Periodontology Fifth Year First semester Al Azhar University Gaza Palestine By Lama El Banna

1. PeriodontologyII
Dr. Rawand Samy Mohamed Abu Nahla
Oral Medicine, periodontology&oral Radiology Department.
Dr. Haydar.A. Shafy Faculty Of Dentistery.
El Azhar University.
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2. Lecture 1:
Diagnosis, Prognosis, And Treatment
Planning
Part (4)
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3. The Treatment Plan
After the diagnosis and prognosis have been established, the treatment is planned. The plan
should encompass short- and long-term goals.
The short-term goals are the elimination of all infectious and inflammatory processes that
cause periodontal and other oral problems that may hinder the patient’s general health.
Basically, the short-term goals are to bring the oral cavity to a state of health.
This may require periodontal procedures, as well as other dental therapy, such as
endodontics and correcting oral mucous membrane pathology. Referral to other dental
and medical specialties will be necessary.
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4. From a periodontal viewpoint, the short-term goals are important, since they consist
of the elimination of gingival inflammation and correction of the conditions that
cause and perpetuate it.
These include pocket eradication or reduction and establishment of good
gingival contours and mucogingival relationships conducive to good periodontal
health.
Restoration of carious areas and the correction of poor existing restorations may also
be necessary.
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5. The long-term goals are the reconstruction of a healthy dentition that fulfills all
functional and esthetic requirements.
 Long-term planning involves consideration of prosthetic reconstruction of the
dentition, which may require implant therapy, including surgical preparation of the
implant site. Also, the need for orthodontic treatment should be evaluated.
 The financial impact of long-term treatment requires careful consideration and
understanding by the patient.
 The age and medical health status of the patient must also be considered.
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6. The treatment plan is the blueprint for case management. It includes all
procedures required for the establishment and maintenance of oral health and
involves the following decisions:
Need for emergency treatment (pain, acute infections)
Teeth that will require removal
 Periodontal pocket therapy techniques (surgical or nonsurgical)
Endodontic therapy
 The need for occlusal correction, including orthodontic therapy
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7.  The use of implant therapy.
 The need for caries removal and the placement of temporary and final restorations.
 Prosthetic replacements that may be needed and which teeth will be abutments if a
fixed prosthesis is used.
 Decisions regarding esthetic considerations in periodontal therapy.
Sequence of therapy Unforeseen developments during treatment may necessitate
modification of the initial treatment plan. However, except for emergencies, no therapy
should be initiated until a treatment plan has been established.
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8. Master Plan for Total Treatment
The aim of the treatment plan is total treatment, that is, the coordination of all the
short- and long-term goals for the purpose of creating a well-functioning dentition in
a healthy periodontal environment.
The master plan of periodontal treatment encompasses different areas of therapeutic
objectives for each patient according to his or her needs.
It is based on the diagnosis, disease severity, risk factors, and other factors.
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9. Sequence of Therapeutic Procedures
Periodontal therapy is an inseparable part of dental therapy.
The sequence in which these phases of therapy are performed may vary to some
extent in response to the requirements of the case.
Although the phases of treatment have been numbered, the recommended sequence
does not follow the numbers.
Phase I, or the nonsurgical phase, is directed to the elimination of the etiologic
factors of gingival and periodontal diseases. When successfully performed, this phase
stops the progression of dental and periodontal disease.
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10. Immediately after completion of phase I therapy, the patient should be placed on the
maintenance phase (phase IV) to preserve the results obtained and prevent any further
deterioration and recurrence of disease. While on the maintenance phase, with its
periodic evaluation, the patient enters into the surgical phase (phase II) and the
restorative phase (phase III) of treatment.
These phases include periodontal surgery to treat and improve the condition of the
periodontal and surrounding tissues. This may include regeneration of the gingiva and
bone for function and esthetics, placement of implants, and restorative therapy.
