Factors responsible for the failure of periodontal therapy

FACTORS RESPONSIBLE
FOR FAILURE OF
PERIODONTALTHERAPY
BY
DR. ANTARLEENA SENGUPTA
PG, DEPTT OF PERIODONTOLOGY
MCODS MANGALORE
2020
1

CONTENTS
■ Introduction
■ Failures – dentist related factors
■ Failures – patient related factors
■ Classification of failures
– Pre-therapeutic
– Therapeutic
– Post-therapeutic
■ Summary
■ Conclusion
■ References
2

INTRODUCTION
■ Treatment failures appear to occur more frequently in periodontology than in other dental
disciplines. Inappropriate patient selection, incomplete diagnostic procedures, errors in
diagnosis or prognosis, treatment difficulties, unsupervised healing, and the absence of
maintenance therapy may be causes of such failures. A regular recall program can largely
prevent such failures (Rateitschak, 1994)
 Comprehensive analysis
 Presence of plaque even after successful primary care
 Intensity and quality of oral hygiene
 Pathogenicity of the microorganisms
 Immune status of the patient
3

INTRODUCTION
■ The following clinical parameters must be considered as treatment failure:
Continued bleeding on
probing
Symptoms of activity (exudate/pus) in
addition to bleeding are seen in response to
probing.
Probing depth is not
reduced or continues
to increase.
Attachment loss is
progressive
Tooth mobility is
increased.
4

Treatment failures can be:
Dentist-related
failures Patient-related
failures
5

DENTIST-RELATED FAILURES
Gathering data
Improper diagnosis
Improper investigations
Inadequate motivation
Improper treatment sequencing
Incomplete treatment
Lack of adequate post-op instructions
Irregular follow-ups
6

PATIENT-RELATED FACTORS
Maintenance
Smoking
Systemic Diseases
Poor healing potential
Psychological component
Compliance of the patient
7

Pre-therapeutic
Therapeutic
Post-therapeutic
8

INCORRECT PATIENT SELECTION
■ A properly educated and motivated patient is a prerequisite for
comprehensive periodontal therapy. (Johnson GK, Hill M., 2004)
■ Poor oral hygiene
■ Smokers– not ready to quit
■ Age
■ Socio-economic status
10

INCORRECT PATIENT SELECTION
■ Incorrectly selected patients also include those patients who have a
systemic disease that could promote periodontitis.
 Diabetes Mellitus
 Blood Dyscrasia
 Immune deficiencies
 Genetic disorders
 Vitamin deficiencies
 Side effects of various drugs (-induced DIGO)
11

- INCOMPLETE DIAGNOSTIC PROCEDURE
- MISDIAGNOSIS
- INCORRECT PROGNOSIS
■ The seriousness of the disease must be established exactly
■ For each tooth individually and for each side of a tooth.
■ Important to describe the pathobiology of the periodontal state
‐ Improper Clinical diagnosis
‐ Radiological interpretations
‐ Microbiological interpretation
‐ Biochemical interpretation
‐ Immunological interpretation
12

■ Inappropriate or improper dental restorations or prosthesis
- Overhanging Class II , overextended crowns & bridges.
■ Failure to carry out associated prosthetic-restorative procedure
■ Morphology of tooth surfaces :
- Lateral accessory canals
- Developmental grooves
- Resorption lacunae – act as “Guide plane” for bacterial penetration
■ Habits
■ Occlusal corrections or teeth preparation
- TFO prevent proper adaptive remodeling of periodontium
13

