SEND-UP EXAMINATION 2023

3RD YEAR BDS 2023

Periodontology
SEQS PAPER KEY

Q1. (A) What are the effects of smoking on prevalence and severity of periodontal disease?

(B) What are the effects of smoking on response to non-surgical periodontal therapy.

Q1 Key Marks
A 3

B 2

Q2. Give the composition of dental plaque and how is it formed?

(A) Key Marks

 The intercellular matrix consists of organic and inorganic materials 2
derived from saliva, gingival crevicular fluid and bacterial
products.
Organic constituents of the matrix include polysaccharides,
proteins, glycoproteins, lipid material, and DNA. Albumin.

. The inorganic components of plaque are predominantly calcium

and phosphorus, with trace amounts of other minerals such as sodium,
potassium, and fluoride.

. Plaque Formation: -
(1) The formation of the pellicle on the tooth surface,
(2) The initial adhesion/attachment of bacteria, and 0.5
 (3) Colonization/plaque maturation.

(B). What are effects of uncontrolled diabetes mellitis on periodontium?

Key Marks
. A tendency towards large gingiva, sessile or pedunculated gingival polyps, polypoid 2.5
gingival proliferations, abscess formation, periodontitis and loosened teeth.
There is reduction in defense mechanisms and increased susceptibility to infections,
leading to destructive periodontal diseases.
Severe gingival inflammation, deep periodontal pockets rapid bone loss and frequent
periodontal abscess occur in diabetic patients with poor oral hygiene.
Findings include greater loss of attachment, increased bleeding on probing, increased
tooth mobility.
Diabetes mellitis does not cause gingivitis or periodontitis but evidence indicates that it
alters the response of periodontal tissues to local factors, hastening bone loss and
delaying post-surgical healing of the periodontal tissues. Frequent periodontal abscess
appear to be an important feature of periodontal disease in diabetic patients.

Q3. A 15-year-old girl presents to your dental office with complaint of distolabial migration of the
maxillary incisor. On clinical examination, there is very little plaque and calculus with no obvious signs
of inflammation in the gums. The patient is diagnosed to be suffering from Localized Aggressive
Periodontitis. Enlist the therapeutic modalities you will use to treat this patient?

(A) Key Marks

1. In almost all cases, systemic tetracycline hydrochloride 250 mg qid for at least a 2
week should be given in conjunction with local mechanical therapy. If surgery is
indicated, systemic antibiotics are advised with patient instructed to begin taking the
antibiotic approximately 1 hour before surgery.
2. Doxycycline 100mg/day may also be used
3. Chlorhexidine rinses should be prescribed and continued for several weeks to
enhance plaque control and facilitate healing.
4. In refractory cases, tetracycline resistant Aggregatibacter species have been
suspected. In such cases, a combination of amoxicillin and metronidazole has been
suggested.
(Ref Shantipriya pg 209, Carranza 10th ed pg 698, 13th ed pg 485)
(B) Describe briefly

(A) Secondary trauma from occlusion.

(B) Radiographic signs of trauma from occlusion.

A Key Marks

Secondary trauma from occlusion: Occurs when the adaptive capacity of the tissues to 1
withstand occlusal forces is impaired by bone loss that results from marginal
inflammation. This reduces the periodontal attachment area and alters the leverage on
 the remaining tissues. The periodontium becomes more vulnerable to injury and
previously well tolerated occlusal forces become traumatic

B Radiographic Signs 2

 Increased width of the periodontal space often with thickening of the

lamina dura along the lateral aspect of the root, in the apical region and in
bifurcation areas

 A vertical rather than horizontal destruction of interdental septum

 Radiolucency and condensation of the alveolar bone

 Root resorption

(Ref Carranza 13th ed pg 332, 334)

Q4. A 37-year-old patient complains of swelling in the gums. Clinical examination shows red, ovoid,
fluctuating swelling on the lateral aspect of lower left first molar. Extra-oral examination reveals
regional lymphadenopathy and elevated body temperature. The clinician feels that the swelling is of
either a pulpal or a periodontal nature. Enlist the features that would enable you to differentiate
among these two possible conditions.

Q4 Key Marks
 5

Q5. A 55-year-old patient presented to you with clinical probing depths of 5-7 mm. You have a plan to
go for periodontal surgery. Enlist the indications for periodontal surgery.

(A) Key Marks

 2.5

(B) Describe briefly the indications and use of interdental brushes.

