STep Three Treatment

Question 1

regenerative vs resective

Answer 1

regenerative - aims to promote new bone and cementum deposition
resective - removal of parts

Question 2

aims of step 3 treatment

Answer 2

• treat areas of dentition not adequately responding to step 2
  may include: repeated subgingival instrumentation, access flap surgery, resective flap surgery, regenerative flap surgery

Question 3

why can local antimicrobials not be used without conjunction of PMPR

Answer 3

they dont disrupt plaque biofilm and dont remove plaque and calculus - so PMPR essential

Question 4

periochip

Answer 4

chlorhexidine infused gelatine matrix
inserted into pocket and CHX released slowly over 7 day period

very minute improvements in PPD

Question 5

dentomycin

Answer 5

gel that is deposited into pockets via syringe
requires 3-4 applications 2 weeks apart

very minute improvements in PPD

Question 6

what is the proposed mechanism of action when antibiotics are prescribed for treating periodontal disease

Answer 6

suppress bacterial species responsible for biofilm growth leading to a less pathogenic oral environment

Question 7

what antibiotic could be used for periodontitis should it be deemed appropriate

Answer 7

400mg metronizadole, 3x daily for 7 days
full mouth subgingival PMPR in 24hour period before beginning regime

Question 8

when might periodontal surgery be indicated

Answer 8

• NSPT has not resolved pocketing and there is ongoing inflammation/infection
• pocketing >6mm
• teeth have reasonable prognosis
• infrabony defects, furcation disease

Question 9

patient factors for suitability for perio surgery

Answer 9

• adequate OH (<20% plaque, <10% bleeding)
• quality of maintenance available post surgery
• cost
• aesthetics of site and potential for post op recession
• ability of patient to tolerate procedure (LA only as elective)

Question 10

tooth factors in determining suitability for periodontal surgery

Answer 10

tilting
overeruption
proximity to adjacent roots
access (trismus, posterior tooth etc)

Question 11

systemic factors which decrease the likelihood of periodontal surgery success

Answer 11

smoking (impairs healing)
unstable angina
uncontrolled hypertension
MI/stroke within 6 months
poorly controlled diabetes
immunosuppressed

Question 12

access surgery/ open flap debridement

Answer 12

aims to access areas of continued inflammation or infection (usually reserved for pockets >=6mm)
1. full thickness flap raised on buccal and palatal aspects to expose root surface
2. granulation tissue removed and root surface curettage to leave clean root surface and bone
3. suture and aim for primary closure

Question 13

indications for regenerative periodontal surgery

Answer 13

intrabony defects >3mm
class 2 or 3 furcation defects

Question 14

give 2 examples of methods of periodontal regeneration surgery

Answer 14

GTR (guided tissue regeneration) - bone dervived grafts placed into intrabony defect, acts as scaffold for patients own bone to grow
free gingival graft

Question 15

3 treatment options for furcation lesions

Answer 15

regenerative surgery
root resection/ root separation
tunnelling(bone and soft tissue recontoured to allow insertion of ID brush)