing of FGG
0-2 days - plasmotic circulation No vascularization plasma, RBCs, WBCs flow btwn graft and host, forming fibrin "net" as early "attachment" Critical for graft survival: if there is any movement then fibrin network is interrupted 2-4 days - vascular invasion Vascular (capillary) granulation tissue invades net from host to establish more permanent circulation 4-7 days - CT formation and attachment 4 days - graft and host are attached via formation of CT 7 days - complete attachment without delineation between graft and host with more blood vessels - can remove sutures 10-14 days - complete union (functional "new" grafted tissue into host) 10 days - bridge of vascular channels Early CT organization 14 days - total repair, epithelial surface is mature 21 days can't tell difference at interface zone, well organized CT
Hamp furcation
0-3 (No furcation involvement, 1-3, greater than 3mm, through and through)
Loe plaque index
0-3 (No plaque, film, moderate, abundance)
Loe gingival index
0-3 (Normal to spontaneous bleeding)
17. In the cohort of Norwegian men who received good dental care and practiced good oral hygiene, what was the rate of periodontal disease progression in mm/year? 0.01 0.05 0.10 0.50
0.05 mm/year
Socransky 1984
0.1mm CAL/yr is the average loss from several papers
Becker (tooth loss over 5 years)
0.36 teeth per year who were not treated 0.22 teeth who were treated and not maintained 0.11 teeth who were treated and maintained
According to Waerhaug (1981), toothbrush bristles penetrate ___ mm below the gingival margin 0.5 to 1.0 1.5 to 2.0 2.5 to 3.0 3.5 to 4.0
0.5 to 1.0
Haffajee antibiotics
0.5mm improvement in attachment level with SRP. Also improved results when antibiotics were included with SRP.
AAP Position paper 2004 who needs antibiotics
1) Acute or sever perio disease 2) Aggressive types 3) Medical conditions that predispose them to perio disease
Sullivan and Atkins - stages of graft take
1) Plastic circulation: diffusion 1-2 days 2) vascularization: capillary ingrowth by 8th day 3) organic union: finishes at 10th day
Wound healing explained around teeth
1) formation of fibrin clot 2) replacement of fibrin clot with CT matrix attaching to root surface Maintain fibrin clot, get CT attachment Disrupt fibrin clot, get LJE Hence importance of flap immobilization
What are the local contributing factors to periodontal Disease?
1- Calculus 2- Iatrogenic: Restorative margin, overhang, cement 3- Anatomic: Keratinized gingiva, open contact, root proximity, hopeless teeth, 3rd molars 4- Enamel morphology: CEPs, enamel pearls 5- Anatomic factors: intermediate bifurcationridge, palatogingival groove, accessory canals, cemental tears
Glickman furcation
1-4 (Incipient lesion to visible through and through defect)
Root Planing
1. 60-70° 2. Longer, lighter strokes
Scaling
1. 80-90° 2. Shorter, heavy strokes
Exploratory Stroke
1. Approximately 0-25° 2. Light touch 3. Feel for calculus and base of pocket
Periostat is good for __________ to provide defined but minor improvements **AAP 2002 information paper
1. diabetics 2. smokers (Preshaw et al. 2003) 3. Genetic predisposition to breakdown ALSO: unresponsive/refractory perio patients
55. According to the 2017 World Workshop Consensus Report, the gingival thickness threshold is ___ mm for periodontal probe visibility while probing. 0.5 1.0 1.5 2.0
1.0
Wilson.
1/3 compliant 1/3 sporadic 1/3 non-compliant
Loe et al
11%, 81%, 8% (rapid) profession in tea workers with no preventative care
Ramfjord and Costich
1963 Healing after GV - Tendency to sever CT attachment during SRP after gingivectomy Tendency is to lose some attachment (lose 0.5mm) 1968 Healing after exposure of periodontium Denuded bone vs leaving periosteum -> delayed healing, similar degrees of bone resorption Leave thick CT - top part will necrose
Pfeiffer
1965 Reaction of alveolar bone to flap procedures in man Compare apical position full vs split -> more osteoclastic activity Total vs partial denudation -> more bone loss
Schallhorn
1970 Post-op problems associated with iliac bone grafts: chronic inflammation, infection, sequestration (most common), varying rates of healing, root resorption, defect recurrence Iliac cancellous bone and marrow implants can gain bone apposition beyond pre-op coronal bony margins (attachment at 3 months) Regeneration of new bone, cementum, PDL ---- Support for ePTFE + composite bone graft vs ePTFE alone in furcation grade II/III, dehiscence, wide intrabony defects
Ramfjord
1973 Michigan study of periodontal therapy (7 years) - if we have deep pocket surgery it is better to reduce pockets Aimed to test curettage vs pocket elimination (GV/osseous) sx In short term (1-3 years), curettage resulted in slight gain of attachment whereas surgical pocket elimination had slight loss A significant loss of attachment occurred between 3-5 years following completion of tx for both groups Long term (4-7) loss of attachment not significantly different for both groups Pocket elimination: greater and sustained following surgical elimination Degrees of pocket reduction did not relate directly to variations in attachment levels 1974 MWF OT REVIEW Traumatic occlusion does not initiate or aggravate gingivitis or initiate pockets, BUT it can increase mobility and may accelerate bone loss and pocket formation depending on inflammation Bruxism can perpetuate trauma Splinting not indicated in self-limiting trauma from occlusion but indicated in conjunction with occlusal adjustment when trauma from occlusion is progressive Mobility of teeth may be decreased by reducing inflammation
Ellegaard
1974 New attachment after tx of intrabony defects in monkeys Comparing no transplants, cancellous bone (from EXT sites), fresh/frozen bone marrow in 3 wall defects: new attachment CAN be achieved in intrabony defects with and without autogenous bone grafts, but more frequently with bone grafts Using fresh autogenous bone marrow -> resorption, ankylosis, vs frozen autogenous hip marrow and cancellous bone grafts -> new cementum formation, establish of new PDL Prevention of new attachment due to infection and epithelial downgrowth --- 1971 New attachment of periodontal tissues after tx of intrabony lesions in humans (no histology) The more walls the better: within 6 months, 80% of 3 wall defects and 70% of 2-wall defects healed more than half or completely (more in anterior teeth) Failures mostly associated with shallow defects vs complete regeneration in deep defects There was no difference in new attachment between grafted and nongrafted, but this may be because intraoral autogenous bone grafts employed in widest and deepest pockets
Hamp
1975 tx of multirooted teeth Describes system for classifying and tx furc involvements F0 - no furc involvement F1 - probe can penetrate < 3 mm F2 - > 3mm but not through and through F3 - through and through 5 year post-op eval of 100 pts treated for perio breakdown in bi/tri-furcatoin areas It is possible to stop further destruction within root furc area due to elimination of plaque retentive areas for bi/tri furc areas and meticulous OH
Rosling
1976 healing of periodontal tissues following different techniques of periodontal surgery in plaque free dentitions. A 2 year clinical study. 5 diff surgeries (apically positioned and MWF with and without osseous, GV without osseous) -> in optimal OH, healthy gingival conditions can be achieved and maintained and perio disease stopped regardless of surgical technique
Hirshfeld and Wasserman
1978 Long term survey of tooth loss in 600 treated perio patients Tooth retention more related to case type (molars, furc involvement, severe bone loss, mobility, deep pocket, individual susceptibility) than surgery performed (well maintained, downhill, extremely downhill groups) Perio disease is bilaterally symmetrical w predictable order of tooth loss based on position in arch Furc involvement in extremely downhill group increases odds of losing teeth
Knowles
1979 Results of periodontal treatment related to pocket depth and attachment level - 8 year follow up Pt randomized to curettage, MWF, pocket elimination after SRP 1-2 mm pockets -> lost attachment with surgery, no changes in PD 4-6 mm PD -> slight gain in attachment attachment, reduction in PD more in surgeries 7-12 mm PD -> gained attachment, reduced PD in surgeries
Lindhe and Nyman
1980 Alteration of gingival levels after flap sx (10 year f/u) During active therapy - will get GM apical migration, but during post-op maintenance, will have coronal migration Amount of KT does not matter with good OH Longitudinal studies 1975, 1977: no matter what kind of procedure you do, plaque control is most important to prevent recurrence of periodontitis and to maintain CAL. Professional maintenance of 2-3 months, not 6 months ------ Jiggling in dogs (occlusal forces) is cofactor in periodontal disease -> bony defects and CAL Hypermobile teeth can be maintained once perio disease is treated Progressive tooth mobility in inflammation -> more mobility, more attachment and bone loss
Moghaddas + Stahl
1980 Alveolar bone remodeling after osseous sx - interradicular (.23 mm) < radicular (.55) < furcation (.88)
Caffesse
1980 Longitudinal evaluation of periodontal surgery Opinion paper biased against osseous/resective; maintain pocket without inflammation ---- + Guinard - Confirmed that coronally repositioned graft with FGG provides satisfactory solution in treating localized gingival recessions Compared to lateral sliding: similar amount of root coverage, but 1 mm gingival recession on donor tooth after 3 years with lateral 1 mm creeping attachment after 1 year No correlation btwn width and depth of defect 2 stages, as Bernimoulin
Axelsson (+Lindhe)
1981 - Effect of controlled oral hygiene procedures on caries and perio disease in adults, results after 6 years If you have proper maintenance (once every 2-3 months) -> recurrence of caries and perio progression stopped 1981 - Significance of maintenance care in tx of perio disease - susceptible pts (esp after perio sx) should come every 2-3 months
Nyman
1982 New attachment First histologic study to show that new cementum with inserting collagen fibers was observed on previously diseased root surface, but no signs of coronal regeneration of alveolar bone
Stahl
1982 Periodontal Healing Following Open Debridement procedures - most common mode of healing is by LJE 1971 Soft tissue healing following curettage and root planing No effect of curettage prior to GV compared to just GV - Complete epithelialization after 14 days, CT elements and wound vascularity did not return to post-op levels 28 days after GV, Inflammation increased with time and at 28 days -> CT organization not mature completely
Ericcson
1982 Splinting fails to prevent or slow attachment loss in dogs
Pihlstrom
1983 Molar and non-molar teeth Compared SRP vs SRP+MWF on teeth over 6.5 years Deeper pockets had better outcome with surgical tx Says nonsurgical and surgical have no differences in CAL gain and PD reduction across different pocket depths, even tho chances of recurrence higher in nonsurgical 1983 Comparison of surgical and nonsurgical tx of periodontal disease 1-3 mm pocket -> avoid surgery, loss of attachment 4-6 mm - surgical and nonsurgical the same 7 mm - more stable outcome with surgery --- 1983 Molar and non-molar teeth Compared SRP vs SRP+MWF on teeth over 6.5 years Deeper pockets had better outcome with surgical tx Says nonsurgical and surgical have no differences in CAL gain and PD reduction across different pocket depths, even tho chances of recurrence higher in nonsurgical 1983 Comparison of surgical and nonsurgical tx of periodontal disease 1-3 mm pocket -> avoid surgery, loss of attachment 4-6 mm - surgical and nonsurgical the same 7 mm - more stable outcome with surgery --- Teeth with mobility / widened PDL -> more loss of CAL, PPD, and more bone loss than teeth without Teeth with mobility / widened PDL but equal CAL to teeth without -> more bone loss Teeth with occlusal contacts in centric relation, working/nonworking, or protrusive -> no greater periodontitis than teeth without
Pontoriero
1989 GTR in tx of furcation defects in mandibular molars (III) The smaller the amount of PDL remaining, the smaller amount of new attachment may form Wide and shallow furcation defect has greater regeneration chance than defect with same volume but narrow and high
Baderstein
1990 Score of plaque, bleeding, suppuration, and PD to predict probing attachment loss — odds of different factors and how they can predict attachment loss Residual probing depth >/= 7 mm -> predictability of attachment loss is 50% Increase in probing depth >/= 1mm -> predictability about 80% Accumulated plaque and bleeding scores -> 30%
Matter
1992 Creeping attachment 1 mm after 1 year, occurs better with thick tissue and isolated recession
Majzoub
1992 tooth morphology following root resection procedures in max first molars Resected DB root Biologic width violated in 86% of cases Only 6% have favorable topography for perio maintenance and prosth reconstruction Poor root anatomy -> perio failures of teeth after resection
Langer and Langer
1st to describe sub-epithelial CTG and coronally position flap for root coverage (previously was FGG) Advantage: 1 procedure, minimal palatal denudation, close color Indications: inadequate donor site for horizontal sliding flap, isolated gingival recession/multiple root exposures/min attached gingiva/recession next to edentulous area that also needs ridge augmentation At least 1/2 of the graft should be covered Sometimes gingivoplasty may be needed to recontour excess thickness Graft gets double blood supply: from CT on nondenuded part of the root and undersurface of labial flap Recipient site is partial thickness ---- Langer 1982 an evaluation of root resection (10 year study) 71% of failures after 10 years Most of failures occur at 10 years Most failures in mandibular molars due to fx of PA pathoses
What are three phases of repair according to Wilderman (for bone exposure)?
2-10 days osteoclastic phase 10-28 days osteoblastic phase (peaks at 21-28 days) 1-6 months - maturation of bone, new CT attachment, epithelial attachment
Wadhwani et al. 2012 • The margins that were ..........mm below soft tissue level showed the greatest cement excess weight of all groups • If crowns fail to seat completely, greater excess cement may be extruded • ......... cements are highly radiographically detectable and aid in post-cementation removal
2-3 ZOE
Grossi et al (smokers)
2.7 times more likely to have perio I'd smoke
Deas
2002 After crown lengthening, biologic width ~3-4 mm -> position flap where you want crown margins to be If you suture flap <1 mm from bone, you get more tissue rebound than if it were further
Oates
2003 - systematic review Greater gain in both root coverage and keratinized tissue width for CTG+CAF compared to GTR or CAF alone
Gutmann et al. 1978, • Accessory canals demonstrated in the furcation region in .........% of total sample (..........% in mandibular molars, and ..........% in maxillary molars) • .............% of total teeth sampled exhibited canals in "furcation" itself Accessory Canal Summary: • If pulpal pathology is present, accessory canals could be a patent source of inflammation to the furcation region of multi-rooted teeth • This should be considered a possible etiologic entity in isolated furcation involvement • If concomitant pulpal-periodontal pathology exists in these cases, treatment should include obturation of any present accessory canals.
28.4% 29.4% 27.4% 24.5%
Gutmann
28.4% of molars have accessory canals in the furcation
B14. According to Masters and Hoskins (1964), the prevalence of cervical enamel projections (CEP) in mandibular molars was ___% 9 19 29 39
29%
Mineralization of the plaque begins within .... days (................ et al. 1960). And usually calculus provides an ideal foundation for bacterial colonization, however it does not induce inflammation (Waerhaug 1952).
3 Zander Waerhaug
A.54 HbA1C values reflect the average plasma glucose concentration for a ___ month period 1 3 6 9
3 Month period
B1. According to Lang et al. (1986), sites with BoP on four successive maintenance visits had a ___ % probability of losing ≥ 2 mm of attachment 1.5 3 14 30
30%
Lang and Loe
32 dental students 2 mm width of KT (1 mm of attached gingiva) is adequate for gingival health They are looking at gingival index as measure of health, but thin tissue is more red -> looks more inflamed
C31. According to ALHarthi 2019, a __% reduction in the odds ratio was observed for periodontitis for each additional year of quitting smoking 4 14 24 34
34%
Albrektson
38% failure rate of implants at 5 years 12% failure rate at one year
11. According to the 2017 AAP/EFP World Workshop, PD threshold for a successfully treated periodontitis patient should be _____mm 3 4 5
4 mm
Melcher 1976
4 types of healing after Perio surgery: 1) Epithelial cells 2) gingival CT cells 3) bone cells 4) PDL cells
AAP position paper on maintenance 2003 and compliance
45% compliance rate of perio maintenance patients over a 10 year period
B16. According to THE 2009-2012 NHANES data, what is the approximate prevalence of periodontitis in the Unites States for those ages 30 and older? 26% 36% 46% 56%
46%
According to Lan (1973), the longest interval between effective oral hygiene procedures that maintains gingival health is ____ hours 12 24 48 71
48
McClain
5 year result of GTR alone or with root conditioning + osseous bone graft -> latter was enhanced GTR
Lindhe
5 yr study showing maintenance is necessary to treat advanced diseases
B17. According to Kogon (1986), the approximate prevalence of palato-radicular grooves on maxillary incisors is ...% 5 10 15 20
5%
C2, Normal HbA1c levels are typically less than ___% in non-diabetic patients 5.5 6.0 6.5 7.0
5.5%
Michalowicz 1994, ........% of enhanced risk for periodontitis can be attributed to genetics: • Aim: To assess genetic and environmental variation in adult periodontitis using adult twins • M&M: - 117 same-sex twins (64 pairs of monozygotic and 53 of dizygotic) - Clinical periodontal examination (PD, GM, PI, GI, CAL) + health hx • Results: - All clinical measurements in MZ twins were more ............. than DZ. - Heritability for AP was estimated to be ~........% o Applications: 50% is genetic, 50% is bacterial plaque etc. - Heritability for AP not altered by adjusting behavioral variables including smoking. - There was ................ of heritability for gingivitis after incorporating behavioral covariates (dental visits and smoking) were incorporated. • Conclusion: - Heritability for periodontitis is likely biological and reflects genetically determined variations in immunological host defenses. - Heritability for gingivitis is associated with oral health- related behaviors.
50 similar 50 no evidence
According to Bowers(1979), what percentgae of furcation entrances measures ≤ 0.75 mm? 36% 58% 81% 94%
58%
Kogon et al 1985, ........% of the grooves that extended past the CEJ onto the root surface extended more than .......mm from the CEJ PG Groove Summary: • Palato-gingival grooves occur most commonly on the ....................... • They can be associated with increased periodontal inflammation and attachment loss, especially if they are deep and extend apically onto the root surface. • If a PG groove is suspected to be contributing to periodontal decline, treatment options are limited and questionable.
58% 5 maxillary lateral incisor
Sherman et al. 1990
58% of surfaces had residual calculus after SRP when clinician thought it's free of calc.
C12. According to the American Diabetes Association, an HBA1C of ___ % is consistent with a diagnosis of prediabetes 4 5 6 7
6
C12. According to the American Diabetes Association, an HBA1C of ___ % is consistent with a diagnosis of prediabetes 4 5 6 7
6
Sonic Scaler: An instrument vibrating in the sonic range (approximately ................ cps) that, accompanied by a stream of water, can be used to remove adherent deposits from teeth. Ultrasonic Scaler: An instrument vibrating in the ultrasonic range (approximately ................... to ........................ cps) which, accompanied by a stream of water, can be used to remove adherent deposits from teeth.
6,000 25,000 to 30,000
C16. According to Godson et al (1984), clinical attachment loss preceded radiographic bone loss by __ months 0-2 3-5 6-8 9-12
6-8
Ericsson & Lindhe (1982) also confirmed Glickman's concept: • Histologic study - 8 beagle dogs • Aim: effect of jiggling forces on progression of plaque associated periodontitis • Results: ............% AL (....................................), compared to ..........% control • Conclusion: jiggling forces applied to teeth with periodontitis may enhance the rate of destruction
62.6 CEJ to most apical cell JE 45.1
In regard of raising a flap, results showed that scaling with a flap increased the percentage from 43% to ......% for root surface without calculus compared to SRP alone in PDs of 4-6 mm and from 32% to .........% with a PD of >6mm. They also concluded that the extent of residual calculus was greatest at the CEJ or in association with grooves, fossae or furcations. (.............. et al. 1986)
76 50 Caffesse
13. In the natural history of periodontal disease in man, Loe et al (1986) found that in an untreated Sri Lanka population ___% of population were rapid progressors 8 11 18 25
8%
In ........% of furcations, the entrance was 1mm or less, and in .......% the entrance was 0.75mm or less Width of curette blade face: was within the range of .......mm to .......mm ............................ et al 1979
81 58 0.75mm to 1.10mm
C79. Acording to Bowers, what percentage of furcation entrance measure ≤ 1 mm? 36% 58% 81% 94%
81%
Hou and Tsai 1987
82.5% of 325 teeth with Grade II & III CEPs had FI No association with Grade I
Linkevicius et al. 2013 • 77 patients, 129 implants with biological complications between 2006-2011 o Group 1: implants in patients with history of periodontitis o Group 2: implants in periodontitis-free individuals o Control group: set of 238 screw retained implant restorations, in 66 patients during same time period • Peri-implant disease present in ......% of the 73 implants with cement o Group 1 (39 implants); hx of perio Of the 39 implants that had cement remnants in pts with a history of periodontitis, • ........% developed peri-implantitis o Group 2: (30 implants); no hx of perio Of the 30 implants that had cement remnants in periodontally healthy patients: • 20 out of 30 had peri-implant mucositis (.......%) • 3 out of 30 had early peri-implantitis (10%) o No cement group/screw retained 14/56 implants with screw retained and a hx of periodontitis ended up getting peri-implantitis 2/185 implants with screw retained and no hx of periodontitis ended up getting peri-implantitis • Implants with cement remnant in pts with hx of periodontitis may be more likely to develop peri-implantitis, compared with pts without hx of periodontitis.
