Periodontal Treatment 4

Question 1

Why do some patients require supportive periodontal care?

Answer 1

Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis (eg increased pocket depth, bone loss, tooth loss)
The more often patients present for recommended support periodontal treatment the less likely they are to lose teeth.

Question 2

Treated patients who do not return for supportive periodontal care are how many times at a greater risk for loss loss than compliant patients?

Answer 2

5.6x greater.

Question 3

Do plaque control and probing depths go up or down when we don’t follow up our perio patients?

Answer 3

They go up.

Question 4

What tool can you use before and after treatment for periodontal patients?

Answer 4

Previsor tool.

Question 5

What happens during part 1 of supportive periodontal care?

Answer 5

Similar to the initial evaluation of the patient
Updating medical history
Oral mucosa inspected for pathologic conditions
Evaluation of restorations, varies, prostheses, occlusion, tooth mobility, bleeding on proving, and periodontal and peri implant probing depths
Analysis of the current oral hygiene status of the patient is essential
The dentist primarily looks for changes that have occurred since the last evaluation.

Question 6

What happens during part 2 of supportive periodontal care?

Answer 6

Treatment
Required scaling and root surface debridement are performed (based on pocket chart/plaque chart)
Care must be taken not to instrument normal sites with shallow sulci (1-3mm deep- that do NOT have any calculus)
because studies have shown that repeated sub gingival scaling and root planing in initially normal periodontal sites result in significant loss of attachment
*if pocket is 4mm or above and is bleeding then it needs plaque removed from it on a regular basis.

Question 7

What are causes of recurrence if periodontal disease?

Answer 7

Reason for reoccurrence should be established
Often can be traced to inadequate plaque control on the part of the patient or failure to comply with recommended SPT schedules
Inadequate or insufficient treatment that has failed to remove all the potential factors favouring plaque accumulation
Incomplete calculus removal in areas of difficult access
Failure of the patient to return for periodic check ups. This may be a result of the patients conscious or unconscious decision not to continue treatment or the failure of the dentist and staff to emphasise the need for periodic examinations
Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque.

Question 8

What are the challenges of SPT?

Answer 8

• Periodontal patients, even though they have received effective periodontal therapy, are at risk
of disease recurrence for the rest of their lives.
• Pockets in furcation areas may not have been eliminated by initial treatment or surgery.
• The only way of determining areas that are losing attachment is to use a well-organized charting system. Some computerized systems allow easy retrieval and comparison of past findings. Comparison of sequential probing measurements gives the most accurate indication of the rate of loss of attachment.
• At present, no ‘test’ accurately predicts disease activity, and clinicians rely on the information provided by combining probing, bleeding on probing, and sequential attachment measurements.
• New methods may be developed in the future to help predict disease activity. The clinician must be able to interpret whether a test may be useful in determining disease activity and future loss of attachment. Tests should be adopted only when they are based on research that includes a critical analysis of the sensitivity, specificity, disease incidence, and predictive value of the proposed test.

Question 9

Why might you decide not to put new crowns on a periodontitis patient that has had pocket resolution?

What is a treatment option for this patient?

Answer 9

They are going to look very long and you might have to prep the root to put crown margins into it. They will be uncleansable and have long contact points and square crowns

Acrylic porcelain veneers.

Question 10

What is a negative of acrylic porcelain veneers?

Answer 10

The patient will have to have amazing oral hygiene as these are a plaque trap- need to warn the patient that they will get root caries.

Question 11

What is the process of creating an acrylic porcelain veneer?

Answer 11

Take upper impression
Make special tray with horizontal path of insertion from 5-5
Block out undercuts between teeth to the point of maximum con with as you want to dictate where the extensions of the acrylic will go
Red ribbon wax
(Alginate for impression)
Liase with lab how much tooth show and extension that you want- further back it goes more likely to break
Want the patient to take them out as much as possible.

Question 12

What is another treatment option for a person with periodontal disease and their pockets aren’t improving?

