Dr. P. Srujan Kumar MDS Reader

1. RATIONALE
FOR
PERIODONTAL TREATMENT
Presented by
Dr. P. Srujan Kumar
MDS Reader

2. RESULT OF PERIODONTAL THERAPY
pain
gingival inflammation
reduce periodontal pockets
arrest the destruction of bone
Eliminates: reduce tooth mobility
establish optimal occlusal function
re-establish physiological gingival contour
prevent the recurrence of disease
reduce tooth loss

3. EXCELLENT HEALING CAPACITY OF PERIODONTIUM
ONE WEEK AFTER SURGERY
7 MONTHS AFTER SURGERY

4. LOCAL THERAPY
Cause: PLAQUE ACCUMULATION
The removal of plaque and all the factors
that favor its accumulation is therefore the
primary consideration in local therapy

5. SYSTEMIC THERAPY
Indicated: LAP & GAP
[ Systemic antibiotics are used to completely
eliminate the bacteria ]
PERIODONTAL MANIFESTATIONS OF
SYTEMIC DISEASES
NON-STEROIDAL ANTIINFLAMMATORY
DRUGS
[ flurbiprofen & ibuprofen – slow down –
gingivitis, loss of alveolar bone]
BISPHOSPHANATE -- used in pagets disease
has a inhibitory effect on bone resorption

6. FACTORS AFFECTING HEALING
Plaque micro-organisms
Excessive tissue manipulation
LOCAL: Trauma to the tissues
Presence of foreign bodies
Age
Diabetes
SYSTEMIC: Insufficient food intake
Deficiency in VIT-C & Proteins
Hormones [ACTH – inhibits growth of fibroblasts
ESTROGEN – inhibits granulation tissue form
n

7. TWO POSSIBLE OUTCOMES OF POCKET ELIMINATION
A. Periodontal pocket before treatment
B. Normal sulcus re-established at the level of
the base of the
pocket
C. Periodontium restored on the root surface
previously denuded by disease [NEW ATTACHMENT]

8. HEALING AFTER PERIODONTAL SURGERY
REGENERATION
REPAIR
NEW ATTACHMENT

9. REGENERATION
Growth and differentiation of new cells and
intercellular substances to form new tissues
Regeneration takes place by growth from
same type of tissue that has been destroyed or
from its precursor

10. GINGIVAL EPITHELIUM : EPITHELIUM
CONNECTIVE TISSUE
PERIODONTAL LIGAMENT : CONNECTIVE TISSUE
CEMENTUM
BONE
REGENERATION OF THE PERIODONTIUM IS A
CONTINUOUS PHYSIOLOGICAL PROCESS
REGENERATION IS ALSO GOING ON DURING
DESTRUCTIVE PERIODONTAL DISEASE

11. SOURCES OF REGENERATING CELLS
IN THE
HEALING STAGES OF A PERIODONTAL POCKET
Left: infra bony pocket right : after therapy
a. marginal epithelial cells
b. connective tissue cells
c. osteoblasts
d. periodontal ligament cells

12. REPAIR
Re-establishing a normal gingival sulcus at
the same level on the root as the base of the
pre-existent periodontal
pocket
This process, called healing by scar, arrests
bone destruction without increasing bone height

13. NEW ATTACHMENT
Embedding of new periodontal ligament fibers
into new cementum and attachment of gingival
epithelium to a tooth surface
“previously denuded by disease”

14. A. Enamel surface
B. Area of cementum denuded by pocket formation
C. Area of cementum covered by junctional epithelium
D. Area of cementum apical to the junctional epithelium
New attachment is the New Junctional Epithelium
and attached connective tissue fibers formed on zone B

15. REATTACHMENT
Attachment of the gingiva or the PDL to areas
of the tooth removed in the course of treatment

16. EPITHELIALADAPTATION
Close apposition of the gingival epithelium to
the tooth surface without complete obliteration
of the pocket

17. EPITHELIAL ADAPTATION AFTER TREATMENT
A. PERIODONTAL POCKET
B. AFTER TREATMENT
[ the pocket epithelium is
closely adapted to,
but not attached to the root ]

18. CONCLUSION
During the healing stages of a periodontal
pocket, the area is invaded by cells from
four different sources:
ORAL EPITHELIUM
GINGIVAL CONNECTIVE TISSUE
BONE
PERIODONTAL LIGAMENT

19. EPITHELIAL CELLS proliferates -- tooth surface
--- long junctional epithelium
CONNECTIVE TISSUE CELLS -- fibres parallel to the
tooth surface and remodeling of the alveolar bone
with no attachment to the cementum
BONE CELLS -- root resorption & ankylosis
PERIODONTAL LIGAMENT CELLS -- formation of
new cementum and new periodontal ligament