85% 100% 66%
Babbush
88% success rate on immediate loaded implants. 1700 implants. First to study this in 1980's
C45. According to Ross and Thompson (1978), what is the approximate survival rate of treated maxillary furcation involved molars after 5-24 years? 60% 70% 80% 90%
90%
Carnavalle
93% success rate of resected teeth after 10 years (still successful; nonresected 99%)
Lindhe
A critical determinant of perio therapy is not technique (NS vs S) but the quality of debriding the root surface and home care.
How do Rough implant surfaces (SLA) compare with machined smooth surface implants?
Abrahamsson 2004 - SLA implants showed faster and greater degree of bone formation compared to smooth surface implants in dogs
In a study by ......................, they evaluated the numbers and distribution of bacteria invading the roots of periodontally diseased. They had two groups being extracted periodontally diseased teeth and the control being periodontally healthy teeth. Data looked at samples from the pulp-tissue & for the samples obtained from the inner, middle, & outer dentin layers. Their results showed that bacterial growth was detected within the dentin in .......% of the periodontally diseased teeth (.................. et al. 1988)
Adriaens 87 Adriaens
Tibbets
Advantages of mandibular lingual approach to osseous surgery: wider embrasures -> can reach craters since interdental craters are below contact point, mandibular teeth are tilted lingually, Buccal approach would compromise lingual and over-treat buccal Lingual embrasures wider
There is a greater incidence of periodontitis in .......................... and ...................... populations. In a study by ................ & ................ 1991 that looked at aggressive periodontitis, ........................... were found to be at much greater risk than Caucasians. They also looked at age and other demographics that are considered risk determinants.
African American Hispanic Loe and Brown African Americans
13. Which category is NOT included in the 2018 AAP/EFP classification? Aggressive periodontitis Necrotizing periodontitis Periodontitis as a manifestation of systemic disease
Aggressive Periodontitis
How does smoking effect the response to resective periodontal therapy?
Ah 1994 (Nebraska group) - Smoker responded less favorable than non-smokers to all periodontal therapy: SRP, MWF, and Osseous
............................. in 1998, conducted a study on N=156 individuals for ............year follow-up. Clinical examinations were .................. & ................. & ................................... His conclusion was that dental calculus and gingival inflammation are important determinants of attachment loss in individuals with early-onset periodontitis and may contribute significantly to development of new lesions.
Albandar, 6, Loss of Attachment LOA, BoP, supra and subginval calculus.
................... et al. 2011 • Looked at four implants from four different systems (3i, Astra, Staumann, and Nobel) • Placed implants in left side of mandible in 6 dogs o Radiographic bone gain occurred at implants with turned (3i), TiOblast (Astra), and SLA (Straumann) surfaces, while at TiUnite (Nobel) implants, additional bone loss was found after treatment o Resolution of peri-implantitis achieved in tissues surrounding implants with turned and TiOblast surfaces • Conclusion: Resolution of peri-implantitis following treatment without systemic or local antimicrobial therapy is ................, but the outcome of treatment is influenced by implant surface characteristics.
Albouy possible
In a study by ........., they evaluated tetracycline-HCL and ..................... effect on new attachment on roots. Their results showed that tetracycline-HCl treated group demonstrated a mean reattachment of .............. mm, with parallel connective tissue fibers perpendicular to the root ( ............ et al. 1990)
Alger fibronectin 0.27 Alger
Van Winkelhoff et al. 1992
All patients received Sc/RP + 250 mg metronidazole / 375 mg Amoxicillin TID for 1 week
Wang
All stress for axial or lateral bearing forces on an implant are directed at the crest. Tooth lateral forces are directed at the apical third.
............................... 1965 injected calculus (30 mg portions) into guinea pig (sterile and non-sterile calculus). o Sterile calculus lead to ................................, foreign body reaction. o Non-sterile calculus lead to ............................. reaction with a tendency for ......................... formation. o The cause is the plaque not the calculus.
Allen & Kerr, granulomatous, suppurative, abscess
Does a periodontal dressing improve healing after periodontal surgery?
Allen, Caffesse 1983 - Periodontal dressing doesn't improve or hasten healing following MWF
.................. et al. 2008 (31) found evidence to suggest that alcohol consumption is a risk indicator for periodontitis. Longitudinal studies on this association between alcohol dependence and consumption with periodontitis are needed to confirm the association
Amaral
AAP Position paper on what AB's recommended for combined therapy for aggressive diseases
Amoxicillin Metronidazole
AAP position paper 2004 antibiotics for periodontal abscess
Amoxicillin 1g followed by 500mg TID for 3 days
What is the dosage for the Winklehoff cocktail? Amoxicillin 500mg and Metronidazole 500mg for 7 days Amoxicillin 250mg and Metronidazole 250mg for 7 days Amoxicillin 375mg and Metronidazole 250mg for 7 days Amoxicillin 500mg and Metronidazole 250mg for 7 days
Amoxicillin 375 mg and Metronidazole 250 mg for 7 days
Barnett 1985
Ampicillin, other penicillins, and infrequently tetracyclines have been associated with a low incidence of oral contraceptive failure n It suppress GI bacteria essential to reabsorption of steroid conjugates excreted in bile n This results in low plasma concentrations of contraceptive steroids and more rapid clearance from the body n Though this subject is controversial, additional methods of contraception should be recommended when antibiotics are given
Does addition of DFDBA to GTR improve results (osseous defect depth reduction) when treating class II furcation defects?
Anderegg (1991) - DFDBA with GTR → 85% decrease in osseous defect depth - GTR alone → 50% reduction
How does calculus affect periodontal disease?
Anerud, Loe 1991: Sri Lanka tea worker study (patients with no oral hygiene) - Sites with calculus demonstrated significantly more attachment loss compared to sites without
Nabers and Friedman
Apically repositioned flap
Lang and Loe
Areas with less than 2mm of keratinized tissue exhibited gingival inflammation in spite of effective oral hygiene
Hanes & Purvis 2003
Arestin® + Sc/RP - additional PD reductions n Atridox® + Sc/RP - additional CAL gains n PerioChip® + Sc/RP - additional CAL gains n Indication: Localized 5-6mm residual PDs after Sc/RP
B17. Genetic studies of aggressive periodontitis patients suggest that disease transmission is most consistent with a ___ pattern X-linked non chromosomal autosomal recessive autosomal dominant
Autosomal Dominant
...................... & .................... 1981(35) • 90 pts; ...........+..........+.......... • 1x/2w for 1st 2m w/ professional cleaning, then: 1/3 of pts were sent to GP 2/3 received SPT at the perio office • Exam at .... & ....y • 52/77 pts had SPT 1x/2 m for 1st 2y & 1x/3m for the next 4y • Non-recall pts had increased plaque, inflammation & recurrent periodontitis • 99% in recall group & 45% in non-recall group had no CAL • In non-recall group ......% had CAL 2-5mm Summary Proper maintenance recall is necessary to prevent recurrence and maintain perio stability, regardless of different surgical modalities; Pathogenic bacteria quickly harbored the sites in the absence of care.
Axelsson & Lindhe OHI+SRP+MWF 3 & 6 55
................ and ................. 1981(26) • 6y follow-up • 2 groups based on OH, gingivitis, perio disease and caries Test: o 375 pts o 2-3m recall w/ OHI & prophy Control: o 180 pts o Yearly exam • Test: Resolved gingivitis & prevent periodontal disease & caries progression • Control: Do not prevent periodontal disease & caries progression
Axelsson and Lindhe
Lang on BOP
BOP can predict periodontal health
What is the expected blood loss following periodontal flap surgery? What factor most influences blood loss?
Baab 1977 - 134 mL blood loss with a range of 16 mL - 592 mL - Duration of the procedure has the most correlation with amount of blood loss
Which has a better prognosis for periodontal disease, Single rooted teeth or multi-rooted teeth?
Badersten - Single rooted teeth have better prognosis over multi-rooted teeth
How much variation exists in probing depths between 2 different examiners?
Badersten 1984: Reproducibility of probing attachment level - Differences in probing between 2 practitioners is ± 1 mm
Is non-surgical therapy alone effective in preventing attachment loss with deep residual probing depths?
Badersten 1990 - Non-surgical therapy alone does Not predictably prevent loss of attachment in deep residual PD (only non-molar teeth included in this study)
Is bacterial sampling but absorbent paper point an accurate representation of the bacterial species?
Baker 1991 - Bacterial samples by absorbent paper point misrepresents presence of bacterial species
What minimal flap thickness is needed for complete root coverage when performing a Coronally Advanced Flap (CAF)?
Baldi 1999 - 0.8 mm flap
.................. et al., 1984(29) • Retrospective; 44 pts. • Active tx (SRP/osseous) but no maintenance • Exam interval 5.25y • PD, CAL; 2 FMXs • Tooth mortality: ........% • 1117 teeth 90% were given prognosis "favorable" in first examination. 3% lost by second exam. • 31% of molars FI • PD NSSD • SSD bone loss
Becker 4.7
................ et al. 1984 (8) • 44 patients treated for periodontal disease that elected not to participate in maintenance care- looking at tooth mortality over time, comparing it to studies like Hirschfeld and Wasserman (study of pts compliant with maintenance) • Prognostic categories: o If teeth had more than one of the following problems, given a questionable prognosis: Bone loss close to .......% of root length PD ........mm Class II furcation involvement with minimal interradicular space Presence of a deep vertical groove on palatal aspect of maxillary incisors Mesial furcation involvement of maxillary first bicuspids Teeth with extensive decay which might not be restorable o Teeth with more than one of the following problems were given a hopeless prognosis Loss of over .......% of supporting bone PD greater than .....mm Class III furcation involvement Class III mobility with tooth movement in M-D and vertical directions Poor crown-root ratio Root proximity with minimal interproximal bone and evidence of horizontal bone loss History of repeated periodontal abscess formation o Teeth with less than these issues listed above were considered to have a good prognosis • Results o Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.22 (4.7%) This was adjusted to not include those teeth that were considered to have a hopeless prognosis at the initial examination o Mean PD at second examination showed no SSD from first exam PD were similar after a prolonged time without maintenance as they were to the pre-treatment levels. o Measurements of bone levels revealed a worsening of bone scores between examinations o In unmaintained population, higher incidence of tooth loss with both good and questionable prognosis o It is difficult to determine hopeless teeth, as many labeled "hopeless" were still present at end of 5 years • Conclude: o Periodontal therapy without maintenance is of little value in terms of restoring periodontal health.
Becker 50 6-8 75 8
Defect fill of 3-wall intrabony defects following Open Flap Debridement
Becker, Becker (1986) - Mean defect fill of 3-wall intrabony defects following OFD was 61% (study models of the bony defect filled with gunpowder to assess defect fill)
Under what circumstances can significant bone fill of intrabony defects be expected when treated with Open Flap Debridement alone?
Becker, Becker (1986) - Significant bone fill can be achieved in *3-wall bony defects* with OFD
About how much CAL gain can be expected with GTR of Class II and Class III furcations?
Becker, Becker 1986 - PTFE membranes without graft resulted in 1.3mm CAL gain for Class III and 2.3mm CAL gain for Class II
How many teeth are lost per patient per year in patients who have been treated for periodontitis without maintenance?
Becker/Becker 1984 - 0.22 teeth lost per patient per year (≈1 tooth every 5 years)
How many teeth are lost per patient per year in patients who have been treated for periodontitis with good maintenance?
Becker/Becker: 1984 - 0.11 teeth lost per patient per year (≈1 tooth every 10 years)
How many teeth are lost per patient per year in patients with untreated periodontitis?
Becker/Berg: 1979 - 0.36 teeth per patient per year (≈1 tooth every 3 years)
........................ et al. 2007 • 5 beagle dogs • 3 implants with either a sandblasted acid-etched surface (SLA) or a polished surface (P) were installed bilaterally in the edentulous premolar regions • Induced periodontitis until ......% of ht of supporting bone lost o Radiographs of all implant sites were obtained before and after active experimental peri-implantitis as well as at the end of the experiment • Biopsies harvested and used for histological examination • Results: o Similar amount of bone loss at SLA and P sites during active breakdown period o However, progression of bone loss was more at .......... than ................. sites following ligature removal o Histo exam revealed both bone loss and size of inflammatory lesion in CT larger in SLA than P o More plaque at SLA surface than polished surface • Suspect that progression of peri-implantitis, if left untreated, is more pronounced at implants with a moderately rough surface than at implants with a polished surface.
Berglundh 40 SLA polished
Smoking how many cigarettes per day is associated with greater attachment loss?
Bergstrom 1991 - Smoking >10 cigarettes per day is significantly associated with greater attachment loss
What author(s) wrote extensively on Smoking and its influence on periodontitis?
Bergstrom and Preber
A.53 Type 2 diabetes is preceded by systemic inflammation, leading to a reduced pancreatic _____ cell function alpha beta gamma delta
Beta
Misch
Big name in implants and implant occlusion
Gargulio
Biologic width is epithelial attachment + CT (~2 mm) most variable component is epithelial adhesion (epithelial attachment decreases with age); CT is most stable
Cordaro et al
Block graft resorption: Horizontal - 20% Vertical - 40%
Leckhold and Zarb
Bone density D1-D4
Wilderman studies
Bone exposure -> epithelial attachment is more apical Lost bone replaced by CT Thick bone -> repair will return to original at 4 months Thin bone -> bone will resorb at crest and CT will replace bone Periosteum exposure -> heals faster than if bone were left exposed, less bone resorption Interproximal/furcation vs radicular -> repaired vs never completely reconstructed (lose 50%) Histologic repair after osseous -> 1.2 mm loss of crestal bone, gain of 0.4mm of bone -> net loss 0.8mm
AAP Position paper 2005 on GTR
Bone grafts can be used successfully in class II furcation defects for GTR cases.
......................... and .......................... 1956 o 12800 employees of met life insurance assessed o Found definite and symmetrical patterns of periodontal destruction o SSD among teeth in different positions similar to ....................... and ..............................
Bossert and Marks Hirschfeld and Wasserman
How does smoking affect BOP and PD?
Bostrom 2001 - Decreased BOP (due to vasoconstriction) - Increased PD
........ et al. 2008 • Cross sectional study • To determine if any association between width KT and health of peri-implant tissues o Group A: KG ≥2mm (n=110), Group B: KG <2mm (n=90) o GI, PI, Radiographic bone loss were SS higher for group B. o BOP was significantly higher for group B: ........% vs. .....% in group A
Bouri 89% 71%
Dimensions of Furcation morphology. What is the Entrance diameter for most furcations?
Bower 1979 - 81% of all furcations have an entrance diameter of <1 mm - Cavitron tip best instrument for cleaning furcations due to narrow furcation entrances
Where is the thickest and thinnest Width of attached gingiva on the Facial surfaces?
Bowers 1963 - Thickest: Maxillary central and lateral incisors - Thinnest: Mandibular canine - 1st premolar
Who found histologic evidence of new attachment (regeneration) in humans on previously pathologically exposed root surfaces?
Bowers 1985: Histologic evaluation of new attachment in humans - Regeneration of Bone, Cementum, and PDL in humans on previously pathologically exposed root surfaces using DFDBA
What is Enamel Matrix Derivative (EMD)? What is the primary protein that comprises EMD?
Boyan 2000 - Osteopromotive material derived from embryonal enamel of porcine origin. - Amelogenins comprise 90% of proteins in EMD
............... et al., 1992(16) ................. etal., 1986(17) Study design: Human; ext. teeth Appliance: Water pik - .......% of pocket depth - Pocket depth %: ......% shallow (<3mm) ........% moderate(4-7 mm) .......% in deep (> 7 mm)
Boyd Eakle 54 71 44 68
How long should you wait after surgical crown lengthening (CL) for gingival stability?
Bragger 1992 - Stable periodontal tissue levels occurred over 6 months - 12% of the sites with crown lengthening procedure showed 2-4 mm recession of the free gingival margin between 6 weeks and 6 months postoperatively.
.......... et al., 1992(18) Human; ext. teeth Rinsing SubG irrigation .......% of the pocket (mean) .......% of pocket (≤6mm) .......% of PD (7mm)
Braun 21 90 64
What are the most common locations for residual calculus following SRP
Brayer 1989 - CEJ - Root concavities - Line angles
What is the benefit of ridge preservation following extraction? What difference is there between FDBA and 70/30 FDBA/DFDBA mix?
Brian Mealey: multiple studies out of San Antonio - Improved results with ridge preservation vs. no ridge preservation (any graft material, no difference between groups) - 70/30 FDBA/DFDBA produces significantly more vital bone compared to 100% FDBA (no difference in ridge dimensions)
................... & .................... 1990 o Literature review. o > ............ of restored tooth have overhang & > ...... of adult have overhang. o ......... + ........., more accurate. o The larger the overhang, more destructive. • Summary: Overhang is contributing to perio disease by multiple approaches including subgingival microflora change; removal of overhang shows improvement.
Brunsvold & Lane, 25%, 33%, Xray, tactile.
Hanamura
Bruxism not associated with periodontitis
..................... et al. (1992) compared the effect of occlusal adjustment after surgical or non-surgical tx: • Randomized clinical trial - 50 adults with moderate-severe chronic periodontitis • Aim: to evaluate the effects of occlusal adjustment in conjunction with surgical or non-surgical tx • Results: 2-years o goal of occlusal adjustment: even & stable contacts in centric relation freedom in centric smooth, gliding contacts in centric & eccentric movement elimination of balancing interferences o ...........mm gain in attachment level with occlusal adjustment, regardless of type of perio therapy o NSSD with PPD reduction w/wo occlusal adjustment • Conclusion: occlusal adjustment with either surgical or non-surgical therapy yields a gain in attachment level but has no significant effect on pocket depth reduction.
Burgett 0.4
Name the author who coined the term GBR.
Buser (1993) - GBR using non-resorbable membrane with tenting screws and collagen to stabilize the clot
Describe the "Early implant" placement technique.
Buser 2008 - Extraction performed without ridge perservation. - Implant placed 4-8 weeks after extraction - Autogenous bone placed over Bio-Oss - Two collagen membranes covering the graft: one vertical, one horizontal
Which of the following instruments is has the shortest cleaning time, piezoelectric, magnetostrictive, and hand scaling? Which leaves the root surface the most rough?
Busslinger 2001 - Piezoelectric scaler has the shortest cleaning time but left the root surface more rough
AAP position paper 2003 on disease diagnosing
CAL is best predictor for disease using a periodontal probe. Radiographs are helpful for exams, they cannot be used for diagnosing alone.
A.42 Which biomarker provides insight into association between CAD and periodontitis? CTx CRP HbA1C serum cotinine
CRP
Gargiulo 1960
CT = 1.07 Epi = .97 Sulcus = .69 Epi dec with age CT most constant
How does GTR compare to OFD in treatment of Class II furcation defects?
Caffesse 1990 - GTR resulted in 2.8 mm PD reduction - OFD resulted in 1.8 mm PD reduction
According to the 2017 world workshop classification, how are recession defects classified?
