What substance does S. sanguis produce that inhibits the pathogenesis of periodontal disease?
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H2O2 (Hydrogen Peroxide)
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What substance does S. sanguis produce that inhibits the pathogenesis of periodontal disease?
H2O2 (Hydrogen Peroxide)
What are the key components of health according to the WHO?
Complete physical, mental, and social well-being.
What does the 2018 Classification address in terms of periodontal health?
Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium.
What is the status of the periodontium in health?
The periodontium is intact and exhibits complete physical, mental, and social well-being.
What major change was made in the 2018 classification of periodontitis?
The chronic and aggressive classifications from Armitage 1999 were merged into a single classification called 'periodontitis'.
Where are accessory and furcation canals commonly found?
In furcal areas.
What does Stage IV Grade C periodontitis indicate?
It indicates aggressive periodontitis with a molar-incisor pattern.
What is the incidence of lesions developing in the marginal periodontium from accessory and furcation canals?
It seems to be low.
What are the two main criteria for staging periodontitis?
Severity of disease and anticipated complexity of management.
Are microbes consistent between endodontic infections and deep periodontal pockets?
Yes, microbes are consistent between endodontic infections and deep periodontal pockets.
What is the main distinction between Stage III and Stage IV periodontitis?
The distinction is mainly based on the complexity of management, such as a high level of mobility indicating Stage IV.
Do endodontic lesions often involve the marginal periodontium?
No, endodontic lesions rarely involve the marginal periodontium unless abscessed.
What type of epithelium regenerates during healing from oral epithelium?
Oral epithelium
What factors are considered in grading periodontitis?
Rate of disease progression, risk of further progression, potential responsiveness to standard therapy, and effect on general health.
What is the prognosis if there is communication between endodontic and periodontal lesions?
The prognosis is poor to hopeless.
What are the two components of the basement membrane between epithelium and underlying connective tissue?
Lamina densa and Lamina lucida
What is the default grade for periodontitis?
Grade B is the default.
What factors influence the prognosis of a tooth with endodontic and periodontal communication?
Factors include the cause, level of attachment loss (LOA), healing response, oral hygiene, supportive periodontal therapy (SPT) compliance, restoration longevity, and skill of the clinician.
What does the periodontal ligament (PDL) connect?
Bone to cementum
What is the histological state of pristine gingiva?
Histological perfection is a theoretical concept with no infiltrate and continuous sparse neutrophil migration into the coronal JE and crevice.
Name three types of cells found in connective tissue (CT).
Fibroblasts, cementoblasts, osteoblasts/clasts
Why is exposure of subgingival caries contraindicated in the aesthetic zone?
Because it can lead to recession of papillae and margins.
What are some examples of benign neoplastic lesions in the oral cavity?
Fibromas, papillomas, peripheral and central granulomas, leukoplakia, gingival cyst.
What are the clinical characteristics of pristine gingiva?
Sulcus < 3mm, pink, firm, scalloped outline, no bleeding, stippled, knife-edge margin.
What arteries supply blood to the teeth and periodontal tissues?
Superior/inferior dental artery, dental artery, intraseptal artery, rami perforantes.
List three types of immune cells found in the periodontium.
Neutrophils, lymphocytes, macrophages
What are the two methods of orthodontic extrusion mentioned?
Slow if bone surgery is involved, and rapid if orthodontic extrusion is combined with fibrectomy.
What is the recommended review period after managing the acute phase of a periodontal condition?
48 hours (Rincon says 24-48, eTG says 48-72)
What are some examples of malignant neoplastic lesions in the oral cavity?
Carcinoma (e.g., squamous cell carcinoma), melanoma.
What cellular activity is observed in clinically healthy gingiva?
Some PMNs in JE and sulcus, lymphocytic infiltrate 5% of CT, pro-inflammatory cytokines leading to vasodilation.
Which arteries contribute to the blood supply of the gingiva?
Sublingual, Mental, Buccal, Facial, Greater palatine, Intraorbital, Posterior superior dental artery.
What are the principal fibres of the periodontal ligament?
Alveolar crest fibres, horizontal fibres, oblique fibres, (peri)apical fibres
Name a rare disease that can directly manifest as periodontitis.
Papillion-Lefèvre Syndrome
What are some restorative considerations for root-resected teeth?
Remove overhang, avoid convexities, reduce occlusal table, and use a metal finishing line.
