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.
Describe the ideal patient to be considered for periodontal surgery?
OHI targets met.
Sites =/>6mm
Ability to tolerate procedure
No medical contraindications
Acceptable morphology
What medical contra-indications are there for periodontal surgery?
Smoking
CVS disease
Poorly controlled diabetes
Immunosuppressed patients
Anti-coagulant therapy
Anti-platelet therapy
What are the potential risks of periodontal treatment?
Pain
Swelling
Bleeding
Bruising
Tooth sensitivity
Failure to resolve pockets
Tooth mobility
Non-vitality
What is GTR?
Guided tissue regeneration
Bone-grafting of area, membrane prevents gingival epithelium from entering defect, allows osteogenesis and PDL regeneration.
What is the recommendation for class III furcation teeth?
Periodontal management
No justification for extraction
What are the management options for periodontal furcation involved teeth?
Regenerative surgery
Root resection
Separation
Tunnelling
What is TIPPS?
Talk
Instruct
Plan
Practice
Support
What is the maximum depth you can perform PMPR to subgingivally?
4mm
What patient factors should be considered for mucogingival surgery?
OHI: >20%P >10%B
Motivated
Patient able to tolerate
Compliance of post-op maintenance
What tooth factors should be considered for mucogingival surgery?
Access to non-responding sites
Shape of defect
Pros/endo considerations
Tooth position
What are the medical contra-indications for mucogingival surgery?
Smoking
Unstable angina
Hypertension
MI within 6 months
Immunosuppressed
Anti-coagulated
What are the general indications for mucogingival surgery?
Perio lesions
Deformities
Short clinical crowns
Removal of frenal attachment
Creation of more favourable bed of tissues for implants
What are the main approaches to mucogingival surgery?
Full thickness flap/Split thickness
Free gingival graft
Pedicle sliding graft
Connective tissue graft
Guided bone regeneration
Describe the aetiology of gingival recession.
Localised recession:
- Toothbrushong
- Traumatic incisors
- Habits
- Anatomical
Generalised:
- On going periodontal disease
Local/general:
- Orthodontic treatment
How is gingival recession classified?
Recession type 1 (No interprox)
Recession type 2 (Mid buccal)
Recession type 3 (worse than mid buccal)
What are the treatment options for gingival recession?
Record
Eliminate aetiological factors
OHI
Topical desensitising agents
Gingival veneer
Crowns
Mucogingival surgery
What are the indications for surgical crown legnthening?
Increase height for adequate margin
Exposure enough clinical crown to make a ferrule
Expose subgingival caries/margins/fractures
Correction of uneven gingival contour