Cairo Recession type 1 (RT1): gingival recession with no loss of interproximal attachment RT2: recession with loss of attachment. Interproximal loss < buccal attachment loss RT3: recession with interproximal loss > buccal attachment loss
.................. et al 1979 redid Zander's experiment. o Light microscopic, SEM, TEM. o 63 extracted teeth. o Mode #3 was rejected. o Most common: mechanical locking of the calculus into the tooth.
Canis
14. According to 2017 AAP/EFP World Workshop, grade modifiers for periodontal diagnosis include all except smoking diabetes cardiovascular disease
Cardiovascular Disease
B83. Which study design is used to investigate risk factors associated with rare diseases? RCT Cohort Case-control Cross-sectional
Case Control
B83. Which study design is used to investigate risk factors associated with rare diseases? RCT Cohort Case-control Cross-sectional
Case-Control
Masters & Hoskins 1964
Cervical Enamel Projections 17% of maxillary and 28.6% of mandibular molars
................ et al., 1998(10) • Compared flossing and interdental brushes, split mouth • 26 untreated pts (moderate to severe periodontitis) • 6w period • Plaque removal and PD↓ SSD better w/ .................... • ................ in Bleeding indices • Pts preferred the interdental brush
Christou interdental brush NSSD
Tonetti
Cigarette smoking adversely affects regenerative therapy Perio therapy with GTR/bone replacement material has additional benefits in terms of CAL gains, PPD reductions, and predictability of outcomes compared to papilla preservation flaps alone
Karring
Citric acid doesn't work as an agent to help promote formation of CT on roots
Evans et al (furcation treatment)
Class II involvement improved by 50% and a complete resolution in 20%. Beat option was bone grafting and membrane.
Dragoo (+Schallhorn)
Clinical & Histological Eval of Autogenous Iliac Bone Grafts 1973 Fresh iliac grafts Achieved true reattachment 2-3 months (new cementum, functionally oriented PDL), increase in bone level Autogenous iliac bone grafts: common to see root resorption from undifferentiated bone marrow cells, ass with chronic inflammation; if inflammation resolves then repair may occur
Glickman
Clinical report on GV - it is a successful way of removing perio pockets
Proposed the critical mass concept, which aim to reduce the quantity rather than the quality of bacterial plaque to a critical level that create equilibrium between residual microbes and host response (................ 2002)
Cobb
B27. According to Loe et al. (1965), after abolishing tooth cleansing, the first phase of bacterial proliferation consisted mainly of rods cocci vibrios Spirochetes
Cocci
Carnevale
Combined CL with furcation removal and tooth prepping
Kaldahl and Kalkwarf (Nebraska studies)
Compared FO, MWF, SCRP, CS, split-mouth design in multi-rooted teeth over 2 years Probing depths: FO group showed greatest reduction in probing depth for shallow, moderate, and deep probing depths Attachment: Shallow pockets: FO can produce AL loss, whereas SCRP and CS result in gain (Lindhe) Moderate pockets: MWF and SRP produce greatest gain Deep: FO, MWF, SCRP produce gain Recession greatest for FO > MWF > SCRP > CS During maintenance phase, increase in PD for FO and MWF groups due to coronal mv't of marginal gingiva Breakdown incidence: Greater in deep sites, smokers, CS>SCRP>MWF>FO Most of gain with deep pockets More stable outcome in mild to mod pocket
Waerhaug
Complete Subgingival plaque can be removed 3mm or less. Once we hit 5mm pockets the probability of removing it completely drastically reduced.
_____ is the genetic determinant of the overlying epithelium
Connective Tissue (Karring, Lang, Loe, 1975) - rationale for CT grafts to gain keratinization - monkey study: CT graft from maxillary gingiva compared to CT graft from mucosa
Refractory periodontal disease ASP position paper 2003/2004
Continual loss of attachment that won't respond to treatment despite diligent therapy. Often need genetic testing or microbial testing to find any resistance present.
Baldi
Coronally positioned flap thickness > 0.8-1mm associated with 100% root coverage
Waerhaug
Correlation between absence of plaque and absence of gingival inflammation Failure rates of removing calculus increase with pocket depth 90% of time cannot remove sub gingival plaque on all surfaces Plaque free zone is 0.5-1mm apical to plaque --- OCCLUSAL TRAUMA Bacterial plaque + local anatomy was primary cause of intrabony defect formation, not occlusal trauma Mobility did not reflect destructiveness of periodontal condition
During GTR procedures, are Resorbable or Non-resorbable membranes more effective in terms of CAL gain?
Cortellini - No significant difference between resorbable and non-resorbable membranes in terms of CAL gain - Patient morbidity was lower in the Resorbable membrane group
What factors influence the long term stability of Clinical Attachment following GTR?
Cortellini 1996 - Long term stability associated with compliance: Perio maintenance, Oral Hygiene, Cigarette smoking - Unstable patients lost more CAL at 5 year follow-up than they gained in the first year
What is the effect of tooth vitality on regenerative surgery (GTR)?
Cortellini 2001 - No significant difference in CAL gain and PD reduction between Vital and Non-vital teeth
Classification of Altered passive eruption
Coslet 1977 - Type 1A: Wide KT, normal alveolar crest (≈ 2 mm apical to CEJ) - Type 1B: Wide KT, alveolar crest at CEJ - Type 2A: Normal KT, normal alveolar crest (≈ 2 mm apical to CEJ) - Type 2B: Normal KT, alveolar crest at CEJ
Ochsenbein 1986
Craters: Shallow (1-2mm) Medium (3-4) Deep (5mm+) MD craters seen easier radiographically 10 degree slope for osseous surgery
82. Which study design is used to investigate the association between risk factors and disease prevalence? case-control cross-sectional restospective cohort prospective longitudinal
Cross Sectional
B82. Which study design is used to investigate the association between risk factors and disease prevalence? Case-control Cross-sectional Retrospective cohort Prospective longitudinal
Cross-sectional
Histologic comparison of CTG to Alloderm
Cummings 2005 - Similar histologic outcomes and attachment to root surfaces - Transplanted elastic fibers present in Alloderm graft
Bowers G M. Study of the Width of Attached Gingiva. J Periodontol 1963;34:201‑209
DISCUSSION: A fairly consistent pattern exists in the variation of the facial AG. Extreme and average measurements could be useful in determining an acceptable width of attachment and as a guide when re-establishing a zone of attachment. Healthy gingiva can be maintained even when widths of attachment are very narrow. Some width of attachment is necessary for oral health. COMMENT: Other studies agree that less than 1 mm of AG is adequate (Dorfman and Kennedy, Miyasato et al.). Lang and Loe feel 2 mm of keratinized (1 mm attached) is necessary for health. Hangorsky and Bissada found no relationship between attachment width and gingival health.
Gargiulo A, et al. Dimensions and Relations of the Dentogingival Junction in Humans. J Periodontol 32:261‑267, 1961.
DISCUSSION: There is a somewhat definite proportional dimensional relation between the dentogingival junction and the supporting tissue of the tooth. During passive eruption, physiologic shift of the dentogingival junction is responsible for tooth exposure rather than a "peeling back" of the Epithelial Attachment. The EA was found to be highly variable and the magnitude diminished during passive eruption (50% reduction in length of EA from phase I-IV). The connective tissue (CT) attachment appeared to be constant during all phases of passive eruption. The biologic width - attachment to tooth.
....................... and .................... 1975 • 1,140 adult human teeth made transparent and root canal anatomy observed • Roots were divided into regions: .........., ............, and .............. • Accessory, secondary, and/or lateral canals existed in .........% of the teeth sampled • Usually located in ............. region of the root • .................. and .................. showed the greatest variety of these canal types
De Deus and Horizonte apical, body, and base 27.4% apical Premolars and molars
B.26 The formation of advanced glycation end-products results in ___ collagen solubility and turn over rate increased no change in decreased
Decreased
B12. Nunn and Harrell (2001) concluded that teeth with initial occlusal discrepancies were found to have ____ PDs compared to teeth without occlusal discrepancies deeper similar shallower
Deeper
C21 According to diagnostic guidelines set forth by the American Diabetes Association, a fasting plasma glucose level of 126 mg/dL is considered normal prediabetes impaired fasting glucose diabetes
Diabetes
Wang et al. 2000
Difference between progression of treated vs. untreated Perio at 5yrs is 0.7mm and 1.4mm at 10yrs
Walker et al
Difference between socket preservation and non was 1.4mm only in vertical dimension. No difference in horizontal dimension.
Ramfjord
Distal wedge procedure
Hausmann 1991
Distance from CEJ or alveolar crest was 0.4-1.9mm = no bone loss
Miyasoto
Don't need KT to keep attachment level; it will not cause recession but plaque control is important
What is the effect of orthodontic movement of mandibular incisors with respect to keratinized gingiva?
Dorfman 1978 - Tooth movement in presence of 0-2 mm keratinized gingiva may significantly affect gingival healing in mandibular anterior
Tetracycline has been used as an antibacterial and chelating agent in periodontal therapy. ................... also come in this group. It showed that it can remove smear layer and demineralize dentin. And it was found that maximal binding was observed when >50 mg/ml of tetracycline HCl solutions were used. (..................... et al. 1986)
Doxycycline Wikesjö
What material is best for subgingival restoration of root caries? What type of wound healing is observed in these subgingival restorations?
Dragoo 1997 - Resin-glass-ionomer - Connective tissue attachment directly to the restorative material (human histology)
What is the incidence of root resorption following autogenous iliac bone grafts?
Dragoo, sullivan 1973 - 2.8% incidence of root resorption
Wikesjo
Dynamics of wound healing in periodontal regenerative therapy: same as oral wound healing Early phase (up to 3 days) - inflammation Late phase (up to 10 days) Granulation tissue formation & wound contraction (up to 2 weeks) Matrix formation and remodeling
Orban
Dynamics of wound healing: 24 hours - blood clot, PMNs 24-48 hours - neo-angiogenesis 4-5 days - fibroblasts 1 week - epithelium formation 14 days - tissue maturation 4-6 weeks - CT maturation, epithelialization, adhesion
.............is a chelating agent but with neutral pH in comparison to acidic chemicals like citric acid. So it does not have the unwanted effect on soft tissues and can be considered as more biocompatible. Early studies in 1990s indicated that it can enhance ........................ by exposing collagen fibers on the dentinal surface, while decreasing gingival recession and probing depth. (.................... et al. 1996)
EDTA cell attachment Blomlöf
Fenestration is more common in the ______ while Dehiscence is more common in the ______
Elliot 1963 - Fenestration: Maxilla - Dehiscence: Mandible
How does diabetes affect risk of developing periodontal disease? Pima indian study.
Emrich/Genco 1991 - Diabetes increases risk of periodontal disease by 3 times
Masters and Hoskins
Enamel projection in furcation: 1 - change in CEJ 2 - approaching furcation but not into 3 - into furcation
Engler
Epithelium moves at 0.5mm a day Peak mitotic activity of CT is 2 days, epithelium is 1 day Complete healing after GV is 2-5 weeks depending on width of wound
Greenstein
Eval 4-6 cause healing is done in 4 weeks after SRP
Mellonig
Eval GTR in tx of grade II molar furcations: better horizontal bone fill when ePTFE membrane was used compared to no membrane 1992 - processing of DFDBA results in inactivation of HIV - FDBA has potential --- 1981 Evaluated osteoinductive potential (rate and amount of bone formation) in guinea pig skulls: DFDBA > BB (bone blend) = OC (coagulum) > FDBA with regard
.....................&....................... 1972 (4) • Extracted tooth study: o 625 Max laterals boiled in water defatting agent dried freed of calculus loupe visualization o 12 teeth (shallow radicular groove, not to apex), 3 teeth (deep radicular groove not to apex), 3 teeth (deep radicular groove extending to the apex) o Prevalence: .......%
Everett and Kramer 1.9%
................ et al. 1957 (1) • Observation of the bifurcation area of 328 extracted ................ • Sectioned teeth in three different ways (ground off distal half, ground off mesial half, and ground off roots up to 2mm from the furcation height) and looked at under dissection microscope • First paper to coin term "intermediate bifurcational ridge." • Found to be present in .........% of mandibular 1st molars • The ridge crosses from mesial to the distal root at the midpoint of the bifurcation • Mainly composed of ........... with a base in .................. • It is described as "guarding the entrance to the furcation" and possibly "determining ease of access to the exposed furcation" • Another anatomical variation that could affect periodontal therapy
Everett, mandibular first molars 73% cementum, dentin
How long should you wait before entering a healing extraction site to secure autogenous bone graft material?
Evian 1982 - 8 to 12 weeks
Glickman
Excessive occlusal trauma induced by crowns in abnormal functional relationships in rhesus monkeys changed pathway of inflammation so that it went into bone at PDL, instead of going into gingiva Zone of irritation (due to bacterial plaque, coronal) vs zone of co-destruction (more susceptible to occlusal forces, apical)
Smith (1980) - compare open flap curettage and osseous recontouring
FO able to maintain PD reduction but with AL vs flap curettage (PD recurred, AL stable) .6 mm interproximal, 1.2 mm buccal/lingual
T/F Long junctional epithelium formation is more prone to new pocket formation compared to a normal junctional epithelium
False *Magnusson* 1983 - Long junctional epithelium is not more prone to new pocket formation and reinstitution of disease (ie. long JE is stable)
Gottlow
Father of GTR; use of membrane allows PDL to grow and bac isolation First person to introduce guided tissue regeneration -> more attachment with test vs control
Neeman
First to study GTR
Regeneration
Formation of functionally oriented PDL, bone, and cementum
Sullivan and atkins
Ft graft thickness .75- 1.25mm Thinner graft better vasculature Thinner graft less primary shrinkage Thicker graft more resistant to high stress areas Circulation restored in graft after 3 days
How does oral bisphosphonate use affect implant placement?
Fugazzotto 2007 - History of oral bisphosphonate use for a mean period of 3.3 years was not a contributing factor to development of osteonecrosis following immediate implant placement.
........................ et al 1988 removed the calculus in 1 group and left it on the other after reflecting flap in ..... dogs, followed ........ days. The area with calculus show more persistent inflammation and PD. 10% of the instrumented surfaces showed calculus.
Fujikawa, 8, 120
Hamp et al 1975
Furcation (horizontal) involvement: 1) less than 3mm 2) more than 3mm 3) T&T
Bower 1979
Furcation entrance diameter - 81% <1 mm - 58% <0.75 mm
Hamp
Furcation treatment: Class 1: SRP Class 2/3: resection, extraction
Average depths of the dentogingival junction
Gargiulo, Wentz, Orban 1961 - Sulcus: 0.69 - Epithelial attachment: 0.97 - Connective tissue: 1.07
A study by ............... et al 1999 found that ................. and the coping mechanism of the patient were related to periodontal disease. • M&M: o Erie county study population o stress measured by .................... • Results: o Stress (financial strain) and depression were associated with greater levels of periodontal disease (higher CAL loss and ACH loss- alveolar crest height). o Individuals with good coping skills that were under financial stress did not exhibit increases in periodontal disease.
Genco financial stress questionnaire
A.52 Which affects HBA1C in patients with and without diabetes? Plaque induced gingivitis Localized, slight, aggressive periodontitis Generalized, severe, chronic periodontitis
Generalized severe Chronic Periodontitis
Which furcation entrance of the maxillary 1st molar is closest to the CEJ?
Gher and Dunlap 1985 - Mesial: 3.6 mm - Buccal: 4.2 mm - Distal: 4.8 mm
Goldman
Gingivectomy in 50's
Page and Schroeder
Gingivitis = plaque (2-4d) Initial lesion = vasculitis (4-10d) Early lesion = acute inflammation (2-3weeks) Established lesion = apical migration of JE (years) Advanced lesion = periodontitis and plasma cell predominance
.......................... & ............................ (1965) observed buttressing bone as a result of TFO. This increase in bone quantity was thought to be a protective response to excess force. This idea however was ....................... by ...................... in 2000 , where he evaluated 52 cadaver specimens and saw no relationship between TFO and buccal exostosis. He did observe an increase in buccal lipping at the point of maximum flexing stress, but this finding was not statistically significant. He observed that 76.9% of specimens had either buccal exostosis or lipping, regardless of occlusal forces.
Glickman & Smulow contradicted Horning
Occlusal theory of Co-destruction
Glickman 1963 - Inflammation and trauma from occlusion both contribute to periodontitis
............................. Concept (1965) : He concluded that ........................ & ................... are co-destructive factors in periodontal disease. He saw that the orientation of collagen fibers change with TFO & that will aid in apical migration of plaque. This combination of effects will lead to bone loss & creation of infrabony pockets. He also discussed that the bone loss due to TFO may be ...................... when trauma is dissipated, but the capacity to repair will be impaired in presence of inflammation. ....................... named the components of periodontal tissue into two zones: Zone of ................. o marginal & interdental gingiva, in contact with hard tissue (tooth) o only on one side not effected by occlusion plaque induced lesions o gingival lesions first involve alveolar bone and then PDL horizontal bone loss Zone of ........................ o root cementum, PDL, & alveolar bone o coronal limit: trans-septal and dentoalveolar fibers o collage fibers can be affected by inflammation from zone of irritation or traumatic changes in zone of co-destruction o damage to collage fibers allows migration of inflammation to PDL leading to vertical bone loss .......................... Concept (1979a , b ): On the other hand, he conducted a series of studies on extracted teeth and saw ..................... that TFO is a cofactor in periodontal disease. He believed inflammation and bone loss are due to ..................................
Glickman's inflammation & TFO repaired Glickman Irritation Co-destruction Waerhaug's no evidence subgingival plaque accumulation
Where is the thickest and thinnest portion of the facial gingiva?
Goaslind 1977 - Thickest: Posterior - Thinnest: Anterior
Infrabony pocket classification
Goldman 1958 - 1, 2, and 3 wall defects - 3 wall defects have the most favorable prognosis
In the progression of periodontal disease, which is lost first, Attachment level or Bone level?
Goodson 1984 - Attachment loss precedes bone loss by 6-8 months
What is Arestin?
Goodson 2007 - Minocycline Microspheres used adjunctive to SRP - 0.37 mm improvement in PD compared to SRP alone
Guided tissue regeneration. Name the author associated with the first GTR studies.
Gottlow 1986 - one of the first GTR studies Gottlow 1992 - Attachment gain following GTR could be maintained over 5 years with good maintenance
AAP position paper 2004 on type of bacteria to cause disease
Gram negative anaerobic rods
Scaling and root planing decreased ........................ organisms and increased .......................... rods and coccal species, a microbial shift associated with periodontal health. ............................ et al 1978
Gram-negative Gram-positive Listgarten
In a study by .................... 1997, treatment of periodontal disease resulted in a ........% drop in blood sugar levels (HBA1c). The purpose of this study was to assess the effects of treatment of periodontal disease on the level of metabolic control of diabetes.
Grossi 10
..................... et al 1997 (21) investigated the effect of cigarette smoking on 143 patients' clinical and microbiological responses to mechanical therapy. Treatment included ........... to ............ sessions of subgingival scaling and root planing and instruction in oral hygiene. Results indicate that current smokers have ........... healing and reduction in subgingival Bacteroides forsythus and Porphyromonas gingivalis after treatment compared to former smokers and nonsmokers, suggesting that smoking ................. periodontal healing. As the healing and microbial response of former smokers is comparable to that of nonsmokers, smoking cessation may restore the normal periodontal healing response. According to ............. et al. 2000 (22), smokers are ....... times more likely to have periodontal disease than non-smokers.