Answer 12

Full mouth debridement with systemic antibiotics.

Question 13

What are some treatment options to replace missing anterior lower teeth?

Answer 13

Partial lower denture (Co/Cr)
Bridge
Implants.

Question 14

People with moderate to advanced periodontitis should receive SPT every how many months?

Answer 14

Every 3 months.

Question 15

How many patients fall under the complete, none and erratic compliance category for periodontal care?

Answer 15

Complete 16.44%
None 34.13%
Erratic 49.43%.

Question 16

What do you as a clinician have to look at to predict disease activity?

Answer 16

Probing
BoP
Sequential attachment measures
Plaque scores
Pocket depths
Bleeding scores.

Question 17

When should tests be adopted when they are based on research that includes a critical analysis?

Answer 17

Sensitivity
Specificity
Disease incidence
And predictive value of the proposed test.

Question 18

What are the SDCEP recommendations for a treatment plan for a periodontitis patient?

Answer 18

SDCEP recommends the 6PPC is performed every year in patients with BPE score of 4 or with more than 1 site with BPE score of 3

However, for patients with more advanced disease for the first couple of years you might want to consider doing your pocket chart more regularly than that (maybe every 6 months)

But every year as a guideline / as a minimum

Having plaque scores makes a massive difference

Make sure patients know what their plaque scores should be as they tend to respond well to knowing

Periodontitis patients need their plaque scores to be well below 20%

Be careful with plaque retentive factors (especially ones that are already created)

These will cause rapid attachment loss for these patients

Want to do debridement for the deep pockets

If you can find subgingival plaque or calculus then remove it (might need LA)

Although supportive care is called maintenance is it actually quite an active process

It is not just watching the pockets and seeing what happens

It is watching pockets and responding to where they are

When there is a pocket present you need to get the plaque and calculus out of it

Need to keep an eye on your patient

Ask if there are changes to their medical history?

If something does change eg patient is diagnosed with diabetes you might try to increase their recall visits (if the patient is happy to comply with this)

Want to try and get this all done in one appointment as you don’t really want to have to keep asking the patient to come in for endless appointments

Be very clear when the patients come in what it is you are trying to achieve for them so you can work as efficiently as possible.

Question 19

What does a dot mean on a periodontal pocket chart?

Answer 19

A pocket less than the value of 4mm.

Question 20

Why does the dot on a 6PPC make it easier for the clinician?

Answer 20

Way of doing a quicker 6PPC on patients who are under a review schedule

The dots represent sites of pockets of less than 4mm so you essentially don’t need to treat them

Makes the chart easier to read, especially if you are looking at several different charts (like a series of charts)

Allows you to see fairly quickly what sites need treatment and what sites maybe just need support.

Question 21

What do you need to explain to a patient about the aesthetics of their gums before commencing periodontal treatment?

Answer 21

Need to explain to the patient that with successful periodontal treatment there will come gingival recession.

Question 22

What 3 things contribute to getting rid of a pocket?

Answer 22

When you have pocket resolution of these deep pockets what you tend to find is that you get some attachment of long junctional epithelium, you get some connective tissue attachment but you will also get gingival recession.

Question 23

Name an example when gingival grafting might not be feasible?

Answer 23

f there is no papilla and there is no bone then grafts don’t work ie there is nothing to graft onto basically

Not an option for this patient as it won’t work

If you had a narrow cleft of a recession defect then that can be suitable for gingival grafting.

Question 24

Name some principles that you have to consider when delivering a denture?

Answer 24

Same principles as delivering a denture:

Check the fit

Check for areas likely to rub

Check for relief on the frenal attachments

Review patients a couple of weeks later to see how they are getting on with the gingival veneer

Give careful instructions on how to clean it (just like a denture) as well as how to take care of their teeth.

Question 25

What type of bite is useful when placing a lower bridge?

Answer 25

An anterior open bite.

Question 26

How can you fill the space on upper anterior teeth to improve aesthetics?

Answer 26

Add composite.