154 Periodontalogy- Prof. Sok Chea

Acellular dermal grafts are most effective when they are fully covered by a mucoperiosteal flap during the healing process. This ensures that the graft remains protected and undisturbed, allowing for proper integration and optimal healing. By being submerged beneath the flap, the graft is shielded from external forces and can successfully regenerate and integrate with the surrounding tissues. Therefore, the statement "Acellular dermal grafts work best when they are completely submerged beneath a mucoperiosteal flap during healing" is true.

The correct answer is 3mm because the question asks for the period of time that substances like EDTA or Tetracycline paste should be applied to the root surface. The answer options provided are measurements of millimeters, which suggests that the question is asking for the depth or extent of application. Therefore, the correct answer is 3mm, indicating that the substances should be applied to the root surface for a depth of 3 millimeters.

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Charter's method is the best method of brushing technique preferred for patients with orthodontic appliances. This method involves using a small circular motion to clean the teeth and gums, focusing on the area around the brackets and wires. It is effective in removing plaque and food debris from hard-to-reach areas and helps maintain good oral hygiene during orthodontic treatment. The Bass method and Stillman method are also commonly used brushing techniques, but Charter's method is specifically designed for patients with orthodontic appliances.

Based on the given information, the patient is a 40-year-old diabetic with periodontal attachment loss. This indicates that the periodontitis is a manifestation of their systemic disease, which is diabetes. Diabetes is known to have an impact on oral health and can contribute to the development of periodontitis. Therefore, the correct classification for this case is "Periodontitis as a manifestation of systemic disease."

Root planning is the process of removing diseased cementum along with other root deposits. Diseased cementum is the outer layer of the root surface that becomes infected and needs to be removed to promote healing and prevent further damage to the tooth and surrounding tissues. This procedure is typically performed by a dental professional to treat periodontal disease and improve the health of the gums and supporting structures of the teeth.

The average human biologic width is 2mm. This refers to the space between the bottom of the gum pocket and the bone level. It is important to maintain this width in order to ensure the health and stability of the surrounding tissues and structures. Deviations from this average can indicate periodontal disease or other oral health issues.

The correct answer includes three types of periodontal surgery: periodontal flap surgery, periodontal plastic surgery, and resective osseous surgery. These are all commonly performed procedures in periodontal surgery.

After scaling and root planning, there is a reduction in inflammation and pocket depth. Scaling and root planning is a deep cleaning procedure that removes plaque and tartar from the teeth and roots. This helps to eliminate bacteria and toxins that cause inflammation and infection in the gums. As a result, the gums become healthier, and the pockets around the teeth become shallower. Therefore, the correct answer is reduction in inflammation and pocket depth.

The success of a subgingival curettage procedure relies on the removal of the epithelial lining of the pocket. This is because the epithelial lining can harbor bacteria and contribute to the progression of periodontal disease. By removing the epithelial lining, the dentist can effectively eliminate the source of infection and promote healing of the periodontal tissues. Removal of free gingiva, removal of cementoenamel junction, and placement of sutures may also be important steps in the procedure, but they are not critical for its success.

Gingivectomy is a surgical procedure that involves the removal of gum tissue. It can be done using different instruments and techniques. The Kirkland knife is a commonly used instrument for gingivectomy, as it allows for precise cutting of the gum tissue. Potassium hydroxide is sometimes used as a chemical agent to assist in the removal of the gum tissue. Electrosurgery, which involves the use of high-frequency electrical currents, can also be used for gingivectomy. Therefore, all of the above options are correct as they represent different methods or instruments that can be used for gingivectomy.

The amount of attached gingiva has the greatest effect on the type of incision to be given. Attached gingiva refers to the firm, keratinized tissue that is bound to the underlying bone. It provides stability and protection to the periodontal tissues. When there is an inadequate amount of attached gingiva, it may be necessary to perform a surgical procedure to increase the amount of attached gingiva. This can involve techniques such as a gingival graft or a frenectomy. The other clinical findings mentioned (frenum attachment, depth of the vestibule, and probing depth) may also influence treatment decisions, but the amount of attached gingiva is considered the most important factor in determining the type of incision to be given.

