Periodontics

Maintenance Phase Short Essays

Question 1. SPT (Supportive Periodontal Treatment).
Answer:

SPT Rationale:

• Prevent/minimize the recurrence of disease
• Control etiological factors of disease

SPT Goals By Aap:

• Prevent/minimize recurrence and progression of dis-ease
• Prevent/reduce the incidence of tooth loss
• Increase the probability and treating in a timely manner.

SPT Objectives:

• Preservation of bone support
• Maintenance of attachment
• Oral hygiene maintenance

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SPT Procedure:

Maintenance Phase Short Question And Answers

Question 1. Describe in short the important factors causing periodontal disease
Answer:

Causes Of Recurrence Of Periodontal Diseases:

• Inadequate or insufficient treatment that has failed to remove all the potential factors favoring plaque accumulation
• Incomplete calculus removal in areas of difficult access is a common source of problems
• Inadequate restorations placed after the periodontal treatment was completed
• Failure of the patient to return for periodic check-ups
• Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque

Splint In Periodontal Therapy Definition

Periodontal splint

• Splint is an appliance used for maintaining or stabilizing mobile teeth to their functional position

Splint In Periodontal Therapy Important Notes

1. Classification of splints

• According to the Period of stabilization
  1. Temporary<6 months
  2. Provisional – for months up to several years
  3. Permanent – Indefinite
• According to the type of material
  1. Bonded composite
  2. Braided wire
  3. A-splints
• According to the location
  1. Intra-oral
  2. Extra-oral

2. Requisites of splints

• Easy to prepare
• Economical
• Rigid, durable, and stable
• Easy to remove and replace
• Self-cleansing
• Easy to maintain
• Esthetically accepted
• Non-irritating to adjacent tissues

Splint In Periodontal Therapy Long Essays

Question 1. Define periodontal splint. Give indications and contraindications for splinting of teeth.
Answer:

periodontal splint Definition:

• Splint is an appliance used for maintaining or stabilizing mobile teeth to their functional position

periodontal splint Indications:

• Stabilize mobile teeth to improve patient comfort and to provide stability
• Stabilize moderate to advanced tooth mobility
• Stabilize teeth in secondary occlusal trauma
• Stabilize teeth following acute trauma
• Stabilize teeth when increased tooth mobility interferes with normal masticatory function
• Stabilize teeth following orthodontic movement
• Prevent tipping or drifting of teeth
• Create adequate stability
• Prevent extrusion of unopposed tooth

periodontal splint Contraindications:

• Presence of periodontal inflammation
• Presence of an insufficient number of nonmobile teeth to stabilize mobile teeth
• Presence of inadequate oral hygiene
• Absence of prior occlusal adjustment

Question 2. Define periodontal splint. Discuss their role as ad adjuncts in periodontal therapy.
Answer:

periodontal therapy Definition:

• Splint is an appliance used for maintaining or stabilizing mobile teeth to their functional position

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periodontal therapy Role Of Splinting In Periodontal Diseases

1. Rest
   • Immobilization permits undisturbed healing
2. Redirection of forces
   • Splinting leads to the redirection of forces in the axial direction over all the teeth
3. Redistribution of forces
   • Distributes forces over a number of teeth and thereby prevents excessive forces on mobile teeth
4. Restoration of functional stability
   • Restores functional occlusion
   • Stabilizes the remaining mobile abutment teeth
5. Maintenance of arch integrity
   • Proximal contacts are restored
   • Prevents food impaction and further breakdown of Loop wire is tightened periodontal tissues
6. Psychologic well being
7. • Restores feeling of dentition, comfort, and esthetics

Question 3. Define periodontal splinting. Mention the ideal requisites of a periodontal splint and write in detail about the splinting procedure.
Answer:

periodontal splinting Definition:

• Splint is an appliance used for maintaining or stabilizing mobile teeth to their functional position

periodontal splinting Requisites:

• Easy to prepare
• Economical
• Rigid, durable, and stable
• Easy to remove and replace
• Self-cleansing
• Easy to maintain
• Esthetically accepted
• Non-irritating to adjacent tissues

periodontal splinting Procedure:

Splint In Periodontal Therapy Short Essays

Question 1. Splints.
Answer:

Splints Definition:

• An appliance is used for maintaining or stabilizing mobile teeth to their functional position.

Splints Objectives

• Provide rest
• By redirecting forces
• Preserve arch integrity
• Restores function
• Stabilizes mobile teeth
• Prevent eruption of unopposed teeth

Splint In Periodontal Therapy Short Question and Answers

Question 1. Permanent splinting
Answer:

• Permanent splints are indicated in dentitions that cannot maintain final stability after periodontal and restorative treatment
• They can be either fixed or removable
• Permanent splints utilizing cast restoration may be placed as part of a restorative phase of therapy

Pulpoperiodontal Problems Short Essays

Question 1. Endo-perio lesion.
Answer:

Originally endodontic problem with fistulization from the apex and along the root to the gingiva. Pulpal infection can also spread through accessory canals to the gingiva or to the furcation (primary endo lesion)

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A periodontal pocket can infect the pulp through a lateral canal and this in turn can result in a periapical lesion (primary periosecondary endo lesion)

A periodontal pocket can deepen to the apex and second- dary involve the pulp (primary percolation)

A long-standing periapical lesion draining through the periodontal ligament can become a secondary complication, leading to a “retrograde periodontitis” (primary endosecon- diary percolation)

Pulpoperiodontal Problems Viva Voce

1. The most common cause of the pulpal disease is dental caries
2. The organisms being cultured predominantly from the infected root canals are Gram-negative anaerobes
3. If the inflammatory lesion of the pulp cannot be resolved even after the elimination of the source of trauma then it is described as irreversible pulpitis
4. Sensation from the core of the pulp is initiated by unmyelinated C fibers
5. While treating combined periodontal and endodontic lesions, endodontic lesions should be treated first
6. A dental abscess with a draining sinus tract indicates a lesion of endodontic origin

Furcation Involvement Definition

Furcation involvement

• Furcation involvement refers to the invasion of the bifurcation and trifurcation of multirooted teeth by periodontal disease.

