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Treatment plan


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Treatment plan

  2. 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. 3. Screening for peridontal disease <ul><li>Basic Periodontal examination codes: </li></ul>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 <ul><li>Standard of oral hygiene. </li></ul><ul><li>Location & quantity of plaque & calculus. </li></ul><ul><li>Examination of gingiva: </li></ul><ul><ul><li>Inflammation </li></ul></ul><ul><ul><li>Recession </li></ul></ul><ul><ul><li>Hyperplasia </li></ul></ul><ul><li>Furcation involvement </li></ul><ul><li>Degree of tooth mobility. </li></ul><ul><li>Occlusal assessment </li></ul><ul><li>Any systemic disease. </li></ul><ul><li>Radiographic examination </li></ul>
  5. 6. Treatment Plan <ul><li>Definition:- It is the blue print for case management. </li></ul><ul><li>Treatment Goals:- </li></ul><ul><ul><li>Reduction or resolution of gingivitis. </li></ul></ul><ul><ul><li>Reduction in probing pocket depth. </li></ul></ul><ul><ul><li>Elimination of open furcation in multirooted teeth. </li></ul></ul><ul><ul><li>Individually satisfactory esthetic & function. </li></ul></ul>
  6. 7. Phase of Periodontal Therapy <ul><li>Emergency Phase </li></ul><ul><li>Phase I :- Etiotropic phase </li></ul><ul><li>Phase II :- Surgical Phase </li></ul><ul><li>Phase III :- Restorative phase </li></ul><ul><li>Phase IV :- Maintenance Phase </li></ul>
  7. 8. Preferred sequence Of Periodontal Therapy. <ul><li>Emergency Phase </li></ul><ul><li>Etiotropic Phase </li></ul><ul><li>Maintenance Phase </li></ul><ul><li>Surgical Restorative </li></ul><ul><li> Phase Phase </li></ul>
  8. 9. EMERGENCY PHASE <ul><li>Treatment of any type of pain </li></ul><ul><li>Extraction of hopeless teeth. </li></ul><ul><li>Draining of the abscess </li></ul><ul><li>PHASE I ETIOTROPIC PHASE </li></ul><ul><li>“ Cause related therapy” </li></ul><ul><li>“ Non surgical periodontal therapy” </li></ul><ul><li>Objective:- </li></ul><ul><ul><li>Elimination & Preventing of reformation of bacterial deposits on tooth & root surface. </li></ul></ul>
  9. 10. <ul><li>This Phase includes : </li></ul><ul><li>Diet Counseling (Specially in patients with rampant caries) </li></ul><ul><li>Removal of plaque retentive factors - it may be: </li></ul><ul><li>Natural - Crowding, </li></ul><ul><ul><li>Developmental grooves </li></ul></ul><ul><ul><li>Enamel Pearls </li></ul></ul><ul><ul><li>Iatrogenie - Poor Margins or over contoured </li></ul></ul><ul><ul><li>restorations </li></ul></ul><ul><li>Supragingival scaling </li></ul><ul><li>Subgingival Scaling </li></ul><ul><li>Root Planning. </li></ul><ul><li>Occlusal therapy </li></ul><ul><li>Antimicrobial therapy </li></ul><ul><li>Correction of restorative & prosthetic irritatonal factors. </li></ul>
  10. 11. <ul><li>Excavation of caries & restoration. </li></ul><ul><li>Temp. or final :- Depending on whether the definite prognosis for the teeth has been arrived at the location of caries. </li></ul><ul><li>Minor orthodontic movement. </li></ul><ul><li>Chemical plaque control (for acute conditions. </li></ul><ul><li>EVALUATION OF RESPONSE TO ETIOTROPIC PHASE ( Ideally after 3 months) </li></ul><ul><li>Rechecking for :- </li></ul><ul><li>Oral hygiene status </li></ul><ul><li>Gingival inflammation & bleeding </li></ul><ul><li>Probing depth </li></ul><ul><li>Attachment level </li></ul><ul><li>Calculus </li></ul><ul><li>Caries. </li></ul>
