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PERIODONTOLOGY www.bdsnext.
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SMART NOTES
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CEDEES…………… PERIODONTOLOGY SMART NOTES
1. Differences between Stillman’s cleft & Mc Call’s festoon (Description of gingival contour)
Stillman’s cleft ( 1st image): Apostrophe shaped indentation of the gingival margin/ Gingival
recession that consists of narrow triangular shaped gingival recession. (www.bdsnext.com)
Mc Call festoon ( 2nd image) : Life preserver shaped enlargement of gingival margin/ rolled
thickened band of gingiva that is usually seen adjacent to the cuspids when recession
approaches the MGJ.
2.
Colonizers Complex Micro-organisms Gram stain/
Motility
Primary/Early Blue Various Actinomyces species G+,
colonizers Non-motile
Purple Veillonella parvula G-,
Actinomyces odontolyticus Non-motile
Yellow Streptococcus mitis G+,
S oralis Non-motile
S sanguis
S gordonii
S intermedius
Red Porphyromonas gingivalis G-, non motile
Tannerella forsythus G-, non motile
Treponema denticola NA, motile
Secondary/ Orange Campylobacter gracilis
Late Campylobacter rectus
colonizers Campylobacter showae
Fusobacterium nucleatum G-, non motile
Prevotella intermedia
Prevotella nigrescens
Eubacterium nodatum
Peptostreptococcus micros G+, non motile

Streptococcus constellatus
India’s BEST MDS Entrance Coaching Centre……………. We transform lives

Green Eikenella corrodens

complex Capnocytophaga gingivalis
Capnocytophaga ochracea G-, non motile
Capnocytophaga concisus
A actinomycetemcomitans
(www.bdsnext.com)
3. When comparing the microbiota among conditions of health, gingivitis, and periodontitis,
the following microbial shifts can be identified as health progresses to periodontitis:
• From gram-positive to gram-negative
• From cocci to rods (and, at a later stage, to spirochetes) (www.bdsnext.com)
• From nonmotile to motile organisms
• From facultative anaerobes to obligate anaerobes
• From fermenting to proteolytic species
(www.bdsnext.com)

4. Steps of plaque formation
5. Gingipains, a group of arginine or lysine specific cysteine proteinases major virulence

factors in P gingivalis. Gingipains are involved in adherence to and colonization of
epithelial cells, haemagglutination and haemolysis of erythrocytes, disruption and
manipulation of the inflammatory response, and the degradation of host proteins and
tissues. Older name for Gingipain was periodontain
6. Predominant immunoglobulin in GCF is IgG. Predominant immunoglobulin in saliva is IgA

(although IgG & IgM) are also present. (www.bdsnext.com)
7. The ratio of T cells: B cells is reversed from normal of 3:1 in peripheral blood to 1:3 in GCF
8. Different types of smokers: (www.bdsnext.com)

Current Smokers have smoked ≥100 cigarettes in their lifetime and currently smoke.
Former smokers have smoked ≥100 cigarettes in their lifetime and do not currently smoke.
Nonsmokers have not smoked ≥100 cigarettes in their lifetime and do not currently smoke.
9.

10. Angulation refers to the angle between the face of a bladed instrument and the tooth surface.
It may also be called the tooth-blade relationship. Correct angulation is essential for effective
calculus removal.
(www.bdsnext.com)
11. The two earliest sign of gingival inflammation preceding established gingivitis are:
 Increased GCF production rate
 BOP from gingival sulcus on gentle probing
BOP: objective, easily detected clinically so valuable in early diagnosis. (www.bdsnext.com)
BOP appears earlier than change in color or other visual signs of inflammation.
12. Differences b/w Suprabony & Infrabony pockets: (www.bdsnext.com)

13. Tooth mobility occurs in two stages:

Initial/intra-socket stage: tooth moves within the confines of the pdl. This is associated with
viscoelastic distortion of the pdl and redistribution of pdl fluids, inter-bundle content and fibers.
This initial movement occurs with forces of about 100lb and is of the order of 0.05-0.10mm
(50-100µm)
Secondary stage occurs gradually and entails elastic deformation of the alveolar bone in
response to increased horizontal forces. (www.bdsnext.com)
14. Primary TFO-

