Treatment Plan in Periodontics

1. DR AMIT DE
3rd YEAR M.D.S. STUDENT, DEPT. OF PERIODONTICS,
GURU NANAK INSTITUTE OF DENTAL SCIENCES & RESEARCH

2. Treatment Plan
Treatment
Plan

3. Ref. : Essentials of Public Health dentistry, Soben Peter, 5th Edition
Planning is a systematic
approach to defining the
problem, setting priorities,
developing specific goals
and objectives and
determining alternative
strategies and methods of
implementation.
E.C. Banfield has presented
a basic definition of the
term plan : “ A plan is a
decision about a course of
action”

4.  After the diagnosis and
prognosis have been
established, the treatment
plan is chalked out.
 The treatment plan is the
blueprint for case
management.

5. Treatment plan in
periodontics

6. Goals of
Treatment
plan
Short-term
Goals
Long-term
Goals
Elimination of all
infectious and
inflammatory
processes that cause
periodontal and
other oral problems
that may hinder the
patient’s general
health.
Reconstruction of a healthy
dentition that fulfills all
functional and esthetic
requirements.
Long term planning
involves consideration of
prosthetic reconstruction,
which may require implant
therapy.
Also the need for
orthodontic treatment
should be evaluated.

7. 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.

9. • 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.
• 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.
It includes all procedures required for the establishment and
maintenance of oral health and involves the following decisions:

10. Extracting or Preserving a Tooth
• Treatment is directed to establishing and maintaining the health of
the periodontium throughout the mouth rather than attempting
spectacular efforts to “tighten loose teeth.”
-- Carranza’s Clinical Periodontology, 11th Edition
Therefore attempts to save questionable teeth may jeopardize adjacent
teeth and may lead to the loss of bone needed for implant therapy.
Teeth on the borderline of a hopeless prognosis do not contribute to the
overall usefulness of the dentition.
Such teeth become sources of recurrent problem to the patient.

11. A tooth should be extracted under
the following conditions :
1. It is so mobile that function
becomes painful.
2. It can cause acute abscesses
during therapy.
3. There is no use for it in the
overall treatment plan.
A tooth can be retained under the
following conditions:
It maintains posterior stops and may be
functional after implant placement in
adjacent areas. When the implant is
restored, these teeth can be extracted.
 In the anterior esthetic zone, a tooth can
be retained during periodontal therapy and
removed when treatment is completed
and a permanent restorative procedure can
be performed.

12. Except for emergencies, no therapy
should be initiated until a treatment
plan has been established.

13.  When to plan?
 Why is called INITIAL treatment plan?
INITIAL
TREATMENT
PLAN
Unforeseen developments during
treatment may necessitate modification of
the initial treatment plan.

14. 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).
Phase I
Phase II
Phase III
Phase IV
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
• Antimicrobial therapy (local or systemic)
• Occlusal therapy
• Minor orthodontic movement
• Provisional splinting and prosthesis
Surgical Phase (Phase II Therapy)
• Periodontal therapy, including placement
of implants
• Endodontic therapy
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

15. Although, the phases of treatment in this model
have been numbered, the recommended
sequence does not follow the numbers.

16. SEQUENCE OF THERAPEUTIC
PROCEDURES
(Preliminary Phase)
(Phase I Therapy)
(Phase II Therapy) (Phase III Therapy)
(Phase IV Therapy)

17. Ref. : Khalid G Azouni, Bassel Tarakji : The Trimeric
Model: A New Model of Periodontal Treatment Planning,
Journal of Clinical and Diagnostic Research. 2014 Jul,
Vol-8(7): ZE17-ZE20

18. Trimeric Model

19. THE EXTENDED TRIMERIC MODEL
1. It has a unique position in the periodontal treatment
plan, as it should be undertaken only after active
periodontal disease has been controlled .
2. Failure to control active periodontitis can result in acute
exacerbations and bone loss during tooth movement.
1. The Expansion of
the Surgical Phase
Periodontal Surgery
E.g. pocket reduction
surgeries
Preprosthetic Surgery
E.g. crown
lengthening surgery,
root coverage surgery
2. Adjunctive
Orthodontic Therapy

20. THE EXTENDED TRIMERIC MODEL
The green
highlighting
indicate the disease
control phase which
includes the initial
phase and part of the
surgical phase
(specifically
periodontal surgery)
but not Adjunctive
Orthodontic
Therapy.

21. Patients must understand the purpose of the
maintenance program, and the dentist must
emphasize that preservation of the teeth
depends on maintenance therapy.

22. RATIONALE FOR MAINTENANCE THERAPY
• Inadequate plaque control
• Incomplete subgingival plaque removal
• Bacteria are present in the gingival tissues
in chronic and aggressive periodontitis
cases.
• Bacteria transmitted between spouses and
other family members
• Microscopic nature of the dentogingival
unit healing after periodontal treatment

23. OBJECTIVES
To prevent the progression and recurrence of
periodontal disease in patients who have
previously been treated for gingivitis and
periodontitis

24. 10
minutes
36
minutes
14
minutes
Maintenance Recall Procedures
1st Qtr
2nd Qtr
3rd Qtr
Oral hygiene reinforcement
Scaling
Polishing
Chemical irrigation or site-
specific antimicrobial
placement
Write report in chart.
Discuss report with patient.
Clean and disinfect
operatory.
Schedule next recall visit.
Schedule further periodontal
treatment.
Schedule or refer for
restorative or prosthetic
treatment.
Patient greeting
Medical history changes
Oral pathologic
examination
Oral hygiene status
Gingival changes
Pocket depth changes
Mobility changes
Occlusal changes
Dental caries
Restorative, prosthetic, and
implant status

25. MERIN’S CLASSIFICATION FOR RECALL
INTERVALS

27. References
 Caranza’s Clinical Periodontology, 11th Edition
 Clinical Periodontology and Implant Dentistry, J
Lindhe, 5th Edition
 Khalid G Azouni, Bassel Tarakji : The Trimeric
Model: A New Model of Periodontal Treatment
Planning, Journal of Clinical and Diagnostic
Research. 2014 Jul, Vol-8(7): ZE17-ZE20
 Essentials of Public Health dentistry, Soben Peter,
5th Edition

28. THANK
YOU