Root resection

• It is the surgical removal of all or a portion of the root before or after endodontic treatment.

Hemisection

• One root with its corresponding crown portion is cut and removed

Bicuspidisation

• The molar is cut without the removal of any part of the crown or root

Furcation Involvement Important Notes

1. Types of furcation

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Furcation Involvement Long Essays

Question 1. Define and classify furcation. Enumerate treatment of grade III furcation areas.
Answer:

Furcation Definition:

• Furcation involvement refers to the invasion of the bifurcation and trifurcation of multirooted teeth by periodontal disease.

Classification of furcation:

1. According to Glickman:

• Grade 1
  • Early/Incipient lesion
  • Suprabony pocket
  • Slight bone loss
  • No radiographic changes
• Grade 2
  • Bone destruction on one/more aspects
  • But the portion of the bone is intact
  • Cul-de-sac lesion
  • A radiograph may or may not reveal the involvement
• Grade 3
  • Complete inter-radicular bone loss
  • No soft tissue loss
  • Radiograph shows the radiolucent area between roots
• Grade 4
  • Inter-radicular bone loss
  • Gingival recession
  • Radiolucent area radiographically

2. According to Tarnow & Fletcher:

• Subgroup A: Vertical bone loss upto 1/3rd of inter-radicular height (0-3 mm)
• Subgroup B: Vertical bone loss upto 2/3rd of inter-radicular height (4-7 mm)
• Subgroup C: Vertical bone loss beyond apical third (>7 mm)

Treatment:

Objectives:

• Facilitate maintenance
• Prevent further attachment loss
• Obliterate furcation defects

Treatment Options:

1. For grade 1

• Scaling and root planning
  • Grade I can be accessible by scaling and root planning
• Curettage
  • Done by Gracey curettes, Quetin furcation cu- rettes
• Gingivectomy
  • It is the excision of the soft tissue wall

2. For grade 2

1. Traditional methods
   • Scaling and root planning- inaccessible areas
   • Curettage
   • Osteoplasty
   • It involves shaping of bone to prevent plaque accumulation
   • Hemisection
   • It is the surgical removal of the root with the associated part of the crown
2. Regenerative procedures
   • GTR (Guided Tissue Regeneration)
   • It involves the placement of membrane to prevent
   • formation of long junctional epithelium
   • Coronally repositioned flap
   • Root conditioners

3. For Grade 3

• Tunneling
  • Done in mandibular 1 molar due to better ac- accessibility
• It transforms Grades 2 to Grades 3 and 4
• Has increased risk of root caries
• So not used nowadays
• GTR
• Hemisection

4. For grade 4

• Extraction is done

Furcation Involvement Short Essays

Question 1. Root Resection.
Answer:

Root Resection Definition:

• It is the surgical removal of all or a portion of the root before or after endodontic treatment.

Root Resection Indication:

• Gingival recession
• Class 2 or 3 furcation
• Severe bone loss

Root Resection Contraindications:

1. Local:

• Poor oral hygiene
• Fused roots
• Endodontically untreated roots.

2. Systemic:

• Systemic diseases

Root Resection Technique:

Furcation Involvement Short Question And Answers

Question 1. Grade 3 furcation involvement
Answer:

furcation involvement Features:

• Complete inter-radicular bone loss
• No soft tissue loss
• Radiograph shows the radiolucent area between roots

furcation involvement Treatment:

• Tunneling
  • Done in mandibular I molar due to better accessibility
  • It transforms Grades 2 to Grade 3 and 4
  • Has increased risk of root caries
  • So not used nowadays
• GTR
  • It involves the placement of membrane to prevent for- motion of long junctional epithelium
• Hemisection
  • It is the surgical removal of the root with the associated part of the crown

Question 2. Tunneling
Answer:

• Done in mandibular 1 molar due to better accessibility
• It transforms Grades 2 to Grades 3 and 4
• Has increased risk of root caries
• So not used nowadays

Question 3. Hemisection
Answer:

• It is the surgical removal of the root with the associated part of the crown
• Commonly performed on mandibular molars with buc- cal or lingual class 2 or 3 furcation

Hemisection Technique:

Furcation Involvement Viva Voce

1. The most commonly performed root resection is disto- the buccal root of the maxillary first molar
2. Furcation is most commonly involved in mandibular molars
3. Least commonly involved in maxillary 1st premolars
4. The prognosis is poor if the furcation areas are in- involved in maxillary 1st premolars
5. Hemisection and bicuspidisation are suitable for mandibular molars

Pregnancy Gingivitis Short Essays

Question 1. Gingival Changes in Pregnancy.
Answer:

• Time after first trimester

Gingival Changes in Pregnancy Changes:

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Gingival Changes in Pregnancy Cause:

• Aggravation of previous inflammation
• Altered tissue metabolism

Gingival Changes in Pregnancy Gingiva:

• Color Bright red/magenta
• Consistency Soft and friable
• Bleeding on probing – Positive
• Size – Increased
• Surface texture – Stippling lost
• Shape – Mushroom like flattened spherical

Pregnancy Gingivitis Viva Voce

1. The microorganism associated with pregnancy gingivitis is P.intermedia
2. A pregnancy tumour is a non-neoplastic gingival enlargement

 

Periodontal Restorative

Periodontal Restorative Short Question And Answers

Question 1. Biologic Width.
Answer:

Biologic Width Definition:

• The soft tissue attachment to the tooth between the base of the gingival sulcus and the crest of the alveolar bone is called biologic width.

