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Are You Suprised ? 1998 Board Questions and Answers DAPE 761 – Advanced Periodontology Dr. Dwight E. McLeod November 12, 2004 1998 BOARD QUESTIONS AND ANSWERS (ASSIGNMENT #3) These questions and answers were provided for your convenience to allow you to study for the National Board Part II. The explanations were included to give you a clear understanding of why each choice was selected. Should you encounter any doubts or problems in your interpretation of the explanation, it is your responsibility to consult your textbook, journal articles or handouts for further clarification. I will also be available to assist you if needed. I hope that the explanations below will not only help you to understand each question better but will help to broaden your knowledge in Periodontics as you prepare for the examination. Good Luck! 1. When would you prescribe an antibiotic in conjunction with periodontal scaling and root planing? a. Severe gingivitis b. Localized aggressive periodontitis* c. Advanced Chronic periodontitis d. Linear gingival erythema Antibiotic therapy is not generally recommended for patients with a diagnosis of chronic periodontitis, unless there are some unique systemic problems or compromised conditions. Patients with chronic periodontitis and severe gingival inflammation usually respond well to elimination of the local factors (nonsurgically and/or surgically) and compliance with oral hygiene and supportive periodontal care. Patients with the more aggressive forms of periodontitis (Localized Aggressive Periodontitis and Generalized Aggressive Periodontitis) are generally treated with antibiotics. There is usually a specific microbe that is associated with the disease process, which may have the potential to invade the host’s connective tissues. The microbe, Actinobacillus actinomycetemcomitans, is associated with LAP. The antibiotic is usually an effective adjunctive treatment. Tetracycline/doxycycline is effective against the microbe that is associated with LAP. Other antibiotic alone or in combination may be used such as amoxicillin and metronidazole. 1 1998 Board Questions and Answers 2. Polly Pontic is a 50 - year - old female patient who presented with a Class III furcation lesion, on tooth # 3 that communicates with the facial and distopalatal furcations. The distal root showed bone loss approaching the apex of the root. The tooth exhibits no significant mobility and the other remaining roots showed minimal bone loss. The patient showed strong interest in saving the tooth. Which would be the best definitive treatment option? a. Vital root amputation of the distal root* b. Osseous surgery c. Guided tissue regeneration d. Periodontal scaling and root planing In this case a vital root amputation of the distal root would be the choice of treatment since the palatal and mesiobuccal root have good bone support. Usually the patient does not experience any pulpal discomfort after a vital root amputation. The root canal therapy and the restorative treatment can be done at a later date. 3. Which one (s) of the following antimicrobial agents has (have) been shown to have a substantivity of 12 hours? a. The essential oils in Listerine b. The chlorhexidine digluconate in Peridex c. The triclosan in Colgate Total toothpaste d. B and C* e. All of the above Chlorhexidine (0.12%) has been shown to have a 12 hour substantivity. When prescribed the instructive is usually to rinse twice daily. Triclosan (0.30%) that is an antimicrobial agent that is found in Total Toothpaste and it also has a substantivity of 12 hours. This is made possible by the 2% copolymer which enhances the substantivity of the Triclosan. The essential oils are said to have a substantitivy of approximately 4 to 6 hrs. 4. In performing a gingivectomy incision in a person with drug induced gingival hyperplasia, the tip of the scalpel is held in what direction relative to the base of the pocket? a. At right angle to the base of the pocket b. Coronal to the base of the pocket c. Apical to the base of the pocket* d. None of the above The gingivectomy incision is made slightly apical to the base of the psuedopocket. The starting point is from the external surface of the gingiva toward the tooth. The blade is angled at a 45 degree such that a bevel is created. Thus the term external bevel or bevel incision. 2 1998 Board Questions and Answers 5. What is the type of incision that is used in the gingivectomy procedure? a. Bevel incision b. Inverse bevel incision c. Intrasulcular incision d. External bevel incision e. A and D* See explanation for question number 4 6. Of the instruments listed below, which one is the most reliable for detecting furcation involvement? a. EXD 11/12 explorer b. 17/18 curette c. Periodontal probe d. Nabers furcation probe* The Nabers furcation probe is very similar to the CH3 explorer except that it has millimeter gradations which makes it much easier to measure the extent of horizontal furcal penetration. This would be very appropriate for use with the Hamp’s furcation classification. 7. Osseous surgery is a procedure used: a. to treat shallow interdental craters.