1
Q
what is the importance of a furcation arrow
A
Deas 2006 - furcation arrow is an accurate predictor of furcation invasion 70% of the time. However, when there is a furcation invasion, the furcation arrow is only seen in 40% of the sites
2
Q
is the presence of crestal lamina dura mean there is no active breakdown
A
Greenstein 1981 - crestal lamina dura was NOT related to the presence or abscence of inflammation, BOP, PD, or CAL
3
Q
incidence of accessory canals in the furcation area
A
Gutmann 30%
4
Q
reasons for intrabony defect
A
-endo-perio lesion (fracture, ERR,perforation)
-vertical root fracture
-occlusal trauma
-tooth-related factors (developmental root groove, ERR)
-perio abscess
5
Q
3 ways you can have endo-perio lesion with root damage
A
- root fracture
- root canal perforation
- external root resorption
6
Q
what are all the “localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontal disease”
A
- cervical root resorption
- cemental tears
- palato-radicular groove
- root concavity
- cervical enamel projection
- enamel pearl
- altered passive eruption
- root fractures
- root proximity
7
Q
ways you can have a perio abscess in a non-perio pt
A
- impaction (floss, ortho elastic, toothpick, popcorn)
- harmful habits (nail biting)
- ortho forces
- gingival overgrowth
- altered root surface (invaginated tooth, dens evaginatus, cemental tears, enamel pearls, developmental grooves, perforations, fracture, ERR)
8
Q
signs of a perio abscess
A
-ovoid elevation
-pus
-mobility
-sensitive on palp or perc
-pain
9
Q
what info do u need to know about perio abscess
A
-hx of chronic perio or recent perio interventions
-is there a perio pocket
-is there pus
-radiograph (may see bone loss)
10
Q
management of perio abscess
A
2-stage approach
-drain pocket with SRP (and may need to make incision through abscess to further drain)
-systemic antibiotics if systemic involvement
-after 4-6weeks, re-eval to see if flap surgery is needed to correct residual defect
11
Q
can periodontal disease cause pulpal pathosis?
A
Bergenholtz: only 3% of perio involved teeth required RCT
-periodontal disease rarely causes pulpal necrosis due to the exposure of lateral and/or accessory canals.
-if perio pocket reaches apex, there is an avenue for bacteria to enter the pulp and cause endo pathosis
12
Q
reasons for a residual deep pocket after IT and re-eval
A
-inadequate instrumentation
-local anatomical factors (furcations, grooves)
-endo-perio with root damage( VFR, root resorption)
-endo-perio without root damage
-occlusal trauma
-poor OH
13
Q
treatment for residual deep pocket on 16M
A
-re-instrumentation (with or without flap surgery for access)
-consider adjunctive therapies (local antibiotics)
-odontoplasty
-check occlusion and adjust if needed
-check vitality
-check CBCT if suspecting fracture (or flap access sx to see clinically)
-review OHI
-can consider GTR or osseous
14
Q
what is the effect of flap access sx compared to non-surgical or re-instrumentation
A
Sanz 2020 guidelines
-for PD4-5mm: NSPT is recommended (shows better CAL gain than sx and no difference in PD reduction long term)
-for PD>6mm, flap sx is recommended (shows better CAL gain and PD reduction)
Becker
-after 5 years, no sig difference in SRP, osseous, and MWF
15
Q
how does OFD compare to osseous
A
Becker
-after 5 years, no sig difference in SRP, osseous, and MWF
16
Q
NUG clinical features
A
-punched-out necrotic papilla
-pseudomembranes
-pain
-bleeding
-halitosis
-lymph node involvement, fever
17
Q
etiology of NUG
A
