BDS4 Perio Lectures Flashcards
What is the aim of step three treatment?
To treat areas of the dentition which do not respond adequately to step two in engaged patients.
What may be included in step three treatment?
Repeated subgingival instrumentation
Treatment adjuncts
Access flap surgery
Resective flap surgery
Regenerative flap surgery
What local antimicrobials can be given?
Disinfectants (CHX - Periochip)
Local antibiotics (Dentomycin)
When should local anti-microbials be considered for periodontal patients?
As an adjunct to PMPR
Maybe indicated in unresponsive sites where surgery is contra-indicated.
Comment on the effectiveness of periochip.
Small short term improvements to pocket depth, however insufficient data on long term.
Comment on the effectiveness of dentomycin?
Short term improvements to pocket depth when compared to PMPR alone - long-term benefits unclear.
What is dentomycin?
2% minocycline gel, delivered into pocket following PMPR.
3-4 applications every 14 days.
What is the main SDCEP guidance for step three anti-microbial use?
Can consider local agents, but not routinely given.
System antibiotics not recommended.
Outline the risk/benefits of systemic anti-microbials for periodontal disease.
Anti-biotic stewardship.
Link to increasing resistance
Side effects of ABx
May result in improvement in outcome by supressing biofilm growth.
Consider in grade C younger adults with a high rate of progression.
What is periostat?
Sub-antimicrobial dose of doxycyline.
Currently no evidence to show it increases ABx resistance
Statistically improved outcome when compared to PMPR alone
Not currently recommended as unclear side effects to liver.
What is the recommendation for deep residual pockets or furcation involvement post step 1/2 therapy?
Recommend surgical treatment by dentists with additional training.
If referral not possible, repeated step 1 and 2 treatment without RSD.
How deep is a deep residual pocket?
Equal or greater than 6mm
How deep is a moderately deep residual pocket?
4-5mm.
When should access flap and RSD be carried out?
Deep residual pockets (equal or greater than 6mm). Less than this should have repeated subgingival PMPR.
What is the appropriate management of deep residual pockets associated with intra-bony defects?
Intra-bony defects of 3mm or more should be treated with regenerative periodontal surgery.