• Alterations in occlusal forces on tooth with a healthy periodontium.
• No change in CAL, does not initiate pocket formation.
• Supra-crestal gingival intact & prevent the apical migration of the junctional
epithelium.
Ex: (1) the insertion of a “high filling”
(2) crown excessive forces on abutment and antagonistic teeth
(3) the drifting movement or extrusion of the teeth into spaces created by unreplaced missing
teeth
(4) the orthodontic movement of teeth into functionally unacceptable positions.
15. Secondary TFO

• Reduced ability of the tissues to resist the occlusal forces.
• Adaptive capacity of the tissues to withstand occlusal forces is impaired by bone
loss -marginal inflammation.
(www.bdsnext.com)
16. Stages of tissue response to TFO:
Stage I: Injury: increase in areas of resorption
Stage II: Repair: decreased resorption and increased bone formation
Stage III: Adaptive remodeling increase in areas of resorption: resorption & formation
return to normal

17. Radiographic features TFO

1) Widened PDL space, thickening of the lamina dura (favorable response to increased occlusal
forces)
2) Bone loss: vertical rather than horizontal destruction of the interdental septum.
3) Radiolucency & condensation of alveolar bone (www.bdsnext.com)
4) Root resorption
18. Fremitus/ Functional mobility

• Used to clinically detect TFO
• Tooth displacement created by patient’s own occlusal force
• Ability of patient to displace & traumatize teeth
• Mobility without fremitus- no occlusal trauma
19. Theories of TFO (www.bdsnext.com)

Glickman ‘s concept (1965, 1967) : pathway of the spread of a plaque-associated gingival
lesion can be changed if forces of an abnormal magnitude are acting on teeth harboring
subgingival plaque.

Waerhaug’s concept
Refuted the hypothesis that TFO played a role in the spread of a gingival lesion into the "zone
of co-destruction".
The loss of connective attachment and the resorption of bone around teeth are,
EXCLUSIVELY the result of inflammatory lesions associated with subgingival plaque.
Angular bony defects and infra-bony pockets occur when the subgingival plaque of one tooth
has reached a more apical level than the microbiota on the neighboring tooth, and when the
volume of the alveolar bone surrounding the roots is comparatively large.
20. Conclusions about TFO: (www.bdsnext.com)

1. TFO DOES NOT initiate gingival inflammation.
TFO occurs in the supporting tissues and does not affect the gingiva . The marginal gingiva is
unaffected by TFO because its blood supply is not affected, even when the vessels of the
periodontal ligament are obliterated by excessive occlusal forces.

2. In the absence of inflammation, TFO will result in increased mobility, widened PDL, loss
of crestal bone height and bone volume, but NO ATTACHMENT LOSS.
3. In teeth with progressive, plaque-associated periodontal disease, trauma from occlusion
may enhance the rate of progression of the disease, i.e. act as a co-factor in the destructive
process.
4. In cases of periodontitis along with TFO: Proper treatment of plaque associated with
periodontal disease will arrest the destruction of the periodontal tissues even if the occlusal
trauma persists. (www.bdsnext.com)
Treatment of TFO alone (occlusal adjustment or splinting), may reduce the mobility of the
traumatized teeth and result in some regrowth of bone, but it will not arrest the rate of further
breakdown of the supporting apparatus caused by plaque.
21. Severity of gingival enlargement can be measured by GO index given by Bokenkamp

et al
Grade I: enlargement confined to interdental papilla
Grade II: enlargement involves papilla and marginal gingiva
Grade III: enlargement covers three-fourths or more of the crown
22. PHENYTOIN, NIFEDIPINE, AND CYCLOSPORINE are responsible for > 50% cases of
DIGO. Other drugs associated with GO:
Anticonvulsants (Epilepsy): Phenobarbital, Valproic acid
Ca channel blockers (for coronary artery disease) Diltiazem, Verapamil Amlodipine,
Felodipine, etc (www.bdsnext.com)
23. Different types of DIGO (drug induced gingival) lesions demonstrate a thick, stratified
squamous epithelium with long, thin rete pegs extending deep into the connective tissue.
Fibrosis common in phenytoin-induced GO and those caused by calcium channel blockers

