Podcast Beta
Questions and Answers
What is the ultimate goal of periodontal treatment?
What type of defects has the best prognosis for osseous regeneration?
What is the purpose of osteoplasty in osseous resective surgery?
What is the role of the remaining available bone in osseous regeneration?
Signup and view all the answers
What is the purpose of guided tissue regeneration (GTR) in periodontal treatment?
Signup and view all the answers
What is the interface between the newly regenerated bone and the previously diseased root surface composed of?
Signup and view all the answers
What is the purpose of a lateral pedicle graft in the treatment of gingival recession?
Signup and view all the answers
What is the difference between osteoplasty and ostectomy?
Signup and view all the answers
What is an advantage of the lateral pedicle graft over other surgical procedures?
Signup and view all the answers
What is a common indication for the lateral pedicle graft?
Signup and view all the answers
What can accumulate in pseudopockets in the maxillary tuberosity region?
Signup and view all the answers
What are the three main causes of gingival enlargement?
Signup and view all the answers
What is the goal of osseous resective surgery?
Signup and view all the answers
What is a classification of flaps based on?
Signup and view all the answers
What type of incision involves the least amount of tissue loss?
Signup and view all the answers
What is a characteristic of a papilla preservation flap?
Signup and view all the answers
What is a type of horizontal incision?
Signup and view all the answers
What is the main reason why regenerative surgery may be considered the best treatment choice in deep, one-wall intrabony defects?
Signup and view all the answers
Which of the following bacteria are associated with periodontitis?
Signup and view all the answers
What is the main difference between the Nonspecific Plaque Hypothesis and the Specific Plaque Hypothesis?
Signup and view all the answers
What is the term for the thin layer of bacteria that harbors pathogenic types of bacteria when left undisturbed?
Signup and view all the answers
What is the role of collagenase in periodontal disease?
Signup and view all the answers
What is the primary function of antibodies or immunoglobulins in response to oral bacteria?
Signup and view all the answers
What is the characteristic of the microbial flora in a clinically healthy periodontium?
Signup and view all the answers
What is the component of the gram-negative bacterial cell wall with significant pathogenic potential?
Signup and view all the answers
What is the most likely source of bacteria found in diseased periodontal tissue?
Signup and view all the answers
What is the term for the group of bacteria that includes Treponema denticola, Tannerella forsythia, and Porphyromonas gingivalis?
Signup and view all the answers
What is the effect of plaque accumulation on the severity of gingivitis?
Signup and view all the answers
What is the primary factor in determining the location of incisions in periodontal flap surgery?
Signup and view all the answers
What is the main purpose of distal wedge procedures in periodontal flap surgery?
Signup and view all the answers
In which area is the distal wedge procedure contraindicated?
Signup and view all the answers
Smoking has been shown to increase the risk of developing periodontal disease by how much?
Signup and view all the answers
What is the effect of smoking on the host defense mechanisms?
Signup and view all the answers
What is the association between osteoporosis and periodontal disease?
Signup and view all the answers
What is the effect of bisphosphonates on periodontal disease?
Signup and view all the answers
What is the association between autoimmune conditions and periodontal disease?
Signup and view all the answers
What is the effect of radiation therapy on periodontal disease?
Signup and view all the answers
What is the role of matrix metalloproteinases (MMPs) in periodontal disease?
Signup and view all the answers
Which cytokine is responsible for stimulating bone resorption and inducing tissue-degrading proteinases?
Signup and view all the answers
Which of the following is NOT a diagnostic aid for gingival or periodontal disease?
Signup and view all the answers
Which periodontal pathogens are responsible for producing Matrix Metalloproteinases (MMPs)?
Signup and view all the answers
What is the primary function of cyclooxygenase-2 (COX-2)?
Signup and view all the answers
Which vitamin is essential for the absorption of calcium from the Gl tract and for the calcium-phosphorus balance?
Signup and view all the answers
What is the primary function of macrophages in the immune response?