- Dull instruments: burnishing of
calculus
- regular sharpening of instruments
- improved patient comfort and
operator performance.
FAILURES ASSOCIATED WITH NON-SURGICAL
PERIODONTALTHERAPY
■ 1⁰ objective of NSPT  to restore gingival health
- completely removing inflammatory elements
- Plaque
- Calculus
- Necrotic cementum
- Endotoxin embedded on the root surface
Failures
associated
with SRP
Persistent
inflammation
Instrument
condition
Faulty
technique
- Residual embedded calculus
- inadequate accessibility & visibility-- deep
pockets
- complex anatomical areas of the tooth
(furcation areas, grooves & concavities present
on the root surface)
- ↓angulation (<45º to the long axis of
the root surface) -- burnishing of
calculus
- prevent it from being removed in
total.
- ↑angulation (>90º to the long axis of
the root surface) can lead to
laceration and trauma to the gingival
tissues.
■ Abscess formation can also be noticed in situations wherein residual calculus is embedded in the
tissues.
■ Mechanical therapy which follows the principles of periodontal instrumentation will result in reduction
in failures in periodontal therapy.
ABBAS et al.., 2009
15

SPLINTING
■ Failures could be:
- Increased plaque accumulation
- Inflammation in the area
- Higher bite force application
- Fracture of splint
- Complete/Partial debonding of splint from tooth
surface
- Detachment of overlying composite
FAILURES ASSOCIATEDWITH NON-SURGICAL PERIODONTALTHERAPY
16

OCCLUSALTHERAPY
■ Diagnosis of occlusal abnormalities
■ Pre-existing parafunctional habit
■ Poor mandibular muscle coordination
■ Assessment of tooth
■ Can lead to:
– Dental instability
– Functional discomfort
– Dental or musculo-articular
complaint
[Clark & Adler, 1985]
[Hallmon et al., Perio 2000, 2004]
17

LOCAL DRUG DELIVERY (LDD) OF
ANTIMICROBIALAGENTS
■ Difficulty in placing LDD in inaccessible, deep
pockets and in furcation
■ Development of resistance among bacteria/
refractory periodontitis
■ Time consuming and expensive if many sites are
involved with periodontal disease
(Rateitschak KH, 1991)
18

SUPRAGINGIVAL & SUBGINGIVAL IRRIGATION
(i) Persistence of inflammation as the irrigant solution
cannot be penetrated into deeper pockets.
(ii) The drug present in the irrigant gets thrown out of
the gingival sulcus/periodontal pocket by the
constantly oozing crevicular fluid (which is known as
“wash-out effect”).
(iii) Irrigation cannot be employed as a solo therapy, it is
weakly effective even as adjunctive therapy.
[Cosyn et al., 2007]
19

FAILURES ASSOCIATEDWITH
SURGICAL PERIODONTALTHERAPY
In general:-
■ Improper treatment sequencing
■ Improper selection of technique
■ Incomplete treatment
■ Improper asepsis
■ Improper primary closure
20

■ FAILURE: Persistence of inflammation after procedure
■ FACTORS FOR FAILURE:
1. Diagnosis per se
2. Procedural errors
- Instrumentation
- when to stop
3. Failure to irrigate
4. Remnant tags of granulation tissue
5. Suture a curetted area
FAILURES ASSOCIATEDWITH SURGICAL PERIODONTALTHERAPY
GINGIVAL CURETTAGE
21

GINGIVAL CURETTAGE
- No evidence that gingival curettage has any therapeutic
benefit in the treatment of chronic periodontitis
- American DentalAssociation has deleted that code from
the fourth edition of Current DentalTerminology (CDT-4).
- American Academy of Periodontology, in its Guidelines for
PeriodontalTherapy, did not include gingival curettage as a
method of treatment.This indicates that the dental
community as a whole regards gingival curettage as a
procedure with no clinical value. [2002]
22

ABSCESS DRAINAGE
1. Identification of source/ origin tortuosity of pocket &
complexity of the tooth
2. Removal of entire abscess wall-- remnant tags act as a
nidus
3. Chronic abscesses tend to show more recurrence.
4. Systemic/ Local drug delivery is mandatory; if it’s a
periodontal abscess.
23

FRENECTOMY
Reattachment of frenum
Gaping wound
- Improper incision design
- Failure to sever underlying periosteal
attachment
- Improperly placed sutures
24

