1. Positive architecture refers to:

A. Alveolar bone that is more coronal interdentally than facially or lingually. B. Alveolar bone that is more apical interdentally than facially or lingually. C. Alveolar bone that has undergone even resorption over a long period of time. D. A bone pattern that results after osseous grafting.

2. Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION?

A. A trough. B. A dehiscence. C. A hemiseptum. D. An interdental crater.

3. Which of the following is not an infrabony defect?

A. Interdental crater. B. Hemiseptum. C. Dehiscence. D. Three-walled.

4. What characterizes freeze-dried bone allografts?

A. Usually rejected by the host. B. Exfoliated after a short time period. C. Contains viable cells with osteogenic potential. D. Eventually replaced by host bone.

5. Freeze-dried bone allografts are decalcified because:

A. The product is made safer. B. Calcium may block bone morphogenetic protein. C. Without decalcification the product is difficult to manipulate. D. All of the above.

6. What is the process by which a bone graft material is capable of promoting osteogenesis?

A. Contact inhibition. B. Osteoinduction. C. Osteoconduction. D. Guided tissue regeneration.

7. Which of the following has the greatest osteoinductive potential?

A. Hip marrow. B. Osseous coagulum. C. Contiguous autograft. D. Maxillary tuberosity autograft.

8. A 50-year-old patient with fibrotic deep pockets and multiple bone defects undergoes . The reflects the tissue, and debrides the two-walled and three-walled defects, then scales and root planes. What is the next immediate step?

A. Treat the adjacent bone with citric acid and place a bone graft. B. Treat the adjacent bone with and place an occlusive membrane. C. Decortification of the adjacent bone and placement of a bone graft. D. Any of the above procedures are acceptable.

9. A graft between individuals of the same species but with non-identical genes is called:

A. Xenograft. B. Allograft C. Autograft. D. Isograft.

10. A freeze-dried decalcified bone graft taken from a human donor and placed in a periodontal defect in another patient is termed an:

A. Allograft. B. Autograft. C. Isograft. D. Alloplastic graft. 11. Which of the following bone donor grafts has the greatest osteogenic potential?

A. Xenograft. B. Alloplast. C. Allograft. D. B and C have very similar osteogenic potential.

12. Which type of bony defect has the greatest potential for regeneration?

A. A narrow three-walled defect. B. A wide three-walled defect. C. A four-walled (circumferential) defect. D. A one-walled, hemi-septal defect.

13. Hydroxyapatite (HA) can be utilized when all but one of the following are expected:

A. Osteoinduction. B. Excellent tissue compatibility. C. Osteoconduction. D. Encapsulation by collagen.

14. A graft between different species is referred to as a(n):

A. Xenograft. B. Allograft. C. Autograft. D. Isograft.

15. Which cells of the are considered to have the greatest progenitor ability?

A. Junctional epithelial cells. B. Periodontal ligament cells. C. Odontoblasts. D. Gingival fibroblasts.

16. Which of the following areas of the mouth has the widest zone of attached gingiva?

A. Molars>premolars>anteriors. B. Anteriors>molars>premolars. C. Premolars>anteriors>molars. D. Molars>anteriors>premolars.

17. The lateral sliding flap procedure is contraindicated when:

A. There is inadequate donor tissue. B. The patient is allergic to penicillin. C. There is inadequate tissue at the recipient site. D. has exceeded three millimeters.

18. The survives during the first 24 hours by:

A. Diffusion of fluid from the host bed. B. Fluids remaining in the donor tissue. C. New blood vessels forming from the underlying connective tissues. D. Severed blood vessels in the surface area connecting with blood vessels in the donor material.

19. Which is most related to initiation of root caries in the elderly?

A. Gingival recession. B. Defective restoration. C. Erosion. D. .

20. Following the placement of a free mucosal graft, the graft epithelium undergoes:

A. Dysplasia. B. Orthokeratinization. C. Formation of hypo-keratinized granules. D. Desquamation.

21. What is vital to the success of the free gingival graft?

A. Immobilization. B. Large fibrin clot. C. Thin flap with periosteum covering bone. D. Use of ice and NSAID's to minimize swelling.