Periodontal surgery may be necessary in cases of horizontal bone loss. The most appropriate procedure for this condition is the papilla preservation flap. This procedure involves making an incision along the gingival margin and reflecting a flap to expose the underlying bone. The papilla between the teeth is preserved during this procedure, which helps to maintain the esthetics and function of the area. The papilla preservation flap allows for access to the affected area, while also minimizing the risk of further damage or loss of the gum tissue.

The outcome of results of a laterally positioned flap depends on the presence of sufficient bone support at the donor site, as this provides stability and proper healing. Additionally, the thickness of attached gingiva at the donor site is important for successful flap placement, as a thicker gingiva provides better blood supply and reduces the risk of complications. The width of attached gingiva at the donor site is also crucial, as a wider area allows for better coverage and protection of the underlying tissues. Therefore, all of these factors play a role in determining the outcome of a laterally positioned flap.

After the placement of a free gingival graft, it undergoes degeneration. This is because the graft tissue, which is taken from another area of the mouth, goes through a process of breaking down and reabsorption. This allows for the integration and healing of the graft with the surrounding tissues. It is a normal part of the healing process and is necessary for the successful outcome of the grafting procedure.

After reflection of a full-thickness graft, the post-surgical alveolar bone loss is greatest at the thin facial margin. This is because the thin facial margin is the area where the graft is attached, and during the healing process, some bone loss may occur in this region. The thick lingual margin and interproximal bone are not directly affected by the graft, so they are less likely to experience significant bone loss. The statement "no bone loss at all" is incorrect, as some degree of bone loss is expected after a full-thickness graft procedure.

The Langer technique is used in subepithelial connective tissue grafts. This technique involves harvesting a graft of connective tissue from the palate and then placing it beneath the recipient site to enhance soft tissue thickness and improve esthetics. This procedure is commonly used in periodontal surgery to treat gingival recession and improve the appearance of the gumline.

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Periodontal pack is not given in GTR procedures without osseous transplants because in this procedure, the focus is on guided tissue regeneration, which involves the use of membranes and/or graft materials to encourage the growth of new tissue and bone. A periodontal pack is typically used to protect surgical sites and promote healing, but it is not necessary in GTR procedures without osseous transplants as the emphasis is on regenerating tissues rather than protecting the surgical site.

The most common indication for a Coronally Positioned Flap is root coverage. This surgical technique is commonly used in periodontal therapy to treat gingival recession and expose more of the tooth's root surface. By repositioning the gum tissue, the flap helps to cover and protect the exposed root, improving aesthetics and reducing sensitivity.

After root coverage surgery on a tooth, it is suggested to wait for a healing period of 12 weeks before making the final impression for the final restoration. This is because it takes time for the tissues to heal and stabilize after the surgery. Waiting for 12 weeks allows for proper tissue regeneration and ensures a more accurate and successful final impression for the restoration.

The first indication to apply for controlling bleeding at the donor site is pressure with a moistened gauze. This method helps to apply direct pressure on the bleeding site, which can help to stop the bleeding. Moistening the gauze can also help to enhance the effectiveness of the pressure by promoting clotting. Other methods like suturing, collagen with or without stent, vasoconstriction, and pressure with a tea bag may be used in certain situations, but the most immediate and commonly recommended method is applying pressure with a moistened gauze.

The most successful approach to treatment for an adult patient with chronic adult periodontitis is initial periodontal therapy followed by maintenance therapy alone. This approach involves a thorough cleaning of the teeth and gums to remove plaque and tartar, followed by regular maintenance visits to prevent further progression of the disease. Surgery may be necessary in some cases, but it is not always the most successful approach. Extreme initial treatment followed by yearly reviews may not be as effective as continuous maintenance therapy. Therefore, the best approach is to start with initial periodontal therapy and then focus on maintenance therapy to ensure long-term success.

