Periodontics Part 5: Adjunctive Therapy

Question 1

What are the different types of Adjunctive Therapy used in Perio?

Answer 1

1. Antibiotics
2. Host Modulation Therapy
3. Occlusal Correction
4. Furcation correction

Question 2

Antibiotics

Answer 2

Decrease bacteria in periodontal pocket

Use ONLY w/mechanical debridement phase 1

Used for:
* LocalizedAggressive Perio
* Refractory perio (does not resolve even w/tx)

Question 3

Antibiotics: Tetracyclines

Answer 3

concentrate in GCF

Doxycycline: (-cycline)
* 1 dose per day
* improves patient compliance

Question 4

Antibiotics: Amx + MTZ

Answer 4

Amoxicillin (500mg TID) + Metronidazole (250mg TID) for 14 days
* duration is more important than dose; the longer the better
* Avoid alc w/MTZ

Question 5

Local Delivery Antibiotics (LDA)

Answer 5

After conventional therapy, if:
* localized, recurrent, and/or residual PD>/= 5 mm
+
Inflammation

Arrestin=Minocycline
Atridox=Doxycycline
Periochip=Chlorhexidine

Question 6

Host Modulation Therapy

Answer 6

Downregulate the destructive parts of host reponse
* ONLY use w/mechnical debridement during Phase 1

Used for:
* chronic perio

Types:
NSAIDs
Bisphosphonates
SSD

Question 7

NSAIDs

Answer 7

inhibit prostaglandins
* side effects: Long term use

Question 8

Bisphosphonates

Answer 8

• Inhibit osteoclasts
• Side effects: BRONJ

Question 9

SDD

Answer 9

Subantimicrobial Dose Doxycycline

inhibits MMPs (Collagenases to eat up PDL)
* 20mg 2x/day for 3-9 months (Periostat)
* Lonly one approved by FDA and accepted by ADA

Question 10

Locally administered host-modifying agents

Answer 10

Emdogain:
* enamel matrix proteins

PDGF:
* GEM 21S

Might influed periodontal regeneration

Question 11

Occlusal Correction: Traumatic Occlusion

Answer 11

When Malocclusion=source of problem

Traumatic Occlusion:
* periodontium injury due to extreme occlusal forces (can’t repair)
Primary Occlusal Trauma:
* excessive occlusal forces on normal periodontium
Secondary Occlusal Trauma:
* normal occlusal forces on reduced periodontium

Question 12

Fremitus

Answer 12

Vibration of teeth when closing
* tooth mobility when functioning

Question 13

Occlusal Therapy

Answer 13

Delay until after inflammation is gone

Occlusal Adjustment
* aka coronoplasty
* selective reshaping of occlusal surfaces

Interocclusal appliance
* aka bite guard
* redistributes occlusal forces
* minimizes excessive force on individual teeth

Question 14

Splinting

Answer 14

Improve patient comfort & function by
immobilizing severely mobile teeth

Not indicated for fremitus or mobility
* unless it bothers the pt

Question 15

Furcation Correction

Answer 15

Can’t Keep clean!

Types:
Furcation Plasty
* Open furcation areas
* move furcation up/remove tooth

Tunneling
* remove bone & move tissue down
* create through & through furcation

Root Amputation (Root Resection)
* Cut one root off

Hemisection/Premolarization
* Cut molar in half
* retain teeth as 2 premolars