Grossi four to six less impairs Grossi 2.7
..................... et al 1994 (16) aimed to investigate the role of ....................., socio-economic factors, smoking, occupational hazards, and ....................................... as risk indicators for attachment loss. Being a cross-sectional study, these findings offer no information over longitudinal time. Only .......................... may be found, but ........................ can be inferred. Perio exam included assessment of supragingival plaque, gingival bleeding, subgingival calculus, PD, and CAL • Subgingival plaque samples taken Results: • More systemic disease seen in individuals with more severe ....... o History of diabetes had odds for more severe CAL that was ........... that of subjects who did not have diabetes • Smoking: o No periodontally healthy subjects were now or previously heavy smokers o Trend seen for increasing AL with increasing packyears o The very light or occasional smoker did not show increased risk, but a heavy smoker (30+ packyears) had an odds ratio of ............ • The only two organisms showing increased percentage of positive subjects form healthy to severe AL groups were ........................ and ...................... Conclusion: • Age, history of DM, smoking, and subgingival infection with P. gingivalis and B. forsythus are significant risk indicators for attachment loss in the adult population • The association between these indicators and attachment loss remained significant after controlling for confounding factors in the logistic model such as gender, race, education, income, socio-economic status, supragingival plaque, and subgingival calculus • These indications are worthy of further examination through longitudinal and intervention studies to determine if they are true risk factors.
Grossi systemic disease subgingival bacteria associations no causality CAL twice 4.75 P. gingivalis B. forsythus
Who was the first to describe the Lateral pedicle flap?
Grupe, Warren (1956)
Intraosseous defects treated with DFDBA vs. DFDBA with ePTFE membranes. What difference was made with addition of an ePTFE membrane?
Guillemin (1993) - No significant difference in bone fill with or without ePTFE membranes. - Statistically significant increased Recession and loss of keratinized tissue in the ePTFE group
What percentage of teeth have patent accessory canals in the furcation region? Are accessory canals more common in the maxilla or mandible?
Gutmann 1987 - 28% of multi-rooted teeth have patent furcation canals - Mandibular molars are more likely to have patent furcation canals
The role of smoking as a risk factor for periodontitis was also assessed by .................. et al 1993 (19). M&M: - Two study groups: diabetic (IDDM) (n = 132) and nondiabetic (n = 95) stratified for age and sex - Patients were recruited by phone, examined, and their medical and dental histories obtained. Results: - Among nondiabetic subjects, the prevalence of periodontitis was markedly higher among current smokers compared with never smokers (P < or = 0.005) in both the 19 to 30-year-old (46% vs. 12%) and 31 to 40-year-old groups (88% vs. 33%). - The subject mean percent of sites with gingival pocket depth > or = 4 mm was higher among current smokers than never smokers (P = 0.001) in the 19 to 30 (8.2% vs. 3.4%) and 31 to 40 (14.3% vs. 4.3%) age groups. - The effects of smoking among IDDM subjects were .............. to that observed in the nondiabetic population. - There were ........................... between current and never smokers in the proportion of sites positive for plaque. Conclude: Attributable risk percent from prevalence data suggest that among nondiabetic subjects, a large proportion, perhaps as much as 51% of the periodontitis in the 19 to 30-year-old group and 32% of the periodontitis in the 31 to 40-year-old group, is associated with smoking.
Haber similar no differences
....................... and .................... 2001 investigated the effect of smoking on ................................. by looking at smoking history and classified into never, past, and current smokers. Took subgingival plaque samples. • Results: o Highest bacterial counts for all groups were: A. naeslundii, Veillonella parvula, and members of the orange complex o Current smokers showed higher values of: B.f., F.nucleatum, ss vincenti, S. gordonii, and T. denticola o Cigarette smoking may complicate therapy by providing a more favorable environment in shallow pockets for periodontal pathogens.
Haffajee and Socransky subgingival microbiota
How do open contacts correlate with periodontal disease?
Hancock 1980 - Open contacts associated with food impaction have increased attachment loss and probing depths - Open contacts without food impaction have no associated increase in PD or CAL
....................... et al 1980 (24) o 44 male, 1040 proximal contacts, good OH. o GI, PI, calculus, caries, proximal restorations, overhangs, integrity of contacts (Defined as tight, loose, open by resistance, with ..................). o Findings: -Periodontal status worse in ............................ -Contact did not have direct effect on PD alone. -Loose contacts were most associated with food impaction (4% of sites). -PD least for tight, intermediate for loose and greatest for open contacts. o No significant relationship btw contact type and GI or PD. o Significant relationship btw food impaction and contact type, and btw food impaction and PD, reinforced food impaction contributes to periodontal disease. • Summary: Open contact does not lead to perio disease directly if not associated w/ food impaction.
Hancock, unwaxed floss, posterior
Schluger
Harmonious osseous and gingival architecture for maintenance of pocket elimination
.............. & ................... (2001) in their follow-up study, observed that occlusal adjustment helps ................ progression of periodontal disease: • Retrospective study - 26 adults • Aim: effect of TFO & occlusal adjustment on progression of perio disease • Results: teeth without adjustment are .......x as likely to worsen in mobility. They have greater increase in PPD. • Conclusion: occlusal adjustment reduces progression of perio disease
Harrel & Nunn reduce 1.3
Acellular dermal matrix vs. Connective tissue autograft
Harris 2000 - Statistically equal in terms of root coverage - CT graft resulted in slightly greater improvement in probing depth and width of keratinized tissue
Repair
Healing by long junctional epithelium
Amler 1969
Healing of socket: 24 hours: blood clot 2-3D: granulation tissue 4-5D: epithelium migration 3 wks: CT and osseous form in socket 6 wks: first sign of healthy bone
.................. & ................ 1986 (27) o D <........mm ======== only PDL. o .......mm>D>.......mm ======== laminae dura. o D >.........mm Cancellous bone along with laminae dura. o The minimum inter-root distance between adjacent posterior teeth occurs most frequently at the coronal third of the root.
Heins & Wieder, 0.3, 0.3-0.5, 0.5
What is the prognosis of Class III furcations that were treated with tunnel preparations?
Hellden (1989) - 75% of teeth were caries free and in function at the 5 year follow up
Does orientation of acellular dermal matrix (ADM) affect root coverage?
Henderson 2001 - Orientation of ADM doesn't affect % root coverage
Following periodontal flap surgery, when does gingival flap adhesion occur?
Hiatt 1968 (dog study) - strength of flap attachment occurred by 2 weeks
Which tooth is most likely to be lost following perio surgery? Which tooth is least likely to be lost following perio surgery
Hirschfeld and Wasserman - Most: Mx 2nd molars - Least: Mn canines
............................. & ................................. 1978, 1. ........................ patients in a private periodontal practice were reexamined an average of ....... years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, .......... patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth (well maintained, downhill, extreme downhill) 3. Of 2,139 teeth that originally had been considered of questionable prognosis, ......... were lost. Of these, 394 were lost by one-sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, .......... were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally ................ and there is a predictable order of likelihood of tooth loss according to position in the arch.
Hirschfeld and Wasserman Six hundred 22 300 666 460 symmetrical
Name the authors of the classic study involving a Long-term survey of tooth loss in 600 treated periodontal patients. Into what three groups were the patients divided?
Hirschfeld and Wasserman 1978 article: 22 year follow up on average - Well maintained (0-3 tooth loss): 83% of patients - Downhill (4-9 tooth loss): 13% - Extreme downhill (>10 tooth loss): 4%
According to whom and teeth are greatly to survive after periodontal surgery?
Hirschfield and Wasserman 1978 Mandibular Cuspids and BiCuspids
Does osteoporosis have an effect on survival of dental implants?
Holahan 2008 - Osteoporosis and osteopenia do not contribute to increased risk of implant failure
What are the PASS Principles for GBR?
Hom Lay Wang (2006) - Primary closure - Angiogenesis - Space maintenance - Stabilization
Updated edentulous ridge classification
Hom Lay Wang 2002 HVC ridge deficiency classificaiton H - Horizontal V - Vertical C - Combined
Hamp 1975
Horizontal Furcation 1) not exceeding 3mm 2) greater than 3 3) through and through
....... & ........ 1987 o Molars w/ and w/o FI, w/ and w/o CEPs in 78 pt. o Using probing, PAs, and flap. o Masters & Hoskins classification for CEPs; Glickman's for FI. o Patient level: ..........% of pt had CEP (NSS correlation w/ gender). o Molar level: ........% of molars had CEP. o Majority are grade 2 & 3. o Highest prevalence in mand. 1st M (followed by max. 1st M, then mand. 2nd M, then max. 2nd M) and lowest in max 3rd M. o SS relationship bw CEP and FI, PlI, and GI. o ........% of molars w/ CEPs had FI. o Majority of CEPs are bilateral. o In molars w/ CEPs, frequencies of FI ........... w/ age.
Hou & Tsai, 67.9%, 45.2%, 82.5%, increases
.................&.................. 1997 , Masters and Hoskins classification was used for CEPs. New grading system for IBRs was established. Grade I: dimension < ....................... Grade II: dimension < ...................... Grade III: dimension ≥ to 2mm X 2mm • Among 87 molars with furcation involvements, 55 had CEPs and IBRs (.........%) • Prevalence was greatest in the .............................. • The differences in mean PD, CAL, and GI between the molars with and without CEPs and IBRs were highly significant • IBRs are a common finding in mandibular first molars • The knowledge of their anatomy and prevalence should be kept in mind for root instrumentation • Contribution to periodontal disease progression is unconfirmed
Hou and Tsai < 1mm X 1mm 2mm X 2mm 2mm X 2mm 63.2% mandibular first molars
Goldman and Cohen
How to classify bony defects Most common defect is two wall defect (crater) -> use resective surgery
Freedman - 10 year longitudintal study
If no inflammation, small amount of KT may remain stable over long periods of time
Van der Valden
If you leave inter proximal completely denuded, if the crest of bone to apical portion of contact area is <5 mm, it will get filled
Albrektsson et al
Implant success is 85% after 5yrs and 80% after 10 years Pts with perio disease are 16x more likely to get peri-inplantitis than those that are healthy
Sanchez-Perez et al
Implant success rate: Smokers 84% Non-smokers 98%
Chang
Implants have thicker tissue and greater probing than natural teeth
B7. In the European Federation Periodontology Workshop (2018), it was reported that periodontal therapy ____ HbA1C levels improved had no effect worsened
Improved
Herrera et al. 2002
In chronic periodontitis, most studies show at best a slight, short term clinical benefit by adding antibiotic therapy (within 1mm) - In patients with aggressive disease, most studies indicate a significantly better clinical response with antibiotics and it is advisable to do so
Wennstrom
In good hygiene, lack of adequate zone of attached gingiva does not result in increased incidence of soft tissue recessions No relationship with KT and recession? ---- prevalence of furc involvement Higher prevalence in max molars (distal aspect) than mand molars Narrowest furc entrance found on buccal aspect of max and mand molars Mesial aspect of the second molar had least frequency of furc involvement
Badersten 1990
Inc PD most predictable CAL No molars used though
B81. When assessing disease ______, the cohort design is the most appropriate severity incidence odd ratio prevalence
Incidence
B81. When assessing disease ______, the cohort design is the most appropriate severity incidence odd ratio prevalence
Incidence
C19. According to Papanou and Wennstrom (1991), the presence of angular bony defects entails a(n) __ risk for further alveolar bone loss increased similar decreased
Increased
Zitzman, Berglund Lindhe
Inflammatory lesions in gingiva following resective (GV)/non-resective (OFD) periodontal therapy Surgical therapy —> regenerated gingival units with smaller lesions and smaller inflammatory cell infiltrate
Which is not an acute-phase protein produced in the liver CRP interferon mannose-binding lectin fibrinogen
Interferon
Everett 1958
Intermediate Bifurcation Ridge 73% of mandibular molars
Widman
Internal bevel to remove a collar
Ochsenbein
Interproximal crater classification (change from Ochsenbein 1964): shallow (1-2 mm), medium (3-4 mm), deep (5+mm) Medium is most common Average root trunk (max/mand): short 3/2, average 4/3, long 5/4 Goal of osseous surgery is to remove the minimal amount of bone for adequate architecture Advocates palatal approach to osseous surgery - lots of KT, increased embrasure space, cleansing effect of tongue, less resorption, avoid exposure of buccal furcation, better aesthetics
Ramjford 1974
Introduced Modified widman flap Reattachment and readaption without extending beyond MGJ
Waerhaug 1978
JE became attached after 2 weeks of SRP
.................... et al., 2006(12) • Single blind, randomized controlled clinical trial • 12 w w/ 77 pts w/ chronic periodontitis • Compare ...................... & ........ • Sig improvement for both groups • Both at 6 & 12w, ........................... show better results Summary: Not much dif regarding floss type; Interdental brush works better esp. for open interproximal spaces.
Jackson interdental brush & floss interdental brush
Do FGGs have more shrinkage over denuded alveolar bone or over periosteum?
James/McFall 1978 - FGGs placed over denuded alveolar bone have less shrinkage
...................... & ...................... 1980 o Cross sectional study. o Evaluate perio destruction around overhang restoration of various sizes. o Categorized overhangs by the % of the interproximal space they took up (small <20%, medium=20-50%, large > 51%) o Found that overall the bone loss was ........ when there is overhang. o The larger overhang, the more destructions. o Severity increased w/ ....... of the pt and the longer the overhang presents. o Both medium and large overhangs result in greater bone loss.
Jeffcoat & Howell, greater, age
What is the effect of overhanging class II restorations on alveolar bone destruction?
Jeffcoat 1980 - Greater bone loss occurs around teeth with larger overhangs in all perio disease types - medium and large overhangs associated with greater destruction (small: <20%, medium: 20-50%, large: >50%)
What is Perio Chip?
Jeffcoat 1998 - Chlorhexidine chip used in local delivery of antibiotics as adjunctive use with SRP - Deep probing sites retreated with perio chip but not SRP in this study (study flaw)
.............. & ................. (1992)iv proposed the Trauma from Occlusion Index (TOI) and Adaptability Index (AI). They observed that some of the teeth exposed to TFO have ....................... 2 combined indices, i.e.. the trauma from occlusion index (TOI) and the adaptability index (Al). were proposed for the identification of occlusa! trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit ........... PD. more AL and less osseous support than TOI-negative teeth; however, ,AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment levels. TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss. •Conclusion: premature contacts do not have an effect on PD, AL or BH, but will cause widened ........... space.
Jin & Cao adapted deeper PDL
............. & .................. (1992) described two indexes for TFO. One index describes destructive signs and other describes adaptive signs of TFO: 1. Trauma from Occlusion Index (TOI) a. ................................. b. .................................. 2. Adaptability Index (AI) a. ........................................ b. ........................................
Jin & Cao functional mobility radiographically widened PDL space pronounced tooth wear radiographically thickened lamina dura
How do furcations respond to periodontal therapy?
Kalkwarf, Kahldahl 1988 - All patients lost attachment in furcations regardless of treatment modality (coronal scaling, SRP, MWF, or osseous)
Describe the classification of sagittal root position in relation to the anterior maxillary osseous housing
Kan 2011 - Class I: root positioned against labial plate - Class II: root centered in the middle of the alveolar housing without engaging either coritcal plate - Class III: root positioned against the palatal plate - Class IV: At least 2/3 of the root is engaging both labial and palatal cortical plates
What is the effect of Splinting of teeth on Mobility reduction
Kegel/Selipsky 1979 - No reduction of mobility in splinted teeth compared to non-splinted teeth during initial perio therapy
In maxillary and mandibular molars, which root trunks are longest and which are shortest?
Kerns 1999 - Mandibular molars: Buccal root trunks are shorter than lingual root trunks (buccal < lingual) - Maxillary molars: Buccal root trunks are the shortest. distal root trunks are shorter than mesial root trunks. (buccal < distal < mesial)
How does osseous surgery affect tooth mobility?
Kerry 1982 - Osseous surgery will temporarily cause increased mobility
Is there added benefit to Citric acid conditioning prior to GTR?
Kersten (1992) - No benefit from citric acid root conditioning
The effect of root roughness on PD and CAL between smooth and rough clean root surfaces
Khatiblou 1983 - No clinical difference in PD and CAL
......... et al. 2008 o Longitudinal study, evaluating association btw root proximity and the risk for alveolar bone loss (ABL). o PA of mand. incisors from 473 subjects. o Interradicular distance (IRD) at ...... and bone crest at baseline and last follow-up were assessed. o SS non-linear association btw IRD and ABL rate. o IRD ≤ ........... mm showed more bone loss than ≥ .......... mm. If < 0.6 mm it had a ......% chance of losing ≥ 0.5mm & ....% chance of losing ≥ 1mm in 10 years. • Summary: No evidence to show the relation btw Root Proximity and OH. Root proximity might affect bone loss.
Kim, CEJ, 0.6, 0.8, 28, 56
In a study by ...................... et al 1997 (28), .......% of the severe periodontitis patients were either smokers or had the IL-1 genotype • M&M: o 134pts (>35yrs) with mild to severe periodontitis included o All of Caucasian Northern European heritage. o Clinical evaluation and bloodwork completed • Results o In the non-smokers, there was a ............... correlation between the severity of periodontitis and the composite genotype: - Allele 2 of IL-1A -889 polymorphism + Allele 2 of the +3959 polymorphism of the IL1B gene -OR = 6.8 • This composite genotype comprises a variant in the IL-1B gene that is associated with high levels of IL-1 production • Conclusion o The combination of either smoking or the specific composite genotype accounted for .......% of the severe forms of periodontitis subjects. o The IL-1 genotype was a very strong predictor of severe disease in non-smokers o specific genetic markers, that have been associated with increased IL-1 production, are a strong indicator of susceptibility to severe periodontitis in adults.
Kornman 86 strong 86
......................... et al 1991 (32) o Evaluated the healing after 3rd molar extraction for pts younger than 20 y and older than 30 y by looking at Plaque score, PD, angular bone defect. o Older group: cases with high plaque scores and deep PD demonstrated SSD deeper intrabony defects than cases with no pre-op plaque and deep pockets. o 3rd molar that is in position to cause defect should be removed early. o Factors include: mesial inclination + males + ostectomy + sectioning • Summary: Impacted 3rd molars will contribute to perio destruction, regardless of instrumentations; if cause defect, remove early.
Kugelberg,
..................... et al., 1982(8) • 80 pts • 4 groups (2 waxed & 2 unwaxed) • Exam at 0, ..... and .......d • ................. btw the types of floss in plaque removal and gingival response
Lamberts 28 56 NSSD
.............. & ........... 1972 (19) o 32 dental students, 19-29 yrs old, no pockets. o 1406 tooth surfaces, 1168 plaque free. o Suggested that ......... of KG is necessary to maintain gingival health by looking at GI and the amount of KG. o With < 2mm of KG and < 1mm AG it is harder to MTN proper plaque control.
Lang & Loe, 2mm
Is bleeding on probing (BOP) a good indicator for progression of periodontal disease?
Lang 1990 - Presence of BOP is not a good indicator of disease progression - Absence of BOP is a reliable indicator for periodontal health
................&.................... 1981(13) • ..................... and .................... • 40 dental students o 1) mouth rinsing w/ placebo; o 2) mouth rinsing w/ 0.1% CHX; o 3) fractionated jet irrigators w/ placebo; o 4) fractionated jet irrigator w/ 0.05% CHX; o 5) monojet irrigator w/ 0.05% CHX. • SS plaque reduction w/ ........ • Less plaque w/oral irrigators than rinsing, esp. fractionated
Lang and Räber Rinsing and oral irrigation CHX
............. 1983 o .......................... study (each group received both test and control treatment). o 9 pts, 10 teeth (......... sites) MOD gold onlay. o 8-27 wks. o Overhang restorations (..........): -Change in the subgingival microflora composition that is associated with periodontal disease. -Increased ........................................... -Increased GI preceded increase in BPB. -No loss of CAL. o "Perfect" margin: -Microflora consistent w/ health/ initial gingivitis. o Conclusion: -Change in subgingival microflora is associated w/ overhang margins, as potential mechanism for initiating disease. -Removal of the etiologic factor removed the pathogenic changes.
Lang, Cross-over, 20, 1mm, black pigmented Bacteroides
First authors to describe the subepithelial connective graft
Langer and Langer 1985
Greenstein
Lateral window 4mm
How does platform switching affect alveolar crestal bone levels around dental implants?
