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ECD IV Perio_Study guide 2023 ☺ ECD IV DMD 2026 Exam 3 Dr. Boehm Material Study Guide :For best success in answering exam questions on my material, be able to answer the following questions: Necrotizing Periodontal Disease: 1. What are signs and symptoms of necrotizing gingivitis and necrotizing per...

ECD IV Perio_Study guide 2023 ☺ ECD IV DMD 2026 Exam 3 Dr. Boehm Material Study Guide :For best success in answering exam questions on my material, be able to answer the following questions: Necrotizing Periodontal Disease: 1. What are signs and symptoms of necrotizing gingivitis and necrotizing periodontitis? Which of these are different compared to (conventional) gingivitis or periodontitis? • Necrotizing gingivitis: Erosion of interdental papilla tip, lesion extends to marginal gingiva and complete loss of interdental papilla, but no bone exposure • Necrotizing periodontitis: Affects most of attached gingiva; possible bone exposure, obvious exposure of necrotic bone • Key diagnostic sign: Punched out, crater-like depressions at crest of interdental papilla, where gingival tissue will be missing o May also be lined by slough (gray, pseudomembranous tissue film) or exposed, white alveolar bone Necrotizing Periodontitis Symptoms 1. Abrupt onset with development of severe pain. Described as radiating, gnawing pain. 2. Difficulty eating or sleeping 3. Severe stomach upset 4. Loss of appetite 5. Constipation 6. General feeling of sickness (malaise) 7. Extreme pain when eating hot and spicy foods 8. High fever 9. Tachycardia 10. Confusion 11. Foul mouth odor similar to rotten meat, some complain of a metallic taste Systemic-Periodontal Relationships 1. What medical conditions increase the risk of developing periodontitis? Trisomy 21, Papillion-Lefevre Syndrome, Chediak Higashi Syndrome, diabetes mellitus ● ● ● Papillon-Lefevre syndrome Trisomy 21 Trisomy 21, Papillion-Lefevre Syndrome, Chediak Higashi Syndrome, diabetes mellitus 2. For which medical condition may treatment of periodontitis help medical management? Diabetes mellitus - Periodontal Disease Caused by Systemic Disease 1. Which type of cancer can cause single severe bone defects around teeth, resembling localized severe periodontitis? Leukemia Periodontics and Restorative Treatment 1. True/False: Restorative Treatment has no effect on soft tissue esthetics. • 2. What microorganisms are thought to be responsible for causing local tissue necrosis? • Treponema spirochetes: infiltrate surrounding tissue • Selemonas: responsible for foul odor • Also orange and red complex bacteria (Fusobacterium nucleatum, Prevotella intermedia) • • • Treponema spirochetes: infiltrate surrounding tissue Selemonas: responsible for foul odor Also orange and red complex bacteria (Fusobacterium nucleatum, Prevotella intermedia) 3. Fill in the blank: Stress is the typical trigger for an episode of necrotizing gingivitis affecting young adults (i.e. college students, military recruits in basic training). History of AIDS or chemotherapy are key patient history findings in typical necrotizing periodontitis cases. • Fill in the blank: Stressful events are the typical trigger for an episode of necrotizing gingivitis affecting young adults (i.e. college students, military recruits in basic training). History of AIDS or conditions producing severe immunodeficiency are key patient history findings in typical necrotizing periodontitis cases. Rare periodontal diseases: Non-plaque induced gingival diseases 1. What are clinical features of Herpes infections of the gingiva (Herpetic gingivostomatitis)? Severe mouth pain and ulcerations but will have multiple shallow ulcers across gingiva and no focus of interdental tissue or plaque accumulation A. B. C. D. E. F. Field of shallow ulcers Ends at midline Triggered by stress (i.e. injections, surgery), UV light for lips Prodromal phase Extremely painful Resolves on its own 2. What are fungal infections that can cause non-healing ulcers in gingiva? Candidiasis, Histoplasmosis • Oral candidiasis can cause non-healing ulcers, pseudomembranous lesions, or red lesions. Candidiasis, Histoplasmosis Link between periodontitis and heart disease Link between