Signup and view all the answers
Which of the following is a characteristic of healthy gingival tissue?
Signup and view all the answers
What is the primary role of IL-8 in periodontal disease?
Signup and view all the answers
What is the impact of vitamin A deficiency on the periodontium?
Signup and view all the answers
What is the primary function of prostaglandin E2 (PGE2)?
Signup and view all the answers
What is the origin of the lateral periodontal cyst?
Signup and view all the answers
What is the most significant factor in periodontal disease?
Signup and view all the answers
What is the typical age of occurrence of the lateral periodontal cyst?
Signup and view all the answers
What is the primary composition of the microbiota in chronic gingivitis?
Signup and view all the answers
What is the characteristic of the associated tooth in a lateral periodontal cyst?
Signup and view all the answers
What is the primary function of the acquired pellicle on tooth surfaces?
Signup and view all the answers
What is the radiographic feature of the lateral periodontal cyst?
Signup and view all the answers
What is the most common cause of bad breath?
Signup and view all the answers
What is the primary difference between a good prognosis and a fair prognosis in periodontal disease?
Signup and view all the answers
What is the effect of diabetes on the periodontal tissues?
Signup and view all the answers
What is the characteristic of the gingiva in poorly controlled diabetes?
Signup and view all the answers
What is the characteristic of the microbiota in health compared to gingivitis and periodontitis?
Signup and view all the answers
What is the effect of chronic hyperglycemia on collagen and extracellular matrix?
Signup and view all the answers
What is the primary factor influencing the prognosis of a periodontally-involved tooth?
Signup and view all the answers
What is the primary component of the acquired pellicle on tooth surfaces?
Signup and view all the answers
What is the typical location of the lateral periodontal cyst?
Signup and view all the answers
What is the primary cause of the shift from gram-positive to gram-negative bacteria in dental plaque development?
Signup and view all the answers
What is the primary reason for the shift from facultative to obligate anaerobes in the microbiota?
Signup and view all the answers
What is the main difference between the lateral periodontal cyst and a lateral periodontal abscess?
Signup and view all the answers
What is the characteristic of the bone loss in advanced periodontitis?
Signup and view all the answers
What is the primary characteristic of the microbiota in periodontitis?
Signup and view all the answers
What is the minimum percentage of bone mass loss required for a change in bone height to be appreciated on radiographs?
Signup and view all the answers
What is the clinical feature that distinguishes periodontitis from gingivitis?
Signup and view all the answers
What is the term used to describe the wear of tooth structure due to functional contacts with opposing teeth?
Signup and view all the answers
What is the term used to describe the loss of tooth structure due to mechanical wear?
Signup and view all the answers
What is the term used to describe the hypersensitivity of roots due to exposure of dentinal tubules?
Signup and view all the answers
What is the scoring system used to evaluate the degree of gingival enlargement?
Signup and view all the answers
What is the term used to describe the isolated, sessile or pedunculated, tumor-like enlargement of gingiva?
Signup and view all the answers
What is the type of radiograph used to assess alveolar bone loss?
Signup and view all the answers
What is the term used to describe the distance from the gingival margin to the base of the pocket?
Signup and view all the answers
What is the primary etiologic factor in plaque-induced gingivitis and/or periodontitis?
Signup and view all the answers
What type of pocket is formed by gingival enlargement without apical migration of the junctional epithelium?
Signup and view all the answers
What is the role of calculus in periodontal disease?
Signup and view all the answers
What is the average biologic width?
Signup and view all the answers
What is the effect of hormonal changes during pregnancy on the gingiva?
Signup and view all the answers
What is the role of the nonmineralized layer of plaque on the calculus surface?
Signup and view all the answers
What is the result of a prolonged exposure to dental plaque?
Signup and view all the answers
What is the relationship between plaque and calculus in periodontal disease?
Signup and view all the answers
What is the result of an increase in crevicular fluid associated with gingival inflammation?
Signup and view all the answers
What is the effect of orthodontic therapy on plaque retention?
