Docstoc

PERIODONTAL PATHOLOGY - UCLA School of Dentistry

Document Sample
PERIODONTAL PATHOLOGY - UCLA School of Dentistry Powered By Docstoc
					TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
UCLA SCHOOL OF DENTISTRY




                  SECTION OF PERIODONTICS
Presents   Dr. E. Barrie Kenney
           Professor & Chairman
           Section of Periodontics




           Dr. Heddie O. Sedano
           Professor Emeritus & Lecturer
           Section of Periodontics
PHASE ONE THERAPY
(INITIAL THERAPY)
Comprehensive
• Emergency Therapy
• Examination Diagnosis and Treatment Plan
  – Phase one therapy (initial therapy)
  – Evaluation of phase one therapy
  – Phase two therapy
  – Evaluation of phase two therapy
  – Maintenance therapy
Phase two therapy
•   Periodontal surgery
•   Dental implants
•   Crown and bridge
•   Removable partial dentures
EMERGENCY   NECROTIZING
            ULCERATIVE
 THERAPY
             GINGIVITIS
               (NUG)
  Two weeks           Proceed to
 NUG resolved          complete
by root planning   examination and
 and good oral        diagnosis
    hygiene
Phase one therapy
•   Control of plaque
•   Control of diet
•   Control of systemic factors
•   Control of oral malodor and taste abnormalities
•   Control of tobacco smoking
              Presence of
CONTROL of   plaque in red
 PLAQUE          for 4
              surfaces of
              each tooth
                Need to stress
 Presence of
                   floss or
interproximal
                 interdental
   plaque is
                    brush
  prominent
                 utilization
Plaque and bleeding
  scores at 4 time
      periods              Progressive
                       improvement to less
                      than 20% of surfaces
                           with plaque
CORRELATION OF MANUAL
      DEXTERITY
 AND KNOWLEDGE WITH
    ORAL HYGIENE
 MANUAL
DEXTERITY
  TEST
CORRELATION COEFFICIENTS BETWEEN RIGHT
  HAND DEXTERITY AND BUCCO-LINGUAL
                PLAQUE
             IN 59 ADULTS
       DAY 0            0.41
       DAY 7            0.38
       DAY 14           0.33
CORRELATION COEFFICIENTS BETWEEN KNOWLEDGE
         AND BUCCO-LINGUAL PLAQUE


             DAY 0          0.38
             DAY 7          0.32
             DAY 14         0.30
Patient with
   plaque
  induced
 gingivitis
   Three weeks
    following
 compliance with
  excellent oral
hygiene and plaque
     control
Soft brush     Brush is
positioned    vibrated by
 at 45° to       bass
 gingiva     technique of
             oral hygiene
         Best used for
Dental   interproximal
Floss     plaque when
           interdental
          papillae are
             present
Interdental
   brush
               Tuft
              brush
               Best used
Interdental      when
   brush      interdental
              papillae are
                reduced
  Rubber      Least efficient
interdental   interproximal
stimulator        cleaner
 Use of gauze
                    Gauze is
to clean distal
                      most
  surface of
                  efficient for
teeth adjacent
                   these teeth
to edentulous
     areas
Electric brushes      Electric brushes
used for patients   can motivate some
with poor manual    patients to improve
    dexterity        their oral hygiene
Clinical Evaluation of the
Efficiency and Safety of a
New Sonic Toothbrush

                Johnson, B.D., McInnes, C.,
                J. Periodontol 65:692, 1994
51 subjects got either Sonicare or
hand brush. Instructed in use or
Modified Bass Technique with
Oral B 30.
Plaque scores, gingivitis scores
and sulcular bleeding scores at
0, 1, 2, 4 weeks.