periodontits and diabetes mellitus type II True/False: Restorative Treatment has no effect on soft tissue esthetics. Implant Placement Surgery 1. (This may be a short answer question on the exam). When and for what purpose do you use the following instruments/drills during implant placement? a. Pilot drill or Lindemann drill i. Decortication (removal of cortical bone) b. Initial diameter Osteotomy drill i. Creates initial osteotomy c. Final diameter Osteotomy drill i. Creates osteotomy ii. Multiple drills increasing in diameter to allow for gradual widening of osteotomy d. Paralleling pin or Direction indicator i. Used after initial osteotomy ii. Pin is placed and PA is taken iii. Used to guide orientation of implant e. Bone tap i. Used to create threaded channel in bone to allow for insertion and screwing of implant f. Implant driver i. Used to insert implant g. Implant wrench i. Used to insert or remove implant h. Cover screw i. Used in two-stage surgery, placed to protect implant during healing and later retrieved during second stage and replaced with healing abutment. Placed sub-gingivally i. Healing abutment i. Placed on top of implant, immediately in one stage or 3-6 months after implant placement in two stage surgery. Promotes hard and soft tissue healing around implant a. Pilot Drill or Lindemann Drill: ● ● When: Initial stage. Purpose: Creates a pilot hole for precise implant placement. b. Initial Diameter Osteotomy Drill: ● ● When: After the pilot drill. Purpose: Enlarges the hole to the initial implant size. c. Final Diameter Osteotomy Drill: ● When: Following the initial drill. ECD IV Perio_Study guide 2023 ☺ 3. What are clinical signs and symptoms of allergic reactions in the oral cavity? Gingival erythema, BOP, burning sensation, ulcerations a. b. c. d. a. Sore bright red gums Swelling Itching Burning sensation What are lichenoid drug reactions? i. Drug reaction resembling lichen planus (red or white lesions/erosions/ulcerations) on oral mucosa and gingiva. Caused by drugs like ACE inhibitors, beta blockers, diuretics, NSAIDs, etc. Lichenoid drug reactions, also known as Lichenoid Mucositis (LM), is a generalized term used for a wide range of mucosal lesions that closely mimic oral lichen planus. Oral lesions caused by LM have been associated with drug intake, systemic diseases, food allergies, hypertension, and diabetes mellitus as well as many other foreign substances. They appear as gray to white interlacing reticular patterns set within an erythematous background. Lesions are usually unilateral and may exhibit ulceration and/or sloughing of the affected mucosa. b. What can be local mucosal and gingival responses to restorative materials? i. Foreign body reaction, enlargement, erythema, inflammation of mucosa/gingiva ● Purpose: Further enlarges to the final implant size. d. Paralleling Pin or Direction Indicator: ● ● When: Before drilling. Purpose: Guides drilling direction for accurate placement. e. Bone Tap: ● ● When: After osteotomy preparation. Purpose: Threads the implant site for stability. f. Implant Driver: Oral lesions related to dental restorative materials are commonly linked to metallic dental appliances and other restorative materials, presenting as a localized allergic reaction of the oral mucosa. c. What does an allergy towards toothpaste or mouth rinses look like? How can you find out if it an allergy? If known, what history of present illness detail makes this a sure diagnosis? i. Inflammation or erythema of gingiva/mucosa, itching or burning sensation. Begin perio therapy, OHI, avoid spicy foods, avoid alcohol, use baking soda, warm saltwater rinse. Reevaluate in two weeks, if it is gone in two weeks then slowly start reintroducing food and OH products one at a time to identify cause. If the lesion is not gone, biopsy or refer to allergist. An allergy towards toothpaste or mouth rinse would have the following clinical presentation. a. Unilateral blisters b. Erythema of the entire oral cavity with possible extension to the lips, with no injury or changes in medical history. c. Unilateral white lesions that resemble lichen planus. The best way to diagnose an allergic reaction is to question the patient/collect data. The goal