What was the main point of the Lang study in 1973?
Effective oral hygiene needs to occur every 48 hours to maintain gingival health
also, rate of plaque accumulation increased before clinically detectable gingivitis
What was the main point of the Claydon 2002 abstract?
Comparing manual toothbrush designs, found NO significant differences. THE USER IS THE most significant variable.
What was the main point of the Drisko 2013 study?
Professional cleanings are of little value without OHI
also, powered brushes are at least as effective as manual, interdental brushes remove plaque
What was the 2005 AAP paper conclusion about supragingival irrigation?
Rinse benefits are confirmed for gingivitis
also, it was affective following root planing
What was the conclusion of the 2017 cochrane review?
Insufficient evidence to determine the reduction of gingivitis associated with CHX alone in mod-severe inflammation.
High evidence showing reduction in plaque with CHX
No CHX concentration better than other
Rinsing with CHX for 4 weeks or longer causes tooth stain
Reduction gingivitis (high evidence)
What is the molecular weight of CHX?
505 g/mol
Mechanism of CHX
Bactericidal effect due to the cationic binding to extra microbial complexes and causes cell death by distrupting cell wall
Main results of the Ramfjord study 1975?
Compared 3 modalities of perio therapy
MWF vs. sub g curettage vs. pocket elimination
Results
Curettage had greatest attachment up to 3 years
- Results were not significantly different for the 3 methods except at the first year of follow up when the attachment level was maintained best after curettage.
- Buccal pocketing tends to return to baseline after 5 year post tx in all modalities.
- Oral hygiene does not seem to be the reason for pockets returning to baseline after tx since buccal aspect is easy to clean
- Subgingival curettage gave the most favorable result regarding attachment levels and was least effective in pocket reduction.
- Pocket elimination surgery reduced pocket depth most effectively but was least effective in maintenance of attachment levels.
The most important finding in the Philstrom 1981 paper
MEASUREMENTS for when it is beneficial to do surgical therapy on perio disease
1-3mm SRP
4-6 (can be SRP or surgery)
6-7mm Surgery
Study compared the long term effectiveness of SRP vs SRP w Surgery
SRP 7mm pockets were both reduced by SRP, but flap added greater reduction for attachment
Which study gave us the critical probing depths for sites subjected to SRP?
Lindhe 1982, sites less than 2.9mm CPD were likely to show attachment loss after SRP
CPD for MWF was 4.2mm
Besides Crictial probing depth measurement, Lindhe 1982 had another main finding
Oral hygiene after treatment is more critical than the modality of treatment
Main point of the Badersten 1984 FIRST article
There is no certain magnitude of initial probing depth where nonsurgical periodontal therapy is no longer effective
Tells us we should always start with SRP
Main point of the Badersten 1984 SECOND ARTICLE?
Repeated instrumentation is of LIMITED VALUE
Becker, and both Baderstens showed something in common with their findings.
- SRP works better in anterior than posterior!
- Study suggests that periodontal healing from definitive therapy continues for at least 1 year
MWF and Osseous are better for reduction 4-7mm pockets
What did Kalkwarf conclude about perio therapy in 1988
Compared furcation with all types of modalities
Found that 1 year rebound is due to coronal movement of gingival margin, but 2nd year is due to Attachment loss
Likely inadequate instrumentation of furcations
Becker 2001 found that
All treatment modalities has good long term results can happen with good patient maintenance and holds for 5 years.
What did Serino find in 2001?
Surgical vs non-surgical, found that surgical was more effective than non-surgical in eliminating pockets.
Which medications are associated with gingival enlargement?
In 1966 Donnenfeld & Glickman, the slight reduction in width of attached gingiva following gingivectomy (0.3mm) was found to be caused by…
coronal migration of MGJ AND apical shift in the location of the base of the healed gingival sulcus
Nabers in 1954 describes
Indications for apically repositioned flap
Ochsenbein in 1963 and 1964 explains
rationale for palatal approach to osseous surgery. mostly for the upper arch, develops a classification
What were the important measurements found in Wilderman 1970? (histogenesis of repair following osseous surgery
Average of 1.2 Bone loss with 0.4mm of bone apposition so in total it was 0.8mm NET LOSS!
