What are Carranza’s steps? (7)
1) limited plaque control instruction
2) supragingival removal of calculus
3) recontouring of defective restos/crowns
4) obturation of carious lesions
5) comprehensive plaque control instruction
6) subgingival debridement
7) tissue re-evaluation, determine need for further therapy and definitive tx
What are the reasonable expectations of phase I therapy? (3)
1) reduction in redness and gingival bleeding
2) gingival shrinkage (recession, gaps between teeth)
3) dentinal sensitivity
What factors does dentinal sensitivity after phase I therapy depend on? (3)
1) marginal plaque control
2) acidity of diet
3) saliva quality and quantity
What are the clinical parameters to assess when re-evaluating non-surgical perio therapy?
- marginal plaque control
- marginal tissue character (colour, texture, oedema)
What is the signifance of bop: origin, +/-/suppuration and what is the end goal of therapy?
origin: marginal or base of pocket?
+ bop: active site
- bop: less chance of being active
combined with suppuration: greater severity
end goal: absence of bop
Does a decrease in PD after non-surgical therapy equal attachment gain?
no
What determines if you should ahead with active/corrective or supportive therapy after initial therapy? (2)
If PD ≥ 4mm with BOP
Name some examples of corrective vs supportive therapy.
corrective
- more non-surgical therapy
- +/- adjunctive antimicrobials
- perio surgery
- restore function and aesthetics (definitive restos, implants, ortho)
supportive
- recall at appropriate intervals to diagnose
- monitor perio status
- re-motivate/educate pt
- repeat OHI
- re-treat disease
- monitor… further recall
What to do during exam and re-evaluation? (
- all the usual things (update med/dent hx, smoking status, assess OH/plaque score)
AND
- reassessment perio charting (compare readings to baseline)
Definition of supportive periodontal therapy
therapeutic measures to support patient’s own efforts to control periodontal infections and avoid re-infections
What constitutes the SPT appointment?
- examination, re-evaluation, diagnosis
- motivation, re-instruction (OH, smoking cessation)
- treatment of re-infected sites
a. non-surgical perio therapy (adjunctive antimicrobials if needed) b. minor surgical therapy - polishing, fluorides
- determine future recall visits
What are the goals of SPT? (4)
- prevent/minimise disease recurrence or progression
- prevent/minimise tooth/implant loss by monitoring
- treat any diseases found
- ensure adequate supragingival plaque control by pt
What is the biological basis and rationale of SPT?
- balance between microbial challenge, host response and conducive plaque ecology/environment
- individual PRA
- regular SPT → less CAL and tooth loss
- tooth loss inversely proportional to SPT frequency
- recurrent periodontitis can be prevented/limited with optimal OH
- SPT provides for monitoring following implant placement or perio therapy
What is the biological basis and rationale of SPT?
- balance between microbial challenge, host response and conducive plaque ecology/environment
- individual PRA
- regular SPT → less CAL and tooth loss
- tooth loss inversely proportional to SPT frequency
What would the treatment plan for this patient /typically include?
- plaque control instructions
- necessary exos
- scale and debridement
- systemic abx?
- surgical tx if required
- healing for 3 months
- referral to ortho
What classifies low, moderate and high risk in PRA?
low: ≤ 1 moderate parameters
moderate: ≥ 2 moderate risk & at least one high risk
high: ≥ 2 high risk
What classifies low, moderate and high risk in PRA?
low: all low or
What is the recall interval?
subjective to each case
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Re-evaluation and Supportive Periodontal Therapy18
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Surgical Periodontal Therapy 147
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Surgical Periodontal Therapy 255
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S2 - Aesthetic Periodontal Surgery27
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S2 - Perio-systemic relationships 153
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MS2 - Interdisciplinary perio 1 (Restorative and Ortho)35
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MS2 - Interdisciplinary perio 2 - Endo-perio34
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MS2 - Perio Systemic Relationships 223
