Perio III

PERIODONTOLOGY III COURSE SYLLABUS
DENT 6613

DH 4136

Division of Periodontology
Department of Developmental and Surgical Sciences
School of Dentistry
University of Minnesota

Spring Semester 2009

School of Dentistry, Periodontology III, Spring Semester 2009

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LECTURE SCHEDULE

PERIODONTOLOGY III (DENT 6613 & DH 4136)

Spring Semester 2009

Wednesday, 7:45-8:35 A.M., 2-530 MHST

Friday, 7:45-8:35 A.M., 2-530 MHST

DATE TOPIC FACULTY
Wednesday, January 7 Introduction to Periodontology III Bakdash
Wednesday, January 14 Periodontal surgical therapy: I Johnson
Wednesday, January 21 Periodontal surgical therapy: II Johnson
Wednesday, January 28
Periodontal surgery: Gingival surgical procedures Johnson
Wednesday, February 4
Periodontal surgery: Periodontal flap procedures Wolff
Wednesday, February 11
Periodontal surgery: Osseous resective and reconstructive: I Wolff
Friday, February 13 Periodontal surgery: Osseous resective and reconstructive: II Wolff
Wednesday, February 18 Periodontal surgery: Osseous resective and reconstructive: III Wolff
Friday, February 20 Periodontal surgery: Furcation involvement and management Michalowicz
Wednesday, February 25 Periodontal surgery: Plastic and esthetic procedures Johnson
Friday, February 27 Implantology in periodontics: I
Johnson
Wednesday, March 4 Written Examination#1 Bakdash


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DATE TOPIC FACULTY
Friday, March 6 Implantology in periodontics: II
Johnson
Wednesday, March 11 Recent advances in periodontal surgical technology Johnson
Friday, March 13 Periodontal maintenance and supportive therapy Bakdash
Wednesday, March 25 Chemotherapeutic and host modulation agents: I Wolff
Friday, March 27 Chemotherapeutic and host modulation agents: II Wolff
Wednesday, April 1 Periodontal-Restorative interrelationships Bakdash
Friday, April 3 Occlusal and orthodontic therapy in periodontics Johnson
Wednesday, April 8 The periodontics-Endodontics continuum Michalowicz
Friday, April 10 Chemotherapeutic and host modulation agents: III Wolff
Wednesday, April 15
Periodontal Medicine: Impact of Periodontal Infection on
Systemic Health
Wolff
Wednesday, April 22 Results of periodontal therapy Bakdash
Wednesday, April 29 Periodontics in the general practice
Course and faculty evaluation by dental hygiene Students
Bakdash
Bakdash
Friday, May 1 Written Examination#2 Bakdash


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THE COURSE

Periodontology III is a didactic course that is offered during Spring Semester, 2009 to dental students class of
2010 (Dent 6613, 1.5 credits), and f dental hygiene students class of 2009 (DH 4136, 1.0 credit).

For dental students, Dent 6613 is a course in a sequence of ten didactic, pre-clinical, clinical and honor
elective courses that are offered by the Division of Periodontology as a part of the periodontal dental
curriculum.

For dental hygiene students, DH 4136 is a part of a sequence of periodontal related courses that are offered
by the Divisions of Dental Hygiene and Periodontology.

COURSE PURPOSE

This course will provide information relevant clinical procedures associated with the surgical phase of
periodontal therapy including implants will be presented and discussed. Special emphasis will be placed on
evaluation of periodontal treatment as well as the maintenance phase and the relationship between
periodontics and other disciplines in dentistry. Use of pharmacological agents, periodontal medicine, clinical
research and integrating periodontics into the general practice will also be emphasized.

COURSE OBJECTIVES

Upon the completion of this course, both dental and dental hygiene students will be able to recognize,
analyze and apply information presented relevant to the:

1. Periodontal surgical procedures.
2. Implantology in periodontics.
3. Periodontal maintenance procedures.
4. Diagnosis and treatment of periodontal-endodontic lesions.
5. Occlusal and orthodontic therapy.
6. Periodontal considerations in restorative dentistry.
7. Chemotherapeutic and host modulation agents.
8. Periodontal medicine.
9. Efficacy of periodontal therapy.
10. Integration of periodontics into the general practice.

TOPIC PURPOSE, OBJECTIVES AND OUTLINE:

Topic purpose, objectives and outline are stated throughout this syllabus under each individual topic.