CROWN LENGTHENING
■ Inflammation of the gingiva due to
violation of the biological width
■ Unaesthetic appearance
■ Excessive removal of the bone
25

CROWN LENGTHENING
26

GINGIVAL DEPIGMENTATION
■ Lack of patient cooperation in SMOKERS
■ ↑ Melanin pigmentation is associated with ↑ in
smoking – “SMOKER’S MELANOSIS” [HEDIN
CA et al.,Journal of Periodontal Research, 1987]
■ Electrocautery care should be taken to
prevent necrosis of bone
■ Use of chemical agents uncontrolled depth of
action-- may be damage to the bone and
underlying tissue
Prasad et al., Indian J Dent Res., 2005
27

GINGIVECTOMY
■ Failure in Gingivectomy is described by recurrence of lesion either immediately within a few
weeks or by destruction of the periodontal apparatus.
The reasons for the failures may be:
1. Choice of unsuitable cases
2. Failure to map out the pocket depths
3. Commencing or terminating the incision in a papilla
4. Cutting with insufficient obliquity
5. Failure to eliminate pockets
6. Leaving tags
7. Inaccessible interdental spaces
8. Insufficient packing
9. Loose packs
10. Loss of packs
11. Failure to prescribe stimulators
12. Failure to use stimulators
13. Non elimination of etiological factors
14. Non-elimination of predisposing factors
15. Failure to complete treatment
B.A.Wade (1954)
28

TREATMENT OF FURCATION-INVOLVED
TEETH
■ Anatomy
■ Patient-related: inability to maintain furcal area
free of plaque
■ Clinician-related: lack of access
[Needleman I, 2010]
- Frequency and duration of post-op recall intervals
- Levels of plaque control
- Presence of risk factors such as smoking and
genetic susceptibility.
- Endodontic failures, root fractures and caries
development in the furcation area
29

PERIODONTAL FLAP SURGERY
■ Improper anesthesia / block
■ Improper incision
■ Reflection of the flap
■ Debridement of the root surfaces and the bone
■ Suturing
■ Flap perforation
■ Dead space
■ Flap necrosis
■ Injury to nearby artery, nerves
■ Tissue Emphysema
(Raznik JC, 1990)
30

FAILURES ASSOCIATEDWITH SURGICALTHERAPY
PERIODONTALFLAP SURGERY
31

PAPILLA PRESERVATION FLAP
■ Presence of too narrow interdental space
■ Incisions
■ Suturing
Takei et al., 1985
- patient factors
- plaque control
- % of bleeding on probing
- smoking habit
- morphology of the defect
- surgical strategy including flap design
32

SOFTTISSUEAUGMENTATION
SURGERY
■ Common failures associated are
1. Mismatch between graft size and defect
2. Improper graft adaptation to the underlying periosteum
3. To permit adequate transfusion of the graft
4. Graft movement
5. Post-op mobility of graft
Griffin et al., 2006
33

PALATAL FLAPS
■ Common failures associated:
i. Flap may be too short  delayed healing & increased
patient discomfort
ii. Poor marginal flap adaptation  incomplete thinning of
tissue
iii. Incision beyond the vertical height of the alveolus 
severed palatal artery
iv. Extension beveling or thinning of tissue on a low, broad
palate
v. Tissue placement too high onto the teeth  poor flap
adaptation + recurrent pockets
Rateitschak KH. 1994
34

ROOT COVERAGE PROCEDURES
■ PRE-SURGICALCONSIDERATIONS:
- The etiology of the recession must be corrected: position of the tooth, the extent of
malocclusion if present, the thickness of the gingiva present in the adjacent area
- Depth of the vestibule
- Width of attached gingiva
- Graft handling could be one of the reasons for failure-- Squeezing of the graft leads to leakage
of the plasmatic fluid DESSICATION
- Size of the graft: ideal size = 1.25-1.5 mm
- Presence of clot between the graft and root surface  compression of graft against root surface
- Root conditioning: MUST, especially in soft tissue graft procedures
• SOFTTISSUE GRAFTS :
- Sub-epithelial ConnectiveTissue Grafts
- Epithelialized Grafts
• ROTATED FLAPS
35