A soft tissue graft should be considered as an appropriate treatment for gingival recession when there are probing extents beyond the mucogingival junction, abnormal frenum attachment, and symptoms such as root sensitivity and root caries. These factors indicate that the gingival recession has progressed to a point where intervention is necessary to prevent further damage and improve oral health.

The original Widman flap technique involves making two releasing incisions to demarcate the area scheduled for surgical therapy. A scalloped reverse bevel incision is then made in the gingival margin to connect these two releasing incisions. This technique is used to access and treat periodontal pockets and is named after Dr. E. J. Widman, who first described it. The other options listed are different periodontal flap techniques, but they do not involve the specific steps mentioned in the question.

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The periodontium refers to the supporting structures of the teeth, which include the cementum (a layer covering the tooth root), the gum (also known as gingiva), the alveolar bone (the bone surrounding the tooth sockets), and the periodontal ligaments (fibrous tissue that connects the tooth root to the bone). Therefore, the correct answer is "Cementum, gum, alveolar bone, and periodontal ligaments."

After curettage, re-epithelialization of the sulcus occurs within 2-7 days. Curettage is a dental procedure that involves the removal of diseased or infected tissue from the gum pocket. After the procedure, the body initiates the healing process, which includes the formation of new epithelial cells to cover the exposed area. This process typically takes 2-7 days, during which the sulcus gradually heals and the gum tissue regenerates.

Gingivoplasty is the correct answer because it refers to the reshaping process of the gingiva (gums) without the presence of a periodontal pocket. Curettage involves the removal of diseased tissue from the periodontal pocket, while gingivectomy is the surgical removal of gum tissue. Flap operation is a more extensive procedure that involves lifting and repositioning gum tissue. Therefore, gingivoplasty is the most appropriate option for reshaping the gingiva without a periodontal pocket.

Periodontal surgery may accomplish the elimination of pocket. This means that the surgery aims to remove or reduce the deep pockets that form between the teeth and gums in cases of periodontal disease. These pockets can harbor bacteria and lead to further damage to the gums and bone supporting the teeth. By eliminating the pocket, the surgery helps to improve the health of the gums and prevent further progression of the disease.

The term gingival ablation indicates gingival recession due to friction from soft tissue. This means that the gingiva (gums) have receded or pulled away from the tooth surface due to friction or rubbing from the adjacent soft tissues, such as the lips or cheeks. This can be caused by factors such as aggressive tooth brushing, incorrect flossing technique, or habitual biting or chewing on the soft tissues.

The estimated width of attached gingiva after treatment can be calculated by subtracting the pre-treatment pocket depth (6 mm) from the width of attached gingiva before treatment (2 mm). Therefore, the estimated width of attached gingiva after treatment would be 4 mm.

A free gingival graft is typically placed on the periosteum. The periosteum is a layer of connective tissue that covers the bone and provides a source of blood supply for the graft. Placing the graft on the periosteum allows for better integration and healing of the graft with the surrounding tissues.

The correct answer is a swedged suture needle. A swedged suture needle is commonly used in periodontal surgery because it has a rounded point, which helps prevent tissue damage, and a double cutting edge, which allows for easier and cleaner suturing. This type of needle is designed specifically for dental procedures and is preferred for its precision and effectiveness in periodontal surgery.

The anchor suture is recommended for apical procedures because it provides excellent stability and support. This type of suture involves placing multiple stitches around the apex of the wound, creating a strong anchor point. This helps to prevent any tension or pulling on the wound, promoting proper healing and minimizing the risk of dehiscence or wound breakdown. The anchor suture is particularly useful in areas where there is a high risk of tension or movement, such as the apical region.

Reattachment procedures most commonly reduce pocket depth by formation of long junctional epithelium. This involves reattaching the gingival tissue to the root surface, allowing for the formation of a new attachment between the epithelium and the root surface. This procedure helps to reduce the depth of the periodontal pocket and promote the healing process. It is typically used when the aesthetics of the area is not a primary concern.

