MILLER GINGIVAL RECESSION CLASSIFICATION

This illustration depicts class I, II, III and IV gingival recession classification.
Please see the legend at the bottom of the illustration that shows the attached
gingiva and mucosal tissues. Class I and II gingival recessions have no loss of
interdental bone while Class III and IV defects have loss of interdental bone.

Mcguire Summary for prognosis

Good prognosis: Control of etiologic factors and adequate periodontal support

ensure the tooth will be easy to maintain by the patient and clinician.
Fair prognosis: Approximately 25% attachment loss and/or Class I furcation
involvement (location and depth allow proper maintenance with good patient
compliance).
Poor prognosis: 50% attachment loss, Class II furcation involvement (location and
depth make maintenance possible but difficult).
Questionable prognosis: >50% attachment loss, poor crown-to-root ratio, poor root
form, Class II furcations (location and depth make access difficult) or Class III
furcation involvements; >2+ mobility; root proximity.
Hopeless prognosis: Inadequate attachment to maintain health, comfort, and
function.
FURCATION CLASSIFICATIONS

Hamp 1975 (Horizontal component)

Degree I: Horizontal loss of periodontal tissue support < 3 mm.
Degree II: Horizontal loss of support 3 mm but not encompassing the total
width of the furcation.
Degree III: Horizontal through-and-through destruction of the periodontal tissue in
the furcation.
The Hamps classification does not include a Degree IV classification;
however, the Glickmans classification which is less quantitative includes a
Grade IV classification

Glickman 1958 (Horizontal component)

Grade I: Pocket formation in the flute but intact inter-radicular bone.
Grade II: Loss of inter-radicular bone and pocket formation of varying depths into
the furcation but not completely through to the opposite side of the tooth.
Grade III: Through-and-through lesion.
Grade IV: Same as Grade III with gingival recession, rendering the furcation
clearly visible.

Tarnow and Fletcher 1984 (Vertical component)

Subclass A: 0 TO 3 mm depth for probing.
Subclass B: 4 TO 6 mm depth for probing.
Subclass C: > 7 mm depth for probing.

MOBILITY CLASSIFICATION

Miller 1950 Miller Index

Class I = first distinguishable sign of movement greater than normal.
Class II = movement of the crown up to 1 mm in any direction
Class III = movement of the crown more than 1 mm in any direction and /or
vertical depression or rotation on the crown in the socket.
Location of the internal bevel incisions for the
different types of flaps
SURGERIES Resective Regenerative Pre- Interdisciplinary Mucogingival Esthetic
Prosthetic
Surgery Surgery Surgery Surgery Surgery

Gingivectomy/ Yes No Yes Yes No Yes

Gingivoplasty

Modified Yes No No No No No

Widman

Osseous Yes Can be No Yes No No

combined
Surgery with
Regenerative
sx. Advanced
approach
(Grad)

Crownlengthening Yes No Yes Yes No Yes

Surgery

Free No No Yes Yes Yes Yes

Gingival

Graft

Lateral No No Yes Yes Yes Yes

Pedicle

Graft

Connective No No Yes Yes Yes Yes

Tissue Graft/

Tunnelling
INCISIONS RESECTIVE RESECTIVE RESECTIVE REGENERATIVE MUCOGINGIVAL
SURGERY SURGERY SURGERY SURGERY SURGERY
Gingivectomy Osseous Crownlengthening GTRs
Gingivoplasty Surgery Surgery Bone Grafts

Bevel Yes No Yes No No

Incision (Gingivectomy)

Inverse Yes Yes Yes No No

Bevel (Osseous Surgery)

Intrasulcular No Yes Yes Yes Yes

Incision
Full Thickness No Yes Yes Yes No
Flap (Osseous Surgery)

Partial No No No No Yes
Thickness
Flap
Undisplaced No Yes Yes No No
Flap
PERIODONTAL GINGIVECTOMY/ OSSEOUS CROWN- REGENERATIVE/ CONNECTIVE FREE

FLAPS GINGIVOPLASTY SURGERY LENGTHENING BONE GRAFT TISSUE GINGIVAL

GRAFT
SURGERIES SURGERY SURGERIES GRAFT
SURGERIES
SURGERIES

Gingival Flap NO NO NO YES NO NO

Modified NO NO NO NO NO NO

Widman Flap

Mucogingival NO YES YES YES YES NO

Flap

Positioned NO YES YES YES YES NO

Flap/

Sliding Flap

Apically NO YES YES NO NO YES

Positioned Flap

Coronally NO NO NO YES YES NO

Positioned Flap

Pedicle Flap NO NO NO NO YES NO

Replaced Flap NO NO NO NO NO NO

Undisplaced NO YES YES NO NO NO

Flap

Mucoperiosteal/ NO YES YES YES YES NO

Full Thickness
Flap

Partial NO NO NO NO YES YES

ThicknessFlap
 ORAL PATHOLOGY
COMPLEX ODONTOMA

COMPOUND ODONTOMA

AMELOBLASTOMA (Solid- Looks like cyst)

