Perio Final Flashcards by A G

The part of gingiva that surrounds the tooth and is not directly attached to the tooth surface

Free gingiva

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The portion of gingiva bound to the tooth and the alveolar bone, extending from the free gingival groove to the MGJ

Attached gingiva

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What makes up keratinized gingiva?

Free + attached gingiva

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Histological: GM to MGJ
Clinical: GM to MGJ measured clinically

Keratinized gingiva

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Histological: Most coronal cells of JE to MGJ (KG width – FG width)
Clinical: KG width - PD

Attached gingiva

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What are the 3 ways to detect the mucogingival junction?

Inspection (color/texture)
Roll technique (tissue mobility)
Stain (povidone-iodine solution)

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What are the following associated with?

Biotype
Recession
Lack of keratinized gingiva
Decreased vestibular depth
Aberrant frenum/muscle position
Excess gingiva
Abnormal color

Mucogingival deformities and conditions around teeth

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Which mucogingival deformity or condition around teeth?

Thin scalloped
Thick scalloped
Thick flat

Biotype

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Which mucogingival deformity or condition around teeth?

Facial or lingual surfaces
Interproximal (papillary)
Severity of recession (Cairo RT1, 2, 3)
Gingival thickness
Gingival width
Presence of NCCL/cervical caries
Patient aesthetic concern (smile esthetic index)
Presence of hypersensitivity

Recession

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Which mucogingival deformity or condition around teeth?

Pseudo-pocket
Inconsistent gingival margin
Excessive gingival display
Gingival enlargement

Excess gingiva

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Which biotype?

Slender, triangular-shaped teeth

Thin scalloped

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Which biotype?

Subtle cervical convexity

Thin scalloped

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Which biotype?

Interproximal contacts close to incisal edge

Thin scalloped

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Which biotype?

Narrow zone of KT

Thin scalloped
Thick scalloped

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Which biotype?

Clear, thin, delicate gingiva

Thin scalloped

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Which biotype?

Relatively thin alveolar bone

Thin scalloped

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Which biotype?

Thick, fibrotic gingiva

Thick scalloped
Thick flat

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Which biotype?

Slender teeth

Thick scalloped

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Which biotype?

Pronounced gingival scalloping

Thick scalloped

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Which biotype?

Square-shaped teeth

Thick flat

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Which biotype?

Pronounced cervical convexity

Thick flat

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Which biotype?

Large interproximal contact located more apically

Thick flat

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Which biotype?

Broad zone of KT

Thick flat

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Which biotype?

Thick alveolar bone

Thick flat

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Which biotype? Develops more recession

Thin

Which biotype? Might influence integrity of perio through the pt's life

Thin

Which biotype? Risk when applying ortho, implant, and restorative treatments

Thin

What are the following methods used to assess? 1. Transgingival probing 2. Probe visibility 3. Ultrasonic device

Gingival thickness

Which gingival thickness assessment? Accuracy to the nearest 0.5 mm Local anesthesia

Transgingival probing

Which gingival thickness assessment? Can be done with color-coded or regular probe Thick: > 1 mm Thin: ≤ 1 mm

Probe visibility

Which gingival thickness assessment? High reproducibility within 0.5-0.6 mm range

Ultrasonic device

The migration of the marginal soft tissue to a point apical to the CEJ of a tooth or the platform of a dental implant

Recession

What are the following associated with? Perio High frenum attachment Tooth malalignment Overhang restoration Iatrogenic trauma Toothbrush trauma Ortho Tobacco Self-inflicted (ex: piercing)

Recession

What type of recession? Apical migration of junctional epithelium Apical shift of gingiva

Root exposure

What type of recession? CEJ to the attachment

Actual recession

What type of recession? Visible on clinical examination Gingival margin to the CEJ

Apparent recession

Fenestration vs dehiscence (photo on slide 17 of recession lecture)

Types of recession (photo on slide 18 of recession lecture)

Which Miller class of recession? REC not to MGJ, no IP bone or papilla loss, 100% coverage

