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Learn about the sequential procedures involved in a complete treatment plan for achieving optimal oral health and well-functioning dentition. Understand the objectives of periodontal therapy and the factors that affect healing.
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Dr.JafarNaghshbandiD.D.S ; M.S , Diplomate Of The American Board Of Periodontology
‘’whoever taught me a word made me his servant’’ Dr. Jim Simon Dr.RaulCaffesse
INTRODUCTION • The aim of the treatment plan is, total treatment i.e., co-ordination of all treatment procedures for the purpose of creating a well-functioning dentition in a healthy periodontal environment. Treatment plan is the blue print for the management of a case and establishment of periodontal health. Treatment procedures should be performed in a systematic sequence and should be planned well in advance.
Preliminary Phase or Emergency Phase Treatment of emergencies: • Dental or periapical abscess. • Periodontal abscess. • Extraction of hopeless teeth and provisional replacement if needed.
Phase I Therapy (Etiotropic Phase) • Plaque control. • Diet control. • Removal of calculus and root planing. • Correction of restorative and prosthetic irritational • factors. • Excavation of caries and restorations (Temporary or • final). • Antimicrobial therapy. • Occlusal therapy. • Minor orthodontic movement • Provisional splinting • Evaluation of Response to Phase I Rechecking:• Pocket depth and gingival inflammation • • Plaque and calculus, caries
Phase II Therapy (Surgical Phase) • Root canal treatment. • Periodontal-surgery including placement of implants.
Phase III Therapy (Restorative Phase) • Final restorations. • Fixed and removable prosthodontics.• Evaluation of response to restorative procedures. • Periodontal examination.
Phase IV Therapy (Maintenance Phase) • Periodic recall visits. • Checking for plaque and calculus. • Gingival condition (Pockets, inflammation). • Occlusion, tooth mobility and other pathologic changes.
OBJECTIVES OF PERIODONTAL THERAPY If properly performed, periodontal treatment can accomplish the following: • Eliminate pain. • Eliminate gingival inflammation. • Eliminate gingival bleeding. • Eliminate infection. • Reduces periodontal pockets and mobility of the teeth. • Stops pus formation. • Arrests the destruction of soft tissue and bone. • Establish optimal occlusal function. • Restores tissue destroyed by disease. • Re-establish the physiologic gingival contour. • Prevent the recurrence of disease. • Reduces tooth loss.
Local Factors • Healing is delayed by contamination of micro-organisms, irritation from plaque, food debris, necrotic tissue remnants and trauma from occlusion. Excessive tissue manipulation during treatment, trauma to the tissues can delay healing. In addition repetitive treatment procedures which affect the orderly cellular activity in the healing process, topically applied cortisone and ionizing radiation can retard healing. Healing is improved by a local increase in temperature, debridement, immobilization of the healing area and pressure on the wound.
Systemic Factors Healing is delayed in: • Older patients (Because of atherosclerotic vascular • changes which results in reduced blood circulation). • Generalized infections especially in patients with diabetes and other debilitating diseases. • By insufficient food intake, vitamin C deficiency, • deficiency of proteins and other nutrients. • Increased levels of hormones such as cortisone hinder repair by depressing the inflammatory reaction or inhibiting the growth of fibroblasts, the production of collagen and the formation of endothelial cells. • Systemic stress, thyroidectomy, testosterone, adrenocorticotropic hormone and large doses of estrogen suppresses the formation of granulation tissue and retard healing.
HEALING AFTER PERIODONTAL THERAPY a. Regeneration: It is the biologic process by which the architecture and function of lost tissues are completely restored by formation of new periodontal ligament, alveolar bone and cementum. b. Repair: It is the healing of tissues without completely restoring the lost tissues. c. New attachment: This is the reunion of connective tissue with a root surface that has been pathologically- exposed. d. Reattachment: This is the reunion of connective tissue and a root surface that have been separated by incision or injury.
KEY POINTS TO NOTE • If periodontal treatment is properly performed it can restore the normal health of the periodontal tissues. • Theperiodontaltreatmentconsistsofbothlocalandsystemic therapy. • The primary objective of local therapy is removal of plaque and all those factors that may favour its accumulation. • Systemic therapy is used as an adjunct to local therapy and • is mainly indicated in localized and generalized aggressive • periodontitis. • Healing is affected by local and systemic factors, under local • factors, those factors that can delay the healing are, excessive tissue manipulation, unnecessary trauma to the tissue, presence of foreign bodies etc. Healing is improved mainly by good debridement and proper immobilization of the wound. • Systemic conditions that may have an effect on healing are, infections like diabetes, and other debilitating diseases, malnutrition, increased levels of hormones, systemic stress.
