30.Treatment sequence Flashcards
Aim of systemic phase
- Identify conditions, diseases and medications that contribute to periodontal disease
- Identify conditions, diseases and medications that can endanger the patient during treatment
- Diseases and conditions that are dangerous to medical staff
Number of groups of conditions, diseases and medications
3
Group 1 conditions
- Puberty
- Pregnancy
- Menopause
Group 1 diseases
- Diabetes
- Vitamin C deficiency
- Leukemia
Group 1 medications
- Immunosuppressants-Cyclosporin
- CCB-Nifidipine
- Anticonvulsants-Phenytoin
Group 2 conditions
Allergies(latex/asthma)
Group 2 diseases
*Endocarditis=>
* Debridement may exacerbate condition
Group 2 medications
Anticoagulants(aspirin)
Group 3 conditions
Psychological
Group 3 diseases
- All infectious diseases
- Viral hepatitis
- Covid
Aim of hygienic phase
- To achieve a clean infection free oral cavity free of plaque and calculus
- Removal of all plaque retentive factors
- Extraction of irrational to treat teeth
- Debridement-Scaling and root planing
Treatment sequence is according to
Ramfjord
Natural plaque retentive factors
- Calculus
- Deep fissures and equators
- Variations in dental anatomy
- Exogenous tooth discolouration
- Caries
- Crowding
- Furcations
- Malocclusion-crowding, rotations
- Frenuli
- Recession
- Shallow vestibulum
Types of frenulum
- Gingival
- Mucosal
- Papilla
- Papilla penetrating
Iatrogenic plaque retentive factors
- Poorly adapted restorations
- Fixed orthodontic appliances
- Mouth breathing-xerostomia/hyposalivation
Types of prognosis
- Good
- Doubtful
- Irrational to treat
Factors used in different types of prognosis
- Periodontal
- Endodontic
- Dental
- Functional
Periodontal doubtful prognosis
- Furcation involvement=1 or 2
- Angular bony defects
- Horizontal bone defect reaching 2/3 of root
Periodontal irrational prognosis
- Recurrent abcess
- Combined endo and periodonal lesion
- Attachment loss to apex
- Furcation involvement= 3
Endodontic doubtful prognosis
- Large post or screw obturations
- Incomplete root canal
- Peri-apical pathology
Endodontic irrational to treat prognosis
Perforations in apical half of root
Dental doubtful prognosis
- Extensive root caries that does not extend into root canal
Dental irrational to treat prognosis
- Extensive root caries extending into root canal
- Verical root fractures 2/3 of root
- Oblique fractures into middle third of tooth
Functional irrational to treat prognosis
- Third molars only without antagonist
- Grade 3 mobility
- Periodontitis and caries
When re-evaluation done
6 week to 6 months
What is done during re-evaluation
- Periodontal risk assessment
- Full periodontal status
Information contained in periodontal risk assessment
- Age
- Number of implants
- Number of sites per tooth/implant
- No. of bop positive sites
- No. of sites w/ pocket depths >5mm
- No. of missing teeth
- % alveolar bone loss
- Systemic genetic diseases
- Smoking(environmental factors)
Environmental factors include
- Non smoker
- Former smoker
- Occasional smoker
- Smoker
- Heavy smoker
When epithelium regenerates
10-14 days
When connective tissue regenerates
6 weeks
When bone reforms
6 weeks to 3 months
When periodontal healing takes place
up to 6 months
Aim of corrective phase
- Restore function and health of periodontium=>
- Surgical treatment
- Orthodontics
- Prosthetic treatment
- Conservative(RCT)
- Periodontal surgery
- Implant placement
- Re-evaluation after surgery
Aim of maintainence phase
Prevent re-infection and disease recurrence
Maintainence phase includes
- Anamnesis
- Extra and intra-oral status
- Indexes
- Scaling
- Periodontal status
- Periodontal risk assessment
How patient recall is dettermined
- High risk-3 months
- Medium risk- 6 months
- Low risk- 12 months