Lazzara 2006 - Radiographic analysis shows Less crestal bone resorption in platform switched implants
.................... et al. 1996 (9) • 17 extracted single-rooted teeth with one cemental tear surface and one opposite intact surface • Stained in 0.1% toluidine blue to visualize attached PDL remnants under LEM • LOA measured from CEJ to most coronal level of PDL fiber • Cemental tear surfaces demonstrated greater LOA than opposite intact surfaces • Histological exam revealed split between root and torn fragment occurred along the ................................ border • Should be considered as a possible etiologic entity in localized rapid periodontal breakdown
Leknes cemento-dentinal
When should Splinting of teeth be considered?
Lemmerman 1976: Rationale for Stabilization - Following trauma - Patient Comfort - Prevent drifting of teeth - Prevent mobility (does not improve mobility)
A comparative study by Leon, compared ultrasonic vs hand instruments in furcation areas (........... et al.) F1 hand instrument .......... to ultrasonic F2 and F3 ultrasonic is ............ (number of motile rods and spirochetes are reduced significantly using ultrasonic compared to hand scaling) This difference can be explained by applicability to use ultrasonic tip in all angulations rather than in certain angulation like hand instrument
Leon similar better
What instrumentation should be used for debridement of class II and III furcations?
Leon 1987 - Ultrasonics are significantly more effective in debridement than hand instrumentation.
Does periodontitis affect success of implant survival?
Levin 2011 - Periodontal disease is a significant risk factor for late implant failure
Occlusion studies on beagle dogs
Lindhe 1974 - Trauma from occlusion with inflammation may accelerate progression of experimental periodontal disease
Critical probing depths
Lindhe 1982 - SRP: 2.9mm - MWF: 4.2mm
What are the critical determinants in success of Non-surgical periodontal therapy?
Lindhe 1984 - Quality of root debridement - Plaque control
How does patient age affect periodontal treatment with resective surgeries
Lindhe 1985 - Age had no effect on response to resective surgeries
Is connective tissue reattachment related more to level of alveolar bone or to root surface?
Lindhe/Nyman 1984: monkey study - Root surface more related to CT reattachment - Root planed surfaces healed with long junctional epithelium while non-root planed surfaces healed with CT reattachment in healthy teeth
Oschenbein and bohanan
Lingual palatial approach for osseous
..................... et al. 2013 • 53 patients with 53 single implant-supported metal-ceramic restorations • Measured subgingival location of the margin MDBL and placed into .......... groups based on this measurement • Cemented with resin-reinforced glass-ionomer • After cleaning, radiograph taken to assess cement removal, then abutment was unscrewed for evaluation clinically • Calculated: o The relation between cement remnants area and the total area of the abutment/restoration o The relation between the cement remnants and the total area of implant soft tissue contour • Results: o Undetected excess cement increased when the margin was located ............... subgingivally SSD was found among all groups (equi-gingival, 1mm subgingival, 2mm subgingival, and 3mm subgingival) o Radiographic evaluation showed that cement remnants mesially were visible in four cases of 53 mesially (7.5%) and in six cases of 53 distally (11.3%)
Linkevicius four deeper
How does vertical soft tissue thickness affect crestal bone changes following dental implant placement?
Linkevicius 2015 - Thin tissue thickness ≤2 mm has more radiographic bone loss compared to patients with thick tissue >2 mm
........................... & ........................... 1973 o 2 monkeys w/ gingivitis. o Showed presence of an attachment btw the JE & the adjacent surface of residual calculus. o JE was attached to the dental cuticle covering the tooth & the calculus surface by means of typical .............................. & ........................... o If you leave calculus behind, you will have attachment to it. • Summary: Calculus is harmful lead to more plaque accumulation.
Listgarten & Ellegaard, hemidesmosomes & basement lamina
What is the effect of tetracycline combined with SRP compared to SRP alone on periodontal disease?
Listgarten 1987 - Tetracycline improves short term parameters but not long term
Plaque was established to be considered as the primary etiological factor in periodontal disease initiation and progression (................. et al. 1965)
Loe
.......... et al., 1986(31) • The "............................." group • ∼...% w/ rapid progression (CAL 0.1-1mm/y) • ∼....% w/ moderate progression (CAL 0.05-0.5mm/y) • ∼....% w/ no progression worst was gingivitis (CAL 0.05-0.09mm/y)
Loe Sri Lankan 8 81 11
Who is the author of the Gingival index, plaque index, and retention index systems
Loe 1967 - subjective score 0-3. A score of 0 is pristine health or cleanliness while a score of 3 is severe inflammation or excessive plaque build-up - Loe and Silness: Gingival index - Silness and Loe: Plaque index
..................... and ................... 1991 Early Onset Periodontitis in US • In this paper, "Early Onset periodontitis" includes: -Localized Juvenile Periodontitis -Generalized Juvenile Periodontitis M&M: • National survey conducted by the National Institute of Dental Research from 1986-1987 (school year) across seven regions of US • 11,007 subjects from grades 8-12 (14-17yrs) were given periodontal assessment o No radiographs o Attachment loss (AL) o Bleeding on Probing (BOP) B and M sites of fully erupted permanent teeth • LJP was defined: At least one 1st molar and at least 1 incisor or 2nd molar and 2 or fewer cuspids or premolars with 3mm or more of AL • GJP was defined: If 4 or more teeth had ≥3mm AL and at least 2 affected teeth were 2nd molars cuspids or premolars. • ILPA (incidental loss of periodontal attachment) was defined: As having or more teeth with at least 3mm of AL but didn't fit the criteria of LJP or GJP. Results: • Est. prevalence: o LJP = .........% o GJP = .........% o ILPA = ........% • In LJP: o ................... were most commonly affected (........%) o ................... were next (.........%) o incisors (......%) • In GJP: o Wide distribution of 37% of premolars and 33% of molars being affected. • Age: o Kids with LJP increased in prevalence until they hit age 16 o Kids with GJP showed no increase in prevalence with age after 15 • Sex: o No significant difference, o trend towards higher LJP, GJP, and ILPA in males AA: males more likely Caucasian: females more likely • Race: o AA more likely to have all three of the diseases listed in study. o AA males were .......x more likely to get LJP than AA females Conclusion: When race was considered alone, AA were ......X more likely to have LJP and ......X more likely to have GJP.
Loe and Brown 0.53 0.13 1.61 1st molars 40 2nd molars 21 10 2.9 15 25
In a group of Sri Lankan tea workers without oral hygiene, how did periodontitis progress?
Loe, Anerud 1986 - Rapid progression: 8% (complete tooth loss by age 45) - Moderate progression: 81% (7 teeth lost on average by age 45) - No progression: 11% (essentially no tooth loss)
Who is the author for Experimental Gingivitis using dental students who stopped brushing? How long does it take for gingivitis to develop? To resolve?
Loe/Theilade 1965 - Gingivitis produced when oral hygiene is removed in 15 - 21 days - Removal of bacterial plaque causes resolution in 7 days
Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38
Long chapter that revisits the basic structural configuration of the periodontium and to portray the cellular elements whose normal functions maintain the homeostatic balance known clinically as periodontal health. Epithelium is summarized below, read the full text for a good review of connective tissue and vasculature.
Cortellini
Long-term stability of clinical attachment following GTR and root planing therapy are similar, and more dependent on individual characteristics than on therapy See diagrams for decision tree making in pt selection, defect selection, and tx selection MIST, MPPT, SPPF RCT does not affect outcome (% CAL gain) of GTR
Olson
Longitudinal study comparing apically positioned flap with and without osseous surgery flap curettage -> return of pre-op probing depths, whereas osseous is more effective with long-term stabilization for probing depths 5-8 mm (also get recession tho)
What horizontal distance between dental implant and natural tooth is associated with a full papilla? What vertical distance between the contact point to alveolar crest is associated with a full papilla?
Lops 2008 - 3 to 4 mm horizontal between tooth and implant - 3 to 5 mm vertical between the contact point to the alveolar crest
. Gingivitis model showed that cessation of oral hygiene resulted in increased accumulation of oral debris at the gingival and changing of the bacterial flora into gram negative which produced gingivitis (.......... et al. 1965
Löe
How does membrane exposure affect healing on GBR around implants? How does membrane exposure affect healing on GTR around natural teeth?
Machtei (2001) - Membrane exposure results in major negative effects on GBR around implants - Exposure results in minimally negative effect on GTR around natural teeth
............................... et al., 1984(34) • 16 perio pts; 32w; 4 quads SRP Group A (n = 9) no recall in 1st ..... weeks, then same as group B Group B (n= 7) recall 1x/2 w & rinsed 2x daily w/ 0.2% CHX • Marked subG microbiota ↓ after SRP in both groups • Large number of spirochetes & motile rods re-established sooner (4-8w) in group A. • No such increase in group B
Magnusson 16
"All-on-four" concept for implant placement in edentulous arches
Malo
40. According to Hou and Tsai (1997), the ___ molar has the highest prevalence of combined CEP and intermidiate bifurcational ridges maxillary first maxillary second mandibular first mandibular second
Mandibular First
40. According to Hou and Tsai (1997), the ___ molar has the highest prevalence of combined CEP and intermidiate bifurcational ridges maxillary first maxillary second mandibular first mandibular second
Mandibular First Molar
............. & .................. 1964 o Classify CEP: 1. Grade I, a distinct change in CEJ attitude with enamel projecting toward the bifurcation. 2. Grade II, approaching the furcation, but not actually making contact with it. 3. Grade III, extending into the furcation proper. o ...... of mand. molars (B) and ........ of max. molars (B&D) had CEPs. o CEP doesn't mean furcation involvement, but furcation involvement might mean CEP is present.
Masters & Hoskins, 28%, 17%
Cervical enamel projections, grading system for molar teeth
Masters 1964 - Grade I: shallow projection of enamel - Grade II: Enamel projection approaches the furcation without contact - Grade III: Enamel projection extends into the furcation
What Systematic antibiotics may improve results of periodontal treatment in Smokers?
Matarazzo 2008 - SRP + Metronidazole + Amoxicillin provided best results in smokers
Also ultrasonic instrumentation appears to more adequately remove calculus in the narrow furcation ( ........... et al. 1986).
Matia
How efficient is instrumentation of furcations with surgical access?
Matia 1986 - Closed instrumentation of furcations is ineffective in removing calculus - Open flap and ultrasonics indicated for debridement of narrow furcations
Creeping attachment
Matter 1980 - Creeping attachment occurs between 1 month - 1 year (about 1 mm gain)
How does Ochsenbein classify average root trunk lengths for maxillary and mandibular molars?
Maxilla - Short 3, average 4, long 5 Mandible - Short 2, average 3, long 4
Bower 1979
Maxillary furcation concavities - 94% MB root - 31% DB root - 17% P root Mandibular furcation concavities - 100% of M roots - 99% of D roots
Most common place for furcation involvement
Maxillary molars. Narrowest entrance space on buccal of all molars. Most frequent site was distal of maxillary second molar.
Lin et al 2011, • .................... or ........................... (.........%) were most frequently affected by cemental tears • Teeth with cemental tears occurred more commonly in ....... and patients 60 + years • ............% of cemental tears sampled could be detected on preoperative radiographs • Age, sex, tooth type, and ............ are the significant predisposing factors
Maxillary or mandibular incisors 76.1% men 56.3%
......................... and .......................... 1996 (10) • Aim: o To determine the relationship of each clinical factor to the assignment of initial prognosis, improvement in prognosis at 5 years, and worsening in prognosis at 5 years • M&M o 100 treated periodontal patients under maintenance for 5 years 38/100 followed for 8 years Increased probing depth, more severe furcation involvement, greater mobility, unsatisfactory crown-to-root ratio, malpositioned teeth, and teeth used as fixed abutments resulted in worse initial prognoses • Results o The coefficients from this model were able to predict accurately the 5- and 8- year prognoses ......% of the time However, when teeth with "good" prognoses were excluded, the predictive accuracy dropped approximately ........% o The regression model indicated improvement in prognoses and worsening in prognoses were both strongly associated with initial PD, initial furcation involvement, initial tooth malposition, and smoking when adjusted for initial prognosis. • Conclusion o Some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time o The traditional approach for assigning prognoses is .......................... for teeth with an initial prognosis of less than good
McGuire and Nunn 81 50 ineffective
Which bone grafting material has the highest osteogenic potential (highest osteoinductivity)?
Mellonig/Bowers 1981 - DFDBA has the highest osteogenic potential - DFDBA > Autogenous > FDBA
Gattlow et al
Membrane types: 1 - nonresorbable 2 - resorbable 3- resorbable with agent delivery 4- PFT membrane and electro spinning
What is the mechanism by which diabetes influences periodontal disease?
Meng 1999 - Impaired cellular immunity - Decreased leukocyte and neutrophil chemotaxis, phagocytosis, and adherence - Advanced glycosylation end products (AGEs) accumulation in capillary and tissues impeding O₂ perfusion and collagen turnover
D7. According to Gher and Dunlap (1985), which furcation entrance of maxillary first moalr is closest to the CEJ? distal mesial buccal
Mesial
Most common place for persistent perio defects
Mesial of maxillary first molar and mesial of first maxillary premolar
Classification of recession defects
Miller 1985 - Class I: recession before the MGJ - Class II: recession beyond the MGJ without interproximal bone loss - Class III: recession beyond the MGJ with interproximal bone loss - Class IV: recession beyond the MGJ with severe attachment loss
...................... and ................... 1942 o Examined radiographs of 500 clinic periodontal patients o rated alveolar support of each tooth on 1-5 scale and sum of scores were averaged Found bilateral symmetry in a pattern similar to what found in ...................... and ..........................
Miller and Seidler Hirschfeld and Wasserman
Miller
Miller classification I - recession has not reached beyond mucogingival junction, interproximal bone loss coronal to CEJ II - recession has reached / beyond mucogingival junction, interproximal bone coronal to CEJ -> 100% root coverage III - recession reached / beyond mucogingival junction, interproximal bone loss apical to CEJ // malpositioning of teeth -> partial root coverage IV - recession reached . beyondmucogingival junction, severe interproximal bone loss apical to CEJ/ malpositioning of teeth -> no root coverage FGG + citric acid for root coverage is successful as one procedure, w/ no correlation with width and depth of defect
Seymour et al. 1983
Minimal cell infiltrate within 21 days after no oral hygiene Mainly lymphocytes Gingivitis predominantly T-cell
49. According to the 2017 AAP/EFP World Workshop, there are ____ differences between the microorganisms found in endodontic and periodontal lesions between the major moderate minor
Minor
.................. et al., 2006(19) • Retrospective; 15 to 23y follow-up; 505 pts • Maintenance therapy (≥10 y) • Assessed compliance complete (> ......% maintenance visit) erratic (< .......% maintenance visit) • Assessed PD, BOP, PI, and tooth loss • Erratic compliers had a ......% decreased risk for losing ≥ 1 teeth compare to complete compliers • Tooth loss could not be improved in the long-term by changing erratic to complete compliance • Elders show more compliance • Complete compliers show less inflammation (BOP, PlI) Summary: Compliance w/ SPT is an essential component for the prevention of disease recurrence and tooth loss; Lack of compliance with SPT is associated w/ disease progression and higher rates of tooth loss.
Miyamoto 70 42
.................... 1977 (20) o 16 subjects; buccal aspect of lower ................. regions; KT. o Teeth with minimal width of KT (................) had no amount of AG. o The teeth with appreciable width of KG had a mean of 1.1 mm of AG. o Absence of plaque on mid-buccal surface. o Suggested that health can be maintained in areas with minimal (<1mm) KT.
Miyasato, bicuspid, ≤1 mm
Miller
Mobility Class 1 - first sign of mobility Class 2 - up to 1mm Class 2 - more than 1 and depressible
ASP position paper on maintenance 2003 and who treats severe diseases
Moderate to severe perio disease patients need to be treated in periodontists office for maintenance
Following osseous surgery, how much osseous remodeling is expected?
Moghaddas 1980 - Average loss of 0.8 mm following osseous surgery
Polson and Zander
Monkeys OT alone -> reversible bone loss, no CAL loss/pocket formation OT + inflammation -> no reversible bone loss In inflammation, OT does not produce add'l loss of attachment, but can accelerate bone loss / widen PDL
In 1986, .............. found that .....% of LPS can be removed by water rinses and brushing. Which excluded the need for aggressive removal of root surface material (............ et al. 1986).
Moore 99 Moore
...................&..................... 1990 (36) o Review about enamel pearls. o Discrete, glass-like globular bodies attached to the root by a sessile base. o Classification: ............................., ..............................., ........................., and .......................... o Histogenesis -Pfluger = ...................................... -Malassez = .......................................... o Incidence = ............. > ............... > ................ > ................ • Summary: CEP/enamel pearls are associated w/ FI.
Moskow & Canut, Composite enamel pearls, Enamel-dentin pearls, Enamel-dentin-pulp pearls, and Interdental pearls, Hertwig's epithelial root sheath, Anomaly in The cells of the interior layer of the enamel max 3rd > mand 3rd > max 2nd > mand 2nd
Following SRP, how is the subgingival microflora affected regarding coccoid and spirochete bacteria? How long does the change last?
Mousques, Listgarten 1980 - Coccoids increase in percentage and return to baseline at day 21 - Spirochetes decrease and return to baseline at day 42
Maynard
Mucogingival problems occur in children Insufficient KT develomentally related FGG recommended to prevent incipient mucogingival problems from progressing If ortho is anticipated and there is not enough KT, FGG should be placed prior to tooth mv't Grafts recommded in children with <1mm of KT, not >2mm KT or >1mm AG
Ochsenbein
My root trunk 4mm avg MD root trunk 3mm avg
It was believed that abfraction is a sign of TFO. In a review by ............................... et al. in 2016 , we learn that abfraction has a .............................. etiology. Abfraction, being a noncarious cervical lesion, is usually found on buccal surface and is most commonly seen on mandibular ........................ & .................... These cervical lesions are formed by a combination of ........................., .........................., and ............................. When these lesions have sharp edges and are only seen on an isolated tooth, it is thought that occlusal trauma is the primary etiologic factor. When they have more of a broader, saucer-shape, they may be due to multiple factors. Therefore, the idea that abfraction is only caused by occlusal discrepancies has been contradicted.
Nascimento multifactorial premolars and incisors acid erosion mechanical abrasion abnormal occlusal forces
27. According to the 2017 AAP/EFP World Workshop, ____ is defined as an acute inflammatory process of the periodontium characterized by the presence of necrosis/ulcer of the interdental papillae, gingival bleeding, halitosis, pain and rapid bone loss: - gingival abscess - periodontal abscess - necrotizing gingivitis - necrotizing periodontitis
Necrotizing Periodontitis
Does addition of GEM21 (rhPDGF-BB) in patients with localized severe periodontal defects improve CAL and bone levels?
Nevins 2013 - Long-term improvement and stability of CAL and bone growth when GEM21 was used
Karring 1985
New attachment is formed by coronal migration of cells originating from the PDL
Zucchelli
New surgical approach to coronally advanced flap in multiple recession defects (Miller 1/II)
................... 1974 o Relation btw subgingival margin and ....... (distance from the bone crest ......., ........, ......., and ...........). o If the crown margin is more than ......... subgingival there are negative effects on gingival health.
Newcomb, GI, 0.25, 0.5, 0.75, and 1.0mm, 0.5mm
AAP position paper on maintenance 2003 and implants
No clinical data supports the relationship between implant maintenance technique and implant failure. Titanium instruments do roughen implant surfaces and decrease # of attached fibroblasts
Greenstein 1981
No correlation between presence of lamina dura and inflammation, BOP, CAL or PD
In a comparative study between hand and ultrasonic instrumentation by Badreston to investigate the healing events following nonsurgical periodontal therapy in 15 patients with moderately advanced periodontitis. They concluded that, ............................... of results could be observed comparing hand and ultrasonic instrumentation (........................ et al. 1981).
