types of periodontal flaps (3)
modified widman flap
undisplaced flap
apical flap
modified widman flap (MWF)
instrumentation for root therapy
no pocket depth reduction but removes pocket lining --> pocket shrinkage bc healing
internal bevel incision
undisplaced flap
PD reduction
excisional procedure of gingiva = gingivectomy
internal bevel gingivectomy
final placement of flap determined by first incision
apical positioned flap
pocket elimination
(by apical position) and/or increases width of attached gingiva
best position is 2 mm apical to alveolar crest
internal bevel incision
perio flaps preferred for...
mandibular anteriors
lateral repositioning is done for...
gingival recession
least desirable location to place graft? why?
mand 1st PM space due to mental nerve
extrusion of canine, what flap to use?
apical repositioning flap
flap reflection with MWF is 2-3 mm where?
2-3 mm beyond the alveolar crest (NOT beyond the mucogingival line)
what incision to use for palatal tuberosity (max tori) reduction?
double Y
with a midline incision and anterior and posterior side arms extending bilaterally from the ends of the midline incision
where NOT to do apical positioning flap?
maxillary palatal area
distal wedge contraindication?
3rd M without attached gingiva (aka it is limited to the formation of the ramus)
bleeding points purpose?
guide for incision
how to fix gingival recession in anterior region?
pedicle graft
indications for gingivectomy?
gingival hyperplasia
supra bony pocket
contraindications for gingivectomy?
infrabony pockets
high smile line
little attached gingiva/ keratinized gingiva
base of incision of gingivectomy is located...
above the MGJ (mucogingival junction)
type of bevel used in gingivectomy
internal bevel incision (??)
how many mm does epithelium grow over CT per day?
0.5-1.0 mm/ day
How does external bevel gingivectomy heal?
secondary
primary healing = flap
secondary healing = SRP and reg gingivectomy
tertiary healing = tissue grafts
after gingivectomy (or flap or graft), how does the site heal?
epthelial attachment via
long junctional epithelium
and CT adhesion
goals of perio flap
regenerate PDL, cementum, bone
where does external bevel start?
starts at top of junctional epithelium
periodontal regeneration involves
sharpey's fibers, cementum, and alveolar bone
regeneration
type of healing which completely replicates the original architecture and function of a part
involves
formation of new cementum, PDL, and alveolar bone
repair
replacement of loss apparatus with scar tissue which does not completely restore the architecture or fxn of part replaced
involves
formation of long junctional epithelium
after flap surgery, where does repair occur?
PDL moves
occlusally
tooth has epithelium above CEJ, what flap to use?
undisplaced/ replaced flap
type of flap used in crown lengthening?
apical repositioning flap (with osteotomy and ostectomy)
tooth has RCT, post and core, and crown lengthening. why crown lengthening?
ferrule effect
to keep crown from falling off
most common OS incision
envelope flap
where should incision be for removal of mandibular tori?
fro gingival sulcus of the adjacent teeth
what has the largest effect on a flap?
final position of the flap
correction of inadequate zone of attached gingiva on several adjacent teeth is best done with...
FGG (free gingival graft)
during maintenance therapy, pt has recurrent 6 mm pockets. what's 1st tx option?
flap surgery
which flap to use to prevent exposure of dehiscence or fenestration?
partial or split thickness flap
split thickness flap involves...
epithelium
and
CT
(submucosa) but NOT periosteum
full thickness flap will result in
bone atrophy in thin periradicular bone
difference b/t regenerative vs flap surgery
regenerative surgery - to regenerate with bone graft
flap surgery - to get access for better SRP
donor site complication when performing free gingival graft (FGG)
damage to
greater palatine nerve bundle
FGG gets blood from
base 1st
what has ultimate effect on thickness of epithelium of FGG?
recipient CT
disadvantage of CT graft
2 surgical sites
only 4 mm of bone above max sinus on the alveolar ridge; how to do bone graft?
fill towards sinus
(NOT top of ridge)
which graft is best for sinus lift?
autogenous
and
alloplastic
autogenous bone graft defn
graft that uses pt's own bone taken from another site
best graft
autograft
xenograft
graft from a different species
bone grafts are usually taken from
iliac crest
which graft is
osteogenic
?