New attachment refers to the process of embedding new periodontal ligament fibers into new cementum and the attachment of new gingival epithelium to a tooth surface that was previously denuded by disease. This process helps to restore the attachment between the tooth and surrounding tissues, promoting the healing and regeneration of the periodontium.

During a hemisection or root section of a maxillary first molar, the root that is commonly removed is the distobuccal root. This is because the distobuccal root is usually the most affected or damaged root, and removing it can help preserve the remaining healthy roots and promote better oral health.

The basic principle of intra-oral suturing is to achieve an even distribution of tension across the wound. This helps in ensuring proper wound closure and healing. Knotting to the lingual, the more the better, or all of the above are not correct principles of intra-oral suturing.

Infection is the primary reason for failure of free gingival graft. Infection can lead to inflammation and tissue damage, compromising the graft's ability to survive and integrate with the surrounding tissues. It can also impair the healing process and increase the risk of complications such as graft necrosis. Therefore, proper infection control measures are crucial to ensure the success of a free gingival graft procedure.

A soft tissue graft should be considered as an appropriate treatment of gingival recession when probing extents beyond the mucogingival junction, abnormal frenum attachment, root sensitivity, and root caries are present. These factors indicate that the gum tissue has receded significantly, causing exposure of the tooth roots, which can lead to sensitivity and decay. A soft tissue graft can help restore the gum tissue, cover the exposed roots, and improve overall oral health.

The incision in the esthetic zone should initially be made at the mucogingival junction. This is because the mucogingival junction provides a stable and predictable reference point for the incision. It helps to ensure that the incision is placed at the correct level and allows for precise control of the depth and direction of the incision. By starting the incision at the mucogingival junction, the surgeon can create a clean and well-defined flap that can be easily elevated for the semi-lunar graft treatment of gingival recession.

Regional lymphnode enlargement is present in acute pericoronitis. Acute pericoronitis is an inflammation of the soft tissues surrounding a partially erupted tooth, usually the third molars (wisdom teeth). This inflammation can cause swelling and tenderness in the nearby lymph nodes, which are part of the body's immune system response. The other conditions listed, such as lichen planus, pemphigus vulgaris, pemphigoid, and chronic ulcerative stomatitis, do not typically cause regional lymph node enlargement.

The papilla preservation flap is a surgical technique used for teeth with wide interdental spaces. This flap procedure aims to preserve the papilla, the triangular gum tissue between the teeth, while accessing the underlying structures. By utilizing this technique, the dentist can maintain the aesthetic appearance of the smile and prevent the formation of black triangles between the teeth.

The main aim of restoration of carious lesions in phase-I therapy is to reduce the microbial source. Carious lesions are caused by bacteria that break down the tooth structure, leading to decay. By restoring the tooth and removing the carious lesion, the microbial source is reduced, preventing further decay and promoting oral health. Restoring the function and form of the tooth are secondary objectives in this context.

The primary purpose of scaling and root planing is to remove the sulcular epithelium. This procedure involves removing the diseased tissue and bacteria from the periodontal pockets, which are the spaces between the teeth and gums. By removing the sulcular epithelium, the dentist or dental hygienist can access and clean the root surfaces of the teeth, removing calculus and softened necrotic cementum. This helps to promote healing and prevent further progression of gum disease.

The major problem in scaling and root planing in interproximal areas of mandibular anterior teeth is the proximity of root surfaces. When the roots of adjacent teeth are close together, it becomes difficult to access and clean the interproximal areas effectively. This can lead to the accumulation of plaque and calculus, which can result in gum disease and other oral health issues. The small dimensions of the crown and root may also contribute to the difficulty of the procedure, but the primary challenge lies in the proximity of the root surfaces.

