Chapter 24 Flashcards

1
Q

Characteristics of nonsurgical therapy

A
  • Considered the “gold standard”
  • AKA: initial therapy, anti-infective phase, phase I therapy, soft tissue management, hygienic phase
  • For most people, effective in controlling disease
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2
Q

What are the broad objectives of nonsurgical therapy?

A
  • Eliminate bacteria in biofilm and calculus
  • Eliminate inflammation of the periodontium
  • Return the periodontium to a healthy, maintainable state
  • Eliminate or reduce etiologic, as well as local and systemic risk factors
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3
Q

Factors influencing therapy outcomes

A
  • Patient compliance- poor comliance –> unfavorable outcomes
  • Lifestyle and systemic factors–> may give rise to increasedprevalence, incidence or severity
  • Disease factors–> Some cases do not r4espond wel despite well-executed therapy
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4
Q

Goals of nonsurgical therapy

A
  • Minimize bacterial challenge- remove calculus/biofilm
  • Eliminate or control local contributing factors- Defective restorations, tooth-related factors etc.
  • Minimize impact of systemic risk factors- diabetic control, smoking cessation
  • Stabilize attachment level by eliminating inflammation
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5
Q

Nonsurgical therapy procedures

A
  • Customized self-care instructions- mechanical/chemical biofilm control, supra/subgingival irrigation
  • Periodontal instrumentation
  • Use of antimicrobial agents
  • Correction of local contributing factors
  • Interdisciplinary care for correction/control of systemic risk factors
  • Modulation of host defenses
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6
Q

Indications for nonsurgical therapy

A
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7
Q

What is the main goal of nonsurgical therapy when it comes to cementum?

A
  • Removal of supra and sub-gingival biofilm and calculus while preserving root cementum
  • Conservation is necessary for optimal periodontal health as well as for periodontal regeneration
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8
Q

Describe healing following nonsurgical therapy

A
  • Healing occurs primarily through the formation of long junctional epithelium
  • Following instrumentation, there is normally no formation of new AB, cementum or PDL
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9
Q

What is the soft tissue response of nonsurgical therapy?

A
  • Complete resolution of the inflammation resulting in shrinkage of the tissue (recession) and a shallow probing depth
  • Readaptation of the tissues to the root surface w/ a long JE resulting in a shallow probing depth
  • Little change in the level of the soft tissues resulting in residual pocket depth
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10
Q

Describe the base of the pocket before and after nonsurgical therapy

A
  • Before- tip of the probe penetrates inflamed soft tissue at the base of the pocket
  • After- more resilient to deeper penetration of the probe, and there has been a reduction of edema
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11
Q

How many types of embrasure spaces are there?

A
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12
Q

What is contained within dentinal tubules that is involved in dentinal, hypersensitivity?

A

Odontoblastic process surrounded by dentinal fluid

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13
Q

What are the three theories of dentinal hypersensitivity?

A
  • Direct stimulation- nerve extends through length of tubule (false)
  • Odontoblastic transducer- odontoblasts act as receptors relaying signals (no synapses)
  • Hydrodynamic- Stimulation causes dentinal fluid movement that excited nerve endings
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14
Q

How is dentinal hypersensitivity managed?

A

Meticulous plaque control
Tubule occlusion- At Home: TP, potassium nitrate, strontium chloride, sodium citrate, fluorides
Tubule occlusion- In-Office: potassium oxalate, ferric oxalate, fluoride solution/varnish
- Restorative materials
- Laser
- Soft tissue root coverage

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15
Q

Occluding agents

A
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16
Q

When do we do reevaluation after nonsurgical therapy and what is included?

A
  • Typically 4-6 weeks
  • Update medical history
  • Perform perio clinical assessment
  • Compare initial assessment w/ reevaluation data
  • Decision regarding the next steps in therapy
17
Q

What are the steps in nonsurgical therapy?

A
  1. Clinical assessment to establish perio diagnosis
  2. Nonsurgical perio therapy
  3. Reevaluation of nonsurgical perio therapy
  4. Additional nonsurgical therapy or perio surgery where needed
  5. Establish a program of perio maintenance
18
Q

Indications for nonsurgical and surgical therapy

A
19
Q

Indications for co-treatment by a periodontist

A
  • Unresolved inflammation or continued attachment loss after nonsurgical therapy
  • Managing stage III or IV perio
  • Intensive management of grade B or C perio
  • Non-plaque-induced conditions (recession)
  • Surgical procedures: tissue augmentation, regeneration, mucogingival problems, infrabony defects, furcation invasion
  • Pts requiring surgery involving bone reshaping (crown lengthening)
  • Implant placement
  • Complex med history: radiation, biphosphonate therapy, bleeding disorders
  • Pts who general dentist does not feel comfortable treating