maintence Flashcards
what are the general objectives?
survival of functional dentintion with satisfactor esthetics for ptns
What are the objectives specific for perio?
prevent reinfection
maintain attachment levels
what are the goals of periodontal therapy?
- maintain stability of attachment levels: improve/gain attachment when feasible
- keep inflam severity as low as possible
- maintain a functional and esthetically pleasing dentition for ptn
what are the goals of maintenance?
- to minimize recurrence and progression of Pd in ptns who have previously been treated
- to reduce incidence of tooth loss by monitoring the dentition and any prosthetic replacement of natural teeth
- to increase the probability of locating and treating, in timely manner, other disease or conditions found within oral cavity
in a study with 77 ptns with advanced PD, the re-exam done in ___ months? This lead to two groups of patients? Then Reeval after ___ years?
2; 52 ptns rigorous maintenance and 25 ptns general practitioner; 6 years
In study of attachment level changes, % of surfaces showing changes from 2 month exam: AL gain in maintenance vs control? AL stable? Attachment loss <= 1mm? 2-5 mm?
17, 01;
72,10;
10, 34;
01, 55
What are the results of proper maintenance? (5)
- preservation of alverolar bone support
- stability of attachment levels
- inflam levels kept low as possible
- improved self-performed plaque control and motivation
- preservation of oral health
what are the purposes/classifications of maintenance?
preventive, trial, and compromise
What is preventive maintenance? Where does it fit in the flow chart?
healthy patient;
- initial exam
- diagnosis
- nonsurgical therapy/cause-related therapy
- reevaluation
- then retreatment surgical/nonsurgical & maintenance
- retreatment surg/non also goes to maintenance
What is trial maintenance and where does it fit in flow chart?
questionable prognosis, assess need for further treatment;
- non-surgical tx
- reeval
- maintenance
- goes to both surgical tx and restorative tx (these can go back to maintenance)
- surgical also goes to restorative
What is compromise maintenance and where does it fit in the flow chart?
special situations in which the results of therapy are less than-ideal;
- periodontal exam
- nonsurgical perio therapy
- to both maintenance and 6 wk post-nonsurgical therapy eval
- both maintenance and additional nonsurgical perio therapy or proceed to perio surgical therapy
- both maintenance and 6 wk post therapy eval
- again to maintenance
what factors included in initial diagnosis? (3)
anatomic consequences of disease progression, inflam changes, presence of local eto factors
what is included in anatomic consequences of disease progression? (3)
attachment loss, pocketing, mobility
what is included in inflam changes? (2)
gingival margin
bottom of pocket/subgingival
what factors involved in maintenance diagnosis?
diagnosis and assessment levels of risk factor for recurrence
what is involved in maintence diagnosis?
comparative to the previous appointment
also consider stability in comparison to status after active therapy (reeval)
what assessment levels of risk factor for recurrence?
- ptn/individual- interval b/t appointments
- tooth- time allocation during the appointment
- site- type of procedure/intervention
what is the rationale for maintenance?
dynamic health-disease process
persisstance of eto factors
motivation
what is involved in motivation in rationale for maintenace?
transmission of periodontopathogens
interference on biofilm (OH deficient in some areas)
what are the effects of a single episode of mechanical disruption of subgingival biofilm?
- decrease on total # of m. os.:
up to 90%/site, 42 days for recolonization by periodontopathogens - changes on microbial ecology:
interference on biofilm, increases on initial colonizers (commensal, non-pathogenic bacteria)
effect of subgingival instrumentation on microbial biofilm?
right after instrumentation, very little patho and nonpathogenic bacteria;
later get recolonization w/ greater number of nonpathogenic bacteria and very little pathogenic
procedures to do for maintenance? (7)
- assess plaque control
- reinforce motivation
- remove local eto factors
- correct retentive/iatrogenic factors
- subgingival plaque control
- professional prophylaxis
- reeval recurrence risk/clinical stability of case
what are the clinical procedures?
- update dental/medical hx
- assess presence of local eto factors
- diagnosis of dx activity: gingivitis and periodontitis
- assessment of risk of progression (parameters): biochemical/immunological, genetic, microbiological, psycho-social, clinical
maintenance appointment sequence
- reeval of hx
- clinical exam and reeval
- radio exam
- supportive tx
- tx of recurrent disease: if necessary considering time allocated and extent
factors in clinical exam
- periodontal status: plaque control (technique and habit), inflam levels (marginal and subgingival), attachment levels, mobility
- oral exam (mucosal surfaces and lymphonodes
- restorative dentistry: new and preexistent
- caries activity
factors in radio exam
- severe: complete periapical series every 3 yrs, bite wings annually
- moderate-mild: complete pa serious every 5 yrs, bw annually
- areas of special interest: pa radiographs annually
general considerations of radiographs
low sensitivity
critical reproductibility
usually indicated when signs of recurrent/active dx found
factors in supportive tx
- information and motivation: discuss relevance of maintance; ptn’s responsiblity b/t appointments (improved OH “to go to the office”), positive reinforcement
- scaling and remove of subgin biofil: supra and subgin, curettes
factors in treatment of recurrent disease
- SRP: supra and subgin
- Reeval after 4-6 weeks
- systemic antibiotics: aggressive perio
- local chemotherapeutics: isolated sites, aggressive perio
- surgical tx
factors for interval b/t appointments
continious eval of risk
levells of assesment: ptn, tooth, site
criteria???
