1. Rationale of Periodontal Surgery Flashcards
[reads slide] \_\_\_\_ is not diagnostic for perio disease ◦ Gives general overview ◦ But it doesn't show exactly what interdental bone levels are
____ is better tool to diagnose perio disease
Pan
FMX
BOP
• Until new classification published in 2018, gingivitis was simply recognized by ____ and CAL = ____
BOP
0
CAL
CAL = 0
OR
CAL > 0 with no evidence of progressive ____
attachment loss
Identifying a Gingivitis Case
BOP score ≥ ____% of sites
- ____ (BOP ≥ 10% and ≤30%)
- ____ (BOP > 30%).
It can occur on either ____ peridontium or ____ peridontium
10 localized generalized intact reduced
Periodontitis
◦ Periodontitis classified as deep ____, ____ and ____
PDs
CAL
BOP
Periodontitis (OLD CLASSIFICATION)
Extent:
Generalized: CAL in >____% of teeth
Localized: CAL in ≤ ____% of teeth
Severity:
Slight: CAL= ____mm or radiographic BL ≤____% and PD < ____mm
Moderate: CAL= ____mm or radiographie BL ____% & PD = ____ mm
Severe: CAL ≥____mm or radiographic BL >____% and PD ≥ ____ mm.
30
30
1-2
15
5
3-4
16-30
5-6
5
30
7
Identifying a Periodontitis case
____ CAL at ≥2 non-adjacent teeth,
OR
Buccal or oral CAL ≥____ mm with pocketing >____ mm at ≥2 teeth
the observed CAL is not due to non-periodontal causes:-
- gingival ____ of traumatic origin
- caries extending in the ____ area of the tooth
- Not on the distal aspect of a ____ molar and associated with malposition or extraction of a ____ molar
- an endodontic lesion draining through the ____
- ____ root fracture
interdental
3
3
recession cervical second third marginal vertical
• Identify first the intact vs reduced periodontium
◦ New classification
◦ If still confused about these terms, refer to classification lecture
• Pt classified as Clinical Health, Gingivitis Case, or Periodontitis Case
• [reads through Gingivitis Case]
• Periodontitis Case
◦ ____ (scored from 1-4) reflects the severity of disease and complexity of treatment
◦ ____: localized, generalized, or incisor-molar
◦ ____
‣ Risk factors: smoking, diabetes
stage
extent
grade
What’s the primary etiology of gingivitis
____
plaque
What is the goal of treatment in periodontal disease?
- Elimination of the etiologic factor
• ____
2. Elimination of the local contributing factors • \_\_\_\_ • Pockets • \_\_\_\_ - Crown margins • Cervical enamel projections • \_\_\_\_ groove
- Control of the systemic contributing factors
• ____
• Diabetes
• ____
microbial plaque
calculus
overhangs
distopalatal
smoking
medications
What is the Sequence of Treatment in Periodontal Disease?
I. Phase I Therapy (non-surg)
Step 1: Plaque or Biofilm Control ____
Step 2: Removal of ____ or Biofilm and Calculus
Use of antimicrobial agents if needed,
Treatment of occlusal trauma
Extraction of hopeless teeth
Step 3: ____ and/or replacing Defective
Restorations and Crowns “contributing to the pockets”)
Step 4: Management of ____ Lesions
instruction
supragingival and subgingival plaque
recontouring
carious
What is after phase I therapy?
- Re-evaluation
• “Assess improvements following initial therapy”
• Ideal time ____ weeks
• Check ____, ____, ____
• Assess compliance to ____
• Assess the need for retreatment or referral
• Assess the tissue condition prior to surgical
tx
It is very important to note BOP (she sees this missing a lot on charts)
You are assessing oral hygiene of pt and their compliance to your instructions
◦ If you see no improvement, you must ____ yourself and give OHI again
◦ Bring pt mirror, brush, and floss, make them engaged and make them practice in front of
you
4-6 PD BOP mobility OHI repeat
Additional Treatment Following Re-evaluation
Active therapy should continue until all areas of ____ disease have been eliminated
• Patients who have 5mm or deeper pockets with BOP cannot go into ____
• Non-surgical
◦ [reads list]
◦ You see some factors like overhang margins that you can detect
‣ Maybe there was a lot of inflammation in the first round of SRP, but now you can see it better and correct it
• [reads surgical list]
unresolved
maintenance
What is the Sequence of Treatment in Periodontal Disease?
3 possible options after phase I re-eval
Phase I Therapy (non-surg)
- ____
- ____
- ____
re-evaluation
phase II therapy
periodontal maintenance
• Let’s say after Phase 1 Re-eval, you decide to send pt to periodontist for surgical treatment ◦ They will do necessary surgery and follow up with pt
◦ depending on type of surgery, you cannot probe
‣ If an osseous surgery was done by periodontist, cannot probe for at least ____ months
‣ If a regeneration treatment was done (Ex: GTR), no probing for ____ months
◦ You may see patients like this in clinic for recalls, encourages communication between student dentist and periodontist
3
6
• Comprehensive charting must be updated every 12 months
◦ If you don’t need comprehensive charting, you still must do ____
◦ Still checking probing depths, BOP, mobility, furcation,….just coding differently on recall 2 form
• This is important because if you see any sites breaking down after treatment,
patient must go through phase 1 therapy again
PSI (perio screening index)
Critical Probing Depth
- Study compared the effect of SRP alone vs. modified Widman flap (MWF) with the resultant level of attachment and in relation to initial pocket depth.
- SRP: caused CAL in pockets < ____ mm while gain of attachment in ____ pockets.
- MWF: induced CAL if performed in pockets < ____ mm but resulted in a ____ gain of attachment than SRP in pockets deeper than 4.2 mm.
2.9
deeper
4.2
greater
Limitation of phase I (non-surgical SRP)
____ teeth planned for extraction with 42 pockets with PD= 2-10mm
____ performed with ultrasonic and hand instruments
Root surface assessed for ____, calculus, and signs of instrumentation under magnification
7
SRP
residual plaque
