Evaluation of Initial Therapy Flashcards
An Evaluation of Initial Therapy (EIT) Done to?
Determine patient’s response to periodontal treatment
Determine effectiveness of home care
Confirm tooth by tooth prognosis
Confirm decisions regarding further treatment
What are the EIT Parameters?
Gingival color, consistency, and contour
Plaque score
Probing depths
Attachment level
Furcation invasion
Suppuration
Tooth mobility
Bleeding on probing
Why is 4-8 weeks the optimal time frame for evaluation of the periodontium post initial therapy?
Reestablishment of junctional epithelium
Repair of connective tissue
Microbial repopulation of sulcus
EIT – Expected Probing Depth and Attachment Level Changes Tagge et al., 1975
*P < 0.001
What changes in probing depth and attachment level are expected as a result of initial periodontal therapy?
Probing depth reduction: 1-2 mm
Attachment level gain: 0.5 mm
What is the significance of bleeding on probing (BOP) / Gingival Index (GI)?
Correlation with histological findings
Predictor of future attachment loss
What did Anderson et al. (1991) find a significant correlation between?
Bleeding on probing (BOP) and histological inflammation at the base of the pocket
What did Anderson et al. (1991) find no significant correlation between?
Visual signs of inflamed marginal gingiva and histological inflammation at the base of the pocket
What was the purpose of the Lang et al. (1986 & 1989) studies on BOP?
To determine if there is a correlation between BOP and attachment loss > 2 mm
What were the outcomes of the Lang et al. (1986 & 1989) studies on BOP?
No BOP - 1.5% chance of progression
One out of four - 3% chance of progression
Two out of four - 6% chance of progression
Three out of four - 14% chance of progression
Four out of four - 30% chance of progression
What is the clinical significance of BOP in predicting attachment loss?
There is a correlation between BOP and eventual attachment loss; the absence of BOP is a good indicator for maintaining healthy periodontal tissue
What does the presence of BOP likely indicate?
Subgingival plaque and calculus
What is the clinical risk when BOP is present?
Greater chance of future attachment loss
What actions should be considered when BOP is present?
Reinforcing oral hygiene instructions
Scaling and root planing
Local delivery agents
Surgical access
Periodontal maintenance every 3 months
What does the absence of BOP indicate?
Healthy gingiva
What is the clinical significance of absent BOP?
Little chance of future attachment loss
What are the EIT Expected Response Decrease in?
Plaque score
Probing depth
Tooth mobility Improvement in gingival health:
Tissue color, contour, and consistency
Bleeding on probing
Decrease in percentage of sites with BOP
Decrease in gingival index
Suppuration
What are some Clinical Scenarios at EIT?
No further ODCT periodontal treatment is indicated; periodontal maintenance phase is recommended
Further ODCT periodontal treatment (non-surgical or surgical) is indicated; patient proceeds with recommended treatment
Further ODCT periodontal treatment (surgical) is indicated; patient does not proceed with recommended treatment
When does the maintenance phase begin?
At the end of ODCT treatment and is performed simultaneously with reconstructive phase treatment
What are the goals of the maintenance phase?
Maintenance of probing depths
Elimination of gingival inflammation
Control and/or modification of etiology
What may non-surgical periodontal therapy consist of?
Local drug delivery
Treatment of isolated residual pocket
What are clinical indicators for non-surgical therapy?
Pocket free of plaque and calculus
Pocket depth (~5 mm) moderately manageable
Absence of a vertical bony defect
Occlusion therapy needed
What are clinical indicators for surgical periodontal therapy?
Generalized residual probing depths
Need for access to subgingival calculus
Deep pockets
What are signs/symptoms of gingival inflammation indicating surgical need?
Visual signs
Bleeding on probing (BOP)