Biologic Width Significance:

• Avoid its invasion during restorative procedures to prevent attachment loss

Biologic Width Calculated As:

• Biologic width = Junctional Epithelium + Connective tissue attachment

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• 0.97mm + 1.07 mm = 2.04 mm

Periodontal Restorative Viva Voce

1. Biological width is defined as the physiologic dimensions of junctional epithelium and connective tissue attachment
2. The biologic width is the distance between the coronal end of the junctional epithelium to the alveolar crest
3. Placement of the supragingival margin of restoration has the least impact on the periodontium
4. To correct the violation of biological width after rapid orthodontic extrusion of a tooth suprarenal fibrotomy is per- formed every 1 week

Mucogingival Surgery Definition

Mucogingival surgery

• Surgical procedures are performed to correct/eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa.

Mucogingival Surgery Important Notes

1. Mucogingival surgeries

• Techniques of increasing the width of attached gingiva
  • Free gingival graft
  • Apically displaced flap
• Techniques for coverage of denuded roots
  • Laterally displaced pedicle graft
  • Coronally displaced flap
  • Free gingival graft
• Techniques to deepen the vestibule
  • Free autogenous grafts
• Techniques for removal of a frenum

2. Undisplaced flap

• It surgically removes the pocket
• It does not increase the width of the attached gingiva, instead, it decreases the width
• It is essentially an excisional procedure of the gingiva

3. Disadvantages of full-thickness flap

• Loss of facial bone height
• Not preferred in cases of fenestrations and dehiscence

Mucogingival Surgery Long Essays

Question 1. Define periodontal plastic surgery. Describe procedures available to cover denuded root surfaces.
Answer:

Periodontal plastic surgery Definition:

• Surgical procedures are performed to correct/eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa.

Periodontal plastic surgery Procedures For Root Coverage:

Periodontal plastic surgery Conventional Procedures

1. Laterally displaced flap:

Recipient site:

Periodontal plastic surgery  Donor site:

• Transfer the flap to the recipient site
• Suturing of flap
• Placement of periodontal pack

2. Double papilla flap:

By Wainberg:

• Dissecting both facial and lingual papilla

3. Coronally-repositioned flap:

Regenerative Procedures:

Mucogingival Surgery Short Essays

Question 1. Free gingival graft
Answer:

• A free gingival graft is used to create a widened zone of attached gingiva

2. Variant techniques:

1. Accordion technique
   • Achieved by giving alternate incisions on opposite sides of the graft
2. Strip technique
   • Consists of 2 or 3 strips of tissue to cover the entire length of the recipient site
3. Connective tissue technique

Question 2. GTR.
Answer:

• After the flap surgery, epithelium from the excised margin. No need for donor site may proliferate apically

1. Classical technique of GTR:

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• This results in the formation of long junctional epithelium
• Thus this should be prevented
• To prevent this, a membrane is placed between healing connective tissue and cementum
• Such a membrane is GTR (Guided Tissue Regeneration)

Types of GTR:

• Degradable- Collagen, Guidor membrane
• Non-degradable- Millipore, Teflon membrane

GTR Indications:

• Esthetic demand
• In single tooth with wide deep localized recession
• In the presence of root sensitivity
• In recession associated with class V restorations

GTR Advantages:

• No need for a donor site
• Highly esthetic
• Disadvantages:
• Technique sensitive
• Expensive

GTR Technique:

• The incision along with releasing incisions extending

Question 3. Coronally displaced flap
Answer:

Coronally displaced flap Indications:

• Esthetic coverage of exposed roots
• Gingival recession

Coronally displaced flap Advantages:

• Treatment of multiple areas
• Adjacent teeth are safe
• The high degree of success
• It does not increase the existing problem

Coronally displaced flap Disadvantages:

• No need for two surgical procedures

Coronally displaced flap Technique:

Mucogingival Surgery Short Question And Answers

Question 1. Frenectomy.
Answer:

• It is the complete removal of the frenum including its at-attachment to the underlying bone

Frenectomy Technique:

Question 2. Mucogingival Problems.
Answer:

• Deep pockets
• Recession
• High frenal attachment
• Inadequate width of attached gingiva

Question 3. Indications of Mucogingival surgery.
Answer:

• Augmentation of the edentulous ridge
• Prevention of Residual Ridge Resorption (R)
• Crown – lengthening
• Esthetic purpose

Question 4. Frenectomy and frenotomy
Answer:

Frenectomy:

• It is the complete removal of the frenum including attachment to the underlying bone

Frenotomy:

• It is the relocation of the frenum usually in a more apical position

Frenectomy Indications:

• Esthetic purposes
• Deepening of vestibule in mandibular anterior area

Frenectomy Technique:

Question 5. High frenal attachment
Answer:

• High frenal attachment is a condition where the frenum is. attached too close to marginal gingiva.