Class 1

Which Miller class of recession? REC past MGJ, no IP bone or papilla loss, 100% coverage

Class 2

Which Miller class of recession? REC past MGJ, IP bone or papilla loss, malposition, partial coverage

Class 3

Which Miller class of recession? REC past MGJ, severe IP bone or papilla loss, malposition (rotation), no coverage

Class 4

Which classification of recession type? Buccal: recession & attachment loss Interproximal: No attachment loss

RT 1 (combines Miller class 1 and 2)

Which classification of recession type? Buccal: recession & attachment loss Interproximal: attachment loss Buccal < interproximal

RT 3 (Miller class 4)

Which classification of recession type? Buccal: recession & attachment loss Interproximal: attachment loss Buccal ≥ interproximal

RT 2 (Miller class 3)

Which classification of recession type? Mean root coverage rate: 89% Complete root coverage rate: 74%

RT 1

Which classification of recession type? Mean root coverage rate: 69% Complete root coverage rate: 24%

RT 2

Which classification of recession type? Mean root coverage rate: 11% Complete root coverage rate: 0%

RT 3

Which classification of recession type? Gingival recession with no loss of interproximal attachment Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth

RT 1

Which classification of recession type? Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss is less than or equal to the buccal attachment loss

RT 2

Which classification of recession type? Gingival recession associated with loss of interproximal attachment The amount of interproximal attachment loss is higher than the buccal attachment loss

RT 3

What are the following complications associated with? Undesirable esthetics Root hypersensitivity Impaired oral hygiene practice Root caries

Recession

Which biotype in the absence of recession? Prevent recession through good OHI and monitoring

Thick

Which biotype in the absence of recession? A greater risk for future development of recession

Thin

Which biotype in the absence of recession? Mucogingival surgery may be indicated in sites that are high-risk for recession (ortho, implants, restorations w/ subgingival margins)

Thin

What are the following diagnostic and tx considerations associated with? Conservative approach Perio charting Monitor root surface lesions

Recession but not concerned/complaining

What are the following diagnostic and tx considerations associated with? Treatment-oriented approach Mucogingival surgery Cervical restorations

Recession and they are concerned or complaining about esthetics, sensitivity, or caries

For natural teeth and a lack of KT, ________ amount of gingiva is enough for maintenance of periodontal health in the presence of optimal oral hygiene

any

For fixed prostheses and a lack of KT, gingival _____________ is recommended

augmentation

What are the 3 goals for a pt with fixed prostheses and a lack of KT?

Esthetics Hygiene/maintenance Function

Which goal for a pt with fixed prostheses and a lack of KT? Decreased show-through of margin Increased harmonious architecture

Esthetics

Which goal for a pt with fixed prostheses and a lack of KT? Increased KT width may improve patient comfort and oral hygiene compliance

Hygiene/maintenance

Which goal for a pt with fixed prostheses and a lack of KT? Better pontic adaptation Less leakage and food impaction

Function

Narrow or wide KT? Lower modified plaque index Lower modified gingival index Lower mucosa recession Lower attachment loss

Wide KT

What does narrow KT mean? What does wide KT mean?

Narrow KT is < 2 mm Wide KT is ≥ 2 mm

Distance between the coronal margin of the attached gingiva (the base of the gingival sulcus) and the greatest concavity of the mucobuccal fold below

Vestibular depth

What are the following causes of? Alveolar atrophy following tooth ext Trauma Gingival recession Coronally advanced/positioned flap

Decreased vestibular depth

Mucous membrane fold which contains muscle and connective tissue fibers that attach the lip and the cheek to the alveolar mucosa, the gingiva and the underlying periosteum

Frenum

Made up of dense, collagenous tissue, elastic fibers, and muscle fibers

Frenum

What are the following indications of? An aberrant frenal attachment is present, which causes a midline diastema

Frenectomy (frenum removal)

What are the following indications of? A flattened papilla with the frenum closely attached to the gingival margin is present, which causes a gingival recession and a hindrance in maintaining the OH

Frenectomy (frenum removal)

What are the following indications of? An aberrant frenum with an inadequately attached gingiva and a shallow vestibule is seen

Frenectomy (frenum removal)

Which frenum classification? When the frenal fibers are attached up to the MGJ

Mucosal

Which frenum classification? When the fibers are inserted within the attached gingiva

Gingival

Which frenum classification? When the fibers are extending into the interdental papilla

Papillary

Which frenum classification? When the frenal fibers cross the alveolar process and extend up to the palatine papilla

Papillary penetrating

Which frenum classifications are definitely "problems" and should be removed?

