Periodontal Topics                                     

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1. Anatomy, Epidemiology, Indices, Etiology, and Diagnosis
   1. Calculus, root anatomy and mouth breathing
      1. Calculus formation
      2. Calculus composition
      3. review articles on calculus
      4. calculus attachment to root surfaces
      5. palatogingival groove
      6. root surface area factors
      7. bifurcational ridges
      8. cervical enamel projections
      9. open interdental contacts
      10. food impaction
      11. the effect of mouth breathing on the periodontium
      12. review of local factors that effect the periodontium

       

   2. The Microbiology of Periodontal Disease
      1. specific and non specific plaque hypotheses
      2. the microbiologic changes after the cessation of tooth cleaning
      3. the bacteria in health, gingivitis and periodontitis
      4. the transmissibility of periodontal pathogenic bacteria between people, sites and implants
      5. the bacteria in diagnosis
      6. the risk assessment, prognosis and natural history of periodontitis
      7. Adult Periodontitis Microbiology
      8. Refractory Periodontitis Microbiology
      9. Bacterial tissue invasion
      10. review articles

       

   3. Anatomy of The Periodontium
      1. Attached Gingiva and Soft Tissue Anatomy
         1. components of gingival tissue
         2. components of gingival tissue
         3. the different types of epithelium found in the oral cavity
         4. the interdental papilla
         5. the retrocuspid papilla
         6. determinants of epithelial keratinization
         7. gingival pigmentation
         8. the blood supply to the gingiva
         9. gingival stippling
         10. the significance of gingival color
         11. the parameters and changes of attached gingiva over time
         12. surgical considerations pertaining to thickness of keratinized tissue
         13. the necessity of attached gingival around implants
      2. Dentogingival Junction
         1. anatomy and development
            1. junctional epithelium
            2. dentogingival juction
            3. internal basal lamina
            4. rete pegs
            5. gingival crevicular fluid
            6. dentogingival surface area
            7. biologic width of dentogingival junction
         2. pocket epithelium histology
         3. wound healing of the DGJ
         4. epithelial rests of Malassez
      3. PDL and Collagen
         1. Periodontal Ligament main functions
         2. Cementum
         3. transalveolar fibers
         4. PDL dimensions
         5. collagen types in PDL
         6. cell types in collagen production
         7. mesenchymal stem cells
         8. changes in collagen with periodontitis
         9. collagenase
         10. matrix metalloproteinases
         11. collagen response in smokers

              

   4. Epidemiology and Indices / Study design and reliability
      1. epidemiology, indices, prevalence, disease progression
         1. prevalence of periodontal diseases in North America
         2. risk factors and indicators
         3. periodontal indices
         4. gingival index
         5. plaque index
         6. O'Leary plaque score
         7. bleeding indices
         8. progression of periodontal disease
         9. rate of periodontal destruction
         10. natural history of perio disease
         11. natural rate of bone loss or "physiologic bone loss"
         12. risk factors for development of periodontitis
         13. alcohol and periodontal disease
         14. obesity and periodontal disease
      2. Study Design and Reliability
         1. Ramfjord teeth
         2. reliability of attachment level measurements
         3. regression towards the mean
         4. equivalence and superiority testing
         5. clinical versus statistical significance
         6. composite endpoints to assess efficacy

          

   5. Diagnosis: Diagnosis, Prognosis, Treatment Planning
      1. diagnostic classifications of periodontal disease
      2. Interpretations of periodontal probing
      3. Histological evaluation of probing depth
      4. Effects of pressure variation during probing
      5. reproducibility of probing measurements
      6. pathologic tooth migration
      7. splinting teeth
      8. McGuire classification of prognosis
      9. Kwok and Caton classification of prognosis
      10. Molar prognosis classification of Miller-McEntire
      11. Factors to consider in treatment planning
      12. Critical probing depths
      13. strategies for decision making
      14. anatomic factors in treatment planning (root proximity, sinus)
      15. patient awareness and chief complaints

