What are the objectives of periodontal pocket elimination?
Remove diseased tissue and assist the client in daily plaque control
(T/F) Coincidental curettage is a deliberate procedure performed separately from scaling and root planing.
False
The most common oral site for donor tissue for free gingival graft procedures is the
palate
Following gingival curettage, healing begins with
blood clot formation
What is the advantage of silk braided sutures?
They are easy to manipulate
Gingival curettage is performed using all EXCEPT which of the following?
Placing the cutting edge on the tooth/root surface
Incidental (inadvertent) gingival curettage removes which of the following?
Sulcular epithelium
A clinician performs gingival curettage for a patient. Histologically, the patient's gingival tissues are most likely to exhibit which of the following?
Long rete pegs
The purpose of placing sutures after periodontal flap surgery is to
1. Hold the soft tissue in place
2. Maintain the blood clot
3. Protect the wound
4. Prevent food impaction into the wound area
Regenerative periodontal surgical procedures
selectively encourage the growth of cells of the attachment apparatus
When is a gingivectomy primarily used?
When there is an adequate zone of attached gingiva
What situation would be an indication for a gingivectomy?
A fibrotic area of free gingiva that covers part of the occlusal of #31
When does a mucogingival problem exist?
The base of the pocket extends apically to the mucogingival junction
(T/F) Periodontal surgery is most successful when pocket depths are between 5mm and 9mm deep because indications for periodontal surgery are more affected by measurements of the clinical attachment loss than by those of pocket depths.
The statement is CORRECT, but the reason is NOT.
The purpose of deliberate gingival curettage is to remove
chronically inflamed granulation tissue
Which of the following procedures is necessary before performing gingival curettage?
All of the procedures are necessary prior to performing gingival curettage.
(scaling and root planing, sharpening instruments, periodontal probing, determining the need for anesthetic)
The types of periodontal surgery that increases the predictability for growth of new tissues for the periodontal apparatus are called procedures for
guided tissue regeneration
The types of periodontal surgery in which the periodontist shapes the alveolar bone with chisels or burs to remove bony defects are called procedures for
treatment of osseous defects
Gingival curettage serves to accomplish each of the following except one. Which of the following is the EXCEPTION?
Reduce fibrotic tissue
Which situation would be an indication for regenerative periodontal surgery?
an infrobony pocket of 6mm on the vital aspect of tooth #30
To remove light calculus covering implant abutments,
plastic, nylon, graphite, or titanium instruments (scares/curettes) are the instruments of choice
(T/F) The location of an implant influences its success fate. Smoking may affect the success of an implant.
Both statements are TRUE
Investigations comparing peri-implant soft tissues with the periodontal tissues surrounding the natural tooth indicate that the peri-implant soft tissues have
impaired defense because of the lower fibroblast content
What is placed in the bone and can be a blade-shaped or a root-form implant?
Endosseus
What is used only in the mandibular arch to anchor the prosthesis; no direct bone anchorage is provided.
Transosteal
What custom cast framework is placed beneath the periosteum. This implant can be used in both maxillary and mandibular arches.
Subperiosteal
It is known that the highest risk exposure category for children in the United States is which of the following?
Mother with or at risk for HIV infection
The interface or biologic seal found around an implant is created by the formation of a long junctional epithelium that is attached to the implant surface by
hemidesmosomes
Diabetes is a systemic disease affecting which of the following metabolic processes or conditions?
Carbohydrate metabolism
Type 2 diabetes is characterized by
increased cellular non responsiveness to insulin
The term "loading" refers to which aspect of implant therapy?
a placement of abutments and restorations on implants for function
Type I diabetes is usually
insulin dependent and early onset
All of the following are potential risks associated with having dental implant except for one. Which of the following is the exception?
Client may have a decreased bone resorption
Which of the following statements is NOT true regarding the Human Immunodefiency Virus (HIV)?
Risk of acquiring HIV infection from providing dental hygiene care to infected individuals is extremely high.
Acute HIV infection occurs usually within about 2 weeks of exposure and is characterized by which of the following conditions?
All answers are correct.