primary etiology is bacteria on a susceptible host
secondary factors:
-stress
-smoking
-poor OH
-malnutrition
-alcohol
-HIV
18
Q
management of NUG
A
-med consult if suspecting immunocompromised
-debride with LA, remove pseudomembrane areas with cotton pellet with chx
-prescribe chx mouthrinse
-review OH, nutrition, smoking cessation, stress management
-ibuprofen for pain
-systemic antibiotics if there is systemic involvement or they are immunocompromised
-follow up closely (1day, then every other day)
19
Q
where is calculus found in the pocket
A
calculus is located half way from the top of the gingival margin to the base of the bony defect (Richardson)
20
Q
where is plaque found in the pocket
A
-there is about 0.1-0.5mm of attached plaque that is found in front of the calculus
-then there is a plaque free zone of 0.2mm-0.4mm (Waerhaug 1978) between the plaque and the junctional epithelium
21
Q
Initial Lesion (gingiva appears healthy)
A
Day 2-4:
-vasodilation
-increase in GCF
-migration of inflammatory cells (mainly NEUTROPHILS)
22
Q
Early Lesion (Early Gingivitis, appears with erythema)
A
Day 4-10:
-increase vasodilation and # of vessels
-increase in NEUTROPHILS AND LYMPHOCYTES
-damage to fibroblasts
-loss of collagen fibers in the CT which provides more space of inflammatory cells
-rete peg proliferation
23
Q
Established Lesion (chronic gingivitis, appears with erythema and edema and BOP)
A
2-3 Weeks:
-further increase in GCF and inflammatory infiltrate (PLASMA CELLS BECOME MORE PREDOMINANT)
-continued fibroblast damage
-loss of collagen apically and laterally
-rete pegs extend even further into CT
-JE transforms into POCKET EPITHELIUM
24
Q
Advanced Lesion (clinically seen as periodontitis)
A
-irreversible damage to the periodontium
-TRUE POCKET formation
-apical migration of the JE, loss of CT attachment, and bone loss
-PLASMA CELLS dominate and make up more than 50% of the infiltrate
25
what are all things to consider for initial therapy phase
1) med consult
2) smoking cessation, diabetic counselling, nutritional counselling (obesity), reduced anxiety protocol w sedation options
3) OHI, pt education, and motivation
4) full mouth SRP (with LA w epi - limit epi for CVS patients)
*5) extract hopeless teeth
*6) occlusal adjustments
*7) consults as needed (resto, endo, prostho, ortho) - address caries, PARL, etc.
8) re-eval 4-8 weeks
26
what might you consider in phase 2 therapy
-osseous
-ofd
-implants
-GTR
-soft tissue augmentation
-GBR
-crown lengthening
-re-eval phase 2
27
what might be part of phase 3
implant crown
28
what is part of phase 4
SPT every 3m
perio re-eval every 12m
radiographs
nightguard
29
what is part of fair prognosis
25% attachment loss
class I furcation
30
what is part of poor prognosis
50% attachment loss
class II furcation (cleansable)
31
what is part of questionable prognosis
>50% attachment loss
poor C:R
class II furcation (difficult access)
class III furcation
class II mobility
significant root proximity
32
what are examples of contributing factors
-inadequate OH
-calculus
-former smoker
-open contacts
-occlusal trauma
-tooth malposition
-loss of teeth
-root proximity
-endo and resto
33
*explain the pathogenesis of periodontal disease
it is a chronic inflammatory disease associated with dysbiotic plaque and exacerbated immune response leading to progressive destruction of the periodontium
it is influenced by several local and systemic factors that can exacerbate disease progression
its progression is described by page and schroders model...