       

   6. Diagnosis: Gingival Crevicular Fluid
      1. Gingival Crevicular Fluid - Overview
      2. Association of GCF with health or disease
      3. The composition of gingival fluid
      4. GCF and the susceptibility or resistance to periodontal disease
      5. antibiotics in the gingival crevicular fluid
      6. periodontitis disease markers in GCF

       

   7. Diagnosis: Radiographs
      1. Are Radiographs an accurate?
      2. Furcation Arrow
      3. Evaluating alveolar crest levels
      4. comparison of digital vs. conventional radiographs
      5. using panoramic radiographs
      6. computed tomography (CBCT)
      7. the significance of the lamina dura
      8. Can radiographs be used to detect progression of periodontitis?
      9. using radiographs to assess healing after surgery
      10. Comparing radiographic measurements to clinical measurements
      11. Comparison of radiographic techniques
      12. Review articles

       

   8. Pathogenesis / Disease Activity
      1. Immunologic responses in the periodontal tissues
         1. immunolobulins
         2. hypersensitivity reactions
         3. Immune system review (T and B lymphocytes)
         4. Modulation of PMN function
         5. Cytokines and prostaglandins
         6. Th1 and Th2 paradigm
         7. role of neutrophils in periodontal disease
         8. Cell-mediated immune system regulation in periodontitis
         9. Natural killer cells
         10.  immune dysfunction in periodontitis
         11. immune response to periodontopathic bacteria
         12. Localized Juvenile Periodontitis
      2. Pathogenesis and inflammation
         1. Leukotoxin
         2. Endotoxins
         3. burst hypothesis
         4. Pathogenesis of Inflammatory Periodontal Disease- Page and Schroeder model
         5. Gingivitis
         6. Inflammatory cytokines
         7. transition from gingivitis to periodontitis
         8. Pocket formation
         9. enzymes implicated in periodontal destruction
         10. matrix metalloproteinases
         11. MMPs and TIMPs
         12. Mechanisms of alveolar bone destruction in periodontitis
         13. RANKL and Osteoprotegerin
         14. Vascular Endothelial Growth Factor
         15. Host Modulation
      3. Disease Activity and Bleeding on Probing
         1. Bleeding on Probing in Diagnosis
         2. Bleeding on Probing in Prognosis
         3. Gingival Suppuration

         4. Bleeding on Probing and Histologic Changes

         5. The Effect of Treatment on Bleeding on Probing

         6. Predictors of Disease Activity

         7. Patterns of Disease Activity

         8. asynchronous multiple burst pattern

          

   9. Atypical Periodontal Conditions I:  Aggressive Periodontitis(AgP)  

      1. previous nomenclature for aggressive periodontitis

      2. current classification for aggressive periodontitis

      3. prevalence, sex ratio and racial predilection of aggressive periodontitis

      4. bacterial etiology of aggressive periodontitis

      5. antibiotic regimens to treat aggressive periodontitis

      6. periodontal treatment of AgP (surgical vs non surgical)

      7. inheritance patterns of AgP

      8. immunologic abnormalities seen with AgP

      9. AgP and altered root surfaces

       

   10. Atypical Periodontal Conditions and Pathology

       1. mucocutaneous disorders

          1. lichen planus

          2. desquamative gingival lesions

       2. gingival enlargement

       3. viral oral mucosal lesions

       4. acute periodontal lesions

       5. acute necrotizing ulcerative gingivitis

       6. NUG in HIV patients

       7. periodontal abscess

       8. prepubertal periodontitis

       9. other periodontal issues

       10. bisphosphonates and osteonecrosis   

        