is to figure out if the patient has introduced something different to her diet or oral hygiene routine. Abscesses if the Periodontium 1. What are clinical features of a … a. Gingival abscess? i. seen in young, healthy patients with periodontal health or gingivitis ii. history of eating crunchy foods or recent injury like a snapped ortho elastic, floss cut, or tooth brush bristle cut iii. tooth is vital or has sound RCT iv. no radiographic bone loss v. shallow probing depth vi. may not have fistula tract vii. base of abscess may contain foreign body b. Periodontal abscess? i. Typically associated with pre-existing moderate or severe periodontitis (stages II-IV) ii. Tooth is most likely vital or has sound RCT/restoration iii. Bone loss is coronal to apex, localized around furcation of mandibular molar, PDL space not enlarged iv. Deep probing depth but only extend to area of bone loss/midroot v. Gutta percha point inserted into fistula tract or deep pocket points to mid-root area c. Endodontic abscess? i. Seen in patients with severe caries ii. Associated to tooth with necrotic pulp iii. Bone loss around apex iv. Gutta percha point inserted into fistula points to apex of tooth v. Probing depths end far short of root apex vi. Soft tissue swelling may not be present, if so it usually is a small 5 mm round sessile lesion with a fistula tract next to the apex of the involved tooth near the floor of the vestibule Signs and Symptoms of an untreated abscess include: ● Pain: Slight discomfort to severe pain ● Gingival swelling ● Systemic involvement in some cases ● Radiographic bone loss: none to rapid and severe ● Suppuration ○ Spontaneous ○ Or after pressure on abscess ● ● When: During implant insertion. Purpose: Drives the implant into the prepared site. g. Implant Wrench: ● ● When: During implant placement. Purpose: Tightens the implant into the bone. h. Cover Screw: ● ● When: After implant placement. Purpose: Seals the implant opening during healing. i. Healing Abutment: ● ● 2. When: After healing. Purpose: Facilitates restorative access and shapes soft tissue. Fill in the blank: In free handed placement of a single ZimVie (formerly known as Zimmer) implant at a site bordered by natural posterior teeth in normal arch alignment, the implant platform should ideally be… a. More than 1.5 mm from the nearest tooth root surface b. More than 1.5 mm from the facial surface of the alveolar bone c. At or slightly above the alveolar bone surrounding the platform d. Aligned with the central grooves of the adjacent teeth e. _____ between the distal and mesial adjacent root surfaces ☺ at least 3mm + selected implant diameter f. Aligned with the ____ of the posterior implant crown supported by the implant ☺ center axis g. Aligned so that the implant long axis is _____ to the occlusal table ☺ perpendicular a. More than 1.5 mm from the nearest tooth root surface b. More than 1.5 mm from the facial surface of the alveolar bone c. At or slightly supragingival to the alveolar bone surrounding the platform d. Aligned with the central grooves of the adjacent teeth e. 1.5 to 2.0 mm between the distal and mesial adjacent root surfaces f. Aligned with the long axis of the posterior implant crown supported by the implant g. Aligned so that the implant long axis is parallel to the occlusal table 3. How do you avoid the following pitfalls in implant placement? a. Bone necrosis: avoid using dull drills, always use irrigation b. Drill getting stuck in bone: use sharp drill with pulsating up and down movements, do not stall or tip implant drill during initial osteotomy c. Inferior alveolar nerve damage: take CBCT, study it, refer to it during surgery d. Implant position renders it unrestorable: use surgical guide and good surgical techniques to avoid incorrect placement a. Avoiding Bone Necrosis: ● Use proper drilling techniques with sufficient cooling. ECD IV Perio_Study guide 2023 ☺ ● Avoid excessive heat by intermittent drilling. b. Avoiding Drill Getting Stuck: ● ● Ensure proper drill size and sharpness. Use steady and controlled drilling motion. c. Avoiding Inferior Alveolar Nerve Damage: ● ● Perform thorough preoperative assessment. Use surgical guides for precise placement. d. Avoiding Unrestorable Position: ● ● INDBE-style questions 1. Can you identify each of the following conditions? a. Necrotizing gingivitis b. Necrotizing periodontitis c. Herpetic gingivostomatitis d. Toothpaste allergy e. Gingival abscess f. Periodontal abscess g. Endodontic abscess Necrotizing gingivitis Plan implant placement with final prosthesis in mind. Collaborate closely with restorative dentist for aligned goals. INDBE Style Questions The case will involve implant placement in a patient with type 2 diabetes. 