Relative Risk for Periodontitis Associated with Cigarette Smoking - PowerPoint

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					Periodontal Examination
          Possible
         Diagnostic
         Categories




Health   Gingivitis   Periodontitis
           Treatment Plan

 Includes all procedures required for the
  establishment and maintenance of oral
  health
 Determined after the diagnosis and
  prognosis have been established
    Overall Treatment Plan
 Preliminary phase
 Phase I therapy

 Re-evaluation

 Phase II therapy – (surgical phase)

 Phase III therapy – (restorative phase)

 Phase IV therapy – (supportive periodontal
  therapy)
Explaining the Treatment Plan
        to the Patient
     Be specific in explaining:
           The problem
           The treatment
           The prognosis
          The maintenance
      Start Out Positively
 Talk about teeth to be retained
 Present all of the treatment as a unit

 Best results with prompt treatment
    Preliminary Phase

 Treatment   of emergencies
    Acute infection
    Caries control

    Other
Periodontal Abscess
Pericoronitis
Necrotizing Ulcerative Gingivitis
Acute Periapical
  Infections
           Phase I Therapy
          (Etiotropic Phase)

 Plaque control
 Diet control

 Scaling and root planing/scale & polish

 Caries control

 Occlusal therapy

 Provisional splinting
    Scaling / Root Planing

 ADA code D4341
 Patient with LOA and gingival
  inflammation
       Scale and Polish

 ADA code D1110
 Patient with gingival inflammation and
  no LOA
   Re-evaluation
Diagnosis of Periodontitis


   Initial Therapy S/RP
     and Home Care



      Re-evaluation
Response to Phase I

Re-checking
   Probing    depths
   Mobility

   Recession

   Plaque   control
 Response to Phase I
Tissue response
   Color

   Consistency

   Contour

   Texture

   Bleeding   on probing
    Endpoint Objectives of
     Periodontal Therapy
 Resolution of inflammation
 No BOP
 No suppuration
 Gingival contours WNL in color,
  texture and form
 Gingival attachment which is resistant
  to recurrent disease
Criteria Indicating These Goals
      Have Not Been Met

 Ongoing attachment loss / recession
 Signs of inflammation
     BOP
     Suppuration

   Periodontal pockets > 5mm
Criteria Indicating These Goals
 Have Not Been Meet (con’t.)

   Increasing tooth mobility
   Significant osseous defects
       Furcations

       Verticaldefects
       Bony craters
 Establish   periodontal treatment plan
   Additional S/RP followed by re-eval
   Supportive periodontal therapy

   Periodontal surgery
Treatment vs. Referral?
       Patient for Referral

 Inflammation that does not resolve
 Inadequate attached gingiva
 Severe root exposure
 Aggressive periodontitis
 Patients with systemic disease
 All severe periodontal disease
Watching Is Not Considered
   Periodontal Therapy
    Phase II Therapy
    (Surgical Phase)
Periodontal surgery
 Resection
 Regeneration

 Periodontal plastic surgery

 Crown lengthening
            Pre bone
            resection




Post bone
resection
             Intrabony
               Defect




Bone Graft
 Placed
          Pre-op




Post-op
          Pre-op




Post-op
     Phase III Therapy
    (Restorative Phase)

 Final restorations
 Fixed and removable prosthodontics

 Implants
      Phase IV Therapy
     (Maintenance Phase)

 Supportive periodontal therapy
 Periodontal Maintenance Program

 Recall Maintenance

 ADA code D4910
Supportive Periodontal Therapy

    I.   Examination
          Update  medical history
          Oral pathology exam

          Radiographs prn

          Oral hygiene status
Supportive Periodontal Therapy

       I. Examination
          Probing depths
          Tissue condition

          Plaque control

          Occlusion

          Tooth mobility

          Recession
Supportive Periodontal Therapy

   II. Treatment
       Oral hygiene reinforcement
       Scaling (RP prn)

       Polishing

       Chemical irrigation prn
Supportive Periodontal Therapy

    III. Scheduling
         Next recall visit
         Additional periodontal tx

         Restorative treatment
Patients With Periodontitis

        3 months SPT
Patients With Gingivitis and
    No History of LOA

         6 month SPT
Time for SPT appointments

       45-60 minutes
      SPT Practice Patterns

 Typically, periodontist and generalist
  perform every-other-SPT
 Frequent SPT visits (< 3 months apart) may
  make sense
 Communication is critical

				
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