   11. Periodontal Medicine: Systemic Effects of Periodontitis

       1. The Perio-Systemic Link

       2. Bacteremia-flossing

       3. Bacteremia with probing

       4. Bacteremia with scaling and toothbrushing

       5. Bacteremia after extraction

       6. Bacteremia after suture removal

       7. Antibiotic prohylaxis

       8. Treating patients with cardiac pacemakers

       9. cardiovascular conditions and periodontitis

       10. C-reactive protein and periodontitis

       11. treatment effects on systemic inflammatory markers

       12. perio and diabetes

       13. perio treatment effect on glycemic control

       14. untreated periodontitis on pregnancy outcomes

       15. perio treatment effect on pregnancy outcomes

       16. perio and pulmonary issues   

        

   12. Risk Factors and Indicators for Periodontal Disease

       1. systemic risk factors for periodontitis

       2. genetics factors that contribute to periodontal disease

       3. smoking as a risk for periodontal disease

       4. effect of smoking on systemic health

       5. smoking and wound healing

       6. smoking cessation and the reversibility of periodontal damage

       7. smokeless tobacco and perio tissues

       8. alcohol as a risk factor for periodontitis

       9. diabetes as a risk factor for periodontitis

       10. patient populations that are at greater risk for diabetes and periodontitis

       11. osteoporosis as a risk factor for periodontal disease

       12. stress as a risk factor for periodontal disease

       13. obesity as a risk factor for periodontal disease

        

   13. Systemic Host Factors The effects on the periodontium of the following:
   1. aging
   2. pregnancy
   3. puberty
   4. nutrition and disease progression
   5. nutrition and wound healing
   6. HIV / AIDS

2. Etiology Control
1. Plaque Control A
1. patient education and motivation
2. toothbrushing
3. effects of oral hygiene
4. plaque control review articles
   
   
2. Plaque Control  B
1. interproximal cleaning
2. oral irrigators
3. Keyes technique
4. subgingival pocket irrigation
5. systemic and local drug delivery
1. Periochip
2. Arestin
3. Periostat
   
   
3. Plaque Control C - chemical agents and antibiotics
   1. Evidence Based Review
   2. Chlorhexidine
   3. Listerine
   4. Triclosan
   5. Medicaments - Fluorides
   6. Miscellaneous Compounds
   7. Comparative chemical agent studies
   8. Antibiotics
      1. Review of Concept
      2. Rationale for use
      3. Resistance
      4. Combination therapy
      5. Tetracyclines
      6. Macrolides
      7. Fluoroquinolones
      8. Augmentin

       

3. Occlusion
1. Occlusion in Periodontics- I
1. occlusal trauma defined, signs and symptoms
2. splinting teeth
3. theories of occlusion and its relationship to the periodontium
4. histological findings from trauma from occlusion
2. Occlusion in Periodontics- II
   1. canine guidance
   2. group function
   3. tooth contacts in chewing, intercuspal posion and retruded cuspal position
   4. occlusal adjustment in periodontal therapy
   5. parafunction and bruxism
   6. buttressing bone
   7. options for the treatment of bruxism
   8. review articles

 

4. NonSurgical Care

1. Root surface management
1. topic overview
2. evidenced based reviews of root planing
3. surface effect of instrumentation
4. diamond coated tips
5. temperature rise in dentin
6. aerosoles from scalers
7. clinical parameter changes from instrumentation
8. subginigival microflora changes after root instrumentation
9. instrumentation efficacy in  furcations
10. root surface charateristics after debridement
11. effectiveness of closed instrumentation
12. closed vs open root planing- in non molars
13. closed vs open root planing- in molars
14. closed vs open root planing- in furcations
15. periodontal endoscopy
16. soft tissue effects of root planing
17. bacteremia
18. clinical and microbiological changes after root planing
19. calculus control agents
20. antimicrobial adjuncts
1. atridox
2. periochip
3. periostat

 

2. Nonsurgical therapy vs Surgical
   1. nonsurgical therapy: scaling and root planing
   2. the effectiveness of scaling and root planing in removing calculus
   3. comparison of hand vs ultrasonic instrumentation
   4. healing in deep pockets after root planing
   5. masking of periodontitis
   6. response following SRP
   7. SRP + antibiotic tx could eliminate the need for sx
   8. reviews
   9. comparison of sx with non sx therapy
3. Statistics used in periodontal research
   1. sensitivity and specificity
   2. sample size requirements
   3. regression towards the mean
   4. statistical significance vs. clinical significance
   5. the randomized clinical trial
4. Root Caries
   1. susceptibility to root caries after perio tx
   2. prevention of root caries