■ Recipient bed is too small to provide adequate blood supply
■ Perforation of the mucosal flap
■ Inadequate (small) size of the graft
■ Inadequate coronal positioning of the flap
■ Poor root preparation and/or root conditioning
■ Too thick a connective tissue graft
■ Poor papillary bed preparation
■ Inadequate immobilization of graft
■ Excessive tension (frenal pull/suturing)
■ Unprotected site
■ Lack of plaque control
Langer & Langer, 1992
SUBEPITHELIALCONNECTIVETISSUEGRAFT
36

■ Increase in early wound failures or post‐operative
complications
■ Width of the residual keratinized tissue before the root
coverage procedure
■ Use of a specific flap design with or without vertical
releasing incisions.
(Cairo,Cortellini et al., 2016)
SUBEPITHELIALCONNECTIVETISSUEGRAFT
37

 The sutured graft should always be either at the level or higher
than the level of adjacent recipient bed but never below; this
leads to graft rejection (Chiranjeevi ,1989).
 Recipient bed preparation should be beveled and broader at
the base.
EPITHELIALIZEDGRAFT
38

■ INTRA-SURGICALCONSIDERATIONS:
- Horizontal incision; mandatory to maintain viability of papilla.
- Cut-back incision; prevents tissue ledges.
- Partial thickness is desired as this may prevent donor site recession
- Coronally displaced flaps fail most often because they are either secured in tension and are
not stable; thus vertical incisions play a critical role in success of this procedure.
- These procedures show limited success if inter-proximal recession is also present
ROTATED FLAPS
39

■ CORONALLY DISPLACED FLAP
- Secured in tension
- Not stable
■ LATERALLY POSITIONED FLAP
- Tension– distal incision
- Narrow flap
- Exposure of bone
- Poor stabilization
ROTATED FLAPS
40

■ DOUBLE PAPILLA FLAP
– Non union of component flaps
– Full thickness flap  Dehiscence or fenestrations
– Inadequate attached gingiva in the papillary area
– Proper placement of the flap on periosteal bed
– Adequate fixation of the flap to prevent shifting
ROTATED FLAPS
41

REGENERATIVETECHNIQUES
■ Bone grafting Procedures
■ GTR Procedures
■ Growth Factor usage
42

■ PRE-SURGICALCONSIDERATIONSTOAVOID GRAFT FAILURE–
I. Assessment of defect morphology
II. Technique of placement
III. Maintenance of vascular continuity
IV. Overfilling the defect
V. Flap margin bleed
VI. Postoperative infection control
VII. Graft sterilization
VIII. Primary closure with no intervening graft particles
BONE GRAFTING PROCEDURES
43

 GENERAL CONSIDERATIONSTO PREVENT FAILURE OF MEMBRANE
‐ Adaptation of membrane
‐ Prevention of collapse
‐ Trimmed membrane
‐ Membrane exposure
‐ Membrane suture
GTR PROCEDURES
44

GTR PROCEDURES
BARRIER-INDEPENDENT FACTORS
• Poor plaque control
• Smoking
• Occlusal trauma
• Sub-optimal tissue health (e.g., persistent
inflammation)
• Mechanical factors (aggressive toothbrushing)
• Overlying gingival tissue
- Inadequate zone of keratinized tissue
- Inadequate tissue thickness
• Surgical technique
- Improper incision
- Traumatic flap elevation & management
- Excessive surgical time
- Inadequate flap closure/suturing
• Post-surgical factors
- Premature tissue challenge (plaque
recolonization, mechanical insult)
- Loss of wound stability (loose sutures etc)
BARRIER- DEPENDENT FACTORS
• Inadequate root adaptation (absence of barrier effect)
• Non-sterile technique
• Instability (movement) of barrier against root.
• Premature exposure of barrier to oral environment &
microbes.
• Premature loss or degradation of barrier.
45

