NSPT and Periodontal Surgery

1.) All of the following are contraindications or reasons for a delay in periodontal surgery except one. Which one is the exception?

a) Poor oral hygiene

b) Periodontal abscesses

c) Unstable hypertension

d) Intravenous bisphosphonates

e) Uncontrolled diabetes mellitus

a) Poor oral hygiene

b) Periodontal abscesses

c) Unstable hypertension

d) Intravenous bisphosphonates

e) Uncontrolled diabetes mellitus

2.) Which of the following types of surgery is best to treat a periodontal bony lesion with deep pockets and vertical bone loss (three-wall defect)?

a) Connective tissue graft

b) Free gingival graft

c) Modified Widman flap

d) Regenerative bone graft

a) Connective tissue graft

b) Free gingival graft

c) Modified Widman flap

d) Regenerative bone graft

3.) Which of the following periodontal conditions is best treated with a subepithelial connective tissue graft?

a) Three wall bony defect

b) Soft tissue recession with root exposure

c) One wall bony defect

d) Class III furcation defect

4.) Which of the following healing responses of periodontal tissues after surgery describes the reformation of tissues that were destroyed due to periodontal disease?

a) New attachment

b) Repair

c) Regeneration

d) Reattachment

a) New attachment

b) Repair

c) Regeneration

d) Reattachment

5.) Which one of the following should be used by a patient to help reduce inflammation and swelling immediately after periodontal surgery?

a) Ice packs

b) Salt water rinsing

c) Aspirin

d) Heat packs

a) Ice packs

b) Salt water rinsing

c) Aspirin

d) Heat packs

6.) Which of the following surgical techniques is indicated for a patient who has gingival enlargement due to nifedipine but no bone loss?

a) Free gingival graft

b) Gingivectomy

c) Connective tissue graft

d) Osseous surgery

a) Free gingival graft

b) Gingivectomy

c) Connective tissue graft

d) Osseous surgery

7.) Which of the following defects heals best with periodontal surgical regeneration?

a) Grade III maxillary molar furcation

b) Horizontal bone loss

c) Three wall bony defect

d) One wall bony defect

a) Grade III maxillary molar furcation

b) Horizontal bone loss

c) Three wall bony defect

d) One wall bony defect

8.) Which of the following bone grafts is taken from an existing mandibular tori in the patient's mouth?

a) Autograft

b) Allograft

c) Xenograft

d) Alloplast

a) Autograft

b) Allograft

c) Xenograft

d) Alloplast

9.) Which of the following bone grafts is taken from human cadavers?

a) Xenograft

b) Alloplast

c) Autograft

d) Allograft

a) Xenograft

b) Alloplast

c) Autograft

d) Allograft

10.) Which of the following materials is used to inhibit epithelial migration into the surgical site?

a) Bone grafts

b) Barrier membranes

c) Sutures

d) Connective tissue

a) Bone grafts

b) Barrier membranes

c) Sutures

d) Connective tissue

11.) Which of the following terms is used for a surgical procedure that will impede the epithelial migration during healing of the periodontal wound?

a) Guided tissue regeneration

b) Incision and drainage

c) Gingival curettage

d) Connective tissue graft

a) Guided tissue regeneration

b) Incision and drainage

c) Gingival curettage

d) Connective tissue graft

Name four Phase I Goals of Treatment:
a.

b.

c.

d.

Name four Phase I Goals of Treatment:
a. complete removal of calculus

b. correction/replacement of poorly-fitting restorations and prosthetics

c. restoration of caries

d. extraction of hopeless teeth

Re-evaluation of tissue response should occur _____ to _____ weeks after periodontal debridement (non-surgical).

Re-evaluation of tissue response should occur 4 to 8 weeks after periodontal debridement (non-surgical).

Non-surgical debridement becomes less effective when probing depths are above _____ mm.

Non-surgical debridement becomes less effective when probing depths are above 4 mm.

TRUE or FALSE: A gain in clinical attachment is possible with non-surgical therapy.

FALSE

The rate of subgingival biofilm recolonization is dependent upon ____________________________.

The rate of subgingival biofilm recolonization is dependent upon supragingival biofilm accumulation (oral hygiene self-care).

TRUE or FALSE: NSPT is used to regenerate tissues.

FALSE

Following NSPT, the epithelium forms a ________ ___________ ____________.

Following NSPT, the epithelium forms a long junctional epithelium.

In the lamina propria, the inflammatory infiltrate will be replaced by collagen but the JE does not allow a new CT attachment to form. Why?

NSPT allows for the repair, not the regeneration, of tissues. The healed tissue is a scar, and the destroyed CT attachment is replaced with a long JE. The destruction/damage done to the CT attachment and root surface CANNOT return to a state of pristine health, nor can it be regenerated via NSPT.

Repair and healing can be altered and/or delayed in patients who are:

a.

b.

c.

Repair and healing can be altered and/or delayed in patients who are:

a. diabetic

b. immunocompromised

c. smokers

Reduction in probing depths after NSPT is due to what?

A combination of gingival recession (shrinkage) and an increase (NOT regeneration!) of the clinical attachment (top of the long JE).

Periodontal debridement becomes less effective in pockets that are _____________.

Periodontal debridement becomes less effective in pockets that are >4mm.

Re-evaluation of initial therapy includes:

a.

b.

c.

d.

