Step 3 Treatment Flashcards
What defines a “non-responding site” in reference to perio?
What are the 4 sequential steps to periodontal therapy? (based on BSP guidelines)
- good OH & healthy lifestyle to reduce inflammation + supragingival PMPR
- Thorough subgingival PMPR
- More complex treatments e.g surgery & more subgingival PMPR
- Long-term supportive care to prevent relapse
What are the aims of Step 3?
- treat non-responding areas
- further access to subgingival instrumentation
- regenerating or resecting lesions that add complexity in periodontitis management
What may Step 3 include?
- repeated subgingival PMPR
- access flap surgery
- resective flap surgery
- regenerative flap surgery
What are local antimicrobials that can be used during step 3 perio treatment?
- disinfectants (e.g chlorhexidine)
- locally delivered antibiotics
- adjuncts to PMPR
- may be indicated in unresponsive sites where surgery is contraindicated or not desired
What is a periochip?
- biodegradable gelatin matrix
- 2.5mg chlorhexidine digluconate
- insert into pocket following PMPR
- released slowly over 7-day period
What is the effectiveness of periochip?
- short term improvements in PPD compared to subgingival PMPR alone
- improvements small, no significant difference in CAL
What is dentomycin periodontal gel?
- 2% minocycline gel
- syringe deliver, insert into pocket following subgingival PMPR
- 3-4 applications required every 14 days (0, 2, 4 and 6 weeks)
- reduces pathogenic load of periodontal bacteria in pocket
Give examples of local adjuncts that can be used in step 3 treatment?
- dentomycin periodontal gel
- periochip
What is the mechanism of systemic antimicrobials?
suppression of the bacyerial species responsive for biofilm growth, leading to a less pathogenic oral environment
Why are systemic antimicrobials not routinely prescribed for periodontitis treatment?
Antibiotic stewardship
- increasing incidence of bacterial resistance
Numerous side effects associated with systemic antibiotics
If you think that a periodontitis patient would benefit from systemic antimicrobials, what does the guidance suggest you do?
Refer to specialist
What patients may benefit from systemic antimicrobials as part of periodontal treatment?
- periodontitis grade C in younger adults with high rate of progression
- other systemic illness or predisposition to perio
What systemic antibiotic dose could be used as a part of periodontitis treatment?
- full mouth instrumentation in a 24hr period
- followed by 400mg TDS for 7 days
What is host modulation therapy?
Uses local or systemic drugs as adjuncts to conventional periodontal treatment
- aim to modify the destructive aspects of host inflammatory response to microbial biofilm
What is an example of host modulation therapy treatment used as perio treatment?
Periostat = sub-antimicrobial dose doxycycline
What are the downsides of host modulation therapy? [eg. periostat]
- requires pts to use long term systemic medication
- costly
- alterations to liver enzymes
When do we consider surgical perio treatment?
- deep residual pockets of > 6mm
- stage 3 and 4 may benefit
- no medical contraindications
- teeth of restorable prognosis
- infra-bont defects, furcation disease
What pathology tends to respond best to surgical periodontal treatment?
infra-bony defects
What does marginal bleeding show?
day-to-day ability to clean plaque from teeth at home
[different from bleeding at base of pocket]
What can occur post-periodontal surgery?
Recession
What tooth relating factors need to be considered when deciding if periodontal surgery is suitable?
- access to non responding sites
- shape of defect [pattern of bone loss]
- pros/endo considerations
- tooth position/anatomy = tilting, overeruption, proximity to adjacent roots, enamel pearls, ridges/root grooves
What systemic/medical relating factors need to be considered when deciding if periodontal surgery is suitable?
- smoking [impaired wound healing]
- unstable angina, uncontrolled hypertension, MI/stroke within 6 months
- poorly controlled diabetes
- immunosuppressed pts
- pt taking anticoags
What operator relating factors need to be considered when deciding if periodontal surgery is suitable?
- skill & experience of operator