What is SRD and when should it ideally be performed?
SRD stands for Scaling and Root Debridement, and it should ideally be performed at the first appointment, depending on the patient's pain level.
What does the clinical attachment level indicate?
It tells you where the bone is by measuring the level of the bottom of the pocket (depth in relation to soft tissue) relative to the cementoenamel junction (CEJ).
How do the blood vessels of the gingiva anastomose?
They anastomose with alveolar bone and PDL vessels.
What vascular changes occur in clinically healthy gingiva?
Increased hydrostatic pressure and vascular permeability leading to exudate into CT and increased GCF flow.
What are Sharpey's fibres?
The part of the fibres embedded in cementum and bone
What happens to the junctional epithelium (JE) during the established gingivitis lesion stage?
The JE detaches from the tooth, forming pocket epithelium that is ulcerated and more permeable, allowing further apical migration of biofilm.
What is a neoplasm that can manifest as periodontitis?
Squamous Cell Carcinoma (SCC)
What are the different pontic designs mentioned?
Sanitary, (Modified) Ridge lap, Ovate, and Conical.
What are some corrective treatments to restore normal gingival topography?
Corrective treatments include gingivectomy, gingivoplasty, and regenerative/respective surgery.
What tool is used to grade furcations in periodontal examination?
Naber’s probe.
What tissue changes are observed in early gingivitis?
Loss of collagen, fibroblast degeneration, rete peg proliferation in coronal JE, clinical signs like BOP and marginal erythema.
What are the clinical signs of established gingivitis?
Bleeding on probing (BOP), increased oedema, and changes in color and contour indicating moderate to severe inflammation.
Which rare disease associated with periodontitis involves a deficiency in leucocyte adhesion?
Leucocyte adhesion deficiency
What are some techniques for alveolar ridge reconstruction?
Rolled flap, Pouch graft, (Combined) Onlay graft, and GBR.
What is the management approach for Grade 1 horizontal bone loss?
Scaling and root debridement (ultrasonic), odontoplasty (reshaping crown).
What is a periodontal abscess?
A periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus due to an inflammatory process that attracts PMNs.
What cellular activity is predominant in early gingivitis?
PMNs predominate, infiltrate 15% of CT, lymphocytes and plasma cells appear.
What percentage of connective tissue (CT) is infiltrated during the established gingivitis stage?
30% of the connective tissue is infiltrated.
What is the recommended treatment for Class I periodontal disease?
Non-surgical debridement with ultrasonic tools.
What is the role of diabetes and smoking in periodontitis?
They are modifying factors, not diagnoses.
What factors are essential for aesthetic tissue management in interproximal embrasures?
Interproximal embrasures, tooth contact, and papilla.
What is the management approach for Grade 2 horizontal bone loss?
Tunnel preparation, open flap debridement, root resection, guided tissue regeneration (especially for mandibular molars).
What are some causes of a periodontal abscess?
Causes include foreign body impaction, bacterial invasion, and underlying systemic diseases such as diabetes.
What vascular changes are seen in early gingivitis?
Vessels in dento-gingival plexus remain dilated, increased vascular proliferation with looping and activation of previously inactive capillary beds.
What type of cells increase in number during the established gingivitis stage?
Plasma cells (10-30% infiltrate) and B cells increase.
Does diabetic periodontitis have unique phenotypic features?
No, there are no unique phenotypic features unique to diabetic periodontitis.
What additional treatment is recommended for Class II/III periodontal disease?
Debridement with surgery.
What are the average measurements for papilla height?
4.5-5 mm on average.
What are the management steps for a periodontal abscess?
Management steps include draining the abscess through the pocket by compression or incision, or extraction if the tooth is hopeless, debriding the pocket, and irrigating with water or 0.2% solution.
What factors influence the management of Grade 3 vertical bone loss?
Tooth-related factors such as mobility, probing depth (PD), sound tooth remaining, occlusal antagonisms/tooth position, and endodontic condition.
What changes occur in the gingival crevicular fluid (GCF) during established gingivitis?
There is an increase in GCF flow.
Why is maintenance crucial in periodontal disease management?
To ensure ongoing oral health and prevent disease progression.
Which rare disease associated with periodontitis involves a deficiency in alkaline phosphatase?
Hypophosphatasia
What are some methods for reconstructing papilla?
Pedicle graft, Semilunar coronally positioned flap, and Envelope.