22. Which artery are you at risk of severing while obtaining a sub-epithelial autograft?

A. Facial. B. Greater palatine. C. Lingual. D. Incisive foramen.

23. In a state of gingival health, the narrowest width of keratinized gingival tissue is usually found on the facial aspect of which of the following teeth?

A. Mandibular central incisors. B. Mandibular first premolars. C. Maxillary second premolars. D. Maxillary central incisors

24. After a free gingival graft, the primary source of nutrition for the graft during the first 24 hours is the:

A. Primary vascular anastomosis. B. Residual nutrients within the graft. C. Diffusion of nutrients from the underlying connective tissue. D. Diffusion of nutrients from adjacent vessels of the periodontal ligament.

25. Which of the following is the procedure of choice in obtaining root coverage when gingival recession has occurred on the facial surface of a with interproximal bone and soft tissue in its original position?

A. Free gingival graft (FGG) B. Connective tissue graft C. D. Modified Widman Procedure E. Gingival curettage

26. (1) It is desirable to have a large blood clot between a free gingival graft and the underlying periosteum, (2) because the clot will encourage vasculization of the overlying graft.

A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

27. The distance from the marginal gingiva to the is 5mm and the probing depth in this area is 7mm. Which of the following is acceptable treatment?

A. A soft tissue autograft. B. An apically positioned flap. C. A laterally positioned flap. D. A double papillae flap.

28. Which procedure is best performed in an area with inadequate attached gingiva and a frenum that retracts the marginal gingiva?

A. Frenectomy. B. Free gingival graft with frenum removal. C. Connective tissue graft. D. Rotated papilla graft. E. Double papilla flap.

29. During the healing of a free gingival graft:

A. Sloughing of the donor epithelium occurs. B. The graft is initially maintained by a transudate from the host vessels. C. Revascularization of the grafts starts by the second or third day. D. At the donor site, epithelium migrates from the edges of the wound. E. All of the above.

30. (1) Traumatic occlusion causes gingival recession. (2) Adjustment of the occlusion can halt or reverse gingival recession.

A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

31. A gingivectomy will re-establish proper contours when which of the following pathologic conditions are present?

1. Pseudopocket 2. Suprabony pocket 3. (hyperplasia) 4. Infrabony pocket 5. Cleft involving alveolar mucosa

A. 1, 2, and 3 B. 1, 2, and 5 C. 2, 3, and 4 D. 2, 4, and 5 E. 3, 4, and 5 F. All of the above

32. In which area of the mouth would you want to avoid a vertical releasing incision?

A. Maxillary anterior facial. B. Mandibular anterior facial. C. Mandibular posterior lingual. D. Maxillary posterior facial.

33. Which of the following has the greatest Impact on the success of a periodontal- flap procedure?

A. The type of Initial incision. B. The extent of flap reflection. C. The position of the flap at closure. D. The level of post-operative plaque control. E. The post-operative width of attached gingiva.

34. Guided tissue regeneration works on the principal of selected cell repopulation by:

A. inhibiting the maturation of connective tissue cells. B. blocking the down growth of epithelium. C. destroying migrating epithelial cells. D. inhibiting the maturation of epithelial and connective tissue cells.

35. Which suturing technique permits different tension on facial and lingual flaps?

A. The horizontal mattress suture. B. The vertical mattress suture. C. The Interrupted figure eight suture. D. The continuous sling suture.

36. Which kind of suture is best used when only the buccal surface of an area has been flapped for a surgical procedure?

A. The horizontal mattress suture. B. The vertical mattress suture. C. A simple loop suture. D. The sling suture.

37. What is the main difference in the Apically Positioned Flap procedure and the Modified Widman procedure?

A. The initial incision. B. The utilization of a post-operative periodontal dressing. C. The degree of root Instrumentation. D. The final position of the flap margin.

