Periodontics: Part 3-Treatment Planning Flashcards
Tx Planning: Short term goal
Reduce gingival inflammation
* by correcting conditions that cause it
Tx Planning: Long Term Goal
- Eliminate pain
- Stop tissue destruction (meaured by CAL)
- Establish Occlusal stablity & function
- Reduce tooth loss-not designed to save all teeth
- prevent disease recurrence
List the phases of treatment
5 phases:
* 0=Preliminary Phase
* 1=Nonsurgical phase
* 2= Surgical Phase
* 3= Restorative phase
* 4=Maintenace Phase
Phase 0
Preliminary Phase
* tx emergencies
* Ext hopeless teeth
Phase 1:
Non-Surgical Phase:
Plaque control & patient education
* diet control
* caries control
Involves:
* Prophylaxis, SRP, OHI to remove local factors
* correct restorative irritational factors
* local or systemic antibiotics
Periodontal Re-evaluation/EIT
4-8 wks after Phase 1(SRP) is complete
* pocket depths
* inflammation
Allow Junctional Epithelium to form
Phase 2:
Surgical Phase:
* Regenerate periodontal tissue and eliminate pockets
All Periodontal Surgical Therapy:
* place implants
* Endodontic Therapy (RCT)
Phase 3:
Restorative Phase: perio must be under control
* Final restorations
* Fixed and removable prosthodontics (Crown, bridges, partials)
Phase 4:
Maintenance Phase:
* Aka Supportive Periodontal therapy
eval
* OHI
* Periocondition
Perio Maintenace:
* every 3 month for 1st year
* performed w/phase 2 and 3 therpy
Risk Elements
- Risk Factor
- Risk Determinant
- Risk Indicator
- Risk marker or predictor
Risk Factor
Causal Association (cause associated w/disease)
- Smoking
- Diabetes
- pathogenic bacteria
- Microbial tooth deposits
Risk determinant
Unchangeable characteristics
Genetics:
* IL-1 gene Polymorphism=severe chronic periodontitis
Age:=prolonged exposure to etiologic factors
NOT aging
Gender:
* Males=more CAL than females
Socioeconomic status:
* decreased dental awareness, frequency of visits, and more smoking
Risk Indicators
ASSOCIATED but does NOT cause
- HIV/AIDs:
* ANUG/ANUP increased in immunocompromised - Osteoporosis:
- Infrequent dental visits
- Stress
Risk Marker
- quantitative association w/disease
- Previous history of perio
- BOP
- CAL
Prognosis
Predict disease outcome
The prognosis for individual teeth:
* always consider w/entire dentition
Prognosis: Clinical Factors
Age:
* younger pt w/same level of disease as older patient has a worse prognosis
Disease Severity:
* CAL is more important than PPD
Plaque Control:
* Poor OH
Patient compliance:
* Noncompliant & uncooperative=worse prognosis
Vertical bone loss is better than horizontal
* can be treated w/regenerative therapy
* esp 3 wall defect=Trough
Prognosis: Systemic Factors
Smoking
* Increased prevalence & severity of periodontal disease
* Decreased healing response to nonsurgical and surgical therapy
Diabetes:
* poor controll=worse prognosis (poor healing)
Parkinsons:
* pt unable to perform oral hygiene (Impacts motor ability)
Prognosis: Local Factors
- Plaque and calculus
- Subgingival restorations: plaque retention
Prognosis: Anatomic Factors
- Short, tapered roots
- cervical enamel projections
- enamel pearls
- bifurcation ridges
- root concavities (M of Max 1st premolar)
- Developmental grooves
- root proximity
- Furcation involvement (more dificult to clean)
- Tooth mobility: Do not respond as well to tx
- Developmental grooves
Prognosis: Prosthetic & Restorative Factors
- Abutment selection
- Caries
- Nonvital teeth
- root resorption
Good Prognosis Classification:
Good control of hygiene
High Likelihood for tooth to be maintained by maintenance
Fair Prognosis Classification
- 25% CAL (Radiographically & Clinically)
Class 1 Furcation
-allowing adequate maintenance
Poor Prognosis Classification
50% CAL & Class 2 Furcation
proper maintenance possible but difficult
Questionable Prognosis Classification
> 50% CAL
POOR clinical crown:root ratio
Bad class 2 or 3 Furcation Involement
Class 2 or 3 mobility
Hopeless Prognosis Classification
Severe CAL
EXT Suggested
Gingival Recession Classification
Type 1 Recession:
* Recession + No inter proximal CAL
* Interproximal CEJ not clinically detectable
Type 2 Recession
* Recession + Interproximal CAL
*Interproximal CAL </= Buccal CAL:
Type 3 Recession:
* Recession + Interproximal CAL
* Interproximal CAL > Buccal CAL
CPD for SRP vs Surgical Therapy?
SRP: 2.9 mm
Surgical: Modified Widman Flap: 4.2
Tetracyclines
Congregate in GCF
* Doxycycline; 1 dose per day
Amoxicillin + Metronidazole
Amox 500 mg TID
Metronidazole 250 mg TID
14 days, avoid alcohol
Bisphosphonates
Inhibits osteoclasts
Arrestin
