Corrective Therapy Flashcards by A C

What are the 3 parts of periodontal treatment plan?

Initial therapy
Corrective therapy
Supportive therapy

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What can corrective therapy include?

further periodontal, conservative, prosthetic and orthodontic treatment

How well did you know this?

Not at all

Perfectly

What do you constantly need to do to the treatment plan

The plan requires constant review and reassessment of periodontal status

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Why might initial therapy fail?

Inadequate instrumentation
Poor plaque control/motivation
Confounding systemic factors
Gross deposits
Smoking habit changes
Host factors
Microbial factors

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How can you review how your treatment is going?

Check plaque levels, calculus, marginal bleeding free score

How well did you know this?

Not at all

Perfectly

When should you return to the initial therapy phase?

If non surgical therapy has not succeeded

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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).

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What treatment can me give someone who has lost a tooth?

Crowns
bridges
implant placement restoration
dentures

How well did you know this?

Not at all

Perfectly

What is periodontal care dependant?

Patient availability
Operator experience
Correct equipment

How well did you know this?

Not at all

Perfectly

How long can periodontal treatment take?

4-6 hours

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are some limitations of adjunctive therapy?

Operator skill
Allergy
Patient comfort
Patient availability for repeated applications
Efficacy
Cost

How well did you know this?

Not at all

Perfectly

What might me place in non-responsive sits?

Locally placed antimicrobials
Locally placed disinfectants
In certain severe cases we may use Systemic antibiotics

How well did you know this?

Not at all

Perfectly

Name some locally placed antimicrobials

Minocyline gel (Dentomycin)
Metronidazole gel (Elyzol)

How well did you know this?

Not at all

Perfectly

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?

1. Once oral hygiene is of a high standard 2. When inflammation is resolved 3. 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?

1. If periodontal condition not stabilised, increased risk of drifting, abscess and exfoliation 2. 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?

1. To splint very mobile teeth where periodontal infection controlled 2. To splint where mobility causes discomfort 3. To retain orthodontically repositioned teeth 4. To reduce excessive occlusal disturbances 5. To prevent drifting and over eruption

What are some problems associated with splinting teeth?

1. If periodontal condition not stabilised, increased risk of mobility and exfoliation 2. May affect OH provision 3. 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?

1. To aid mastication 2. To distribute loading 3. To aid speech 4. To protect tooth structure 5. To maintain tooth alignment 6. 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: 1. Severely mal-positioned teeth 2. Drifted incisors 3. Severe recession

Name some Periodontal surgery used to aid aesthetics

1. Crown lengthening surgery 2. Root coverage surgery 3. surgery to remove overgrowth/hyperplasia 4. Papillary enhancement surgery 5. 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?

1. Potential for post-operative infections 2. Perforations 3. Prolonged, involved treatment plan 4. Risk tooth fracture 5. 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?

1. To Restore/replace missing or weak teeth 2. Gingival masks for recession 3. Pink porcelain on cervical margins 4. To maintain space 5. Denture to replace bone contour

What are some Benefits of corrective therapy for aesthetics?

1. Decreased gingival swelling 2. Decreased bleeding 3. Sharper gingival contours may return 4. Motivates patients to continue with good OH 5. Often improves access for OH 6. Facilitates impression taking

What are some adverse effects of corrective therapy?

1. Recession and exposure of cervical dentine (abrasion, staining, caries, sensitivity) 2. Loss of papillary contour 3. Supra gingival crown margins 4. May complicate access for OH

What must treatment plans take account of?

1. Patient wishes and availability 2. Age and adaptability/motivation 3. Medical status 4. Disease levels 5. Resources 6. Skill levels (patient and operator)