No difference Badreston
Iqbal and Kim
No difference in survival or RCT tooth or single implant
.............. & ................. (2001) observed worsened perio parameters with occlusal discrepancies and concluded that this is an independent risk factor for periodontal disease. • Retrospective study - 89 adults • Aim: relationship between initial occlusal discrepancies & initial perio parameters • Results: teeth with initial occlusal discrepancies have worse initial PPD, mobility, and prognosis • Conclusion: strong association between initial occlusal discrepancies and worsened initial perio parameters. After adjustments to known risk factors, it is concluded that occlusal discrepancy is an independent risk factor for perio disease. Summary: TFO alone does not cause periodontal disease, but in presence of plaque & inflammation it can worsen it. The widened PDL in health is reversible, but this bone loss is ...................... in presence of periodontal disease.
Nunn & Harrel not reversible
In confirming this same finding canine study was performed, teeth were subjected to periodontal surgery using a flap procedure. The root surfaces of the experimental teeth were scaled and the exposed root cementum was removed using diamond stones while the roots of the contralateral teeth were only polished with the use of rubber cups no cementum were removed. The found no obvious differences in the healing between the two treatments and junctional epithelium with connective tissue was formed in both (........................., et al. 1986).
Nyman
............... et al., 1977(30) • 25 pts w/different Sx; no recall; OHI given • 5 groups 1) APF w/ osseous 2) APF 3) MWF w/ osseous 4) MWF 5) gingivectomy • Exam at ...., ..... and .....m after Sx • OHI only temporarily useful • Plaque re-accumulation cause perio disease recurrence • CAL rate: .......mm/y • All 5 techniques equally ineffective in preventing recurrence of destructive periodontitis
Nyman 6 12 24 1
Which surgical procedure is effective in preventing loss of CAL in the absence of periodontal maintenance?
Nyman 1977 - Without perio maintenance, no surgical procedure will be effective in preventing loss of CAL
True/False Success of fixed bridges is dependent on Ante's Law (PDL area of the abutment teeth should be equal or greater than the PDL area of the teeth being replaced).
Nyman/Ericsson 1982 - False - Success of fixed bridges can be achived without meeting Ante's Law. - Fixed bridges can be maintained with minimal periodontal support
Trombelli systematic review on osseous graft materials and biologic agents in periodontal intraosseous defects
OFD alone vs any biomaterial: more gain of clinical attachment with graft, BUT OFD is more consistent
B22. In the NHANES 2009-2012 data, all of the following were found to increase the risk of severe periodontitis, EXCEPT age obesity smoking Hispanic race
Obesity
Svanberg (and Lindhe)
Occlusal trauma + experimental periodontitis accelerated periodontal breakdown - still showed increased vascular leakage, leukocyte migration, osteoclastic activity (pocket formation, loss of attachment) Occlusal trauma without experimental periodontitis (recovery from periodontitis) did not necessarily induce pocket formation or loss of attachment Still have widened and inflamed PDL with bone resorption -> adaptation to functional forces
Palatal approach to osseous surgery
Ochsenbein 1986
How is Disc displacement managed clinically?
Okeson 1991 - Only treat symptomatic disc disorders. - Non-surgical management first (anterior mandible positioning and stepping back over time).
Osseous surgery vs. Open flap debridement
Olsen, Ammons 1985 - Osseous surgery at 5 year recall resulted in fewer residual pockets and less inflammation than flap curettage alone
Wilson
Only 16% of maintenance pts were completely compliant. 49% erratic. Zero teeth lost in compliant and 60 teeth lost in erratic group after 5 years.
Cobb
Open or closed flap SRP does not lead to a favorable result in furcation defects
Goldman
Opinion piece on gingivectomy/gingivoplasty Indications: remove pathologically deep gingival crevices, remove gingiva to bottom of pocket Contraindications: shallow pockets where gingiva is swollen due to inflammation, infra bony pockets
...................... et al 1982 o 18 pts, 18-25y, similar bilateral impactions. o Compared btw doing SRP and curettage then extraction of 3rd molar and extraction only. o Curettage and root planing of 3rd molars will .................. the destruction process on the distal of the 2nd molar.
Osborne, not prevent
Friedman 1955
Osseous surgery introduction Osteoplasty vs. ostectomy
Miller
Over 200% increase in loosing a tooth if you are a current smoker
2020.b34. According to the 2017 AAP/EFP, separate chronic and aggressive periodontitis classification categories were eliminated due to: overlapping etiologic factors unique features of host responses consistencies with implicated microbes
Overlapping Etiologic Factors
C77. Which is an orange complex pathogen? T. forsythia P. gingivalis P. Intermedia A. Actinomycetemcomitans
P. Intermedia
Effectiveness of Mechanical Instrumentation - Calculus Caffesse et al. 1986
PD <3 -- 86% 3-5mm -- 43% >5mm -- 32%
Effectiveness of Mechanical Instrumentation - Plaque Waerhaug 1978
PD <3 -- 89% 3-5mm -- 61% >5mm -- 11%
Cohn D W. The blood supply of the gingival tissues. J Periodontol 25:64, 1954
PURPOSE: Abstract of the vascularity of the gingiva CONCLUSION: Occlusal trauma or forces have very little opportunity to injure the vascularity of the gingiva since the vascular supply is independent of any result of the force. Since the gingiva is supplied by supraperiosteal arterioles, the health of the gingiva can be improved by massage, and massage can affect the speed and degree of vascularity.
Levin M, Cutright D. The Retrocuspid Papilla. J Periodontol 1977;48:464‑466
PURPOSE: Evaluation of 6 biopsy specimens, 10 clinical cases and primate microcirculation studies to determine the origin of the retrocuspid papilla. DISCUSSION: The anastomosis of the plexus and mucosal circulation usually occurs just apical to the crestal bone. As an unerupted deciduous mandibular cuspid moves coronally, the plexus causes erosion of the lingual cortical plate and anastomosis gives rise to formation of the papilla. During eruption of the permanent cuspid, a similar joining of the vascular plexus with the papilla vessels occurs. Easley and Weis (1970) found that the papilla occurs as a surface elevation before birth. It becomes more prominent in children and tends to regress with age (Baer and Benjamin, 1974). COMMENT: Location and blanching are the keys to diagnosis. Biopsy is unnecessary.
Kobayashi K, et al. Ultrastructure of the Dento‑Epithelial Junction. J Periodont Res 1976;11:313‑330.
PURPOSE: Report on an SEM evaluation of the dento-epithelial junctions of rhesus monkeys DISCUSSION: This study confirms the concept of an attachment apparatus and that the apparatus works as a functional and dynamic unit. Indicates electrostatic forces and Van Der Waals interactions between sub-lamina lucida and tooth surface.
Saglie R. Scanning Electron Microscopy of the Gingival Wall of Deep Periodontal Pockets in Humans. J Periodont Res 1982;17:284‑293.
PURPOSE: To analyze, with SEM, the soft tissue wall in deep periodontal pockets in humans RESULTS: The following areas were found in the soft tissue wall: 1. Areas of relative quiescence: showed boundaries of epithelial cells with occasional shedding of cells. 2. Areas of bacterial accumulation: depressions with abundant debris and a fibrin-like material. Bacterial plaque penetrating into enlarged intercellular spaces. 3. Areas of emergence of leukocytes: hole-like depressions in intercellular spaces. Size corresponded with that of leukocytes which were seen emerging from them. 4. Areas of leukocyte-bacterial interaction: numerous leukocytes emerging frequently covered with bacteria (in the process of phagocytosis). Bacteria found in spaces previously occupied by desquamating epithelial cells. 5. Areas of epithelial desquamation-showed semi-loosened and folded epithelial cells, sometimes with bacteria on them. 6. Areas of ulceration-surrounded by areas of hemorrhage, with exposed collagen fibers and CT cells. 7. Areas of hemorrhage-filled with RBC's. Topographically, the surface of the crevicular epithelium was very smooth. DISCUSSION: Areas appear to be very dynamic, in response to local factors. Periods of quiescence or exacerbation may represent sum total of all factors occurring in that local area. Also, "holes" where PMN's exit intercellularly may provide opportunity for bacterial invasion.
Braga A M, Squier C A. Ultrastructure of Regenerating Junctional Epithelium in the Monkey. J Periodontol 51:386, 1980
PURPOSE: To answer the following questions - Does regeneration of new attachment inevitably occur from gingival epithelium, even when portions of the junctional epithelium (JE) remain after surgery? What is the minimum time necessary for a new epithelial attachment to form? DISCUSSION: 1) After surgical excision of the JE, a new JE originates from the oral epithelium, even when a portion of the original JE remains. 2) The rate of formation is very rapid, with a new attachment forming in as little a 5 days. Listgarten (J Perio Res, 1967) showed that after gingivectomy, the new attachment was formed by the cells that migrate from the cut edge of the gingival oral epithelium. The JE intentionally left behind apparently did not participate in the formation of the new JE. Exclusion of the rapidly advancing gingival epithelial cells is the rationale behind Guided Tissue Regeneration. Comments: Close adaptation of flaps necessary for rapid healing. Possible weaknesses - only 3 subjects, and likely impossible to remove all of JE.
Beaumont R, O'Leary T, Kafrawy A. Relative Resistance of Long Junctional Epithelial adhesions and Connective Tissue Attachments to Plaque-Induced Inflammation. J Perio 1984;55:213-223
PURPOSE: To compare the resistance of natural long junctional epithelial adhesion and connective tissue attachments in health and in disease. DISCUSSION: Conclusions by the author suggests that the reason apical cells of the epithelial adhesion were located coronal to the notch were possibly a progressive coronal healing tendency, with connective tissue replacing cells of the epithelial adhesion at the apical extent. Also, an explanation of ulcerations being found in the connective tissue groups is that a host response had already mounted in the experimental group leading to an increased sulcular resistance to the toxic plaque products. Dog study, know this and Magnusson
Ainamo A, Ainamo J, Poikkeus R. Continuous Widening of the band of Attached Gingiva from 23 to 65 Years of Age. J Perio Res 1981;16:595-599
PURPOSE: To determine if the continuous tooth eruption widened the zone of keratinized gingiva. DISCUSSION: The band of anatomical attached gingiva may continue to increase in width after age 43. Unless there is concurrent reduction in height of gingival tissue due to periodontal breakdown, the average 65 year old can be expected to have more keratinized tissue than the 43 year old. The distance between the CEJ and MGJ seemed to increase more slowly between 43 and 65 than between 23 and 43. There was no difference between males and females within each age category. BOTTOM LINE: In the absence of gingival recession, the width of KG can be expected to increase from 23 year olds to 43 year olds and continue at a slower rate to age 65.
Greene AH. A Study of the Characteristics of Stippling and Its Relation to Gingival Health. J Periodontol 33:176‑182, 1962
PURPOSE: To determine the characteristics of stippling and confirm previous concepts of the relation of stippling to gingival health. RESULTS: In healthy gingival, stippling is present on the maxillary labial and decreases proportionately in amount on the remaining areas and in the following order: mandibular labial, lingual, buccal. When stippling is heavy in the maxillary labial, it will be found in all areas of attached gingiva. Attached gingiva covering root area of canine does not exhibit stippling. Stippling may be present on free gingival margin. Stippling is unique for each person. Stippling first evident about 6, increases gradually up to adulthood and begins to disappear in old age.
Baumgartner W J, et al. The Diagnostic Value of Redness in Gingivitis. J Periodontol 1966;37:294‑297
PURPOSE: To determine whether color change indicates the relationship of gingival disease to time and severity. RESULTS: All biopsies dx as chronic inflammation with mostly lymphocytes present. DISCUSSION: Color may be used as a guide to establish the presence of gingivitis but is unreliable in determining severity.
Caffessee R G, et al. The effect of mechanical stimulation on the keratinization of sulcular epithelium. J Periodontol 53: 89-92, 1982
PURPOSE: To evaluate the effect of mechanical stimulation on the keratinization of the sulcular epithelium in four adult Rhesus monkeys DISCUSSION: Controlling plaque formation whether by chemotherapeutics, mechanical methods, or a combination of the two is an effective means of reducing gingival inflammation. Reducing inflammation allows for the development of sulcular keratinization. Daily subgingival prophylaxis significantly increased the development of sulcular keratinization leading the authors to surmise that mechanical stimulation of sulcular epithelium enhances the keratinization process in that area.
Nobuto T, et al. Periosteal Microvasculature in the Dog Alveolar Process. J Periodontol 1989;60:709-715
PURPOSE: To evaluate the periosteal vasculature of the gingival and mucosal tissues by SEM and vascular casts DISCUSSION: The relatively linear, open meshwork of the gingival arterioles and venules reflect the direct attachment of the lamina propria to the subjacent periosteum, where the connective tissue is firmly combined with the alveolar process in areas. However the dense mesh of arterioles, venules and numerous capillaries in the mucosa coincide with the fibrous structure of many elastic fibers loosely attached to the periosteum. Communication between the periosteal plexus and periodontium occurred through large Volkman's canals at the thin crest of the alveolar ridge. This structure may produce a unified histological response by the periosteum and periodontium against the development of periodontal lesions.
Lozdan J C, Squier C. The Histology of the Mucogingival Junction. J Periodont Res 1969;4:83‑93
PURPOSE: To examine the mucogingival junction by histological and histochemical methods DISCUSSION: The differing elastic tissue content of the gingiva and the alveolar mucosa can define the MGJ. The gingiva and alveolar mucosa meet without a gradual transition zone suggesting that an intrinsic difference exists between them. The controlling influence on the epithelium of the mucogingival tissues appears to arise from the underlying corium.
Lang N P, Loe H. The Relationship Between the Width of Keratinized Gingiva and Gingival Health. J Periodontol 1972;43:623‑627
PURPOSE: To examine the width of facial and lingual keratinized gingiva and to determine how much keratinized gingiva is adequate for maintenance of gingival health. RESULTS: Facial keratinized gingiva was widest in the area of incisors and narrowest adjacent to canines and 1 PM. The lingual gingiva of the mandible had greatest width in PM and molar areas, narrowest in incisors. In the maxilla, facial gingiva was 0.5-1.0 mm wider than Md. DISCUSSION: Previous observations on the width and pattern of variation of keratinization of gingiva were confirmed. Gingival health is compatible with a very narrow gingiva. The findings here suggest that 2mm of keratinized gingiva (corresponding to 1mm attached gingiva in this material) is adequate to maintain gingival health.
Goaslind, GD, Robertson, PB, Mahan, CJ, et al. Thickness of Facial Gingiva. J Periodontol 1977; 48: 768-771
PURPOSE: To investigate gingival thickness in areas of free and attached gingiva in a healthy periodontium using ultrasonic echo-ranging instrumentation. DISCUSSION: This article evaluates the widths and thicknesses of the gingiva; however, there are limitations which include lack of discussion about race of the subjects or allowing for variations in gender. Also, there was no mention of the patient's medical history, which can influence gingival enlargement especially if the patient has certain systemic manifestations such as leukemia or is taking medications such as CCBs. The challenge with most articles is the lack of or inconsistent definitions, and in this paper, there is not a clear definition of clinically healthy gingiva.
Magnusson I, Runstad L, Nyman S, Lindhe J. A Long Junctional Epithelium—A Locus Minoris Resistentiae in Plaque Infection? J Clin Perio 1983;10:333-340
PURPOSE: To investigate gingivitis and periodontal disease in areas with a normal or long junctional epithelium. DISCUSSION: The results demonstrate that the apical infiltrated connective tissue (aICT) covered about 60% of the junctional epithelium in the test teeth vs. 90% in control teeth—which equates to the apical border of the ICT being coronal to the aJE (avg. 1.2 mm) for the test group, while control aICT was near or at the aJE. This finding shows that a long JE has the same ability as a normal length JE to respond to plaque insult. BOTTOM LINE: The apical extent of inflammatory connective tissue was found to be similar in test (T and T*) and non-ligated control groups (C)—demonstrating that a long junctional epithelium, even at sites with enhanced plaque accumulation, can be an effective barrier against plaque.
Egelberg J. The Blood Vessels of the Dento‑Gingival Junction. J Perio Res 1966;1:163‑179
PURPOSE: To investigate the arrangement of blood vessels subjacent to the crevicular epithelium and relate observed differences in healthy and inflamed tissue. (creation of vascular loops) DISCUSSION: The difference in the vascular beds of the oral and crevicular tissue is probably related to the difference between the rete ridges of the oral epithelium and the thin sheet of crevicular epithelium. Due to the flat arrangement of arterioles, capillaries and venules immediately subjacent to the crevicular epithelium, these vessels are in a very superficial location. Even in health these vessels range 7 to 40 um, which suggest that the majority of these are not true capillaries, but postcapillary venules and small venules, which have a greater disposition towards permeability than true capillaries and arterioles. This superficiality and permeability may be related to fluid exudation from the gingival crevice. A tendency for venous vessels towards hemorrhage, thrombosis, allergic injury and endotoxin accumulation on vessel walls may predispose the crevicular plexus to the initiation of periodontal lesions.
Wennstrom J. Lack of Association Between Width of Attached Gingiva and Development of Soft Tissue Recession. A 5‑year Longitudinal Study. J Clin Periodontol 1987;14:18
PURPOSE: To longitudinally monitor changes in the position of the soft tissue margin at 26 buccal sites surgically deprived of all gingival tissue. DISCUSSION: In patients maintaining a proper plaque control, the lack of an "adequate" zone of AG does not result in an increased incidence of soft tissue recessions.
Perlmutter S, Tal H. Repigmentation of the Gingiva Following Surgical Injury. J Periodontol 1986; 57:48.
PURPOSE: To report on two patients who were observed for possible repigmentation after surgical removal of the gingiva. DISCUSSION: Repigmentation may occur spontaneously due to the migration of active melanocytes from normal skin and hair matrix. This migration occurs erratically and may be due to inactive melanocytes migrating. Calls for more research.
Karring T, Loe H. The Three‑Dimensional Concept of the Epithelium Connective Tissue Boundary of Gingiva. Acta Odontol Scand 1970;28:917‑933
PURPOSE: To study the morphology of the epithelium-CT interface of the gingiva usine 3-D wax models. Also to determine the relationship between stippling and subsurface structures DISCUSSION: The morphology of the epith-CT interface widely varies in adult human gingiva. Most specimens showed conical CT papillae projecting into epith. Epith. pegs were rarely seen Stippling coincides with intersections of epithelial ridges. The gingival groove could not be related to any structural characteristic.
Tenenbaum H, Tenenbaum M. A Clinical Study of the Width of Attached Gingiva in the Deciduous, Transitional and Permanent Dentitions. J Clin Periodontol 1986;13:270-275
PURPOSE: To study the width of the facial attached gingiva in deciduous, transitional and permanent dentitions DISCUSSION: In the absence of gingival inflammation, the gingival sulcus of the primary dentition will be close to 1.0 mm. With inflammation comes an increase in sulcus depth. The width of the attached gingiva will increase with age, but the sulcus will remain constant at 1.0 mm in the primary dentition. During eruption, the sulcus depth often exceeds the attached gingival depth. In the permanent dentition, the increase in attached gingival width must be related to the decrease in sulcus depth. Sulcus depth changes due to a coronal shift of the CEJ and a coronal migration of the junctional epithelium. After 8 to 10 years, the attached gingiva reaches its adult width. During this time, the sulcus has considerable depth, and since the incisors and first molars are the slowest to mature, a connection to juvenile periodontitis may be present.
Bosshardt DD, Lang NP. The Junctional Epithelium: from Health to Disease. J Dent Res 2005;84:9-20
PURPOSE: review the structural and functional characteristics of this unique epithelial seal around teeth, with a special focus on the host—parasite interactions during the initial development of the periodontal pocket. Conclusion: Excellent and comprehensive review paper...a worthwhile read to review before orals and/or boards. JE is very unique. It's structurally and functionally adapted to control the constant presence of bacteria and their products. Good discussion of role of JE in immunology.
What is the incidence of clinical infection after periodontal surgery?
Pack, Haber 1983 - 1% incidence for all procedures - Prophylactic antibiotics made no difference in post-op infections
What are the 4 stages of periodontal disease progression? What time points do they develop? What is the primary immune cell in each lesion?