High frenal attachment Etiology:

• Genetic
• Gingival recession

High frenal attachment Effects:

• Tension on frenum
• Plaque accumulation
• Inhibit proper placement of toothbrush
• Poor oral hygiene
• Deep maxillary anterior vestibule
• Esthetic problems

Question 6. Vestibuloplasty.
Answer:

• It is a procedure for vestibule extension
• As described by Edlan and Mejchar

High frenal attachment Technique:

Two vertical incisions are given from the junction of marginal and attached gingiva to approx 12 mm from the alveolar margin into the vestibule

High frenal attachment Types:

1. Labial vestibuloplasty
2. Lingual vestibuloplasty

Question 7. Objectives of mucogingival surgery
Answer:

• Widening of attached gingiva
• Coverage of denuded roots
• Removal of an aberrant frenum
• Creation of some vestibular depth
• As an adjunct to routine pocket elimination procedure

Mucogingival Surgery Viva Voce

1. Surgical removal of the frenum is indicated when tension on the frenum may tend to open the sulcus
2. The ideal thickness of a free gingival autograft is 1-1.5 mm
3. Revascularization of a free gingival autograft starts from 2nd or 3rd day
4. The central portion of the free gingival margin is last to vascularize
5. Healing of free gingival autograft of intermediate thickness of 0.75 mm is completed by 10.5 weeks
6. After 24 weeks free gingival autograft placed on de- nude bone shrink by 25%

 

Osseous Surgery Definition

Respective osseous surgery

• It is defined as a procedure by which changes in the alveolar bone can be accomplished to rid it of deformities in- duced by the periodontal disease process or other related factors such as exostosis and tooth supra eruption.

Osteoplasty

• It is the reshaping of bone without removing tooth-supporting bone

Ostectomy

• It is the removal of tooth-supporting bone

Osseous Surgery Definition Important Notes

1. Types of grafts

 

2. Indications for resection osseous surgery

• Interdental craters
• One wall osseous defects
• Wide shallow two-wall defects
• Exostosis
• Supra erupted teeth

3. Guided tissue regeneration, GTR

• It is based on the assumption that only the periodontal ligament cells have the potential for regeneration of the attachment apparatus of the tooth
• The technique consists of placing barriers of different types to cover the bone and periodontal ligament to prevent the migration of epithelium

4. Bioglass

• It is an alloplastic or non-graft material
• It consists of sodium and calcium salts, phosphates and silicon dioxide

5. Types of membranes of GTR

6. Steps in osseous resection surgery

• Vertical grooving
• Radicular blending
• Flattening interproximal bone
• Gradualizing marginal bone

Osseous Surgery Long Essay

Question 1. Define Respective Osseous Surgery. Mention its indication, contraindications and steps involved in it.
Answer:

Respective Osseous Surgery Definition:

• It is defined as a procedure by which changes in the alveolar bone can be accomplished to rid it of deformities in- duced by the periodontal disease process or other related as exostosis and tooth supra eruption.

Respective Osseous Surgery Indications:

• One wall defect
• Thick bony margins

Respective Osseous Surgery  Shallow Crater:

Contraindication:

Respective Osseous Surgery  Orally:

• Improper oral hygiene
• High DMFT

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• Dentinal Hypersensitivity
• Advanced Periodontitis

Respective Osseous Surgery Steps:

1. Vertical Grooving
2. Radicular blending
3. Flattening of interproximal bone

4. Gradualizing marginal bone

• Following these steps

Question 2. Classify bone replacement grafts and describe the merits and demerits of each type
Answer:

Classification of replacement grafts:

replacement grafts Autogenous bone grafts:

1. Bone from intraoral sites:

• Osseous coagulum
• Bone blend
• Intraoral cancellous bone marrow transplants
• Bone swaging

2. Bone from extraoral sites:

• Iliac autograft

replacement grafts Allografts:

• Undecalcified freeze-dried bone allograft
• Demineralized freeze-dried bone allograft

replacement grafts Xenografts:

Non-bone graft materials:

• Sclera
• Cartilage
• Plaster of Paris
• Plastic materials
• Calcium phosphate biomaterials
• Bioactive glass
• Coral derived materials
• Bioactive glass

 

Question 3. Define osseous surgery. Discuss various osseous grafting procedures.
Answer:

 Osseous grafting Definition:

• It is defined as a procedure by which changes in the alveolar bone can be accomplished to rid it of deformities in- duced by the periodontal disease process or other related factors such as exostosis and tooth supra eruption

 Osseous grafting Procedures:

1. Osseous coagulum:

• Donor Sites:
• Lingual ridge
• Exostoses
• Edentulous ridges
• Bone distal to terminal tooth

 Osseous grafting Technique:

Bone is removed from the donor site by carbide bur

2. Bone blend:

3. Cancellous bone marrow transplants:

4. Bone swaging:

• Bone from an edentulous area adjacent to the defect is pushed into contact with the root surface without fracturing the bone at its base

5. Allografts:

Question 4. Describe in brief various reconstructive Osseous techniques.
Answer:

 Osseous Techniques Reconstructive Osseous Surgery:

 Osseous techniques Non-Graft associated new attachment.