34
justify stage I perio
-iCAL of 1-2mm
-pockets of 4mm or less
-bone loss <15%
35
stage 3 versus stage 4
-lost 5 or more teeth due to perio
-need complex rehabilitation due to:
1) bite collapse
2) tooth migration, drifting, flaring
3) loss of posterior support
4) secondary occlusal trauma or mobility 2 or more
5) <20 remaining teeth or 10 opposing pairs
6) loss of masticatory function
36
justify stage 2
-iCAL of 3-4mm
-pockets 5mm or less
-bone loss <33%
37
justify stage 3
-iCAL 5mm or more
-pockets 6mm or more
-bone loss to middle or apical 1/3 of the root
-furcation class 2 or 3
-vertical bone loss 3mm or more
-max 4 teeth lost due to Perio
38
justify stage 4
-iCAL of 5mm or more
-bone loss to middle or apical third of the root
-5 or more teeth lost due to perio
*need for complex rehabilitation due to:
-masticatory dysfunction
-secondary occlusal trauma (tooth mobility 2 or more)
-ridge defect
-bite collapse
-tooth migration, drifting, or flaring
-<20 teeth or 10 opposing pairs, or loss of posterior support
39
justify grade A
-direct evidence of progression: no bone loss over 5 years
-indirect evidence: <0.25 bone loss/age OR heavy biofilm deposits with low levels of destruction
-non-smoker
-non diabetic
40
justify grade B
-direct: <2mm CAL loss over 5 years
-indirect: 0.25-1.0 bone loss/age
-destruction corresponds with amount of biofilm
-<10 cig/day
-<7% HbA1c
41
justify grade C
-direct: 2mm or more CAL/bone loss over 5 years
-indirect: >1 bone loss/age
-destruction exceeds what is expected based on amount of biofilm, may have had periods of rapid destruction and early onset disease (eg. molar/incisor or unresponsive perio)
-smoking 10 or more cig/day
-7% or more HbA1c
42
Localized gingivitis
is defined as
10%–30% sites with BOP
43
generalized gingivitis
is defined as
>30% sites with BOP
44
what is not included in the diagnosis for perio
-gingival recession from trauma
-caries
-impacted 8s
-endo lesion
-vertical root fracture
45
manual vs electric toothbrush
cochrane review by Yaacob supports that electric toothbrushes are more effective in improving plaque and BOP compared to manual toothbrushes
46
interdental aids
Kotsakis
-interdental and waterpiks were better than floss or toothpicks for reducing BOP
47
FMS vs FMD vs quadrant
Jervoe-Storm and Eberhard Cochrane review showed no significant benefits of one or the other
48
ultrasonics or hand scalers
Suvan 2019 - no difference, can use either or or both
49
residual pockets of 4-5mm, tx options?
re-instrumentation.
Sanz-Sanchez 2020:
for moderate pockets - reinstrumentation had better CAL gain. PD difference was only better in the short term for OFD
50
residual pockets of 6mm or more. tx options?
Sanz Sanchez 2020:
-OFD
-OFD results in better PD reduction for deep pockets compared to SRP for short and long term
51
PD 6mm or more, OFD or osseous
Polak 2020 - osseous recommended
-sig higher PD reduction
-long term, no difference in PD or CAL gain (3-5 years)
-more recession in osseous group
52
when to do regeneration
3mm or more intrabony defect
53
what do you expect to gain from GTR
-1.3mm CAL gain
-1.2mm PD reduction
compared to OFD
54
tx options max interdental class 2 furcation
-NSPT
-OFD
-GTR (esp max B or mand B+L furcation)
-root resection
55
signs of occlusal trauma
1) fremitus
2) mobility
3) occlusal discrepancies
4) wear facets
5) tooth migration
6) fractured tooth
7) thermal sensitivity
8) discomfort on chewing
9) widened PDL
10) cemental tear
11) root resorption
56
5As for smoking cessation
Ask
Assess
Advise
Assist
Arrange
57
when do you re-eval and why
4-8 weeks
Proye - after 1 week there is recession and after 3 weeks there is a gain in CAL
Morrison - showed perio parameters increase after 4 weeks
Waerhaug - JE takes 2 weeks to heal
Biagini - CT fibers take 4-8 weeks to mature and orient
Magnusson -showed that in the abscense of plaque control, subgingival bacteria re-populate sites within 4-8 weeks
