Aim of gingival curettage
To reduce pocket depth by...
1. Enhancing gingival shrinkage
2. New connective tissue attachment
3. Both of the above
Curettage
In periodontitis refers to the scraping of the gingival wall of a pocket to separate diseased soft tissue. Remove diseased pocket wall.
Scaling
refers to the removal of deposits from the root surface.
Planing
Refers to the smoothing of the root to remove necrotic or diseased tooth substance. The thought is glass like surface.
gingival curettage
Consists of the removal of the inflamed soft tissue lateral to the pocket wall.
Subgingival curettage
Refers to the procedure that is performed apical to the epithelial attachment, severing the CT attachment down to the osseous crest.
Inadvertent curettage
The
unintentional
removal of the pocket epithelium while performing scaling and root planning procedures.
Chronically
Curettage removes the __________ inflamed granulation tissue that forms in the lateral wall of the periodontal pocket.
Attachment of new fibers
The removal of granulation tissue and the deep strands in the epithelium, removes the barrier to what?
bacteria, resorbed
When the root is thoroughly planed, the major source of _________ is removed and the existing granulation tissue is ____________.
NO
Does scaling and root planning with curettage improve the condition of the perio pocket beyond SRP alone?
site-specific
The availability of _________-__________ drug therapies and guided tissue regeneration offer improved and more predictable results.
Indications for gingival curettage
1. To attempt to achieve new attachment in moderately deep intrabony pockets in accessible areas.
2. To reduce inflammation in patients preparing for surgical procedures or for those who more aggressive procedures are contraindicated.
3. At recall visits
against soft tissue
Where should the blade of a curette be placed when performing gingival curettage?
horizontal
What type of strokes should be made with curette during gingival curettage?
JE
After curettaging the pocket, the curette should be placed beneath the cut edge of the _____ to undermine it.
Subgingival
In _______ curettage, the pocket is removed with a scooping motion, the area is flushed to remove debris, and the tissue is partly adapted to the tooth by gentle pressure or possibly suturing the papilla and applying a perio. pack.
Ultrasonic
_________ curettage has been found effective for debriding the epithelial lining of pockets creating a necrotic band of tissue which strips off the inner lining of the pocket.
Inflammation, removal
Ultrasonic curettage tends to create less ________ and less ______ of underlying CT.
blood clot
Immediately after scaling and curettage a ______ ______ will form filling the pocket area and the tissue will appear bright red.
Hemorrhage
____________ provides abundant polymorphonuclear leukocytes on the ground surface.
Rapid proliferation
__________ ______ of the granulation tissue leads to a decrease in the number of small blood vessels.
2-7 days
Restoration of the sulcus requires _____-_____ days. Gingival height is reduced, but remains red in color.
21
Immature collagen fibers appear in how many days?
Long JE
End result of gingival curettage is a ________ ___ with no new connective tissue attachment.
2
After ___ weeks with good OH, the tissue color, consistency, and texture appear normal and the gingival margin is well adapted to the tooth.
Periodontal Abscesses
___________ ________ are common in patients with deep pockets. Exudate and purulent material gets trapped in the pocket with no pathway for drainage.
Vital
When dealing with a periodontal abscess is the tooth vital or nonvital?
Acute periodontal abscess
1. painful, edematous, red, shiny circular elevations on the gingival margin or the attached gingiva.
2. Tx- alleviate pain, control infection spread, establish drainage.
3. Antibiotics may be needed.
4. Drainage through an external incision is preferred.
Gingival abscess
A lesion of the marginal or interdental gingiva that is usually produced by an impacted foreign object. Will be red, smooth, painful (sometimes), and fluctuant in swelling.
EX: popcorn kernel
TX gingival abscess
Application of topical and local anesthetic, the lesion incised and the incision should be widened to allow for drainage. The area should be cleansed with warm water and covered with gauze. Patient should rinse with warm water every 2 hours. Reevaluate in
Surgically
If a residual lesion is still large it should be removed ___________.
periodontal abscess specifics
1. Associated with preexisting periodontal pocket, caries or both.
2. Pulp test is vital
3. Swelling generalized and located around the involved tooth and gingival margin. Seldom with a fistulous tract.
4. Pain is dull, constant, less severe. Pain is loca
pulpal abscess
1. Associated with deep restoration
2. Pulp test is nonvital
3. Swelling localized, fistulous opening in the apical area. May be located away from offended tooth.
4. Pain is usually severe, throbbing and may last for days. Pt. may not be able to locate of
Acute Periocoronitis
Inflammtion over a partially erupted tooth.
inflammation, systemic, retaining
The tx of periocoronitits is determined by the severity of __________, the __________ complication, and likelihood of __________ the involved tooth. Symptom free flaps should be removed to prevent against subsequent acute infections.
NUG
Periocoronal flaps are often referred to as primary incubation zones for _________.
pulpitis
Inflammation of the pulp
osteomyelitis
inflammation of bone and bone marrow.
bacterial infection
In the mandible and maxilla inflammation is usually the result of a ___________ ___________ that reaches the bone through non-vital teeth, periodontal lesions, or traumatic injuries.
osteomyelitis subtypes
1. pulpitis
2. periapical abscess
3. acute osteomyelitis
4. chronic osteomyelitis.
Features of the pulp making it fragile and susceptible to infection.
1. encased in hard tissue: dentin and enamel
2. No collateral circulation to maintain vitality when primary blood supply is compromised
3. biopsies and direct application of medication is impossible
4. pain is the only indicator of severity of inflammatio
referred pain
Why is it sometimes difficult to locate the affected tooth when dealing with pulpitis?
Pulpitis diagnosis
1. Results of heat, cold, electric, and percussion test.
2. Patient history
3. Clinical exam
4. Clinician experience
irreversible
The more intense the pain and the longer the duration of symptoms, the greater the damage and likelihood of __________ damage.
Etiology of pulpitis
Inflammation is the result of the injury. The pulpal response includes stimulation of odontoblasts to deposit reparative dentin. With severe injury-necrosis occurs.
Injuries leading to pulpitis
1. Caries is the most common cause
2. operative dental procedures: heat, friction, chemicals, and filling materials
3. Trauma
4. periodontal disease
Reversible pulpitis
1. Pain- mild
2. Vitality test- reversible sensitivity to cold
3. X-ray- No change
Acute pulpitis
1. Pain- Severe and constant
2. Vitality test- Hyperresponse or no response
3. X-rays- No change
Chronic pulpitis
1. Pain- Mild and intermittent
2. Vitality test- Reduced response
3. X-rays- No change
focal reversible pulpitis
_________ ________ ________ can recede returning the pulp to a normal state if the cause is identified and removed.
Endodontic Tx and extraction
What are the two options when treating a pulp with neutrophil infiltration and tissue necrosis?