Management of periodontitis in the maintenance phase Flashcards
Treatment strategy
Initial treatment Cause-related therapy Non-surgical treatment Surgical treatment Maintenance/ Supportive therapy
Initial treatment management should be based on the following
Emergency treatment (where necessary)
Extraction of teeth which are irrational to treat
Patient information
Plaque control including correction of plaque
retention factors
Root surface debridement
Initial occlusal adjustment (where necessary)
Reassessment and monitoring
Treatment aim of initial treatment
Shallow pockets with no bleeding on probing
Review of initial treatment
Check that all the necessary treatment has been carried out (incl replacement restorations etc.) Check Oral Hygiene (plaque score) 6-point charting Evaluation – is treatment aim reached? Plan follow-up
Future treatment planning after initial treatment
Initial Phase is complete and treatment
aims are achieved:
-Follow-up : individualised recallprogramme
Initial Phase is complete and treatment
aims are partially achieved :
- Follow-up :Perio surgery
Initial Phase is incomplete
- Follow-up ,review diagnosis &treatment
plan(extr.,endo,ab) –>Reassessment
Maintenance and monitoring after initial treatment
Research confirms that maintained patients do better! Re-motivation. Patients cannot clean subgingivally Re-infection issues. Episodic nature of disease
Aim of maintenance
Maintain infection control
Diagnosis and prognosis per tooth in maintenance phase
Clinical
Radiological
Clinical criteria for diagnosis and prognosis
• note amount and position of plaque bop • pocket depth, CAL • furcation -analysis • occlusion and articulation, mobility • evaluation restorations/prosthese • examination for caries
Radiological criteria for diagnosis and prognosis
- Bone levels in relation to CEJ
- Type of bone defect
- furcation-analysis
- breadth of periodontal space
- impacted teeth
- evaluation restorations/ prosthese
- examination for caries
Structure of an average maintenance apt
Mainly S&P; OHI; pol F-/ Chlx RSD Risk-level Diagnosis Interval Notes
Influences on risk level
Easily affected pts
More plaque
Less resistance
Causes of periodontitis
Quality of bacterial flora Quantity of: -compliance/ concordance -OHI (15% plaque = acceptable) -number and depth of pockets -furcation involvement -restorative retention factors
Resistance to periodontitis
Systemic factors Genetic factors? Age 'Lifestyle': -smoking (>10cigs per day > risk) -stress -drinking
Systemic factors (resistance)
Diabetes Medication Pregnancy HIV Crohn's disease Sjoegren's syndrome Radiotherapy Menopause
BOP
BOP > 25% > risk
BOP < 10% < risk
Is an adjunct needed?
0.05% chlorhexidine
Risk analysis
Essential to decide whether 3, 4, 6, 12 month recall interval necessary
The bone level/age ratio is calculated
by dividing the percentage bone loss by
the patient’s age
Risk level and recall
Low Risk Patient = all catagroies low with a maximum of 1 item from the medium risk category
-6 monthly recall interval
Medium Risk Patient = maximum of 3 in medium
category and/or maximum of 1 in the high category
-4 monthly recall interval
High Risk Patient = 4 or more in the medium
category or 2 x high category and a maximum of 3 in
the high category
-3 monthly recall interval
More than 4 items in High Risk => requires further
investigation and diagnosis.
Low risk
BOP <10% PD>4mm \<4 Bone level/ age ratio \<0.5 Non-smoker No medical history No perio pathogens present No active root caries lesions in previous 3 years
Medium risk
BOP 10-25% PD>4mm: 5-8 Bone level/ age ratio: 0.5-1 Well controlled conditions (MH) 1-2 active root caries lesions in previous 3 years
High risk
>25% BOP PD>4mm: 9+ Bone level/ age ratio >1 Smoking 20+ per day Unstable conditions (MH) Perio pathgens present >2 active root caries lesions in previous 3 years
Long term maintenance
- Full periodontal assessment every 2 years
* Radiological assessment every 5 years
