Pretest 2003 with answers/explanations DAPE 761 – Advanced Periodontics Name: ________________________ Dr. Dwight E. McLeod October 24, 2003 PRETEST 1. Gingivectomy is a surgical procedure that is performed to eliminate periodontal pockets and includes eshaping of the gingiva. Gingivoplasty is a surgical procedure that includes reshaping of the gingiva to create physiologic contours with the sole purpose of recontouring the gingiva in the absence of pockets. A. Both statements are true.* B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true. Gingivectomy means excision of the gingiva. By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots, creating a favorable environment for gingival healing and restoration of a physiologic gingival contour. Gingivoplasty is similar to gingivectomy, but its purpose is different. Gingivectomy is performed to eliminate periodontal pockets and includes reshaping as part of the technique. Gingivoplasty is a reshaping of the gingival to create physiologic gingival contours, with the sole purpose of recontouring the gingiva in the absence of pockets. 2. Indications for the gingivectomy procedure include: A. Elimination of suprabony pockets. B. Elimination of gingival enlargements. C. Elimination of suprabony periodontal abscesses. D. A and B E. All of the above* The gingivectomy procedure may be performed for (1) elimination of suprabony pockets, regardless of their depth, if the pocket wall is fibrous and firm, (2) elimination of gingival enlargement, and (3) elimination of suprabony periodontal abscesses. 3. Contraindications for the gingivectomy procedure include: A. The need for osseous surgery or evaluating the bony topography. B. Conditions in which the base of the pocket is apical to the mucogingival junction. C. Esthetics considerations. D. A and B E. All of the above* Pretest 2003 with answers/explanations Contraindications for the gingivectomy includes (1) the need for bone surgery or examination of the bone shape and morphology, (2) situations in which the bottom of the pocket is apical to the mucogingival junction, and (3) esthetic considerations, particularly in the anterior maxilla. 4. Which one of the following instruments cannot be used for a gingivoplasty procedure? A. Periodontal knife B. Scalpel C. Rotary coarse diamonds D. Electrodes E. None of the above* The gingivectomy technique may be performed by means of scalpels (also periodontal knives – Orban/Kirkland), electrodes (electrosurgery), laser beams, or chemicals (no longer used). The gingivoplasty technique may be done with a periodontal knife, scalpel, rotary coarse diamond stones, or electrodes (electrosurgery). 5. The purpose of using a membrane to treat an infrabony defect during guided tissue regeneration procedure is to prevent: A. A blood clot from forming in the periodontal defect. B. Apical migration of epithelial cells and formation of a long junctional epithelium.* C. Osteoblast and periodontal ligament cells from migrating coronally. D. A and C E. A, B, C Guided tissue regeneration procedures attempt to regenerate lost periodontal structures through differential tissue responses. Barrier techniques (resorbable or nonresorbable membranes) such as expanded polytetrafluroethylene, polyglactin, polylactic acid, and collagen are employed in the hope of excluding epithelium (sulcular, gingival and junctional) and the gingival connective tissue (corium) from the root surface in the belief that they interfere with regeneration. Excluding the epithelium and the gingival connective tissue from the root surface during the postsurgical healing phase not only prevents epithelial migration into wound but also favors repopulation of the area by cells from the periodontal ligament and bone. 6. A periodontal abscess is a localized accumulation of pus within the gingival wall of a periodontal pocket. A periodontal abscess may be acute or chronic. A. Both statements are true.* B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true. A periodontal abscess is a localized accumulation of purulent inflammation (pus) in the gingival wall of a periodontal pocket. It is also known as a lateral or parietal abscess. A periodontal abscess may form due to several reasons. The reasons are (1) Extension of infection from a periodontal pocket deeply into the supporting periodontal tissues and localization of the suppurative inflammatory process along the lateral aspect of the root; (2) Lateral extension of inflammation from the inner surface of a periodontal pocket into the connective tissue of the pocket wall (Localization of the abscess results when drainage into the pocket space is impaired); (3) In a pocket that Pretest 2003 with answers/explanations describes a tortuous course around the root, a periodontal abscess may form in the cul-de-sac, the deep end of which is shut off from the surface; (4) Incomplete removal of calculus during treatment of a periodontal pocket (In this instance the gingival wall shrinks, occluding the pocket orifice, and a periodontal abscess occurs in the sealed-off portion of the pocket.); and (5) A periodontal abscess may occur in the absence of periodontal disease after trauma to the tooth or perforation of the lateral wall of the root in endodontic therapy. 