Corrective Therapy Flashcards
aims of corrective therapy
- RESTORE FUNCTION and provide a STABLE OCCLUSION for the patient
- RESTORE AESTHTETICS
INITIAL therapy may fail due to reasons such as..
inadequate instrumentation poor plaque control/ motivation confounding systemic factors gross deposits (left behind/ newly formed) smoking habit changes host factors microbial factors patient compliance
as part of the WHOLE therapy you are providing REVIEW of __ is essential
review of the diagnosis
must be very clear with the patient about future prognosis
smoking can lead to a poor response in treatment. why
- reduced vascularisation= reduced tissue healing
2. altered host response
HOW do you know initial therapy has failed
at the review you would carry out perio chartings.
- residual BOP
- residual pockets
- residual calculus
- ineffective self-care/ OH regimen
at review you would ensure did not fail due to…
- systemic factors (smoking, diabetes)
- local factors (occlusion, poor restoration)
- compliance
if patient fails initial therapy, which stage of treatment do they progress to
back to initial therapy phase
what does corrective therapy entail
- replacing missing teeth, crown, bridges, implants, dentures
ADJUNCTIVE TREATMENTS such as…
- perio treatment/ surgery (rare)
- endo surgery
- orthodontics
- root canal therapy
- definitive restorative treatment and occlusal therapy
which factors affect PERIODONTAL CARE
patient availability operative experience correct equipment time consuming (4-6hrs if experience) cost
WHEN would you use ADJUNCTIVE TREATMENTS
when deep pockets unresponsive sites non-responsive patients no allergy known willing patient
adjunctive treatment: perio treatment, can include locally placed…
- locally placed ANTI MICROBIALS in non responding sites
e. g. metranidazole gel (elyzol)
e. g. minocycline gel (dentomycin) - locally placed DISINFECTANTS
e. g. chlorohexidine (cordodyl)
e. g. gelatine shield (periochip)
nb. a periochip is often combined with chlorohex.
adjunctive treatment: perio treatment, can include systemic antibiotics such as…
ONLY in very severe cases/ stage 3/4
- tetracyline
- doxycycline
- metranidazole with amoxicillin
why are systemic antibiotics not widely used
- resistance
- PDs are caused by a large no. of bacterial species, simply removing them, only causes them to be replaced with a different microflora which also causes PD
it is RARE to carry out perio SURGERY- but you would in cases such as…
- to reduce HYPER-plastic gingivae
- for LOCALISED persistent pocketing >6mm
- to aid ACCESS for RSD in diseased furcation regions
- to SECTION roots from teeth with gross bone loss
- to reduce FRENAL (folds of mucosa) INTERFERNCES to OH
perio sugery as part of corrective therapy requires the patient to ..
have good oral health
AND
non-smoker
NB. there is no overwhelming evidence to suggest that surgical approach is more effective than non-surgical in chronic disease
WHEN would you perform corrective therapy
after initial therapy when…
OH is of a high standard with a high PFS
when inflammation is resolved- bleeding indices
when there IS A RESPONSE to initial therapy (pocket depth, recession, CAL, motility)