Papillary Papillary penetrating

Discoloration of the gingiva due to a variety of lesions and conditions associated with several endogenous and exogenous etiologic features

Gingival pigmentation

Physiologic pigmentation develops during the first 2 decades of life but may not come to the patients notice until later

Physiologic pigmentation

Due to greater melanocyte activity rather than greater number of melanocytes

Physiologic pigmentation

Most common site = attached gingiva

Physiologic pigmentation

Common populations = African, Asian, Mediterranean

Physiologic pigmentation

Can be caused by endocrine diseases like Addison's, Albright's, Acromegaly, Nelson's

Pathologic pigmentation

Can be caused by heavy metals like lead, bismuth, mercury

Pathologic pigmentation

Can be caused by Kaposi's sarcoma

Pathologic pigmentation

Can be caused by drugs like chloroquine, quinine, zidovudine, bleomycin

Pathologic pigmentation

Can be caused by smoking, hemangioma, amalgam/graphite tattoo, nevus, melanomas

Pathologic pigmentation

All procedures that involved both the gingiva and the alveolar mucosa

Mucogingival surgery

The techniques in mucogingival surgery are designed to enhance the _______ of the gingiva/KT and correct particular ________ __________ defects

width; soft tissue

What surgery do the following refer to? Gingival augmentation Root coverage Tooth exposure Crown lengthening Vestibular deepening

Mucogingival surgery/periodontal plastic surgery

What is the adequate width of gingiva?

2 mm

T/F: Any amount of gingiva is enough for maintenance of periodontal health in the presence of optimal oral hygiene

True

T/F: The presence of a narrow zone of gingiva cannot justify surgical intervention with gingival augmentation

True

What are the following indications of? 1. Discomfort during brushing/chewing due to interference from a lining mucosa at teeth or implants 2. Ortho tx that could result in an alveolar bone dehiscence 3. Implants/subgingival restorations are placed in areas with thin marginal tissue

Gingival augmentation

A soft tissue graft that is completely detached from one site and transferred to a remote site

Free gingival graft

No connection with the donor site is maintained

"Free graft"

What are the 3 donor sites for a free gingival graft?

Hard palate Edentulous ridge Buccal gingiva

What is used for postoperative bleeding control and patient comfort following a free gingival graft surgery on the hard palate?

Acrylic stent

What is expected 0-3 days after free gingival graft surgery to the recipient site wound healing?

Plasmatic circulation

What is expected 4-11 days after free gingival graft surgery to the recipient site wound healing?

Vessel anastomosis

What is expected 11-42 days after free gingival graft surgery to the recipient site wound healing?

Maturation

Which stage of recipient site wound healing after free gingival graft surgery? The graft is maintained by diffusion of fluid from the host bed, which provides nutrition and hydration essential for the initial survival of the transplanted tissues

Plasmatic circulation

Which stage of recipient site wound healing after free gingival graft surgery? Many graft vessels degenerate and are replaced by new ones. Capillaries from the recipient bed proliferate into the graft to form a network of new capillaries and anastomose with pre-existing vessels

Vessel anastomosis

Which stage of recipient site wound healing after free gingival graft surgery? A fibrous union is established between the graft and the underlying CT

Vessel anastomosis

Which stage of recipient site wound healing after free gingival graft surgery? The vascular system of the graft appears normal after approximately 14 days

Maturation

Which stage of recipient site wound healing after free gingival graft surgery? By the 17th day, functional integration of the graft occurs

Maturation

Which stage of recipient site wound healing after free gingival graft surgery? The epithelium gradually matures with formation of a keratin layer

Maturation

By what day does the functional integration of the free gingival graft occur?