factors in frequency of maintenace
- severity of disease
- efficiency of OH: speed of plaque/calculus formation
- caries activity
- age
- individual susceptibility: systemic/ambiental/genetic
factors in ptn/individual
- systemic health: hormonal alterations, pathologies, medications, psycho-social factors
- compliance
- smoking
- prevalence/extent of attachment loss/age
- efficiency of plaque control: 20-40%, consider factors associated with host response
- % of bleeding sites: =4 mm)
factors in tooth eval
- iatrogenic factors: restorative dentistry/prosthesis
- residual attachment level: oclusion (functional/traumatic), recurrence may lead to tooth loss
- strategic relevance to the dentition
- mobility: functional (reduce AL), traumatic (progressive)
factors of site
- BOP
2. PD AND AL: reproductivity of probing, restrospective nature (does not reflect current activity)
Concerning BOP, absence indicates? want to assess? need for?
stability;
reproductivity of probing, status of gingival margin;
need for repeated eval (to determine persistance)
For interval b/t appointments; in 1st year following active therapy? Adjusted according to?
every 3 months;
each ptns individ needs: susceptibility, efficiency of self-care (motivation)
indications for 3 month interval?
- inadequate OH
- severe involvement: prev perio surgery
- residual or recurrent perio pockets
- recurrent dental caries
indications for 6-12 month interval
- good OH
- mild/moderate involvement: age of ptn
- no contributing systemic/local factors
what occurs during the maintenance appointment
- diagnosis (perio/teeth/mucosa): clinical exam/update hx
- motivation/instruction/instrumentation: disorganization of supra and subgingival biofilm
- txx of reinfected sites: reeval of consult may be necessary
- prophylaxis/topical flouride
- scheduling next appointment
What to do for patients with dental implants
- do not use metallic instruments
- periapical radio annually
- avoid acidulated fluoride
- scaling/polishing: plastic instruments, rubber cup/prophy jet
- failing signs: pain to pressure/occlusion, supuration, mobility
%s of complicance
40% eventual
34% none
17% complete
renewing the motivation
- manual dexterity
- acceptance of OH program by ptn
- interruption of OH devices
- anatomical considerations: gingival recessions, mal-positioned teeth, prosthesis and ortho
- psycho-social aspects
Supervised neglect leads to?
attachment loss, failure
supertreatment leads to
greater costs, attachment loss, dismotivation, failure
Reccurrence of periodontitis was observed at ____ ____ time intervals, and concentrated on ___% of the individuals. Factors involved in study?
completely unpredictable, 25%;
- 61 ptns w/ severe PD
- nonsurgical/surgical therapy
- maintenance 3 month interval for 14 yrs
Number of ptns losing teeth during maintenace period, according to the number of lost teeth: how many ptns and %
36 patients- 16% of total (63% of lost teeth)
when is maintenace successful
- absence of plaque
- ao marginal beeding
- ao BOP (subgin bleeding)
- ao PD > 4 mm
- ao decreased attachment
- ao bone resorption
- maintenance of teeth- satisfactory function and esthetics
maintenance =? success =? anatomic characteristics =?
absence of plaque;
ideal anatomic characteristics
long term stability
In a study of 49 ptns (ages 24-64 yrs), they found? After clinical eval every 3 months? ____ were not considered? Overall ptns showed?
PD >= 5mm with calculus and bleeding in 2 sites/tooth, nonsurgical tx;
24 month followup, progression: attachment loss >1.5 mm;
molars; good plaque control
In a study, ___% of sites showing progression (___ out of 2532), ___% of ptns w/o progression, ___% showed progression in 6% of sites or more. % of total # of sites according to initial PD? (3)
5%, 120; 50%; 20%
- 7 mm = 5%
In a study w/ 17 ptns (32-65 yrs) w/ generalized chronic periodontitis included what factors? After clinical assessment every 3 months? Study included? Ptns showed?
AL, calculus, subgingival and BOP, nonsurgical tx;
42 mo follow up, subgingival instrumentation on bleeding sites, progression: attachment loss >1.5mm;
all teeth included; moderate self-performed plaque control
In study, __% of sites showing progression. ___% of ptns showing progressive sites. ___% had 20% or more sites with progression
10%;
100%
70%
What are the final considerations of perio maintenance?
- the responsibility for effective maintenance is permanently shared b/t professional and ptn
- the most important parameters to asses stability are: attachment levels and alveolar bone ht
- maintenance is fundamental to attain perio stailibity, regardless of tx modality