What are the characteristics of the advanced lesion stage in periodontitis?
Apical down-growth of biofilm, increasingly anaerobic environment, irreversible damage, pocket deepening (≥ 5mm), JE migrates apically from the CEJ, extensive damage to collagen fibers, and loss of connective tissue attachment.
What does the O’Leary plaque score represent?
The percentage of plaque present in the mouth.
Name a neoplasm other than SCC that can manifest as periodontitis.
Langerhan’s cell histiocytosis
What type of cells predominate in the advanced lesion stage of periodontitis?
Plasma cells predominate (>50%).
What are the types of bone loss detectable in radiographs?
Horizontal, vertical, and angular bone loss.
What type of epithelium is the sulcular epithelium?
Multilayer and parakeratinised with rete pegs.
What begins to occur in the alveolar bone during the advanced lesion stage of periodontitis?
Alveolar bone loss begins.
Why is angular bone loss considered to have a better prognosis than horizontal bone loss?
Because it provides more surfaces for possible bone formation.
How many layers does the junctional epithelium have?
Two layers: basal and suprabasal.
What is the recommended management for gingivitis?
3-monthly recall for prophylaxis and oral hygiene instruction (OHI) for 3 years, followed by a life-long commitment. Only scale if there’s calculus to avoid unnecessary gum irritation.
What should be checked to ensure that radiolucency is not due to accessory canal infection?
The endodontic condition of the tooth, including a pulp test.
What shape is the junctional epithelium and where is it wider?
Triangular shape, wider coronally.
What are the clinical signs of clinical gingival health?
Less than 10% bleeding on probing (BOP) and probing depth of ≤ 3 mm. It also assumes biological and inflammatory markers compatible with homeostasis, with health being predominantly neutrophilic infiltrate for immune surveillance.
What factors should be considered regarding the strategic value of a tooth?
Whether the tooth is needed for removable partial dentures (RPDs) or other functional and aesthetic demands.
How does the presence of calculus affect periodontal disease?
The presence of calculus is associated with periodontal disease, except in cases of aggressive periodontitis.
What structures attach the junctional epithelium to the tooth and other epithelial cells?
Hemidesmosomes attach to the tooth, and desmosomes attach to other epithelial cells.
What are the main components of the periodontium?
The periodontium includes the gingiva, periodontal ligament, cementum, and alveolar bone.
What percentage of bone loss and furcation grade is associated with a 'Questionable' prognosis according to McGuire (1991;1996)?
50-70% bone loss with Grade II furcation
How is plaque-induced gingivitis defined?
An inflammatory lesion resulting from interactions between the dental plaque biofilm and the host’s immune-inflammatory response, which remains contained within the gingiva and does not extend to the periodontal attachment beyond the mucogingival junction.
What are some pros of using radiography in periodontal disease management?
Aids diagnosis, helps determine prognosis and treatment, adjunct to clinical assessment, reveals altered calcification, shows past effects on bone, detects systemic skeletal conditions.
Does susceptibility to recession compromise bone dimension?
No, if the bone is thick; Yes, if the bone is thin.
What is extrinsic fiber cementum and what role does it play?
Extrinsic fiber cementum contains primarily extrinsic fibers, such as Sharpey's fibers, which are continuous with the principal fibers of the periodontal ligament. These fibers are oriented perpendicularly to the cementum surface and play a major role in tooth anchorage.
What are the types of oral mucosa?
The types of oral mucosa are masticatory, lining, and specialized mucosa.
What is the reduced enamel epithelium and when does it form?
It forms after amelogenesis when ameloblasts become reduced in height, produce a basal lamina that contacts enamel, and epithelial cells communicate via hemidesmosomes.
What percentage of bone loss and furcation grade is associated with a 'Hopeless' prognosis according to McGuire (1991;1996)?
70% bone loss with Grade III furcation
What is the primary aim of periodontal treatment?
To establish and maintain oral health.
What are some local predisposing factors for plaque-induced gingivitis?
Plaque-retentive factors and oral dryness.
What are some cons of using radiography in periodontal disease management?
Not diagnostic of active periodontal disease, no indication of cellular activity, shows less bone loss than actual, crestal lamina dura not related to clinical inflammation, angulation can influence detection, shallow palate can distort CEJ and alveolar crest, may not show interdental defects, thick bone can hide defects.
What is the minimum residual bone required to avoid root proximity issues?
0.8 mm of residual bone.