Day 17

What are the following objectives associated with? Augment width of gingiva/KT Extend vestibular depth

Free gingival graft

T/F: Free gingival grafts can be used to cover recession

FALSE

During the maturation phase following a free gingival graft, what days should you use a soft bristle toothbrush?

Days 14-40

What surgery are the following indications associated with? Esthetic demands Root sensitivity

Root coverage

What surgery are the following causative factors associated with? Traumatic toothbrushing Plaque-induced perio inflammation/periodontitis

Root coverage

What are the 2 different root coverage procedures?

Flap only Flap with graft/materials

Which root coverage procedure has the following options? Lateral positioned flap (LPF) Coronally advanced flap (CAF)

Flap only

Which root coverage procedure has the following options? Lateral positioned flap (LPF), Coronally advanced flap (CAF), Tunnel + Connective tissue graft (CTG) Soft tissue allograft (Alloderm) Collagen-based materials Platelet Rich Fibrin (PRF) Enamel Matrix Derivatives (EMD) Growth factors

Flap with graft/materials

T/F: Root coverage surgery is used to cover recession

True!

Which surgery? Autogenous soft tissue graft without epithelium layer

Connective tissue graft (sub-epithelial)

Which surgery? Typically covered by the flap (fully or partially)

Connective tissue graft (sub-epithelial)

Which surgery? Blood supply from both sides of the graft

Connective tissue graft (sub-epithelial)

What are the 3 donor sites for a connective tissue graft?

Hard palate Edentulous ridge Tuberosity

Which palate has the MOST distance between the CEJ and the greater palatine artery and nerve?

High palate

Which palate has the LEAST distance between the CEJ and the greater palatine artery and nerve?

Shallow palate

Which surgery is associated with the following problems that may be encountering during or after the procedure? Excessive bleeding Bone exposure Recurrent herpetic lesions Delayed healing Graft mobility Failure of graft union

Connective tissue graft

What may be a sequela to soft tissue grafting and that response may be stimulated by surgical trauma?

Bony exostosis

A post-operative migration of the free gingival margin in a coronal direction

Creeping attachment

When does creeping attachment occur?

1 month to 1 year after surgery

The mean amount of creeping attachment which occurs by 1 year is __________

0.8 mm

Which surgery has the following indication? Impacted permanent tooth

Exposure

Which surgery has the following goal? To expose adequate tooth structure to allow placement of an orthodontic bracket and forced eruption of the tooth

Exposure

Which surgery? Care needs to be taken not to create defects to adjacent teeth and preserve keratinized tissue

Exposure

Which surgery has the following techniques? 1. Excision, apically positioned flap 2. Closed eruption, repositioned flap

Exposure

Which surgery? Pedicle flaps and/or soft tissue grafts can be used as well

Exposure

Which surgery? The choice of surgical technique depends on: 1. Vertical position of the tooth in relation the the MGJ (apical or coronal to the MGJ) 2. Faciolingual position (intra-alveolar or out-alveolar) 3. Amount of keratinized tissue 4. Adjacent teeth / tissues

Exposure

Which surgery has the following indication? Excessive gingival display

Esthetic crown lengthening

What might result from the following? Altered passive eruption (appearance of short clinical crowns) Gingival overgrowth Skeletal deformity (vertical maxillary excess-appearance of high lip line) Upper lip (short lip, hypermobility of lip)

Excessive gingival display

What are the following tx options associated with? Perio surgery Orthognathic surgery Lip augmentation Lip repositioning surgery Muscle training Botox

Excessive gingival display

Which surgery? Procedure used to deepen a shallow vestibule, mainly in the mandibular anterior side

Vestibular deepening

Which surgery has the following techniques? 1. complete denudation 2. periosteal retention 3. vestibular incision

Vestibular deepening

Which surgery? The procedures were proven to be highly unpredictable with minimal final gain in vestibular depth