(Lymphadenopathy, headache, rash, fever)
All of the following are possible contraindications for patients considering implants except one. Which contraindication is the exception?
Adults over 60 years of age
What is the major cause of failure in most joint prosthesis replacements?
infection
(T/F) Data suggest that uncontrolled diabetes increases the risk for periodontal infections. A controlled-diabetic has the same predisposition for periodontal disease as a healthy individual.
Both statements are TRUE
Severe attachment loss is often associated with all of the following diseases except one. Which of the following is the exception?
hyperparathyroidism
Mrs. Jones is seated in the dental chair for supportive periodontal therapy. The dentist has written in her chart that her implant failed because of a hole in the buccal or labial play of the alveolar process. The hole in the bone is known as which of the following?
Dehiscence
All of the following oral hygiene tools can be used safely for home care of the dental implant except one. Which one is the exception?
proxy brushes with metal wire
Why are systemic factors important in the pathogenesis of periodontal disease?
Systemic factors can intensify the response of the periodontium to local factors
(T/F) The initial treatment during the first appointment for a patient with NUP includes thorough and complete debridement of all plaque, calculus and debris.
False
A flap of tissue covering, or partly covering an erupting tooth is called
operculum
Which of the following descriptions best characterizes orthofunction?
Adaptive capacity of the orofacial complex
(T/F) Pain from a periapical abscess is usually characterized as sharp, severe, intermittent, and difficult to localize. Pain from a periodontal access is usually constant, localized and less severe.
Both statements are TRUE
What is the term for an abscess that is found on the marginal gingiva and is not involved in the deeper periodontium?
Gingival abscess
All of the following are diagnostic of occlusal trauma except for one. Which of the following is the exception?
Increased loss of attachment
(T/F) Occlusal trauma without periodontal disease present will cause loss of attachment.
True
A periapical abscess that is draining can resemble which of the following?
acute periodontal abscess
Radiographic indicators of occlusal trauma include
All answers are correct
(widened PDL space, root resorption, bone loss)
The term for heavy occlusal forces that have caused injury to tissues and bone in a normal periodontium is called
primary traumatic occlusion
The temporomandibular joint is the articulation of the junction of the
temporal bone and mandible
The etiology of temporomandibular disorder is described as
multifactoral
Which of the following factors contributes to the development of necrotizing ulcerative gingivitis?
smoking and stress
An acute periodontal abscess can occur as the result of all of the following except for one. Which is the exception?
Antibiotic usage
(T/F) Acute pericoronitis usually occurs around erupting third molars.
True
Which of the following is NOT a sign of necrotizing ulcerative gingivitis?
fibrosis
The normal jaw should achieve an opening distance of at least
40mm
Each of the following usually results from parafunctional occlusal habits except one. Which one is the exception?
periodontal pockets
Centric relation is
the position of the upper to the lower jaw
A patient with deep infra bony pockets and furcation involvement is scheduled for root planing. What emergency has the most potential to occur after the first scaling appointment?
acute periodontal abscess
Uses bone from another person (cadaver bone)
Allograft
Provides root coverage
subepithelial connective tissue graft
Indicated for drug-induced gingival hyperplasia
gingivectomy
Donor site is typically the palate
free autogenous gingival graft
Uses donor bone from the patient
Autograft
Acellular Dermis Graft
Alloderm
What is the term for a periodontal bone graft that is made from bovine or porcine bone material?
xenograft
The function of a barrier membrane during guided tissue regeneration (GTR) procedure is to
exclude epithelium
Donor tissue accessed from adjacent tooth or papilla
Lateral pedicle graft
Uses synthetic bone materials
Alloplast
The soft tissue crevice around an implant is lined with
sulcular epithelium
What structure is absent in the soft tissue surrounding an implant?
Periodontal ligament
The destructive inflammatory response around an implant is ________ that around a tooth.
greater than
What is the most effective way to remove plaque from the undersurface of a non removable hybrid denture?
All of the above.
(interdental brush, floss, end tuft brush)
Instrument selection is based on:
The component needing debridement
Which instrument is the most appropriate when heavy calculus on the abutment is present and access is difficult?