The correct answer is Gingival curettage. Gingival curettage is a dental procedure that involves the removal of the soft tissue lining of the periodontal pocket. It is indicated in the early stages of gum disease to remove diseased tissue and promote healing. Scaling and root planning, gingivectomy, and flap surgery are also dental procedures, but they are not specifically indicated in the early stages of gum disease like gingival curettage.

During the healing process of gingival wounds, epithelial cells migrate at a rate of 0.5-1.0 mm/Day. This means that the epithelial cells move and cover the wound area at a speed of 0.5-1.0 mm per day. This migration of cells is an important part of the healing process as it helps in the re-epithelialization of the wound and the formation of new tissue.

Following flap surgery or curettage, the most frequently formed structure at the tooth-tissue interface is the long junctional epithelium. This is because during these procedures, the gingival tissue is manipulated and repositioned, leading to the formation of a new junctional epithelium that is longer than the original one. The long junctional epithelium helps to provide a seal and attachment between the tooth surface and the gingival tissue, promoting healing and preventing further infection or inflammation.

The mandibular first permanent molar is commonly involved with furcation involvement. Furcation involvement refers to the loss of bone and attachment in the area where the roots of a multi-rooted tooth divide. This can lead to increased risk of periodontal disease and tooth loss. The other teeth listed in the options may also experience furcation involvement, but the mandibular first permanent molar is the most commonly affected tooth.

The correct answer is polymorphonuclear neutrophils (PMNs), mast cells, and macrophages. These cells are typically found in the healthy periodontium and play important roles in the immune response. PMNs are the first line of defense against bacterial infections and help to eliminate pathogens. Mast cells release inflammatory mediators and play a role in allergic reactions. Macrophages are involved in phagocytosis and antigen presentation, helping to regulate the immune response. Together, these cells contribute to maintaining the health of the periodontium.

The first cellular line of defense against periopathogens is PMN (polymorphonuclear leukocytes). PMNs are a type of white blood cell that play a crucial role in the immune response by engulfing and destroying pathogens. They are part of the innate immune system and are among the first cells to arrive at the site of infection or inflammation. PMNs are highly effective in killing bacteria and other pathogens, making them an important component of the body's defense against periopathogens.

The dento-gingival restorative interface is the average dimension extending from the free gingival to the redeveloped bone. This dimension is 3mm.

The statement "Flaps elevated after marginal incisions never need sutures" is not true for the marginal incision technique. This technique involves making incisions along the margins of a wound to create flaps, which are then elevated. While this technique may provide good bleeding control and be surgically safe, sutures are often necessary to secure the elevated flaps and promote proper healing.

The correct answer is 2mm. When using autogenous grafts utilizing the palatal connective tissue, the initial incision for graft harvesting should be made at a measurement of 2mm above the gingival margin of the maxillary teeth. This measurement is important as it ensures that enough palatal tissue is harvested for the graft while still maintaining the health and stability of the surrounding teeth and gingiva.

The given symptoms of loss of interdental marginal stippling, blue-red tissue color, and bleeding upon gentle probing are indicative of chronic gingivitis. Chronic gingivitis is characterized by inflammation of the gum tissue, which can cause the gum tissue to appear bluish-red and lose its stippling or textured appearance. Bleeding upon probing is also a common sign of chronic gingivitis. Systemic diseases and advanced periodontal diseases may also present with similar symptoms, but the given symptoms specifically point towards chronic gingivitis as the most likely diagnosis.

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Removable prosthodontic appliances do not come under phase 1 therapy because phase 1 therapy primarily focuses on the initial treatment of periodontal disease. Plaque control, root planning, and restoration are all part of phase 1 therapy as they involve the removal of plaque and calculus, restoration of damaged teeth, and establishment of proper oral hygiene practices. Removable prosthodontic appliances, on the other hand, are prosthetic devices used to replace missing teeth and are typically considered part of phase 2 or 3 therapy.

