The document outlines the importance of treatment planning in periodontal therapy, detailing the various factors influencing the management of each case, such as tooth retention, surgical options, and necessary restorative procedures. It emphasizes a systematic approach to treatment, from emergency interventions to maintenance phases, and stresses the impact of untreated periodontal disease on overall health. Additionally, it addresses common patient concerns and provides rationale for active treatment to prevent serious systemic health risks.

1. TREATMENT PLANNING
HARSH VARDHAN (1818)

2. DEFINITION
.
Treatment plan is the blueprint for the
management of a case and establishment of
health. Treatment procedures should be performed in
a systematic sequence and should be planned well in
advance

3. FACTORS INFLUENCING TREATMENT
PLANNING
• Teeth to be retained or extracted.
• Pocket therapy techniques, surgical or nonsurgical, that will be used.
• The need for occlusal correction, before, during, or after pocket therapy.
• The use of implant therapy.
• The need for temporary restorations.
• Final restorations that will be needed after therapy, and which teeth will be abutments if a fixed prosthesis
is used.
• The need for orthodontic consultation.
• Endodontic therapy.
• Decisions regarding esthetic considerations in periodontal therapy.
• Sequence of therapy

4. EXTRACTION OR PRESERVING TOOTH
Removal, retention, or temporary (interim) retention of one or more
teeth is a very important part of the overall treatment plan. A tooth
should be extracted when any of the following occurs:
• It is so mobile that function becomes painful.
• It can cause acute abscesses during therapy.
• There is no use for it in the overall treatment plan

5. PRESERVATION OF TOOTH
A tooth can be retained temporarily, postponing the decision to extract it until
after treatment, when any of the following occurs:
• It maintains posterior stops; the tooth can be removed after treatment when it
can be replaced by a prosthesis.
• It maintains posterior stops and may be functional after implant placement in
adjacent areas. When the implant is exposed, these teeth can be extracted.

6. • In anterior esthetic areas, a tooth can be retained during periodontal
therapy and removed when treatment is completed, and a permanent
restorative procedure can be performed. This approach avoids the need for
temporary appliances and can be considered when retention of the tooth will
not jeopardize adjacent teeth.
• Removal of hopeless teeth can also be performed during periodontal
surgery of neighboring teeth. This approach reduces appointments for
surgery in the same area

7. EXPLAINING TREATMENT PLANNING TO PATIENT
1) BE SPECIFIC
2) AVOID VAGUE STATEMENT
3) BEGIN YOUR DISCUSSION WITH POSITIVE NOTE
4) PRESENT THE ENTIRE TREATMENT PLAN AS A UNIT

8. PERIODONTAL TREATMENT DECISION TREE

9. PREFERRED SEQUENCE OF THERAPY

10. EMERGENCY PHASE
1
2
3
TREATMENT OF EMERGENCIES
Dental or periapical abscess.
Periodontal abscess.
Extraction of hopeless teeth and provisional
replacement if needed.

11. ETIOTROPHIC PHASE
• Plaque control.
• Diet control.
• Removal of calculus and root planing.
• Correction of restorative and prosthetic irritational
factors.

12. • Excavation of caries and restorations (Temporary or final).
• Antimicrobial therapy.
• Occlusal therapy.
• Minor orthodontic movement.
• Provisional splinting.

14. SURGICAL THERAPY
• Periodontal surgery including placement of implants
• Root canal treatment.

16. RESTORATIVE PHASE
• Final restorations.
• Fixed and removable
prosthesis.
• Evaluation of response to
restorative procedures.
• Periodontal examination.
This Photo by Unknown Author is licensed under CC BY-NC

17. MAINTENANCE PHASE
• Periodic recall visits.
• Checking for plaque and calculus.
• Gingival condition (Pockets, inflammation).
• Occlusion, tooth mobility and other pathologic changes.

18. GENERAL QUESTION FROM PATIENT TO DENTIST
• “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?”

19. DENTIST GUIDANCE TO PATIENT
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.

20. 2. It is not feasible to place restorations or 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 that, with
proper treatment, could serve as the foundation for a healthy, functioning
dentition