S3 Step Flashcards
Step 3 aims
Treat step 2 non-responsive sites with invasive interceptive measures to gain further access for subgingival pmpr
To regenerate/resect areas which complicate management of perio
S3 tx options
Treatment adjuncts
Access surgery
Regenerative options
Furcation options
Adjunctive local antimicrobials used
Periochip- 2.5mg CHX chip- insert into pocket following PMPR- biodegradable
Dentomycin-2%- syringed into pocket following PMPR
Adjunctive systemic antimicrobials used
400mg metronidazole 3xD for 7 days
Host modulators- periostat
Specialist only- not recommended for routine care= antibiotic stewardship
When might periodontal surgery- access flap surgery be indicated
> 6mm pockets
No medical contraindications
Teeth of reasonable prognosis
Patient factors to consider in periodontal surgery
OH- <20% plaque, <10% bleeding
Ability to tolerate procedure/ maintain site
Cost
Risks of recession
Tooth factors to consider in periodontal surgery
Access
Shape of defect
Tooth position/anatomy
Medical factors to consider in periodontal surgery
Smoking
Unstable angina/hypertension/MI/ stroke within 6M
Uncontrolled diabetes
Immunocompromised
Clotting disorders
Periodontal surgery- regenerative surgery indications
Intrabony defects >3mm
Class 2/3 furcation defect
Types of regenerative surgery
GTR- guided tissue regeneration
EMD- emdogain- enamel matrix derivative
Why treat furcation lesions
Good survival rates
Cost- cheaper to retain than implants
Pt preference
Furcation management- options for surgical interventions
Regenerative surgery
Root resection/separation
Tunelling
Guided bone regeneration- indications for success
3 or 2 walled bony defect
1 walled- inadequate