Vestibular deepening

Sub-marginal, wide free gingival graft might be a more successful technique for this type of surgery

Vestibular deepening

A post extraction phenomenon which is progressive and irreversible, resulting in a host of prosthodontic, esthetic, and functional problems

Alveolar ridge resorption

The greatest amount of bone loss is in the ___________ dimension and occurs mainly on the ________ aspect of the ridge. There is also loss of vertical ridge height, which has been described to be most pronounced on the _______ aspect

horizontal; facial; buccal

Post extraction bone loss is accelerated in the first ___________, followed by a gradual modeling and remodeling of the remaining bone, with as much as 40% of the alveolar _________ and 60% of alveolar _________ lost in the first 6 months

6 months; height; width

Change in size or shape of bone

Modeling

Turnover of existing bone

Remodeling

Function is to anchor the tooth in the alveolar bone through the invested PDL

Bundle bone

As the tooth is extracted, the _______ bone will lose its function, and subsequently, will resorb

bundle

Loss of ridge height results in prosthetic _________ as the crest of the ridge approaches muscle attachments and mobile mucosa

instability

In extreme cases, loss of ridge height results in involvement of the _____________ or nasal cavity, requiring extensive reconstructive surgery for traditional or implant-supported prosthetics

maxillary sinus

Loss of ridge height results in vital structures, such as the mandibular neurovascular bundle, becoming ___________ due to exposure and impingement of the overlying denture

vulnerable

Esthetic tooth replacement with implants is complicated by loss of tissue __________

contours

Which ridge defect? Bucco-lingual loss of tissue with normal ridge height in the apico-coronal dimension

Class I (horizontal loss)

Which ridge defect? Apico-coronal loss of tissue with normal ridge width in a bucco-lingual dimension

Class II (vertical loss)

Which ridge defect? Combination bucco-lingual and apicocoronal loss of tissue, resulting in loss of normal height and width

Class III (combination)

Which ridge defect? Most predictable when reconstructing

Class I (horizontal loss)

Any procedure undertaken at the time of or following an extraction to minimize external resorption of the ridge and to maximize bone formation within the socket

Socket preservation

T/F: Socket preservation procedures at the time of tooth extraction improve the prognosis regarding maintenance of the width and height of remaining bone

True

What are the following techniques associated with? Traditional (horizontal/vertical) Ridge expansion/splitting Distraction osteogenesis Sinus augmentation

Guided Bone Regeneration (GBR)

What are the following techniques associated with? Bone augmentation w/ barrier membrane and grafting Block grafting Combination

Traditional Guided Bone Regeneration

Which bone graft has the following advantages? Vital bone cells More rapid healing No disease transmission/allergy

Autogenous

Which bone graft has the following advantages? Decreased morbidity Decreased patient anxiety Dimensional stability Unlimited supply

Non-autogenous

Which bone graft has the following disadvantages? Second surgical site (Donor) Greater morbidity Increased patient anxiety Dimensional instability Limited availability

Autogenous

Which bone graft has the following disadvantages? Cost of material Longer healing time High percentage of residual bone graft

Non-autogenous

When using autogenous bone graft, what are the 4 intraoral donor sites?

Ascending ramus (anterior border) External oblique ridge Anterior mandible (symphysis) Tuberosity

Which bone graft has the following advantages? Horizontal alveolar ridge augmentation documented up to 7.5mm

Autogenous

Which bone graft has the following advantages? Rapid integration allows early reentry for implant placement

Autogenous

Which bone graft has the following advantages? Optimal bone density for implant stability due to the cortical nature of the graft

Autogenous

Which bone graft has the following advantages? Space maintenance during healing ensures the shape and stability of the bone block is retained with minimal collapse

Autogenous

Which bone graft has the following disadvantages? Limited availability Post-operative morbidity Nerve damage/Paresthesia Mandibular fracture Trismus Esthetic concerns (symphysis grafts) - esthetically unpleasing chin droop, lip incontinence

Autogenous

What bone is preferred in the ridge expansion/splitting technique?

