5. Maintenance Flashcards
What is the goal of maintenance
There are 3…
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
What is the success of maintenance in terms of tooth loss per year
Who said this Becker 1984
Untreated disease 0.36/yr
Treated and not maintained 0.29/yr
Treated and maintained 0.11/yr
Becker 1984
What determines the success of treatment
Plaque control
All periodontal surgeries successful in presence of adequate plaque control
What is the maintenance interval
3 month interval most commonly
Based on patient risk factor
Why is recall every 3/12
- Time needed for bacteria to repopulate the Subgingival environment
- Increase plaque free surfaces
- Stop disease progression
What is the compliance with maintenace
Totally Compliant - 16%
Partially Compliant - 49%
Never Compliant - 34%
What effect does reminder have on compliance
Who said this
It increases to 32%
Wilson 1984
What are the causes of non compliance
There are 4…
- Fear
- $
- Type of treatment
- Pt motivation
What is the completed at the maintenance appointment
There are 10 steps…
- Medical and Dental history
- Perio assessment
- Plaque Index
- Oral Hygiene Review
- Polish/ Floss
- Ultrasonic
- Hand Instrument
- Caries Assessment
- Chemical therapy
- F Rinse
What are the indications for re treatment during maintenance
increase PD during maintenance, this means periodontal breakdown is occuring.
When would you delay surgical treatment
If plaque control is poor
What do you do for 1 site not responding
RSD and chemotheraputic
What do you do for multiple sites not responding
Surgery
What do you do generalized loss continuing
Check systemic health
What do you do if the mobility is increasing following treatment
Check occlusion
How do impl attach to tissue
Junctional Epithelium via basal lamina and hemi desmosomes
NO CT attachment, but it is in close proximity
What directions to fibers run at implants
Parallel to the implant surface
What is the microbiology of implant health
Very similar to a health tooth site
Gram +
Aerobic, non motile cocci
What is the microbiology of implant disease
Gram -
Anaerobic motile
P Inter / P Ging
Do implants get seeded from perio disease
Yes..
What about probing implants
You can
What about probing depths with KT v alveolar mucosa
Less PD with KT
What is the value of radiographs in maintenance
Important
Allow assessment of the crest
When to take a PA for implants
- Fixture Placement
- Abutment Insertion
- Prosthesis Insertion
- 6 month post op
- Yearly if no issues
