Corrective Therapy Flashcards
What are the 3 parts of periodontal treatment plan?
- Initial therapy
- Corrective therapy
- Supportive therapy
What is the definition of corrective therapy?
It is the stage following the initial “hygiene” therapy for a patient, where re-assessment and definitive treatment planning is undertaken
Corrective therapy may then include further periodontal, conservative, prosthetic and orthodontic treatment
What can corrective therapy include?
further periodontal, conservative, prosthetic and orthodontic treatment
What do you constantly need to do to the treatment plan
The plan requires constant review and reassessment of periodontal status
What is the aim of corrective therapy?
- To restore function and provide a stable occlusion for the patient
- To restore aesthetics after resolution of inflammation and healing following extractions
Why might initial therapy fail?
- Inadequate instrumentation
- Poor plaque control/motivation
- Confounding systemic factors
- Gross deposits
- Smoking habit changes
- Host factors
- Microbial factors
Why is harder to treat smokers with periodontitis?
They have a poorer response to treatment
Tissue healing is impacted by reduced vascularisation and altered host response
What should you do if your patient is not compliant with homecare?
- Think again
- Counsel patient
- Tailor OHI and education/motivation
- Keep full clinical record
How can you review how your treatment is going?
Check plaque levels, calculus, marginal bleeding free score
When should you return to the initial therapy phase?
If non surgical therapy has not succeeded
How can you check to see if your non surgical therapy has not succeeded ?
If there is:
- Residual Bleeding on Probing
- Residual pockets
- Residual calculus
- Ineffective self care oral hygiene regimen
- Ineffective instrumentation
If initial therapy is unsuccessful what should you look at to judge why it has been unsuccessful?
You should ensure response to the initial therapy is not affected by systemic (smoking diabetes) or local factors (occlusion, poor restorations).
What procedures and therapies are part of corrective therapy??
- Replacement of missing teeth
- Adjunctive treatments
- Periodontal surgery
- Endodontic surgery
- Orthodontics
- Root canal therapy
- Definitive restorative treatment and occlusal therapy
What treatment can me give someone who has lost a tooth?
Crowns
bridges
implant placement restoration
dentures
What is periodontal care dependant?
Patient availability
Operator experience
Correct equipment
How long can periodontal treatment take?
4-6 hours
When do you use adjunctive treatments?
If a patients has: 1. Deep pockets
2. Unresponsive sites or patients
Where no allergy known and make sure the patient is willing
What are some limitations of adjunctive therapy?
- Operator skill
- Allergy
- Patient comfort
- Patient availability for repeated applications
- Efficacy
- Cost
What might me place in non-responsive sits?
Locally placed antimicrobials
Locally placed disinfectants
In certain severe cases we may use Systemic antibiotics
Name some locally placed antimicrobials
Minocyline gel (Dentomycin) Metronidazole gel (Elyzol)
Name some locally placed disinfectants
Chlorhexidine (Corsodyl) gelatine shield (Periochip)
When might we administer systemic antibiotics?
in severe cases of periodontitis only (Stage 3 or 4)
Name some systemic antibiotics we may use
Tetracycline
Doxycycline
Metronidazole with Amoxicillin
When is periodontal surgery performed?
- Reduction of hyperplastic gingivae
- For localised persistent pocketing (> 6mm)
- To aid access for RSD in diseased furcation areas
- To section roots from teeth with gross bone loss
- To reduce frenal interferences to OH
What criteria must patients fir to be considered for periodontal surgery?
Must have good oral hygiene
Must not smoke
What are some problems associated with surgery?
Patient tolerance
Also there’s not a lot of evidence to suggest the surgical approach is more effective than non surgical methods in chronic diseases
When is other corrective therapy performed?
- Once oral hygiene is of a high standard
- When inflammation is resolved
- Where there is a response to initial therapy
How do we assess if oral hygiene is at a high standard?
We use a plaque free score
How do we assess when inflammation has resolved?
We use a bleeding indicies
When would we cary out orthodontic treatment on a periodontitis patient?
Only when their periodontal tissues are healthy
When their RSD completed, PD < 3mm, subgingival plaque removed
Why might a patient who’s had periodontitis need orthodontic treatment?
To fix Drifting anterior teeth, open bites and to aid lip seal
To fix Tilted molars and Traumatic overbites
What problems are assayed with dong orthodontic treatment on periodontal patients?
- If periodontal condition not stabilised, increased risk of drifting, abscess and exfoliation
- Requires permanent dentures or fixed appliances which are harder to clean affecting OH access
Why and why is occlusal therapy sometimes needed for periodontal patients?
- To splint very mobile teeth where periodontal infection controlled
- To splint where mobility causes discomfort
- To retain orthodontically repositioned teeth
- To reduce excessive occlusal disturbances
- To prevent drifting and over eruption
What are some problems associated with splinting teeth?
- If periodontal condition not stabilised, increased risk of mobility and exfoliation
- May affect OH provision
- Differing mobility will fail by de-bonding
What are some restorative treatments we may give to periodontal patients?
Fixed and removable Prostheses and implants may be given
Why might we do some restorative treatment on periodontal patients?
- To aid mastication
- To distribute loading
- To aid speech
- To protect tooth structure
- To maintain tooth alignment
- To maintain horizontal and vertical jaw relationships
What are some problems associated with doing restorative treatment on periodontal patients?
If periodontal condition not stabilised, increased risk of mobility and exfoliation
May affect OH access and provision
What typeof teeth would we extract in patients for aesthetic purposes?
We may extract:
- Severely mal-positioned teeth
- Drifted incisors
- Severe recession
Name some Periodontal surgery used to aid aesthetics
- Crown lengthening surgery
- Root coverage surgery
- surgery to remove overgrowth/hyperplasia
- Papillary enhancement surgery
- Pre-prosthetic surgery
Name some treatments that can aid root coverage
Connective tissue graft, coronal flap.
Name some treatments used to remove overgrowth/hyperplasia
Gingivectomy
What does papillary augmentation use?
uses restorative, ortho and perio treatment
Why might we do a Papillary augmentation on a patient?
For aesthetics
What are the negatives of papillary augmentation?
It is complicated, success and results are limited
Why do we do root fillings?
To eliminate pulpal disease
When might w carry out a rot filling?
Where there is apical pathology and/or a chronic sinus
When a multi rooted tooth is to be sectioned
What are some complications associated with root fillings?
- Potential for post-operative infections
- Perforations
- Prolonged, involved treatment plan
- Risk tooth fracture
- Plan final crown in advance
Why might orthodontics be used to aid aesthetics in periodontal patients?
To realign drifting
To decrease overjet
To upright tilting and rotation
Why might restorative treatments to aid aesthetics in periodontal patients?
- To Restore/replace missing or weak teeth
- Gingival masks for recession
- Pink porcelain on cervical margins
- To maintain space
- Denture to replace bone contour
What are some Benefits of corrective therapy for aesthetics?
- Decreased gingival swelling
- Decreased bleeding
- Sharper gingival contours may return
- Motivates patients to continue with good OH
- Often improves access for OH
- Facilitates impression taking
What are some adverse effects of corrective therapy?
- Recession and exposure of cervical dentine (abrasion, staining, caries, sensitivity)
- Loss of papillary contour
- Supra gingival crown margins
- May complicate access for OH
What must treatment plans take account of?
- Patient wishes and availability
- Age and adaptability/motivation
- Medical status
- Disease levels
- Resources
- Skill levels (patient and operator)