What characterizes intrinsic fiber cementum and where is it predominantly located?
Intrinsic fiber cementum contains primarily intrinsic fibers produced by cementoblasts, oriented parallel to the cementum surface. It is predominantly located at sites undergoing repair following surface resorption and plays no role in tooth anchorage.
What happens to the reduced enamel epithelium during the approach of an erupting tooth?
The reduced enamel epithelium and the basal layer of oral epithelium increase mitotic activity and migrate into the underlying connective tissue, forming an epithelial mass that prevents bleeding.
Where is masticatory mucosa found?
Masticatory mucosa is found on the hard palate and gingiva.
What developmental condition is associated with more coronal gingival margins and sometimes bone, leading to pseudopockets and aesthetic concerns?
This condition can be corrected with periodontal surgery.
What was the accuracy of McGuire's prognostication at 8 years?
35% overall
What systemic complications should be controlled in periodontal treatment?
Uncontrolled diabetes (HbA1c <6.5%), immunosuppression, acute infections, and medication-related issues.
What are some systemic modifying factors that influence the immune-inflammatory response in gingivitis?
Smoking, metabolic factors (e.g., hyperglycemia), nutritional factors (e.g., scurvy), pharmacological agents (e.g., phenytoin, cyclosporine, nifedipine), hormonal changes, and hematological conditions (e.g., leukemia, myelodysplasia, thrombocytopenia, clotting-factor deficiencies).
What components are involved in the formation of the acquired pellicle on the tooth surface?
Salivary proteins (e.g., mucins, antibodies, slatherin, enzymes) and lipids.
What is necessary to see in periodontal retreatment?
Improvement in soft tissues and oral hygiene.
What is mixed fiber cementum?
Mixed fiber cementum contains a mixture of extrinsic and intrinsic fiber cementum.
What covers the portions just apical to the incisal area of enamel when a tooth penetrates?
The junctional epithelium (JE) covers these portions.
What is the gingival margin?
The gingival margin, also known as free gingiva, has a dull surface, a rounded and scalloped outline, and is firm.
According to Splieth (2002), what was the common attachment level for teeth extracted due to periodontal reasons?
Most had 50-70% attachment
What is the most important step in tooth preparation according to periodontal principles?
Placement of margins, considering the base of the sulcus as the top of the attachment.
What are the standard management steps for periodontitis?
OHI (smoking cessation, tooth brushing, and interdental cleaning), SRD (± LA, e.g., ultrasonic cleaning and/or hand scaling), and periodontal surgery if advanced (OFD ± bone recontouring).
What medications are considered in systemic therapy for periodontal treatment?
Bisphosphonates, cyclosporine, and amlodipine.
What are non-plaque-induced gingival diseases caused by?
Developmental/genetic factors, infections, immune conditions, reactions, neoplasms, endocrine diseases, trauma, etc.
How does the acquired pellicle affect bacterial adhesion to the tooth surface?
It alters the charge and free energy of the tooth surface, increasing bacterial adhesion.
What are the histopathological inflammatory zones in necrotising periodontal diseases?
Superficial bacterial zone, Neutrophil-rich zone, Necrotic zone, Spirochaetal/bacterial infiltration zone
What is the prognosis for a successful root canal treatment (RCT)?
Long-term survival if successful; retreatment required if failed.
What are the components of an osteon in alveolar bone?
An osteon is comprised of lamellae, which are concentric layers of compact bone surrounding the central Haversian canal. The blood supply is facilitated by Volkmann’s canals that communicate with Haversian canals to connect osteons and supply nutrients to the bone.
What happens to the reduced enamel epithelium in the later phases of eruption?
It is replaced by the junctional epithelium, which becomes continuous with the oral epithelium and provides the attachment between the tooth and gingiva.
What is the difference between attached gingiva and free gingiva?
Attached gingiva extends from the sulcus to the mucogingival line and is stippled, while free gingiva is the gingival margin with a dull surface and rounded outline.
When should teeth be extracted based on periodontal prognosis?
Only non-restorable teeth, those with concurrent endo-perio lesions with grade III mobility, and 8s with poor accessibility or furcation involvement
What term replaced 'biological width' in the 2018 classification system?
Supracrestal attached tissues.
What did Sgolastra et al. (2012) find in their meta-analysis regarding SRP + AMX/MET?