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11. Phases of Periodontal Therapy
Preliminary Phase
Treatment of emergencies:
• Dental or periapical
• Periodontal
• Other
Extraction of hopeless teeth and provisional replacement if needed (may be
postponed to a more convenient time)
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12. Nonsurgical Phase (Phase I Therapy)
Plaque control and patient education:
• Diet control (in patients with rampant caries)
• Removal of calculus and root planing
• Correction of restorative and prosthetic irritational factors
• Excavation of caries and restoration (temporary or final, depending on whether a definitive prognosis for the
tooth has been determined and the location of caries)
• Antimicrobial therapy (local or systemic)
• Occlusal therapy
• Minor orthodontic movement
• Provisional splinting and prosthesis
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13. Evaluation of Response to Nonsurgical Phase
Rechecking:
• Pocket depth and gingival inflammation
• Plaque and calculus, caries
Surgical Phase (Phase II Therapy)
• Periodontal therapy, including placement of implants
• Endodontic therapy
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14. Restorative Phase (Phase III Therapy)
• Final restorations
• Fixed and removable prosthodontic appliances
• Evaluation of response to restorative procedures
• Periodontal examination
Maintenance Phase (Phase IV Therapy)
Periodic rechecking:
• Plaque and calculus
• Gingival condition (pockets, inflammation)
• Occlusion, tooth mobility
• Other pathologic changes
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15. Explaining Treatment Plan to the Patient
The following discussion includes suggestions for explaining the treatment plan to
the patient.
Be specific. Tell your patient, “You have gingivitis” or “You have periodontitis,”
then explain exactly what these conditions are.
Avoid vague statements. Do not use statements such as, “You have trouble with your
gums” or “Something should be done about your gums.” Patients may not
understand the significance of such statements and may disregard them.
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16. Begin your discussion on a positive note. Talk about the teeth that can be retained and
the long-term service they can be expected to render. Do not begin your discussion
with the statement, “The following teeth have to be extracted.” This creates a negative
impression, which adds to the erroneous attitude of hopelessness the patient already
may have regarding his or her mouth.
Make it clear that every effort will be made to retain as many teeth as possible, but do
not well on the patient’s loose teeth. Emphasize that the important purpose of the
treatment is to prevent the other teeth from becoming as severely diseased as the loose
teeth.
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17. Present the entire treatment plan as a unit. Avoid creating the impression
that treatment consists of separate procedures, some or all of which may
be selected by the patient.
 Make it clear that dental restorations and prostheses contribute as much
to the health of the gingiva as the elimination of inflammation and
periodontal pockets. Do not speak in terms of “having the gums treated
and then taking care of the necessary restorations later” as if these were
unrelated treatments.
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18. Patients often seek guidance from the dentist with questions such as the
following:
• “Are my teeth worth treating?”
• “Would you have them treated if you had my problem?”
• “Why don’t I just go along the way I am until the teeth really bother me
and then have them all extracted?”
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19. Explain that “doing nothing” or holding onto hopelessly diseased teeth as
long as possible is inadvisable for the following reasons:
1. Periodontal disease is a microbial infection, and research has clearly shown it to be an
important risk factor for severe life-threatening diseases such as stroke, cardiovascular
disease, pulmonary disease, and diabetes, as well as for premature low-birth-weight
babies in women of childbearing age. Correcting the periodontal condition eliminates a
serious potential risk of systemic disease, which in some cases ranks as high on the
danger list as smoking.
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20. 2. It is not feasible to place restorations or fixed bridges on teeth with
untreated periodontal disease because the usefulness of the restoration
would be limited by the uncertain condition of the supporting structures.
3.Failure to eliminate periodontal disease not only results in the loss of teeth
already severely involved, but also shortens the life span of other teeth. With
proper treatment, these teeth can serve as the foundation for a healthy,
functioning dentition.
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21. Therefore the dentist should make it clear to the patient that if the periodontal
condition is treatable, the best results are obtained by prompt treatment. If the
condition is not treatable, the teeth should be extracted.
It is the dentist’s responsibility to advise the patient of the importance of
periodontal treatment. However, if treatment is to be successful, the patient must
be sufficiently interested in retaining his or her natural teeth and to maintain the
necessary oral hygiene.
Individuals who are not particularly perturbed by the thought of losing their teeth
are generally not good candidates for periodontal treatment.
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22. Thank you
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