Periodontal Treatment Step 3

Question 1

what are the aims of step 3 perio?

Answer 1

• tx areas of dentition not responding adequately to step 2 with purpose of gaining further access to subgingival instrumentation

may include:
- repeated subgingival pmpr
- access flap surgery
- resective flap surgery
- regenerative flap surgery

Question 2

what are local antimicrobial measures that can be used?

Answer 2

• disinfectants (chx)
• locally delivered antibiotics
• adjuncts to PMPR
• may be indicated in unresponsive sites where surgery is contraindicated/not desired

Question 3

what does BSP-S3 & SDCEP say about locally delivered antibiotics?

Answer 3

• may be considered as adjunct to subgingival instrumentation
• NOT RECOMMEND for routine dental care/management of pt with periodontitis

Question 4

mechanism of action for systemic antimicrobials & perio?

Answer 4

suppressing the bacterial species (P. gingivalis) responsible for biofilm growth, leading to less pathogenic oral environment

Question 5

risk vs benefit of systemic antimicrobials?

Answer 5

• must be considered - antibiotic stewardship??
• inappropriate antibiotic use linked to increasing incidence of bacterial resistance

Question 6

when might periodontal surgery be indicated?

Answer 6

• in sites where good quality non-surgical PMPR has not managed to resolve pocketing, ongoing inflammation
• perio pocketing (greater/equal) 6mm

Question 7

what patient factors needed to consider for surgery?

Answer 7

• OH (<20% plaque, <10% marginal bleeding)
• quality of maintenance available & pt access
• ability for pt to tolerate procedure
• will pt comply post surgery
• cost & pt acceptance
• aesthetics & site/potential for post-op recession

Question 8

What TOOTH factors needed to consider for perio surgery?

Answer 8

• access to non-responding sites
• pros/endo considerations
• shape of defect
• tooth position/anatomy (tilting, overeruption, roots)

Question 9

What SYSTEMIC/MEDICAL factors needed to consider for perio surgery?

Answer 9

• smoking
• unstable angina, uncontrolled hypertension
• poorly controlled diabetes
• immunosuppressed pts
• anticoagulants (DOAC, Vit K antagonist, antiplatelet)

Question 10

aim of access surgery/open flap debridement?

Answer 10

• access areas of continued inflammation/infection
• usually for areas PPD (greater/equal) 6mm
• Allow access for surgical debridement

Question 11

why do we treat furcation lesions?

Answer 11

• clinical relevance
• economic considerations (retaining tooth more cost-effective than XLA & replacement with implant)
• Pt preference to keep tooth

Question 12

what is a root resection?

Answer 12

process which one or more of the roots of a tooth are removed at the level of the furcation while leaving the crown

Question 13

why may root resection may be done?

Answer 13

to eliminate/ reduce pockets and create healthy root surfaces

Less root surface = less damage

Question 14

what is tunnelling in furcation surgery?

Answer 14

bone & soft tissue recontoured to allow insertion of interdental brush

Risk: root hypersensitivity, root caries