They found significant CAL gain (WMD = 0.21; 95% CI = 0.02 to 0.4; P <0.05) and PD reduction (WMD = 0.43; 95% CI = 0.24 to 0.63; P <0.05) in favor of SRP + AMX/MET.
What are the components of emergency therapy in periodontal treatment?
Managing acute conditions such as pain (e.g., abscesses), rapid bone loss, and ANUG.
What is the risk status of stable periodontitis patients with a history of periodontitis?
They have an increased risk of recurrent periodontitis even if there is no current disease and can go through periods of exacerbation. They are still considered periodontitis cases if inflammation is present.
Which types of bacteria are considered early colonizers in oral biofilm development?
Gram-positive cocci, such as Oral streptococci (e.g., S. sanguis, S. gordonii, S. oralis).
What are the clinical features of necrotising periodontal diseases?
Papilla necrosis, ulcers, bleeding on probing (BOP), pain, halitosis, pseudomembrane formation, lymphadenopathy, fever
What determines if a faulty restoration is restorable?
The extent of the caries and the condition of the restoration.
What is acellular extrinsic fiber cementum and where is it located?
Acellular extrinsic fiber cementum is located in the cervical 2/3 of the tooth, including the coronal and midroot areas. It is characterized by well-defined collagen type I fibrils, specifically Sharpey's fibers.
What is the mucogingival line?
The mucogingival line is the boundary between the attached gingiva and the alveolar mucosa, present only on the buccal mucosa.
What are the characteristics of a 'Fair' prognosis?
Less than adequate bone support, patient cooperation, some tooth mobility, Grade I furcation, and SPT possible
What are the components of the supracrestal attached tissues and their respective dimensions?
Supra-crestal connective tissue attachment (1.07 mm) and junctional epithelium (0.97 mm).
What were the findings of Zandbergen et al. (2013) regarding systemic antimicrobial therapy as an adjunct to SRP?
They found that systemic antimicrobial therapy using a combination of amoxicillin and metronidazole can enhance the clinical benefits of non-surgical periodontal therapy, with a full-mouth weighted mean change for PD improvement of 1.41 mm and CAL gain of 0.94 mm.
What is Phase I therapy in periodontal treatment also known as?
Initial phase therapy, local therapy, hygiene phase, non-surgical phase, or host-related phase.
What mechanisms do early colonizers use to attach to the acquired pellicle?
They form reversible attachments via van der Waals and hydrogen bonding interactions, and then irreversible attachments via specialized surface adhesins and receptors.
What additional clinical feature is present if necrotising periodontitis occurs?
Bone loss
How does the crown-to-root ratio affect support?
A favourable ratio is less than 1:1; an unfavourable ratio is greater than 1:1.
What is prognosis in the context of periodontal disease?
Prognosis is the prediction of a disease’s probable course duration and outcome, established after diagnosis and before treatment.
Where is cellular mixed stratified cementum found and what is its composition?
Cellular mixed stratified cementum is found in the apical 1/3 of the tooth and furcation areas. It is composed of mineralized extrinsic collagen (Sharpey's fibers) that are more irregular than in acellular cementum, and it includes a combination of intrinsic and extrinsic fibers with trapped cementoblasts.
Where is specialized mucosa found?
Specialized mucosa is found on the dorsum of the tongue.
What is considered a low risk number of remaining teeth for functionality of dentition?
Less than 4 teeth.
What are the characteristics of a 'Poor' prognosis?
Moderate to advanced bone loss, doubtful cooperation, tooth mobility, Grade I/II furcation, difficult to maintain, and systemic/environmental factors
What are some key actions in Phase I therapy?
Extracting hopeless teeth, caries control, endodontic treatment, and oral hygiene instruction (OHI).
What are the two gingival responses to the infringement of supracrestal connective tissue attachment by subgingival restorations?
What did Smiley et al. (2015) conclude about the effectiveness of SRP with adjunctive therapies?
They found a 0.5-millimeter average improvement in CAL with SRP, and combinations of SRP with assorted adjuncts resulted in CAL improvements between 0.2 and 0.6 mm over SRP alone. Four adjunctive therapies were judged beneficial with moderate certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser.
What role does F. nucleatum play in the coaggregation and microbial succession stage of biofilm development?
F. nucleatum acts as a bridge between initial colonizers and later colonizers, forming corn-cob-like structures as filamentous bacteria adhere to the oral streptococci.
What additional clinical feature is present if necrotising stomatitis occurs?