    

5. The Effects of Therapy - No Tx vs Tx
   1. untreated periodontal disease and the consequences
   2. automated probing device
   3. radiographic and clinical assessments in untreated periodontitis
   4. rate of tooth loss in treated and untreated periodontitis
   5. the benefits from periodontal therapy
   6. comparison of various forms of treatment
   7. risk predictors of future disease proression
   8. changes in subgingival microbiota between treated and un-treated periodontitis
   9. changes in the maxillary sinus after periodontal therapy
   10. changes in patient perceptions following different treatment modalities

    

6. Supportive Periodontal therapy (referred to as SPT or maintenance) and Re treatment
   1. the necessity of supportive periodontal therapy
   2. prevalence of tooth loss during maintenance
   3. attachment loss during maintenance therapy
   4. the importance of plaque control during maintenance
   5. patient compliance during  maintenance therapy
   6. the effect of maintenance on wound healing
   7. the results of periodontal treatment when patients are not maintained
   8. treatment results when maintenance id done at general dentists offices
   9. the ideal maintenance frequency after periodontal treatment
   10. treatment failure and the need to retreat
   11. refractory periodontitis and it's management

   
   

5. Surgery involving Bone

1. Alveolar Bone: Normal Anatomy, Extraction socket healing, bone loss, osseous defects
   1. anatomy, embryonic origin, metabolism, deposition and resorption of bone
   2. different types of osseous topography
   3. the relation between gingival form and osseous topography
   4. types of bony outgrowths, incidence and treatment considerations
   5. sequence of bone repair after extractions
   6. socket wound healing can be affected by.....
   7. risk factors for bone loss and bone metabolism
   8. types of bone loss and bony defects
   9. anatomic factors that affect the type of bone loss

    

2. Osseous Surgery (resection) I
1. osseous surgery- purpose indications and history
2. guidelines for osseous surgery
3. anatomic factors to be considered in osseous surgery
4. the palatal approach to osseous surgery
5. lingual approach to mandibular osseous surgery
6. much bone is removed during osseous surgery
7. the use of ultrasonic scalers in osseous surgery
8. healing sequence in the hard and soft tissues following osseous surgery
9. healing if bone is left exposed
10. optimal postsurgical flap placement
11. long-term results following osseous surgery
12. osseous surgery compare to other treatment modalities
    
3. Osseous Surgery 2
1. flap curettaage / open flap debridement
2. new attachment, reattachment or regeneration
3. root submergence
4. bone grafts
5. graft particle size
6. principles of regeneration
7. defects amenable to GTR
4. Osseous Surgery 3- Autogenous Grafts
   1. bone swaging
   2. autograft
   3. osseous Coagulum
   4. push up technique
   5. cancellous bone and marrow
   6. grafting results with autogenous
   7. modifications / manipulations to autogenous

5. Osseous Surgery - 4 Augmentation with Allografts
   1. what is an allograft
   2. allografts and HIV
   3. tissue bank processing and safety of bone allografts
   4. what is FDBA?
   5. what is DFDBA?
   6. allogenic bone matrix gel
   7. different preparations of allograft
   8. Does the origin of the bone make a difference in healing potential
   9. the addition of antibiotics to bone allografts
   10. comparing results of bone allografts with autogenous bone grafts
   11. review bone allografts in periodontal therapy
6. Osseous Surgery - 5  Augmentation with alloplasts and xenoplasts
   1. review of bone substitutes
   2. bioceramics
      1. durapatite (Periograft)
      2. tricalcium phosphate (Synthograft)
   3. bioactive glass (Perioglass)
   4. other alloplasts
      1. Bioplant HTR
   5. possible complications in using alloplasts
   6. xenografts
      1. bovine-derived xenograft (PepGen)
      2. porous bone mineral  (BioOss)
7. Osseous Surgery- 6  Augmentation: biologic modifiers and enamel matrix derivative
1. what are biologic mediators
2. what is enamel matrix derivative
3. how and where is Emdogain used
   1. intrabony defects
4. Emdogain healing
5. Emdogain mixed with other materials and compared to other  augmentation therapies
   1. EMD with bovine derived xenografts
   2. DFDBA + EMD
   3. GTR + EMD
6. Review articles on EMD
7. other biologic modifiers
   1. PRP, PRF and PDGF
   2. mesenchymal stromal cells
   3. Bone Morphogenic protein (BMP)
   4. PDGF