1. Removal of Junctional/Pocket Epithelium through the following

• Curettage
• Chemical agents
  • Sodium sulfide
  • Phenol
  • Camphor
  • Antiform
• Ultrasonic methods- Lacks tactile sensation
• Surgical methods
  • ENAP
  • Gingivectomy
  • Widman flap
  • Coronally displaced flap

2. Prevention of Epithelial Migration.

1. GTR
   • Degradable – Collagen
   • Non-degradable – Millipore
2. Clot stabilization, wound protection and space creation by
   • Grafts
   • Membranes
3. Coronally displaced flap
4. Root conditioners
   • Citric acid
   • Fibronectin
   • Tetracycline

3. Growth Factors (GF)

• Regulates events in wound healing
• Example: Platelet-derived GF
  • Insulin-like GF

4. Enamel Matrix Proteins

• Favours periodontal regeneration

 Osseous techniques Graft-associated new attachment

1. Allografts:

• Tissue transfer between individuals of the same species

2. Xenografts:

• Grafts from different species
• Causes severe allergic reactions

3. Alloplasts:

• For restoration of the periodontium
• Example: Sclera, dura, Cartilage

 Osseous techniques Combined techniques

• Combination of both graft and non-graft-associated methods

Osseous Surgery Short Essays

Question 1. GTR (Guided Tissue Regeneration).
Answer:

• After the flap surgery, epithelium from excised margin may proliferate apically.
• This results in the formation of long Junctional epithelium
• Thus this should be prevented
• To prevent this, a membrane is placed between healing connective tissue and cementum
• Such a membrane is (GTR)

Types:

• Degradable – Collagen, Guidor membrane
• Nondegradable – Millipore, Teflon membrane

Procedure:

Question 3. Root conditioners/Root Biomodification effects.
Answer:

Effects:

Examples:

• Citric acid at pH 1
• Fibronectin
• Tetracycline

Procedure:

Question 3. Non-bone graft materials
Answer:

Non-Bone Graft Materials:

1. Sclera
2. Cartilage
3. Plaster of Paris
   • Calcium sulphate
4. Plastic materials
   • Hard tissue replacement
5. Calcium phosphate biomaterials
   • Hydroxyapatite
   • Tricalcium phosphate
   • Calcitite
6. Bioactive glass-consists of
   • Sodium and calcium
   • Phosphates
   • Silicon dioxide
7. Coral derived materials
   • Natural coral material
   • Coral derived porous hydroxyapatite

Question 4. Define osteotomy and osteoplasty. Explain how they differ from each other.
Answer:

Ostectomy:

• It is a procedure of radicular and inter-radicular removal of supporting bone to eliminate osseous deformities
• It is done by a technique which involves the removal of supporting bone to produce a positive gingival and osseous architecture

Ostectomy Indications:

• To reduce hemisepta-like defects and shallow intrabony defects
• To correct reverse architecture induces by periodontal disease
• Moderate to advanced furcation involvements
• Elimination of interdental craters
• Intrabony defects not amenable to regeneration

Ostectomy Contraindications:

• Anatomic limitations like prominent external oblique ridge or zygomatic arch, etc
• Esthetic limitations like high smile line anteriorly
• Availability of effective alternative treatment
• Areas of insufficient remaining attachment

Ostectomy Advantages:

• Pocket elimination
• Establishment of physiologic gingival and osseous architecture
• Establishment of favourable prosthetic environment Loss of attachment
• Increased root sensitivity
• Esthetic compromise

Ostectomy Osteoplasty:

• It is described by Friedman in 1955
• It is a procedure of reshaping the alveolar process to achieve a more physiological form without the removal of supporting bone

Ostectomy Indications:

• Removal of buccal and lingual bony ledges or tori
• Pocket elimination
• Shallow intrabony defects
• Shallow craters
• Thick interproximal areas
• Incipient furcation defects that do not necessitate re-moving supporting bone
• Buttressing bone formation or lipping

Question 5. Allograft
Answer:

• Allografts are tissue transfer between individuals of the same species but with different genetic composition

Allograft Commercial products

• FDBA (Freeze Dried Bone Allograft)-osteoconductive
• DFDBA (Demineralized Freeze-Dried Bone Allograft)

Allograft Disadvantages:

• Foreign to the patient
• Provokes immune response

Osseous Surgery Short Question And Answers

Question 1. Types of Osseous Surgery.
Answer:

1. Depending on the relative position of interdental to radicular bone

• Positive Architecture
  • Radicular bone apical to interdental bone.
• Negative Architecture
  • Interdental bone apical to radicular bone.
• Flat Architecture
  • Interdental & radicular bone reduced up to the same height.
• Ideal
  • Interproximal bone is coronal to that of facial/lingual surfaces.

2. Depending on the thoroughness of the techniques

• Definitive osseous reshaping
  • Further reshaping would not improve the overall result.
• Compromise osseous reshaping
  • Requires osteotomy procedures.

3. Additive-Restores bone to original levels

• Subtractive Restores bone to the level existing at the time of surgery or apical to it.

Question 2. Instruments of Osseous Surgery.
Answer:

Osseous Surgery Hand Instruments:

• Ronguers Freidman & Blumental
• Interproximal files – Schluger & Sugarman
• Back action chisels
• Oschsenbein chisels

Osseous Surgery Rotary:

• Carbide round burs
• Slow-speed handpiece
• Diamond burs

Question 3. Growth Factors.
Answer:

• They are polypeptide molecules released by the cells in osteoinductive the inflamed area

Growth Factors Secreted by…

• Macrophages
• Endothelial cells
• Fibroblasts
• Platelets

Growth Factors Effects:

• Regulates events in wound healing
• Promotes proliferation of fibroblasts
• Favours bone formation

Growth Factors Examples:

• Platelet-derived growth factors (PDGF)
• Insulin-like growth factor (IGF)
• Fibroblast growth factor (FGF)

Question 4. Enamel Matrix Proteins.
Answer:

• Namely, amelogenin is secreted by Hertwigs Epithelial root sheath during tooth development and induces accel-cellular cementum formation.