7. Symptoms of an acute periodontal abscess may include: A. Throbbing and radiating pain. B. Tenderness of the gingiva upon palpation. C. Increased tooth mobility. D. A,C E. A,B, C* The most common complaints are pain or discomfort (throbbing or radiating pain), and/or the appearance of an area of swelling that is tender to touch, chewing, or toothbrushing. Lymphadenitis may be present, and less frequently, systemic effects such as fever, leukocytosis, and malaise. The area of the swelling may be confined to one tooth, or it may involve multiple teeth. The gingival is elevated, edematous and red, with a smooth shiny surface. Periodontal probing depths are exaggerated in areas of abscess formation and bleeding/exudates upon probing is common. The tooth may display increased mobility but rarely is the tooth hypersensitive to percussion unless the interfurcal zone or apex of the tooth is involved. The vitality of teeth with periodontal abscesses, as determined using either thermal or electrical tests, is normal unless a tooth have been previously treated endodontically or is simultaneously affected by a pulpal lesion (a so-called combine lesion) 8. A gingival abscess may be differentiated from a periodontal abscess based upon: A. The location of the abscess. B. The duration and severity of the pain. C. The history of the abscess. D. A, C* E. A, B, C The principal differences between the periodontal abscess and the gingival abscess are the location and history. The gingival abscess is confined to the marginal gingival, and it often occurs in previously disease-free areas. It is usually an acute inflammatory response to forcing of foreign material into the gingival. The periodontal abscess involves the supporting periodontal structures and generally occurs in the course of chronic destructive periodontitis. 9. The treatment of an acute periodontal abscess may include: A. Incision and drainage of the abscess. B. Endodontic therapy. C. Gingival flap surgery. D. A, C E. A, B, C* The appropriate therapy for a periodontal abscess is determined by the stage of the abscess formation, the location and extent of the abscess, the extent and configuration of the attachment loss on the affected tooth, and the role of Pretest 2003 with answers/explanations the tooth in the overall periodontal plan. Therapy is directed at the resolution of pain and the drainage and debridement of the abscess. Many localized periodontal abscesses can be evacuated and thoroughly debrided through the gingival sulcus. In this case good plaque control and warm oral rinses should be adequate in resolving the abscess. Most patients require mild or no postoperative medication for discomfort. Antibiotic therapy is usually not indicated. Larger abscesses may require incision and drainage plus debridement of the root of the affected tooth. In the case of a combined periodontal-periapical lesion, a flap procedure can be utilized. The mucoperiosteal flap provides excellent access for visualization and instrumentation of the affected area. 10. Which abscess is most likely associated with a sinus or fistula? A. Gingival abscess B. Acute periodontal abscess C. Chronic periodontal abscess* D. None of the above A draining sinus on the lateral aspects of the root suggests periodontal rather than apical involvement; a sinus from a periapical lesion is most likely to be located further apically. However, sinus location is not conclusive. The chronic periodontal abscess usually presents a sinus that opens onto the gingival mucosa somewhere along the length of the root. There may be a history of intermittent exudation. The orifice of the sinus may appear as a difficult-to-detect pinpoint opening, which, when probed, reveals a sinus deep in the periodontium. The sinus may be covered by a small, pink, beadlike mass of granulation tissue. The chronic periodontal abscess is usually asymptomatic. However, a patient may report episodes of dull, gnawing pain, slight elevation of the tooth and a desire to bite down and