SCHOOL OF DENTISTRY COMPETENCIES

The following School of Dentistry related Competencies will be addressed in this course as a major,
minor and/or as foundation knowledge, demonstrating that the dental graduate will be able to:


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1.1 Select, obtain, and interpret patient data, information and radiographs to be able to use these findings to
accurately assess and treat patients.

1.2 Formulate a comprehensive diagnosis and treatment and/or referral plan for the management of patients.

1.3 Prevent, assessment, and manage medical and dental emergencies.
1.5 Assess the outcomes of comprehensive oral health care.

1.8 Prevent, identify and manage periodontal disorders.

1.9 Prevent, identify and manage pulpal and periradicular diseases.

1.10 Perform minor oral surgical procedures.

1.12 Manage the replacement of teeth for the partially or completely edentulous patient.

1.13 Recognize and manage limited developmental or acquired occlusal abnormalities.

1.14 Implement strategies for the clinical management of caries.

1.15 Perform preventive and restorative procedures that preserve tooth structure are esthetic and
functional, prevent hard tissue disease, and promote soft tissue health.

4.2 Maintain and utilize dental records.

6.2 Provide appropriate prevention, intervention, and educational strategies for all patients at risk for disease.

DENTAL HYGIENE PROGRAM COMPETENCIES

The following Dental Hygiene Program related Competencies will be addressed in this course

2.1 Systematically collect, analyze and record data on the general, oral and psychosocial health status of the
patient using methods consistent with medico-ethico-legal principles.

2.2 Assess patient concerns, goals, values and preferences to guide patient care.

2.3 Identify individual risk factors and develop strategies that promote health-related quality of life.
Recognize pre-disposing and etiologic risk factors that require interventions to prevent disease.

2.4 Analyze health conditions and medications that impact overall patient/client care.

2.5 Perform a comprehensive examination using and interpreting the extra and intra oral examination,
hard tissue examination, periodontal examination, radiographic examination and other data
collection procedures to assess the patient needs.

2.7 Identify the need for radiographs and radiographically distinguish normal from abnormal findings.

3.2 Obtain consultations as indicated.


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3.5 Establish a planned sequence of care (educational, preventive and therapeutic) services based on the
dental hygiene diagnosis, identified oral conditions, potential problems, etiologic and risk factors
and available treatment modalities.

3.6 Make referrals to other healthcare professionals.

4.2 Perform dental hygiene interventions to eliminate and/or control etiologic factors to prevent and
control dental caries and periodontal diseases.

4.3 Provide additional assessment data, including indices, diagnostic tests for caries and periodontal
diseases and study models.

4.4 Control pain and anxiety during treatment through the use of accepted clinical and behavioral
management.

5.1 Evaluate the clinical outcomes of dental hygiene interventions using indices, instruments and
examination techniques and feedback from the patient/client and others to improve patient/client
health.

5.2 Evaluate the patients/clients satisfaction with the dental hygiene care received and the oral health
status achieved.

5.3 Compare actual outcomes to expected outcomes, reevaluating goals, diagnoses and services when
expected outcomes are not achieved; provide subsequent treatment and referrals based on
evaluation findings.

5.4 Develop and maintain a recall/continuing care system/health maintenance program appropriate to
the practice setting and individual patient/client needs.

6.6 Provide screening, referral and education services that allow consumers to access the health care
delivery system.

6.10 Identify population risk factors and develop strategies that promote health related quality of life.

COURSE FACULTY

A team of four faculty members is teaching this course. Their names, offices, phone numbers and e-mail
addresses are:

Dr. Bashar Bakdash 7-368a MHST (612) 625-8684 bakda001@umn.edu
Dr. Deby Johnson 7-368b MHST (612) 624-5612 joh03541@umn.edu
Dr. Bryan Michalowicz 17-116 MHST (612) 625-6981 micha001@umn.edu
Dr. Larry Wolff 7-194 MHST (612) 625-5681 wolff001@umn.edu

All students are very strongly encouraged to arrange to meet with various course faculty as needed.
Please keep in mind that the best way to meet with any of the course faculty is to use e-mail to schedule
appointments.


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LECTURES

Each lecturer will elaborate on several of the important points associated with the assigned readings.
All of the important aspects will not be covered in the lectures due to time limitations.
The purposes of the lectures are to increase your understanding of and to complement your assigned
readings. The lectures are not a replacement of the assigned readings and other resources. To maximize
teaching and learning, students are expected to attend all lectures.