Matrix Proteins Actions:

• Enhance periodontal regeneration
• Promote bone cell attachment
• Increases proliferation of more immature bone cells
• It is not osteoinductive, but it is osteopromotive in that it stimulates bone formation when combined with demineralized freeze-dried bone allograft.

Question 5. Osseous Coagulum.
Answer:

Osseous Coagulum Technique:

Osseous Coagulum  Donor Site:

• Lingual ridge on mandible
• Exostosis or tori
• Edentulous ridges
• Bone distal to the terminal tooth.

Osseous Coagulum  Advantages:

• Better resorbed
• Provides additional surface area

Osseous Coagulum  Disadvantages:

• Low predictability
• Poor visibility

Question 6. Bone Swaging.
Answer:

Bone Swaging Requirement:

• An edentulous area adjacent to the defect

Bone Swaging Procedure:

• Push the bone of the edentulous area into the defect
• Avoid fracture of basal bone

Bone Swaging Disadvantage:

• Complicated procedure
• Limited use

Question 7. Positive architecture
Answer:

• When Radicular bone is present apical to interdental bone it is called positive architecture

Question 8. Define root planning.
Answer:

• Root planning is a process by which residual embedded calculus and a portion of cementum are removed from the roots to produce a smooth, hard and clean surface

Question 9. Reversed architecture.
Answer:

• The loss of interdental bone produces these defects including the facial and lingual plates without concomitant loss of radicular bone, thereby reversing normal architecture
• Normally interproximal bone is coronal to facial and lingual plates forming a scalloped osseous margin
• When the loss of interdental bone occurs without significant loss of radicular bone, normal scalloping gets reversed
• It is more common in the maxilla

Question 10. Osteoplasty
Answer:

• It is described by Friedman in 1955
• It is a procedure of reshaping the alveolar process to achieve a more physiological form without the removal of supporting bone

 Osteoplasty Indications:

• Removal of buccal and lingual bony ledges or tori
• Pocket elimination
• Shallow intrabony defects
• Shallow craters
• Thick interproximal areas
• Incipient furcation defects that do not necessitate re-moving supporting bone
• Buttressing bone formation or lipping

Question 11. Ostectomy
Answer:

• It is a procedure of radicular and inter-radicular removal of supporting bone to eliminate osseous deformities
• It is done by a technique which involves the removal of supporting bone to produce a positive gingival and osseous architecture

Ostectomy Indications:

• To reduce hemisepta-like defects and shallow intrabony defects
• To correct reverse architecture induces by periodontal disease
• Moderate to advanced furcation involvements
• Elimination of interdental craters
• Intrabony defects not amenable to regeneration

Question 12. Allografts.
Answer:

• Tissue transfer between individuals of the same species but with different genetic composition

Allografts Commercial Products

 Allografts Name – Effect

1. FDBA [Freeze dried Bone allograft]

• Osteoconductive
• 50% bone file

2. DFDBA [Demineralized Freeze-dried bone allograft]

• Osteoinductive

Question 13. Define osteoconduction and osteoinduction.
Answer:

Osteoconduction: It is an effect by which the matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone

Osteoinduction: A process by which graft material is capable of promoting cementogenesis, osteogenesis and new periodontal ligament.

Osseous Surgery Definition Viva Voce

1. The goal of osseous therapy is to reshape marginal bone
2. Respective osseous surgery is performed in combination with apically displaced flap
3. Interproximal bone normally is pyramidal in shape
4. The level of interdental bone is the same as that of radicular bone in a flat architecture
5. The buccolingual contour of the interdental bone in the pose- ous crater appears as that of the opposite of CEJ
6. Gore-tex is a PTFE membrane
7. Biobrane is a synthetic skin
8. Emdogain is an enamel matrix protein
9. Graft from different individuals from the same species is called allograft
10. Enamel matrix protein is osteoconductive
11. Boplant is xenograft
12. The osseous coagulum is a mixture of bone dust and blood
13. Flap best suited for grafting is the papilla preservation flap
14. Plaster of Paris resorbs completely in 1-2

Periodontal Flap Definition

Periodontal flap

• It is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and the root surface

Periodontal Flap Important Notes

1. Basic requirements of flap

• It should provide adequate exposure to the surgical area
• The flap must have a broad base and good vascular supply
• When placed back after surgery flap should rest on healthy bone

2. Advantages of the flap technique

• Provides adequate visibility and accessibility to the root deposit
• Eliminates or reduces pocket depth
• Expose the area to perform regenerative procedures

3. Condition and the preferred flap

4. Apically displaced flap

• It can be used for pocket elimination or widening the zone of attached gingival
• The pocket wall is transformed into an attached gingival
• It increases the length of the clinical crown and is not indicated for palatal pockets
• The width of the attached gingiva is increased by approximately half the pretreatment pocket depth

Periodontal Flap Long Essays

Question 1. Define periodontal flap. Classify and describe in detail the modified Widman flap.
Answer:

Periodontal Flap:

It is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and the root surface

Classification of Periodontal Flap: 

1. According to the thickness of the flap
   • Full thickness flap
   • Partial thickness flap
2. According to the placement of the flap
   • Non displaced flap
   • Displaced flap
3. According to the design of the flap
   • Conventional flap
   • Papilla Preservation flap

Modified Widman Flap:

• By Ramfjord & Nissle

Periodontal Flap Indication:

• Accessibility to root surfaces
• Pocket lining removal

Periodontal Flap Technique:

Periodontal Flap Short Essays

Question 1. Classification of periodontal flaps.
Answer:

According to Thickness of Flap

Read And Learn More: Periodontics Question and Answers

According to the placement of Flap

1. Non-displaced flap:
   • The flap is returned and sutured in its original position
2. Displaced flap:
   • The flap is placed apically, coronally, or laterally to its original position.