      29 subjects seen at 6 months
All subjects got timer and did not
use floss mouth rinses or other
oral hygiene aids for first 4 weeks.
Plaque Index
               0   1 week 2 weeks 4 weeks
Manual     1.71     1.52    1.51   1.56
Sonic      1.86     1.30    1.16   1.38
Sulcular Bleeding Index
             0     1 week 2 weeks 4 weeks
Manual     71.6      56.7   46.6   45.9
Sonic      57.5      49.2   45.7   40.7
Gingivitis
              0     1 week 2 weeks 4 weeks
Manual       1.58    1.43    1.29   1.28
Sonic        1.47    1.37    1.30   1.26
No increase in gingival recession
or other oral lesions associated
with either brush at 6 months.
Comparison of an Oscillating Rotating
Electric Toothbrush and a Sonic
Toothbrush in Plaque Removing Ability
              Van Der Weijden, S.A., Timmerman,
              M.F., Van Der Velden, V.
              J Clin. Periodontol 23:407, 1996
35 non dental students given a
Sonicare and a Braun Oral B plak
control brush and instructed to use
each brush every other day.
2 weeks later subjects no brushing
for 24 hours then reevaluated then
mouth brushed by an examiner
split mouth using both brushes.
Plaque Index
After 2 minutes Professional Brushing
                   Baseline        Enpoint
Braun Oral B         1.82               0.54
Sonicare             1.81               0.68
They repeated this 4 weeks later
with brushing using Zendium
toothpaste by the students.
Plaque Index
After 2 minutes Panellist Brushing
                   Baseline          Enpoint
Braun Oral B         2.00             1.10
Sonicare             2.00             1.20
At end of study they could keep
one brush. 34 out of 35 kept
Braun brush.
Clinical efficacy of flossing versus use of
antimicrobial rinses.Zimmer. S, et al J.
Periodontol. 2006 77:1380
156 patients used brush +daily rinse 0.06%
chlorhexidine 0.025% fluoride or brush+ 0.1%
cetylpyridiniumchloride +fluoride or brush +
floss or brush alone.Evaluated at 8 weeks.
  MODIFIED PROXIMAL PLAQUE INDEX




CHX NaF 1.58 CPC/NaF 1.54 FLOSS 2.10
BRUSH 2.00 /
   Papilla Bleeding Index



CHX /NaF 0.67 CPC/NaF 0.75 FLOSS 0.77
BRUSH 0.89
Additional effect of dentifrices on the instant
efficacy of tooth brushing.Paraskevas S .et al J.
Periodontol.2006 77:1522
3 toothpastes used in 40 patients each after 48
hours plaque accumulation.Split mouth hand
brush with or without paste.
Tooth paste gave average of 3% more plaque
than brush alone.More abrasive pastes no more
effective.
            CONTROL OF DIET

More benefit comes from reduction of sucrose in
diet so less caries and less plaque minimal effect
  on gingival inflammation from other dietary
                   modifications
CONTROL OF SYSTEMIC FACTORS
 CONSULT WITH PATIENT’S M.D.
 Control of Hemostasis
 Control of Bacteremia
 Control of Diabetes
 Control of Medications
  CONTROL OF ORAL MALODOR
  AND TASTE ABNORMALITIES
Plaque control is most predictable way to
 reduce oral malodor together with daily
 tongue scarping to reduce bacterial load
              of oral cavity.
CONTROL OF TOBACCO SMOKING

 Elimination of smoking significantly
  improves tissue response to initial
               therapy.
       PHASE ONE THERAPY
Removal of pathologic tissue for biopsy
Removal of caries-endodontic therapy
Removal of hopeless teeth
Removal of calculus
  Clinical       Biopsy
 diagnosis     should be
of possible        done
malignant     immediately
ulceration      in initial
                 therapy
  Exophitic      Immediate
 growth from    biopsy result
     area       diagnosis of
  previously     squamous
diagnosed as        cell
lichen planus    carcinoma
Non ulcerated
lesion present
 for at least 3
     years
   Tissue
  removed       Diagnosed as
  includes         benign
periphery of    hemangioma
normal tissue
Biopsy site
 sutured
                      Furcal bone
                     loss resolved
Removal of caries         after
                      endodontic
   Endodontic          treatment
    therapy           carried out
                      before any
                    periodontal care
              Tooth # 3
Removal of
              has 8 mm
 hopeless
             pockets and
   teeth
               grade 3
              mobility
 Radiograph     Recommend
  confirms      extract tooth
  hopeless       # 3 during
prognosis for      initial
  tooth # 3       therapy
Deep pockets
seen of distal
 of tooth # 4
Tooth # 4 shows
  periodontal      Pocket depth
  remodeling       improved on
after extracting      distal of
   tooth # 3         tooth # 4
REMOVAL OF CALCULUS