In the 1976 Selipsky study, it found the average bone loss following osseous surgery was
0.6mm
3-6 weeks is the peak mobility and slowly decreases over the course of a year.
Moghaddas 1980 suggested this amount of time to wait for osseous healing
3-6 months although small sample size
Kerry 1982 evaluated effect of periodontal treatment of tooth mobility and found
gradual slight decrease in mobility over 2yrs of maintenance regardless of trt
mobility increased after 1mo of pocket elimination but returned to WNL in 1yr
IMPORTANT Carnevale 2000 found about osseous surgery
Definitions
Osseous surgery- Modifying bony support of teeth
Osteoplasty- Modify alveolar process without supporting bone
Ostectomy- Excision of bone or portion of bone. done to reduce deformities caused by periodontitis including supporting bone
- Limited use in treating cases with very deep intrabony or hemiseptal defects
- Provides surest method of reducing pockets with intrabony or hemiseptal component of 3mm of less
Melcher 1976 describes on repair of periodontal tissues , 4 regeneration compartments and how many does periosteum have
Osteocytes
Bonecells in marrow
Cells of the endosteum: The osteogenic layer of the periosteum appears to be continuous with the endosteum where canals open onto the surface of the bone.
Osteogenic cells of periosteum: Periosteum exhibits two features that are important in any consideration of its role in healing: The Periosteum consists of at least two layers, an outer fibrous layer that does not appear to possess osteogenic potential and an inner cambium or osteogenic layer that does.
Garrett in 1978 found this about citric acid
Only consistent in roots that had prior planing prior to acid treatment
Cortellini in 1999 about The Simplified Papilla Preservation Flap
The simplified papilla preservation flap technique showed a potential to help increase the success of GTR procedures by providing a predictable coverage of barrier membranes, especially in areas of narrow interdental spaces and posterior sites
Cortellini in 1995 about the MODIFIED papilla preservation technique
Conclusion
The proposed modified papilla preservation technique allowed complete coverage of the Teflon membrane and primary closure in the interdental space in 93% of cases.
73% of sites maintained coverage up to 6 weeks.
This technique allows for coronal placement of the membrane in single defect sites and was best at single rooted anterior teeth and molars without a neighboring tooth.
**In narrow sites, this technique has the potential risk of resulting in papilla necrosis.
Takei in 1984 spoke about a flap technique
Described the technique to preserve papilla
○ When this was written this technique had been performed 25 times
■ 6 months follow up
■ No evidence of graft exfoliation
○ No soft tissue craters developed
■ Easier for patients to maintain optimal oral hygiene
○ Areas with regular flap technique would develop small craters○ Great for esthetics
Cortellini in 2011 about the periodontal regeneration vs. extraction compared clinical and patient-based outcomes following periodontal regeneration or extraction of teeth with chronic perio-endo lesions and/or attachment loss to or beyond the apex .... He concluded
1. Regenerative periodontal therapy resulted in favorable clinical healing even in hopeless teeth, presenting with bone loss at or beyond the root apex.
2. Regeneration led to retention of 92% hopeless teeth scheduled for extraction and improved their prognosis. Retained teeth had clinically-stable periodontal parameters, comfort and function for a 5-year period.
3. Both implant- and tooth-supported reconstructive therapies were successful in replacing the hopeless extracted teeth and maintaining comfort and function over 5-year.
4. Periodontal regeneration is a suitable alternative to tooth extraction in teeth compromised by extremely severe intra-bony defects.
Draw the MWF accordingto Ramfjord 1974
1. internal bevel incision made
2. gingiva reflected
3. crevicular incision
4. interdental incision
5. removal of granulation tissue, tags scaled
6. interrupted direct sutures
Steffileno 1966 describes histologic study of cellular mobilization following periosteal retention operation via split thickness mucogingival flap surgery What are the steps?
1. Cellular mobilization: Firstly was congestion of capillaries, rearrangement of cellular position within capillaries, movement of RBC into extravascular spaces.
2. 0-48 hours: disorganization of the collagen fibers which allows mononuclear cells to move into these fibers. FIbers directly on the bone were undisturbed, but showed some interstitial edema. In this edematous space, mononuclear cells were present, called the reserve cells, progenitor cells or the pluripotential cells.