Cyclosporin A–induced GO lesions have more inflammatory infiltration and increased

vascularization compared with GO caused by phenytoin or calcium channel blockers. It is most
commonly seen in anterior labial gingiva.
24. Decision tree for DIGO: when to do gingivectomy and when to do flap surgery:
25. Pregnancy tumor vs Pyogenic granuloma (www.bdsnext.com)

Pregnancy tumor is a Conditioned response to plaque due to Increased vascular permeability
caused by increased levels of Progesterone and estrogen levels by almost 10 to 30 times!
Pyogenic granuloma is a Non-specific conditioned response to Minor trauma
Patient history is an important way to distinguish between the two conditions as clinically they
may look identical.
26. Rules for Vertical incisions:

 Vertical incision should not split papilla
 Vertical incision should not be placed over root prominences

 When 2 vertical incisions are used, the length of the flap should not be longer than the
width of the flap and
 The base of the flap should not be narrower than the margin of the flap
27. External bevel incision vs Incision: (www.bdsnext.com)

The external bevel incision/ bevel incision starts at the surface of the gingiva apical to the
periodontal pocket and is directed coronally toward the tooth apical to the bottom of the
periodontal pocket. Used in Gingivectomy, (scalpel or a knife).
Internal bevel/reverse bevel incision can be sulcular or crestal.

 Sulcular incision: It starts in the gingival crevice and is directed apically through the
junctional epithelium and connective tissue attachment and down to the bone
 The crestal/marginal incision starts at gingival margin and is directed apically down
through the epithelium and connective tissue to the bone.

28. Following are the general principles of suturing in periodontics/oral surgery:
29. Some commonly used suturing techniques: (www.bdsnext.com)

a) Figure of 8 : Used when flaps are not in close approximation. Easier than direct loop suturing

b) Direct loop suture: Better closer of inter dental papilla, closer approximation than in figure
of 8
(www.bdsnext.com)
c) Sling suture: can be used for a flap on one surface of a tooth that involves two interdental
spaces

d) Modified mattress suture: used in regenerative surgery when using Bone grafts/GTR
(www.bdsnext.com)
30. Periodontal Dressings/Packs have no curative properties but assist healing by protecting
the tissue rather than providing “healing factors.”
The dressing minimizes the likelihood of postoperative infection, facilitates healing by
preventing surface trauma during mastication, and protects the patient from pain
induced by contact of the wound with food or with the tongue during mastication.
31. Modified Widman flap:

• Given In 1974 by Ramfjord & Nissle

• Facilitates instrumentation but does not attempt to reduce pocket depth
• Bone architecture is not corrected unless it prevents intimate flap adaptation.
• It is not intended to reduce /eliminate pocket depth, Except reduction occurs by
tissue shrinkage during healing> it removes pocket lining but not the pocket wall
• The first incision- removes pocket lining, conserves the relatively uninvolved outer
surface of gingiva, produces sharp thin flap margin for coaptation
(www.bdsnext.com)
32. Undisplaced flap

• Internal bevel gingivectomy: surgically removes the pocket wall
• Definite elimination of pocket
• Should ascertain: enough attached gingiva remaining after removal of pocket wall
• 1st incision: carried to a point apical to the alveolar crest
• Flap edge should rest on root bone junction
• Continuous sling suture: to secure F & P flaps
33. Apically displaced flap:

Given by Friedman 1964 (www.bdsnext.com)
Uses:
 Pocket eradication
 Widening the zone of attached gingiva
 Can be full thickness or split thickness ( thickness of gingiva)
34. Papilla preservation flap:

• Used in regenerative periodontal surgery, Tonetti 1985

• Maximum amount of gingival tissue and papilla are retained to cover the bone
graft/GTR placed in the pocket.
• Retains entire papilla
• Requires adequate interdental space to allow intact papilla to be reflected with the facial
or palatal flap
35. The dimension of the furcation entrance is variable but usually quite small; 81% of
furcations have an orifice of 1 mm or less, and 58% are 0.75 mm or less.
36. Important anatomic factors wrt furcation: (www.bdsnext.com)
Root Trunk Length: The shorter the root trunk, the less attachment needs to be lost before the
furcation is involved. Once the furcation is exposed, teeth with short root trunks may be more
accessible to maintenance procedures, and the short root trunks may facilitate some surgical
procedures.