Signup and view all the answers
What is the characteristic of the enlarged gingiva during pregnancy?
Signup and view all the answers
What is the term for the lesion that appears in the gingival margin or interproximal space during pregnancy?
Signup and view all the answers
Which of the following systemic conditions can impact the immune response and affect gingival disease?
Signup and view all the answers
What is the main goal of oral hygiene during pregnancy?
Signup and view all the answers
Which of the following medications can cause gingival enlargement?
Signup and view all the answers
Which of the following is a type of gingival disease of specific bacterial origin?
Signup and view all the answers
What is the term for the relationship between periodontal infection and certain diseases or systemic conditions?
Signup and view all the answers
Which of the following is a complication of diabetes?
Signup and view all the answers
What is the effect of well-controlled diabetes on the risk and severity of periodontal disease?
Signup and view all the answers
Which of the following is a risk factor for developing periodontitis?
Signup and view all the answers
What is the primary objective of the maintenance phase of periodontal therapy?
Signup and view all the answers
What indicates that the crevicular epithelium is ulcerated due to active gingival or periodontal disease?
Signup and view all the answers
When should the first recall visit be scheduled after periodontal treatment?
Signup and view all the answers
What is a common observation during puberty?
Signup and view all the answers
What is the effect of hormonal contraceptives on the gingival response?
Signup and view all the answers
What is a common observation in patients with blood dyscrasias?
Signup and view all the answers
What determines if the patient is maintaining adequate plaque control?
Signup and view all the answers
How often should the interval between recall visits be lengthened with excellent plaque control and maintenance of periodontal health?
Signup and view all the answers
Which of the following is NOT a characteristic of Necrotizing Gingivitis (NG)?
Signup and view all the answers
Which bacteria are most abundant in a healthy sulcus?
Signup and view all the answers
At what age does the oral flora resemble that of an adult?
Signup and view all the answers
What is the primary characteristic of Desquamative Gingivitis (DG)?
Signup and view all the answers
Which of the following is NOT a type of necrotizing periodontal disease?
Signup and view all the answers
Which of the following bacteria are normal inhabitants of the oral cavity?
Signup and view all the answers
What is the significance of a biopsy in Desquamative Gingivitis (DG)?
Signup and view all the answers
Which of the following diseases can be mistaken for Desquamative Gingivitis (DG)?
Signup and view all the answers
What is the primary role of bacterial endotoxins in gingival inflammation?
Signup and view all the answers
What is the significance of the removal of plaque in reducing inflammation?
Signup and view all the answers
Study Notes
Osseous Resective Surgery
- Indications: one-wall defects, interdental craters, and wide, shallow two-walled defects
- Steps involved:
- Vertical grooving
- Radicular blending (osteoplasty)
- Flattening of the interproximal bone
- Gradualizing marginal bone (ostectomy)
Osseous Regeneration
- Best prognosis in defects with three bony walls and are deep in nature
- The remaining available bone acts as a matrix for the development of new osseous tissue
- Development of a new attachment apparatus can be facilitated by placement of a membrane for guidance or guided tissue regeneration (GTR)
Gingival Recession
- Treatment options:
- Pedicle soft tissue grafts
- Free soft tissue grafts
- Regenerative techniques
- Lateral pedicle graft:
- A root coverage technique
- Indicated in isolated, deep, narrow defects
- Contraindicated if sufficient adjacent keratinized tissue and bone does not exist at the donor site
Periodontal Flap
- Classification:
- Bone exposure after flap reflection
- Full thickness (mucoperiosteal)
- Partial thickness (mucosal)
- Placement of the flap after surgery
- Nondisplaced flaps