Oedema in the tissue determines the amount of shrinkage of inflamed tissue after scaling and root planning. Oedema refers to the swelling caused by an accumulation of fluid in the tissue. Inflammation can cause fluid to accumulate in the tissue, and scaling and root planning help remove the cause of inflammation. As the inflammation subsides and the oedema resolves, the tissue can shrink back to its normal size. Therefore, the presence of oedema in the tissue is the determining factor for the amount of shrinkage that occurs.

Gingivoplasty is a surgical procedure that involves reshaping and contouring the gum tissue. It is typically performed to improve the appearance of the gums or to correct gum abnormalities. ANUG, or Acute Necrotizing Ulcerative Gingivitis, is a severe gum infection that causes painful ulcers and necrosis of the gum tissue. Gingivoplasty may be useful in ANUG to remove the damaged tissue and promote healing. Therefore, ANUG is the condition in which gingivoplasty is more likely to be useful.

After gingivectomy, the complete repair of connective tissue takes around 5-7 weeks. This procedure involves the removal of excess gum tissue, and the healing process involves the formation of new tissue to replace the removed tissue. This repair process typically takes several weeks for the new tissue to fully develop and integrate with the surrounding gums. Therefore, it is expected that complete repair of connective tissue would occur within 5-7 weeks after gingivectomy.

An apically positioned flap is a surgical technique used in periodontal procedures to increase the clinical crown length and preserve the width of attached gingiva. It involves repositioning the gum tissue to a lower position on the tooth, which eliminates pockets and improves the overall health of the gums. However, this technique is not commonly done on the palatal side, as it is typically used on the facial or buccal side of the tooth.

In this case, the patient has a recession on a labially prominent upper canine, with a shallow vestibule and lack of keratinized gingiva in that area. The best method to create a zone of attached gingiva in this case would be a free pedicle graft. A free pedicle graft involves taking a graft of tissue from the palate and attaching it to the area of recession, allowing for the formation of new attached gingiva. This technique is effective in increasing the width and thickness of the gingiva, providing better protection for the exposed root surface.

Elevating a partial thickness flap is the best way to prevent exposure of dehiscence during a surgical procedure. This technique involves lifting only the outer layers of the flap, leaving the underlying tissues intact. By preserving the blood supply and minimizing trauma to the surgical site, the risk of dehiscence, which is the separation of the wound edges, is reduced. This allows for better healing and reduces the chances of complications during the recovery process.

Glickman classified furcation involvement into 4 grades based on the horizontal measurement of attachment loss. This means that the extent of furcation involvement is determined by measuring the amount of attachment loss horizontally, rather than vertically or not at all. This classification helps in understanding the severity of furcation involvement and planning appropriate treatment strategies.

The main indication for using a Sling Suture is when only the buccal flap is elevated. This suggests that the Sling Suture is specifically designed to be used in cases where only the buccal flap needs to be elevated, and not in cases where both the buccal and lingual flaps are elevated or where the buccal and palatal flap are elevated.

The common indications for an Apically Positioned Flap are crown lengthening and pocket reduction. Crown lengthening is a procedure used to expose more of the tooth structure for restorative purposes, while pocket reduction is performed to reduce the depth of periodontal pockets and improve oral hygiene. Root coverage, on the other hand, involves techniques like connective tissue grafts and is not typically associated with an Apically Positioned Flap. Therefore, the correct answer is "a and b only".

The height of the interproximal bone affects the % of root coverage following root coverage surgery the most. The interproximal bone refers to the bone between the roots of adjacent teeth. If the interproximal bone is at a sufficient height, it provides support for the soft tissues and allows for successful root coverage. However, if the interproximal bone is too low, it can limit the amount of root coverage that can be achieved during surgery. Therefore, the height of the interproximal bone is a critical factor in determining the success of root coverage surgery.