Root length is directly related to the quantity of attachment supporting the tooth. Teeth with
long root trunks and short roots may have lost a majority of their support by the time that the
furcation becomes affected.
Teeth with long roots and short to moderate root trunk length are more readily treated
because sufficient attachment remains to meet functional demands.
37. Contra-indications of root resection:

• Teeth with poor Crown :Root ratio on the remaining roots (www.bdsnext.com)
• Inadequate bone support on the roots to be retained
• Un-favourable root anatomy of retained teeth
• Long root trunk, fused root, bell shaped crown
• Poor surgical access
• Poor oral hygiene, high caries index
38. Different types of bone grafts:
39. Osteogenic /Osteo proliferative: Refers to the formation (or) development of new bone
by cells contained in the graft. E.g. Autogenous grafts.
40. Osteo-induction: Is a chemical process by which molecules contained in the graft
(BMP’s) provide a biologic stimulus that induces the progression of mesenchymal stem cells
and other osteoprogenitor cells towards osteoblast lineage. Eg: Allografts- DFDBA

41. Osteo-conduction: Is a physical effect by which the matrix of the graft forms a scaffold
that favours outside cells to penetrate the graft and form new bone, e.g. Alloplasts.
42. Autogenous Cortical bone grafts are preferred for implant placement as cortical bone
exhibit minimal resorption and maintain their dense quality.
43. Intraoral sources of autogenous bone: edentulous spaces, maxillary tuberosity, mandibular
ramus/symphysis, extraction sites. Bone from a recent extraction site ( within 6-12weeks) may
have the advantage of increased osteogenic activity compared with other sites, which are static
and undergoing little or no osteogenesis.
The maxillary tuberosity provides a more cellular source of autogenous bone compared with
other sites. However, the trabecular nature of this site provides a lesser quantity of mineralized
matrix and the resultant total volume of bone available for grafting is often inadequate.
44. For greater amounts of bone, it is more desirable to harvest bone from the mandibular ramus
or symphysis. This bone is more cortical, can be harvested as a block graft or can be ground or
shaved into small fragments and used as a particulate graft.
45. Biologic properties of various bone graft material (www.bdsnext.com)
Source Osteoconductive Osteo-inductive Osteogenic
Alloplast yes No No
Xenograft yes No No
Allograft yes Yes/No No
Autograft yes yes Yes
46. DFDBA and FDBA are both examples of Allograft.

DFDBA has both osteo-inductive and conductive properties while FDBA is only
osteoconductive.
47. Melcher’s concept: In 1976, Melcher suggested: the type of cell which repopulates the
root surface after periodontal surgery determines the nature of the attachment that will form.
(www.bdsnext.com)
48. Regeneration is defined as the reproduction or reconstruction of lost or injured tissue so
that the form and function of the lost structures are restored

49. Repair: healing of a wound by tissue that does not fully restore the architecture or function
of the part
50. New attachment (NA): union of CT/epithelium with a root surface that has been deprived
of its original attachment apparatus. (tooth surface previously denuded by disease)
51. Reattachment: refers to repair in areas of the root not previously exposed to the pocket,
such as after surgical detachment of the tissues or following traumatic tears in the cementum,
tooth fractures, or the treatment of periapical lesions.
52. GTR ( guided tissue regeneration) -is defined as procedures attempting to regenerate lost
periodontal structures through differential tissue response.
 prevent apical migration of gingival epithelium & CT
 maintenance of wound space into which a selective population of cells is allowed to
migrate favoring new attachment (www.bdsnext.com)
53. Osteopromotive/bioexclusive: Physical means of sealing off an anatomical site in order

to prevent other tissues to interfere with osteogenesis and to direct the bone formation.
54. Osteoplasty refers to reshaping the bone without removing tooth-supporting bone.
55. Ostectomy/ osteo-ectomy, includes the removal of tooth-supporting bone.
56. Indications of resective osseous surgery

 One-walled angular defects, Shallow intra-bony defects
 Thick, bony margins.
 Shallow crater formations
 Clinical crown lengthening for restorative/ prosthetic treatment
 Incipient furcation involvements (www.bdsnext.com)
57. Contraindications of Resective osseous surgery:

• Deep osseous craters.
• Three-wall osseous defects
• Moderate to deep circumferential defects
• If furcation involvement will occur.
• Esthetics- attachment loss
• Extended tooth mobility.