58
is there an association between osteoporosis and perio
-2-5x more
likely to have loss of alveolar bone compared with
subjects with normal bone scores
-worse CALs have been seen with worsened T scores
-association is stronger in those >70 years old and worsened T scores
59
what is the risk of MRONJ
-cancer 1-5%
-osteoporosis <1%
60
what are risk factors for MRONJ
-taking antiresorptive medication (eg, bisphosphonate)
-extraction (or other sx)
-comorbidities
-corticosteroid use
-indication: malignancy vs osteoporosis
-dose and duration of medication (>2 years for cancer, >4 years for OP)
-type of medication
-IV versus oral
-mandible
-denture use
61
association of osteoporosis and implants
-no difference in implant survival rate
-more MBL compared to non-osteoporosis pts
if on medications:
-low dose oral bisph is ok and does not compromise implant survival (rate of MRONJ is 0.5%)
-high risk if: high dose anti-resorptive med for cancer, long-term use of oral BP, and those with comorbidities
considered contraindication for those on antiresorptive medications for cancer
62
pre-op abx for implants
Esposito
-benefit of single dose of 2 g prophylactic amoxicillin
prior to dental implant placement to reduce implant failure rates
63
amoxicillin allergy on implants
French
-higher infection rate and x3 higher implant failure rate in pts with amoxicillin allergy
64
definition of MRONJ
1. Current or previous use of anti-resorptive medication.
2. Exposed bone or bone that can be probed through a fistula, presenting for >8 weeks.
3. No history of radiation or cancer to the jaws
65
stage 1 MRONJ
-Exposed and necrotic bone or probable fistula to the bone
-asymptomatic
66
stage 2 MRONJ
-Exposed and necrotic bone, or fistula that probes to the bone
-symptomatic
-infection/inflammation
67
stage 3 MRONJ
-Exposed and necrotic bone or fistulae that probes to the
bone
- evidence of infection
-one of the following:
-extends beyond alveolar bone like the inferior border and ramus, sinus, zygoma).
- fracture.
-Extraoral fistula.
-Oral antral/oral-nasal communication.
-Osteolysis extending to the inferior border of the mandible or sinus floor.
68
how can you prevent MRONJ
-high-risk surgical procedures prior to initiating therapy
-pre op and post op antibiotics and antimicrobial rinses
-primary wound closure
-good OH
-overall good pt health
69
can hopeless teeth be maintained
Machtei -
no detrimental effect of hopeless teeth on adjacent dentition as long as perio maintenance is provided
70
what is stippling and what is its significance
stippling is correlated with rete ridges in the epithelium associated with high keratinization
the presence of stippling can indicate health but the absence of stippling does not necessarily indicate disease unless there was previously stippling that was subsequently lost
71
can you have perio in the established lesion phase
technically, the definition of perio is having CAL and bone loss and apical migration of the epithelium which is only seen in the advanced lesion
a person can be in the established lesion and never convert to periodontitis. transition from gingivitis to periodontitis differs between people and occurs when the shift in symbiosis to dysbiosis occurs due to environmental, systemic, or host factors along with the inflammation
72
does perio advance the same way for everyone?
no, sri lanka tea worker study found 3 different rates of disease progression in a population without dental tx:
-moderate progression 81% (0.05-0.5mm CAL loss/year)
-rapid progression 8% (0.1-1.0 mm/year)
-no progression 11% (0.05-0.09 mm/year)
73
describe the rate of periodontal disease progression overtime? is it continuous?
Socransky - continous at most sites, but some sites will have random bursts or activity and some sites will have almost no progression
74
how does maintenance affect tooth loss
Becker - 0.11, 0.22, 0.36
75
Do all maintained patients retain their teeth?
