step 3 Flashcards
What Tx adjucts are there
local
systemic
inidcations
outcomes
What are local Tx adjuncts
Disinfectants eg. chlorhexidine
Locally delivered antiobiotics
Adjucts to PMPR
May be indicitive to sites where surgery contraindicated or not desired
What is perio chip
Biodegradeable gelatin matrix
2.5mg chlorehidine diglucontate that is slowly released over 7 days
Insert to pocket after PMPR
What is dentomycin periodontal gel
2% minocycline gel that is inserted via syfringe into pocket after PMPR
3-4 applications every 14 days
In SDCEP guidance should locally delivered antimicrobials be considered as an adjunct to PMPR in perio pt
Not recommended for routine care and management of pt with perio
How do systemic antimicrobials work
Suppress bacterial species responsible for bioflim grwoth leading to a less pathogenic oral enviroment
When consider systemic
Younger Pt with grade C where high rate of progression documented
What used for sytemic in gdh
Full mouth instrumentation within 24hr then 400mg metrondiazole TDS 7days
When perio surgery indicated
Sites where good quality non-surg perio Tx not working
Perio pocket >/= 6mm
If pt has no contraidications, teeth with good prognosis, infrabony defects and furcation disease
What are the pt factors for surgery to happen
OH <20% plaque <10%BOP
Pt can maintain perio health
Pt can tolerate and pt compliance to maintenance post surgery
Cost and pt acceptance
Aestheics of site and potentional for post op recession
What tooth factorsd are there for surgery
Access to site
Shape of defect
Pros and endo considerations
Tooth postion and anatomy
Systemic/MH factors for surgery
Smoking
Unstable angina, uncontrolled HyperT, MI/stroke within 6months
Poorly controlled diabetes
Immunsupressed
Anti coags
What are the aims of access surgery/open flap debridement
access areas of continued inflam or inf
PPD >/= 6mm
Allow acess for debridement
What are the stages of access surgery/open flap debridement
- Exam shows pre-surgery dep perio pocket with good superficial gingival health and good OH
- Full thickness flap raised with inverse bevel intra crevicular inicion to periosteum to expose root
- defect granulation tisse removed and root suraface curettage to leave clean root and bone & identify any other reasons for nonresponsiveness such as root fracture
- Suture and aim for primary closure and use MONOFILAMENT as plaque retention
- Follow up after 1wk to remove sutures, 6wk to check, 3month proper review
What is regenerative periodontal surgery
Procedures that regenerate lost bone and tissue supporting your teeth
Indications for perio regen surgery
Infrabony defects 3mm or deeper
Class 2 or 3 furcationc defect
What is guided tissue regeneration
Barrier membrane +/- bone grafts
-eg. BoneOss
Membrane prevents gingival epithelium or connective tissue from entering bone defect and induce osteogenesis and PDL regen
Creates space t oact as a scaffold for vascularisation and cell ingrowth from base of defct
What is enamel matrix derivative
Emdogain
tissue healing agent derived from porcine tooth germ
Forms a matrix on root surface that mediates production of cementum by modulating wound healing process
Can induce regen of functional attachment in perio
what options are there for furcation surgery
Regen surgery
Root resection
Root seperation
Tunelling
When use regen furcation surgery
Mandubular class II furcation
Maxiallary Class II furcation (buccal)
Maxiallry class II furcation (interdental) can also use root seperation or resection
When use Root resection or seperation
Class III lesions or multiple class II in same tooth
Good endo needed
Root assessed radiographically, not be mobile and tooth restorable
Pt is motivated and excelletn OH and low caries rate
When use tunneling
Mandib Class III lesions
Bone and soft tissues recontiured to allow insertion of ID brush
