perio 3 Flashcards
Discuss the treatment sequence and prognosis of teeth 3x with a periodontic – endodontic lesion.
which tx outcome more important? perio/endo??
Treatment involves a coordinated approach.
Diagnosis and Evaluation: Accurate diagnosis through clinical examination and radiographic analysis to determine the primary cause and extent of the lesion.
ACUTE PHASE- eliminate pain -Pulpectomy: For lesions with an endodontic origin or combined lesions, + /or incision and drainage of an abscess.
Periodontal Therapy under LA : do scaling and root planing, Abx+systemic signs
Definitive phase, tx perio before endo- or prognosis remain low–>
Surgical intervention to address the periodontal component of the lesion. Regenerative procedures may be considered to manage bone loss and regenerate periodontal tissues.
Evaluation of Response+perio maintainence, completion of RCT-f/up visits.
prognosis of teeth with periodontic-endodontic lesions depends on factors such as the extent of structural damage, the patient’s compliance with treatment and maintenance, and the ability to control etiological factors such as plaque.
Successful management requires a multidisciplinary approach and close monitoring to ensure the resolution of infection and the stabilization of periodontal and endodontic health
3x Pathogenesis of Gingival Overgrowth dt medication:
give examples:-
Fibroblast Proliferation: Medications may stimulate fibroblast proliferation and extracellular matrix production.
Altered Collagenase Activity: Drugs may inhibit collagenase activity, leading to an accumulation of extracellular matrix.
Plaque-induced host inflammatary response can exacerbate the overgrowth.
eg of Ca- chnl blocker medications: nifedipine/nicardipine/amlodipine////verapamil/ diltiazem[nonhydropyridine- SA+AV node of heart]
Phenytoin (Dilantin)-seizure control, higher prevalence in children and onset typically within 3 months of use.
Cyclosporin: An immunosuppressant drug, post organ transplant, particularly affecting the interdental papilla, > obvious esp. in patients with poor oral hygiene.
Peri-implant diseases are defined as inflammatory lesions of the surrounding peri-implant tissues and include 2 type
1peri-implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) 2peri-implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration)
Factors to Consider for Dental Implant Suitability:9x
1 Medical h/o DM/osteoporosis/RT+ medication esp that may affect bone healing or the risk of infection.
2 Oral Hygiene Proficiency: poor plaque control can lead to peri-implantitis and implant failure.
3 Bone Quality and Quantity: sufficient alveolar bone[ideally type 1 or 2, avoid D4 bone- only fine trabeculae] and consider the need for bone grafting or augmentation procedures.
4 Periodontal Status: Given the history of severe periodontitis, ensure that the periodontal disease is controlled to reduce the risk of peri-implant disease.
5 Lifestyle Factors: Smoking and other lifestyle factors -stress.
6 Age and Life Expectancy: While age alone is not a limiting factor, the patient’s life expectancy and the long-term prognosis of the implant should be considered.
7 cognitive and Mobility Status: Assess the patient’s understanding and physical ability to undergo dental surgery and post-operative care.
8 Financial
9 Aesthetic and Functional Expectations: The patient’s expectations need to be realistic and achievable.
Management Strategy for Periodontal Maintenance Post-Implant Restoration in generalised chronic periodontitis Stage III Grade B (Unstable) 10x
1 Regular Maintenance Visits: Schedule-regular maintenance visits to monitor the implant and the health of the surrounding tissues.
2 OH proficiency: Reinforce - meticulous oral hygiene and provide the patient with tailored plaque control instructions and tools; include interdental brushes, antimicrobial rinses, or other aids-waterflossers- adjunct [ Manual dexterity]
3 Lifestyle Counseling: monitor- smoking cessation.
4 Monitoring for Peri-implantitis: Regularly assess for signs of peri-implantitis, such as bleeding on probing, suppuration, or increasing probing depths.
5 Occl loads: adjust occlusion to prevent excessive forces
6 Radiographic Evaluation: Periodically to monitor bone levels and ensure there is no progressive bone loss.
7 Professional Cleaning around the implant-ultrasonics + plastic-tipped
8 Fluoride Therapy
9 Patient Education: signs of peri-implantitis and the importance of immediate reporting of any changes or discomfort in the implant area.
10 Multidisciplinary Approach: Work closely with other healthcare providers to manage any systemic conditions that may impact the long-term success of the implant.
clinical changes around teeth suspected to have trauma from occlusion
1Mobility Changes:
i Fremitus during function
ii Progressive and functional mobility
2Occlusal Changes:
occl Discrepancies +Wear patterns-Heavy occlusal contacts
3Tooth Migration: FED
Flaring/Drifting/Extrusion
4Other Symptoms:
iSensitivity to pressure or chewing
ii Temporomandibular joint disorder (TMD)
iii Potential fractures-localised deep pockets
-Buttressing bone or exostosis myb present
radiographic changes around teeth suspected to have trauma from occlusion
1 Periodontal Ligament (PDL):
i Widened PDL space-altered stress distribution
ii Thickened lamina dura
2 Types of bone loss: furcational, vertical, circumferential Rluc/ condensing sclerosis-Ropac
3Root Changes:
Resorption
Hypercementosis// cemental tears
Root fractures
Discuss the histological changes that occur around teeth with healthy periodontium, reduced periodontium, and periodontitis, when subjected to excessive occlusal forces.
