Periodontitis Step 3 Flashcards
Aims of step 3
to treat areas of the dentition not responding adequately to step 2
step 3 periodontal therapy may include
repeated sub gingival instrumentation with or adjunctive therapies
access flap surgery
respective flap surgery
regenerative flap surgery
Step 3 - deep pockets >6mm remain - how would you proceed?
consider alternative causes
- e.g. furcation lesion, infrabony defects
- root fracture?
step 3 treatment adjuncts
disinfectants
- e.g. chlorhexidine
locally delivered antibiotics
adjuncts to PMPR
may be indicated in unresponsive sites where surgery is not desired or contra-indicated
periochip - what is it and how to use
biodegradable gelatin matrix
2.5mg chlorhexidine digluconate
insert into pocket following PMPR
released slowly over 7 day period
periochip effectiveness
short term improvement in PPD compared to sub gingival PMPR alone
small improvements
insufficient data on bleeding and pocket closure
dentomycin periodontal gel application
2% minocylcine gel
syringe delivery
- insert following surgical PMPR
3-4 applications required every 14 days - 0, 2, 4 and 6 weeks
treatment should not normally be repeated within 6 months
systemic antimicrobials mechanism
surpresses bacteria species responsible for biofilm growth
- leads to less pathogenic oral environment
may result in clinically significant outcomes
risks of systemic antimicrobials for Periodontal treatment
inappropriate use - bacterial resistance
numerous side effects
other therapies which can be used in step 3
statins
bisphosphonates
probiotics
NSAIDs
Omega 3 fatty acids
metformin
periodontal surgery indications
sites where good quality non surgical treatment has not resolved periodontal pocketing and there is ongoing inflammation or infection
pocketing >/= 6mm
teeth of reasonable prognosis
patient factors required to be suitable for surgery
oral hygiene
<20% plaque. <10% marginal bleeding
ability of patient to tolerate procedure
likelihood of compliance post surgery
cost and patient acceptance
aesthetics of site and potential for post-op recession
systemic/medical contraindications for periodontal surgery
smoking
unstable angina , uncontrolled hypertension, MI/stroke within 6 months
poorly controlled diabetes
immunocompromised patients
anticoagulants
what cases may systemic antimicrobials be considered in periodontitis?
Grade C in younger adults
- where a high rate of progression is documented
defects which usually respond well to periodontal surgery
infra-bony defects
furcation defects
aims of open flap debridement
access to areas of continued inflammation or infection
usually for areas PPD >6mm
allow access for surgical debridement
open flap debridement, technique
full thickness flap raised to exposure affected root surface, periodontal bone and associated defect
granulation tissue removed from defects
root surface instrumented
suture and aim for primary closure
regenerative periodontal surgery indications
intrabony defects 3mm or deeper
class 2 or class 3 furcation defect
furcation surgery options
regenerative surgery
root resorption
root separation
tunneling