Lecture notes (PowerPoint of slide presented) are posted in advance of each presentation on the course
website located at: http://www1.umn.edu/perio/dent6613/index.html. Please make sure that you have
such notes with you during each lecture.

ATTENDANCE

If you are unable to attend class due to a medical or family emergency, you should contact the School of
Dentistry Academic Affairs Attendance Office at (612) 624-3300 or e-mail dent.cas@umn.edu.

COMMUNICATIONS

All individual and full class communication with be through your University of Minnesota e-mail
account. Announcements intended for the whole class will be sent by e-mail. It is a requirement of the
course to check your e-mail daily. While in class, please turn off all pagers and cellular phones.

TEXTBOOK

The required textbook is the 2006-updated 10th edition of CARRANZA'S CLINICAL PERIODONTOLOGY.
This book provides a very comprehensive and authoritative periodontal resource. Clearly illustrated, it describes
various clinical aspects of modern periodontology.

COURSE AND FACULTY EVALUATION
There will be a course evaluation at the end of this course. Dental students will have the opportunity to
evaluate the course as well as each of the lecturers using the School of Dentistry CoursEval System.

Dental hygiene students will also have the opportunity to evaluate the course as well as each of
the lecturers using a paper based University of Minnesota evaluation form.

EXAMINATIONS AND GRADING

Examples of test questions will be released to students on the first day of the course. Two written
examinations will be given.

Examination#1 will consist of multiple-choice questions covering lectures given prior examination#1 up to
and including Friday, February 27, 2009.


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Examination#2 will consist of multiple-choice questions covering all topics given after examination#1.

All questions for both examinations will be based on materials from the lectures and from the assigned
readings from the textbook.

For each examination scores will be based on answers recorded by each student on his/her computerized
answer sheet. Failure to answer all examination questions and/or answering questions out of order may
lead to receiving a lower grade or failing the course.

The following is a selected summary of the School of Dentistry rules and regulations relevant to student
examination and grading:

Both examinations for this course will be given on the assigned dates. Students with excused
and approved absences (See School of Dentistry Student Handbook for more details) will be
accommodated to meet each student circumstances. The course director will set the date and
location of the examination.

All grade disputes must first be addressed to the course director. For comprehensive and complete
information relevant to taking examinations, grade disputes and Academic Code of Conduct, please refer
to the most recent edition of the Student Handbook published by the School of Dentistry, University of
Minnesota.

The letter grade for the course will be determined in the following way:

GRADE PERCENT OF HIGHEST TOTAL SCORE OBTAINED
ON EXAMINATION 1 & 2

A 100 - 90
B 89 - 80
C 79 - 70
F Under 70

Individuals receiving "F" grade in Periodontology I will be offered the opportunity of one re-examination.
The course director may require the student to hire a tutor and complete a formal prescribed program.

Faculty assistance will be also available as needed. Both examinations #1 and #2 test booklets for
Periodontology III will be available for review in the Periodontology office (Room 7-368). Please stop by
or call the divisional secretary, Barb Sundt at (612) 625-5166 or sundt002@umn.edu to set up an
appointment to review the tests. Remember to bring your student diagnostic reports with you.


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The re-examination may include multiple-choice questions, essay questions, and or oral examination
covering the entire course. In order to pass the course, student must achieve a minim score of 70% of the
maximum possible score. The highest grade attainable after successful re-examination is a C.
No further re-examination will be permissible. If the student fails the one re-examination, he/she will be
required to register for, and satisfactorily complete, the course at its next regular offering. Furthermore,
students may not be permitted to take or participate in any of the periodontal courses and/or clinics until
they have successfully completed Periodontology I. Finally, the School of Dentistry Scholastic Standing
Committee reviews all student failures and the ultimate decision for remediation for students in academic
difficulty lies with that committee

STUDENT DIAGNOSTIC REPORT AND COUNSELING

Within a short time from the date examinations #1 and #2, students will receive feedback regarding their
performance. The Student Diagnostic Report will give the student's score and summarizes the relative
standing of the score within the class. In addition, an explanation and/or references to the source materials
are printed for each item missed by the student, together with the correct response.

All students are encouraged to arrange to meet with various course faculty as needed. Students achieving
low scores on examination#1 are highly encouraged to meet with the appropriate course faculty for tutoring
and individual guidance. Students with course grades of "F" are required to meet with the course director.


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POLICY ON MAKEUP EXAMINATIONS FOR LEGITIMATE ABSENCES

Students shall not be penalized for absence due to unavoidable or legitimate circumstances. Such
circumstances include, but are not limited to, verified illness, participation in intercollegiate athletic
events or other group activities sponsored by the University, subpoenas, jury duty, military service, and
religious observances. Students are responsible for providing documentation to the course director to
verify the reason for the absence.