Excessive Occlusal Forces on Healthy Periodontium
Induce adaptive changes: increased bone resorption and apposition, leading to increased mobility. Changes are typically reversible if trauma is removed.
PDL may widen as an adaptive response.
Without inflammation, periodontium can withstand increased forces.
Reduced but Healthy Periodontium
Post-Periodontal Treatment: Similar adaptive capacity to normal height periodontium. Lower threshold for trauma due to reduced support.
Increased likelihood of mobility and potential bone loss.
Periodontitis
Trauma from occlusion exacerbates the inflammatory process leads to more rapid periodontal breakdown.
Increased bone loss and resorption.
Irreversible damage to the periodontium.
Further attachment loss and potential tooth migration.
describe and explain the management strategy of 50-year-old female patient presented with a complaint of “shaky upper front teeth that seem to be getting worse” after the extraction of all her molars due to severe periodontitis. She was diagnosed with generalized chronic periodontitis Stage IV Grade B.
Initial Steps:
Assessment & Diagnosis: Clinical examination, periodontal charting, and radiographic evaluation.
Patient** Education**: Inform about condition, implications, and importance of OH.
Risk Factor Management: Smoking, diabetes control, and lifestyle adjustments.
Oral Hygiene Enhancement:
Instruction: Personalized techniques for effective plaque control.
Tools: Use of toothbrushes, interdental brushes, and antimicrobial rinses.
Cause-Related Therapy:
Procedures: Subgingival scaling and root planing.
Adjunctive Therapies: Consider local/systemic antimicrobials based on clinical needs.
Reassessment:
Evaluate response to initial therapy to determine necessity for further treatment.
**Phase II - referral to perio +prostho- **
Surgical Interventions: Periodontal surgery for deep pockets and furcation involvements.
Prosthodontic Rehabilitation: Implants or prostheses to restore function and aesthetics.
Maintenance:
Supportive Periodontal Care (SPC): Periodic evaluation +professional cleaning..
Regular Follow-Ups: Ensure long-term treatment success and prevent further tooth loss.
Mechanical Plaque Control Rationale in periodontitis mx.
+ benefits
Methods:
Toothbrushing.
professional cleaning- S+RP
Main method for treating and preventing periodontitis by removing dental plaque, the main cause of dvlpt + progression of periodontitis.
Disrupts biofilm, reducing bacterial load.
Benefits of both method:
Reduces supragingival plaque.
Decreases subgingival pathogens like Porphyromonas gingivalis.
Outcomes:
Lowers gingival inflammation.
Prevents periodontal tissue destruction.
Mechanical debridement still most crucial- which paper?
Suvan 2005
daily home plaque control combined with** professionally delivered plaque removal** significantly reduces supragingival plaque and the number of subgingival sites with pathogenic bacteria like Porphyromonas gingivalis. [paper,yr]
.Hellstrom et al., 1996 =Supporting Evidence:
supported by Suvan, 2005:
Limitations -Mechanical Plaque Control : 5x
1 Toothbrushing alone often fails to clean interdental spaces, critical for periodontal health.
2 Timing: Plaque must be removed every 48 hours to prevent inflammation or recolonization occurs; technique efficiency is critical.
3 Probing Depth:** Effectiveness decreases in deeper pockets (Rabbani et al., 1981).
4 ** Patient Factors: Compliance, dexterity, and motivation significantly impact success.
5 Tissue Trauma: Aggressive brushing can cause gum damage.
Mechanical debridement Effectiveness 3x
1 Gingivitis Mx: Resolves inflammation signs (redness, edema, bleeding) effectively (Badersten et al., 1981, 1984).
2 Periodontitis Impact: Offers modest probing depth reduction; more effective in early stages.
3 Scaling and Root Planing: Essential for managing moderate to advanced periodontitis; removes subgingival plaque and calculus-prevent progression.
Wound-Healing Process post-Mechanical debridement: 8x
1 Initial Inflammatory Response: Post-cleaning bleeding, clot formation as healing scaffold.
2 Granulation Tissue Formation: Cellular invasion within the first week [fibroblast-> collagen].
3 Proliferative Phase: Reattachment of new connective tissue and epithelial cells (5-12 days).
4 Epithelial Regeneration: Junctional epithelium repairs within 5-7 days.
5 PDL and Fiber Formation: New PDL fibers align parallel to the root surface after one week.
6 Final Remodeling Phase: Tissue maturation with myofibroblast involvement in wound contraction.
7 Regeneration Capability: PDL supports reconstruction of lost periodontal structures.
8 The evaluation of gingival response, including signs of gingival inflammation, PD,CAL,BOP, M, PUS [6x] after 6 wks