38. Following a gingivectomy, where do the epithelial cells come from?

A. The periodontal ligament. B. The surrounding attached gingiva. C. The surrounding alveolar mucosa. D. The underlying osseous structures.

39. Under what circumstances would you not want to use a partial thickness flap?

A. The presence of parakeratosis. B. The presence of thin tissue. C. A patient with . D. In the maxillary anterior where aesthetics is a concern.

40. Guided tissue regeneration is best used for which classification of ?

A. Class one. B. Class two. C. Class three. D. Class four (no tissue in furcation).

41. How would you treat a class two furcation with probing depths of 5-8 mm on the facial surface of tooth #31?

A. Guided tissue regeneration. B. Osseous surgery. C. Gingivectomy. D. Extraction.

42. You are performing guided tissue regeneration on tooth #19 with a buccal class two furcation involvement. Which of the following circumstances would enhance regeneration in this area?

A. Short root trunk. B. A large vertical component to the furcation. C. A large horizontal component to the furcation. D. Low or minimal interproximal bone.

43. Which of the following clinical findings has the greatest influence on the type of incision to use in periodontal flap surgery?

A. Probing depth. B. Frenum attachment. C. Depth of the vestibule. D. Amount of attached gingiva. E. Presence of intrabony defects.

44. Gingivectomy Is NOT likely to be the treatment-of-choice for the elimination of pockets when the base of the pocket Is located at the mucogingival junction or:

A. apical to the alveolar crest. B. below the free gingival groove. C. coronal to the cementoenamel junction. D. apical to the cervical convexity of the tooth crown.

45. The initial Incision for a Gingivectomy is made apical to which structure?

A. The crest of bone. B. The . C. The periodontal ligament. D. The mucogingival junction. E. Gingival attaching fibers.

46. Why is a periodontal dressing used after a surgical procedure?

A. To hold the tissues In their final position. B. To keep from forming at the surgical site. C. To protect the tissues from trauma from mastication. D. All of the above.

47. In the gingivectomy technique, the depth of pockets is indicated by bleeding points made with a or with a pocket marking forceps. Incisions are then made coronal to the bleeding points.

A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

48. In the Modified Widman Surgical Procedure what form of attachment occurs in most cases?

A. Regeneration of bone, PDL and . B. Long Junctional Epithelium. C. Bone attached to the root surface. D. Connective tissue attachment to the previously diseased root surface.

49. In Guided Tissue Regeneration, the only cells which have the potential for regeneration of the attachment apparatus of the tooth are best described as:

A. the epithelial cells with lateral cell growth. B. the periodontal ligament cells which proliferate coronally. C. the bone cells which proliferate coronally. D. the epithelial cells which migrate apically.

50. A modified Widman flap would be indicated when the goal of therapy is to provide:

A. complete pocket elimination. B. regeneration of the periodontium. C. access to root surfaces for thorough . D. increased keratinized tissue.

51. Indications for Guided Tissue Regeneration include:

A. three wall bony defects. B. Class II mandibular defects. C. Class III maxillary defects. D. one wall bony defects. E. C and D. F. A and B.

52. In which of the following surgical procedures is an external beveled incision made?

A. Gingivectomy. B. Apically positioned flap. C. Modified Widman. D. Excisional New Attachment Procedure.

53. Which is a common cause of tearing during a flap procedure?

A. Excess tension with the periosteal elevator during tissue reflection. B. Inadequate finger rest or hand support. C. Inadequate flap extension mesially and distally. D. All of the above.

Answers

1. Positive bone architecture refers to: A. Alveolar bone that is more coronal interdentally than facially or lingually.

2. Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION? B. A dehiscence.