It is the responsibility of the student to notify the course director of such circumstances as far in advance
as possible. The course director will provide reasonable accommodations / opportunities to make up
examination that have an impact on the course grade.

Please note that the format for the make-up examination may include one or more of the following
formats: multiple choices, essay and oral examination.

STUDENTS WITH DISABILITIES

It is the University of Minnesota policy to provide, on a flexible and individualized basis, reasonable
accommodations to students who have disabilities that may affect their ability to participate in course
activities or to meet course requirements. Students are referred to the School of Dentistry Office of
Student Affairs and/or the Universitys Office of Disability Services for evaluation and determination of
accommodations. To make an appointment for evaluation, please contact Barbara Blacklock at Disability
Services Office, the phone number is (612) 626-7379.

STUDENT ACADEMIC INTEGRITY AND SCHOLASTIC DISHONESTY

Academic integrity is essential to a positive teaching and learning environment. All students enrolled in
this course are expected to complete coursework responsibilities with fairness and honesty. Failure to do
so by seeking unfair advantage over others, can result in a disciplinary action. The University Student
Conduct Code defines scholastic dishonesty as follows:

Scholastic Dishonesty: submission of false records of academic achievement; cheating on assignments
or examinations; plagiarizing; altering, forging, or misusing a University academic record; taking,
acquiring, or using test materials without faculty permission; acting alone or in cooperation with another
to falsify records or to obtain dishonestly grades, honors, awards, or professional endorsement.

Within this course, a student responsible for scholastic dishonesty can be assigned a penalty that may
include taking a new examination (multiple choices, essay and oral examination), or even given an "F"
for the course.

For more detailed information relevant to Student Academic Integrity and Scholastic Dishonesty, please
go to: http://www1.umn.edu/oscai/


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POLICY ON USE OF CLASS NOTES FOR COMMERCIAL PURPOSES

Students may not distribute, via the Internet of other means, lecture notes or instructor-provided materials
for compensation or for commercial purposes without the express written consent of the instructor.

The provisions of this policy are enforceable as University rules under the University of Minnesota
Statement of Standards of Student Conduct, and violations may result in warning, required compliance,
confiscation, probation, suspension, or expulsion.
If the faculty of a department or collegiate unit, as a group, or individual faculty in a particular course,
have assented to or authorized the distribution of lecture notes or instructor-provided materials, such a
practice does not violate this policy.

For more detailed information relevant to the Policy on Use of Class Notes for Commercial Purposes,
please go to: http://www.fpd.finop.umn.edu/groups/senate/documents/policy/classnotes.html

We would appreciate very much your comments and suggestions regarding the contents and approach used
in this course so that future courses may be modified to better meet your education needs.

Bashar Bakdash, D.D.S., M.P.H., M.S.D.
Professor and Director
Division of Periodontology
Department of Preventive Sciences
7-368 Moos Health Sciences Tower

Telephone (612) 625-8684
E-mail bakda001@umn.edu
Web URL www.umn.edu/perio

Online version of this course syllabus is available at: www.umn.edu/perio/dent6613/index.html.
The syllabus and related resources are viewable in Adobe Acrobat format (PDF). You must have
Acrobat Reader on your computer. If you do not have the Acrobat Reader on your computer, please
go to: http://www.adobe.com/products/acrobat/readermain.html. and download one free of charge.


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TOPIC: Introduction to Periodontology III

PURPOSE: To provide an overview of Periodontology III.

TOPIC OUTLINE: A. Course objectives for dental and dental hygiene students

B. Requirements

C. Examinations and grading

D. Student counseling

REQUIRED READING: Periodontology III Course syllabus, PP. 4-10


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TOPIC: Introduction to Periodontal Surgery: I

PURPOSE: To define, present and discuss the rationale, indications, and contra-
indications for periodontal surgery. To explain the different
techniques applicable for the treatment of gingival recession, root
exposure and for increasing the width of attached gingiva.

