2 Perio II Exam 2 Study Materials: Insights on Periodontium and Restorative Dentistry

inter-proximal attachment loss on 2 or more teeth

What defines if a patient is a periodontitis patient or not?

periodontal health

What is the perio diagnosis for a patient with no interproximal attachment loss and 8% BOP?

clinical health on a reduced periodontium

What is the perio diagnosis for a patient with 2 teeth with interproximal attachment loss and 5% BOP?

gingivitis

What is the perio diagnosis for a patient with no interproximal attachment loss and 10% BOP?

gingival inflammation on a reduced periodontium

What is the perio diagnosis for a patient with 2 teeth with interproximal attachment loss and 10% BOP?

active periodontitis

What is the perio diagnosis for a patient with 6 teeth with interproximal attachment loss with deep probing depths of 5mm and 10% BOP?

attachment level and BOP

your perio diagnosis is based on _________

deep probing depths and # of teeth involved

your perio treatment plan is based on ______

periodontitis

Which of the following perio diagnoses should result in as ScRP:

- periodontal health

- gingivitis

- clinical health on reduced periodontium

- gingival inflammation on reduced periodontium

- periodontitis

Scaling in presence of generalized moderate or severe gingival inflammation

What is the treatment for a patient with significant erythema, pseudopockets and subgingival calculus, but no signs of interproximal attachment loss?

gingival pocket (pseudopocket)

When the sulcus is deepened because of gingival enlargement, without destruction of the underlying periodontal tissue/apical migration:

periodontal pocket (true pocket)

When the sulcus is deepened due to apical proliferation of junctional epithelium and destruction of the underlying supporting structures:

Preliminary / Emergency phase

ID the periodontal treatment phase:

- Emergency treatment (dental, periapical, periodontal, others) - Extraction of hopeless teeth

Nonsurgical phase (Phase I Therapy)

ID the periodontal treatment phase:

- Consultation (medical, dental, smoking cessation, )

- Plaque control & patient education, Oral hygiene instructions (OHI)

- Correction of contributing factors (caries control, remove ill-fitting restorations, provisional splinting or prosthesis)

- Prophylaxis or ScRP (depending on diagnosis)

Surgical phase (Phase II Therapy)

ID the periodontal treatment phase:

- Periodontal surgeries, implant surgeries

- Endodontic therapy

Restoration phase (Phase III Therapy)

ID the periodontal treatment phase:

- Final restorations

- Orthodontic therapy

Maintenance phase (Phase IV Therapy)

ID the periodontal treatment phase:

- Supportive periodontal therapy (every 6 months prophylaxis, every 3 months periodontal maintenance (D4910)

- Occlusal guard

• Ability to see the teeth and assess restorability

• Tissues will not bleed during restorative work

• Gingival margin stabilizes

• Improved oral hygiene will help longevity of restorations

• Esthetic benefits

What is the rationale for doing periodontal therapy before restorative work?

I & II

Periodontal prognosis is re-evaluated and finalized AFTER phase ____

Can the tooth be kept?

Can it be part of a comprehensive prosthetic restoration?

Periodontal prognosis may answer 2 questions:

good

ID the McGuire and Nunn Classification prognosis:

- control of the etiological factor and enough clinical and radiographic periodontal support ti enable the tooth to be maintained by the patient and clinician with proper maintenance

fair

ID the McGuire and Nunn Classification prognosis:

- approx. 25% attachment loss, measured clinically and radiographically. Class I furcation involvement, but would allow adequate maintenance

poor

ID the McGuire and Nunn Classification prognosis:

- 50% attachment loss and Class II furcation. location and degree of furcations would accommodate proper maintenance, although difficult, Class I mobility

questionable

ID the McGuire and Nunn Classification prognosis:

- greater than 50% attachmentl loss, poor crown/root ratio, Class II or Class III furcation, Class II mobility or more, significant root proximity

hopeless

ID the McGuire and Nunn Classification prognosis:

- severe attachment loss, extraction suggested

• Open flap debridement

• Osseous surgery

• Periodontal regeneration

• Extraction and ridge preservation

If periodontitis is not eliminated or stabilized, what additional periodontal procedures may be performed to treat periodontal disease?

gingival recession

the apical migration of the gingival margin resulting in exposure of the root surface. Typically observed on mid-buccal surfaces:

connective tissue graft

Gingival recession is repaired with a _________

• Root sensitivity

• Root caries

• Esthetic problems

Gingival recession may result in:

2

A minimum of __ mm keratinized gingiva (with 1mm attached) is recommended around teeth for resistance to mastication, brushing and dental restorations.

