Step 3 of Treatment Flashcards
What is the aim of step 3 perio treatment?
To treat those areas of the dentition not responding adequately to step 2 with the purpose of gaining further access to subgingival instrumentation, or at aiming at regenerating or resecting those lesions that add complexity in the management of periodontitis (infra-bony defects & furcation lesions- benefit from surgical intervention)
What does step 3 of perio treatment include?
Repeated subgingival instrumentation with or without adjunctive therapies
–Access flap surgery
–Resective flap surgery
–Regenerative flap surgery
What is the proposed mechanism for the use of systemic antimicrobials for treating periodontal disease?
Proposed to act by suppressing the bacterial species responsible for biofilm growth, leading to a less pathogenic oral environment
Why are systemic antimicrobials not routinely used for patients with periodontitis?
Inappropriate use of antibiotic therapy is linked to increasing incidence of bacterial resistance
Side effects
Antibiotic stewardship
When may systemic antimicrobials be considered for use?
Periodontitis grade C in younger patients (high rate of progression)
What is the aim of host modulation therapy?
Uses local or systemic drugs as adjuncts to conventional periodontal treatment, with the aim of modifying the destructive aspects of the host inflammatory response to the microbial biofilm
When might periodontal surgery be indicated?
In sites where good quality non-surgical periodontal treatment has not resolved periodontal pocketing and there is ongoing inflammation/infection
Periodontal pocketing more than or equal to 6mm
In cases with suitable patient, tooth and defect factors:
–no medical contra-indications
–teeth of reasonable prognosis
–infra-bony defects, furcation disease- favourable bone loss that responds to surgery
What should the plaque and bleeding scores be for a patient to be considered for periodontal surgery?
<20% plaque and <10% marginal bleeding
What are the systemic/medical contraindications for periodontal surgery?
Smoker
Unstable angina, uncontrolled hypertension, MI/stroke within last 6 months
Poorly controlled diabetes (high Hb1Ac- safe limits: 20-41mmol 4-7%)
Immunosuppressed patients
What are the aims of access surgery/open flap debridement?
Access to areas of continued inflammation or infection
Usually for areas PPD >6mm
To allow access for surgical debridement
What is Regenerative Periodontal Surgery?
Tissue regeneration including bone and functional PDL formation
What are the indications for regenerative periodontal surgery?
Infra-bon defects 3mm or deeper
Class 2 or class 3 furcation defect
What is guided tissue regeneration?
Provision of a barrier membrane +/- addition of bone derived graft
Creates a space to act as a scaffold (for the patients own tissues) and encourages vascularisation and cell ingrowth from the base of the defect- need a barrier membrane on top to stop early epithelial attachment to tooth
What are the options for furcation surgery?
Regenerative surgery
Root resection
Root separation
Tunnelling
What is root resection surgery?
Resect one root of a tooth but keep the crown and other root intact
Usually for Class III lesions but can also be for multiple Class II lesions in the same tooth
