22. Localized Agg. Periodontitis Depending on the preference of the Practitioner & the patient Two approaches are proposed. (Wilson/Kornman) 1. Treatment with the aid of microbial information 2. Treatment with out the aid of microbial information
24. Treatment with out the aid of microbial information The clinician can assume that micro-org present will be sensitive to a member of the Tetracycline family of antibiotics. Surgery is carried out in conjunction with the antibiotic regimen. STP is accompanied by DNA Probes or microbiologic monitoring if clinical / radiographic signs of the disease recur.
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26. STAGED APPROACH (Lindhe) Mechanical therapy + Meticulous oral hygiene Clinically re-assessed after 4-6 wks Decision made to gain to deep lesions(surgery) & Ab’tic selection depending on culture sensitivity tests
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28. Antimicrobial Therapy + Non-surgical Therapy A combination pf SRP with systemic tetracycline therapy has been shown to be effective treatment for control of localized Agg. Periodontitis.
29. Antimicrobial Therapy + Surgical Therapy Baer & Socransky (1979 ) 1 st reported the combination of flap surgery & systemic antibiotic therapy. Effective means of treating localized Agg. Periodontitis.
30. Surgical Management Recommended to gain access to the subgingival microflora & to remove granulation tissue and infected connective tissue.
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34. Current Approach In almost all cases ,tetracycline(250mg qid,at least 1 wk) should be given. If surgery is indicted, then Ab’tic should be started approximately 1 hr before surgery. Doxycycline – 100 mg/day Chlorhexidine rinses used to augment plaque control.
35. In Refractory LAP cases, Tetracycline-resistant Actinobacillus species suspected. Combination therapy preferred. Amoxicilin -375 mg & Metronidazole -250 mg TID for 7 days.
36. Generalized Agg. Periodontitis Other micro-organism also present. Microbial analysis is recommended before therapy & at each re-evaluation. GOAL :- Elimination of the suspected pathogen which requires systemic Ab’tics adjunct to mechanical therapy
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