6.  Periodontal Surgery, Principles, Wound Healing, Furcation Sx and types of Sx
   
   
   1. Principles of Periodontal Surgery
   1. Antibiotic coverage for periodontal surgery
   2. Infection control
   3. Anatomic considerations and preop information to consider before surgery
   4. Common post surgical complications and management
   5. Sutures and suturing techniques
   6. Surgical dressings- advantages and disadvantages
   7. Post operative instructions- what and how to give them
   8. Postoperative analgesics and anti-inflammatory agents
   9. Local anesthesia
   10. Pre Surgical Evaluation
   11. open
   2. Wound Healing 1
      1. General aspects of wound healing
      2. The effects of age and sex on wound healing
      3. review articles on general wound healing
      4. healing response adjacent to tooth roots and factors affecting it
      5. the affect of chemical cleansing on healing
      6. basic principles of GTR healing
      7. bacterial colonization of membranes
      8. antibiotics influence on clinical and histologic GTR healing
      9. biologic modulators used in regeneration
         1. PDGF and TGF β1
         2. rhBMP-2
         3. enamel matrix proteins
         4. platelet-rich plasma
         5. comparisons and reviews of biologic mediators
   3. Wound Healing 2
      1. the animal histology for GTR using barrier membranes
      2. review of guided tissue regeneration with absorbable barriers
      3. situations that affect clinical results of GTR
      4. the human histology of GTR healing
      5. the clinical results of GTR healing
      6. healing with resorbable barriers
      7. comparison studies between resorbable and non-resorbable membranes
      8. complications that can be encountered with GTR surgery
   4. Gingival Surgery 1: resection (gingivectomy), retromolar area, strategic extractions
      1. gingivectomy procedure
      2. indications and contraindications for the gingivectomy
      3. regeneration of gingiva following gingivectomy
      4. de-epithelialization to remove gingival pigmentation
      5. gingivectomy compared to flap surgery
      6. wound healing sequence following gingivectomy
      7. treating the retromolar areas
      8. distal wedge
      9. strategic extractions
      10. Root Proximity
      11. retention of hopeless teeth
   5. Gingival Surgery 2: curettage, ENAP, epithelium removal, LANAP
      1. curettage
      2. chemical curettage
      3. healing following curettage
      4. AAP statement on curettage
      5. curettage vs scaling and root planing
      6. ENAP
      7. epithelium removal via internal bevel incision
      8. long junctional epithelium
      9. LANAP
      10. AAP statement on Laser ENAP
   6. Gingival Surgery 3: Flap Surgery
      1. modified widman flap
      2. repositioning the attached gingiva
      3. comparisons of flap therapies
      4. flap healing
      5. vertical releasing incisions
      6. scalloped vs. linear incisions
      7. retention of gingival sulcular epithelium on attachment
      8. blood flow during healing of flap
      9. fiber retention procedure
      10. flap and systemic tetracycline

       

   7. Physical and Electric Therapy
      
   1. Review of types of lasers and  and use un periodontal therapy
   2. LANAP and photodynamic therapy
   3. Lasers in the treatment of hypersensitivity
   4. Lasers in the treatment of periimplantitis
   5. Cryosurgery in periodontics
   6. Electrosurgery in periodontics and compared to other modalities
   
