CLASSIFICATION

Question 1

4 workgroups of the classification

Answer 1

1. Gingival Health and Gingivitis
2. Periodontitis
3. Systemic Diseases and Development and Acquired Conditions
4. Peri Implant Diseases and Conditions

Question 2

Categories under Gingival Health, Gingivitis, Periodontitis

Answer 2

1. Gingival Health
   - intact periodontium, reduced periodontium
2. Gingivitis
   - intact periodontium, reduced periodontium
3. Treated Periodontitis
   -gingival health, gingival inflammation
4. Periodontitis
5. Necrotizing Periodontitis (Gingivitis)
6. Periodontitis as a Manifestation of Systemic Disease

Question 3

Extent

Answer 3

Localized <30%
Generalized > than or = to 30%
**must be percent of teeth at the stage defining severity (specific stage used for diagnosis from worst affected tooth in dentition)

Question 4

Periodontitis Staging

Answer 4

Interproximal CAL > than or equal to 2 non adjacent teeth
Buccal or oral CAL> than or = 3mm
Pocketing >3mm, > than or equal to 2 teeth
Unknown reason for tooth loss cannot be included

** interdental CAL detectable at > or equal to 2 non adjacent teeth OR buccal or oral CAL > than or = to 3mm with pocketing >3mm is detectable at > than or = to 2 teeth .

HOWEVER, cannot be ascribed to:
1. Gingival recession or traumatic origin
2. Dental caries extending to cervical area of teeth
3. CAL on 2nd molar distal associated with malpositioned or extraction of a 3rd molar
4. Endodontic lesion draining through marginal periodontium.
5. Vertical root fracture.

Question 5

Relation to stage and prognosis

Answer 5

Stage 1or 2-Good prognosis; no tooth loss expected
Stage 3- Risk of loss of a tooth or teeth up to 4
Stage 4- Risk of loss of arch of dentition (5 or more)

Question 6

Name the 3 parameters for Grading

Answer 6

1. Direct (longitudinal RBL and CAL)
   - A none
   -B <2mm
   -C>2mm
2. Indirect (% BL/Age)
   - A <0.25
   -B 0.25-1.0
   -C >1.0
3. Plaque-BL

Question 7

Name 2 risk factors in grading

Answer 7

1. Smoking
   -A- non smoker
   -B<10cigg/day
   -C- = or >10cigg/day
2. HbA1c
   A- normoglycemic
   B- <7
   C- >than or = to 7

Question 8

Systemic Impact

Answer 8

CRP (mg/L)
A<1
B 1-3
C>3

Question 9

Systemic conditions affecting periodontium

Answer 9

1. Down Syndrome
2. Leukocyte adhesion deficiency
3. Papillon Lefevre syndrom
4. Chediak Higashi Syndrome
5. Hypophosphatasia

Question 10

What conditions fall under Necrotizing Periodontal disease

Answer 10

1. Necrotizing gingivitis
2. Necrotizing periodontitis
3. Necrotizing stomatitis
4. NOMA

Question 11

NPD in severely compromised patients

Answer 11

ADULTS
1.HIV/AIDS
2. Immunosupression
CHILDREN
1. Severe malnourishment
2. Extreme living conditions
3. Severe viral infections

Question 12

NPDin temporarily or moderatley compromised patients

Answer 12

Gingivitis patients
- uncontrolled factors, stress, nutrition, smoking, habits
- previous NPD: residual craters
- local factors: root proximity, tooth malposition
- Gen or Loc NG, may progress to NP

Periodontitis patients
-common predisposing factors
- poor OH, stress, tobacco, alcohol, young age, ethnicity
- NP with infrequent progression

Question 13

Peri Implant Health

Answer 13

Absence of:
- visual inflammation (pink, no swelling, firm tissue)
- BoP (line or drop within 30sec and or suppuration on gentle probing)
-Increase in PD from baseline (prosthesis delivery)
-absence of further BL beyond initial healing, which should not be > than or = to 2mm
- Can exist around an implant with reduced support

• PD usually greater at implants
• IP papilla may be shorter for an implant

Question 14

How to examine an implant?