• Method of draw-- various techniques
- blood bank draw technique
- superior viable platelet concentrate
• Shelf life
- 24 hours
- chair side equipment.
• Use of thrombin– must be used in the ratio 1:7
• Aspiration technique– used in case of fragile platelets
• When used alone will invariably fail to show desired results.
• Prevent standing of PRP leads to premature bursting
GROWTH FACTOR USAGE
46

IMPLANTS
■ Presurgical
■ Surgical
■ Prosthetic Loading
■ Post surgical
47

Presurgical
• Incomplete evaluation
of
• medical history
• Clinical parameters -
periodontal status
,bone density, Implant
size & design,
anatomic location
Surgical
• Improper angulations
• Over heating of the
drill
• Thread exposure
• lack of primary
stability
• Immediate loading
without undermining
occlusion
• Rejected bone graft
Prosthetic loading
• Early placement
• Inadequate time for
gingival formation
• Immediate loading
with function
• Lack of interdental
space
• Improper cuspal
occlusion
• Screw loosening
Post surgical
• Peri implant mucositis
• Peri - implantitis
• Improper maintenance
by the patient
IMPLANTS
48

• IMPLANT
- Previous failure
- Surface roughness
- Surface purity and sterility
- Fit discrepancies
- Intra-oral exposure time
• MECHANICAL OVERLOADING
- Premature loading
-Traumatic occlusion due to inadequate
restorations
• PATIENT (LOCAL FACTORS)
- Oral hygiene
- Gingivitis, Adjacent infection/inflammation
- Bone quantity/quality,
- Periodontal status of natural teeth
- Impaction of foreign bodies (including debris
from surgical procedure) in the implant socket
• PATIENT (SYSTEMIC FACTORS)
-Vascular integrity
- Smoking, Alcoholism
- Predisposition to infection e.g. age, obesity,
steroid therapy, malnutrition, metabolic
disease (diabetes) Systemic illness,
Chemotherapy/radiotherapy
- Hypersensitivity to implant components
IMPLANTS
49

THERAPY OF ENDO-PERIO LESIONS
■ GENERAL CONSIDERATIONS FOR FAILURE OFTREATMENT OF EPL:
- Incorrect diagnosis – poor case selection, misdiagnosis
- Traumatic injuries
- Internal resorption
- Systemic diseases
- Anatomical variations
- Technical difficulties
- Infections
Causes of Endodontic failure
• Poor debridement
• Broken instruments
• Mid treatment flare up
• Mechanical & chemical irritants
• Access preparation
• Excessive haemorrhage
• Improper obturation
• Iatrogenic causes – apical & mid root & furcation
perforation
• Patient compliance
Causes of periodontal failures
• Incorrect diagnosis – poor case selection,
misdiagnosis
• Incomplete debridement
• Patient compliance
Porto et al., 2013
50

ELECTROSURGERY
 FACTORSAFFECTING FAILUREOFTREATMENT OUTCOME
- proper current
- depth of incision (Orban, 1944) concentration of heat stasis of blood flow necrosis
- time in contact with tissue
- proximity of electrode to bone
- thickness of tissue
SIMON et al., 1976
 undamped, fully rectified, current.
51

LASERTHERAPY
- Improper case selection
- Improper use of LASER against protocol
- Overheating of tooth/ implant surface/ soft tissues
- Patient compliance to post-op instructions
- Technique-sensitive; dependent on operator skill
AAP Consensus 2018, MILLS et al.
52