• Inflammation

• Pain or sensitivity

• Plaque accumulation due to sensitivity

• Further gingival recession

Mucogingival deformities may result in:

1. Atraumatic extraction

2. Bone grafting

3. Membrane or collagen plug

4. Suturing

What are the steps for alveolar ridge preservation?

- Not enough tooth structure left to support a crown

- Caries or fracture has spread subgingivally

- Altered passive eruption

What are some indications for crown lengthening?

- Crown may fall off

- Iatrogenic inflammation at deep restoration

- Esthetic concerns

What are some consequences if crown lengthening is NOT done?

The supracrestal attached tissues are damaged ('violation of the biologic width') resulting in chronic inflammation and bone loss

Why is it a problem to place restorations too far subgingivally?

how far apically the damage (caries, fracture) is extended

Contraindications for crown lengthening are related to:

- Poor crown-to-root ratio

- Excessive damage to the periodontium of neighboring teeth

- Furcation exposure

- Unesthetic outcome

Crown lengthening is contraindicated if it would cause:

6-8 week

After functional crown lengthening of posterior teeth, the restorative dentist can take final impressions ________ after surgery

6 months

After esthetic crown lengthening of anterior teeth, the restorative dentist can take final impressions ________ after surgery

6 months

It takes around _______ for new bone to grow into the graft and create a solid bone structure after a ridge augmentation with guided bone regeneration

restorative treatment

what is the treatment for carious cervical lesions?

composite resin filing

what is the treatment for a non-carious cervical lesion on the enamel?

gingival grafting

what is the treatment for a non-carious cervical lesion on the root surface?

true

t/f: most NCCL are caused by toothbrush trauma, not by occlusal trauma

1. Use supragingival margin placement wherever possible (non-esthetic areas) 2. Use equigingival margins for tooth-colored restorations

3. If subgingival margin is necessary, measure sulcus depth and extend crown margin no more than half the sulcus depth (typically 0.5mm)

4. If restoration must be placed deeper, perform crown lengthening first

How to preserve the periodontium when prepping for crown:

0.5mm

If you MUST prep a tooth for a crown subgingivally, what is the maximum you can go?

• Use thinner cord for thin phenotype

• Do not use excessive force

• Remove all cords when finished!

• Digital impression

What are some ways you can protect the periodontium when taking impressions?

- good marginal fit

- proper crown contour

- debris left behind

What are some things to consider to protect the periodontium when making a temp crown ?

ridge lap

Which pontic design is the hardest to clean but esthetic (we don't use this)?

hygienic

Which pontic design is the easiest to clean but NOT esthetic ?

modified ridge-lap

Which pontic design is possible to clean and is esthetic ?

ovate

Which pontic design is possible to clean and has the BEST esthetics ?

- Lower bone levels due to prior tooth extraction

- Lack of connective tissue attachment

- Less vascularized due to lack of blood supply from PDL

- Lack of natural mobility (cushioning by PDL), resulting in stress concentration at crestal bone

Why is the periodontium more vulnerable around implants than around natural teeth?

1-5mm

What is the normal probing depth range for implants?

• Bleeding on probing

• Erythema

• Sponginess

• Suppuration

What are the signs of inflammation around implants?

smooth

When placing and restoring an implant crown, a _____ transition from implant to crown will avoid undercuts

screw

When placing and restoring an implant crown, it is better to use a _____ retained crown

individual

When placing and restoring an implant crown, it is better to _______ vs. splinted crowns because they are easier to clean and repair

1 implant w/ cantilever 2nd crown

When placing and restoring an implant crown with a narrow space, it is better to place ______ thank two implants close together

tissue level

which is better, a tissue level implant or a bone level implant?

30

The prevalence of peri-implantitis was significantly greater in the bone-level group when the emergence angle (EA) was > __ degrees

convex

When a _____ profile was combined with an angle of >30 degrees, the prevalence of peri-implantitis was higher

- tissue level implant

- less than 30 degrees emergence profile

- concave profile

What is the ideal implant morphology: