6. Periodontal Maintenance Flashcards
What is Periodontal Maintenance?
• Procedures performed at selected ____ to assist the periodontal patient in ____ oral health
• Periodontal maintenance following active therapy is NOT synonymous with ____
- Prophylaxis refers to procedures that are done ____, on a patient who has a healthy periodontium.
- Once the periodontium is not healthy, any procedure done on it to maintain it is called periodontal ____, not prophylaxis
• These are two different types of patients with different susceptibility rates. So we will be doing things at different ____ (prophylaxis vs maintenance). We will also encounter and charge the patient differently. Both are ____ differently for insurance and financial purposes.
intervals
maintaining
prophylaxis
preventively
maintenance
intervals
coded
What are the Goals of Periodontal Maintenance?
- To ____ the results of active treatment
- To ____ the results of active treatment
- To prevent ____ progression on all sites in the pt’s mouth.
- To prevent ____ of new disease
As long term studies have shown us, if the pt is ____ with recommended recall interval, things get better, you may get further improvement, both with regards to probing depth and bleeding on probing and hence inflammation.
Periodontal disease can be treated but cannot be ____. So once we treat the pt our goal is to insure that the pt is gonna be stable enough or is gonna lose as less attachment as possible over the course of their lifetime so that they don’t risk losing their teeth.
maintain
improve
progression
development
compliant
cured
Is Periodontal Treatment Effective?
• Long-term Randomized Controlled Clinical Trials w/ Split Mouth Design
• Minnesota studies: SRP - MWF, 6.5 years
• Michigan studies: SRP - SC - APF - MWF, 8 years
• Gothenburg studies: SRP - APF - MWF w/ or w/o OS, 14 years
• Aarhus studies: SRP - APF - MWF, 5 years
• Michigan-Tucson-Houston studies: SRP - MWF - APF w/ OS, 5 years
• Nebraska studies: CS - SRP - MWF - APF w/ OS, 7 years
- Periodontal treatment is an effective treatment whether that is ____ or ____.
- We reviewed the studies - the long term, randomized clinical trials.
surgical
non-surgical
Is Periodontal Treatment Effective?
• All treatment modalities were effective in halting disease ____
• Overall, no significant difference in ____ between treatments
• Overall, no significant difference in ____ between treatments
• Differences between treatments were noted mainly in ____
____ is the key to success
• One of the common thing that all the studies found is that recall, periodontal
maintenance was the key to success.
• The terms recall and periodontal maintenance are terms that are used interchangeably
progression PD CAL molars recall
What is the Ideal Recall Interval?
- Michigan studies: SRP - SC - APF - MWF, 8 years
- Michigan-Tucson-Houston studies: SRP - MWF - APF w/ OS, 5 years
- Nebraska studies: CS - SRP - MWF - APF w/ OS, 7 years
- Recall every ____ months
- Supra- and sub-gingival plaque removal
• In patients who are not periodontal patients but are healthy or gingivitis patients, we perform their prophylaxis every ____ months.
• For periodontal patients the recall interval is every ____ months.
• During that recall period, they would bring in the pt every ____ months and remove both supra
and sub gingival plaque.
• Important to know how often they are called in (3months) and what is done (supra and sub gingival plaque removal).
3
6
3
3
What is the Ideal Recall Interval?
• Minnesota studies: SRP - MWF, 6.5 years
• Recall every ____ months
• ____- and ____-gingival plaque removal
• Minessota study shows a recall interval thats similar but a little wider -
3-4 months
• They also removed supra and sub gingival plaque.
3-4
supra
sub
What is the Ideal Recall Interval?
- Gothenburg studies: SRP - APF - MWF w/ or w/o OS, 14 years
- Recall every ____ weeks for 6 months, then every ____ months
- ____-gingival plaque removal only
• In Gothenburg they used a much more stringent recall interval. Every 2 weeks for 6 months and then every 3 months.
• They were testing the limits of periodontal therapy.
