Step 3 Flashcards
Advantages of local anti microbials in periodontal tx?
Reduced / no systemic dose
High local conc
Less likely for drug interactions
Site specific
No issue with pt compliance
What may be included in step 3?
Repeated subgingival pmpr with or without adjunctive therapies
Access flap surgery - for debridement
Respective flap surgery - removal of inflamed gingival tissue
Regenerative flap surgery
What treatment adjuncts are there in step 3?
Disinfectants - chlorhexadine, periochip
Locally delivered antibiotics
These are adjuncts to pmpr as they do not mechanically remove biofilm / calculus
What is periochip?
Biodegradable gelatin matrix - 2.5mg chlorhexadine digluconate
- insert to pocket following pmpr
- released slowly over 7 days
- good for single spot deep pocketing / furcation
Give another locally delivered antibiotic for periodontal tx
Dentomycin periodontal gel
- delivered into pocket after pmpr
- 3-4 applications required every 14 days @ 0,2,4,6 weeks
- not repeated within 6 months
What is the SDCEP guidance on local antimicrobials in perio
Can be used as adjunct to non responding sites, not routinely used for patients with periodontal disease though
How can systemic anti microbials be used for perio tx?
When used?
Proposed to act by suppressing bacterial species responsible for biofilm growth
- not used routinely due to risk vs benefit of antibiotic stewardship and resistance
What pts would be considered for systemic antimicrobials?
Grade C perio in young individuals - high rate of progression
What systemic tx is used in GDH for perio?
Full mouth instrumentation followed by 400mg metronidazole, TTD for 3 days
What is periostat?
Low dose, sub-anti microbial dose of doxycycline along with PMPR
- currently no evidence contributes to resistance
- does require long term medication though, so issue with compliance
Not recommended by SDCEP! - unclear benefit
If expert referral not available, what tx?
Repeated root surface PMPR and subgingival PMPR, with consider open flap debridement
When access flap surgery recommended?
Residual pockets >=6mm in pts with stage III periodontitis
- no medical contra-indications
- teeth of reasonable prognosis
- furcation disease
- compliance
- <20% plaque and <10% marginal bleeding
- pt tolerate procedure under LA
- cost
- post op aesthetics
What tooth may contraindicate gingival surgery?
Difficult Access to the non-responding site
Shape of defect
Pros / endo considerations
Tooth position / anatomy
- overeruption
- proximity to adjacent roots
- tilting
What systemic issues may contraindicate periodontal surgery?
Smoking - impaired wound healing
Unstable angina, uncontrolled hypertension,, MI/Stroke within 6 months
Uncontrolled diabetes
Immune suppressed pts
Anticoagulant pts
Aims for access surgery in perio?
Access areas of continued inflammation
Pockets >6mm
Re-evaluation of gingival surgery?
Review in 3 months
PMPR form hygienist at 6 weeks
What defects are high risk of relapse after perio surgery?
Angular bone defects
Indications for regenerative periodontal surgery?
- intrabony defects 3mm or deeper
- class 2 or 3 furcation defects
How can intrabony defects be treated?
Guided tissue regeneration
Enamel matrix derivative
- tissue healing agent derived from porcine tooth germ
- induce re attachment in periodontal procedures
Why treat furcation lesions?
Reasonable survival rates observed over 4-30 years
- class II better prognosis than cIII
Economic
- tooth retention after perio more cost effective than extraction and prosthetic replacement
Patient preference
- strong pt preference for keeping sound tooth
What is tunnelling?
For mandibular class 3 furcations (through and through)
- bone and soft tissue recontoured to allow insertion of interdental brush
