Perio Final

Gingival tissues are attached to alveolar bone

True

Dehiscence always comes with recession

False

Smoking research is fully understood

False

Periodontally involved multi-rooted teeth have the same prognosis as single rooted teeth in smokers

False

More variable connection?

Epithelial attachment

Embryologically, alveolar bone is formed by

Ectomesenchyme

The main function of the periodontium is

Support

Embryologically, cementum is formed by

Dental follicle

Embryologically, alveolar bone proper is formed by

Dental follicle

Inner cells of Hertwig’s epithelial root sheath can synthesize following protein(s)

Amelogenin

Cellular cementum

Is blank on blank third and contain blank

Is absent on coronal third and contain cementocytes

Socket wall is derived from

Ectomesenchyme

Which is an example of specialized mucosa?

Dorsum of tongue

Free gingival groove is found at the level of

CEJ

A col is covered by

Non-keratinized stratified squamous epithelium

Free gingival groove is least common in

Maxillary premolars (mandibular M too)

Width of attached gingiva is widest in

Lingual of mandibular molars

Layers of epithelium are arranged in this order (superficial to deep)

Stratum Corneum > Granulosum > Spinosum > Germinativum (Come Get Some German Beer)

Which cell provides sensory function in the oral mucosa?

Merkel’s cells

The basal lamina is made of which two layers?

Lamina Lucida + Lamina Densa

The following ultrastructural organelles decrease moving from deep to superficial layers of epithelium: (more at bottom less at top) (3) GEM

Golgi, ER, Mitochondria

Fibroblast is the predominant cell in gingival connective tissue and comprises ____ of the total cell population

>50%

The smallest unit of collagen is

Tropocollagen

Reticulin fibers stain with which heavy metal?

Silver (Ag)

Which fibers run parallel to the long axis of the tooth? (up & down)

Oxytalan

Free gingival groove forms between insertions of the following gingival fibers (2) DGDP

Dentogingival & Dentoperiosteal

Trans-septal gingival fibers connect the following parts of the periodontium (CAT)

Cementum of adjacent teeth

Which is an example of a glycosaminoglycan found in the gingiva, not bound to a protein?

Hyaluronan sulfate

Gingival morphological characteristics are primarily

Genetically determined

Which of the following is/are not principal fibers of the periodontal ligament? (2) (CT)

Circular fibers & Trans-septal fibers

Largest periodontal ligament principal fiber group is

Oblique

Type of cementum that does not participate in anchoring of the tooth is (AA)

Acellular afibrillar cementum (Cellular intrinsic fiber cementum)

Elastic fibers in periodontal ligament connective tissue run with

Run with the blood vessels

The palatal gingiva is innervated by

Greater palatine n.

The palatal gingiva is drained by

Deep cervical lymph nodes

Organic component of bone matrix is predominantly composed of

Collagen type I

Inorganic component of bone matrix is predominantly composed of

Hydroxyapatite

During bone remodeling, osteoclasts form specialized extracellular compartments called

Howship’s lacunae

Osteoprotegrin (OPG) competes with RANKL

False

Following events occur during socket healing (3) FMR

Tissue formation, Tissue modeling, Tissue remodeling

Osteons are the functional unit of bone

True

Bone multicellular unit contains (3) (BOO)

Osteoblasts, Osteoclasts & Blood vessels

Generally, after extraction, which aspect of the alveolar socket loses more bone volume?

Buccal

Biologic width is comprised of (2)

CT attachment & Junctional epithelium

Which gingival phenotype (biotype) is more likely to undergo recession?

Pronounced scalloped (Thin)

The interdental papilla is always complete when the distance of interdental bone crest to interdental contact is

5mm or less

During compositional tissue change in osseointegration, the following tissue type undergoes linear reduction over time?

Bone debris

In mandibular molars, the lingual furcation entrance width is wider compared to buccal furcation entrance width

True

In maxillary molars, the buccal furcation entrance is furthest from the CEJ

False (Distal is furthest)

During colonization of the root surface by subgingival microbiota, bacteria from which complex colonize first?

Blue complex

Which of the following are gram negative anaerobes considered pathogenic in periodontitis? (4)

(PPAT) PoG, PrI, AgA, TrD

Porphyromonas gingivalis

Prevotella intermedia

Aggregatibacter actinomycetemcomitans

Treponema denticola

Microbes considered commensals in the subgingival environment (yellow complex) fall in the following genus

Streptococcus

In the initial lesion of gingivitis, the expression of which cytokine facilitates formation of neutrophil extracellular traps

IL-8

In early lesion of gingivitis, T cell subpopulations are

Twice as much as CD4 relative to CD8 (2:1 ratio of 2CD4:CD8)

The presence of this cell population can be considered as transition from gingivitis to periodontitis

B cells

In advancing periodontitis, following normal appearing tissue type is noted between the pathology and underlying alveolar bone

Connective Tissue

Inflammatory mediator primarily responsible for connective tissue degradation

MMP

Principally, periodontal abscess forms when

Periodontal pocket is occluded

Localized aggressive periodontitis characteristically affects the following teeth

