Clinical Parameters


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Clinical Parameters

  1. 1. Clinical Parameters Furcation Recession Mobility <ul><li>This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation </li></ul><ul><li>In Slide Show, click on the right mouse button </li></ul><ul><li>Select “Meeting Minder” </li></ul><ul><li>Select the “Action Items” tab </li></ul><ul><li>Type in action items as they come up </li></ul><ul><li>Click OK to dismiss this box </li></ul><ul><li>This will automatically create an Action Item slide at the end of your presentation with your points entered. </li></ul>
  2. 2. Learning Outcomes
  3. 3. Furcations: Clinical Considerations <ul><li>May or may not be clinically exposed </li></ul><ul><li>Bifurcation: 2 rooted tooth </li></ul><ul><li>Trifurcation: 3 rooted tooth </li></ul><ul><li>Radiographs may aid diagnosis </li></ul><ul><li>Suspect furcation involvement when pockets measure 5-6 mm+ </li></ul><ul><li>Increased risk for root caries, root resorption, recession sensitivity, pulp involvement, abscess formation </li></ul>
  4. 4. Furcations <ul><li>Extension of bone loss between roots of teeth </li></ul><ul><li>Teeth with furcation involvement are high risk for continued attachment loss </li></ul><ul><li>Detection of furcation faciliated by using a specially designed furcation probe </li></ul>
  5. 5. Probing Furcations <ul><li>No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe </li></ul><ul><li>Move probe towards location of the furcation & curve into furcation area </li></ul>
  6. 6. Probing Furcations <ul><li>Access to furcations: </li></ul><ul><ul><li>Mesial surface max. molars: </li></ul></ul><ul><ul><ul><li>Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface </li></ul></ul></ul><ul><ul><li>Distal surface of max. molars </li></ul></ul><ul><ul><ul><li>Located more towards midline </li></ul></ul></ul><ul><ul><ul><li>Detected from buccal or palatal approach </li></ul></ul></ul>
  7. 7. Probing Furcations <ul><li>Most common site: mand. First molar </li></ul><ul><li>Least common site: max. first bicuspid </li></ul>
  8. 8. Furcations: Classification, Characteristics, Treatment <ul><li>Perio debridement </li></ul><ul><li>Flap with odontoplasty & osteoplasty </li></ul><ul><li>Guided tissue regeneration (more success with mand. Molars) </li></ul><ul><li>Root resection </li></ul><ul><li>Bone lost on one or more aspects, > 3 mm but not through & through </li></ul><ul><li>Horizontal depth varies </li></ul><ul><li>Vertical bone loss possible </li></ul><ul><li>Possible radiographic visibility </li></ul>Grade II <ul><li>Perio debridement </li></ul><ul><li>Odontoplasty </li></ul><ul><li>Initial involvement, may penetrate area up to 3 mm </li></ul><ul><li>Slight bone loss </li></ul><ul><li>Suprabony pockets </li></ul><ul><li>No radiographic changes </li></ul>Grade I Treatment Options Characteristics Furcation
  9. 9. Furcations: Classification, Characteristics, Treatment <ul><li>Debridement </li></ul><ul><li>Flap surgery </li></ul><ul><li>Interradicular bone absent </li></ul><ul><li>Clinically visible </li></ul><ul><li>“ Through & through” </li></ul><ul><li>Radiographically visible </li></ul>Grade IV <ul><li>Perio debridement </li></ul><ul><li>Flap procedure </li></ul><ul><li>Odontoplasty </li></ul><ul><li>Root resection </li></ul><ul><li>hemisection </li></ul><ul><li>Interradicular bone absent </li></ul><ul><li>Access on fa/li blocked by gingiva </li></ul><ul><li>“ Through & through “ </li></ul><ul><li>Radiographically visible </li></ul>Grade III Treatment Options Characteristics Furcation
  10. 10. Furcations <ul><li>Slimline access </li></ul><ul><li>Radiographic assessment </li></ul>
  11. 11. Root Resection & Hemisection <ul><li>Root resection: </li></ul><ul><ul><li>Performed on vital or endodontically treated teeth </li></ul></ul><ul><li>Hemisection: </li></ul><ul><ul><li>Splitting of two rooted tooth into two parts </li></ul></ul><ul><ul><li>Following sectioning, one or both roots can be retained </li></ul></ul><ul><li>Classification </li></ul>