SPECIFIC OBJECTIVES: A. Objectives of the surgical phase
1. Improve prognosis for teeth and their replacements
2. Improve esthetics

B. Surgical pocket therapy:
1. Critical zones in pocket surgery
2. Methods of pocket Therapy
3. Criteria for method selection
4. Approaches to specific pocket problems
a. Osseous vs soft tissue pockets
b. Shallow, moderate and deep pockets.
c. Anterior vs Posterior pockets
d. Implant placement

C. Outpatient surgery
1. Patient preparation
a. Informed consent
b. Premedication
(1) Antibiotics
(2) Pain control
(3) Steroids
2. Sedation and Anesthesia
3. Periodontal Dressing

D. Postoperative treatment
1. Pain control
2. Antibiotic use
4. Postoperative care
6. Postoperative complications

REQUIRED READING: Carranzas Clinical Periodontology: Newman, Takei,
Klokkevold and Carranza, 10th edition, W.B.
Saunders Co., 2006. Chapters 59 and 60.


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TOPIC: Introductions of Periodontal Surgery: II

PURPOSE: To present surgical instruments used in periodontal surgery. To
define, present and discuss surgical anatomy and its impact on flap
design. To present considerations for access and flap reflection and
surgical plan.

SPECIFIC OBJECTIVES: A. Surgical Instruments
1. Excisional and Incisional Instruments
2. Surgical curettes
3. Periosteal elevators
4. Surgical files and chisels
5. Needle drivers, hemostats and forceps

B. Hemostatis
1. Techniques
2. Materials

C. Anatomical impact on surgical design

1. Mandibular arch
2. Maxillary Arch and Sinus
3. Anatomical Spaces
4. Blood supply

Saunders Co., 2006. Chapters 60, 61.


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TOPIC: Periodontal Surgery: Gingival Surgical Procedures

PURPOSE: To present and discuss the rationale for utilizing soft tissue
resective procedures and demonstrate the surgical technique.

SPECIFIC OBJECTIVES: A. Definitions
1. Gingival curettage
2. Gingivectomy
3. Gingivoplasty

B. Objectives of procedures

C. Indications
1. supra-bony pockets
2. gingival enlargement
3. furcation involvement
4. periodontal abscesses
5. others

D. Contraindications for soft tissue resection

E. Treatment sequence of using blade technique

F . Treatment alternatives
1. Laser
2. Chemosurgery
3. Electrosurgery

G. Healing
1. epithelialization
a. migration rate
b. contact inhibition
c. maturation-keratinization
2. connective tissue

H. Treatment of gingival enlargement
1. Types of gingival enlargement
2. Techniques
3. Healing

REQUIRED READING Carranzas Clinical Periodontology: Newman, Takei,
Klokkevold and Carranza, 10th edition, W.B. Saunders Co.,
2006. Chapters 62 and 63.


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TOPIC: Periodontal Surgery: Flap Procedures

PURPOSE: To present and discuss the classification, indications and
contraindications of periodontal flaps.

SPECIFIC OBJECTIVES: A. Classification of flaps

1. Simple and positioned
2. Full thickness and partial thickness

B. Indications

1. Osseous irregularities in marginal bone
2. Pocket extending beyond mucogingival line
3. Mucogingival repairs

C. Contraindications

D. Healing following flap procedures

1. Epithelium and connective tissue
2. Osseous tissue resection

E. Therapeutic procedures performed in retromolar areas
which are involved in periodontal disease

1. Indications and contra-indications for surgical procedures
2. Technique for surgical procedures in the
retromolar and tuberosity areas molar removal
3. Post-op pain management



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TOPIC: Periodontal Surgery: Osseous Resection and Reconstructive
Procedures: I, II and III

PURPOSE: To present and discuss treatment of osseous defects utilizing
various periodontal procedures: osseous resection, bone grafting
procedures and guided tissue regeneration.

SPECIFIC OBJECTIVES: A. Define:
1. Infrabony defect
2. Osteoplasty
3. Ostectomy
4. One, two and three-wall defects

B. Osseous Resection and Reconstructive Surgery:
1. Contraindications
2. Indications
3. Technique
4. Follow-up care

C. Discuss:
1. Types of bone grafting materials
a. Autogenous grafts
i. intraoral cancellous bone
ii. osseous coagulum
b. Allografts
i. "cadaver: hip marrow
ii. "freeze dried" bone
iii. sclera
c. Heterografts (Xenografts)
i. anorganic bovine bone
d. Synthetic grafts/Non bone graft material/alloplast

2. Guided tissue regeneration (GTR)
a. Types
i. Resorbable
. Polyglycolic acid
. Collagen
. Calcium Sulfate
. Emdogain
ii. Non-Resorbable
. Gore-Tex
. Tef-Gen


