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BDS4 PERIODONTOLOGY > Step 3 Treatment > Flashcards

Step 3 Treatment Flashcards

1
Q

What defines a “non-responding site” in reference to perio?

A
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2
Q

What are the 4 sequential steps to periodontal therapy? (based on BSP guidelines)

A
  1. good OH & healthy lifestyle to reduce inflammation + supragingival PMPR
  2. Thorough subgingival PMPR
  3. More complex treatments e.g surgery & more subgingival PMPR
  4. Long-term supportive care to prevent relapse
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3
Q

What are the aims of Step 3?

A
  • treat non-responding areas
  • further access to subgingival instrumentation
  • regenerating or resecting lesions that add complexity in periodontitis management
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4
Q

What may Step 3 include?

A
  • repeated subgingival PMPR
  • access flap surgery
  • resective flap surgery
  • regenerative flap surgery
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5
Q

What are local antimicrobials that can be used during step 3 perio treatment?

A
  • disinfectants (e.g chlorhexidine)
  • locally delivered antibiotics
  • adjuncts to PMPR
  • may be indicated in unresponsive sites where surgery is contraindicated or not desired
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6
Q

What is a periochip?

A
  • biodegradable gelatin matrix
  • 2.5mg chlorhexidine digluconate
  • insert into pocket following PMPR
  • released slowly over 7-day period
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7
Q

What is the effectiveness of periochip?

A
  • short term improvements in PPD compared to subgingival PMPR alone
  • improvements small, no significant difference in CAL
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8
Q

What is dentomycin periodontal gel?

A
  • 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
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9
Q

Give examples of local adjuncts that can be used in step 3 treatment?

A
  • dentomycin periodontal gel
  • periochip
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10
Q

What is the mechanism of systemic antimicrobials?

A

suppression of the bacyerial species responsive for biofilm growth, leading to a less pathogenic oral environment

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11
Q

Why are systemic antimicrobials not routinely prescribed for periodontitis treatment?

A

Antibiotic stewardship
- increasing incidence of bacterial resistance

Numerous side effects associated with systemic antibiotics

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12
Q

If you think that a periodontitis patient would benefit from systemic antimicrobials, what does the guidance suggest you do?

A

Refer to specialist

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13
Q

What patients may benefit from systemic antimicrobials as part of periodontal treatment?

A
  • periodontitis grade C in younger adults with high rate of progression
  • other systemic illness or predisposition to perio
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14
Q

What systemic antibiotic dose could be used as a part of periodontitis treatment?

A
  • full mouth instrumentation in a 24hr period
  • followed by 400mg TDS for 7 days
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15
Q

What is host modulation therapy?

A

Uses local or systemic drugs as adjuncts to conventional periodontal treatment
- aim to modify the destructive aspects of host inflammatory response to microbial biofilm

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16
Q

What is an example of host modulation therapy treatment used as perio treatment?

A

Periostat = sub-antimicrobial dose doxycycline

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17
Q

What are the downsides of host modulation therapy? [eg. periostat]

A
  • requires pts to use long term systemic medication
  • costly
  • alterations to liver enzymes
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18
Q

When do we consider surgical perio treatment?

A
  • deep residual pockets of > 6mm
  • stage 3 and 4 may benefit
  • no medical contraindications
  • teeth of restorable prognosis
  • infra-bont defects, furcation disease
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19
Q

What pathology tends to respond best to surgical periodontal treatment?

A

infra-bony defects

20
Q

What does marginal bleeding show?

A

day-to-day ability to clean plaque from teeth at home
[different from bleeding at base of pocket]

21
Q

What can occur post-periodontal surgery?

A

Recession

22
Q

What tooth relating factors need to be considered when deciding if periodontal surgery is suitable?

A
  • 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
23
Q

What systemic/medical relating factors need to be considered when deciding if periodontal surgery is suitable?

A
  • smoking [impaired wound healing]
  • unstable angina, uncontrolled hypertension, MI/stroke within 6 months
  • poorly controlled diabetes
  • immunosuppressed pts
  • pt taking anticoags
24
Q

What operator relating factors need to be considered when deciding if periodontal surgery is suitable?

A
  • skill & experience of operator
25
Q

What should be discussed with the patient to gain consent before periodontal surgery?

A
  • reason for providing perio surgery
  • other options for managing area
  • consequences of not providing surgery
  • nature of surgical procedures
  • post-op complications
  • requirement for ongoing post-op maintenance
  • costs
26
Q

What are the aims of access surgery/open flap debridment?

A
  • access to reas of continues inflamation or infection
  • for areas of PPD >6mm
27
Q

What is stage 1 of periodontal access surgery?

A
  • examination pre surgery shows deep periodontal pocket
  • good superficial gingival health
  • good OH
28
Q

What is stage 1 of periodontal access surgery?

A
  • full thickness flap raised to expose affected tooth surface, periodontal bone & associated defect
29
Q

What is stage 3 of periodontal access surgery?

A
  • defect granulation tissue removal and root surface curettage
  • leave clean root surface and bone
30
Q

What is stage 4 of periodontal access surgery?

A

suture and aim for primary closure [monofillament]

31
Q

Why are monofilament sutures used in perio surgery as opposed to multifilament?

A

to prevent plaque adhering to it

32
Q

What is stage 5 of periodontal access surgery?

A
  • 3 months post surgical review
33
Q

What defects are at high risk of relapse after periodontal surgery?

A

angular bone defects

34
Q

What are indications for regerative periodontal surgery?

A
  • intrabony defects 3mm or deeper as assessed radiographically
  • class 2 or 3 furcation defects
35
Q

What is guided tissue regeneration surgery?

A
  • barrier membranes ± addition of bone-derived grafts
  • membrane prevents gingival epithelium or connective tissue from entering bone defect and to induce osteogenesis and PDL regeneration
  • creates a space to act as a scaffold for vascularisation and cell ingrowth from base of defect
36
Q

What is an example of a material used for regenerative periodontal surgery?

A

Enamel Matrix Derivative (EMD - emdogain)

37
Q

How does enamel matrix derivative work?

A
  • tissue healing agent derived from porcine tooth germ
  • forms a matrix on the root surface that mediates the production of cementum by modulating the wound healing process
  • this can induce the regeneration of a functional attachment in perio procedure
38
Q

Why should we treat furcation lesions?

A
  • clinically relevant [reasonable tooth survival rates]
  • tooth retention after perio surgery more cost-effective than XLA and replacement
  • patient preference [pt wants to keep teeth]
39
Q

What options are available to treat furcations surgically?

A
  • regenerative surgery
  • root resection
  • root separation
  • tunnelling
40
Q

What furcation types respond well to regenerative surgery?

A
  • mandibular class II furcations
  • maxillary class II (buccal)
  • maxillary class II (interdental)
41
Q

When is root resection/root separation typically used?

A

class III furcation lesions or multiple class II furcation lesions in same tooth

42
Q

When is root resection/root separation indicated?

A
  • good quality endo treatment
  • good root separation
  • remaining roots should not be hypermobile
  • enough remaining PDL support on remaining roots
  • remaining tooth structure should be restorable
43
Q

How does a hemi-section differ from a root resection?

A

remove part of crown as well as root

44
Q

When is tunnelling furcation surgery used? What is involved?

A

Mandibular class III furcation lesion [through & through]
- bone and soft tissue recontoured to allow insertion of interdental brush

45
Q

What risks are associated with tunnelling furcation procedures?

A
  • root hypersensitivity
  • root caries due to exposed dentine
46
Q
A

BDS4 PERIODONTOLOGY (7 decks)

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