• Risk of root caries is considered high.

• Uncontrolled root hypersensitivity.
• General contraindications for surgery (www.bdsnext.com)
58. Vertical grooving and radicular blending are purely osteoplastic techniques that do not
remove supporting bone. They are performed with rotary instruments: round carbide burs
or diamonds
Flattening Interproximal Bone and Gradualizing of Marginal Bone are ostectomy procedures
that involve removal or tooth supporting bone and must be done with hand instruments.
59. Widow’s peaks: Peaks of bone typically remaining at the F/L line angles of teeth during
correction of craters using osseous resective surgery.
60. Variants of Free gingival grafts:

Were developed to minimize the donor site wound by removing the donor tissue in a different
configuration and altering the shape to maximize coverage over the recipient site.
a. Accordian Technique ( Rateitschak et al)
b. Strip Technique ( Han et al) Strips of FGG is harvested instead of 1 large mass, helps in
quicker healing

61. Miller’s classification of recession (www.bdsnext.com)
62. Laterally (Horizontally) displaced/pedicle flap was developed in 1956 by Grupe and
Warren

(www.bdsnext.com)
Indications:
• For covering the isolated denuded root.
• Adequate donor tissue laterally.
• Sufficient vestibular depth.
63. Semilunar Coronally positioned flap/ Tarnow’s technique
Indication:
• Areas where gingival recession is only 2 to 3 mm. (www.bdsnext.com)
• Thick gingival biotype

64. Per-Ingvar Brånemark coined the term osseo-integration & is the father of modern day
dental implants
65. Osseointegration is defined as the direct structural and functional connection between
ordered, living bone and the surface of a load-bearing implant without intervening soft
tissues. Also known as Functional ankylosis.
66. Critical temperature during implant osteotomy is 47 degree C
67. During early healing no micromovements ( <150µm) is required by successful osseo-
integration of implants
68. Differences b/w soft and hard tissue around tooth and implants:
69. Peri-implant mucositis: Inflammatory changes, which are confined to soft tissue
surrounding an implant is termed as peri-implant mucositis.
70. Peri-implantitis: is a pathological condition occurring in tissues around dental implants,
characterized by inflammation in the peri-implant mucosa and progressive loss of supporting
bone.
71. Peri-implant mucositis precedes peri-implantitis. Following are the clinical features of
peri-implant health, mucositis and peri-implantitis (www.bdsnext.com)

72. The following guidelines should be used when selecting implant size and evaluating the
mesio-distal space for implant placement:
 The implant should be at least 1.5mm away from the adjacent teeth
 The implant should be atleast 3mm away from an adjacent implant
 A wider diameter implant should be selected for molar teeth.
 And at least 1mm of buccal bone and lingual bone should be present buccal and lingual
to the implant respectively to prevent fenestration/dehiscence.
 Minimum distance b/w the apical end of implant & neurovascular structure is 2mm
73. A 1.2mm marginal bone loss during the first year after implant placement and 0.1mm per
year afterwards is expected, while further bone loss is considered abnormal.
74. Composition of calculus: (www.bdsnext.com)

75. Difference b/w supra and subgingival calculus
76. Important points about ANUG:

 Caused by interaction between host & bacteria (mostly fusospirochetes)
 Characteristic lesions are punched-out, craterlike depressions at the crest of the
interdental papillae that subsequently extend to the marginal gingiva and rarely to the
attached gingiva and oral mucosa.
 The surface of the gingival crater is covered by a gray, pseudomembranous slough tat
peels off and leaves raw areas.
 Characteristic fetid odor
 Associated systemic involvement: fever, lymphadenopathy
 Is uncommon in children
 No definite duration
 No demonstrated immunity
 Contagion not demonstrated (www.bdsnext.com)