- Displaced flaps
- Management of the papilla
- Conventional flaps
- Papilla preservation flaps
- Bone exposure after flap reflection
Periodontal Surgery
- Incisions:
- Horizontal (running mesial to distal)
- Vertical incisions
- Internal bevel incision (a type of horizontal incision)
- Sulcular incision (involves the least amount of tissue loss)
- Treatment of periodontal pockets on the distal surface of the terminal molars:
- Distal wedge procedures
- Designs include:
- Triangular
- Square, parallel, or H-shaped
- Linear or pedicle
Smoking and Periodontal Disease
- Smoking is a significant risk factor for periodontal disease
- Effects of smoking:
- Less reduction in probing depth and smaller gains in attachment levels
- Demonstrate more orange and red microbial complexes
- Increase in Tannerella forsythia levels
- Depressed immune system
- Negative effect on the protective elements of the immune system
Systemic Diseases and Periodontal Disease
- Osteoporosis:
- Associated with periodontal disease in post-menopausal women
- Treatments for osteoporosis, such as bisphosphonates, may reduce bone loss
- Autoimmune conditions:
- Associated with a higher incidence of periodontal disease
- Radiation therapy:
- Periodontal attachment loss and tooth loss are greater on the radiated side
- Matrix metalloproteinases (MMPs):
- Primary proteinases involved in periodontal tissue destruction
- Produced by periodontal pathogens, such as P. gingivalis and A. actinomycetemcomitans
Cytokines and Periodontal Disease
- Interleukin-1 (IL-1), IL-8, and tumor necrosis factor alpha (TNFα):
- Central role in periodontal tissue destruction
- Stimulation of bone resorption and induction of tissue-degrading proteinases
- Monocytes/macrophages:
- Important in regulating the immune response through the release of cytokines
- Activated to produce prostaglandins (e.g., prostaglandin E2)
Diagnostic Aids for Gingival and Periodontal Disease
- Inflammation, bleeding on probing, and increased pocket depth
- Gingival color, contour, tone, and texture
- Plaque, calculus, and stippling
- Importance of disclosing solution in evaluating plaque
Nutrition and Periodontal Disease
- No nutritional deficiencies that can cause gingivitis or periodontitis
- Nutritional deficiencies can affect the condition of the periodontium
- Vitamin deficiencies:
- Vitamin A: important for protecting against microbial invasion
- Vitamin D: essential for calcium absorption and bone health
- Vitamin B-complex: contributes to gingivitis
- Vitamin C: severe deficiency results in scurvy
Microbiology of Periodontal Disease
- Gingival crevice harbors bacteria in both health and disease
- Development of gingivitis occurs in parallel with a tremendous increase in bacteria
- Shift in bacterial composition of the plaque
- Important bacteria associated with periodontitis:
- Porphyromonas gingivalis
- Fusobacterium nucleatum
- Aggregatibacter actinomycetemcomitans
- Tannerella forsythia
- Prevotella intermedia
- Peptostreptococcus micros
- Campylobacter rectus
- Treponema denticola
- Eikenella corrodens
Plaque Hypothesis
- Nonspecific Plaque Hypothesis: periodontal disease results from the elaboration of noxious products by the entire plaque flora
- Specific Plaque Hypothesis: only certain plaque is pathogenic, and its pathogenicity depends on the presence of or increase in specific microorganisms
- Biofilm: a thin layer of bacteria that harbors pathogenic types of bacteria
- Red complex of bacteria: a group of bacteria associated with severe periodontitis
- Actinobacillus actinomycetemcomitans: associated with aggressive periodontitis### Desquamative Gingivitis (DG)
• DG is a clinical presentation characterized by fiery red, glazed, atrophic, or eroded-looking gingiva. • It is more common in middle-aged to elderly females, is painful, and predominantly affects the buccal/labial gingiva. • The clinical appearance of DG is not significantly altered by traditional oral hygiene measures or conventional periodontal therapy alone. • The role of plaque is vague in DG. • DG can be mistaken for plaque-induced gingivitis, leading to delayed diagnosis and inappropriate treatment of potentially serious dermatological diseases.