AMELOBLASTOMA (honey comb, soap bubble, root resorption)

ODONTOMA

CEMENTO-OSSIFYING FIBROMA (Fibrous dysplasia of the jaw ground glass

Odontogenic Kerocyst (OKC)

Osteosarcoma
Multiple Myeloma
 2017 Test:
CASES: Young girl with ectopic canine
o Has asthma.. what does albuterol NOT cause.. or what does it cause (excessive
salivation, tachycardia, diarrhea
o Extract? Take out PM and move in spot?
o Asked about her face shapeit was convex
o Lip naso-angle
o Long face/short face terms
o No cavities.. what are next options OHI, sealants..
o #19- stain on occlusal, explorer catches on enamel irregularity but no cavitation,
what would you do? Sealant
CASES: guy caviated and missing a lot of teeth
Pano x-ray questions: 2 RL images on apex.. can see on pano but not FMX why are
those theredue to spacing bw vertebrae showing through
Radiograph FMX, what is RL shown radiographic phenomenon
X ray on mandibular region dense spot where bone gets more dense idiopathic bone
sclerosis or condensing Osteitis ..
Guy with periodontal diseasetooth super erupted #3, class III furcation involvement, tx
plan EXT
Grade III furcation options.
GTR questions for class II furcation
GTR complications
White patch on roof of mouth and soft and hard palate from inhaler
Tooth specific questions, not anatomy but general questions
RO inside pulp cavity pulp stone or dentricle???
CASES: guy wants all teeth out bc he is tired of the pain how to motivate to
notmotivational interviewing? Quit smoking 2 best ways? If you decide to do
what the pt wants, what is contradictory benefalance and automy
TX plan for mandible.. complete denture and extract impacted wisdom teeth do you
remove wisdom teeth before denture? Age?
Dentures: elective endo on root as overdenture?
Veneer on #9 broke down, asked what was thereonly facial prepped.. Most likely
reason for failure occlusion.. improper bonding bw tooth and veneer, wasnt etched
properly..
M-decay #2.. what would be most adverse outcome due to open margin on occlusal
open margin on mesial, overhang on occlusal, overhang on mesial
BP 170/100history of other conditions, heart stent 10yrs ago..angina..3 of conditions
were long term.. what should be most concerned with and refer to physician
(hypertension)
CASE: 11 or 14yo Male, medical conditions, leukemia, on meds causing ging
hyperplasia, what drugKNOW drugs
o tx options what would you do on the first apt.. not perio surgery
o 2 anterior teeth, stain lines, what are they caused by.. and when 3-5 yrs, 8-10
years, or less than 2 years know when caused know calcification of anterior
perm (he put 3-5 years)
 o Kid didnt have 3rd molars.. what would cause this to happen? Disruption during
distodifferential? Disruption during morphodifferentan? Congenitally missing?
Tooth timingwhen certain teeth initiate formation and know calcification schedule;
adult teeth. (1) in utero question
Abusive drug and alcohol past drugs contraindicated in these type pts hydrocodone,
etc
Many similar questions on cases
Tooth #20 or #21. Class I RPD. Which worst option? D-rest with akers (cast) clasp on
MB would be worst bc it would cause the tooth to twerk
Radiographs:
o Periapical cementoosteodysplasia
o Dentigerous cyst (CEJ-CEJ) impacted 3rd molar
o Distal of mandible, posterior, RO/RL lesions OKC, ameloblastoma,
ameloblastic fibroodontoma
o Xray of anterior PA and pano incisive foramen
2 questions on leukotrienes what are they found to be associated with? Asthma?
What does monteleukasts do? Leukotriene inhibitor used in asthma
Actinomycosis sulfur pus filled granules
Pt with broken veneer.. doesnt want to replace, wants to repair what is the sequence of
repairing porcelain (microetch, etch, silane, resin)
Whats best way to differentiate caries: arrested caries (brown.. dentin is soft); smooth
surface caries or hyper-calcified enamel.. use explorer to press down on the area to
determine.. trans illumination
Repairing class II that goes on the facial that you most recently replaced.. pt doesnt like
coloring because its too dark.. be conservative, take out top layer. Another question is
if its too light, use tinting to make it darker, increasing the value.
Endo testing sensitive to percussion, but vitality is normal.. no response to cold or
EPT.. no evidence of periapical RLNo draining fistula vs. draining fistula...Know
diagnostics
Determining vitality on crowned tooth.cold test through crown?
Testing a tooth best for vitality what do you use? ICE stick?
Quartz operative dentistry?
Best for bonding a porcelain veneer ?
Multiple class Vs in 1 quad, on root surface can isolate with Rubber damn, what
would you use? GI 1st part said high caries risk patient
Treating dry socket (alveolar Osteitis).. what you put in or what is the packing for?
BZD how they work? Gabba binding (inc or dec) serotonin (inc or dec)
Major antidepressants NT? Serotonin
Potassium sparing diuretic.Spirolactone?
Antibiotics which would use for pt with infection in sulcus? Azithromycin, penicillin
B, amoxicillin, tevonic acid, ampicillin
Cephlosporin