77. Impaired host response is seen in NUG. NUG is not found in well-nourished individuals
with a fully functional immune system. Predisposing factors for NUG- Immunodeficiency
caused due to:
 Nutritional deficiency,
 Fatigue caused by chronic sleep deprivation, Habits (e.g., alcohol, drug abuse),
 Psychosocial factors, or systemic disease (Diabetes, HIV, other debilitating conditions)
78. NUG is transmissible; however, it is not communicable or contagious.
79. Adequate local therapy with optimal home care/ symptomatic treatment will resolve most
cases of NUG.
Local therapy: Removing the pseudomembrane and nonattached surface debris under topic
anesthetic with cotton pellets. After this the area is cleansed with warm water and superficial
calculus is removed.
Patients with moderate or severe NUG and local lymphadenopathy or other systemic signs or
symptoms are placed on an antibiotic regimen of amoxicillin 500 mg orally every 6 hours for
10 days. Other antibiotics used are erythromycin (500 mg every 6 hours) or metronidazole
(500 mg twice daily for 7 days).
80. Detection of oral malodor:
a. Organoleptic assessment by a judge is still the gold standard in the examination of breath
malodor.
b. The Halimeter is an electronic device that detects the presence of VSCs such as hydrogen
sulfide and methylmercaptan in breath at chair side. An important drawback of the device is
that it detects only sulfur compounds and thus is useful only for intraoral causes of halitosis.
The absence of VSCs does not prove that no breath odor is present.
c. Gas Chromatography
A gas chromatograph can analyze air, saliva, or crevicular fluid. it can detect virtually any
compound when combined with spectrometer and has very high sensitivity & specificity.
Elaborate gas chromatography is available in specialized centers, useful for identifying nonoral
causes. It is expensive and requires trained personnel.
A small, portable “gas chromatograph” (OralChroma) can be used on chair side

81. Difference b/w Gracey & Universal Curette:
82. Double-ended Gracey curettes are paired in the following manner:

Gracey #1-2 and #3-4: Anterior teeth
Gracey #5-6: Anterior teeth and premolars (www.bdsnext.com)
Gracey #7-8 and #9-10: Posterior teeth, facial and lingual
Gracey #11-12: Posterior teeth, mesial
Gracey #13-14: Posterior teeth, distal
Gracey #15-16 is a modification of the standard #11-12 and is designed for the mesial surfaces
of posterior teeth. It consists of a Gracey #11-12 blade combined with the more acutely angled
#13-14 shank.
Gracey #17-18 is a modification of the #13-14. It has a terminal shank elongated by 3 mm
and a more accentuated angulation of the shank to provide complete occlusal clearance and
better access to all posterior distal surfaces. The blade is 1 mm shorter to allow better adaptation
of the blade to distal tooth surfaces.
83. After Five curettes are modifications of the standard Gracey curette design. The terminal
shank is 3 mm longer, allowing extension into deeper periodontal pockets of 5mm or more.
All standard Gracey numbers except for the #9-10 (i.e., #1-2, #3-4, #5-6, #7-8, #11-12, or #13-
14) are available in the After Five series.
84. Mini Five curettes feature blades that are half the length of After Five or standard Gracey
curettes. Mini Five curettes are available in both finishing and rigid designs.
85. Micro Mini Five Gracey curettes have blades that are 20% thinner and smaller than the
Mini Five curettes. These are the smallest of all curettes, and they provide exceptional access
and adaptation to tight, deep, or narrow pockets; narrow furcations.

86. Gracey Curvettes comprise another set of four mini-bladed curettes; the Sub-0 and #1-
2 are used for anterior teeth and premolars, the #11-12 is used for posterior mesial surfaces,
and the #13-14 is used for posterior distal surfaces. The blade length of these instruments is
50% shorter than that of the conventional Gracey curette, and the blade is curved slightly
upward.
87. Hoe scalers are used for scaling of ledges or rings of calculus. The blade is bent at a 99-
degree angle. The blade is slightly bowed so that it can maintain contact at two points on a
convex surface.
88. Explorers are used to locate subgingival deposits and carious areas and to check the
smoothness of the root surfaces after root planing. (www.bdsnext.com)
89. Types of periodontal probes.