INAPPROPRIATETREATMENT
■ Ultimate end point of any periodontal therapy is elimination of plaque
■ Factors affecting failure:
– uneven course of periodontal pocket
– Micro morphology of the root surface
– macro morphology of the root surface
■ Elimination of subgingival plaque is incomplete 
[Rateitschak, 1994]
MAIN REASON
- Course of the pocket floor can be irregular-- early and middle stages of the disease.
- Although a very deep pocket may exist on one side of the tooth, there may be little
loss of attachment on another surface.
- Course of the pocket floor-- may have undercut regions, so that it is very difficult—
particularly during a closed procedure—to reach the pocket floor with the curette and
thus to achieve thorough root cleaning.
- If large masses of bacteria remain deep in the pocket, failure is certain.
- Occasionally small resorptive regions (lacunae) are present on the
root surface
- These may be up to 80 m deep -- cannot be reached by curettes or
other instruments, whether used in closed or open debridement
procedures.
- Microorganisms that promote recurrences remain in these niches.
- In practice, almost no single-rooted teeth have round or oval cross sections-- usually have hourglass
like depressions
- fused roots that often run together in a deep groove -- act as a "guide plane" for bacteria.
- largely inaccessible to curettes-- failures are frequent in teeth with such unfavorable macro
morphology.
- more complicated in the molar region– existing open furcations
- Despite treatment, these sites remain as minor sites of resistance that can lead to failure
54

UNSUPERVISED HEALING
■ Failures arising soon after completion of treatment can be traced to the absence of
supervision of the healing process (Tan AE et al., 2009)
■ Treated region should be professionally cleaned supragingivally ~2 weeks interval
■ The oral hygiene status of the patient must be assessed repeatedly at short intervals
55

ABSENCE OF MAINTENANCETHERAPY
■ Maintenance therapy or supportive periodontal therapy aka PHASE IV
■ Decisive for long term success and prevents recurrence of the disease
■ Frequency of recall is based on variety of factors such as
– Primary diagnosis
– Presence of systemic conditions (e.g., Diabetes)
– Presence of risk factors (e.g., Smoking)
– Success of primary treatment following a period of supervised healing
– Extent to which the patients can be motivated to cooperate
■ Depending on the needs of the individual case, recall visits can be between 2 months to 1 year
American Academy of Periodontology. Parameter on periodontal maintenance. J Periodontol. 2000; 71(5 Suppl):849-50.
56

ABSENCE OF MAINTENANCETHERAPY
■ Specific examinations are necessary at each recall appointment.
■ At each recall appointment gingival status, amount of plaque
■ At longer intervals (12 months) pocket depth and the presence of symptoms of activity in single pockets should be
recorded.
■ >12 months Occlusion, need for reconstruction, condition of restorations, tooth vitality, and existence of new carious
lesions
■ 4 years New radiographs; also prepared if pockets are found to recur or new pocket activity is noted
■ Each recall visit re-motivation of the patient, assessment of oral hygiene and reinforcement of patient instruction,
and removal of plaque and calculus at indicated sites.
– Scaling should not be done on all teeth.
– Teeth free of deposits need not be touched with a scaler.
– Frequent scaling of sound teethloss of attachment. [LINDHE, 1985; RAMFJORD, 1987; KALDAHL, 1990]
– Judicial use of chairside time for regular recall appointments    intended to prevent periodontal treatment
failures is, in most instances, severely underestimated. The great expenditure of time for diagnosis, motivation,
instruction, and actual treatment of patients with periodontitis has been noted. Maintenance therapy also takes
time.Twenty-minute recall appointments are at best "alibi exercises."
WORK DONE ESTIMATEDTIME REQUIRED
Extensive diagnostic measures 5-10 minutes
Brief conversation with the patient about the present
status of the oral cavity + associated re-motivation
efforts
5 minutes
Plaque disclosure + reinstruction about oral hygiene 5 minutes
Instrumental removal of supragingival plaque and
calculus (indicated sites) + subgingival scaling (without
anesthesia) at pockets ≤4 mm deep
20 minutes
Removal of discoloration (Chlorhexidine use/ smoking) 3 minutes
Polishing (full mouth) 5 minutes
Application of topical Fluoride (full mouth) 5 minutes
Final inspection of work done 5 minutes
Patient discharge + disinfection of operatory, fresh
instruments placed
5 minutes
[Rateitschak, 1994] 57