Soft bone

What is the minimum horizontal width and vertical height in the ridge expansion/splitting technique?

Minimum horizontal width = 2 mm Minimum vertical height = 10 mm

The ridge expansion/splitting technique requires there be no ____________ in alveolar bone profile

concavity

In the ridge expansion/splitting technique, the horizontal osteotomies have to end at lease _______ away from the neighboring teeth

1 mm

Uses the long-standing biologic phenomenon that new bone fills in the gap defect created when two pieces of bone are separated slowly under tension

Distraction osteogenesis

In the distraction osteogenesis technique, you must have a minimum of 6 to 7 mm of bone height above ________ __________, such as neurovascular bundles or air passages/sinus cavities

vital structures

In the distraction osteogenesis technique, you must have a __________ ridge defect of 3 to 4 mm, and an edentulous ridge span of ______ or more missing teeth

vertical; 3

A pyramidally shaped cavity, the base of which is the lateral nasal wall and the apex of which is the zygomatic arch

Maxillary sinus

The largest of the paranasal sinuses

Maxillary sinus

Lined by a pseudostratified ciliated columnar or cuboidal epithelium known as the Schneiderian membrane

Maxillary sinus

The primary indication is an alveolar bone height in the posterior maxilla that is deficient

Sinus augmentation

What are the following complications associated with? Intraoperative Bleeding Schneiderian membrane tear/perforation Acute maxillary sinusitis (infection)

Sinus augmentation

What are the contraindications associated with? Tumors/growth in sinus Severe chronic sinusitis Dental infection involving sinus Severe allergic rhinitis Chronic topical steroid use

Sinus augmentation

What are the following systemic factors contraindications for? Radiation involving sinus Metabolic disease Excessive tobacco Mental impairment

Sinus augmentation

What are the following complications associated with? Intraoperative Bleeding Schneiderian membrane tear/perforation Acute maxillary sinusitis (infection)

Sinus augmentation

An endosteal, alloplastic, biologically compatible material surgically inserted into the edentulous bony ridge

Dental implant

The direct structural connection at the light microscopic level between bone and the surface of a load-carrying implant

Osseointegration

What are the following relative contraindications associated with? -Uncontrolled diabetes -Hyperthyroidism; Osteoporosis -Osseous Metabolic Disturbances: Osteomalacia, Paget’s disease, Osteopetrosis, Fibrous dysplasia -Hematologic Disorders: Anemia, Leukemia, Hemophilia -Collagen Disorders: Scleroderma, Sjogren syndrome -Medications: Immunosuppressives, bisphosphonates -Age: Young patients due to continued growth -Smoking -Pregnancy

Implants

What 3 things about the patient's expectations should you discuss before treatment?

Fixed vs removable Budget Total tx time

T/F: Implants are more susceptible to inflammation and plaque because there is less resistance due to lack of PDL fibers

True

What are the following true contraindications for? Active infection Unfavorable jaw relationships Parafunctional habits Poor OH HNRT

Implants

Which category of true contraindications for implants? Perio PARL on adjacent tooth Sinusitis

Active infection

Which category of true contraindications for implants? Severe malocclusions Limited inter-arch distance

Unfavorable jaw relationships

Which category of true contraindications for implants? Damage of cells and vascular elements Risk of osteoradionecrosis Med consult needed

HNRT (large risk if dose is > 70 gray)

How much space is needed btwn an anterior implant and adjacent tooth?

1.5 mm

How much space is needed btwn a posterior implant and adjacent tooth?

≥ 1.5 mm

How much space is needed btwn adjacent implants? Why?

3 mm; need vascularization to the papilla

How much space is needed from the gumline in the coronal-apical direction for an anterior implant? (to hide the threads)

3-4 mm

How much space is needed from the gumline in the coronal-apical direction for a posterior implant?

2 mm

How much space is needed btwn implant and buccal bone?

2 mm

Why is 2 mm of buccal bone required with an implant?

Very prone to resorption

How much space is needed btwn implant and lingual bone?