Re-evaluation of initial therapy includes:

a. Tissue response and condition (color, contour, texture, consistency)

b. Probing depths, BOP, CAL

c. Mobility and furcation involvement

d. Evidence of inflammation

Name five objectives of periodontal therapy:

a.

b.

c.

d.

e.

Name five objectives of periodontal therapy:

a. Reduction in pocket depth to allow for better access for plaque control; to create an oral environment that is maintainable by the pt and DH

b. Gain access to the root and underlying bone, removing remaining calculus, smoothing out gouges and Sharpey’s fibers pits

c. Regenerate periodontal tissues destroyed due to disease

d. Arrest disease progression

e. Improvement of the prognosis of teeth and their replacements, including esthetics

Name five contraindications or precautions for periodontal surgery:

a.

b.

c.

d.

e.

Name five contraindications or precautions for periodontal surgery:

a. uncontrolled DM

b. HIV

c. smokers

d. CV conditions

e. pts who are noncompliant with plaque control or perio maintenance appts

DEFINE:
a. reattachment

b. regeneration

DEFINE:
a. reattachment: reunion of epithelial or connective tissue to a root surface that was not damaged or destroyed by periodontal disease

b. regeneration: attachment apparatus (bone, cementum, PDL) is reformed on a root surface that was previously pathologically exposed

Epithelial tissues are fast-growing and can migrate up to ______ mm/day.

Epithelial tissues are fast-growing and can migrate up to 0.5 mm/day.

How does the fast-growing epithelial tissue interfere with healing and regeneration?

Epithelial growth occurs faster than bone and CT, allowing it to displace bone and tissue grafts and to prevent angiogenesis.

DEFINE:

a. full- (mucoperiosteal) thickness flap

b. partial- (split) thickness flap

DEFINE:

a. full- (mucoperiosteal) thickness flap: gingiva, alveolar mucosa, and periosteum are reflected from the root and underlying bone surface

b. partial- (split) thickness flap: periosteum and some gingival connective tissues are left attached to the bone and are not included in the reflected flap

Why is a crown lengthening procedure done?

A crown lengthening procedure exposes more tooth structure (creates an area for supracrestal tissue attachment) for the purpose of properly restoring a tooth, especially one that is fractured or decayed close to/at/apical to the AC.

DEFINE:
a. ostectomy

b. osteoplasty

DEFINE:
a. ostectomy: removal of tooth-supporting bone

b. osteoplasty: reshaping

A ____ -wall bony defect responds best to regeneration.

A 3-wall bony defect responds best to regeneration.

DEFINE:

a. autogenous

b. allograft

c. xenograft

d. DFDBA

e. osteogenic

f. osteoinductive

g. osteoconductive

DEFINE:

a. autogenous: material harvested from one part of the body and grafted to another part of the pt’s body; the gold-standard grafting material; osteogenic

b. allograft: material obtained from other individuals of the same species but that are genetically different; osteoinductive

c. xenograft: type of natural bone substitute obtained from a genetically-different species; osteoinductive

d. DFDBA: demineralized freeze-dried bone allograft; one of the main forms of bone allografts; osteoinductive

e. osteogenic: process of new bone formation by bone cells from the host or the graft; ex: autogenous bone (autograft)

f. osteoinductive: mesenchymal stem cells from the graft are induced to differentiate into osteoblasts which produce new bone; ex: allografts like DFDBA, BMP-2, and growth factors like PDGF

g. osteoconductive: bone material serves as a scaffold or filler that allows bone from the surrounding area to grow over and into them; does NOT produce new bone and requires the presence of existing bone; ex: alloplasts, xenografts

Name four adverse effects of periodontal surgical procedures:

a.

b.

c.

d.

Name four adverse effects of periodontal surgical procedures:

a. cellulitis/infection

b. tooth mobility

c. gingival recession

d. loss of sensation

Name the three types of soft tissue grafts:
a.

b.

c.

Name the three types of soft tissue grafts:
a. pedicle graft

b. free gingival graft (FGG)

c. connective tissue graft (CTG)

Which type of soft tissue graft is better for augmentation of attached gingiva than for esthetic results?

free gingival graft (FGG)

Which type of soft tissue graft is better for esthetics and root coverage?

subepithelial connective tissue graft (CTG)

Name two sources of tissue for soft tissue grafts:
a.

b.

Name two sources of tissue for soft tissue grafts:
a. surface of palate

b. underneath surface of palate

Periodontal Phenotype and Recession: Cairo Classification System

Mucogingival Conditions

• Periodontal Phenotype: the gingival phenotype determined by gingival thickness and width of keratinized tissue (KTW / total width of gingiva)

  • KTW = distance from FGM to MGJ

  • gingival thickness: observe the probe shining through the gingival tissue after inserting it into the sulcus

    • thin: probe VISIBLE at ≤1mm

    • thick: probe NOT visible at >1mm

• Cairo Classification System: treatment-oriented classification to forecast the potential for root coverage throughout the assessment of interdental CAL

  • RecessionType1 (RT1 or Miller Class I/II): recession with NO loss of interprox. attachment; CEJ is not clinically detectable at mesial/distal aspects; 100% root coverage

  • RecessionType2 (RT2 or Miller Class III): recession WITH loss of interprox. attachment; interprox attachment loss is ≤ buccal attachment loss; 100% root coverage is possible using root coverage procedures

  • RecessionType3 (RT3 or Miller Class IV): recession WITH loss of interprox. attachment; interprox. attachment loss is > buccal attachment loss; full root coverage is NOT achievable