Answer 14

Visual
Probing
Palpation
Radiograph

Question 15

Peri Implant Mucositis

Answer 15

Bleeding on gentle probing
PD increase likely
Can resolve, but may take up to 3 weeks
Main etiology: plaque

Question 16

Peri Implantitis

Answer 16

Inflammation +BoP/suppuration
RBL following initial healing
Increase in PD from suprastructure placement
Progressive RBL compared to 1 year post prosthesis delivery
In the absence of initial radiographs and PD, radiographic evidence of BL> or =3mm AND/OR PD> than or= 6mm with profuse BOP

Question 17

Peri implantitis facts

Answer 17

1. no unique bacteria or cytokines identified
2. PIM assumed to precede PI but factors leading to change from PIM to PI not identified.
3. Progression of PI may be faster than periodontitis
4. Risk indicators (RI): History of periodontitis, poor plaque control, inadequate maintenance

• crestal RBL usually associated with inflammation

**data identifying smoking and diabetes as risk indicators is not conclusive.

• poor placement/position may increase prevalence of PI
• post restorative submucosal cement may lead to increased PI
• progression of PI may be faster than periodontitis

NOT ENOUGH EVIDENCE FOR RISK INDICATORS
- KT, occlusal overload, titanium particules, bone compression necrosis, overheating, micromotion and biocorrosion

Question 18

Peri Implant Disease Treatment

Answer 18

No standard therapy

Question 19

Hard tissue deficiencies

Answer 19

1. Horizontal ridge deficiency
2. Vertical ridge deficiency
3. Pneumatization of maxillary sinus
4. Thin/absent buccal and lingual bone plates

Question 20

Factors leading to bone deficiency

Answer 20

Post extraction healing
Loss of perio support
Endo infection
VRF
Thin buccal bone
Buccal or lingual relative to arch position
Traumatic exo
Injury
Sinus pneumatization
Meds and systemic diseases reducing bone formation
Tooth agenesis
Pressure from soft tissue supported removable prosthesis

Question 21

Soft tissue deficiencies

Answer 21

Thin peri implant mucosa
Lack of KT at peri implant site
Reduced papilla height
Peri implant frenum attachments

Question 22

Factors leading to recession

Answer 22

Poor implant position
Lack of buccal bone
Thin soft tissue
Lack of KT
Status of attachment on adjacent teeth
Surgical trauma

*evidence if equivocal on role of KT

Question 23

Relation of peri implant bone and peri implant soft tissue

Answer 23

Implant tooth papilla height determined by soft tissue attachment to the tooth
Implant to implant papilla height determined by bone crest between implants
Equivocal evidence on necessity of buccal bone plate for long term support of buccal soft tissue

Question 24

Prosthesis and tooth related factors

Answer 24

Localized tooth related factors
- tooth anatomic factors
- root fractures
-cervical root resorption, cemental tears
- root proximity
- APE

Question 25

Localized prosthesis related factors

Answer 25

1.Restoration margin within supracrestal attachment 2. Loss of periodontal supporting tissues caused by fabrication of indirect restoration 3. Hypersensativity/toxicity reactions to dental materials (nickle is most common)

Question 26

Mucogingival deformaties around TEETH

Answer 26

1. Gingival phenotype 2. Gingival recession - facial/lingual -interproximal RT1, RT2, RT3 3. Lack of gingiva 4. Decreased vestibular depth 5. Aberrant frenum/muscle position 6. Gingival excess - pseudopocket, inconsistent gingival margin -excessive gingival display 7. Abnormal colour 8. Root surface condition

Question 27

Periodontal Phenotype

Answer 27

Gingival phenotype (thickness and width of KT) Bone morphotype (thick and thin)

Question 28

Recession and other factors

Answer 28

Tooth position Toothbrushing Cervical restoration margin Orthodontic (buccal positioning)

Question 29

Cairo

Answer 29

RT1= no IP attachment loss- complete root coverage expected RT2= IP loss < or = to buccal AL - partial root coverage expected RT3= IP attachment loss >buccal AL - no coverage expected.