Hirschfeld and Wasserman found that maintained pt will have different rates of tooth loss
well-maintained - 83%, 2% tooth loss
downhill -12%, 22% tooth loss
extreme downhill - 4%, 55% tooth loss
76
does maintenance differ in perio practice vs GP
Axelsson-
-perio practice pts had better perio parameters in PD, CAL, and plaque after 3 and 6 years
Leavy-
specialist can maintain perio stability well. a dentist can provide similar level of care, but it is suggested that the outcomes may be slightly worse in the dental office
from these studies, it is important to assess a patients risk and if they are low risk and demonstrate stability, then they can go back to their dentist for SPT. high risk patients that are not demonstrating good stability should be kept in the specialist office
77
comment on the healing of an extraction socket picture with MRONJ
-delayed healing
-no epithelialization of the socket
-edema
-possible bone exposure
78
differential diagnosis for site with delayed healing after extraction
-MRONJ
-dry socket
-osteomyelitis
-tooth fragment
-delayed healing
79
what information do you need about the healing to finalize dx of MRONJ
-history of healing
-symptoms and their history
-E/O and I/O exam, look for signs of infection or fistula
-radiograph
80
management of MRONJ Stage I
-pt education and reassurance
-antimicrobial rinse
-removal of mobile bone or sequestrum
-pain management
-close followup
-consider systemic antibiotics if progressing
-consider marginal resection if progressing
81
how much is the plaque free zone
0.5mm (Waerhaug)
82
how much improvements do you expect after NSPT
Cobb
-for 4-6mm: reduction of 1.3mm PD, gain 0.5mm CAL
-for 7mm: reduction of 2.2mm PD, gain 1.8mm CAL
83
is there a difference in resistance to healed LJE to true CT attachment
Beaumont1984 - LJE compared to healthy periodontium showed no difference in resistance to disease
84
what is occlusal trauma
an injury to the periodontium caused by excessive occlusal forces that exceed the tooth's adaptive capacity
85
what are the stages of occlusal trauma
injury, repair, and adaptive remodeling
86
describe the injury phase of OT
widening of the PDL and increase in mobility and angular defect
-increase in number of bv
-decrease in local cellularity and hyalinization and necrosis
-undermining bone resorption
-tension side has hemorrhage, tearing of the PDL, and bone resorption
87
describe repair stage of OT
body tries to recover from the damage
-damage tissue is removed
-new CT, cementum, and bone is formed
88
describe the adaptive remodeling stage of OT
reparative capacity exceeds the destructive process
-widened PDL
-increased mobility (but not increasing mobility)
89
does the presence of mobility affect the outcomes of perio therapy
yes, study by Fleszar showed that teeth that were mobile responded worse compared to those that werent mobile
90
what happens with healthy perio and OT
-increased mobility
-bone resorption
-widened PDL
but NO CAL LOSS
91
what happens with perio and OT
-more bone loss and more mobility
-CAL occurs
Polson: no different in CAL compared to no OT
Lindhe: more apical migration of JE compared to no OT
92
what happens if you have perio and OT and then correct the OT
-no improvement in CAL and no bone regeneration until perio is tx'd
-may have improvement in mobility (Lindhe)
93
does OT cause perio
OT does not cause perio but it may be a cofactor that can accelerate perio breakdown in the presence of perio
94
is there a greater gain in CAL if you do an occl adjustment
Yes, Burgett found 0.4mm more CAL gain in adj group, no difference in PD
However Harrel and Nunn found increased PDs with untreated occlusal discrepancies overtime
95
define root proximity
distance between roots of adjacent teeth.
