Step 3 Perio txt Flashcards
What is Step 3 BSP guidance?
Managing non responding site
Reinforce OHI, Risk factor control, behavioural change
Mod 4-5mm residual pockets - re perform subgingival instrumentation
Deep residual pocketing 6mm (Consider alternative causes)
Consider referral for pocket management or regenerative surgery
If cannot refer , re perform subgingival insturmentation
If stable proceed to Step 4
What are the aims of Step 3?
- treat areas not responding adequately to step 2 with purpose of gaining further access to subgingival instrumentation
- Or aiming at regenerating or resecting those lesions that add complexity in management of perio (infra-bony and furcation lesions)
What are Step 3 txt options?
Txt adjuncts
- Local Anitmicrobials , systemic antimicrobials
Periodontal surgery
Give some Local antimicrobials for perio txt adjuncts. Qh
Disinfectants (e.g. chlorhexidine)
Locally deliovered antibiotics such as
They are adjuncts to PMPR
indicated in unresponsive sites where surgery is contraindicated
What is PerioChip?
- Biodegradable gelatin matrix
- 2.5mg Chlorhexidine digluconate
- Insert into pocket following PMPR
- Released slowly over 7 day period
- Shows short term improvements in PPD compared to PMPR alone
What is Dentomycin peridoontal gel?
- 2% minocycline gel
- Syringe delivery insert into pocket following sub PMPR
- 3-4 applications every 14 days
- Txt not normally repeated within 6 months
- Short term improvement in PPD and CAL compared to PMPR alone
- Contraindicated for surgery or don’t want
Are local antimicrobials recommended for periodontal care?
- Not routinely recommended
What is the MOA of systemic antimicrobials? Are they recommended routinely
- Suppress the bactwerial species responsible for biofilm growth. leading to less pathogenic oral environment
No - Implores medical professional antibiotic stewardship
What periodontal surgery options are available for certain pts?
- Access therapy
- Resective therapy
- Mucogingival therapy
- Regenerative therapy
indications for periodontal therapy
- Deep 6mm residual pockets
- where good quality non surgical perio txt has not resolved the periodontal pocketing
- Stage 3 and 4 periodontitis pts non responding sites
- Suitable pt and tooth and defect factors , no medical contra, teeth reasonable prognosis, infra bony defects, furcation disease
Pt related factors for periodontal therpay indication
<20% plaque <10% marginal bl;eeding
Quality of maintenance available and pt access for it
Ability to tolerate procedure
Pt compliance for maintenance post surgery
Cost and pt acceptance
Aesthetics of site and potential for post op recession
What tooth related factors take into account for indications of periodontal surgery?
- Need Access to non responding sites (can they open mouth large enough)
- Shape of defect (bone loss)
- Prosthodontic / endodontic consideration
- Tooth pos/anatomy e.g. tiliting , overeruption, prox to adjacent roots, enamel pearls, ridges/ root grooves (decrease success chances)
What systemic / medical factors contr indicate periodontal surgery?
- Smoking
- Unstable angina, uncontrolled hypertension, MI/Stroke wihtin 6 months
- Poorly controlled diabetes
- Immunosuppressed pts
- Anticoagulants (DOAC/VITK agonist/ Antiplatelets) not absolute contraindication but change drug dose
Delays healing
Give the post op consequences of peridontal surgery
Pain / Swelling / Bruising / Failure to resolve pockets/ tooth mobility/ non vitality / recession
What are the aims of Access Flap therpay? How is it done?
- Improved visibility and accessibility for subgingival instrumentation of both soft and hard root surface deposits which have been removed by non surgical means
- Intracervical incision through gingival pocket and entire gingivae
- Mucoperiosteal flap
- removal of granulation tissue and instrument root surface
- See if anything else causing non healing pockets
- Flaps repositioned to orig pos and sutured
What is the post op care for access flap therapy?
- Reinforce mechanical plaque control
- Post op soft tooth brush
- Chlorhexidine 1-2 weeks
- Analgeisc 2-3days
- AB if indicated (complications)
- Remove sutures 1 week
- 3 month post surgical review - review 6PPC
Indications of regenerative periodontal therapy
- intrabony defects 3mm or deeper as assessed radiographically
- Class 2 or 3 furcation defect
Aims of regenerative periodontal therapy
- Increase periodontla attachment of severe compromised teeth
- Decrease deep pockets to more maintainable range
- reduction of vertical and horizontal components of furcation defects
What is the classification of this intrabony defect?
one wall intrabony defect
What is the classification of this intrabony defect?
two wall intrabony defect
What is the classification of this intrabony defect?
three wall
What is Emdogain?
- Enamel matrix protein derived form porcine tooth germ
- Forms a matrix on the root surface that mediates the prod of cementum
Why treat furcation lesions?
- Good surviavl rate of 4-30 yrs , Class II survive better than Class III
- Tooth retention after perio surgery more cost effective than extraction and and replace with implant
- Pt preference
Give the different types of pockets?
Horizontal bone loss gives Suprabony (supracrestal) pocket
- Base of pocket located coronally to alveolar crest
Vertical (angular) bone loss
- Infrabony, subctestal pocket or defect
- When apical end of pocket located below bone crest
- Called crater when affecting two adjacent teeth and called intrabony when involves root surface one tooth
When would you do a Tunnelling procedure ?
- Mandibular class III lesion
- Bone and soft tissue recontoured to allow insertion of interdental brush
- Risks - root hypersensitivity and increased caries risk due to exposed dentine
