Periodontitis Step 3 (add more cards when done)

Question 1

Aims of step 3

Answer 1

to treat areas of the dentition not responding adequately to step 2

Question 2

step 3 periodontal therapy may include

Answer 2

repeated sub gingival instrumentation with or adjunctive therapies
access flap surgery
respective flap surgery
regenerative flap surgery

Question 3

step 3 treatment adjuncts

Answer 3

disinfectants
- e.g. chlorhexidine
locally delivered antibiotics
adjuncts to PMPR
may be indicated in unresponsive sites where surgery is not desired or contra-indicated

Question 4

periochip - what is it and how to use

Answer 4

biodegradable gelatin matrix
2.5mg chlorhexidine digluconate
insert into pocket following PMPR
released slowly over 7 day period

Question 5

periochip effectiveness

Answer 5

short term improvement in PPD compared to sub gingival PMPR alone
small improvements
insufficient data on bleeding and pocket closure

Question 6

dentomycin periodontal gel application

Answer 6

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

Question 7

systemic antimicrobials mechanism

Answer 7

surpresses bacteria species responsible for biofilm growth
- leads to less pathogenic oral environment
may result in clinically significant outcomes

Question 8

risks of systemic antimicrobials for Periodontal treatment

Answer 8

inappropriate use - bacterial resistance
numerous side effects

Question 9

other therapies which can be used in step 3

Answer 9

statins
bisphosphonates
probiotics
NSAIDs
Omega 3 fatty acids
metformin

Question 10

periodontal surgery indications

Answer 10

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

Question 11

patient factors required to be suitable for surgery

Answer 11

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

Question 12

systemic/medical contraindications for surgery

Answer 12

smoking
unstable angina , uncontrolled hypertension, MI/stroke within 6 months
poorly controlled diabetes
immunocompromised patients
anticoagulants