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Periodontal therapy / Management

Therapeutic Goals

Etiologic Phase

Reestablish microbial ecology  compatible with periodontal health

Treat inflammation

Reestablish favorable local conditions

Treat periodontal defects

Restore dental and periodontal morphology

Reparative Phase

Regenerate

Restore lost tissue

Restore esthetics

Maintain periodontal health

Remove or control causative factors

 

Nonsurgical

Phase 1 therapy

Accumulation of plaque leads to gingival inflammation and pocket deepening, which in turn increases the area of plaque accumulation.

Curette for subgingival debridement

A, 52-year-old patient with moderate attachment loss and probe depths in the 4- to 6-mm range. Note that the gingiva appears pink because it is fibrotic. Inflammation is present in the periodontal pockets but disguised by the fibrotic tissue. Bleeding occurs on probing. B, Lingual view of the patient with more visible inflammation and heavy calculus deposits. C and D, 18 months after phase I therapy the same areas show significant improvement in gingival health. The patient returned for regular maintenance visits at 4-month intervals

Adjunctive therapeutics

Potential adjunctive therapeutic approaches. Possible adjunctive therapies and points of intervention in the treatment of periodontitis are presented related to the pathologic cascade of events. CAL, Clinical attachment loss.

Host and bacterial factor modulation by risk factors.

Smoking and Periodontal disease (Risk Factor)

Schematic summary of clinical findings of subgingival microflora in smokers

Possible results of pocket therapy. An active pocket can become inactive and heal by means of a long junctional epithelium. Surgical pocket therapy can result in a healthy sulcus, with or without gain of attachment. Improved gingival attachment promotes restoration of bone height, with re-formation of periodontal ligament fibers and layers of cementum.

Surgical Phase 11

Periodontal pocket preoperatively. B, Periodontal pocket immediately after scaling, root planing, and curettage. C, New attachment. The arrow indicates the most apical part of the junctional epithelium. Note regeneration of bone and periodontal ligament. D, Healing by long junctional epithelium. Again, the arrow indicates the most apical part of the junctional epithelium. Note that the bone is new, but the periodontal ligament is not

Reconstructive surgery

Radiographs of a guided tissue regeneration (GTR) case using a non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane. The mesially inclined molar is associated with a three-walled intraosseous defect (A, B). The defect was filled with demineralized freeze-dried bone allograft (DFDBA) and ePTFE was used. Membrane was exposed after 8 weeks and removed 2 weeks later. Radiographic “fill” was halfway after 6 months and maximum fill was present after 12 months (C) with minimal probing depth.

Reconstructive Surgery with Bio-Oss & BioGide


Management overview:

Early understanding of periodontal diseases improves patient compliance and ownership

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