1st molars & incisors

Dominant microorganism in localized aggressive periodontitis include

Aggregatibactor actinomycetemcomitans

Aggregatibacter actinomycetemcommitans serotype is most commonly associated with localized aggressive periodontitis is

B

Bacteriocins

Helps inhibit growth of commensals (counter other bacteria)

Predominantly, the following immunoglobulin is produced in response to A. actinomycetemcommitans

IgG

Local anatomic factor that is the leading cause of isolated furcation involvement in otherwise periodontally healthy patient is

Cervical enamel projections

Palatogingival groove is most common in

Maxillary lateral incisors

4mm deep pockets are best treated by scaling and root planning

True

You are seated in 8 to 9 o’clock position for scaling and therefore you are properly positioned to scale (2)

Posterior teeth & surfaces towards you

Anterior teeth & surfaces towards you

You may underestimate probing depth interdentally if you incorrectly angulate the periodontal probe

True

You have just finished periodontal charting on a new patient and find all PD within 3 mm. However, there is generalized plaque accumulation interdentally and BOP at 45% of the sites. What is your diagnosis?

Generalized gingivitis on an intact periodontium

For reproducible probing depths, a force of _______ grams must be delivered

25 (0.25N)

For diagnosis of gingivitis, positive bleeding on probing should exist in addition to

PD ≤ 3mm

Normal interdental bone levels are at mm from the cementoenamel junction

≤ 2mm

All of the following are part of the “red complex” EXCEPT

Prevotella intermedia

Which are part of the red complex? (3) PTT

Porphyromonas gingivalis

Treponema denticola

Tanerella forsythia

Case definition for diagnosis of gingivitis on a reduced periodontium in a stable periodontitis case is

Presence of clinical attachment loss, probing depths ≤ 3mm, BOP at more than 10% of the sites and presence of radiographic bone loss

The following ultrastructural organelles increase moving from deep to superficial layers of epithelium (2)

Desomosomes & tonofilaments

Mast cells do not secrete this biologically active substance

Nitric oxide

Differentiation of osteoprogenitor cells to osteoblasts predominantly occurs under the influence of (3)

BMP, IGF, PDGF

What does OPG compete with?

RANK

Maxillary molar furcation entrances from the CEJ (3)

Mesial 3mm

Buccal 3.5mm

Distal 5mm

Dominating microorganisms in localized aggressive periodontitis include (4) CAPrE

Capnocytophaga species

A. actinomycetemcomitans

Prevotella species

E. corrodens

Neutrophil dysfunction is associated with periodontal bone loss. Which syndrome is not associated with neutrophil dysfunction?

Cheyne-Hajdu syndrome

Chediak-Higashi, Down & Papillon-Lefevre syndromes are associated with? (3)

Chronic granulomatous disease, chronic neutropenia & leukocyte adhesion deficiency

Which prognostic category includes a tooth with 25% CAL and/or Class I furcation involvement as per McGuire and Nunn’s classification? (Good, Fair, Poor, Questionable, Hopeless)

Fair

A questionable tooth as per McGuire and Nunn's prognosis classification should have (CAL)

>50% clinical attachment loss

Sickle scalers have the following characteristics (3) FT2

Face perpendicular to lower shank

Triangular cross section

2 cutting edges

BOP at 20% sites differentiates localized from generalized periodontitis

False (local is between 10-30%)

A patient is a periodontitis case if (2)

Interdental CAL is detectable at ≥ 2 non-adjacent teeth

Buccal or oral CAL ≥ 3mm with PD > 3mm is detectable at ≥ 2 teeth

Diagnostic parameters for Stage I periodontitis include (3)

(CAL, PD, Bone loss)

CAL of 1-2 mm, maximum PD ≤ 4mm and bone loss less than 15% of the root

Diagnostic parameters for Stage II periodontitis include (CAL, PD, BL)

CAL of 3-4 mm, maximum PD ≤ 5mm and bone loss between 15-33% of the root

Complexity factors for Stage II periodontitis are (2) PD and BL

Maximum PD ≤ 5 mm and mostly horizontal bone loss

In Grade C or rapid rate of periodontal disease progression, primary criteria include

CAL or radiographic bone loss of ≥ 2 mm over 5 years

HbA1c levels of ____ is considered a cut off to differentiated grade B and C of periodontitis

7%

Diabetes HbA1C glycemic control (normal, good, moderate, poor)

Normal < 6%

Good <7%

Moderate 7-8%

Poor >8%

Which of the following is an element of a good informed consent? (3)

Alternative treatments

Foreseeable risks

Foreseeable benefits

Therapeutic dose of Warfarin (Coumadin®) can be measured using (factors 2, 7, 9, 10)

PT (expressed in INR) want less than 3.5

Warfarin (Coumadin®) interaction with medication to increase PT(5)

ASA

Acetaminophen

NSAID

Broad spectrum abx

Metronidazole

Therapeutic dose of Dabigatran Pradaxa (factor 2) can be measured using

PTT

Rivaroxaban (Xarelto®) acts by inhibiting

Factor Xa

Growth of which of the following pathogens can be favored by sex hormones? (2) PriC

Prevotella intermedia

Capnocytophaga series