3. Which of the following is not an infrabony defect? C. Dehiscence.

4. What characterizes freeze-dried bone allografts? D. Eventually replaced by host bone.

5. Freeze-dried bone allografts are decalcified because: B. Calcium may block bone morphogenetic protein.

6. What is the process by which a bone graft material is capable of promoting osteogenesis? B. Osteoinduction.

7. Which of the following has the greatest osteoinductive potential? A. Hip marrow.

8. A 50-year-old patient with fibrotic deep pockets and multiple bone defects undergoes periodontal surgery. The dentist reflects the tissue, and debrides the two- walled and three-walled defects, then scales and root planes. What is the next immediate step? C. Decortification of the adjacent bone and placement of a bone graft.

9. A graft between individuals of the same species but with non-identical genes is called: B. Allograft

10. A freeze-dried decalcified bone graft taken from a human donor and placed in a periodontal defect in another patient is termed an: A. Allograft.

11. Which of the following bone donor grafts has the greatest osteogenic potential? C. Allograft.

12. Which type of bony defect has the greatest potential for regeneration? A. A narrow three-walled defect.

13. Hydroxyapatite (HA) can be utilized when all but one of the following are expected: A. Osteoinduction.

14. A graft between different species is referred to as a(n): A. Xenograft.

15. Which cells of the periodontium are considered to have the greatest progenitor ability? B. Periodontal ligament cells.

16. Which of the following areas of the mouth has the widest zone of attached gingiva? B. Anteriors>molars>premolars.

17. The lateral sliding flap procedure is contraindicated when: A. There is inadequate donor tissue.

18. The free gingival graft survives during the first 24 hours by: A. Diffusion of fluid from the host bed.

19. Which is most related to initiation of root caries in the elderly? A. Gingival recession.

20. Following the placement of a free mucosal graft, the graft epithelium undergoes: D. Desquamation.

21. What is vital to the success of the free gingival graft? A. Immobilization.

22. Which artery are you at risk of severing while obtaining a sub-epithelial connective tissue autograft? B. Greater palatine.

23. In a state of gingival health, the narrowest width of keratinized gingival tissue is usually found on the facial aspect of which of the following teeth? B. Mandibular first premolars.

24. After a free gingival graft, the primary source of nutrition for the graft during the first 24 hours is the: C. Diffusion of nutrients from the underlying connective tissue.

25. Which of the following is the procedure of choice in obtaining root coverage when gingival recession has occurred on the facial surface of a tooth with interproximal bone and soft tissue in its original position? B. Connective tissue graft

26. (1) It is desirable to have a large blood clot between a free gingival graft and the underlying periosteum, (2) because the clot will encourage vascularization of the overlying graft. B. Both statements are FALSE.

27. The distance from the marginal gingiva to the mucogingival junction is 5mm and the probing depth in this area is 7mm. Which of the following is acceptable treatment? B. An apically positioned flap.

28. Which procedure is best performed in an area with inadequate attached gingiva and a frenum that retracts the

marginal gingiva?

B. Free gingival graft with frenum removal.

29. During the healing of a free gingival graft: E. All of the above.

30. (1) Traumatic occlusion causes gingival recession. (2) Adjustment of the occlusion can halt or reverse gingival recession. B. Both statements are FALSE.

31. A gingivectomy will re-establish proper contours when: A. (1) Pseudopocket; (2) Suprabony pocket; & (3) Gingival enlargement (hyperplasia).

32. Where to avoid a vertical releasing incision: C. Mandibular posterior lingual.

33. Which has the greatest impact on success of a perio flap procedure? D. Level of post-operative plaque control.

34. Principal of guided cell regeneration works by: B. Blocking the downgrowth of epithelium.

35. Which suturing technique permits different tension on facial and lingual flaps? D. The continuous sling suture.

36. What kind of suture is best used with on the buccal surface is flapped? D. The sling suture.

37. Main difference between APF and Modified Widman? D. The final position of the flap margin.

38. Following a gingivectomy, where do the epithelial cells come from? B. The surrounding attached gingiva.

39. When would not want to use a partial thickness flap? B. The presence of thin tissue.

40. Guided tissue regeneration is best used for which classification of furcation defect? B. Class two.

41. How would you treat a class two furcation with probing depths of 5-8 mm on the facial surface of #31? A. Guided tissue regeneration.