Extension beyond the gingiva and bone denudation through alveolar mucosa, osteitis, and bone sequestra (generally only in severely immunocompromised patients)
What increases the chance of failure in post and core restorations?
The presence of extensive caries.
What is cellular intrinsic fiber cementum and where is it located?
Cellular intrinsic fiber cementum is found in resorption lacunae at the apex of the tooth, at sites of cemental repair. It contains cementocytes, which are cementoblasts in the matrix that have lost their secretory ability, and it plays no role in tooth anchorage.
When should the prognosis be re-evaluated in periodontal treatment?
The prognosis should be re-evaluated after Initial Periodontal Therapy (IPT) based on the response to treatment and control of local, systemic, and environmental factors.
What is the epithelial attachment?
The epithelial attachment is the attachment apparatus, including the internal basal lamina and hemidesmosomes, that connects the junctional epithelium to the tooth surface.
What is the implication of having more than 8 teeth lost?
Impaired oral function.
What are the characteristics of a 'Questionable' prognosis?
Advanced bone loss, doubtful cooperation, tooth mobility, Grade II/III furcation, inaccessible areas, and systemic/environmental factors
What does RT0 indicate in the Cairo classification for gingival recession?
No recession
Why is patient education and motivation important in periodontal treatment?
Patients are responsible for compliant oral maintenance and elimination of undesirable habits such as smoking.
What did Angaji et al. (2010) find regarding adjunctive antibiotic therapy in smokers with chronic periodontitis?
They found that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive.
Is there evidence that margins being in the sulcus cause problems if the patient is compliant with self-performed oral hygiene and maintenance?
No, there is no evidence suggesting problems if the patient maintains adequate oral hygiene.
What are the management steps for the acute phase of necrotising periodontal diseases?
Gentle removal of plaque and necrotic debris, ultrasonic debridement, local irrigation with 0.2% chlorhexidine mouthwash or 3% H2O2, elimination of causative factors (e.g., smoking cessation, stress), antibiotic therapy (e.g., Metronidazole: 400 mg orally, 12-hourly for 5 days), analgesics (e.g., 400-600 mg ibuprofen orally, 4-hourly; alternate with 1000 mg paracetamol orally, 4-hourly), oral hygiene instructions (OHI)
What happens during the biofilm multiplication and maturation stage?
Further bacterial proliferation occurs, late colonizers arrive, and an intermicrobial matrix develops, composed of bacterial lysates, GCF, and salivary components.
How does smoking affect periodontal prognosis?
Smokers have a worse prognosis compared to non-smokers.
What type of epithelium is oral epithelium?
Oral epithelium is keratinized stratified squamous epithelium.
What factors influence the decision between extraction and conservation of a tooth?
Factors include initial assessment of patient expectations, treatment expectations (short-term and long-term), aesthetics, financial status, and patient compliance.
What is the significance of having 20 teeth (5-5) in terms of dental arch?
It indicates a shortened dental arch.
What are the characteristics of a 'Hopeless' prognosis?
Advanced bone loss, non-maintainable areas, extraction indicated, and uncontrolled systemic and environmental factors
What is the characteristic of RT1 in the Cairo classification for gingival recession?
Gingival recession with no interproximal clinical attachment loss (CAL)
What are the options to correct biological width violations?
Crown-lengthening, which includes protocols like gingivectomy and apically repositioned flap with ostectomy/osteoplasty.
How does good supragingival plaque control benefit periodontal health?
It can slow the rate of bacterial recolonization and prevent more pathogenic bacteria from emerging and causing disease progression.
What is the recommended chlorhexidine mouthwash regimen for patients with necrotising periodontal diseases?
0.12% chlorhexidine, 15 mL, rinse for 1 minute, 8 to 12-hourly, for a maximum of 2-3 weeks
What environmental gradients develop within a mature biofilm?
Gradients for oxygen, pH, and nutrients develop, with the biofilm becoming increasingly anaerobic in deeper areas.
What were the findings of Santos et al. (2015) regarding adjunctive systemic antibiotic use in diabetic patients?
They found a small additional benefit in terms of reductions in mean PD and mean percentage of BoP, with significant effects favoring SRP plus antibiotic for reductions in mean PD (-0.22 mm) and mean percentage of BoP (4%). There was no significant effect for CAL gain and plaque index reduction.