Lateral Periodontal Cyst
• A lateral periodontal cyst is a slow-growing, asymptomatic, non-expansile odontogenic cyst that may present as a localized, tender swelling. • It occurs in adults, with a mean age of 50 years, and is more common in males than females. • The associated tooth is usually vital. • Radiographic features of a lateral periodontal cyst include a small radiolucency (seldom over 1 cm in diameter) on the lateral surface of the root of a tooth.
Periodontitis
• Early periodontitis: areas of localized erosion of the alveolar bone crest, attachment loss of 1-2 mm. • Moderate periodontitis: destruction of alveolar bone extends beyond early changes, attachment loss of 3-4 mm. • Advanced periodontitis: extensive bone loss, attachment loss of 5 mm or more, teeth show excessive mobility, and are in jeopardy of being lost.
Diabetes Mellitus and Periodontal Disease
• Diabetes is a risk factor for periodontal disease. • Individuals with diabetes have a higher prevalence and severity of periodontal disease than those without diabetes. • Diabetes does not cause periodontal disease, but it alters the response of the periodontal tissues to bacterial plaque. • Poorly controlled diabetics often have enlarged gingiva, sessile or pedunculated gingival polyps, polypoid gingival proliferations, abscess formation, and loosened teeth.
Prognosis for Periodontally-Involved Teeth
• Factors considered in establishing a prognosis for periodontally-involved teeth include tooth type, furcation involvement, bone loss, pocket depth, tooth mobility, occlusal force, patient's home care, presence of systemic disease, and cigarette smoking. • The two most critical factors are attachment loss and mobility. • McGuire and Nun classification system of prognosis: + Good prognosis: control of etiologic factors and adequate periodontal support. + Fair prognosis: approximately 25% attachment loss or grade I furcation invasion. + Poor prognosis: 50% attachment loss or grade I furcation invasion. + Questionable prognosis: greater than 50% attachment loss or poor crown-to-root ratio. + Hopeless prognosis: inadequate attachment to maintain health, comfort, and function.
Microbiota of Gingivitis and Periodontitis
• The initial microbiota of acute gingivitis consists of gram-positive rods, gram-positive cocci, and gram-negative cocci. • The transition to gingivitis is evident by inflammatory changes and is accompanied by the appearance of gram-negative rods and filaments, then by spirochetal and motile organisms. • The microbiota of chronic gingivitis consists of approximately equal proportions of gram-positive and gram-negative species, as well as facultative and anaerobic microorganisms.
Periodontal Examination
• Clinical features to evaluate during a periodontal exam: + Level of the free gingival margin in relation to the CEJ. + Periodontal pocket depth. + Loss of attachment. + Bleeding. + Exudate. + Mucogingival complications. + Erosion. + Abrasion. + Attrition. + Abfraction. + Hypersensitivity of roots. + Gingival enlargement.
Gingival Enlargement
• Gingival enlargement can be scored as follows: + Grade 0: no signs of gingival enlargement. + Grade I: enlargement confined to interdental papillae. + Grade II: enlargement involves papilla and marginal gingiva. + Grade III: enlargement covers three-quarters or more of the crown. • Gingival enlargement may result from chronic or acute inflammatory changes. • Chronic inflammatory gingival enlargement originates as a slight ballooning of the interdental papilla and marginal gingiva.
Pseudopocket
• A pseudopocket is a pocket formed by gingival enlargement without apical migration of the junctional epithelium. • It does not involve bone or attachment loss. • Pseudopockets are also referred to as gingival, false, or relative pockets.
Calculus and Plaque
• Calculus plays an important role in maintaining and accentuating periodontal disease by keeping plaque in close contact with the gingival tissue. • Bacterial plaque is always the primary etiologic factor in "plaque-induced gingivitis and/or periodontitis". • Calculus is a secondary etiologic factor after plaque.
Other Contributing Factors
• Food impaction or retention. • Open and loose contacts. • Overhanging margins of restorations and improperly designed prostheses. • Soft or sticky consistency of diet. • Violation of the "biologic width". • Orthodontic therapy.