A, Marquis color-coded probe. Calibrations are in 3-mm sections.
B, University of North Carolina 15 probe, a 15-mm long probe marked at each millimeter and
color coded at the 5th, 10th, and 15th millimeters.
C, University of Michigan “O” probe, with William’s markings (at 1, 2, 3, 5, 7, 8, 9, and 10
mm).
D, Michigan “O” probe with markings at 3, 6, and 8 mm.
E, WHO/ CPITN-C probe, which has a 0.5-mm ball at the tip and markings at 3.5, 8.5, and
11.5 mm and color coding from 3.5 to 5.5 mm.

90. Three basic types of strokes are used during periodontal instrumentation:
a. The exploratory stroke is a light “feeling” stroke that is used with probes and explorers to
evaluate the dimensions of the pocket and to detect calculus and irregularities of the tooth
surface.
b. The scaling stroke is a short, powerful pull stroke that is used with bladed instruments for
the removal of both supragingival and subgingival calculus.
c. The root-planing stroke is a moderate to light pull stroke that is used for inal smoothing
and planing of the root surface
Any of these basic strokes may be activated by a pull or push motion in a vertical, oblique, or
horizontal direction.
91. The most effective and stable grasp for all periodontal instruments is the modified pen
grasp.
The thumb, index finger, and middle finger are used to hold the instrument as a pen is held, but
the middle finger is positioned so that the side of the pad next to the fingernail is resting on the
instrument shank. It offers maximum stability due to the tripod effect and also enhances
tactile sensitivity

The palm and thumb grasp is useful for stabilizing instruments during sharpening and for
manipulating air and water syringes, but it is not recommended for periodontal instrumentation.
92. Changes in 2017 classification from 1999 classification:
• Definition of Gingival and periodontal health on intact/ reduced periodontium
• Term Plaque has been replaced with biofilm
• Chronic & Aggressive Periodontitis are clubbed as single entity of Periodontitis
• Staging/Grading of Periodontitis has been introduced
• Term Periodontal biotype changed to Periodontal phenotype
• New Classification of gingival recession which takes into account periodontal
phenotype has been proposed
• Term Occlusal trauma changed to Traumatic occlusion
• Term Biological width changed to Supra-crestal tissue attachment (www.bdsnext.com)
93. Cairo et al. (2011) classified gingival recession based on the assessment of CAL at both
buccal and interproximal sites.
Recession Type 1 (RT1) : Gingival recession with no loss of interproximal attachment.
Interproximal CEJ was clinically not detectable at both mesial and distal aspects of the tooth
Recession Type 2 (RT2) : Gingival recession associated with loss of interproximal attachment.
The amount of interproximal attachment loss (measured from the interproximal CEJ to the
depth of the interproximal pocket) was less than or equal to the buccal attachment loss
(measured from the buccal CEJ to the depth of the buccal pocket)
Recession Type 3 (RT3): Gingival recession associated with loss of interproximal attachment.
The amount of interproximal attachment loss (measured from the interproximal CEJ to the
depth of the pocket) was higher than the buccal attachment loss (measured from the buccal CEJ
to the depth of the buccal pocket).
The 2017 classification of periodontal disease has proposed the above classification for
gingival recession. Along with the above the following are also noted:

It takes into account periodontal phenotype and is treatment oriented. (www.bdsnext.com)
94. Full mouth disinfection protocol (Quirynen)

One stage full mouth disinfection is obtained by performing all scaling & root planning within
24 hours together with repeated application of chlorhexidine (CHX) to all intra-oral niches.
It involves rinsing with CHX solution (0.2%) for 1 min, twice
Dorsum of tongue is brushed for 60 secs with 1% CHX gel
Full mouth scaling & root planning with all pockets/sulcus irrigated with 1% CHX gel.
95. Cyto-keratins and their importance:
K1, K2, K-10, K-12 Epidermal type differentiation
K6, K-16 Found in highly proliferative epithelia
K5, K-14 Stratification specific cytokeratin
K-19 Present in para-keratinized only, absent in
ortho-keratinized
K-1 Main component of stratum corneum
K-19 Main keratin in basal cell layer
96. Misch’s classification of bone density