  11. 12. Phase II - Surgical phase <ul><li>(I) Various periodontal surgical procedure. </li></ul><ul><li>Indication:- </li></ul><ul><li>Where there is impaired access for scaling & root surface debridement like:- </li></ul><ul><li>- In deeper ( > 5mm) periodontal pockets </li></ul><ul><li>- On wider tooth surfaces </li></ul><ul><li>- Presence of root fissures </li></ul><ul><li>- Presence of root concavities </li></ul><ul><li>- Furcation involvement </li></ul><ul><li>- Presence of faulty margins on subgingival restorations. </li></ul><ul><li>So it is used to – </li></ul><ul><li>- Gain access for thorough scaling & root surface debridment </li></ul><ul><li>- Establish a gingival morphology conductive to good plaque control. </li></ul><ul><li>- Reduce pocket depths </li></ul><ul><li>- Shift the gingival margin apically to plaque retaining restorations. </li></ul><ul><li>- Crown lengthening. </li></ul>
  12. 13. <ul><li>Contraindication:- </li></ul><ul><ul><li>Patient who is uncooperative during cause related therapy should not proceed to surgery. </li></ul></ul><ul><ul><li>Smoking – Impair healing after surgery. </li></ul></ul><ul><ul><li>Absolute Contraindication : </li></ul></ul><ul><ul><ul><li>Medically compromised patients </li></ul></ul></ul><ul><li>Periodontal surgery may be classified as:- </li></ul><ul><li>Access surgery : </li></ul><ul><li>Provide visual & technical access for through debridement </li></ul><ul><li>Resective surgery – removal of excess soft tissue in gingival over growth & appical relocation of gingival margin. </li></ul><ul><ul><li>Gingivectomy </li></ul></ul><ul><ul><li>Apical displaced flap surgery </li></ul></ul><ul><ul><li>Undisplaced flap with or without osseous resection. </li></ul></ul>
  13. 14. <ul><li>Regenerative surgery :- To regenerate the periodontal attachment complex i.e. cementum, PDL & bone </li></ul><ul><li>(a) flap surgery with flap graft </li></ul><ul><li>(b) flap surgery with osseous graft </li></ul><ul><li>(II) IMPLANT PLACEMENT </li></ul><ul><li>(III) ENDODONTIC THERAPY </li></ul>
  14. 15. Evaluation of response to surgical therapy <ul><li>Oral hygiene status. </li></ul><ul><li>Gingival inflammation & bleeding </li></ul><ul><li>Probing depth </li></ul><ul><li>Attachment level. </li></ul><ul><li>PHASE III – RESTORATIVE PHASE </li></ul><ul><ul><li>Final restoration. </li></ul></ul><ul><ul><li>Fixed prosthesis </li></ul></ul><ul><ul><li>Removable prosthesis </li></ul></ul><ul><li>Evaluation of response to restorative therapy </li></ul><ul><li>- Oral hygiene status </li></ul><ul><li>- Gingival inflammation & blearing </li></ul><ul><li>- Probing depth </li></ul><ul><li>- Attachment level </li></ul><ul><li>- Restoration status </li></ul>
  15. 16. <ul><li>Phase IV – Maintenance phase :- </li></ul><ul><li>Periodic maintenance :- </li></ul><ul><li>For advanced periodontal disease - 3-4 times per year. </li></ul><ul><li>Otherwise in 6 months. </li></ul><ul><li>Checking for :- </li></ul><ul><ul><li>Plaque & gingival indices </li></ul></ul><ul><ul><li>Calculus </li></ul></ul><ul><ul><li>Attachment Level </li></ul></ul><ul><ul><li>Pocket depth </li></ul></ul><ul><ul><li>Bleeding on probing </li></ul></ul><ul><ul><li>Recession </li></ul></ul>
  16. 17. Maintenance recall procedures <ul><li>PART 1 – Examination </li></ul><ul><li>Oral hygiene status </li></ul><ul><li>Gingival changes </li></ul><ul><li>Pocket depth changes </li></ul><ul><li>Mobility changes </li></ul><ul><li>Occlusal changes </li></ul><ul><li>Dental caries </li></ul><ul><li>Restorative & Prosthetic status </li></ul><ul><li>Medical history changes </li></ul><ul><li>Oral pathologic examination </li></ul><ul><li>Radiographic examination </li></ul>
  17. 18. <ul><li>PART 2 – Treatment </li></ul><ul><li>Oral hygiene reinforcement </li></ul><ul><li>Scaling </li></ul><ul><li>Polishing </li></ul><ul><li>Chemical irrigation </li></ul><ul><li>PART 3 – Schedule next procedure </li></ul><ul><li>Schedule next recall visit </li></ul><ul><li>Schedule further periodontal treatment </li></ul><ul><li>Schedule or refer for restorative or prosthetic treatment </li></ul>
  18. 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.