4 days: these reserve cells were not as many, but there were now many osteoclasts along the alveolar crest area and still a dense cell population persisted in the connective tissue until 14 days.
What were the conclusions of Steffileno 1966?
- Epithelium proliferation and complete coverage of wound in 7 days
- Cellular mobilization started at zero hour, continued through 48 hours. This results in reserve cells.
- Increased cell density remained up to 14 days, then decreased
- Osteoclastic activity began at 2 days, peak 4 days, diminished around 7 days
- Osteoblastic activity started at 7 days, heightened at 14 days,
Staffileno 1974 - Significant Differences and Advantages Between the Full Thickness and Split Thickness Flaps. concludes that
Split thickness flap is the least traumatic flap technique.
Histologic findings: similar in the epithelial region, similar in the connective attachment area.
BUT, the alveolar process is a distinct difference in tissue response in resorption. There is a quantitative difference, there is more resorption of the vestibular aspect as well as crest of the alveolar process with full thickness than there is with split thickness.
Healing: Full thickness is a few days behind the split thickness in repair rate.
Thickness of tissue affects decision: if the flap is too thin you will traumatize when doing split thickness.
Which are the BMPs that are used for osteoinduction?
BMP2 and BMP7
rhBMP2 is approved to treat which types of bone grafts
alveolar ridge augmentation and sinus floor elevation
Prostaglandins are believed to be involved in periodontal inflammation, which medications can be used to reduce inflammation?
Non-steroidal prostaglandin inhibitors
According to Loe 1965, which approach was used to generate experimental gingivitis in man
9-21 days without oral hygiene
What is emdogain?
Enamel Matrix Derivative
Regenerative treatments with emdogain have been used with post surgical systemic antibiotics such as amoxicillin and metronidazole. According to Sculean 2001 , what did they say?
Use of post-surgical antibiotics has no additional benefit
Sculean 2001 demonstrated a prospective controlled clinical study regarding regenerative surgery combined with EMD and GTR in the intrabony defect, which statements is true
A. all three regenerative treatments (EMD, GTR and combination of EMD/GTR) Modalities may lead to higher CAL gain than conventional flap surgery. However, there is NO ADDITIONAL BENEFIT by combined treatment compared to other regenerative procedures (EMD or GTR alone
Acute necrotizing ulcerative gingivitis (related to Jimenez et all in 1975)
D. all of the above
Following injury, the first event of an inflammatory response is
Vasoconstriction
In the critical probing depth paper by Lindhe 1982 all of following are true EXCEPT
A. critical probing depth value was the same for SRP and SRP in combination with MWF
Critical probing depths in Lindhe 1982 were
2.9 for SRP and 4.2 for MWF
In the paper the evaluation of four modalities of periodontal therapy, mean probing depth, probing attachment level and recession changes by Kaldahl 1988
A. osseous surgery created the most recession followed by MW, RP and scaling
According to axelsson and lindhe 1987 efficacy of mouth rinses in inhibiting dental plaque and gingivitis in man - which group when used as a supplement to standard tooth cleaning measures markedly improved the OH status and gingival condition of the study participants?
A. control and experimental rinses (listerine, CHX 0.2 and 0.1)
Pucher in 1993 in his paper the effects of CHX on human fibroblasts in vitro determined that CHX is toxic, but no harm done in vivo
Both statements are true
According to oschsenbein palatal approach which is NOT correct
B. class 2 crater can be managed by facial ramping
In the primer for osseous surgery oschenbein outlines variables that should be used in the clinical decision making process on management of craters. Those variables include.
C. the morphology depth of craters in relationship to contigious bone and root anatomy
According to Selipsky osseous surgery, how much do we need to compromise? Avg bone loss during osseous was determined to be ____ of supporting bone
0.6mm
According to Wilderman, histogenesis of repair following osseous surgery 1970, which is true?
E. all of the above
In the primer for osseous surgery by oschenbein he crated a rational approach to osseous surgery, using the relationship of depth of crater to root trunk length as the primary factor responsible for determining the amount of buccal bone that can be removed in molar areas.
True or False
True
According to kerry - effect of periodontal treatment on tooth mobility which statement is not true
D. tooth mobility increased after pocket reduction surgery for up to bone month and the remained at that level