( alloplast / autograft / xenograft / allograft )
autograft
allograft
b/t members of SAME SPECIES
freeze dried cadaver bone is
allograft
decalcified FDB allograft
has
bone morphogenetic proteins (
BMPs
)
osteoconductive
(alloplast/ xenograft/ allograft/ autograft)
all 4
osteoinductive
(alloplast/ xenograft/ allograft/ autograft)
allograft and autograft
osteoinduction induces bone growth
which will least likely need bone graft?
( 1 wall/ 2 wall/ 3 wall wide/ 3 wall narrow)
3 wall narrow
Purpose of lateral graft (pedicle graft)?
for gingival recession
recession for a single tooth, how to treat?
FGG
8 y.o. with anterior crossbite and recession; which tx?
pedicle graft
which tooth is contraindicated in a grafting procedure?
MAX canine (or mand 1st PM)
best prognosis for a GTR?
3 wall defect
or class II furcation
purpose of GTR
surgical procedure to promote new growth of tissue by BLOCKING long junctional epithelium migration of PDL cells to allow cells from the PDL and bone to re-populate the perio defect
3 needs for GTR
bone, sharpey's fibers, and cementum
tx for type III furcation
hemisection for mand molar
root amputation for max molar
how to treat endo treated mand molar?
hemisection, place 2 crowns to act as 2 PMs
hemisection with ONE wall remaining is called
hemiseptum
elevator is OS acts as a
lever
indication for perio/surgical dressing
protect
the wound
after perio surgery, what type of healing most of the time?
repair
restore/ regeneration VS repair
regen - PDL, bone, cementum
repair - LJE and CT
environmental factor that alters healing
smoking
most common complication after extraction
dry socket (alveolar osteitis)
what causes dry socket?
fibrinolysis of blood clot
how to treat dry socket?
medicated dressing, no need for antibiotics
key sign in mandibular fracture
occlusal discrepancy
pt has condylar fracture; what happens when mandible grows?
asymmetric growth w
damaged side lagging
primary consequence of trauma to child's jaw
midline asymmetry and retards growth
most common area of fracture in kids
condyle
how long to splint closed bone fracture (MMF = maxillomandibular fixation)
6 weeks
lower lip numbness is seen in what kind of mandibular fracture?
angle fracture
lefort fracture I is associated with...
maxillary sinus
Guerin's is a sign of...
lefort I
guerin's sign = ecchymosis in the region of greater palatine vessel
lefort I
brings lower midface forward
floating palate
lefort II
separation of the maxilla, attached nasal complex from the orbital and zygomatic fractures
floating maxilla
lefort III
nasoethmoidal complex, the zygomas, and the maxilla from the cranial base which results in craniofacial separation
floating face
most common injured nerve in lefort II
infraorbital nerve
subjunctival hemorrhage is seen in which fracture?
zygomaticomaxillary complex
pt has numbness of upper left lip, cheek, and left side of the nose following midface fracture. this symptom follows a fracture through the...
infraorbital rim
most common fracture in the face
zygomaticocomplex fracture
what age does mandibular symphysis fuse?
6-9 months
if there is fracture in left body of mandible, where will other fracture be?
right condyle - contralateral condylar fracture
most common fracture = condyle, angle of mandible
least common = coronoid, ramus of mandible
x-rays to confirm horizontal fracture
multiple
vertical
angulated x-rays
x-ray for maxillary sinus
waters
x-ray for zygomatic process
SMV
= submentovertex
best x-ray for mandible fracture
pano
x-ray for condylar fracture
reverse towne's
x-ray for zygomatic fractures
submentovertex (
SMV
)
10 y.o. kid has diastema, how to treat?
wait until perm canines have erupted
, close diastema w ortho, do frenectomy
all are risks for ortho tx except...
( frenal diplacement / plaque mgmt / bone loss / resorption )
frenal displacement
modifying labial frenum: why is Z-plasty superior to diamond technique?
it decreases the effects of scar contracture