42. Which will advance regeneration on tooth #19 with a buccal class two furcation involvement? B. A large vertical component to the furcation.

43. Which clinical finding has the greatest influence on type of incision in perio flap surgery? C. Amount of attached gingiva.

44. Gingivectomy is not best treatment for pockets where the base of the pocket is at the Mucogingival junction or: A. apical to the alveolar crest.

45. The initial incision for a gingivectomy is made apical to: B. The junctional epithelium.

46. Why is a perio dressing used after a surgical procedure? C. To protect the tissues from trauma from mastication.

47. Gingivectomy involves marking bleeding points. Incisions are made coronal to the bleeding points. D. The first statement is true; the second is false.

48. In the Modified Widman, what is the most common form of attachment? B. Long Junctional Epithelium.

49. In Guided Tissue Regeneration, the only cells with the potential for regeneration are: B. the periodontal ligament cells which proliferate coronally.

50. A Modified Widman is indicated when the goal is: C. access to foot surfaces for thorough debridement.

51. Indications for Guided Tissue Regeneration include: F (A.) three wall bony defects & (B.) Class II mandibular defects.

52. Which of the following procedures requires an external beveled incision? A. Gingivectomy.

53. What is a common cause of tearing during a flap procedure? D. All of the above: (A) Excess tension on the periosteal elevator during reflection; (B.) Inadequate finger rest or hand support, & (C.) Inadequate flap extension mesially and distally.

An organism frequently associated with is:

A. Streptococcus Mutans B. Bacteroides forsythus C. Camphylobacteria intermedia D. All of the above

Which of the following represents the MOST common form of gingival/ periodontal seen in school-aged children?

A. puberty-associated B. dental plaque-induced gingivitis C. primary herpetic gingivostomatitis D. necrotizing ulcerative gingivitis

Overhanging restorations are considered to be modifying factors in the etiology of . Their presence appears to promote a change in a non-pathogenic subgingival microflora to a pathogenic subgingival microflora.

A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

Which of the following procedures has, as its primary objective, the reduction of existing ?

A. splinting of mobile teeth B. C. mucogingival surgery D. All of the above

An 18-year-old woman has good and only minute traces of supragingival . Her gingival tissues exhibit , no inflammatory edema, and very little change in color. Probing reveals 5-8 mm pockets around maxillary incisors, mandibular incisors, and first molars. No appreciable bone loss can be seen elsewhere in her mouth. This condition should be diagnosed as which of the following?

A. localized chronic periodontitis B. generalized chronic periodontitis C. generalized D. localized aggressive periodontitis

Which scalpel blade(s) are used in our clinic surgical kit?

A. #11 B. #12(b) C. #15 D. #12(b) and #15 E. all of the above

Primary treatment of necrotizing ulcerative gingivitis in patients free of systemic involvement include: 1. occlusal adjustment. 4. debridement. 2. penicillin therapy. 5. . 3. oral hygiene instruction. A. 1, 2, and 4 D. 2 and 3 only B. 1, 2, and 3 E. 3 and 4 only C. All of the above

The new periodontal disease classification dropped the term Prepubertal Periodontitis and called it:

A. Periodontitis as a Manifestation of Systemic B. Aggressive Periodontitis C. Early Onset Periodontitis D. Congenital Primary Immunodeficiency

Periodontal Surgery is performed to:

1. Provide access to the root surface, making it possible to remove all irritants. 2. ______.(2 points) 3. Reshape soft and hard tissues to attain a harmonious topography

The treatment of Acute Necrotizing Ulcerative Gingivitis is divided into four stages: (2 points)

1. Relieve the Acute Symptoms. 2. Eliminate and correct all local irritating factors and treat any systemic factors.

3. ______

______

4. Restore the gingival tissues to physiologic form.

Upon completion of planned periodontal therapy, it is desirable that the records and a clinical assessment of the patient reveal, where appropriate, that:

1. The patient has been counseled on why and how to perform an effective daily personal oral hygiene program.

2. Accepted therapeutic procedures have been performed to arrest the progress of the periodontal disease(s).

3. Periodontal root planing has left subgingival root surfaces without clinically detectable calculus deposits or rough areas.