How do systemic conditions like diabetes and HIV affect periodontal disease?
Uncontrolled systemic conditions worsen the prognosis, while controlled conditions improve it.
What are the main cell types found in oral epithelium?
The main cell types in oral epithelium are keratinocytes, melanocytes, Langerhans cells, Merkel's cells, and inflammatory cells.
How does pocket depth reflect periodontal disease severity?
Pocket depth reflects disease severity as follows: <5 mm (mild), 5-7 mm (moderate), >7 mm (severe).
Describe RT2 in the Cairo classification for gingival recession.
Interproximal CAL is less than or equal to buccal CAL
What is the most effective way to examine for periodontal or peri-implant disease?
Probing.
What are the indications for crown-lengthening procedures?
No adequate zone of attached gingiva, supracrestal attachment < 3 mm, improve bone architecture, and recontouring periodontal defects.
What is strongly associated with necrotising periodontal diseases?
Host immune impairment
What is the purpose of debridement in periodontal treatment?
To remove plaque, bacterial by-products, and calculus while preserving cementum to aid in healing.
Why does the pathogenicity of a biofilm increase in deeper areas?
The biofilm becomes more anaerobic, attracting Gram-negative strict anaerobes such as spirochetes and Aggregatibacter actinomycetemcomitans (Aa).
What did Grellman et al. (2016) find about the efficacy of adjunctive therapy in diabetic subjects?
They found that adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects, with a WMD in PD reduction of -0.15 mm favoring antibiotic use. However, WMDs in CAL gain, PI, and BOP reductions did not favor adjunctive antibiotic use.
What is the difference between IV and oral bisphosphonates in periodontal treatment?
IV bisphosphonates have a higher risk of complications compared to oral bisphosphonates.
What are the layers of oral epithelium?
The layers of oral epithelium are the basal layer, prickle cell layer (stratum spinosum), granular cell layer (stratum granulosum), and keratinized cell layer.
What does tooth mobility indicate in periodontal disease assessment?
Tooth mobility indicates the severity of periodontal disease: 0/1 (normal or slight), 2 (moderate), 3 (severe).
What does RT3 signify in the Cairo classification for gingival recession?
Interproximal CAL is greater than buccal CAL
What pocket depth is considered healthy?
1-3 mm.
What factors influence the effectiveness of periodontal treatment?
Clinician’s skill level, initial pocket depth, predisposing factors, tooth morphology, tooth type, time, and patient’s compliance.
Why is ultrasonic instrumentation favored in periodontal debridement?
It is effective in removing plaque and calculus, flushes out bacteria and by-products, is anti-bacterial via cavitation, and causes less fatigue for the clinician.
How do clinical skills affect periodontal treatment outcomes?
Experienced clinicians achieve better outcomes compared to those with minimal experience.
What is the lamina propria?
The lamina propria is the underlying connective tissue of the oral epithelium.
What is the prognosis for a tooth with recurrent periodontal abscess?
A tooth with recurrent periodontal abscess generally has a hopeless prognosis.
What factors influence the presence of a black triangle according to Singh et al. (2013)?
Underlying osseous support, bioform (scalloping), and tooth morphology
What pocket depth indicates a high probability of periodontal disease?
Greater than 4 mm.
Why is occlusal therapy sometimes necessary in periodontal treatment?
Because periodontal disease may be related to occlusal overload.
What are the characteristics of an excellent prognosis according to McGuire and Nunn (1996)?
No bone loss, good cooperation, excellent gingival condition, and no systemic/environmental factors.
How does the distance from the alveolar bone to the contact point affect the presence of the papilla?
If the distance is 5 mm, the papilla is present in 98% of cases; if 7 mm, it is present in only 27% of cases.
How is bone loss categorized in periodontal disease severity?
Bone loss is categorized as <30% (mild), 30-65% (moderate), >65% (severe).
What does a pocket depth greater than 6 mm indicate?
Incomplete treatment and requires further therapy.
What is the recommended time frame for reviewing a patient after initial debridement?
4-6 weeks after initial debridement.
What are the characteristics of a good prognosis according to McGuire and Nunn (1996)?
Adequate bone support, patient cooperation, control of aetiological factors, and manageable systemic or environmental factors.
What is the significance of bone defect morphology in periodontal prognosis?
Deep, narrow bone defects generally have a better prognosis compared to superficial, wide (horizontal) bone defects, which are associated with poorer outcomes.