(B) Key Marks

Indications: - 2.5

. Large spaces with exposed root surfaces

. Interproximal spaces with no interdental papillae

. Exposed furcations

. Isolated areas of deep recession

. Type II and III embrasures

Use: -

. An interdental brush of any style is inserted through the interproximal spaces and
moved back and forth between the teeth with short strokes. The diameter of the
 brush should be slightly larger than the gingival embrasures to be cleaned. This size
permits the bristles, to exert pressure on both proximal tooth surfaces by working
their way into concavities on the roots. The brush bristles must also reach the
interdental margin.

(Ref Carranza 13th ed pg 518)

Q6. (A) What is Aggressive Periodontitis?

(B) Describe its clinical features.

Key Marks
A Aggressive Periodontitis generally affects systemically healthy individuals less than 30 2
years old, although patients may be older. Aggressive periodontitis may be universally
distinguished from chronic periodontitis by the age of onset, the rapid rate of disease
progression, the nature and composition of the associated subgingival microflora,
alterations in the host's immune response and a familial aggregation of disease
individuals. It is further classified as: -
1: Localized Aggressive Periodontitis
2: Generalized Aggressive Periodontitis
B Clinical Features: - 3
Localized Aggressive Periodontitis: -
. Clinically Localized Aggressive Periodontitis LAP is characterized as having localized
first molar/incisor presentation with interproximal attachment loss on at least two
permanent teeth one of which is first molar and incisor.
. LAP has a striking feature of lack of clinical inflammation despite the presence of deep
pockets and advance bone loss.
. Little or no plaque and inflammatory signs are seen.
Generalized Aggressive Periodontitis: -
. There is a generalized interproximal attachment loss effecting at least three teeth
other than first molar and incisors
. Systemic manifestations are weight loss, depression and malaise
. Deep pockets and bleeding on probing are also seen
(Pg 339, 353, UHS Past Solved Questions)

Q7. A 66 years old male patient present with mild pain in tooth no 45. Clinical examination reveals a
through and through defect in the furcation area covered by the soft tissues.

(A) How would you grade such furcation involved?

(B) Discuss different grades of furcation involvement.

7 Key Marks
A Grade: III 2
B Grade I: involves incipient bone loss 3
Grade II: involves partial bone loss (cul de sac)
 Grade III: involves total bone loss with a through and through opening of the furcation
but the opening of the furcation is not visible to the gingiva which covers the orifice.
Grade IV: Similar to grade III but includes gingival recession that exposes the furcation
to view.
(Ref Carranza 13th ed pg 326)

Q8. A patient aged 45 years presents with chronic periodontitis having deep periodontal pockets.
(A) Classify periodontal pockets.
(B) Outline treatment of periodontal pockets.
(C) Give seven steps outlining the modified Widman flap.

Key Marks
A . Pseudo Pocket 2
. Periodontal pocket:
 Suprabony pocket
 Infrabony pocket
. According to the surface involvement
 Simple
 Compound
 Complex (e.g. spiral pocket)
B . Strict plaque control and rehabilitation of oral hygiene 1
. Root planning and curettage
. Excisional new attachment procedures
. Gingivectomy for suprabony pockets
. Periodontal flap procedures.

(C) Key Marks

Step 1: The first insion parallel to the long axis of the tooth is a 2
scalloped internal bevel incision to the alveolar crest starting 0.5 to 1
mm away from the gingival margin. The papillae are dissected and
thinned to have a thickness similiar to that of the remaining flaps.
Step 2: Full-thickness flaps are reflected 2 to 3 mm away from the
alveolar crest.
Step 3: The second, crevicular incision is made in the gingival crevice to
detach the attachment apparatus from the root.
Step 4: The interdental tissue and the gingival collar are detached from
the bone with a third incision.
Step 5: The gingival collar and granulation tissue are removed with
curettes. The root surfaces are scaled and planed. Residual periodontal
fibers attached to the tooth surface should not be disturbed.
Step 6: Bone architecture is not corrected unless it prevents intimate
flap adaptation. Every effort is made to adapt the facial and lingual
interdental tissue in such a way that no interdental bone remains
exposed at the time of suturing. The flaps may be thinned to allow for
close adaptation of the gingiva around the entire circumference of the
tooth.
Step 7: The flaps are stabilized with sutures and covered with a surgical
dressing.