Not sure...
either hoe graphite or implacare 4R/4L
The ultrasonic insert with plastic sheath should be used on a titanium abutment surface with:
low power
What is the instrument of choice on an exposed coated implant fixture with heavy calculus?
Graphite reinforced curette
What is the instrument of choice when an exposed machine-threaded implant fixture has only plaque and soft debris?
Plastic instrument
The most rigid plastic instruments are reinforced with the following:
Graphite
The microflora in the acute periodontal abscess is predominantly
gram negative and anaerobic
The periodontal abscess is characterized by all of the following symptoms except one. Which is the exception?
bleeding
An acute periodontal abscess can occur as the result of all of the following except one. Which is the exception?
antibiotic use
Which disease may have oral characteristics similar to those found in necrotizing ulcerative gingivitis (NUG)?
leukemia
What is the term for an abscess that is found on marginal gingival and is not involved in the deeper periodontium?
gingival abscess
What is the term for an abscess that is the result of a pulpal infection from caries or trauma?
periapical abscess
A perioapical abscess that is draining can resemble which of the following?
acute periodontal abscess
(T/F) A periapical abscess must be treated as soon as possible BECAUSE infection from this lesion could be life-threatening.
Both the statement and the reasons are correct.
An intraoral examination of the gingiva reveals a clinical picture of punched-out papillae. The patient complains of pain and a bad taste. The history indicates that the patient's diet is poor, he has been under stress and he has had little rest. The course of action would be to
apply a therapeutic course and debride the mouth, recommend hydrogen peroxide mouthiness and possibly systemic antibiotics
Which disease is highly infectious?
acute herpetic gingivostomatitis
What is the term for an abscess that is associated with partially erupted teeth?
pericoronitis
Which of the following condition is not found in cases of ANUG or NUP?
presence of vesicles
Which of the following clinical findings should be taken into consideration when determining the differentiation between an acute periodical abscess and a periodontal abscess?
All of the above
(probing depths, history of gingivitis, extensive caries, radiographs, recession, and tooth vitality testing)
An otherwise health patient has an oral abscess. Which of the following symptoms necessitates instituting antibiotic therapy?
fever
Which of the following bacteria are characteristically associated with necrotizing ulcerative gingivitis?
fusiforms and spirochetes
Which of the following alterations in papillary contour is a sign of previous infection with necrotizing ulcerative gingivitis?
cratering
A tooth is extremely sensitive to percussion and feels "high" during mastication. Likely causes include
occlusal trauma
periapical abscess
periodontal abscess
vertical root fracture
The types of periodontal surgery that increase the predictability for growth of new tissues of the periodontal apparatus are called procedures for
creating new attachment
(T/F) Drug induced hyperplasia is most likely best treated surgically by gingivectomy. Gingivectomy is an incisional form of periodontal surgery.
There first statement is TRUE, the second statement is FALSE.
The following forms of periodontal surgery are examples of incisional surgery EXCEPT.
gingivoplasty
Indications for root amputation include all of the following EXCEPT
unfavorable dental anatomy that precludes creation of a form that the patient can keep clean
A hemisection refers to a
resection or spitting in half of a mandibular molar
Gingivectomy procedures are indicated in the following situations EXCEPT
in the reduction of infra bony pockets and pockets extending to or beyond the mucogingival junction
When there is an inadequate zone of attached gingiva present, the treatment of choice is
free gingival graft
When root coverage is needed, it may be best obtained by a
connective tissue graft
Which of the following osseous defects could be expected to have the best chance for osseous regeneration in periodontal regenerative procedures?
Three bony walls
The most common cause of prolonged root sensitivity following periodontal surgical procedures is
bacterial biofilm
Subsequent to root debridement and closure of the gingival flap with sutures, which cells are the first to migrate apically and effect wound closure?
epithelial cells
Subsequent to surgical treatment of an infra bony defect, progenitor cells from the periodontal ligament (PDL) compete with epithelial cells and bone-forming cells to close the wound. If epithelial cells win the "race," what type of attachment results?
a long junctional epithelium
Exclusion of cells other than progenitor cells from the PDL allows these cells to enter the wound and differentiate into
both a and b are correct
fibroblasts which produce a PDL attachment to the previously diseased root surface and cementocytes which procedure cementum covering the previously diseased root surface
(T/F) An internal beveled incision is used in most flap procedures to remove the pocket epithelium, epithelial attachment, and a portion of the inflamed connective tissue.
