Periodontal Treatment Step 3 (Surgery) Flashcards
what are the aims of step 3
treat areas of dentition not responding adequately to step 2 with purpose of gaining further access to subgingival instrumentation or aiming at regenerating or resecting those lesions that add complexity in management of periodontitis
what can step 3 treatment include
repeated subgingival PMPR
access flap surgery
resective flap surgery
regenerative flap surgery
what are the treatment options for step 3
treatment adjuncts (antimicrobials)
access surgery
regenerative options
furcation treatment options
when would local antimicrobials be indicated
in unresponsive sites where surgery is contraindicated or not desired
give 2 examples of local antimicrobials
periochip
dentomycin
what is periochip
chlorhexidine gel inserted into pocket during PMPR released slowly over 7 days
what is dentomycin
minocycline gel syringe delivered into pocket after subgingival PMPR but needs 3-4 applications every 14 days
what are the outcomes of using local antimicrobials
short term improvements in PPD but long term benefits not clear
what does the guidance say about local antimicrobial usage
consider as an adjunct but not recommended routinely
what is the aim of systemic antimicrobials
suppressing bacterial species responsible for biofilm growth leading to less pathogenic oral environment
what do we need to consider with systemic antimicrobials
antibiotic stewardship
bacterial resistance
numerous side effects with antibiotics
what does the guidance say about systemic antimicrobials
do not recommend routine use
refer to specialist if you think it could be needed
who might benefit from systemic antimicrobial usage
grade c in young patients
what is host modulation therapy
local or systemic drugs as adjunct to conventional perio treatment with aim to modify the destructive aspects of host inflammatory response to biofilm
what is given for host modulation therapt
sub-antimicrobial dose of doxycycline
periostat is brand used
when would you consider periodontal surgery
persisting pockets 6mm+
where good quality non-surgical treatment has not resolved pocketing
suitable patient
what defines a suitable patient, tooth and defect for surgery
no medical issues
teeth of reasonable prognosis
infra-bony defects, furcation disease
what patient factors do we consider for periodontal surgery
oral hygiene
quality of maintenance accessible
ability to tolerate
compliance
cost
aesthetics of site
recession
what tooth factors do we consider for periodontal surgery
access to non-responding site
shape of defect
prosthodontic/endodontic considerations
tooth position
what systemic factors do we consider for periodontal surgery
smoking
unstable angina, uncontrolled hypertension, MI/stroke
poorly controlled diabetes
immunosuppressed patients
anticoagulants
what is needed in the consent process for surgery
reason for surgery
alternatives
consequences of no surgery
nature of surgical procedure
post-op consequences
requirement for post-op maintenance
what is the aim of access surgery
access to areas of continued inflammation or infection
for areas PPD >6mm
allow access for surgical debridement
what are the stages of access surgery
examination
full thickness flap raised
remove granulation tissue and debride
place suture
follow up
what are the indications for regenerative surgery
infrabony defects 3mm or deeper as assessed radiographically
class 2 or 3 furcation
what materials can be used for regenerative surgery
guided tissue regeneration
enamel matrix derivative - emdogain
why are furcations treated
reasonable survival rates of tooth
tooth retention more cost effective than implants placed
patient preference
what are the options for furcation surgery
regenerative surgery
root resection
root separation
tunnelling
what furcations would be suitable for regenerative surgery
mandibular class 2
maxillary class 2
what furcations would be suitable for root resection
class 3 lesions or multiple class 2 on same tooth
what furcation is suitable for tunnelling
mandibular class 3
what is tunnelling
bone and soft tissue recontoured to allow insertion of ID brush
what are the consequences of tunnelling
root hypersensitivity and root caries