96
how is root proximity related to perio
Kim:
sites with <0.8mm root distance is a significant risk factor for bone loss
McGuire and Nunn: have sig root proximity under "Questionable" category
97
is there a classification for root proximity
Heins:
<0.3mm: no bone, only PDL space
0.3-0.5mm: cortical bone and PDL
>0.5mm: cancellous bone present
Vermylen:
Location: A, B, C (apical, middle, coronal third)
Severity: 1 (0.5-0.8mm),2 (0.3-0.5mm),3 (<0.3mm)
98
most important factors for prognosis
mobility
parafunction without biteguard
smoking
bone loss
PD
furcation
99
indications for occlusal adjustment
-occlusal trauma
-increased mobility
100
what factors affect the outcome of NSPT
1. smoking
2. diabetes and other systemic health that affect host response
3. pocket depth
4. furcations, root proximity, grooves
5. quality of the root debridement
6. maintenance
7. oral hygiene
101
does calculus cause perio
calculus provides the ideal environment for plaque adhesion, growth, and maturation, but the calculus itself doesnt. infact, Listgarten (1973) demonstrated that disinfected calculus can still have epithelial attachment
102
cafesse study for calculus-free surface
1-3mm: 86%, 86%
4-6mm: 76%, 43%
6mm+: 50%, 32%
103
How good is compliance
Wilson:
16% complete
50% erratic
34% non compliant
They found that you can increase compliance from 16 to 32% if you have adjustments in office and motivation
104
modes of calculus attachment according to zander 1953
1) secondary cuticle
2) direct attachment into irregularities of cementum * 20%
3) penetration into cementum *10%
4) mechanical retention in areas of resorption
105
prevalence of CEP in mand and max molars
28% (mand)
17% (max)
106
effect of subgingival margins on periodontal health
-Schatzle: subgingival margins cause CAL loss 1-3 years after subgingival resto but then a “burn-out” effect occurs.
However, according to the WW2017, if they have good OH and maintenance, they have no detrimental effect
They should not have invasion of biological width
107
effect of overhang margins
-Lang 1983: increased proportions of gram neg anaerobic bacteria, black-pigmented Bacteroides, and an increase in anaerobe
-Jeffocat: overhangs associated with more bone loss
108
are radiogarphs accurate for measuring perio bone loss
yes, Jeffcoat found correlation between CAL loss clinically and radiographically (80% correlation)
109
which dentrifices were the best
Figuero:
stannous fluoride was one of the more effective toothpastes for reducing PI and GI
mouthwash: essential oils was best for reducing GI
crest pro-health
110
Describe possible mechanisms for the effects of diabetes on periodontitis.
1. Impairment of neutrophil chemotaxis, recruitment, and function
2. Increased proinflammatory state with increased vascular permeability
3. Increase in AGEs:
1) altered cell function
2) increase in ROS
3) increase in RANKL/OPG
4. inhibits fibroblast viability
5. Decreased collagen formation and increased collagenase activity
111
relationship between diabetes and perio
Uncontrolled diabetics have poorer response to periodontal tx
NSPT can reduced hba1c by 0.3%–0.4%
112
113
How accurate is the system for estimating tooth retention
5-8 year prediction accuracy of 80%, but if you take out the “good” category, it drops to 50% so it is ineffective for teeth with initial prognosis of less than good
114
How effective are implants in a patient with history of perio
-Costa: hx of perio pts were 9 times more likely to develop peri-implantitis
115
What is the average CAL and tooth loss per year for non-compliant pts?
-Becker
-0.11 teeth/year for those treated + maintained
-0.22 teeth/year – treated + not maintained
-0.36 teeth/year – no treatment
116
Justify Stage 3 grade c perio diagnosis
-generalized (affects >30% teeth, around 9)
-interdental CAL on 2 non adjacent teeth
-buccal CAL >3 with pocket of >3
-pockets >6
-interdental bone loss > 33%
-furcation 2
-<4 teeth lost to perio
-HbA1c >7%
117
Pathologic tooth migration (PTM)
a change in tooth position due to a disruption of forces that maintain teeth in a normal relationship
118
How effective is SRP
-Stambaugh: effective instrumentation limit is 6.21mm
119
Is it more effective to do SRP or FMD?
-Swierkot et al: no difference between quadrant SRP and full mouth SRP or full mouth disinfectant
120
What is more effective - scalers or ultrasonic?
-Hallmon: mechanical was just as effective as ultrasonic
121
Does contaminated cementum need to be removed?
