Boundary of attached gingiva

# Which one describes the boundaries that define the attached gingiva?
A. From the gingival margin to the interdental groove
B. From the free gingival groove to the gingival margin
C. From the mucogingival junction to the free gingival groove
D. From the epithelial attachment to the cementoenamel junction

The correct answer is: C. From the mucogingival junction to the free gingival groove.

In an adult, normal gingiva covers the alveolar bone and tooth root to a level just coronal to the CEJ. The gingiva is divided anatomically into marginal, attached, and interdental areas.

- Marginal or unattached gingiva: is the terminal edge or border of the gingiva surrounding the

teeth in collar- like fashion. In about 50% of cases, it is demarcated from the adjacent attached gingiva by a shallow linear depression, the free gingival groove. Usually about 1 mm wide, the marginal gingiva fonns the soft tissue wall of the gingival sulcus.

- Attached gingiva: is continuous with the marginal gingiva. It is firm , resilient, and tightly bound

to the underlying periosteum of alveolar bone. The fac ial aspect of the attached gingiva extends to

the re latively loose and movable alveolar mucosa and is demarcated by the mucogingival junction.

" Stippling" of the attached gingiva refers to the irregular surface texture of the attached gingiva, similar to the surface of an orange peel. Stippl ing occurs at the intersection of epithelial ridges that causes the depression and the interspersing of connective tissue papillae between these intersections giving rise to the small bumps.

Dental Water irrigation devices

# Water irrigation devices (oral irrigators) have been shown to:
A. Eliminate plaque
B. Clean nonadherent bacteria and debris from the oral cavity more effectively than toothbrushes and mouth rinses.
C. Disinfect pockets for up to 12 hours
D. Prevent calculus formation

The correct answer is B. Clean nonadherent bacteria and debris from the oral cavity more effectively than toothbrushes and mouth rinses.

Oral irrigators for daily home use by patients work by directing a high-pressure, steady or pulsating stream of water through a nozzle to the tooth surfaces. Most often, a device with a built-in pump generates the pressure. Oral irrigators clean nonadherent bacteria and debris from the oral cavity more effectively than toothbrushes and mouth rinses.

When used as adjuncts to toothbrushing, these devices can have a beneficial effect on periodontal

health by reducing the accumulation of plaque and calculus and decreasing inflammation and pocket depth.

Oral irrigation has been shown to disrupt and detoxify subgingival plaque and can be useful in delivering antimicrobial agents into periodontal pockets. Note: Daily supragingival irrigation with a dilute antiseptic, chlorhexidine, for 6 months resulted in significant reductions in bleeding and gingivitis compared with water irrigation and ch1orhexidine rinse controls. Irrigation with water alone also reduced gingivitis significantly, but not as much as the dilute chlorhexidine.

Important: Oral irrigators may be contraindicated in patients requiring antibiotic premedication

prior to dental treatment since these devices have the potential for causing bacteremia. The patient's physician should be consulted.

Remember: The pathology associated with gingivitis is completely reversible with the

removal of plaque and the resolution of the inflammation.

In implantology, countersinking means:

# In implantology, "countersinking" refers to the process of:
A. Flaring or enlarging the coronal end of the osteotomy
B. Reversing the engine to remove the implant
C. Placing the implant in a counterclockwise rotation
D. Torquing the abutment to place

The correct answer is A. Flaring or enlarging the coronal end of the osteotomy.

As one of the final steps in the creation of the osteotomy to receive the implant body, a special bur is activated and inserted into the occlusal end of the osteotomy in order to increase the diameter of the opening slightly or to otherwise shape it. This step is referred to as "countersinking." Countersinking the implant osteotomy is called for by some manufacturers to compensate for very dense cortical bone or to prepare the bone for a particular implant shape (e.g., a flared implant shape at the coronal end).

Another of the final steps in the creation of the osteotomy is to place a threaded bur into the osteotomy so as to create a spiral groove on the wall of the osteotomy. This groove is placed so as to receive and guide the threads on the side of the implant during surgical placement and thus minimize the torque required and to minimize heat. This process of creating the groove on the inside of the osteotomy wall is referred to as "tapping" the osteotomy.

All of the burs used to create the osteotomy are used at relatively slow speeds (r.p.m.) to prevent injury to the bone, especially overheating of the bone. Also, water or saline irrigation is used to cool the burs and the bone during drilling.

Most common periodontal diagnosis in adults

# Which of the following periodontal
diagnoses is MOST COMMON in adults?
A. Localized aggressive periodontitis
B. Gingival hyperplasia
C. Generalized chronic periodontitis
D. Necrotizing ulcerative gingivitis
E. Plaque associated gingivitis

The correct answer is E. Plaque associated gingivitis.

Plaque associated gingivitis (marginal
gingivitis) is the MOST COMMON
periodontal diagnosis.

Prolonged exposure to plaque creates an
inflammatory response in the gingiva,
causing mild gingivitis.

Gingival overgrowth can be experienced
when taking:
- Calcium channel blockers
- Phenytoin
- Dilantin
- Cyclosporine

Localized aggressive periodontitis is MOST
COMMONLY seen younger patients and is
associated with Aggregatibacter
actinomycetemcomitans.