  12. 12. Mobility <ul><li>Risk factor for PD </li></ul><ul><li>Measure extent, determine cause </li></ul><ul><li>Normal physiologic movement not graded </li></ul><ul><li>Degree of mobility not always correlated to amount of bone loss </li></ul>
  13. 13. Causes of Mobility <ul><li>Mobility may be related to: </li></ul><ul><ul><li>Trauma from occlusion </li></ul></ul><ul><ul><li>Loss of periodontal support </li></ul></ul><ul><ul><li>Gingival inflammation </li></ul></ul><ul><ul><li>Pregnancy & hormonal changes </li></ul></ul><ul><ul><li>Periodontal surgery </li></ul></ul><ul><li>Minor mobility can usually be maintained </li></ul><ul><li>Increasing mobility – more frequent PMT and/or referral for surery </li></ul>
  14. 14. Classification of Mobility <ul><li>Nomenclature used varies across systems: </li></ul><ul><ul><li>Class I etc. </li></ul></ul><ul><ul><li>Grade I etc. </li></ul></ul><ul><ul><li>I mobility etc. </li></ul></ul><ul><ul><li>Grade 1 etc. </li></ul></ul><ul><ul><li>1, 2, 3 </li></ul></ul>
  15. 15. Classification of Mobility <ul><ul><li>N=normal physiologic mobility </li></ul></ul><ul><ul><li>Grade I=slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction </li></ul></ul><ul><ul><li>Grade II=moderate mobility, > 1 mm of horizontal displacement </li></ul></ul><ul><ul><li>Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical) </li></ul></ul><ul><ul><ul><li>Nield-Gehrig & Houseman, 1996 </li></ul></ul></ul><ul><li>Mobility can be measured using 2 instrument handles </li></ul>
  16. 16. Recession <ul><li>Disturbance to the gingiva results in an apical shift of the gingiva margin </li></ul><ul><li>Actual recession: </li></ul><ul><ul><li>Level of the epithelial attachment on tooth </li></ul></ul><ul><li>Apparent recession: </li></ul><ul><ul><li>Level of the crest of the gingival margin </li></ul></ul>
  17. 17. Etiology of Gingival Recession <ul><li>Causes: </li></ul><ul><ul><li>Mechanical trauma: hard brush, vigorous technique </li></ul></ul><ul><ul><li>Crown margins </li></ul></ul><ul><ul><li>Periodontal disease </li></ul></ul><ul><ul><li>Occlusal trauma </li></ul></ul><ul><ul><li>Defects in bone </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>Trauma from teeth in opposing jaw </li></ul></ul><ul><ul><li>Oral habits, oral piercing </li></ul></ul><ul><ul><li>Poorly designed partial dentures </li></ul></ul><ul><ul><li>Tooth position </li></ul></ul><ul><ul><li>Healing response following periodontal surgery </li></ul></ul>
  18. 18. Gingival Recession <ul><li>Toothbrush Trauma </li></ul>
  19. 19. Gingival Recession <ul><li>Trauma from denture </li></ul>
  20. 20. Gingival Recession <ul><li>Oral Piercing </li></ul>
  21. 21. Gingival Recession <ul><li>Orthodontics </li></ul>
  22. 22. Gingival Recession <ul><li>Prominent Roots </li></ul>
  23. 23. Gingival Recession <ul><li>Frenal Attachment </li></ul>
  24. 24. Symptoms/signs <ul><li>Client usually complains of: </li></ul><ul><ul><li>Sensitivity </li></ul></ul><ul><ul><li>Aesthetics </li></ul></ul><ul><li>Complications: </li></ul><ul><ul><li>Increased sensitivity </li></ul></ul><ul><ul><li>Loss of tissue from root surface (erosion, abrasion) – protective cementum removed </li></ul></ul><ul><ul><li>Caries </li></ul></ul><ul><ul><li>Greater risk for PD: greater surface area for plaque retention </li></ul></ul>
  25. 25. Treatment Options <ul><li>Depends on cause </li></ul><ul><li>Nonsurgical treatment includes : </li></ul><ul><ul><li>Debridement </li></ul></ul><ul><ul><li>Oral self-care instruction </li></ul></ul><ul><ul><li>Local medicaments for sensitivity </li></ul></ul>
  26. 26. Treatment Options <ul><li>Surgical treatment : </li></ul><ul><ul><li>Laterally positioned flap </li></ul></ul><ul><ul><li>Connective tissue graft </li></ul></ul>