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TOPIC: (continued) Periodontal Surgery: Osseous Resection and Reconstructive
Procedures: I, II and III

b. Indications for GTR
i. Grade II furcations
ii. Infrabony defects
iii. Recession defects
iv. Osseous defects and implants
v. Ridge augmentation
vi. Extraction sockets
c. Techniques

3. Tissue stabilization following flap procedures
a. Choice of needles and suture material
b. Understand the indications and contra-
indications and technique for various suturing
procedures
c. Periodontal dressings
d. Tissue adhesives

4. Post-operative Care
a. Post-operative instructions to the patient
b. Analgesics for post-surgical pain
c. Antibiotics for the post-surgical period
d. Post-surgical hemorrhage control
e. Dressing changes and suture removal
f. Post-surgical tooth hypersensitivity



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TOPIC: Periodontal Surgery: Furcation Involvement and Management

PURPOSE: To discuss the treatment options for furcation involvements on
multi-rooted teeth.

SPECIFIC OBJECTIVES: A. Location and architecture of furcations

B. Impact of furcation involvements on the prognosis of
multi-rooted teeth

C. Treatment options and long-term complications of teeth with
furcation involvements

1. Scaling and root planing
2. Odontoplasty
3. Apically positioned flap
4. Tunneling
5. Root resection/hemisection
6. Regenerative therapy

Saunders Co., 2006. Chapters 68.


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TOPIC: Periodontal Surgery: Periodontal Plastic and Esthetic Surgery

PURPOSE: To define, present and discuss the rationale, indications, and contra-
indications for mucogingival surgery. To explain the different techniques
applicable for the treatment of gingival recession, root exposure and for
increasing the width of attached gingiva.

SPECIFIC OBJECTIVES: A. Define
1. Recession
2. Mucogingival defect
3. Millers classification of recession

B. Etiology of recession
1. Abrasion
2. Abfraction
3. Frenum attachment
4. Malpositioned teeth
5. Gingival biotype

C. Gingival augmentation apical to recession
1. Free Gingival Graft
2. Apically Displaced Flap
3. Free connective tissue autografts

C. Gingival augmentation coronal to recession
1. Free Gingival autograft
2. Free connective tissue autograft
3. Pedicle autografts
4. Subepithelial connective tissue graft
5. Guided tissue regeneration
6. Alloderm

D. Technique, variations and healing
1. Free gingival graft
2. Subepithelial connective tissue graft
3. Pedicle graft
4. Guided tissue regeneration

F. Frenectomy

G. Criteria for selection of techniques and principles for success
1. Plaque free
2. Blood supply
3. Anatomy of the recipient and donor sites
4. Stability of grafted tissue in recipient site
5. Minimal trauma to surgical site

Saunders Co., 2006. Chapters 69.


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TOPIC: Implantology in Periodontics: I

PURPOSE: To develop an understanding of newer concept in implant
dentistry, including implant surface modifications, platform
switching, microgap, and subject selection.

SPECIFIC OBJECTIVES: A. Implant surface types and effects
1. Hard tissue
2. Soft tissue
3. Healing Times

B. Pretreatment evaluation
1. Clinical exam and diagnostic models
2. Radiographic exam
3. Anatomical structures
4. Spacing
5. Medical complications
6. Habits

C. Microgap
1. Impact on bone level
2. Platform Switch

REQUIRED READING: Carranzas Clinical Periodontology:
Newman, M.G, Takei,Henry, H, and Carranza, F.A.,
10th edition, W.B. Saunders Co., 2006. Chapter 73, 74 and 76.


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TOPIC: Implantology in Periodontics: II

PURPOSE: To describe special surgical techniques for site development and ridge
preservation prior to implant placement

SPECIFIC OBJECTIVES: A. Ridge preservation after tooth extraction
1. Ridge modification after extraction
2. Ridge preservation technique

B. Ridge augmentation

1. Expansion
2. Block grafts
3. Guided Bone Regeneration

C. Sinus Elevation

1. Direct sinus elevation
2. Indirect sinus elevation

D. Implant Maintenance
1. Evaluating Implant stability
2. Patient hygiene materials
3. Normal vs Abnormal finding
4. General maintenance

REQUIRED READING: Carranzas Clinical Periodontology: Newman, M.G, Takei,
Henry, H, and Carranza, F.A., 10th edition, W.B. Saunders
Co., 2006. chapters 76. 77. 78


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TOPIC: Recent Advances in Periodontal Surgical Technology

PURPOSE: To present exciting and developing techniques in periodontal surgery.