According to the management of the papilla

1. Conventional flap:
   • The interdental papilla is split beneath the contact point between the teeth
   • Modified Widman flap is a conventional flap
   • Indications:
   • Narrow interdental area
2. Papilla preservation flap:
   • It incorporates the entire papilla
   • Indications:
   • Esthetics
   • Regenerative procedures

 

Question 2. Types of periodontal flap surgical procedures for pocket therapy. Describe the apically displaced flap.
Answer:

Periodontal Flap:

• It is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface

Periodontal Flap Types Of Flap For Pocket Therapy:

• Modified Widman flap
• Undisplaced flap
• Apically displaced flap

Periodontal Flap Apically Displaced Flap:

• It is described by Friedman

Periodontal Flap Indications:

• Elimination of pocket
• Better accessibility
• Widening of attached gingiva

Periodontal Flap Technique:

Question 3. Classify periodontal flaps and give indications of periodontal flap surgery.
Answer:

Periodontal flap surgery:

It is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface

Classification of periodontal flap surgery:

1. According to the thickness of the flap

• Full thickness flap
• Partial thickness flap

2. According to the placement of the flap

• Non displaced flap
• Displaced flap

3. According to the design of the flap

Conventional flap

Papilla preservation flap

periodontal flap surgery Indications Of Flap Surgery

• To increase accessibility to root deposits
• To eliminate or reduce pocket depth by resectioning the pocket wall
• To expose the area to perform regenerative methods
• To reshape soft and hard tissues to physiologic architecture

Question 4. Apically Displaced flap.
Answer:

• By Friedman

Displaced flap Indications:

• Elimination of pocket
• Better accessibility
• Widening of attached gingiva

Displaced flap Technique:

Question 5. Incisions.
Answer:

Horizontal incision:

1. Internal bevel incision:

• Extend: Marginal gingiva to the bone crest
• Synonyms: First incision
• Reverse bevel incision
• Advantages: Eliminates pocket
  • Preserves remaining structures
  • Provides good adaptation of tooth to bone
• The blade used: No. 15 and 11 – surgical scalpels

2. Crevicular incision:

1. Second incision
   • Extend – Base of the pocket to the crest of bone
   • Blade – No.12B
   • Effect – Formation of tissue wedge

Interdental incision:

• Third incision
• Purpose to separate the collar of the gingiva
• An instrument used – Orban knife

Vertical Incision:

1. On either side of the horizontal incision
   • Extend – Beyond the mucogingival junction
2. Indications: Displaced flap
   • Isolated deep pockets

Periodontal Flap Definition Short Question And Answers

Question 1. Envelope flap.
Answer:

• A flap with only a horizontal incision without any releasing incisions given is called an envelope flap
  Indication: Undisplaced flap

Question 2. Indications of Flap Surgery.
Answer:

• Root debridement
• Pocket elimination
• Reshaping of tissue
• Regenerative procedures

Question 3. Papilla Preservation flap.
Answer:

Reservation flap By Takei et. Al & Cortellini

Reservation flap Technique:

 

Reservation flap  Advantages:

• Esthetic
• No root exposure
• No post-operative sensitivity

Question 4. Healing after flap surgery.
Answer:

Question 5. Name horizontal incisions for flap surgery.
Answer:

1. Internal bevel incision:

• It extends from the marginal gingiva to the bone crest

Flap surgery Synonym:

• First incision
• Reverse bevel incision

Flap surgery Advantages:

• Eliminates pocket
• Preserves remaining structures
• Provides good adaptation of tooth to the bone

Flap surgery Blade Used:

• No. 15 and 11, surgical scalpels

2. Crevicular incision:

• It is the second incision
• It extends from the base of the pocket to the crest of bone

Flap surgery Blade Used:

• No 12B is used

Flap surgery Effect:

• It leads to the formation of tissue wedge

3. Interdental incision:

• It is the third incision
• It is used to separate the collar of the gingiva

Flap surgery Instrument Used:

• Orban knife

Question 7. Two advantages and disadvantages of lateral pedicle graft.
Answer:

lateral pedicle graft Advantages:

• One surgical site
• Good vascularity

lateral pedicle graft Disadvantages:

• Risk of gingival recession at the donor site
• Dehiscence or fenestration at the donor site

Question 8. Indications and contraindications of lateral pedicle graft.
Answer:

lateral pedicle graft Indications:

• Isolated denuded root
• Sufficient vestibular depth
• Sufficient width of interdental papilla

lateral pedicle graft Contraindications:

• Deep pockets
• Prominent root surfaces
• Loss of interproximal bone

Periodontal Flap Viva Voce

1. Apically displaced flaps cannot be performed in the palatal aspect of maxillary posterior teeth
2. Unattached gingiva is absent in the palatal aspect of maxillary posterior teeth
3. Widening of the attached gingiva as well as pocket elimination is accomplished by apically displaced flap
4. An internal bevel incision is also called a reverse bevel incision
5. The second incision in the periodontal flap is a crevicular incision
6. The interdental incision is called the third incision
7. After flap surgery fully epithelized gingival crevice occurs after 1 month.
8. An undisplaced flap is essentially an excisional procedure of the gingival

