57. Supportive periodontal therapy. Flashcards
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
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
Peri-implant mucositis
*Reversible inflammatory process=>
* Soft tissue surrounding functioning implant
Peri-implantitis
Inflammatory process characterised by loss of peri-implant bone
Peri-implant mucositis clinical features
- Similar to gingivitis
- Difference in morphology of mucosa=>
- Lack of light transmission through metal of device may mask inflammation
- Assessed by Bop
Risk factors for peri-implant mucositis
- Poor OH
- History of periodontitis
- Smoking
- Immunodeficiency condition
- Impaired bone metabolism
- Inadequate implant surface
Microbiology of peri-implant mucositis
- Increase in spirochetes and G(-) bacilli
- Fusobacterium
- Prevetella
- Porphyromonas
- Tanerella forsythia
Treatment of peri-implant mucositis
- Patient hygiene routine
- Subgingival debridement
- Irrigation
- Antimicrobial mouthwash-CHX
Peri-implantitis clinical features
- Inflammation
- Loss of peri-implant bone
- Mobility not characteristic but may occur at final stages
- Suppuration frequent
Treatment of peri-implantitis
- Non surgical periodonatal therapy
- GBR and bone graft techniques
- Bone implant removal if bone loss extended to apical half
How microflora of implants differs between partially edentulous and completely edentulous patients
- Partially edentulous patients=>implant microflora similar to natural teeth
- Completely edentulous patients=>microflora differs as not influenced by presence of natural teeth
Importance of treating periodontal disease before implant placement
- Necessary for the maintenance of periimplant health=>
- Periimplantitis is difficult to treat=>
- Preventing periodontal disease avoids complications
Three main differences in maintenance procedures for patients with implants compared to natural teeth
- Special instrumentation that will not scratch implants for calculus removal
- Avoidance of acidic fluoride prophylactic agents
- Use of non-abrasive prophy pastes
Oral hygiene practices for implant patients
- Ultrasoft brushes
- Chemotherapeutic rinses
- Tartar control pastes
Instruments used on implants during recall appointments to avoid damage
- Plastic instruments or specially designed gold-plated curettes=>calculus removal
- Metal hand instruments and ultrasonic and sonic tips avoided=>alter titanium surface
Polishing materials recommended for use on abutment surfaces
- Rubber cup w/ flour of pumice=>
- Tin oxide, or special implant-polishing pastes on abutment surfaces=>
- Light, intermittent pressure to avoid damaging implant