True
(T/F) A gingivectomy removes the epithelial attachment whereas a gingivoplasty does not.
True
(T/F) The periodontal flap procedure is used in the treatment of periodontal pockets that extend to or beyond the mucogingival junction and infabony pockets.
True
(T/F) In osseous regeneration, the infrabony pocket is eliminated by the regeneration of lost alveolar bone rather than by removing the bone that is creating the defect.
True
(T/F) Osteoplasty refers to the process of recontouring alveolar bone that is not directly supporting the tooth.
True
(T/F) The primary objective of the Modified Widman Flap procedure is not pocket elimination per se, but maximum healing of periodontal pockets with minimum loss of tissues.
True
(T/F) The primary objective of osseous surgery is pocket elimination so there is better access for the client and therapist to maintain the treated areas.
True
(T/F) Open flap curettage, along with regenerative procedures work best in advanced bone loss cases.
True
(T/F) Esthetics and root sensitivity are not a problem in periodontal flap procedures.
False
(T/F) The goal of gaining access and visibility for debridement of the pocket may provide a better rationale for surgery than pocket elimination.
True
(T/F) Guided tisse regeneration (GTR) is most predictable when connective tissue is excluded from the wound area in order to allow epithelium to migrate apically and seal off the osseous graft material placed in the osseous defect.
False
(T/F) Guided tissue regeneration is the most predictable with Class II furcation defects in mandibular molars.
True
(T/F) Goretex is a resorbable material used in GTR which does not need to be removed.
False
(T/F) Free gingival grafts are the treatment of choice for obtaining root coverage.
False
(T/F) The periodontal ligament and bone are important sources of cells in guided tissue regeneration in order to obtain wound healing.
True
(T/F) Free gingival grafting is the treatment of choice to establish a zone of attached gingiva in order to prevent recession when root coverage is not the primary goal.
True
(T/F) Horizontal bone loss responds well to guided tissue regeneration procedures.
False
(T/F) Class III furactions are less predictable with GTR than class II furcations.
True
(T/F) Maintenance of space under the GTR barrier membrane is critical to the success and predictability in wound healing.
True
(T/F) In advanced periodontal disease, osteotomy has limited applicability.
True
(T/F) One major difference between a chronic and an acute periodontal abscess is pain.
True
(T/F) All plural problems have symptoms.
False
(T/F) In most circumstances where there is an endo/perio problem, the periodontal treatment is started first.
False
(T/F) Periodontitis cannot cause a plural infection.
False
(T/F) As periodontitis advances apically, there becomes an increasingly greater chance of pulpal inflammation by way of lateral or accessory canals.
True
(T/F) With a combine endodontic/periodontal infection, it may be difficult to diagnose which created the main defect/pathology; the endo or the period problem
True
(T/F) Regeneration of the alveolar bone and PDL cannot be accomplished on an endodontic tooth.
False
Gingival enlargement is a common side effect of
calcium channel blockers
A differential diagnosis of generalized destruction of alveolar bone in a 6 year old child would include all of the following except one. Which of the following is the exception?
Cystic Fibrosis
Tobacco is a strong risk factor for all except which of the following conditions?
gingival bleeding
Why are systemic factors important in the pathogenesis of periodontal disease?
Systemic factors can intensify the response of the periodontium to local factors
The primary cause of inflammatory periodontal disease in diabetic patient is
dental plaque biofilm
Which of the following reflects our current state of knowledge on the connection between diabetes control and periodontal health?
Periodontal infection or sever periodontitis has an adverse effect on glycemic control
(T/F) If a HIV positive patient's viral load is 200,000 a medical consult is recommended.
True
The relationship between periodontal complications and diabetes is more difficult to establish in the elderly because
the prevalence of both chronic periodontitis and diabetes increases with age
