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Treatment plan

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  • 1. TREATMENT PLAN
  • 2. General Dental Practitioner Oral Health Educator Dental Nurse Prevention of Periodontal Disease Dental Hygienist Dental Therapist Secondary Care Consultant in Restorative Dentistry High Street specialist In Periodontology.
  • 3. Screening for peridontal disease
    • Basic Periodontal examination codes:
    BPE Code Clinical Status 0 – Coloured band is completely visible, No bleeding, No Calculus Health Periodontium 1- Only Gingival bleeding Gingivitis 2 – Calculus Gingival Bleeding Gingivitis 3- Colored band is partly visible Periodontitis, Pocket depth :- 3.5 - 5.5 mm. 4. Colored band completely disappear Periodontitis Pocket depth ≥ 5.5 mm. * Furcation involvement or attachment loss > 7mm.
  • 4.  
  • 5. Other Periodontal examination
    • Standard of oral hygiene.
    • Location & quantity of plaque & calculus.
    • Examination of gingiva:
      • Inflammation
      • Recession
      • Hyperplasia
    • Furcation involvement
    • Degree of tooth mobility.
    • Occlusal assessment
    • Any systemic disease.
    • Radiographic examination
  • 6. Treatment Plan
    • Definition:- It is the blue print for case management.
    • Treatment Goals:-
      • Reduction or resolution of gingivitis.
      • Reduction in probing pocket depth.
      • Elimination of open furcation in multirooted teeth.
      • Individually satisfactory esthetic & function.
  • 7. Phase of Periodontal Therapy
    • Emergency Phase
    • Phase I :- Etiotropic phase
    • Phase II :- Surgical Phase
    • Phase III :- Restorative phase
    • Phase IV :- Maintenance Phase
  • 8. Preferred sequence Of Periodontal Therapy.
    • Emergency Phase
    • Etiotropic Phase
    • Maintenance Phase
    • Surgical Restorative
    • Phase Phase
  • 9. EMERGENCY PHASE
    • Treatment of any type of pain
    • Extraction of hopeless teeth.
    • Draining of the abscess
    • PHASE I ETIOTROPIC PHASE
    • “ Cause related therapy”
    • “ Non surgical periodontal therapy”
    • Objective:-
      • Elimination & Preventing of reformation of bacterial deposits on tooth & root surface.
  • 10.
    • This Phase includes :
    • Diet Counseling (Specially in patients with rampant caries)
    • Removal of plaque retentive factors - it may be:
    • Natural - Crowding,
      • Developmental grooves
      • Enamel Pearls
      • Iatrogenie - Poor Margins or over contoured
      • restorations
    • Supragingival scaling
    • Subgingival Scaling
    • Root Planning.
    • Occlusal therapy
    • Antimicrobial therapy
    • Correction of restorative & prosthetic irritatonal factors.
  • 11.
    • Excavation of caries & restoration.
    • Temp. or final :- Depending on whether the definite prognosis for the teeth has been arrived at the location of caries.
    • Minor orthodontic movement.
    • Chemical plaque control (for acute conditions.
    • EVALUATION OF RESPONSE TO ETIOTROPIC PHASE ( Ideally after 3 months)
    • Rechecking for :-
    • Oral hygiene status
    • Gingival inflammation & bleeding
    • Probing depth
    • Attachment level
    • Calculus
    • Caries.
  • 12. Phase II - Surgical phase
    • (I) Various periodontal surgical procedure.
    • Indication:-
    • Where there is impaired access for scaling & root surface debridement like:-
    • - In deeper ( > 5mm) periodontal pockets
    • - On wider tooth surfaces
    • - Presence of root fissures
    • - Presence of root concavities
    • - Furcation involvement
    • - Presence of faulty margins on subgingival restorations.
    • So it is used to –
    • - Gain access for thorough scaling & root surface debridment
    • - Establish a gingival morphology conductive to good plaque control.
    • - Reduce pocket depths
    • - Shift the gingival margin apically to plaque retaining restorations.
    • - Crown lengthening.
  • 13.
    • Contraindication:-
      • Patient who is uncooperative during cause related therapy should not proceed to surgery.
      • Smoking – Impair healing after surgery.
      • Absolute Contraindication :
        • Medically compromised patients
    • Periodontal surgery may be classified as:-
    • Access surgery :
    • Provide visual & technical access for through debridement
    • Resective surgery – removal of excess soft tissue in gingival over growth & appical relocation of gingival margin.
      • Gingivectomy
      • Apical displaced flap surgery
      • Undisplaced flap with or without osseous resection.
  • 14.
    • Regenerative surgery :- To regenerate the periodontal attachment complex i.e. cementum, PDL & bone
    • (a) flap surgery with flap graft
    • (b) flap surgery with osseous graft
    • (II) IMPLANT PLACEMENT
    • (III) ENDODONTIC THERAPY
  • 15. Evaluation of response to surgical therapy
    • Oral hygiene status.
    • Gingival inflammation & bleeding
    • Probing depth
    • Attachment level.
    • PHASE III – RESTORATIVE PHASE
      • Final restoration.
      • Fixed prosthesis
      • Removable prosthesis
    • Evaluation of response to restorative therapy
    • - Oral hygiene status
    • - Gingival inflammation & blearing
    • - Probing depth
    • - Attachment level
    • - Restoration status
  • 16.
    • Phase IV – Maintenance phase :-
    • Periodic maintenance :-
    • For advanced periodontal disease - 3-4 times per year.
    • Otherwise in 6 months.
    • Checking for :-
      • Plaque & gingival indices
      • Calculus
      • Attachment Level
      • Pocket depth
      • Bleeding on probing
      • Recession
  • 17. Maintenance recall procedures
    • PART 1 – Examination
    • Oral hygiene status
    • Gingival changes
    • Pocket depth changes
    • Mobility changes
    • Occlusal changes
    • Dental caries
    • Restorative & Prosthetic status
    • Medical history changes
    • Oral pathologic examination
    • Radiographic examination
  • 18.
    • PART 2 – Treatment
    • Oral hygiene reinforcement
    • Scaling
    • Polishing
    • Chemical irrigation
    • PART 3 – Schedule next procedure
    • Schedule next recall visit
    • Schedule further periodontal treatment
    • Schedule or refer for restorative or prosthetic treatment
  • 19. CONCLUSION After the diagnosis & prognosis have been established,the treatment plan is made to coordinate all treatment procedures to create a well functioning dentition in a healthy Periodontal environment.