SPECIFIC OBJECTIVES: A. Microsurgery

1. Magnifying loops
2. Surgical Microscope

B. Lasers in Periodontal Therapy

1. Application for periodontal therapy
2. Advantages and disadvantages

C. Piezoelectric Surgery

D. Computerassisted implant surgery

1. Cone beam CAT Scan
2. Uses and Requirements

2006. Chapter 70 and 79.


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TOPIC: Periodontal Maintenance and Supportive Therapy

PURPOSE To review an organized sequence for a periodontal maintenance
appointment.

SPECIFIC OBJECTIVES: A. Define maintenance and state overall objective of periodontal
therapy

B. List five major steps to be accomplished during recall
appointment

C. Review of clinical trials on:

1. Rate of disease progression without treatment
2. Access of submarginal plaque to conventional
oral hygiene
3. Degree of patient compliance with recommended
recall intervals
4. Stability of clinical attachment levels with and
without maintenance procedures
5. Effects of supragingival mouth rinses on clinical
attachment levels
6. Time intervals for periodontal maintenance recall

Saunders Co., 2006. Chapter 82.


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TOPIC: Chemotherapeutic and Host Modulation Agents: I, II and III

PURPOSE: To discuss the role of various pharmacological agents and regimens
in relation to their antiplaque properties in their role in the
prevention and treating of gingival and periodontal diseases.

SPECIFIC OBJECTIVES: A. Rationale for the Use of antimicrobial agents

1. Indications
2. Contraindications
3. ADA Seal of Approval

B. Types of topical antimicrobial agents and their indications

1. Chemical composition/concentrations
2. Antibacterial effectiveness
3. Physiological effect

C. Types of local delivery antimicrobial agents and their
indications

1. Actisite Tetracycline
2. Perio Chip Chlorhexidine
3. Atridox Doxycycline
4. Arestin - Minocycline
5. Indications for local delivery antimicrobial agents.

D. Indication for Low dose doxycycline as an adjunct to
periodontal therapy

E. Guidelines and indications for the use of systemic
antimicrobial agents in periodontal therapy

1. Not necessary with most gingivitis and periodontitis
2. May be necessary with refractory periodontitis
3. May be necessary in aggressive periodontitis
4. May be necessary in patients with systemic disease that
influence severity of periodontal disease
5. Use of antibiotics in women who are pregnant and who
have periodontal disease
6. May be useful in patients with periodontal abscess
7. May be useful in patients with NUG/NUP


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TOPIC: (Continued) Chemotherapeutic and Host Modulation Agents: I, II and III

Klokkevold, Carranza, 10th edition, W.B. Saunders Co.,

RECOMMENDED READING: Carranzas Clinical Periodontology: Newman, Takei,
Klokkevold, Carranza, 10th edition, W.B. Saunders Co.,
2006. Chapters 53.


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TOPIC: Periodontal-Restorative Interrelationships

PURPOSE: To develop rational and concepts of the interrelationships of
fixed and removable restorative procedures to periodontal therapy.

SPECIFIC OBJECTIVES: Discuss:

A. Impact of iatrogenic dentistry on the periodontium

B. Preparation of the periodontium for restorative procedures

C. Occlusal related factors and restorative dentistry

D. Single restorations and crowns

1. Tooth preparation in relation to gingival margins
2. Restoration design, contour and materials used
3. Gingival retraction and related impression procedures

E. Fixed bridges

1. Criteria for selecting abutment teeth in terms of probing
depths, attachment level and mobility
2. Abutment preparations and related procedures

F. Removable partial prosthesis

1. Multiple abutments
2. Features of proper design
3. Precision attachment

G. Full dentures with periodontal stabilization (overdentures)



28

TOPIC: Occlusion and Orthodontics Therapy in Periodontics

PURPOSE: To establish occlusal evaluation and therapy requirements. Splint
use and occlusal adjustment. To describe combined orthodontic
therapies for treatment of osseous defects, fractured teeth and
esthetic defects. To explain technique for cuspid exposure. Use of
mini implants for orthodontics. Describe wilcodontic techniques.

SPECIFIC OBJECTIVES: A. Occlusal evaluation
1. Parafunctional habits
2. Traumatic occlusion
3. Fremitus

B. Occlusal intervention
1. Splinting
2. Stents

C. Orthodontic treatment of osseous and esthetic defects
D. Exposure of impacted canines
E. Use of mini-implants for anchorage
F. Wilcodontics



29

TOPIC: The Periodontics-Endodontics Continuum

PURPOSE: To discuss the methods used to diagnose and treat lesions that arise
from the periodontal as well as peri-apical regions of teeth.