4.______

______

5. A recommendation has been made for the correction of any tooth form, tooth position, restoration, or prosthesis, considered to be contributing to the periodontal disease process.

6. ______

Which organism associated with periodontal disease substantially increases during the second trimester of pregnancy?

______P. I.______

Define reattachment: ______

______

Utilizing the diagram name the muscles indicated by the numbers:

1. ______

3. ______

6. ______

Studies of employed adults in the United States show that about ___ % of 18-to-19-year-old subjects exhibit at least one site with 2mm or more of attachment loss.

A. 25% B. 50% C. 75% D. 100%

Which of the following subgingival microorganisms have not been associated with chronic periodontitis:

A. . B. . C. Streptococcus intermedius. D. Treponema species. E.

What is the correct term for lack or loss of appetite for food?

A. Anorexia. B. . C. Malaise. D. Dysphagia.

TRUE or FALSE The addition of gingival curettage to root-planing in the treatment of generalized periodontitis with shallow suprabony pockets produces statistically significant improvement in probing depth and clinical attachment level beyond that obtained by scaling and root planing alone.

TRUE or FALSE Localized aggressive periodontitis is less common than generalized aggressive periodontitis. True or False. In the papilla preservation flap, the incisions are such that the entire papilla is incorporated into one of the flaps.

True or False. The majority of HIV-positive individuals experience periodontal disease in a manner similar to the general population.

T F An individual who develops Acute Herpetic Gingivostomatitis will, in most cases, give a history of previous RHL (recurrent

TRUE OR FALSE When utilizing a partial thickness flap, the periosteum that remains can be utilized to suture a flap in an apical position.

In “plaque associated gingivitis”, the degree of inflammation is equal to the volume of plaque + the microbiological makeup of plaque +

______.

. Which suturing technique permits different tension on facial and lingual flaps?

A. the horizontal mattress suture B. the vertical mattress suture C. the interrupted figure eight suture D. the continuous sling suture

Following a gingivectomy, where do the epithelial cells come from?

A. the periodontal ligament B. the surrounding attached gingiva C. the surrounding alveolar mucosa D. the underlying osseous structures

Vertical incisions should be made at

A .the middle of the tooth. B .the middle of a papilla. C .at the line angle of a tooth. D. 1 and 3 E. 1 and 2 F.

The interdental denudation procedure....

A. Produces in an excessive amount of interdental bone loss. B. Usually produces a poor post-surgical contour to the interdental soft tissue. C. Results in a lack of adequate gingiva in the interdental areas. D. None of the above.

You have diagnosed Necrotizing Ulcerative Gingivitis and have performed local debridement. The patient is to return in 3 days for evaluation. What instructions will you give the patients between these visits?

A.

B.

C.

D.

Gingivectomy is indicated in the treatment of each of the following EXCEPT one. Which one is this EXCEPTION?

A. Suprabony pockets. B. Infrabony pockets. C. Phenytoin-induced hyperplasia. D. Hereditary gingival fibromatosis.

What is the difference between a dental prophylaxis (0110) and a periodontal prophylaxis (4910)?

Are any laboratory tests of assistance in diagnosing acute necrotizing ulcerative gingivitis?

What is the most difficult part of treating a patient with gingivitis?

.In class a case of puberty gingivitis was presented. What periodontal treatment resolved this condition?

Which of the following should be considered in selecting a surgical approach to treat Periodontitis:

A. Age and general health of the patient B. Existence of mucogingival problems. C. Esthetic considerations D. A and C only E. A B and C are all correct.

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