Subgingival plaque is the plaque that accumulates below the gumline, in the periodontal pocket. This environment is mostly anaerobic, meaning it lacks oxygen. Anaerobic bacteria thrive in this environment and are the predominant type of bacteria found in subgingival plaque. Additionally, these anaerobic bacteria in subgingival plaque are frequently gram-negative, which means they have a particular cell wall structure that stains pink when exposed to a Gram stain. This distinguishes them from gram-positive bacteria, which stain purple. Therefore, the statement "Subgingival plaque consists mostly of anaerobic bacteria (frequently gram-negative)" is true.

Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the cyclooxygenase (COX) enzyme, which is responsible for the metabolism of arachidonic acids. By inhibiting COX, NSAIDs reduce the production of prostaglandins, which are responsible for inflammation, pain, and fever. Blocking anaerobic bacteria or both cyclooxygenase and anaerobic bacteria are not accurate explanations for the pathway that NSAIDs block.

The technique described in the passage involves making multiple incisions to separate the tissue collar from the root surface and the alveolar bone. This technique is known as the Modified Widman flap. The other options mentioned in the question, such as Apical position flap, Original Widman flap, Papilla preservation flap, and Kirdland flap, do not match the description of the technique described in the passage.

The concept of one stage Full mouth disinfection aims to prevent the translocation of microorganisms. This means that by disinfecting the entire mouth in one stage, the spread of microorganisms from one area to another can be minimized or eliminated. This is important because the translocation of microorganisms can lead to the colonization of new areas and the development of infections or diseases. By preventing translocation, the risk of further complications can be reduced, promoting better oral health.

The correct answer is "Internal bevel or first incision". This is because during pocket elimination by reflecting flap, the incision that removes the pocket lining is the internal bevel or first incision. This incision is made along the inner surface of the gum tissue, allowing access to the pocket and facilitating the removal of the lining. The other options mentioned, such as second incisors or crevicular incision and third incision, are not accurate in this context.

The correct answer is "Ultra thin recipient tissue." This means that having ultra thin recipient tissue is not a contraindication for lateral sliding graft. In a lateral sliding graft procedure, a section of tissue is taken from a donor site and placed onto a recipient site to improve the thickness of the tissue. However, if the recipient tissue is already very thin, it may not be suitable for this type of graft. Therefore, having ultra thin recipient tissue would not be a contraindication for the procedure.

The correct answer is 2-5 weeks. Vasculisation of healing of graft refers to the process of blood vessels growing into the graft to supply it with nutrients and oxygen. This process typically occurs within 2-5 weeks after the graft is placed. It is an essential step in the functional integration of the graft, allowing it to become a part of the surrounding tissue and function properly.

The buccal mandibular premolar has the least amount of attached gingiva in the oral cavity. Attached gingiva refers to the firm, tightly bound gum tissue that surrounds the teeth. The buccal mandibular premolar is located in the lower jaw on the cheek side, and it typically has a smaller amount of attached gingiva compared to other areas in the oral cavity. This can make it more susceptible to gum recession and other periodontal issues.

Crown lengthening is a surgical procedure performed to expose more of the tooth's structure, usually to prepare for a dental restoration. The procedure involves removing or reshaping gum tissue and sometimes also removing a portion of the underlying bone. The correct answer "All of the above" suggests that crown lengthening can be performed using either gingival resection and harmonization with or without osseous resection in natural passive eruption or gingival resection and harmonization with osseous resection in delayed passive eruption. In other words, both techniques can be used depending on the specific case and the desired outcome.

All of the above options, tetracycline, EDTA, and citric acid, can be used to treat the root surface during debriding for a soft tissue graft. Tetracycline is an antibiotic that can help eliminate bacteria, EDTA is a chelating agent that can remove mineral deposits, and citric acid can help remove the smear layer and promote root surface demineralization. Using all of these options together can provide a comprehensive treatment for the root surface, ensuring optimal conditions for the success of the soft tissue graft.

The common indications for an Apically Positioned Flap are crown lengthening and pocket reduction. Crown lengthening is a procedure performed to expose more of the tooth structure for restorative purposes. Pocket reduction, on the other hand, is done to reduce the depth of periodontal pockets and improve oral hygiene. Both procedures involve the use of an apically positioned flap, making them the correct answers in this case. Root coverage is not mentioned as an indication for an apically positioned flap.