1. Based on your knowledge of systemic-periodontal relationships, patients with type 2 diabetes mellitus who receive implant treatment are more likely to experience what condition? How could you prevent this condition? Increased risk of poor healing, inflammation, bone loss → peri-implantitis. Ensure diabetes (blood glucose levels, HbA1c) is well-controlled prior to placement and continue to monitor during post-op treatment. Patients with type 2 diabetes undergoing implant treatment may be more susceptible to peri-implantitis. Prevention involves: Control Blood Sugar: Necrotizing periodontitis ● Maintain optimal glucose levels. Oral Hygiene: ● Emphasize meticulous oral care. Regular Check-ups: ● 2. Herpetic gingivostomatitis Toothpaste allergy Schedule routine dental visits. (Critical thinking test – I did not cover this verbatim in class, and I want to see who can figure this out on their own. This will likely be multiple choice item, and there will only be one correct answer). What do you think happens to gingival esthetics if the following happens as result of implant placement? a. Implant platform close to adjacent tooth root: bone loss, gingival recession? b. Implant platform significantly facial to ideal implant position c. Implant platform is significantly coronal to bone level d. Implant platform is significantly apical to the CEJ of adjacent teeth: bone loss, recession? a. Implant Platform Close to Adjacent Tooth Root: ● ● Gingival abscess Periodontal abscess Effect: Risk of visible space between implant and tooth. Preventive: Ensure proper spacing during planning. b. Implant Platform Facial to Ideal Position: ● ● Effect: Increased risk of soft tissue recession. Preventive: Accurate 3D planning for ideal implant position. c. Implant Platform Coronal to Bone Level: Endodontic abscess ● ● Effect: Potential exposure, compromising esthetics. Preventive: Ensure proper implant depth during planning. d. Implant Platform Apical to Adjacent Teeth CEJ: ECD IV Perio_Study guide 2023 ☺ ● Effect: Uneven gingival levels, unnatural appearance. Preventive: Precise placement aligned with adjacent teeth. Use surgical guides. (Purulent swelling between #18 and #19) 2. For each of the conditions mentioned in question 1 (a-g), what is the initial treatment? a. Necrotizing gingivitis/periodontitis: ultrasonic debridement (remove necrotic tissue, calculus, bacterial mass), OHI, antibiotics, multivitamin/protein food supplement b. Herpetic gingivostomatitis: Acyclovir ointment or tablet by mouth to shorten duration, typically resolves on its own c. Toothpaste allergy: remove toothpaste, use alternative toothpaste d. Gingival abscess: SRP of affected tooth, remove foreign body e. Periodontal abscess: SRP of affected tooth f. Endodontic abscess: RCT/EXT a. Necrotizing Gingivitis ➔ Initial Treatment: Remove necrotic tissue, provide oral hygiene instructions, and prescribe antimicrobial mouthwash. b. Necrotizing Periodontitis:➔ Initial Treatment: Extensive debridement, antibiotics (e.g., metronidazole or amoxicillin) in severe cases. c. Herpetic Gingivostomatitis:➔Initial Treatment: Symptomatic relief, such as topical anesthetics, pain relief, and antiviral medications if necessary. d. Toothpaste Allergy:➔Initial Treatment: Identify and stop using the allergenic toothpaste, switch to hypoallergenic alternatives. e. Gingival Abscess:➔Initial Treatment: Drainage, removal of irritants, and antibiotics if needed. f. Periodontal Abscess➔Initial Treatment: Drainage, scaling, root planing, and antibiotics if systemic involvement is present. g. Endodontic Abscess:➔Initial Treatment: Drainage through root canal therapy or tooth extraction, and antibiotics if systemic involvement is present.