2. WHAT ARE WE GOING TO UNDERSTAND ?????
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WHO IS A PERIODONTALLY
HEALTHY PATIENT?
WHAT IS GINGIVITIS,
PERIODONTITIS
TREATMENT PLANNING OF
PATIENT
3. CLINICAL GINGIVAL HEALTH
The lack of bleeding upon probing, erythema,
edema, clinical attachment,
and bone loss define clinical gingival health.
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4. GINGIVITIS
• presence of ≥10% bleeding sites with PDs ≤3.5 mm in the oral
cavity has been adopted as an objective criteria
• primarily a clinical diagnosis, radiographs have no role in
diagnosing a case of gingivitis, as there is no involvement of
alveolar bone
9. Guidelines for treatment
Controlling calculus, subgingival biofilm- goal of the treatment.
Retentive factors- by the tooth’s architecture or, more frequently,
by insufficient restorative margins, should be eradicated to reduce
their detrimental effects on periodontal health.
They frequently induce gingival inflammation and/or the loss of
periodontal attachments.
Subgingival instrumentation removes hard and soft deposits from
the tooth surface in an effort to reduce soft-tissue inflammation.
10. It is therefore recommended using either manual or powered
(sonic/ultrasonic) tools, either separately or in combination, for
subgingival periodontal instrumentation
A traditional quadrant-wise or complete mouth delivery of
subgingival periodontal instrumentation can be accomplished
within 24 hrs
No evidence related to need for an adjunct drug for gingivitis
unless medically compromised.
11. The residual pocket depth after Step 1 of Phase I therapy determines further
line of treatment and shifting the step 2 of phase I therapy.
If end-point of treatment is achieved, the patient is shifted to SPT (Phase III)
If the PD is more than 3.5 mm with BOP, Step 2 of Phase I should be initiated
On re-evaluation, after Step 1 of Phase I therapy, the treatment options can be
divided on the basis of residual pocket depth
Residual pocket is 3.5-5.5 mm
Residual pocket is more than 5.5 mm.
12. Treatment options in case with residual pocket depth is in
between 3.5-5.5 mm.
Repetitive subgingival instrumentation in adjunct with short-
term use of chemotherapeutics (antiseptics)
chlorhexidine mouthwashes is indicated
Specific systemic antibiotics as an adjunctive may be considered
for specific patient category for example generalized
periodontitis in young adult patients
13. The treatment options in case with residual pocket depth is
more than 5.5 mm
These categories of patients are treated under surgical phase.
In order to reduce the inflammation, patients with pocket depth of more than
5.5mm may be subjected to Step 2 of Phase I therapy, as subgingival
instrumentation may be used as presurgical procedure to reduce
inflammation.
14. Surgical treatment, although indicated, may not be feasible due
to uncontrolled diabetes or patients with CVS disorders, age
factors, patient’s apprehensions, economic factors and post
treatment recurrence.
In such cases, shifting the patient to Phase II may not be possible
Such patients where surgery is indicated but cannot be
undertaken, are maintained by implementing Step 2 of Phase I
therapy by repeated use of subgingival instrumentation in
adjunct with short-term use of chemotherapeutics (antiseptics),
notably chlorhexidine mouthwashes