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A partial thickness flap should be composed of both epithelium and connective tissue. Epithelium is the outermost layer of tissue that covers the body's surfaces and lines the internal organs. Connective tissue provides support and structure to the body and includes tissues such as blood, bone, and cartilage. Together, these two types of tissues would form a partial thickness flap.

To maintain proper biologic width after crown lengthening, the crown preparation between the margin of the preparation and the crest of bone should be 3mm. This is because the biologic width consists of the junctional epithelium and the connective tissue attachment, which together have an average height of 2-3mm. By allowing a 3mm space between the margin and the crest of bone, it ensures that there is enough room for the biologic width to be maintained without causing any damage or inflammation to the surrounding tissues.

Horizontal bone loss is a characteristic feature of chronic periodontitis. This condition is characterized by the gradual and progressive loss of the alveolar bone around the teeth, resulting in the formation of horizontal defects. Unlike vertical bone loss, which is seen in aggressive forms of periodontitis, horizontal bone loss occurs when the bone resorption is relatively uniform around the tooth, leading to a more even and consistent reduction in the bone level. Therefore, chronic periodontitis is the most likely condition associated with horizontal bone loss.

Conventional gingivectomy is a surgical procedure used to remove excess gum tissue and eliminate false pockets. It involves healing by secondary intention, where the wound is left open to heal naturally. The procedure can lead to a decrease in the width of the attached gingiva, which is the gum tissue that is firmly attached to the teeth. However, it does not provide accessibility to the alveolar bone, which is the bone that supports the teeth.

Insufficient width of attached gingiva to mucogingival line is a defined indication for mucogingival surgeries (periodontal plastic surgeries). This means that when there is not enough attached gingiva present between the teeth and the mucogingival line (the line where the gums meet the oral mucosa), it can lead to problems such as gingival recession. Mucogingival surgeries aim to correct this issue by increasing the width of attached gingiva, improving the overall health and aesthetics of the gums.

Fibronectin is used in periodontal therapy as a biomodification of the root surface. This means that it is used to modify the surface of the tooth root in order to enhance the attachment of periodontal tissues and promote healing. Fibronectin helps to promote cell adhesion and migration, which is important in the regeneration of periodontal tissues. It can also help to inhibit bacterial colonization on the root surface. Therefore, using fibronectin as a biomodification of the root surface can improve the success of periodontal therapy and promote better oral health.

Actinobacillus actinomycetemcomitans is associated with localized juvenile periodontitis. This bacterium is commonly found in the subgingival plaque of affected individuals and has been shown to play a significant role in the progression of this disease. It is known to produce various virulence factors that can lead to tissue destruction and inflammation in the gums. Therefore, Actinobacillus actinomycetemcomitans is considered a key bacteria associated with localized juvenile periodontitis.

ANUG stands for Acute Necrotizing Ulcerative Gingivitis, which is a severe form of gum disease. The bacteria associated with ANUG include P. gingivalis, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Prevetella intermedia, and the fusospirochetal complex (fusiform bacteria and spirochetes). These bacteria contribute to the development and progression of ANUG, causing tissue destruction and ulceration in the gums. The presence of the fusospirochetal complex, specifically the fusiform bacteria and spirochetes, is particularly associated with ANUG.

Periodontal flap for access is the most appropriate choice for therapy if periodontal surgery is needed in the mandibular anterior region. This procedure involves creating a flap of gum tissue to gain access to the underlying structures, allowing for thorough cleaning, removal of diseased tissue, and repair of any damage. It provides better visibility and accessibility to the affected area, making it an effective option for treating periodontal issues in this specific region.

Surgical lengthening is indicated when there is subgingival caries or fracture, inadequate clinical crown length for retention, or unequal or unesthetic gingival height. This means that surgical lengthening is necessary in all of these situations.