Perio Adjuncts And Surgery Flashcards
When should treatment adjuncts be considered?
In step 3 perio
In deep residual pockets (>6mm) which have not responded to subgingival PMPR
What are the 3 main categories of treatment adjuncts?
Local antimicrobials
Systemic antimicrobials
Host modulation therapy
When are treatment adjuncts used?
Not routinely recommended (requires referral to specialist/ special interest dentist)
What is the function of local antimicrobials?
Adjunct to PMPR to prevent need for surgery (esp in patients not suitable for surgery)
What is Periochip?
Local antimicrobials
Biodegradable gelatin matrix - 2.5mg chlorhexidine digluconate
Insert into pocket following PMPR
Released slowly over 7 days
What is Dentomycin?
Local antimicrobial
2% minocycline gel
Inserted into pocket following PMPR
3-4 applications ever 2 weeks (0, 2, 4, 6)
What is the protocol for systemic antimicrobials in GDH?
Only appropriate for specific patient groups (eg grade C in young adults)
Weigh up risk v benefit
Full mouth instrumentation in 24 hour period followed by 400mg metronidazole TDS 7 days
What is host modulation therapy? Give examples
Use of local/ systemic medications as adjuncts to modify the destructive aspects of perio
Eg
Sub antimicrobial doxycycline (Periostat)
Statins, bisphosphonates, probiotics, NSAIDs
What are the indications for perio surgery?
Non resolving sites (post non surgical treatment)
Pockets >6mm
No MH contraindications
Reasonable prognosis tooth
Infra bony defects and furcation disease
What are some patient factors to consider before perio surgery?
Patient must have excellent OH
- <20 % plaque, <10% bleeding
Pt access to care
Ability to tolerant procedure
What are medical considerations before perio surgery?
Smoking
Poorly controlled diabetes
Immunocompromised
Anticoagulants
What should be included in consent for perio surgery?
- Reasons for perio surgery
- Other treatment options
- Consequences of not providing the treatment
- Nature of surgical procedure
- Post op - pain/ swelling/ bruising/ sensitivity
- Complications - failure to resolve pockets, mobility, non vitality, scarring at flap margins (aesthetics), recession
- Ensure pt is aware of requirement of ongoing care
- Costs (if applicable)
What is access surgery/ open flap debridement?
Access to areas of continued inflammation/ infection to allow surgical debridement
What is the steps of access surgery?
- Full thickness mucoperiosteal flap raised to expose root surface/ perio bone defect
- Defect granulation tissue removed and root surface curettage to leave clean root surface and bone
- Suture and aim for healing by primary intention
- Healing at 3 months - long epithelial reattachment. Continue to step 4 BSP
What are the indications for regenerative perio surgery?
Infrabony defects >3mm
Furcations- class 2 or 3