* b. to regenerate mandibular class II furcations. c. to treat three wall infrabony defects. d. None of the above Shallow interdental craters are not graftable lesions and therefore, they are usually eliminated by osseous surgery to achieve a positive bony architecture. 8. Which of the following tissue(s) listed below is (are) included in a partial thickness flap? a. Periosteum, connective tissue, and epithelium b. Bone, connective tissue, periosteum, and epithelium c. Connective tissue and epithelium* d. Cementum, periosteum, connective tissue and epithelium A full thickness flap is comprised of epithelium on the outer side, connective tissue in the middle and the periosteum on the internal aspect of the flap. When a partial thickness flap is done, the connective tissue is sectioned and thus some connective tissue remained on alveolar bone along with the periosteum. The partial-thickness flap that is reflected is composed of epithelium on the outer side and connective tissue on the inner side. The periosteum is left attached to the alveolar bone 3 1998 Board Questions and Answers 9. You have been instructed by Dr. Roller to perform limited periodontal surgery on tooth # 19. Upon examining the patient you noticed that on the lingual the tooth probed 7 - 2 - 8 mm and on the facial the tooth probed 6 – 3 – 7 mm. What type of periodontal surgery would you perform? a. Modified Widman or Gingival Flap b. Osseous surgery including apically positioned flap* c. Connective tissue graft d. Gingival curettage Gingival curettage is a procedure that is no longer recognized as a specific ADA code. However, each time that you do periodontal scaling and root planing you are inadvertently doing curettage of the soft tissue wall of the periodontal pocket. In other words, you are removing the inflamed epithelial lining and possible some inflamed connective tissue. The Modified Widman procedure is not intended to treat infrabony defects or areas of osseous irregularities secondary to periodontal disease. The main purpose of this surgery is to gain access for root instrumentation. The flap is generally not reflected beyond the mucogingival junction. The connective tissue graft is used for treating gingival recession or augmentation of edentulous ridges but not for treating a periodontal pocket. The objective of osseous surgery is to access the underlying bone for recontouring purposes. This also provides the operator to access the root surfaces for instrumentation. The goal of osseous surgery is to reestablish a more ideal osseous architecture. In the above questions, the periodontal probing depths indicated areas of bony irregularities or infrabony defects. 10. Which inflammatory cell infiltrate predominates the exudate in the acute periodontal abscess? a. Plasma cells b. Lymphocytes c. Eosinophils d. Polymorphonuclear leukocytes* In stage I Gingivitis (Initial Lesion) occurs at days 2-4 and the predominant cell is the PMN. In stage II Gingivitis (Early Lesion) occurs at days 4-7 and the predominant cell is the Lymphocyte. In stage III Gingivitis (Established Lesion) occurs at days 14-21 and the predominant cell is the Plasma Cell. Exudate (Pus) is a fluid product of inflammation, consisting of a liquid containing leukocytes and the debris of dead cells and tissue elements liquefied by the proteolytic and histolytic enzymes (e.g. leukoprotease) that are elaborated by polymorphonuclear leukocytes. 4 1998 Board Questions and Answers 11. Which bacterial species predominates the lesions in Localized aggressive periodontitis? a. Actinomyces viscosus b. Actinobacillus actinomycetemcomitans* c. Actinobacillus migrans d. Actinomyces juvenilli Actinobacillus actinomycetemcomitans (Aa) has been shown by numerous studies to be the predominant bacteria isolated from persons with Localized Juvenile Periodontitis. This bacterial species is the most studied bacteria and is generally used to support the Specific Plaque Hypothesis that not all the bacteria in dental plaque are pathogenic, only specific bacteria in dental plaque cause periodontitis. 12. Tunneling procedure is a surgical procedure that is best reserved for: a. Maxillary molars b. Mandibular molars* c. Maxillary first premolars d. None of the above This procedure surgically converts a Class III furcation defect into Class IV furcation defect. Tunneling procedure is best suited for mandibular molars and usually provides access for the patient to clean the furcation area. A proxy brush or interdental brush would be the recommended dental aid. Recurrent caries are common in the furcal area if plaque control is not ideal and therefore some clinicians recommend using a daily application of fluoride gel or varnish. A tunneling procedure is not typically done on maxillary molars because of the anatomy. The presence of three roots will obstruct the complete passage of the interdental brush. A root amputation would be the treatment of choice for maxillary molars. 13. Allergic gingivitis is most commonly associated with the use of which of the following agents? a.
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