5. Maintenance Flashcards

1
Q

What is the goal of maintenance

There are 3…

A

Prevent or minimize recurrence of disease
Stop progression of disease
Prevent tooth loss

Maintenance is the cornerstone of successful
treatment

Must be part of all treatment plans

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2
Q

What is the success of maintenance in terms of tooth loss per year

Who said this Becker 1984

A

Untreated disease 0.36/yr
Treated and not maintained 0.29/yr
Treated and maintained 0.11/yr

Becker 1984

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3
Q

What determines the success of treatment

A

Plaque control

All periodontal surgeries successful in presence of adequate plaque control

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4
Q

What is the maintenance interval

A

3 month interval most commonly

Based on patient risk factor

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5
Q

Why is recall every 3/12

A
  1. Time needed for bacteria to repopulate the Subgingival environment
  2. Increase plaque free surfaces
  3. Stop disease progression
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6
Q

What is the compliance with maintenace

A

Totally Compliant - 16%
Partially Compliant - 49%
Never Compliant - 34%

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7
Q

What effect does reminder have on compliance

Who said this

A

It increases to 32%

Wilson 1984

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8
Q

What are the causes of non compliance

There are 4…

A
  1. Fear
  2. $
  3. Type of treatment
  4. Pt motivation
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9
Q

What is the completed at the maintenance appointment

There are 10 steps…

A
  1. Medical and Dental history
  2. Perio assessment
  3. Plaque Index
  4. Oral Hygiene Review
  5. Polish/ Floss
  6. Ultrasonic
  7. Hand Instrument
  8. Caries Assessment
  9. Chemical therapy
  10. F Rinse
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10
Q

What are the indications for re treatment during maintenance

A

increase PD during maintenance, this means periodontal breakdown is occuring.

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11
Q

When would you delay surgical treatment

A

If plaque control is poor

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12
Q

What do you do for 1 site not responding

A

RSD and chemotheraputic

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13
Q

What do you do for multiple sites not responding

A

Surgery

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14
Q

What do you do generalized loss continuing

A

Check systemic health

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15
Q

What do you do if the mobility is increasing following treatment

A

Check occlusion

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16
Q

How do impl attach to tissue

A

Junctional Epithelium via basal lamina and hemi desmosomes

NO CT attachment, but it is in close proximity

17
Q

What directions to fibers run at implants

A

Parallel to the implant surface

18
Q

What is the microbiology of implant health

A

Very similar to a health tooth site
Gram +
Aerobic, non motile cocci

19
Q

What is the microbiology of implant disease

A

Gram -
Anaerobic motile
P Inter / P Ging

20
Q

Do implants get seeded from perio disease

A

Yes..

21
Q

What about probing implants

A

You can

22
Q

What about probing depths with KT v alveolar mucosa

A

Less PD with KT

23
Q

What is the value of radiographs in maintenance

A

Important

Allow assessment of the crest

24
Q

When to take a PA for implants

A
  1. Fixture Placement
  2. Abutment Insertion
  3. Prosthesis Insertion
  4. 6 month post op
  5. Yearly if no issues
25
Q

Ho do you assess tissue health visually

A

Colour
Consistency
Contour

26
Q

What teeth most frequently lost during maintenance

A

Molars with furcation involvement

27
Q

Does peri implant mucositis progress to peri implantitis faster than gingivitis to perio dx

A

YES

28
Q

Which professional should do the maintenace

A

Mild Dx - GDP
Moderate - GDP or specialist
Severe - Specialist

29
Q

How do you clean and probe cavitrons

A

Ideally: Titanium probe
Plastic curette or plastic tip on the ultrasonic

Goal is not to roughen the implant surface.

30
Q

What factors influence when to schedule patients for maintenance

A
  1. BOP above 25%
  2. PD above 4 mm
  3. Tooth loss above 8
  4. Amount of attachment loss relative to patients age
  5. Systemic factors eg Diabetis
  6. Environmental eg smoking
  7. Oral Hygiene
  8. Compliance
31
Q

What are the signs of disease recurrence

A
  1. Recurrence of BOP
  2. Increased BOP
  3. Radiographic BL
  4. Progressive mobility