Clinical Treatment Flashcards
Scaling and Root Planing
o Treatment completed by CRDH
o Use the ultrasonic scaler and hand scalers
o Heavy deposits removed and the root surface is scaled to remove plaque and tartar. This smooths the rough spots on the roots where bacteria collect. This helps keep the area free of bacteria and may help ligaments reattach to tooth, reducing pocket depth. Scaling while numb allows the hygienist to reach areas below the gum line that can’t be removed in a regular cleaning.
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
FL- Periodontal Mirco-Surgery/ Osseous Surgery
o Pocket reduction surgery
o Gums are lifted from tooth with periodontal micro-surgery to gain access to the tartar deep within the pocket.
o Removal of all diseased gum tissue and tartar on the root surface
o Sometimes osseous surgery is performed, this involves reshaping and smoothing the bone
o *After completion of surgery the gums shrink or are positioned lower which means the gumline is lower. This leaves the tooth more exposed, sometimes causing sensitivity to the patient to temperature stimuli. Fluoride treatments can be utilized to reduce this
o Suture is placed and typically resorbs on its own 3 to 5 days later
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
FGG- Free Gingival Graft
o When gum isn’t supported by bone, the gum starts to recede or pull away (recession)
o Donor tissue is taken from behind maxillary molar (maxillary tuberosity)
o A wound is created at the recipient area and the donor tissue is placed and glued into place with a tissue glue (no sutures)
o A putty like bandaide (periodontal dressing) is placed over the graft. This can fall off at any time and does not mean the graft has fallen out.
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Crown Lengthening
o Surgery to expose more of the crown and decay
o Tissue is elevated from tooth and the supporting structure (bone and gums) is repositioned apically to expose more tooth to anchor a new crown.
o Sutures are placed
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Gingivectomy
o This is done to remove an overgrowth of gum tissue that causes a gummy smile
o Tissue is reduced and resculpted to ideal position/shape
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Alloderm
o When gum isn’t supported by bone, the gum starts to recede or pull away (recession), but differentiates from the need of a FGG based on the amount of teeth needed to be treated
o The teeth are first prepared with a ultrasonic scaler and prepping agents
o An access hole or pinhole is made allowing doctor to create a tunneling system under tissue
o The tissue is coronally positioned to ideal location, alloderm (dermis cadaver) is inserted and sutured into place
o Sutures stay in for 8 weeks
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
o Z-pack disp 1 pack sig take as directed 0 refill
o Medrol dose pack disp 1 pack sig take as directed 0 refill
PAOO- Periodontally accelerated osteogenic orthodontics
o Creates an increased net width of alveolar bone, used to increase bone width (if it is thin or non-existing), or for accelerated orthodontics.
o Use 100% mineralized cortical powder with ampicillin hydration (if allergy to penicillin, pt is put on oral antibiotic – zpack)
o Tissue is elevated from desired area
o Piezo activation cuts are made into the bone
o Perforation is made into bone
o Bone graft placed and tissue sutured
o Sutures remain and are removed only as they become loose
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
o Z-pack disp 1 pack sig take as directed 0 refill
o Medrol dose pack disp 1 pack sig take as directed 0 refill
Implant
o Used to replace missing teeth or to stabilize a prosthetic devise
o Implant is completed in stages. 1st implant is placed, then patient must wait the desired amount of time (typically 4 months however, if a bone graft is performed then 6 months’ time), next once the ideal time has passed the implant is checked for osteointegration (becoming one with bone) with a radiograph. The patient then returns to general dentist for impressions of their crown/ prosthesis on top (this is an extra expense with general dentist crown is not completed here unless specified)
o Tissue elevated from are exposing bone
o Bone is prepared so the implant can be placed
o The implant is paced after 3 to 4 prepping steps
Precision
2 mm twist
Preparatory drills
Implant placement
o Healing abutment or cover screw will be placed to be determined by doctor
o Sutured with non-absorbable suture
o Ibuprofen 600mg disp 28 1 q 4-6 hours 1 refill
o Amox 500mg disp 32 1 qid starting the day before procedure
Stage II implant
o If a cover screw was placed at initial implant placement a St II surgery will be needed
o The doctor will expose expose cover screw using a small incision or pinhole
o Cover screw is removed and a healing abutment is placed
o This procedure may or may not have sutures, will be determined during procedure
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Sinus augmentation
o The purpose of this procedure is to increase bone height in preparation for and implant
o Tissue is elevated from desired area and a window is created into sinus cavity
o Carefully the doctor releases the sinus membrane from bone and elevates sinus cavity
o Once ideal space is created bone graft is placed into window
o Membrane is used to close window
o Tissue is then sutured into placed using vicryl suture
o Depending on the amount of bone existing prior to sinus augmentation, an implant may or may not be placed same day
o Ibuprofen 60mg disp 28 sig 1 q 4-6 hours prn 1 refill
o Medrol dose pack disp 1 pack sig take as directed on box 0 refill
o Amox 500mg x 32 1 qid starting the day before the procedure 0 refills
Exposure of impacted tooth
o Procedure is completed with the request of orthodontist in order to expose an un-erupted tooth. Bracket is activated by orthodontist to pull tooth into position
o CT scan is used to determine if the tooth is Facially or Lingually positioned
o Tissue is elevated and tooth is exposed
o The tooth is prepared and bracket placed
Etch
Prime
And bracket cemented with resin composite
o Tissue is sutured back in place and chain is secured with ligament wire
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Bone Graft
o After an extraction if the socket is missing a wall or walls of bone a bone graft will be needed
o This is done at same time as extraction
o A mixture of particulate bone hydrated with antibiotics is placed into socket
o Membrane is placed over graft
o Periosteum may be released depending on Doctors assessment
o Tissue is sutured using non-absorbable suture
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
Extraction
o Tissue is elevated from tooth
o The ligaments around tooth are released and tooth removed
o Sometimes, if the ligaments cannot be manually released the crown of tooth is removed and the roots are sectioned
o The doctor then uses the piezo unit to gently release ligaments allowing the root tips to be removed while preserving bone
o Sockets is cleaned and evaluated
o Doctor determines if collagen (gel foam) or bone graft is indicated
o Periosteum may be released for primary closure
o Sutures place (suture type is determined by doctor at time of treatment
o Ibuprofen 600mg x 28 1 q 4-6 hours prn 1 refill
