Management of periodontitis in the maintenance phase

Question 1

Treatment strategy

Answer 1

 Initial treatment
 Cause-related therapy
 Non-surgical treatment
 Surgical treatment
 Maintenance/ Supportive therapy

Question 2

Initial treatment management should be based on the following

Answer 2

 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

Question 3

Treatment aim of initial treatment

Answer 3

Shallow pockets with no bleeding on probing

Question 4

Review of initial treatment

Answer 4

 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

Question 5

Future treatment planning after initial treatment

Answer 5

 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

Question 6

Maintenance and monitoring after initial treatment

Answer 6

Research confirms that maintained
patients do better!
 Re-motivation.
 Patients cannot clean subgingivally
 Re-infection issues.
 Episodic nature of disease

Question 7

Aim of maintenance

Answer 7

Maintain infection control

Question 8

Diagnosis and prognosis per tooth in maintenance phase

Answer 8

Clinical

Radiological

Question 9

Clinical criteria for diagnosis and prognosis

Answer 9

• note amount and position of plaque
 bop
• pocket depth, CAL
• furcation -analysis
• occlusion and articulation, mobility
• evaluation restorations/prosthese
• examination for caries

Question 10

Radiological criteria for diagnosis and prognosis

Answer 10

• Bone levels in relation to CEJ
• Type of bone defect
• furcation-analysis
• breadth of periodontal space
• impacted teeth
• evaluation restorations/ prosthese
• examination for caries

Question 11

Structure of an average maintenance apt

Answer 11

Mainly S&P; OHI; pol F-/ Chlx
RSD
Risk-level
Diagnosis
Interval
Notes

Question 12

Influences on risk level

Answer 12

Easily affected pts
More plaque
Less resistance

Question 13

Causes of periodontitis

Answer 13

Quality of bacterial flora
Quantity of:
-compliance/ concordance
-OHI (15% plaque = acceptable)
-number and depth of pockets
-furcation involvement
-restorative retention factors

Question 14

Resistance to periodontitis

Answer 14

Systemic factors
Genetic factors?
Age
'Lifestyle':
-smoking (>10cigs per day > risk)
-stress
-drinking

Question 15

Systemic factors (resistance)

Answer 15

Diabetes
Medication
Pregnancy
HIV
Crohn's disease
Sjoegren's syndrome
Radiotherapy
Menopause

Question 16

BOP

Answer 16

BOP > 25% > risk

BOP < 10% < risk

Question 17

Is an adjunct needed?

Answer 17

0.05% chlorhexidine

Question 18

Risk analysis

Answer 18

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

Question 19

Risk level and recall

Answer 19

 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.

Question 20

Low risk

Answer 20

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

Question 21

Medium risk

Answer 21

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

Question 22

High risk

Answer 22

>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

Question 23

Long term maintenance

Answer 23

• Full periodontal assessment every 2 years

* Radiological assessment every 5 years