Page & Schroeder - *Initial lesion*: 2-4 days. PMN - *Early lesion*: 1 week. Lymphocyte - *Established lesion*: 2-3 weeks. Plasma cell - *Advanced lesion*: Periodontitis with bone loss at an undetermined time point. Plasma cell
Takei
Papilla preservation flap
Froum and Rosen 2012
Peri-implantitis: Early - greater than or equal to 4mm PD, <25% bone loss, bleeding or suppuration Moderate - greater than or equal to 6mm PD, 25-60% bone loss, bleeding/suppurations Severe - greater than or equal to 8mm PD, >50% bone loss
AAP paper 1996
Perio determinants: 1)site specific previous disease 2)age 3)gender (M>F) 4)SES >2mm change in CAL before clinicians are confident that change is occuring
............. et al. 2013 o Cements containing ........ were the most detectable Excess cement Summary: • The deeper the position of the margin, the greater the amount of undetected cement • Radio-opaque cements aid in the detection of excess cement
Pette Zinc
..................... et al 1986 The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of Periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern of occlusal contacts and severity of Periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: (1) teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had deeper probing depth, more loss of clinical attachment and less radiographie osseous support than teeth without these findings, (2) teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of Periodontitis than teeth without these contacts, (3) teeth with both functional mobility and a radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographie osseous support than teeth without these findings and (4) given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographie osseous support than teeth without these findings.
Philstrom
How does flap tension affect root coverage in Coronally advanced flap procedures?
Pini Prato 2000 - Higher flap tension results in less recession reduction
For CAF procedure, where should the flap be positioned relative to the CEJ?
Pini Prato 2005 - 2mm past the CEJ for complete root coverage
Dorfman
Plaque and gingival indices significantly decreased over 4 years on both experimental and control sites (grafted FGG vs non-grafted scaling) Neither site had further attachment loss but grafted site showed "creeping" attachment with decrease in recession Facial gingival units with minimal or no KT can maintain attachment levels with CONTROLLED inflammation No need for 2 mm width if inflammation is controlled
In a study by ......................., on 6 extracted teeth from 3 monkeys. They looked at the deference between root surfaces after root planing alone vs root planing + ...................... They showed that .................. can remove the smear layer (the layer of debris consisting of organic and inorganic material left behind after mechanical instrumentation) and exposing dentinal tubules which allow for tissue attachment (................ et al. 1984)
Polson citric acid citric acid Polson
...................... et al. (1976b) conducted a histological study to evaluate the reversibility of bone loss due to TFO: • Histologic study - 8 squirrel monkeys • Aim: determine the reversibility of bone loss after jiggling forces, in health or periodontitis • Results: o healthy gingiva o 10 weeks of jiggling: mobility + minimal inflammation + no loss of CT attachment + loss of alveolar bone height o 10 weeks after jiggling was stopped: no mobility + no change in inflammation + increase in bone density, but ............ o periodontitis o 10 weeks of jiggling: extremely mobile + severe inflammation & spontaneous bleeding + apical migration of junctional epithelium + decreased bone height & thickness o 10 weeks after jiggling was stopped: no change in mobility, inflammation, or bone • Conclusion: once TFO is controlled, in presence of inflammation, may ............... potential for bone regeneration
Polson not height inhibit
Occlusion studies on squirrel monkeys
Polson 1976 - Trauma from occlusion in absence of inflammation does not cause perio pocketing "don't monkey with occlusion"
Melcher
Possible sources of cells are from PDL, epithelium, CT, and bone
Magnusson
Post SCRP, bacterial load returns in 4-8 weeks
Deas et al 2006
Presence is suggestive of furcation invasion Absence of furcation arrow image does not necessarily mean absence of furcation involvement. 40% false negative probing is better high specific but low sensitive
AAP definition of periodontitis
Presence of gingival inflammation at sites where there has been pathological detachment of collagen fibers from cementum and apical migration of JE. I.e attachment required to diagnose periodontal disease
AAP definition of gingivitis
Presence of gingival inflammation without the loss of connective tissue attachment
Greenstein 2003
Previous hx best perio predictor
AAP position paper on maintenance 2003 and frequency of visits
Previous pts with perio disease should been seen minimum 4x yearly, but should be individualized
..................................: injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal support (AAP Glossary) ..................................: injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with reduced support. (AAP Glossary)
Primary Occlusal Trauma Secondary Occlusal Trauma
C60. According to Harrel and Nunn (2009), which type of occlusal contact is associated with shallower PD? Balancing contact Protrusive anterior contacts Premature contacts in centric relation
Protrusive Anterior Contacts
Vacek JS, Gehr ME, Asad DA, Richardson AC, Giambarresi LI. The dimensions of the Human Dentogingival Junction. Int J Perio Rest Dent. 1994;14: 154-165
Purpose: Information on the dimensions of the dentogingival junction and other related structure via non-decalcified adult human cadaver's jaw. Conclusion: 1. There were no significant differences for any of the tissue components ( SULcus depth, Epithelial Attachment, Connective Tissue Attachment) b/t tooth surfaces (M, D, B, L) 2. No correlation b/t the Loss Of Attachment and length of CTA/BW was found 3. CTA was the most stable of the tissue dimensions 4. EA was greater on tooth surfaces adjacent to the subGingival restoration 5. CTA + EA were significant higher in the posterior teeth ( Molar teeth) Avg values - 1.14 EA 0.77 CT
Eger T, Muller HP, Helnecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol 1996; 23, 839-845
Purpose: The objectives of this study were to determine the reliability and validity of measuring gingival thickness (GTH) with a newly developed ultrasonic device (SDM), to measure facial GTH in relation to tooth type and age of subjects, and to correlate GTH with varying forms of premolars, canines and incisors. Discussion: The validity and reproducibility of GTH measurements with the SDM device were found to be excellent. In the tested population of males only, no profound influence of age on GTH was found. Possible influence of gender was not addressed.
Stein JM, Lintel-Hoping N, Hammacher C, Kasaj A, Tamm M, Hanisch O. The gingival biotype: measurement of soft and hard tissue dimensions - a radiographic morphometric study. J Clin Periodontol 2013; 40: 1132-1139
Purpose: To assess the correlation between surrogate parameters of gingival biotype with actual measurements of gingival biotype using radiographic morphometric methods. A secondary goal is to assess the correlation between gingival biotype and alveolar bone thickness. Discussion: Both soft and hard tissue parameters can affect the outcomes of periodontal and restorative treatments. Thus knowing the factors that affect these parameters can help to better treatment plan for and hard or soft tissue augmentations that may be necessary to address treatment outcomes. One hindrance to the development of soft tissue parameters is that there currently exists no exact definition of thick vs thin gingival biotype. Confounding matters further, the current study shows that gingival biotype differ at different levels and increase from the level of the gingival margin to the level at the bone crest. One finding of this study that confirms other study findings is that the gingival thickness at all levels measured correlate with the thickness of the buccal bone. In addition, this study found a strong correlation between crown form (CW/CL) and gingival thickness at the CEJ as well as alveolar bone thickness at the crest. However, the height of the gingival scallop was not a reliable predictor of gingival thickness.
Voight J, Goran M, Fleisher R. The Width of the Lingual Attached Gingiva. J Periodont 1978;49:77-80
Purpose: To establish information concerning the pattern, width and variations of the gingiva on the lingual of mandibular teeth. DISCUSSION: The range of widths of attached gingiva in the lingual of the mandible was from less than 1 mm to 8 mm and there was no differences in the mean attached gingiva widths between sexes. The same pattern of variation seen in permanent teeth was also seen in the deciduous dentition. The authors concluded that a knowledge of mean and extreme widths of gingiva could be important in designing surgical procedures for conservation of tissue.
Nuki K, Hock J. The Organization of the Gingival Vasculature. J Perio Res 1974;9:305‑313
Purpose: To investigate morphology of gingival vasculature in health and inflammation. (creation of gingival loops) Discussion: Capillary units in crestal gingiva are among the first vessels affected by inflammation followed by vessels beneath crevicular epithelium, and finally by those beneath buccal epithelium. Arteriolar and venous vessels predominate in apical gingiva while capillaries are most numerous in coronal gingiva.
Prichard
Pushback technique - position tissue at crest of bone, leave bone denuded so it will heal from underneath 1957 Seven step technique for tx of intrabony defections (does not add any additional materials) No pre-surgical scaling -> gingiva removed to vestibular and oral margins of bony walls of defect -> remove transeptal and alveolar crest fibers of PDL, remove calculus, leave cementum -> surgical dressing cannot enter defect, abx, maybe reshape occlusal surface
A.70 Baltacioglu (2014) found positive correlations between bone loss, total oxidant status, and increased: RANK RANKL RANK/OPG RANKL/OPG
RANKL/OPG
.......................................(also called ........................... factors): A risk factor that cannot be modified, i.e., genetic factors, gender, age, and race.
RISK DETERMINANT backround
........................: Environmental, behavioral, or biologic factors that increase the likelihood of developing disease; identified through ........................... studies and confirmed to be present ................. the onset of disease.
RISK FACTOR longitudinal before
............................................: a probable or putative risk factor that has been identified in ................................. correlation studies but not confirmed through longitudinal studies.
RISK INDICATOR cross-sectional
...........................: a probable or putative risk factor that has been identified in cross-sectional correlation studies but not confirmed through longitudinal studies. A wide variety of factors have been proposed as risk indicators in periodontal disease. They include factors like, .................... , ................., ......................., ................., and contraceptive use. Again, these have been identified in cross-sectional studies and do not infer causation.
RISK INDICATOR socioeconomic status obesity alcohol use stress
Who developed the "Envelope" technique for localized root coverage
Raetzke 1985
..................... et al., 1982(22) • 78 pts; 3mo recalls; 8y follow-up • PD & CAL groups in mm (1-3, 4-6 & 7-12) • Compare high 25% plaque score & low 25% plaque score • Maintenance/ 3m, pocket reduction & CAL gained by therapy can be maintained wo/ sig effect of OH
Ramfjord
List the "Ramfjord teeth"
Ramfjord - #3, 9, 12, 19, 25, 28
Longitudinal studies showed that elimination of supra-and subgingival bacterial deposits can resolve inflammation and arrest disease progression (.................... et al. 1987) ( ................. et al. 1988) (.................... et al. 1987).
Ramfjord Kaldahl Badreston
................ & .................. (1981) identified three components as necessary for diagnosis of TFO: 1. continued or increasing hypermobility 2. persistent discomfort or tenderness 3. radiographic evidence of bone and/or root resorption
Ramfjord & Ash
................ & ....................... (1994) discussed the features and use of Michigan Occlusal Splint: • Indications: o TMJ disorders o severe bruxism o TFO o establishment of optimal condylar positions in central relation o stabilization of mobile teeth o to prevent super-eruption o retention after ortho treatment o temporary disocclusion for ortho tx o treatment of tension headaches • Features unique to Michigan Splint: o always adjusted to centric relation o freedom in centric zone: 0.5-1.0 mm on a flat surface o cuspid rise starts about 1 mm from freedom in centric o no incisal guidance from centric occlusion o allows the condyles to seek optimal position o can be used for indefinite time without change in occlusal relations of the teeth
Ramfjord & Ash
................... & .................. (1981)iii in their literature review suggested occlusal therapy & splinting to aid in plaque control, for pt comfort, and to control progressive mobility: • Occlusal Therapy o To aid in plaque control o Plaque control should be done before occlusal therapy o Ortho tx should be done after plaque control, and before surgery or restoration o Splint only when mobility is progressive or uncomfortable o Ortho Tx is indicated in presence of: Impinging overbite: gingival trauma Lack of lip seal: mouth breather's gingivitis Anterior crossbite: unstable jiggling Tipped teeth: plaque accumulation Malpositioned teeth: non-ideal position in alveolar process Extruded anterior: can be repositioned for reattachment Forced eruption: can eliminate pockets or aid in crown lengthening o Temporary Splinting Mobility decreases by plaque control, w/wo splinting 1-year of favorable attachment gain, but no difference in 7 years pre-splinting mobility will return when splint is removed o Bite Planes Eliminate trauma from bruxism, aid in TMJ/muscle pain, prevent hyper-eruption, and for retention following ortho o Occlusal Adjustment Only when definite diagnosis of trauma is made Adjustment is controversial when there is no discomfort Adjustment is recommended when mobility is due to compensatory adaptation, to reduce the chance of further damage o Permanent Splinting Splinted restorations are indicated with progressive trauma
Ramfjord & Ash
.................. & ............. (1981) in a literature review discussed that TFO alone .................. induce periodontal disease, but in presence of inflammation & plaque it may exacerbate the disease. They also suggested ......................... & ................... to aid in plaque control, for pt comfort, and to control progressive mobility. o Conclusion: TFO does not initiate gingivitis or perio pockets TFO may cause hypermobility TFO + inflammation tends to accelerate bone loss & pocketing
Ramfjord & Ash does not occlusal therapy & splinting
Why should we perform periodontal maintenance every 3 months?
Ramfjord 1982 - AL and PD measured 1 year after therapy can be maintained over 7 years with maintenance every 3 months regardless of plaque control
Sullivan and Atkins
Recipient site selection: capacity of recipient bed to form capillary outgrowths for vascularization of graft, hemostasis to prevent hematoma that will separate graft from host Epithelium, CT, and muscle should be sharply dissected from periosteum so that periosteum is not actively bleeding Donor site: areas with KT and dense lamina propria are edentulous ridge tissue, attached gingiva (if not inflamed or hyperplastic), palatal mucosa (remove fat because it creates barrier for vascularity) Full thickness (1.25-1.75)/ split thickness (split categories: thin <0.5mm, intermediate 0.5-0.75, thick 0.75-1.25) Thinner graft more easily maintained by plasmotic circulation, easier to vascularize Thick: primarily primary contraction (initial shrinkage of graft, more liquid) Thin: more secondary shrinkage: adapts better but resorbs with time Survival depends on tissue graft contains and the way they receive nourishment Epithelium exchanges metabolites by diffusion Can maintain graft epithelium and lamina propria for 3 days until circulation is restored based on diffusion Lamina propria (CT) needs direct vascular system Principles of successful graft Time to "take" = 5 days, mature = 14 days, complete = 48 days ?? 0-2 days = plasmic circulation, first necrosis because graft is not vascularized 2 days = beginning vascularization and angiogenesis 4-8 days = graft "takes" - vascularization, not able to remove graft anymore so you can remove sutures 14 days = complete vascularization, complete epithelialization
Is treatment of Class II or Class III furcation defects predictable?
Reddy (2015) AAP regeneration workshop - Class II furcations predictable candidates for regeneration (barrier membrane with bone recommended) - Class III furcations are not predictable
What are the average distances from the CEJ to the greater palatine artery and nerve? (list the different palatal vault morphologies)
Reiser 1996 - High palatal vault: 17 mm - Average palatal vault: 12 mm - Shallow palatal vault: 7 mm
Zitzmann
Resective surgeries have more stable outcome
Siebert
Ridge resorption classification Class 1) horizontal Class 2) vertical Class 3) both
Schropp
Ridge resorption post extraction (at 3-12 mo) Width = 3-7mm Height = 0.7-4.5mm
............................- a possible factor associated with a disease, which is identified from .................... or .......................... studies. This in itself does not infer causality [............... 1996 (14)]
Risk Indicator case control cross-sectional Genco
...........................- a risk factor which is predictive or associated with an increased probability of disease in the future (.............. 1996) • These include factors like: o .................................................... o ..................................................... o .....................................................
Risk Marker Genco Bleeding on probing CAL Previous history of periodontal disease
Distal wedge procedure
Robinson 1966 - Incision designs: Triangular, Square, Linear
Harris
Root coverage with CTG with partial thickness double pedicle graft vs acellular dermal matrix graft - histological and clinical comparison Concludes similar results but ADM has more inflammatory cells Compare CTG (coronally positioned pedicle flap) vs ADM - no statistically significant differences in root coverage between the two GTR vs CTG (partial thickness double pedicle graft) No difference in root coverage Thinner tissue -> less root coverage in GTR (26.7% vs 95.9%) True regeneration does not occur with CTG with partial thickness double pedicle graft - only repair (histological eval)
........................: A treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms. ..........................: Instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus and stains from these surfaces. ...........................: Scraping or cleaning the walls of a cavity or surface by means of a curette.
Root planing Scaling Curettage
Carnevale
Root resection of furcation involved molars, 93% survival at 10 years
How does perio maintenance affect outcomes of periodontal surgery?
Rosling, Nyman 1975 - Perio surgery with good perio maintenance causes long term stability of CAL - Perio surgery without maintenance results to continued attachment loss about 1 mm per year
What drugs are commonly associated with Gingival Overgrowth?
Rossmann 1994 - Nifidipine: Calcium channel blocker - Cyclosporine: immunosuppressant
............... et al., 1999(23) • 153 pts; 5y follow-up • Completed perio Tx • Randomly assigned to 3,6,12, and 18m recall • PI, BOP, PD, PAL (stent) & bone (pre-tx PA) • 3m recall had better PI&BOP • 18m recall had rebound tendency • Recall interval extending for low susceptibility pts may be OK.
Rosén
What are the histologic zones of NUG (necrotizing ulcerative gingivitis)?
Rowland 1999 - Bacterial zone - Neutrophil rich zone - Necrotic zone - Spirochete infiltration zone
A.56 Which feature of an osteoclast indicates that it is actively resorbing bone? Clear cells Ruffled border Multinucleation Golgi apparatus
Ruffled Border
Supragingival calculus is also called ................................
SALIVARY CALCULUS
Subgingival calculus is also called .................................
SERUMINAL CALCULUS
Caton 1980
SRP and MW flap resulted in reformation of an epithelial linjng creating a long junctional epithelium (LJE) Found LJE
Lang
SRP less than 3mm pocket results in attachment loss
What is the rationale for using Chlorhexidine after surgery?
Sanz 1989 - 0.12% chlorhexidine rinse improved postoperative healing Overholser 1990 - CHX is more effective at inhibiting plaque formation but causes more staining
................. & ....................... (1974) sided with ............. and concluded that TFO combined with periodontal disease will worsen bone loss. They looked at jiggling trauma, which is force applied alternately in B-L & M-D direction. • Histologic study - 13 beagle dogs • Aim: study changes in vasculature of PDL in zone of co-destruction, in developing & permanent jiggling o Healthy: - Day 0-30 of jiggling: altered vascular permeability in PDL space (acute inflammation), gradual increase in PDL space, & pronounced osteoclastic bone resorption - gradual increase in mobility + gradual increase of PDL space until it was .......... times as much after 180 days - Day 180: no carbon deposits, leukocytes, or osteoclasts (adapted) o Periodontitis: - initially, 3x higher mobility than healthy group - Day 180: obvious signs of mobility, vascular leakage, leucocyte migration & osteoclastic bone resorption • Conclusion: o Teeth with healthy periodontium ............... at the end of the 6-month period, but teeth with periodontal lesions .................... o TFO combined with periodontal disease accelerates perio breakdown o TFO does not induce pocket formation & attachment loss in healthy periodontium
Savanberg & Lindhe Glickman 2-3 adapted did not
Badersten
Scaled/flapped: Calculus removal- PD1-3mm: 86/86% PD 4-6mm: 43/76% PD >6mm: 32/50%
Who was the original author describing osseous resective surgery?
Schluger 1949 - Involves pocket eliminiation with excessive bone removal
.................... et al. 2009 - ModPI (mPI): Lingual sites with <2mm KM presented with SS more plaque compared to sites with >2mm KM - Bleeding tendency (mBI): Reduced by ......% if ≥2mm KG was present - Recession: Sites with <2mm buccal KM presented with SS greater soft-tissue recession compared to sites with at least 2mm buccal KM • A lack of adequate keratinized tissue around endosseous implants has been shown to be associated with more plaque accumulation, tissue inflammation, MR and AL
Schrott 40
Does addition of rhBMP-2 in DFDBA grafts improve bone induction?
Schwartz 1998 - Addition of rhBMP-2 to DFDBA improved bone induction with high predictability
.................. et al 2001 o Longitudinal study for ..... y. o Relation between subgingival margin and ....., ....., and ........ o Subgingival marginal placement of dental restorations results in a significant loss of attachment which may be detected ....... years after the restorative procedures.