SPECIFIC OBJECTIVES: A. The effects of pulpal disease on the periodontium

B. The effects of periodontitis on the dental pulp

C. How signs and symptoms can be used to differentiate pulpal
from periodontal pathology.

D. Treatment approaches and prognoses for lesions that are:

1. Periodontal in origin
2. Endodontic in origin
3. The result of both periodontal and endodontic pathology

2006. Chapter 58.


30

TOPIC: Periodontal Medicine: Impact of Periodontal
Infection on Systemic Health

PURPOSE: Discuss how periodontal diseases may be a risk factor for
systemic diseases.

TOPIC OUTLINE: A. Pathobiology of periodontitis.

B. Focal infection theory.

C. Periodontal disease and coronary heart
disease/atherosclerosis.

D. Periodontal disease and stroke.

E. Periodontal disease and diabetes

F. Periodontal disease and pregnancy outcome.

G. Periodontal disease and pulmonary/respiratory diseases.

Klokkevold and Carranza, 10th edition, W.B. Saunders
Co., 2006. Chapter 18.


31

TOPIC: Results of Periodontal Therapy

PURPOSE: To present and discuss a number of longitudinal clinical studies and
what has been learned about the prevention and treatment of
periodontal diseases as well as the role of clinical periodontal
research in periodontal therapy.

SPECIFIC OBJECTIVES: A. Current philosophy based on periodontal research

1. Detection of periodontal diseases

a. Activity
b. Stability

2. Prevention of periodontal disease
a. Antibiotics use
b. Recall frequency
1. Plaque control
2. Dietary Counseling

3. Treatment of periodontal diseases
a. Criteria for treatment
b. Scaling and root Planing
c. Surgical

4. Maintenance phase
a. Increased activity
b. Stability

5. Tooth mortality
a. Without periodontal treatment
b. With periodontal treatment
c. Patient habits/diseases systemic

B. Legal implications and periodontal therapy

Saunders Co., 2006. Chapter 83.


32

TOPIC: Periodontics in the General Practice

PURPOSE: To present and discuss on the various aspects of the periodontal
patients in general practice and the periodontist cooperating with
the referring dentist for the benefit of the patient, and to discuss
methods of reporting periodontal therapy to insurance companies.

SPECIFIC OBJECTIVES: A. Trends in dental services performed by general dentists and
dental hygienists

B. Integrating periodontal procedures in the general practice

1. Dental team involvement
2. Education and clinical considerations
3. Internal and external education and marketing
4. Referral related issues:
a. Type of cases
b. Referral criteria
c. Optimal time for referral
d. How to refer
5. Responsibility of periodontists to the patient and referring
dentist/dental hygienist.

C. Insurance related issues

1. Advantages and limitations of dental insurance as related
to periodontal therapy
2. ADA periodontal related insurance codes

REQUIRED READING: http://www1.umn.edu/perio/dent6613/index.html
Go to: Periodontics in the general practice lecture notes.

RECOMMENTED READING: Carranzas Clinical Periodontology: Newman, Takei,
Saunders Co., 2006. Chapters 84, 85 and 86.

Sample of Test Items

PERIODONTOLOGY III (DENT 6613 & DH 4136)

Spring Semester, 2009

1. The internal bevel incision is basic to most periodontal flap procedures. Which of the
following is TRUE regarding the internal bevel incision?

A. It removes the connective tissue but not the pocket lining.
B. The outer surface of the gingiva is removed.
C. It produces a thick, bulbous flap margin for adaptation to the bone-tooth junction.
D. The pocket lining is removed.
E. The internal bevel incision is used in gingivectomy procedures.

2. Which of the following would be the BEST indication for the use of antibiotics as
adjuncts to periodontal therapy?

A. Controlling chronic gingivitis without systemic involvement.
B. Controlling most periodontitis without systemic involvement.
C. Controlling refractory periodontitis without systemic involvement.
D. Controlling ANUG without systemic involvement.
E. In a patient with a periodontal abscess without systemic involvement.

3. Longitudinal studies have shown that surgical treatment of deep (> 7mm) pockets as
compared to non-surgical treatment results in:

A. Greater pocket reduction.
B. Greater gain of crestal bone.
C. Greater gain of clinical attachment.
D. Greater tooth retention.
E. Greater reduction in gingivitis.

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