(www.bdsnext.com)
Bone tap is useful in D1 type bone. It is a device used to create a threaded channel in bone for
a fixation screw or, prior to the insertion of a dental implant, into an osteotomy.
97. Cover screw vs Gingival former/Healing abutment
The cover screw is used to cover the implant connection during its submerged healing
period.
The cover screw is replaced with healing abutment/gingival former. Gingiva former is
screwed onto the top of the implant during surgical procedure to guide the healing of soft tissue
to replicate the contours and dimensions of natural tooth that is being replaced by implant and
to ensure access to the implant restorative platforms for impression and definitive abutment
placement.
98. Implant analog vs impression post
Implant analog is placed in the laboratory stone or plaster model in the location and position
determined for the final prosthesis. Once the impression has been poured and is set, the analog
is screwed onto the impression coping that is embedded in the cast.

(www.bdsnext.com)
99. If after wear of incisal edge, the gingival margin remains at the same position on continuous
tooth eruption, root surface gets exposed: gingival recession occurs, width of attached gingiva
does not change
If after wear of incisal edge, and continuous tooth eruption, the gingival margin moves
coronally along with the tooth, increase in width of attached gingiva occurs.
100. Local drug delivery agents:

 Tetracycline fibers: Actisite
 Doxycycline gel: Atridox

 Minocycline microspheres: Arestin

 Metronidazole gel: Elyzol
 Chlorhexidine gel: Chlo-Site
 Chlorhexidine biodegradable film/chip: Periochip
101. Sub-antibiotic doxycycline (SDD): low dose doxycycline hyclate 20mg (Periostat) which
is prescribed twice a day.
At this dose (i.e., 20mg) Doxycycline is a host modulating agent (does not act as an antibiotic)
rather, it acts an inhibitor of matrix metalloproteinases ( MMPs) that have been implicated in
the pathologic degradation of connective tissue collagen of the periodontal supporting
structures in periodontitis.
102. Comparison of Ultrasonic scalers:
(www.bdsnext.com)

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PERIODONTOLOGY www.bdsnext.

Peptostreptococcus micros G+, non motile

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

Green Eikenella corrodens

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

4. Steps of plaque formation

5. Gingipains, a group of arginine or lysine specific cysteine proteinases major virulence

6. Predominant immunoglobulin in GCF is IgG. Predominant immunoglobulin in saliva is IgA

8. Different types of smokers: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

12. Differences b/w Suprabony & Infrabony pockets: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

13. Tooth mobility occurs in two stages:

14. Primary TFO-

15. Secondary TFO

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

17. Radiographic features TFO

18. Fremitus/ Functional mobility

19. Theories of TFO (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

20. Conclusions about TFO: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

21. Severity of gingival enlargement can be measured by GO index given by Bokenkamp

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

Cyclosporin A–induced GO lesions have more inflammatory infiltration and increased

25. Pregnancy tumor vs Pyogenic granuloma (www.bdsnext.com)

26. Rules for Vertical incisions:

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

27. External bevel incision vs Incision: (www.bdsnext.com)

Internal bevel/reverse bevel incision can be sulcular or crestal.

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

28. Following are the general principles of suturing in periodontics/oral surgery:

29. Some commonly used suturing techniques: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

• Given In 1974 by Ramfjord & Nissle

32. Undisplaced flap

33. Apically displaced flap:

34. Papilla preservation flap:

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

36. Important anatomic factors wrt furcation: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

37. Contra-indications of root resection:

38. Different types of bone grafts:

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

46. DFDBA and FDBA are both examples of Allograft.

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

53. Osteopromotive/bioexclusive: Physical means of sealing off an anatomical site in order

56. Indications of resective osseous surgery

57. Contraindications of Resective osseous surgery:

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

• Risk of root caries is considered high.

60. Variants of Free gingival grafts:

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

61. Miller’s classification of recession (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

63. Semilunar Coronally positioned flap/ Tarnow’s technique

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

74. Composition of calculus: (www.bdsnext.com)

India’s BEST MDS Entrance Coaching Centre……………. We transform lives

75. Difference b/w supra and subgingival calculus