Gingivectomy Definition

• Gingivectomy
• Excision of the soft tissue wall of the pocket

Gingivectomy Important Notes

1. Indications of gingivectomy

• Elimination of supra bony pockets if the pocket wall is fibrous
• Elimination of gingival enlargements
• Elimination of supra bony periodontal abscess

2. Contra indications of gingivectomy

• The need for bone surgery or for examination of bone shape and morphology
• The bottom of the pocket is apical to the mucogingival junction
• Aesthetic regions

3. Disadvantages of gingivectomy

• Long time to heal
• Loss of attached gingiva

4. Electrosurgery

• It can be used for gingivectomy, gingivoplasty, relocation of frenal attachments, incisions of periodontal abscess, and periocoronal flaps
• It is not used for procedures that involve proximity to the bone

Disadvantages:

• Cannot be used in poorly shielded cardiac pacemaker
• Causes unpleasant odor
• Necrosis of bone occurs if contact with bone occurs

Gingivectomy Long Essays

Question 1. Define Gingivectomy. Describe indications, contraindications, and their types. Write a note on a surgical procedure.
Answer:

Gingivectomy:

• Excision of the soft tissue wall of the pocket

Gingivectomy Indications:

• Eliminate – Suprabony pocket

1. Pseudo pockets
2. Fibrous gingival enlargement

• • Creates a physiological form of the gingiva
  • Improves esthetics
  • Creates bilateral symmetry
  • Subgingival restoration
  • Correction of gingival craters

Gingivectomy  Contraindications:

• Thick bony ridges
• Poor oral hygiene
• Infrabony pockets
• Un-cooperative patients
• Dentinal hypersensitivity
• Medically compromised patients

Gingivectomy  Types:

1. Surgical
2. Electrosurgery
3. Laser
4. Chemosurgery

Read And Learn More: Periodontics Question and Answers

Gingivectomy Surgical Gingivectomy Technique:

Gingivectomy Short Essays

Question 1. Electrosurgery.
Answer:

Electrosurgery Electrodes Used:

• Single wire
• Loop electrodes
• Heavy bulkier electrodes
• Frequency used-1.5-7.5 million cycles/second

Electrosurgery Indications:

• Gingival enlargements
• Gingivoplasty
• Frenectomy
• Periodontal abscess
• Periocoronal abscess

Electrosurgery Advantages:

• Adequate tissue contour
• Control of hemorrhage

Electrosurgery Disadvantages:

• Unpleasant odor
• Bone damage
• Tissue damage

Question 2. Gingivectomy
Answer:

Gingivectomy Definition:

• Gingivectomy is the excision of the soft tissue wall of the pocket

Gingivectomy Rationale:

• To provide good visibility and accessibility for complete calculus removal and thorough smoothening of roots
• To facilitate gingival healing by creating a favorable environment
• To restore physiological gingival contour

Gingivectomy Indications:

• Eliminates
  • Suprabony pocket
  • Pseudo pockets
  • Fibrous gingival enlargements
• Creates a physiological form of the gingiva
• Improves esthetics
• Creates bilateral symmetry Subgingival restoration
• Correction of gingival craters

Gingivectomy Contraindications:

• Thick bony ridges
• Poor oral hygiene
• Infrabony pockets
• Un-cooperative patients
• Dentinal hypersensitivity
• Medically compromised patients

Gingivectomy Types:

• Surgical
• Electrosurgery
• Laser
• Chemosurgery

Gingivectomy Short Question And Answers

Question 1. Healing after surgical Gingivectomy.
Answer:

Gingivectomy Steps:

Question 2. Periodontal instruments for Gingivectomy.
Answer:

• Mouth mirror, probe
• Pocket markers
• Interdental knives
• Kirkland & Orban
• Surgical blade with BP handle
• Curettes
• Tissue forceps and scissors
• Periodontal dressing

Question 3. Types of Electrosurgical Techniques.
Answer:

Question 4. Gingivectomy by chemosurgery.
Answer:

• Gingivectomy can be done using chemicals such as 5% paraformaldehyde or potassium hydroxide
• It is not used nowadays because of many disadvantages

chemosurgery Disadvantages:

• Depth of action cannot be controlled
• Injury to healthy attached tissue
• Gingival remodeling is not possible
• Delayed wound healing
• Slow epithelialization and reformation of junctional epithelium

Question 5. Electrosurgery.
Answer:

• Electrosurgery is a technique in which electric current is used for incisions

Electrosurgery Indications:

• Gingival enlargement
• Gingivoplasty
• Frenectomy
• Periodontal abscess
• Pericoronal abscess

Electrosurgery Advantages:

• Adequate tissue contour

Gingivectomy Viva Voce

1. Gingivectomy is not indicated in infra bony pockets
2. After gingivectomy, complete epithelisation of the surgical wound is completed in about 1 month
3. Connective tissue repair is completed in about 2 months
4. The maximum flow of gingival fluid occurs 1 week after a gingivectomy
5. Gingivectomy may be performed surgically by means of scalpels, electrodes, laser beams, or chemicals
6. Gingivectomy incision apical to the pocket markings should be directed coronally
7. Complete epithelial repair after gingivectomy takes about 1 month
8. Complete repair of connective tissue after gingiva- tomy takes about 7 weeks
9. GCF flow reached the maximum level after 7 days of gingivectomy