   
   8. Esthetic Surgery
      1. Recession 1:  Coronally and laterally positioned flaps, free gingival graft
         1. causes and classification for recession
         2. the relationship of keratinized tissue to recession. does limited KG lead to recession?
         3. free gingival graft; theory, healing, results
         4. creeping attachment
         5. fgg recipient site preparation, full or split thickness
         6. pedicle graft or laterally positioned flap
         7. the double papilla flap
         8. coronally positioned flap
         9. treatment for non carious cervical lesions

          

      2. Recession 2- Root coverage through coronally positioned flaps couples with Connective tissue, Allografts, Emdogain, PRP, GTR
         1. CT Graft with coronally advanced flap
         2. histology of CTG healing
         3. Raetzke’s envelope
         4. Nelson’s subpedicle
         5. tunneling technique
         6. bilateral pedicle
         7. Harris double pedicle
         8. anatomic requirement and technique to harvest palatal donor tissue
         9. acellular dermal matrix
         10. Emdogain for root coverage
         11. PRP in root coverage
         12. GTR for root coverage
         13. growth factors and tissue engineering
         14. comparison of different methods and long term stability

          

      3. Esthetics: Root Preparation, Root coverage complications, Soft Tissue Ridge Augmentation (Pontic Site Prep), Papilla management
         1. root preparation and conditioning
         2.  
         3. root coverage on restored surfaces
         4. using microscope in perio plastic surgery
         5. limiting factors for root coverage
         6. tetracycline root conditioning
         7. Emdogain for root coverage
         8. root coverage on non-carious cervical lesions
         9. subepithelial connective tissue graft (Langer)
         10. factors affecting height of papilla
         11. soft tissue augmentation not associated with root coverage
         12.   and surgery to regenerate papillas
   
   
   9. Furcation Therapy
      1. etiology of the furcation involvement
      2. incidence and distribution of furcation involvement
      3. location of furcation entrances
      4. furcation anatomy and dimensions
      5. incidence and distribution of root fusion
      6. the impact of restorative dentistry on furcation involvement
      7. cervical enamel projections and correlation with furcation involvement
      8. debridement as treatment for furcation involvement
      9. tunneling as treatment for furcation involvement
      10. root amputation and hemisection
      11. chemical root treatment in furcation therapy
      12. using barriers for furcation treatment
          1. non-resorbable membranes
          2. resorbable membranes

       

7. Interdisciplinary Topics
   1. Ortho-Perio
      1. the effect of malposed teeth on periodontal health
      2. the effect of root proximity on perio status after ortho
      3. tooth movement on periodontally involved teeth
      4. orthodontic intrusion
      5. using ortho for reconstruction of the interdental papilla
      6. orthodontic extrusion
      7. the fiberotomy procedure
      8. moving teeth into extraction sockets
      9. accelerated osteogenic orthodontics
      10. mucogingival problems and tooth movement
      11. challenges with impacted/unerupted permanent teeth
      12. Temporary Anchorage Devices
   2. Pedo- Perio
      1. anatomic differences in the periodontium between children and adults
      2. treatment of mucogingival defects
      3. periodontal diseases in children
      4. tooth reimplantation and transplantation
   3. Oral Surgery - Perio
      1. third molar extractions
      2. periodontal status of second molars associated with impacted third molars
      3. periodontal concerns with interdental osteotomies after orthognathic surgery
   4. Restorative Dentistry- Perio
      1. general restorative considerations for periodontal health
      2. the effect of amalgam overhangs on perio status
      3. periodontal condition of abutments in fixed bridges
      4. normal dimensions for the dentogingival junction
      5. the crown lengthening procedure
      6. presence or absence of interdental papilla in humans
      7. esthetic crown-lengthening procedures
      8. response of the human periodontium to crown preparations
      9. the affect of removable partial dentures on the periodontium
      10. concepts and indications for splinting teeth
      11. tooth-retained overdentures

       

8. Oral Medicine
   
9. Other