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)
adjunctive treatment: orthodontics would only be carried out when the perio tissues are healthy.
how does orthodontics link with periodontitis
orthodontics is for:
- drifting in anterior teeth
- tilted molars
- traumatic overbites
- if patient has/had periodontitis, then LOW BONE LEVELS thus vulnerable
- drifting is seen often in perio patients, when the periodontitis is resolves, they hate appearance of drift
if the perio condition is NOT stabilised before orthodontic treatment, then the patient is at risk of…
drifting
abcess
exfoliation
adjunctive treatment: occlusal therapy
what does this mean
making changes to occlusion to help function
this can occur via splinting (rare)
what therapy does occlusal therapy include
- splint very mobile teeth where perio infection controlled
- split where mobility causes discomfort
- to retain orthodontically repositioned teeth
- to reduce excessive occlusal disturbances
- to prevent drifting and over eruption
what is splinting and why is it used
a technique to stabalise mobile teeth which has become loose due to losing supporting bone
adjunctive treatment: definitive restorative and occlusal therapy includes
fixed and removable PROSTHESES and IMPLANTS
what aesthetic problems may occur due to periodontitis
severely mal positioned teeth
drifted incisors
severe recession
NB. these cases would require: extraction OR perio surgery
when would perio surgery be used to AID in AESTHETICS
- crown lengthening
- for root coverage (connective tissue graft, coronal flap)
- to remove overgrowth/ hyperplasia (gingiectomy
- papillary enhancement (black triangles)
- pre-prosthetic surgery
what is papillary enhancement/ augmentatation
patients complain of black triangle when smile- the papilla can be replaced by papillary augmentation
low success rate
NB. gingival masks can also be used to cover black triangles
when would you carry out ROOT FILLING
- to eliminate pulpal disease
- where there is apical pathology and a chronic sinus
- when a multi-rooted tooth is to be sectioned
complications linked with root filling
potential for post op infection
perforations
prolonged and involved treatment plan
risk of tooth fracture
plan final crown in advance
when would RESTORATIVE treatment be used to aid in AESTHETICS
to restore/ replace missing or weak teeth
gingival masks for recession and black triangles
pink porcelain on cervical margins
to maintain space
denture to replace bone contour
