The document discusses the treatment plan for periodontal therapy. It defines the treatment plan as the blueprint for case management that includes all procedures needed to establish and maintain oral health. The goals of treatment are to eliminate inflammation, correct conditions that cause it, and establish healthy gum contours. Treatment involves nonsurgical procedures, possible surgery, restorations, and a maintenance phase with periodic checkups. The treatment plan guides the phases of therapy and overall management of the patient's periodontal condition.

2. CONTENTS
 DEFINITION
 RATIONALE
 TREATMENT GOALS
 PHASES
 TIME OF REVALUATION

3. DEFINITION
 The treatment plan is the blueprint for case
management
 Includes all procedures required for
establishment & maintenance of oral health

4.  Perio therapy can restore chronically inflamed
gingiva
 The aim of the treatment plan is total treatment,
that is, the coordination of all treatment
procedures for the purpose of creating a well-
functioning dentition in a healthy periodontium.

5. RATIONALE
 An objective of the overall treatment plan is
the creation and maintenance of oral health,
function, and esthetics. The outcome is thus
long term and in most cases requires the
coordination of several disciplines of dentistry
 Treatment planning should focus on the list of
diagnoses for the patient. Treatment should be
planned in phases. At the completion of each
phase, the patient should be reevaluated to
assess response to treatment, and the
treatment plan may be modified based on this

6. TREATMENT GOALS
 Primary goal is elimination of gingival inflammation &
correction of conditions that cause & perpetuate it
 Includes elimination of root irritants,
 Pocket eradication & reduction,
 Establishment of gingival contours & mucogingival
relationships conducive to preservation of perio health,
 Restoration of carious areas & correction of existing
restorations

7.  Reduction/ resolution of gingivitis – full mouth
mean BoP ≤ 25 %
 Reduction in probing pocket depth (PPD) – no
residual pockets with PPD > 5 mm
 Elimination of open furcation – initial furcation
involvement should not exceed 3 mm
 Absence of pain
 Individually satisfactory esthetics & function

8. Involves following decisions:
 Teeth to be retained/ extracted
 Pocket therapy techniques – surgical/
nonsurgical
 Need for occlusal correction – before/ during/
after pocket therapy
 Use of implant therapy
 Need for temporary restorations

9. Tooth should be extracted when any of
following occurs:
 It is so mobile that function becomes painful
 It can cause acute abscesses during
therapy
 There is no use for it in overall TP
 Tooth can be retained temporarily,
postponing decision to extract it until after
treatment, when any of following occurs:
 It maintains posterior stops - removed after
T/t when it can be replaced by prosthesis

10.  It maintains posterior stops & may be functional
after implant placement in adjacent areas –
When implant is exposed, these teeth can be
extracted
 In anterior esthetic areas, tooth can be retained
during perio therapy & removed when T/t is
completed, & permanent restorative procedure
can be performed
 Avoids need for temporary appliances

11. Removal of hopeless teeth can also be performed
during perio surgery of neighboring teeth - reduces
appointments for surgery in same area
 In formulation of TP a in addition to proper
function of dentition, esthetic considerations
play increasingly important role in many cases

12. Final restorations that will be needed after therapy
& which teeth will be abutments if fixed prosthesis
used
 Need for orthodontic consultation
 Endodontic therapy
 Decisions regarding esthetic considerations in
perio therapy
 Sequence of therapy

14. PHASES OF PERIODONTAL
THERAPY
Preliminary Phase (Emergency phase):
 Treatment of emergencies
 Dental or periapical abscess
 Periodontal abscess
 Extraction of hopeless teeth and provisional
replacement

15. Nonsurgical Phase (Phase I Therapy):
 Plaque control and patient education
 Diet control
 Scaling and root planing
 Demonstration of proper brushing technique
 Correction of restorative and prosthetic factors
 Excavation of caries and restoration
 Antimicrobial therapy (local or systemic)
 Occlusal adjustments
 Minor orthodontic movement
 Provisional splinting and prosthesis
 Evaluation of response to nonsurgical phase
 Pocket depth and gingival inflammation
 Plaque and calculus, caries

16. Surgical Phase (Phase II Therapy):
 Periodontal therapy
 Pocket reduction or elimination procedures:
Gingivectomy
Periodontal flap surgery
Regenerative surgery
 Periodontal plastic surgery
 Preprosthetic surgical procedures
 Resective osseous surgery
 Implant surgery
 Endodontic therapy

17. Restorative Phase (Phase III Therapy):
 Final restorations
 Fixed and removable prosthesis
Maintenance Phase (Phase IV Therapy):
 Periodic rechecking
 Plaque and calculus
 Gingival condition and periodontal status
 Occlusion, tooth mobility
 Other pathologic changes

18.  Systemic phase of therapy including
smoking counseling
 Initial (or hygiene) phase of periodontal
therapy cause related therapy
 Corrective phase of therapy – surgery,
endo therapy, implant, restorative, ortho/
prosthetic treatment
 Maintenance phase (care) – SPT
• Salvi, Lindhe & Lang 2008

19. SEQUENCE OF
PERIODONTAL THERAPY

21. TO BE EXPLAINED
 Be specific
 Avoid vague statements
 Begin our discussion on positive note
 Talk about teeth that can be retained & long term
service expected to render
 Make it clear that every effort - to retain as many
teeth as possible, but do not dwell on patient’s
loose teeth
 Emphasize that important purpose T/t is to
prevent other teeth from becoming as severely
diseased as loose teeth

22.  Present entire treatment plan as unit
 Avoid creating impression that T/t consists of
separate procedures
 Do not speak in terms of “having gums treated &
then taking care of necessary restorations later”
as if these were unrelated treatments
 Treatment is directed to establishing &
maintaining health of periodontium throughout
mouth rather than to spectacular efforts to
“tighten loose teeth

23.  Thus treatment plan is guiding map for
perio treatment – no treatment should be
initiated without forming a solid TP
 Although Its clinician’s responsibility to
make individual patient realize the value of
Treatment – motivated patient is a
prerequisite for optimum outcome of perio
therapy

24. REFERRAL PROTOCOL:
(AAP GUIDELINES 2006
Level 1:
 Patient who benefits from co-management by the referring
dentist and the periodontist.
 Patients with periodontal inflammation and systemic
diseases, under cancer therapy.
Level 2:
 Patient who benefits from co-management by the referring
dentist and the periodontist.
 Patients with periodontitis who needs re-evaluation with one
or more risk factors and indicators.
Level 3:
 Patients who should be treated by periodontist.
 Patient with severe periodontitis, peri-implant disease,
vertical bony defects, furcation involvement, recession.

25. RECALL OF PATIENTS
Merin’s classification
 In the first year patient is recalled every 3 months if the
patient is co-operative and has no systemic or
environmental factors which affects the prognosis.
 In patients with one or more factors which affects the
prognosis the patient is recalled every 1-2 months.
After first year patients are classified as
 Class A: Good oral hygiene, minimal calculus, absence of
prosthetic, environmental and systemic factors- 6 months
to 1 year.
 Class B: Poor oral hygiene, heavy calculus, presence of
some prosthetic, environmental and systemic factors- 3 -
4 months.
 Class C: Very poor oral hygiene, heavy calculus,
presence of many prosthetic, environmental and systemic
factors, many pockets remaining- 1 – 3 months.