Schätzle, 26, PI, GI, and AL, 1-3
What is the effect of additional EDTA root conditioning with OFD and EMD (emdogain)
Sculean 2006 - Addition of EDTA provided no significant improvement in PD or CAL
How does EMD affect the results of guided tissue regeneration?
Sculean 2008 - GTR alone, EMD alone, or EMD+GTR produced significant improvement over OFD alone. - No significant difference between treatment groups
Edentulous ridge classification (classic classification)
Seibert 1983 - Class 1: Horizontal Buccal-lingual loss of tissue - Class 2: Vertical Apico-coronal loss of tissue - Class 3: Combined horizontal and vertical loss
Bowers
Series: I. Submerged models get more regeneration than nonsubmerged (new attachment apparatus, new CELLULAR cementum, new CT, new bone) on pathologically exposed roots - histo - non submerged by LJE repair Series: II. Use of DFDBA vs no DFDBA in tx of intrabony defects in submerged env't results in regeneration compared Series: III. Use of DFDBA + FGG vs no DFDBA in tx of intrabony defects in non submerged environments With DFDBA + FGG, there was regeneration (1.21 mm of new attachment apparatus formed) In contrast, with FGG alone, long junctional epithelium observed along exposed root (repair) - FGG did not enhance regeneration No root resorption, ankylosis, pulp death observed in non-grafted sites ---- 1979 furc morphology Max first molar teeth Furcal aspect of root was concave in 94% of mesiobuccal roots, 31% of DB roots, and 17% of palatal roots Deepest concavity was in furcal aspect of MB root (mean concavity 0.3mm) Furcal aspects of. Buccal roots diverge towards palate in 97% of teeth (mean divergence 22 degrees) Mand first molar teeth Concavity of furcal aspect found in 100% of mesial roots, 99% of distal roots Deeper concavity found in mesial root (0.7 mm) than distal root (mean concavity 0.5mm) Max internal M-D dimension of furc larger than mean MD root separation at B/L (mean difference 1.2mm) Wider root separation -> larger furc entrance diameter 81% of time furcation entrance <1mm, so difficult to debride with curettes (use ultrasonic tip)
How does Ochsenbein classify interproximal craters for osseous surgery?
Shallow crater: 1-2 mm Medium crater: 3-4 mm Deep crater: ≥5 mm (not ideal for osseous surgery)
What bone grafting material has the most and least volume reduction following lateral window sinus augmentation?
Shanbhag (2014) - Autogenous: greatest volume reduction ≈ 50% - Composite grafts (combination): lowest volume reduction ≈ 20%
............... et al 1990 included ........ pts assessing short-term clinical responses to calculus after SRP, showed clinical parameters PPD, PAL, BoP are not related to the residual calculus remaining after thorough subgingival instrumentation.
Sherman, 7
Zarb
Signs of implant overload: screw loosening or fracture, bone loss or implant fracture.
According to Dorfer (2016), gingival level change in the oscillating-rotating power tooth brush group was ____ as compared to the manual toothbrush group over 3 years - greater - similar - less
Similar
Endo-Perio lesions
Simon/Glick 1972 - Primary endo - Primary endo, secondary perio - Primary perio - Primary perio, secondary endo - True combined lesion
Bruno CT graft
Single incision
Grupe
Sliding Pedicle flap
It was noticed in a study by .............. that Gram -ve anaerobe returned to pre SRP proportion after .......... months.
Slots 3-6
........ et al., 1979(27) • 6 perio pts • Clinical and microbiological monitoring x2 (before & after Tx at intervals of 1, 2, 4, 8, 12, 16 & 24 w) • Sig subG microflora shift after Tx. • Takes .....w for total organisms to return to baseline • Several pockets did not show re-establishment even at 6m. • % of spirochetes showed the most drastic and long lasting reduction • Motile rods re-occurred~10 w
Slots 17
Random burst theory
Socransky - Asynchronous bursts of disease activity (not a continuous loss of CAL)
Red complex bacteria: list
Socransky - Porphyromonas gingivalis - Tannerella forsythia - Treponema denticola
Red Complex
Socransky et al. 1998
Loesche and Giordano
Specific and non specific plaque hypothesis
81. The ___ of a test is the proportion of subjects without the disease who test negative specificity sensitivity positive predictive value negative predictive value
Specificity
Staffileno
Split thickness flap healed with minimal loss of bone compared to full thickness
2021.c.12. According to the 2017 AAP/EFP World Workshop, a patient with generalized interdental clinical attachment loss of ≥ 5 mm combined with masticatory dysfunction would be classified as having stage __ periodontitis._ I II III IV
Stage IV
30. According to the 2017 AAP/EFP World Workshop, a patient with interdental clinical attachment loss of ≥ 5 mm combined with teeth drifting, bite collapse, and generalized grade II mobility would be classified as having stage ____ periodontitis I II III IV
Stage IV
Selipsky
Steps for FO (osseous): Vertical grooving Thin bone between grooves Reduce any lips of crater Ostectomy on buccal and lingual for + bony architecture Ostectomy removes only 0.6 mm attachment of supporting bone per tooth, and eliminating the crater doesn't remove much bone When very deep craters are present, up to 1.5 mm circumferential ostectomy can be done (but rare) Bone removed mostly on buccal and lingual surfaces, which is less impt for support than interproximal bone (can remove up to 2 mm in interproximal area) Limits of osseous surgery: better for shallow/moderate craters, ostectomy ~1-2mm, approach from lingual, remove 1-1.5 mm on mid-facial, keep interproximal bone high
Trauma from Occlusion: • injury caused by improper mechanical force during function (..............................)
Stillman 1919
AAP position paper 2004 on pathogens
Strong correlation do perio disease: P. Gingivalis A.a. T. Forsythia Spirochete of ANUG
Langer and langer
Subepithelial CT graft technique
Stages of Graft take (FGGs)
Sullivan and Atkins 1968 - Plasmatic circulation 0-2 days - Vascularization 2-8 days - Organic union 4-10 days
Which author first described the Osteotome technique for sinus augmentation?
Summers 1994 - Crestal sinus floor elevation with osteotomes - original surgical technique described by Summers
Bragger (1992) - Surgical lengthening of clinical crown post-op and 6 months
Surgeries created 3 mm between restoration margin to bone Osseous crest reductions 1 mm>2 mm>3-4mm Mean apical soft tissue recession was 1.32 mm immediately after 33% had 1-3 mm coronal soft tissue displacement, 29% had 1-4 mm recession Need to delay margin placement to areas of esthetic concern up to 6 months after c/l?
Pontoriero Carnevale
Surgical Crown Lengthening 12 mo clinical wound healing study One year after c/l, tissues rebounded coronally, especially in patient's with thick tissue biotype Dr. K - depends where you place flap back - tissue is establishing biologic width; if you place tissue at level of bone then you will need to wait for re-establishment, but if you place tissue where you want it to be in relation to crown, only need 2-3 months
Waerhaug
Surgical elimination of pocket >3mm is most predictable method for adequate subgingival plaque control (Badersten says must SRP works overtime?)
........... & ............ 1976 (34) o .............. Indian skulls. o CEP severe enough to approach or enter a furcation area, may be implicated in the breakdown of periodontal support. o The prevalence of CEP is Mand ...... > .......... > .......... > ................
Swan and Hurt, 2000, 2M > Max 2M > Mand 1M > Max 1M.
A.62 Which is an anti-inflammatory cytokine? IL-1beta IL-17 TGF-beta TNF-alfa
TGF-beta
How does Root proximity affect the prevalence of intrabony pockets?
Tal 1986 - Vertical defects are more common when the Inter-root distance is 2.1-4.1 mm - If the inter-root distance is > 3.1 mm then it is possible to have 2 separate vertical defects
........ et al 1989 o 3 dogs, split mouth, class V amalgam restorations at the alveolar crest. o More inflammation, recession and bone resorption (....... vs ......mm) in test. o Continuous abuse of the gingival attachment results in a certain loss of the periodontal attachment apparatus. o BW is partially restored by a more apical location of a reduced-in-size, supracrestal connective tissue attachment. • Summary: Sub marginal restoration will lead to more plaque accumulation and CAL, regardless of oral hygiene.
Tal, 1.17 vs 0.15mm
........... 1984 (26) o Evaluate 344 IP areas w/ 117 intrabony defects in 81 pts. o Looked at the relation btw root proximity and bone loss at OFD. o Frequency of intrabony pockets increases w/ increase in IP distance when btw ...............mm. o Over .........mm, no further increase in frequency. o Greater than ........mm, tend to have 2 intrabony defects in the same interdental area. o Roots that are closer than ......mm tend to have more horizontal bone loss, while roots that are btw...........mm apart tend to have more angular bone loss, causing intrabony defects.
Tal, 2.1-4.5mm, 4.5, 3.1, 2, 2-4
Semilunar coronally positioned flap
Tarnow 1986
What is the effect of inter-implant distance on the height of inter-implant alveolar crest?
Tarnow 2000 - Greater crestal bone loss in implants with <3 mm distance between adjacent implant compared to >3 mm
What is the average height of tissues from the crest of the bone to the tip of the papilla between 2 adjacent implants?
Tarnow 2003 - Average height of papilla: 3.4 mm - Most frequently 2, 3, and 4
What are the Stages of B cell activation
Tew 1989 - Resting - Activation - Proliferation - Differentiation
Bouri et al 2008
The amount of attached gingiva around implants made a statistical difference between failure rates of implants
Ortman on radiographs
The eye can detect radiographic changes when approximately 50% of bone loss has been lost
What is the Specific and non-specific plaque hypothesis?
Theilade 1986 - Specific: a single pathogen or group of pathogens is the cause of inflammatory perio disease - Non-specific: Implies that plaque will cause disease regardless of its bacterial composition. The bacteria increases above the host resistance threshold
A.51 Gestational diabetes usually has its onset on the ____ trimester of pregnancy First Second Third
Third
Does addition of Platelet rich fibrin (PRF) with OFD produce improved clinical outcomes compared to OFD alone?
Thorat 2011 - Addition of PRF to OFD resulted in significantly better improvement in CAL, PD, GM, and radiographic bone fill (9 months of post-op)
Hausmann
Threshold for radiographic bone loss is 2mm
Lingual approach to mandibular osseous surgery. Why is the lingual approach indicated over the buccal approach?
Tibbetts 1976 - Lingual inclination 25° - Larger lingual embrasures - Lingual furcation is positioned more apically - Lingual CEJs are lower
Bracket and Gargiulo
Tissue graft "take" is initiated by second day and total repair by the 8th
........................... has been described as the strongest modifiable risk factor and predictor of future disease for adult chronic periodontitis. ............................. et al 1991 (18) • Aim: To study the influence of smoking on the interproximal periodontal bone height by comparing current smokers and non-smokers. • M&M: - 210 subjects completed a questionnaire about smoking and included a BWX taken within last 3 years - 3 groups: o non-smokers (no smoking history) o former smokers (previously been regularly smoking but stopped more than 1 year ago) o smokers (individuals smoking 1 or more cigarettes per day). - The BW radiograph represented the right-side molars and premolars. The distance from ............................ to ...................... measured. The presence of radiographically detectable calculus was examined. • Results: - Overall mean of the CEJ-IS (interdental septum) distance (in mm) based on all sites was: o Smokers: 1.71 ± 0.08 mm in smokers o Former smokers: 1.55 ± 0.05 mm o Non-smokers: 1.45 ± 0.04 mm The difference between smokers and non-smokers was .................................... - The distance was greater in high consumption and long duration smokers as compared to low consumption and short duration smokers, respectively - The CEJ-IS distance .................... with increasing lifetime exposure. o The difference between smokers with an exposure of < 100 cigarette/ years and those with an exposure of > 200 cigarette/ years was ................................. - .........% of subjects did not exhibit radiographic calculus on any tooth surface. o These findings do not suggest any relationship between calculus and smoking. • Conclusion: - In adults with good hygiene, loss of periodontal bone is related to smoking. - The smoking related bone loss is not correlated with plaque infection.
Tobacco Bergstrom CEJ to Interdental septum statistically significant increased statistically significant 92
What is the effect of cigarette smoking on perio healing following GTR
Tonetti 1995 - Cigarette smoking associated with reduced healing response after GTR in deep intrabony defects
Waerhaug 1981; Youngblood 1985; Stambaugh et al. 1981
Toothbrush ~1.0 mm Floss - 3 mm Proxabrush - Dependent on the brush, but reported maximum is 2.5 mm Curettes - 3.73 - 5.52 mm
Glickman
Trauma from occlusion is a co-destructive factor in the formation of periodontal disease and intrabony defects
T/F Closed instrumentation of Grade II and III furcations is ineffective in removing calculus.
True Matia 1986
................ et al 2002 investigated the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severe periodontal disease in the US adult population ages 45 years and older. M&M: - Data collected for 4343 persons ages 45-90 years from the National Health and Nutrition Examination Study III were analyzed using weighted multivariable logistic regression. - Severe periodontal disease was defined as 2 + sites with 6 + mm loss of attachment and at least one site with probing pocket depth of 5 + mm. - Individuals with fasting plasma glucose > 126 mg/dL were classified as having diabetes o those with poorly controlled diabetes (PCDM) had glycosylated hemoglobin > 9% o those with better-controlled diabetes (BCDM) had glycosylated hemoglobin <or= 9%. - Additional variables evaluated in multivariable modeling included age, ethnicity, education, gender, smoking status, and other factors derived from the interview, medical and dental examination, and laboratory assays. Results: - Individuals with PCDM had a significantly .............. prevalence of severe periodontitis than those without diabetes (odds ratio = 2.90; 95% CI: 1.40, 6.03), after controlling for age, education, smoking status, and calculus. - For the BCDM subjects, there was a tendency for a ................ prevalence of severe periodontitis (odds ratio = 1.56; 95% CI: 0.90, 2.68). Conclusion: This study supports an association between poorly controlled type 2 diabetes mellitus and severe periodontitis.
Tsai higher higher
Allen
Tunnelling and amount of distance between bone, FGM, resto
Coslet
Type 1 = excessive amount of gingiva A = Normal crest-CEJ relationship (biologic width = ~1mm epithelium and ~1mm of CT) B = Osseous crest at CEJ (no biologic width) Type 2 = normal amount of gingiva A = normal crest-CEJ B = osseous crest at CEJ
B26. Which has been found to have the strongest association with chronic periodontitis? BMI Stress Dyslipidemia Type 2 diabetes mellitus
Type 2 Diabetes Mellitus
Becker 1984
Unless prognosis was good or hopeless, assigning a prognosis was of little value.
Selvig
Use of PTFE preserves clot SEM of PTFE membrane used in GTR after 4-6 weeks of healing Prevent flap tissues from contacting root surface, protect integrity of underlying blood clot by diverting mechanical stress acting on flap during healing Occlusive part of membrane did not have many tissue elements, but surface area had CT elements -> movement of overlying soft tissue possible during early stages
How much variation exists in periodontal probes from different and similar manufacturers?
Van Der Zee 1991 - "Highly significant differences" between probes of different manufacturers (probe tip diameter, probe width, etc.) - Probes from the same batch and manufacturer may differ by as much as 0.5 mm - Etched probes are more accurate than painted probes
Tarnow furcation
Vertical furcation involvement not horizontal
Smuckler
Vital root amputation: clinical and histo study When we do root amp on vital teeth we have 2 weeks to do endo
Where is the thickest and thinnest Width of attached gingiva on the Lingual surfaces?
Voigt 1978 - Thickest: 1st and 2nd molars - Thinnest: Central incisors to canines
...................et al 1966 (5) o 400 Iraqi and British children o Incidence of gingival disease was so symmetrical bilaterally that they found it only necessary to examine .......................
Wade half the mouth
The rough surface of calculus do not themselves irritate the epithelial cells with which they come in contact. Rather the irritating effect of subgingival calculus is caused by bacteria or their toxins (....................... 1956).
Waerhaug
Which author wrote in favor of the "Plaque front"?
Waerhaug - Clinical Attachment recedes 0.2 mm away from plaque
How effective is plaque removal in pockets that are 3 mm or less? How effective is plaque removal in pockets that are > 5 mm?
Waerhaug - Pockets 3mm or less: complete plaque removal achieved 83% of the time - Pockets > 5mm: complete plaque removal achieved 11% of the time
........................ et al., 1976(15) Study design: Human; ext. teeth Interdental brush ......-....... mm
Waerhaug 2-2.5
.................... et al., 1981(4) Study Design: Monkeys; histological Appliance: Dental floss .......mm (2-3.5 mm)
Waerhaug 2.7
In a Study by .................... 1978 on extracted teeth after scaling and root planning. He concluded that .......% of the root surfaces with pocket between 1-3mm were clean, compared with .......% in pocket of 3-5mm and ......% in pockets greater than 5mm.
Waerhaug 83 39 11
........................... et al., 1981 • Measure toothbrush penetration • 4 monkeys, split mouth Bass 3x/w No brush • SubG plaque in control side • Bristles of toothbrush penetrated as far as ...........mm
Waerhaug penetration 0.9
Which author argues against the theory of Co-destruction?
Waerhaug 1979 - No association between trauma from occlusion and periodontal bony defects - Bony defects only associated with down growth of plaque (plaque front)
Brush bristles are able to penetrate up to ______ mm subgingivally
Waerhaug 1981 - 1 mm subgingival
.......................... 1975 o ......... extracted teeth w/ subG restorations (............., amalgam, cement, zinc oxide-eugenol and acrylic). o Notch for GM. o Most restorations were covered with plaque & calculus. o Sub-margin, more plaque accumulate subG even if oral hygiene is maintained. o SubG plaque formed on zinc oxide ....... weeks and ...... months on amalgam. o ........... CAL below ZOE in 6 weeks. o Polished amalgam, less plaque.
Waerhaug, 108, gold, 6, 8, 1mm
............................. and ............................... 1972 (6) o Comprehensive analysis of 516 clinical patients at Columbia University o Scored ....................................... and ........................................ around each tooth o Found symmetry of distribution of both inflammation and periodontal destruction (bilaterally) o Pts with periodontal breakdown had gingival inflammation more often than pts without breakdown, but teeth with the most inflammation and teeth with the most breakdown did not necessarily correspond o Conclude: "Clinically evident inflammatory changes of the gingiva, though considered a precursor of periodontal destruction, may not necessarily evolve into a periodontal destructive lesion." Conclude: o considerable variation occurred between response groups o periodontal disease appears to be ........................................ o tooth loss response emulated this pattern with greatest loss of ................................ and least loss of ................................
Wasserman and Geiger gingival inflammation periodontal destruction bilaterally symmetrical maxillary second molars mandibular cuspids
Prophy jet vs. rubber cup for supragingival tooth stain and plaque
Weaks 1984 - Prophy jet obtained similar results to rubber cup in Less Time
.................. et al., 1983(28) • 24 pts • Baseline PI, GI, PD, and AL (stent) • All had SRP & Sx (........... wo/ osseous) • 3 groups (Healing Phase and maintenance care): Group 1: 1x/.....w Group 2: 1x/.....w Group 3: 1x/......w • Group 1 had less inflammation • Group 3 had ....... CAL than 1 • SSD btw 3 groups when considering the Critical Probing Depth (CPD) Summary Based on RCT & longitudinal data, perio pts w/ Tx that achieved perio stability can maintain over time w/ 3-4m MTN interval; Multiple visits w/ OHI and professional exam decrease caries & perio disease incidence; Recall interval extending for low susceptibility pts may be acceptable;
Westfelt 2 4 12 3x
What are the Three phases of osseous healing following osseous surgery in the dog model?
Wilderman 1960 - Osteoclastic phase: 2-10 days - Osteoblastic phase: 10-28 days - Phase of repair: 2 days - 6 months
What are the Four phases of soft tissue healing following pedicle flap in the dog model?
Wilderman 1965 - Adaptation stage: 0-4 days - Proliferation stage: 4-21 days - Attachment stage: 21-28 days - Maturation stage: 28 days - 6 months (osteoclastic resorption stops by 14 days)