1 mm

Most implant diameters are btwn ___ and ___ mm

3; 6

Most implant lengths are btwn ___ and ___ mm

6; 16

How much keratinized tissue width should you have when placing an implant?

≥ 2 mm

How much keratinized tissue thickness should you have when placing an implant?

> 1 mm

What are the following problems associated with when placing implants? More recession after 3 months Lower esthetic satisfaction Pain during OH

Insufficient KT width

What are the following problems associated with when placing implants? Higher chance of buccal soft tissue recession More peri-implant bone loss

Insufficient KT thickness (thin biotype)

Which smile line? Less than 75% of clinical crown height of maxillary incisor displayed

Low smile line

Which smile line? 75-100% of clinical crown height of maxillary incisor displayed

Average smile line

Which smile line? 2 mm of the contiguous maxillary gingiva is revealed

High smile line

Which implant placement timing? Immediate implant placement after ext

Which implant placement timing? Maintains bone volume, has a high success rate, and saves pt from another surgery

Which implant placement timing? Implant placement 4-8 weeks after soft tissue healing from ext

Which implant placement timing? Implant placement 12-16 weeks after soft tissue healing from ext

Which implant placement timing? Early placement

T2 T3

Which implant placement timing? Implant placement > 16 weeks after soft tissue healing from ext

Which implant placement timing? Delayed placement

T/F: If you don't do immediate implant placement, it is better to do delayed placement. Early placement is never the best choice because you don't have complete healing

True

Allows placement of the implant in the planned position and aids in axis orientation

Surgical stent/guide

Requires good stability, adequate sleeve length, and water cooling

Surgical stent/guide

Primary or secondary stability? Mechanical retention from implant socket

Primary stability

Primary or secondary stability? Mechanical characteristics of original bone, like quality and quantity

Primary stability

Primary or secondary stability? Type of implant used (diameter, length, surface)

Primary stability

Primary or secondary stability? Surgical techniques

Primary stability

Primary or secondary stability? Enhancement of stability as a result of peri-implant bone formation through gradual bone remodeling and osteoconduction

Secondary stability

Primary or secondary stability? Osseointegration

Secondary stability

Proper surgical techniques of implant placement require < ____ degrees Celsius for ____ minute or less to provide predictable healing response and avoid thermal trauma to bone

47; 1

Proper surgical techniques of implant placement require the use of _____ speed, high torque hand pieces

low

Proper surgical techniques of implant placement require a serial drilling _________

protocol

Proper surgical techniques of implant placement require an external or internal _________ system

cooling

Which implant loading timing? Within 48 hrs after implant placement

Immediate loading

Which implant loading timing? 48 hrs - 3 months after implant placement

Early loading

Which implant loading timing? > 3 months after implant placement

Delayed loading

The advantages of immediate implant loading include: -____ stage surgery is eliminated -Saves patient pain and time -Patient does not have to wear a removal prosthesis during healing -Saves dentist overhead time and material -Immediately loaded implants are _______ together during healing which is biomechanically superior -Allows for soft tissue ________ prior to fabrication of final restoration

2nd; splinted; maturation

When is immediate implant loading indicated?

Full arch implants/prosthesis

Implant is physically in the mouth

Implant survival

Absence of pain, infection, mobility

Implant success

Minimal marginal bone loss after loading (≤ 2 mm during 1st yr of loading; ≤ 0.2 mm annually)

Implant success

Harmonious position and esthetic restoration

Implant success

The loss of teeth can create ________ and _________ defects in the edentulous area - deformities of hard and soft tissues in both apico-coronal and buccolingual directions

functional; esthetic

Any dentoalveolar segment that is visible upon full smile

Esthetic zone

Also defined as any dentoalveolar area of esthetic importance to the patient

Esthetic zone

Absence of clinical indicators of inflammation like BOP, no increased probing depth, and no progressive bone loss

Peri-implant health

A disease that includes inflammation of the soft tissues surrounding a dental implant, without additional bone loss after the initial bone remodeling that may occur during healing following the surgical placement of the implant