Treating recurrent herpesAcyclovir wasnt it another acyclovir..
Mechanism for sulfonourea stimulate release of Bcells in pancreas
What do ibuprofen, Tylenol have in common. antipyretic and analgesic
 Tylenol is NOT anti-inflammatory
Meds for pregnant women for pain?
Histamine blocker question
Impression material. which is attracted to water
What is post for? Retaining the core
Why is the ferryl important? Avoid root fracture
Classes (I or II) lower anterior.. class II div 1
Class I even though she had problems, look at molars
How to reduce porcelain crown SS, carbide, diamond, or brimstone?
BULL rule is for the NON FUCTIONAL side
Wear on tooth surface, what could be causing it protrusive and workingMB cusp
Major connector is for rigidity and ____
Post retains the core doesnt support the crown, it retains the core
Molar that is M inclinedorthodontic spring what does the helix do? Counters mesial
molar rotation
3 options to expand area with molar that is M-inclinedwhat direction does the
appliance push
Impression material which are hydrophobic and which are hydrophilic (polyether
attracted to water)
Which impression material to NOT use for final impression? Irreversible hydrocolloid
Die spacerwhat is it for
Most common metal allergy: Ni allergy
Leforte I osteotomy what areas would be affect? Max sinus
MC medical emergency in dental office: syncope
Look through behavioral modifications (Bill stuff pg 156); What is the form of modeling
for different examples?
Nitrous question: is it ok for asthma pts to have nitrous? Yes, not COPD or pts being
treated for psychological issues
Extractions for PM, which forceps should you NOT use? 23
Perio surgery: GTR question, Modified Widman question, partial thickness flap,
gingival graft, recipient site what type of gingiva would you expect to get from graft? is
it based on the CT or the type of graft?
Iliac crest: where you would get an allograft
Splint teeth question not amount of time.
Fracture at angle of mandible, displacement, what muscles are involved? Medial
pterygoid
Impression for denture, post molar of mandible, what are you concerned with?
Mylohyoid muscle attachment
Crown lengthening in molar region, need to be concerned with external oblique ridge
Infection, airway closed, swollen round mandible? Ludwigs Angina
Eye: oculomotor nerve damaged which way would eye more? Down and out
Know SO4LR3
Know muscles of mastication
Classes of Occlusion
 LeWay space gain space
Molar uprighting (First Aid, pg 125)
Ortho ANB measurement: what class is a 6? Class II (anything over 4)
Lingual holding arch crowding between lower anterior for a child.. what do you do to
maintain space for permanent teeth?
Band and loop: 1 primary molar removed what is best way to keep tooth from
demineralizing on the band?
Ortho movements: blood in PDLpressure exerted with movement.. Remodeling
SLOB rule: PM the buccal root, initial was taken toward mesial, what happens to the
buccal root?
Immunocompromised patient.. what is the best mouthwash for plaque control? Answer
choices were different kinds of fluoride and cholorhexidine and the directions for use
Open Apex
Apexification
Apexigenesis
Repair of PDL, what area has the progenitor cells to repair the cells?
Which is most found in the Sulcus on a normal patient? Macrophage, lymphocytes, mast
cells
Infection in body, which is in blood sample? Neutropenia, philia, etc
Biologic width: Junctional epithelial and CT attachment
Gingivetomy: what is apical to the pocket depth?
Periodontal vertical incision. Facts, which is true? Midfacial?
Pt had oral cancer, got 45 Grays chances of osteonecrosis increase or decrease
chances?
Penumbra definition
Child leukemia facts:
Roots: anklossia, hypercementation
External/internal root resorption.. which has best prognosis? Internal
Cledocranial dysplasia:
Cherbism findings: bilateral swelling of mandible
Spray air.. Nitosky sign pempgus vs pempgoid.. basement membrane affected
Hyperparathyroidism, Hypo, hyper/hypo corticoid.
Pagets
Increased interdental spacing
Tongue sensitive to spicy foods, patchy areas surrounded by red line. Erythema
migrans?
Basal cell carcinoma how to explain to them give it to me straight doc
Spots on pts cheeks increase production of melanin.melanocytes
Partially impacted 3rd molar (18-20yo), most likely indication to extract? Make more
room? Periocornitis ?
Fluconazole drug that can be used IV and orally for candidiasis
Von Rickenhouses disease, know symptoms caf a late spots, axillary freckleswhich
finding do you NOT find intestinal polyps
Know other path questions.. what specifically does it HAVE or NOT HAVE
 When speaking with patients the best way to convey information.eye contact, hand
contact
KNOW BEHAVIOR MODIFICATION QUESTIONSSmoking cessationshowing
kids authority
Gluteraldehyde germicidal
Didnt have any autoclave temps..
Beneficence, veracity, autonomy
Practice with 2 other dentists (they are not all working on the same day), hygienist
working on patient and injures a patientSupervising dentist? Hygienist
aloneSupervising dentist and hygieniat, just the dentist, all 3 dentists?