Question 30

Millers Recession Classification

Answer 30

Class 1- recession not to MGJ; no IP bone or papilla loss- 100% root coverage possible Class 2- recession PAST MGJ, no IP bone loss or papilla loss- 100% root coverage possible Class 3- recession PAST MGJ, IP bone and papilla loss, malpostion, partial root coverage possible Class 4- recession PAST MGJ, SEVERE IP bone and papilla loss, malposition, no coverage

Question 31

CEJ (A/B) Step (+/-)

Answer 31

CEJ A- detectable CEJ CEJ B- undetectable CEJ + = root concavity, cervical step >0.5 - = root concavity, no cervical step >0.5

Question 32

PERIO ENDO LESIONS CLASSIFICATION

Answer 32

Endo perio lesion WITH ROOT DAMAGE - root fracture root canal or pump perforation -external root resorption Endo perio lesion WITHOUT ROOT DAMAGE in periodontitis patients Grade 1- narrow, deep periodontal pocket in 1 tooth surface Grade 2- wide, deep periodontal pocket in 1 tooth surface Grade 3- deep periodontal pockets in more than 1 tooth surface

Question 33

Periodontal Abscess

Answer 33

PERIODONTITIS PATIENT Acute: - maintenance SPT -non responsive to treatment - untreated Post treatment: -post SRP, surgery, medication NON PERIODONTITIS PATIENT -Impaction: ortho elastics, popcorn hull -Habits: nail biting, clenching -Ortho: orthoforces , cross bite - Gingival overgrowth/ enlargement - Root surface alterations: cemental tear, peforation, fracture

Question 34

McGuire and Nunn

Answer 34

Good: one or more of the following- control of etiologic factors and adequate periodontal support as measured clinically and radiographically to assure the tooth would be relatively easy to maintain by the patient and clinician assuming proper maintenance Fair: one or more of the following: approx 25% AL as measured clinically and radiographically and or class 1 furcation involvement. The location and depth of the furcation would allow proper maintenance with good patient compliance Poor: one or more of the following, 50% AL with class II furcations. The locations and depths of the furcation would allow for proper maintenance but with difficulty Questionable: greater than 50% AL resulting in poor CR ratio. Poor root form. Class 2 furcations not easily accessible for maintenance care or Class 3 furcations. Grade 2 mobility or greater. Significant root proximity Hopeless: inadequate attachment to maintain the tooth. Extraction performed or suggested

Question 35

McGuire and Nunn (individual and overall prognosis )

Answer 35

Individual- % of BL, deepest PD, horizontal or vertical BL, deepest furcation involvement, mobility, CR ratio, root form, caries or pulp involvement, tooth malpostion, fixed or removable abutment Overall prognosis: age, significant medical history, family history of periodontal disease, hygiene, compliant, maintenance interval, parafunctional habit with bitegaurd, parafunctional habit without bitegaurd.

Question 36

Kowk and Caton

Answer 36

Favourable - periodontal status can be stabilized with periodontal treatment and maintenance. Future loss of periodontal supporting tissues is unlikely if these conditions are met Questionable- periodontal status of a tooth is influenced by local or systemic factors that may or may not to controlled. Periodontium can be stabilized with periodontal treatment and maintenance if these factors are controlled, otherwise future periodontal breakdown may occur. Unfavourable- periodontal status of the tooth is influenced by local and or systemic factors that cannot be controlled. Periodontal breakdown likely to occur even with periodontal tx and maintenance Hopeless - needs exo

Question 37

Becker and Becker Prognosis

Question 38

When to assign prognosis?

Answer 38

1. initial exam 2. re-evaluation 3. post therapy 4. annually during maintenance unless some event indicates a need to re-evaluate the prognosis *prognosis is not static and may change