Peri-implant mucositis

What do the following define? 1. Visual inspection demonstrating the presence of peri-implant signs of inflammation: red as opposed to pink, swollen tissues as opposed to no swelling, soft as opposed to firm tissue consistency 2. Presence of profuse (line or drop) bleeding and/or suppuration on probing 3. An increase in probing depths compared to baseline 4. Absence of bone loss beyond crestal bone level changes resulting from the initial remodeling

Peri-implant mucositis

Defined as a plaque associated pathological condition occurring in tissues around dental implants, characterized by inflammatory lesion of the peri-implant mucosa and subsequent progressive loss of supporting peri-implant bone

Peri-implantitis

What do the following define? 1. Evidence of visual inflammatory changes in the peri-implant soft tissues combined with BOP and/or suppuration 2. Increasing probing pocket depths as compared to measurements obtained at placement of the suprastructure 3. Progressive bone loss in relation to the radiographic bone level assessment at 1 year following the delivery of the implant-supported prosthetics reconstruction 4. In the absence of initial radiographs and probing depths, radiographic evidence of bone level ≥3 mm and/or probing depths ≥6 mm in conjunction with profuse bleeding

Peri-implantitis

What is the key tool to distinguish between healthy and inflamed peri-implant mucosa?

BOP

BOP can originate from which two forms of probing in implants?

Pathologic induction Traumatic BOP

Which form of probing in implants? Often induced by inflammation and could be considered as a disease indicator

Pathologic induction

Which form of probing in implants? Often caused by probing too hard due to difficulty gaining access for normal probing. This is attributed to the tenuous nature of the peri-implant mucosa compounded by the ability to probe around the implant made difficult by the prosthetic contours

Traumatic BOP

Which peri-implant bleeding index score? Normal mucosa, No visible plaque and no bleeding

Score 0

Which peri-implant bleeding index score? Slight peri-implant mucositis, minimal plaque, minor erythema or edema with minimal visible bleeding dot

Score 1

Which peri-implant bleeding index score? Moderate peri-implant mucositis, visible plaque, evident erythema or edema with bleeding line or drop

Score 2

Which peri-implant bleeding index score? Severe peri-implant mucositis or peri-implantitis, evident plaque, severe erythema or edema with ulceration, spontaneous or profuse bleeding with or without suppuration

Score 3pa

T/F: Once peri-implantitis occurs it is extremely difficult to treat. Indeed, there is no reliable evidence on the best way to treat this condition

True

Clinical outcomes of what depend on Biologic factors, Mechanical factors, Oral hygiene?

Peri-implantitis

Which factor of clinical outcomes of peri-implantitis? Presence of inflamed soft tissues surrounding dental implants and radiographic changes in the crestal bone levels

Biologic factors

Which factor of clinical outcomes of peri-implantitis? Stability of the implant fixture and implant supported restoration

Mechanical factors

slide 14 peri-implantitis

Can be seen in unrestored implants, even if submerged

ECBL (early crestal peri-implant bone loss)

Usually presents as minor defects that are not favorable for hard tissue grafting, which challenges the restorative clinical decision-making process

ECBL

What do the following factors influence? Deep implant insertion Thin peri-implant mucosa Short abutments

Early marginal bone loss

T/F: Majority of implants that exceed > 0.5 mm MBL 6 months after loading don’t demonstrate radiographic success in a subsequent 12 month follow-up

True

What is the most relevant factor for preservation of peri-implant bone?

Height of abutment

What is the minimum abutment height for adequate protection against peri-implant bone resorption?

2 mm

What is one of the most important aspects that determines the longterm implant success?

Implant maintenance

What do the following describe? No mobility No radiolucency Avg annual bone loss after first year < 0.2 mm No pain, infection, neuropathy, paresthesia, or damage to nerve canal

Implant success

Positive or negative indicator for implant? Peri-implant phenotype and presence of KM

Positive

Positive or negative indicator for implant? Probing depth Implant site Suppuration Peri-implant bone loss Negative Plaque Hx of periodontal disease Smoking Lack of supportive therapy

Negative

Perio Final Flashcards

(271 cards)