*Golden - NBDE II - Incisions/ Flaps/ Grafts/ Healing/ Fractures/ Frenectomy

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