Perio maintenance Flashcards
Is Periodontal Maintenance effective?
Yes - (1981 Axelsson and Lindhe)
90 frequent recall patients were able to maintain excellent OH standards and stable attachment levels. Non-recall group lost attachment
No - (Echeverria 1996)
Current therapies may be unsuccessful in preventing LOA in some sites in some pts
Optimal frequency of periodontal maintenance?
3 months (1982 Caton) clinical response was maintained for 16 weeks (4,8 16 wks) But frequency is subjective, according to perio status and level of oral hygiene
Patients for 2 month interval
Type III or IV periodontitis who does not want to have or cannot have surgical care
Poor OH causing the disease to progress at a more rapid rate
uncontrolled or recurrent disease not responding to current therapeutic modalities
3 months interval
- Adult ortho pt w/ inflammation which may cause LOA
- pregnant women during the entire 9 month, hormonal influence can exacerbate periodontal dz and even cause pregnancy tumors
- DM pt
- Smokers with periodontitis
- pt > 50 yrs with periodontitis
- pt w/ early perio dz w/ high stress
- pt w/ moderate periodontitis
4 months interval
- Teen and young adults w/ early dz and marginal OH
- pt w/ moderate periodontitis and excellent OH
- pt w/ non-bleeding 4-5 mm PD and good OH
6 months interval
- Healthy pt w/ 1-4 mm non-bleeding PD
- pediatric pt
- gingivitis pt w/ improving OH
Perio maintenance compliance rate?
- (Wilson 1984) 1000 patients for 8 years
16% complied with recommended schedule
49% erratic complier
34% never reported for any maintenance therapy - (Wilson, 1993) an increase in complete compliance from 16% to 32% due to more efforts in office
- (Schmidt , 1990) erratic compliers required more surgical tx, smokers exhibit poorer OH, more tooth loss, and deeper PD compared to non-smokers
Tooth Retention rate for treated patient?
(1984, Becker)
Tooth loss for treated and maintenance pt was 0.11 tooth/yr/pt
Years to lose 1 tooth = 9.1 years
Tooth retention for treated, but not maintained or non-treated?
(1984, Becker)
Treated, but not maintained, tooth loss was 0.22/tooth/yr/pt
Years to lose 1 tooth = 4.5 years
Non-treated, tooth loss was 0.36 tooth/yr/pt
Years to lose 1 tooth = 2.8 years
Tooth loss and PD in periodontally compliant patient
(2002 Konig)
More teeth were lost during the active phase of tx than during perio Mt.
Max 2nd molar most often lost
P.D increased during Perio Mt.
Compliance as a prognostic indicator?
(Recent japanese study ‘06 & ‘10)
Treated and maintained teeth retained for > 15 years
Molars most often lost when pts do not comply
When to re-evaluation of initial therapy?
what happens if too soon or too late?
(2006, Weinberg)
- CT repair continues for 4-8 weeks
- Microbial repopulation within 2 months in the absence of improved home care
- 4-8 weeks is the ideal time for re-evaluation
- Re-eval too soon could result in over treatment
- Re-eval too late could lead to a disease progression and return of pathogenic microbial flora
Re-eval of maintenance by Caton and Polson?
significant decrease in plaque and gingivitis at 4 weeks, maintained for 16 weeks.
value of re-evaluation?
- Identify progression of dz in a timely manner
- This is a best practice procedure
- Identifies the need for possible retreatment
when do you decide to retreat a case?
(1982, Chase, Retreatment in periodontal practice)
- Retreatment should not be completed before an adequate history and trial of conservative therapy prior to surgery.
- most common reason for failure: pt cannot maintain adequate home care