Pregnancy Gingival Enlargement
• Pregnancy gingival enlargement may be marginal and generalized or may occur as single or multiple tumor-like masses. • The enlargement is usually generalized and tends to be more prominent interproximally than on the facial and lingual surfaces. • The so-called pregnancy tumor is not a true neoplasm; it is an inflammatory response to bacterial plaque and is modified by the patient's condition.
Gingival Diseases Modified by Systemic Factors
• Endocrine changes during pregnancy, puberty, and diabetes. • Blood dyscrasias (e.g., leukemia). • Medications (e.g., anticonvulsants, antihypertensive calcium channel blockers, and immunosuppressant drugs). • Genetic origin (e.g., hereditary gingival fibromatosis).
Non-Plaque-Induced Gingival Lesions
• Gingival diseases of specific bacterial origin (e.g., Neisseria gonorrhoeae, Treponema pallidum, Streptococcus species). • Gingival diseases of viral origin (e.g., Herpes virus infections, Varicella zoster). • Gingival diseases of fungal origin (e.g., Candidiasis caused by Candida albicans). • Gingival diseases of genetic origin (e.g., Hereditary gingival fibromatosis). • Gingival manifestations of systemic conditions (e.g., desquamative lesions, ulcerations of the gingiva, or both).
Periodontal Infection and Systemic Conditions
• Periodontal infection may enhance the risk for certain diseases or alter the natural course of systemic conditions via inflammation. • Organ systems and conditions possibly influenced by periodontal infection: + Cardiovascular system (e.g., atherosclerosis, coronary heart disease, angina, myocardial infarction, cerebrovascular accident). + Endocrine system (e.g., diabetes mellitus). + Reproductive system (e.g., preterm low-birth-weight infants). + Respiratory system (e.g., chronic obstructive pulmonary disease, acute bacterial pneumonia).### Diabetes and Periodontal Disease
- Diabetes increases the risk and severity of periodontal disease.
- Poor metabolic control in diabetes patients typically leads to increased prevalence and severity of periodontitis.
- Periodontal disease is considered the "sixth complication of diabetes", along with retinopathy, nephropathy, neuropathy, macrovascular disease, and altered wound healing.
- Well-controlled diabetes does not increase the risk and severity of periodontal disease.
Risk Factors for Periodontitis
- Genetic, environmental, and acquired risk factors can increase susceptibility to periodontitis.
- Risk factors can affect onset, rate of progression, and severity of periodontal disease, as well as response to therapy.
Periodontal Therapy and Maintenance
- The main goal of periodontal therapy is to establish a periodontal environment that can be maintained by the patient through good oral hygiene.
- Prevention of disease recurrence is the main objective of the maintenance phase of periodontal therapy.
- The first year after treatment is critical, as the patient has demonstrated susceptibility to periodontal disease.
- The appearance and condition of the gingival tissues will determine if the patient is maintaining adequate plaque control.
Gingival Tissues and Bleeding
- Bleeding on probing indicates ulcerated crevicular epithelium due to active gingival or periodontal disease.
Periodontal Maintenance Schedules
- After periodontal treatment, the first recall visit should be scheduled at three months.
- With excellent plaque control and maintenance of periodontal health, the interval may be lengthened to 4 to 6 months.
Hormonal Influences on Periodontal Health
- Puberty can lead to an exaggerated response of the gingiva to plaque due to gonadotropic hormones.
- The menstrual cycle is not accompanied by notable gingival changes, but increased gingival bleeding may be seen.
- Hormonal contraceptives can aggravate the gingival response to local factors similar to pregnancy.
- Oral disturbances are not a common feature of menopause, but some females may develop gingivostomatitis.
Systemic Conditions and Periodontal Health
- Patients with blood dyscrasias (e.g. leukemia, anemia, neutropenia, agranulocytosis, thrombocytopenia purpura) often demonstrate disturbances to the gingiva and periodontium.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Understanding osseous resective surgery, a predictable pocket reduction technique in surgical periodontal therapy, including its indications and steps.