FACTORS FOR FAILURES ASSOCIATEDWITH
MAINTENANCETHERAPY
■ Improper Check on the plaque control
■ Improper motivation for plaque control & cessation of smoking
■ Improper Control of systemic diseases
■ Failure to continue with treatment-- conscious or unconscious decision
■ Inadequate treatment at maintenance visits
58

MAINTENANCETHERAPY: CURRENT CONCEPT
59

MAINTENANCETHERAPY: CURRENT CONCEPT
Lang NP, Tonetti MS. Periodontal risk
assessment (PRA) for patients in supportive
periodontal therapy (SPT). Oral Health Prev
Dent. 2003 Jan 1;1(1):7-16.
 Current thinking:
- Patient-focused decision making
- Risk assessments for periodontal disease
 Periodontal risk assessment:
- Current periodontal health
- Genetic influences
- Systemic influences
- Local influences
- Iatrogenic factors
- Lifestyle influences
- Host response
 Length of Phase IV:
- Patients can modify their own disease risk
- Refractory nature– associated with patient compliance
- Reduce frequency of interval based on the above
 Conclusion:
- Life long regime of regular monitoring and support
- Conduct risk assessment to determine recall interval
Page RC, Krall EA, Martin J, Mancl L, Garcia RI.Validity and
accuracy of a risk calculator in predicting periodontal
disease. J Am Dent Assoc. 2002;133:569–76. 60

SUMMARY
■ Because of numerous failures, periodontal treatment is frequently discredited.Careful
attention to a few important points can improve the success rate of periodontal therapy:
1. Only those patients prepared for long-term cooperation should be treated.
2. Time cannot be saved in diagnostic procedures
3. The limits of successful therapy must be recognized
4. Reinfection of the pockets must be prevented through supervision of the healing process by
repeated cleaning of the teeth and checking of oral hygiene
5. Long-term treatment success is possible only if the patient, once treated, is placed on a
regular recall schedule.
61

CONCLUSION
■ Proper diagnosis, selection of correct treatment, prognosis assessment, patient motivation,
gentle tissue handling, strict asepsis and a quick surgery are the key factors for the
prevention of the failures in periodontal therapy.
■ Failures in periodontal therapy is because of failures in the biologic preparation of
periodontal structures, education and psychological preparation of the patient , and
informing the importance of periodontal therapy before subjecting patient to surgery
■ Patient’s confidence and rapport must be established at the initial visits, and that may be
the key factor for the successful management of a surgical case.
62

REFERENCES
1. Rateitschak KH. PeriodontalTreatment Failure. Parodontologie (Berlin, Germany). 1991
Aug;2(3):223-34.
2. Rateitschak KH. Failure Of PeriodontalTreatment. Quintessence International. 1994 Jul 1;25(7).
3. KD Jithendra, BansaliA, Ramachandra SS Failures In PeriodontalTherapy. Bangladesh Journal
Of Medical ScienceVol.09 No.4 Jul’10
4. Dr.Ramaswamy.Causes Of Failure Of PeriodontalTreatment. JISP 1995; 19:23-24.
5. Gerald Kramer. Dental Failures AssociatedWith Periodontal Surgery. DCNA 1972;16:13-31.
6. Bradley Re. Periodontal Failures RelatedTo Improper Prognosis &Treatment Planning. DCNA
1972; 6:1:pg33-43.
7. Wang HL, MacNeil RL. Guided tissue regeneration. Absorbable barriers. Dental Clinics of North
America. 1998 Jul;42(3):505-22.
63

Factors responsible for the failure of periodontal therapy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Factors responsible for the failure of periodontal therapy

Similar to Factors responsible for the failure of periodontal therapy (20)

More from Dr Antarleena Sengupta

More from Dr Antarleena Sengupta (16)

Recently uploaded

Recently uploaded (20)

Factors responsible for the failure of periodontal therapy