• They were removing supra gingival plaque only - they were removing this before it
becomes sub gingival and hence pathogenic.
• This is the ____ standard, but not very practical for everyone.
2
3
supra
gold
What is the Ideal Recall Interval?
Aarhus studies: SRP - APF - MWF, 5 years
Recall every ____ weeks for year 1, every ____ months for year 2, then
every ____ months for years 3-5
____- and ____-gingival plaque removal
In Denmark, they used something in between, where they recalled the patient every 2 weeks for the first year, then every 3 months for the second year and every 6 months for years 3-5
• The rational here was that they would help the pt achieve as good oral hygiene as possible within the first year and then they would make that recall less frequent.
• After the ____ year they performed both supra and sub gingival plaque removal.
2 3 6 supra sub
Is a 6-month Recall Interval Adequate for Patients Treated for Periodontitis?
20 patients with generalized severe chronic periodontitis treated with full mouth periodontal surgery
Randomized controlled clinical trial
• Control: recall every ____ months —- which is what happens in non-periodontitis
• Test: recall every ____ weeks — which is the model that gothenburg was using
PD, BOP, CAL assessed at baseline and ____months
6
2
24
Is a 6-month Recall Interval Adequate for Patients Treated for Periodontitis?
- ____-week recall: shallow PD and gain of CAL that were maintained for 2 years
- ____-month recall: repocketing and continuous loss of CAL over 2 years
- A 6-month recall interval results in ____ to halt periodontal disease progression
2
6
failure
The Key to Success
the key to success for periodontal treatment is the ____-month recall
for removal of all ____- and ____-gingival plaque
- The other studies have used a more reasonable recall of 3-4 or 3 months and we have seen that those studies did not really differ from the Gothenburg studies that used the 2 week recall interval
- Given that 3 months is a much easier interval to employ in clinical practice our conclusion is that: READS slide
- So we are either gonna see pts very frequently, every ____ weeks and not remove supra gingival or we r gonna see them every ____ months and remove both supra and sub gingival plaque - this appears to be very adequate for maintaining periodontal health.
3 supra sub 2 3
What is the Patient Compliance with the Recommended Recall Interval?
961 ____ practice patients with periodontitis treated with SRP or combination of SRP and surgical treatment
Recommended recall interval 3-4 months: ____%
0-2 months: ____%
5-7 months: ____%
Compliance evaluated at ____ years
• When we are talking about shorter intervals, a good q is whether compliance happens with pts.
• There are a series of good studies by Wilson (a private practitioner) and collegues. He looked at about 1000 private practice pts who have either been treated with SRP alone or a combination of SRP and surgical treatment as needed.
• The recommended recall interval was 3-4 months for 92% of his pts.
• 6% of the pts were placed on a shorter recall interval of 0-2 months. That has to do with
____. If you have a pt with a lot of risk factors such as smoking, systemic diseases, diabetes, then we may shorten the recall interval to less than 3 months.
• There are some patients who are less susceptible to periodontal disease and who have excellent oral hygiene, for those pts he recommended a 5-7 month recall interval (2%)
• These were the recommendations, so now lets see what happened when Wilson evaluated
the compliance 8 years later.
private 92 6 2 8 risk factors
What is the Patient Compliance with the Recommended Recall Interval?
- Complete compliance: ____%
- Erratic compliance: ____%
- No compliance: ____%
- Complete compliance ____ over time
These compliance percentages recorded are across all three groups.
• This is not what u wanna have in your practice for a number of reasons.
• A lot of effort, time and money has been put into these pts and still at best they comply
erratically at the recommended interval at around 50%.
• About a third never came back
• Complete compliance decreased with time. The further from our treatment, the lower
the complete compliance.
16
49
34
What is the patient compliance with the recommended recall interval?
- they had pts in ____ groups depending on what type of treatment they had received (osseous surgery, flap procedure and SRP)
- complete compliance was a little ____ when patients received surgical therapy vs non-surgical therapy but w/o any significant difference
3
higher
-poor prognosis = no compliance was ____
higher