     Root Planing
Photomicrograph     Root planing is
   of calculus     needed to remove
  embedded in     embedded calculus
   cementum
 Universal
 curets for
root planing
Gracey curet 5/6     Triangular
                   shaped scaler
                      for small
                   interproximal
                       spaces
Explorers are   Root surfaces
   used to         should be
   confirm      glassy smooth
completion of     and free of
 root planing       calculus
Root surface   Prior to root
 magnified     planing with
                  curetes
 S.EM of    Note surface
new sharp    notches on
  curete    cutting edge
Root surface   Note smooth
 magnified     surface with
  after root    very slight
planing with     striations
    curet
                  Magneto
              strictive effect
Ultrasonic    results in high
 scalers         frequency
                  complex
             movement of tip
  Root surface    Large ripples
magnified after   seen that can
   ultrasonic      be detected
instrumentation   with explorer
          MEAN TOOTH SURFACES
           ROUGHNESS SCORES
Curette          (Kerry)         8.30
Sickle           (Green)         9.12
Hoes             (Green)        12.89
Files            (Green)        13.95
EW.PP            (Kerry)        17.36
EW.PIO           (Kerry)        17.68
               Remove large
   Gross
               deposits with
 amounts of
                ultrassonic
calculus and
                scaler then
   plaque
                root plane
                with curets
Radiographic    Needs root
 evidence of   planing with
  calculus        curets
   Sublingual      Root planing
  calculus with     done with
      acute       curets and oral
inflammation of      hygiene
     gingiva        optimized
                  Normal
Four weeks        healthy
after initial   gingiva. No
  therapy       bleeding on
                  proving
Pocket reduction   No need for further
                   periodontal therapy
    Gingival       Interproximal
 inflammation    pockets are 6 mm
is combination    with attachment
  of acute and   loss and bone loss
    chronic
    changes
                     Residual
 Root planing
                    pockets and
with curete has
                     bone loss
resolved acute
                   require phase
 inflammation
                  two periodontal
                      surgery
 PHASE ONE THERAPY
Occlusal correction
Occlusal splints
Provisional splinting of teeth
Orthodontic movement
Occlusal Adjustment
1.  Correction of Centric
   1. Stable centric relation
   2. No interferences between CR and CO
2. Correction of lateral excurtions
   1. Balancing interferences
   2. Working interferences
   3. Balancing interferences
3. Correction of protrusive excursions
   1. Straight protrusive
   2. Protrusolateral
4. Correction of centric occlusion
OCCLUSAL SPLINTS
    (ORTHOTICS)
PROVISIONAL
  SPLINTS
 PHASE ONE THERAPY

Restorative corrections
 Open contacts
 Overhangs
 Poor margins
 Poor contours
PHASE ONE THERAPY

Correction of inadequate
removable partial dentures
     Change in Alveolar Bone 4 Years After Partial Dentures as
                Percentage of Lengths of the Teeth

                      # of Abutments      Mesial         Distal


Denture Wearers            56          -2.3 (SD 3.3)   -3.9 (SD 5.)


Non Denture Wearers        18          -0.1 (SD 2.7)   -0.2 (SD 2.)
                            PHASE ONE EVALUATION
•   Pocket depth                      •   Mucogingival status
•   Plaque score                      •   Systemic status
•   Bleeding on probing               •   Radiographic evaluation
•   Caries                            •   Oral malodor and taste
•   Occlusal stability                •   Esthetics
•   Mobility, fremitus                •   Modification of phase two treatment plans
•   Mucosal health status
                SECTION OF PERIODONTICS UCLA




TO EXIT CLICK THE SCAPE                  TO REVIEW THIS
KEY ON THE KEY BOARD                     COURSE
                                         CLICK ON THIS LINK

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:11
posted:5/17/2012
language:
pages:167
fanzhongqing fanzhongqing http://
About