Nyman - removal of diseased cementum is not required, as long as the root is planed it is adequate
122
Critical probing depth:
-Lindhe 1982:
-PD <2.9mm – SRP leads to CAL loss
PD <4.2mm – surgical SRP leads to CAL loss
Heitz-Mayfield 2013:
PD>5.4mm – surgical has more CAL gain
Therefore, from 2.9-5.4mm you should do SRP. For PD >5.4mm you should do surgical.
123
causes of pathologic tooth migration
1. loss of bone support
2. inflammation
3. occlusal trauma
4. posterior bite collapse
5. tooth loss
6. soft tissue pressures of the cheek, tongue, and lips
7. oral habits
it occurs when there is a reduction in the periodontal support and a change in the forces that maintain a tooth in its position (eg occlusal forces)
124
when is the best time to do occl adjustments
during or after perio therapy, esp if heavy inflammatory load relating to the mobility (more than the occl trauma)
Since teeth can be displaced by inflammation
If there is increased mobility without extensive bone loss, adjustment first
125
is ortho safe in perio pts
in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes
(Martin 2021)
provided the
results of periodontal therapy are maintained during the active
OT.
126
when should ortho commense after perio IT
once the endpoints of perio therapy are reached
no sites with PPD= 5 mm + BOP
no sites with PPD ≥6 mm
(Herrera)
127
when should OT begin when doing GTR?
In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time
(Jepsen 2021)
128
how often should pts in ortho be seen?
Jiang 2021 - looked at 1,3,6m intervals and found 1 and 3 to be similar for GCF enzymes and plaque and BOP, and both 1 and 3 months was better than 6m
129
implants for stage 4 patients
implants - risk of peri-implantitis (RR:3, Carra) and lower implant survival (HR: 2, Carra)
-shortened dental arch: may be more beneficial compared to RPD as it shows lower plaque scores and gingival inflammation and recession compared with RDPs. A shortened dental arch does not necessarily mean lower chewing function compared to RPD (Witter, Kayser)
For RDPs, may have abutment tooth failure and periodontal problems, and may not necessarily increase masticatory efficiency compared to SDA.
130
RPDs for stage 4 patients
Gotfredsen:
-RPDs may increase the risk for tooth loss and plaque accumulation, and do not necessarily improve masticatory function
131
FPD option for perio patients
Montero: FPDs are successful in perio pts compared to non perio pts. complications are usually Technical than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time.
132
can shortened dental arch be considered in perio pts
yes, if they have sufficient occluding/masticatory units (e.g., from second pre-molar to
second pre-molar, no PTM, and
adequate comfort) no tooth replacement may be considered in
the free-end situation (Kayser).
133
what causes a class 3 malocclusion
main cause is skeletal
-this can occur if the mandible is long, maxilla is short, glenoid fossa is positioned more anteriorly
or a pseudo-class 3 which is due to an interference or crossbite causing the shift into class 3 occlusion, or delay in the eruption of permanent upper incisiors causing them to erupt palatally
or narrow maxilla and wider mandible arch
134
signs of PTM
-mobility
-rotation, spacing, diastemas, flaring, or extrusion
-changing bite
-signs of periodontal disease
135
can PTM be corrected by perio therapy
yes, Gaumet demonstrated that if PTM is in its early stages and not that severe, it can be corrected by perio non-surgical therapy alone
136
asa 2 classification
pt has mild systemic disease
-smoker
-alcohol
-pregnancy
-obesity (BMI from 30-40)
-well-controlled DM or HTN
137
ASA 3 classification
pt has severe systemic disease
-poorly controlled DM or HTN
-COPD
-morbid obesity BMI >40
-history of MI, CVA, TIA more than 3 months ago
138
ASA 4 classification
pt has severe systemic disease that is a constant threat to life
-history MI, CVA, TIA in less than 3 months
139
what to do in a medical emergency
-call 911
-monitor CABs
-administer oxygen
140
how useful is PD at re-eval for predicting future CAL
Claffey - presence of PD 6mm or more was more at risk of further attachment loss, esp with the presence of BOP
