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36 Cards in this Set
- Front
- Back
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What does Periodontal Therapy
Accomplish? |
• The effectiveness of periodontal therapy is
made possible by: the remarkable healing capacity of periodontal tissue • Periodontal therapy can restore chronically inflamed gingiva, such that to gingiva that almost identical with gingiva that has been exposed to excessive plaque accumulation |
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Periodontal treatment include
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• Eliminate pain
• Eliminate gingival inflammation and bleeding • Reduce periodontal pocket • Eliminate infection • Stop pus formation • Arrest destruction of soft tissue & bone • Reduce abnormal tooth mobility • Establish optimal occlusal function • Restore tissue destroyed by disease • Reestablish the physiologic gingival contour necessary for the prevention of periodontal health • Prevent recurrence of the disease • Reduce tooth loss ( very important ) |
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Peridontal treatment is classifed into two types , name them
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Local and Systemtic
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1)) Local periodntal treatment is classifed into two types , name them
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non-surgical
surgical the following is about local treatment in general : The removal of plaque & all the factors that favor it's accumulations is the primary consideration in local therapy • Creating occlusal relations that are more favorable to the periodontium? |
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Principles of Nonsurgical
Periodontal Therapy |
the control of plaque-induced
gingivitis or chronic periodontitis through: – Patient daily self-care measures – Periodontal instrumentation – The use of chemical agents |
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Developing a Treatment Plan for
Nonsurgical Periodontal Therapy |
• Plan treatment that controls or eliminates
– Primary etiologic factors – Local risk factors – Systemic risk factors • Selected procedures should meet the patient’s individual needs. |
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Indications for Nonsurgical
Periodontal Therapy |
• NSPT is required for patients with plaqueassociated
gingivitis and chronic periodontitis. – Usually controls plaque-induced gingivitis – Usually controls slight to moderate chronic periodontal disease – Usually precedes periodontal surgery in those patients with severe chronic periodontitis • Surgery is indicated for patients with more advanced periodontitis AFTER NSPT is completed. • NSPT may minimize the extent of surgery that is needed. • However.. Nonsurgical periodontal therapy is not always the best choice .. |
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Instrumentation as Part of
Nonsurgical Periodontal Therapy |
Objectives of Instrumentation :
• Physical removal of microorganisms and by-products to prevent and treat periodontal infection • Physical removal of bacterial plaque biofilm is the most effective mechanism of control. • Subgingival plaque bioflim within pockets cannot be reached with a toothbrush or floss. • Pockets must be instrumented to disrupt bacterial colonies. |
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Rationale for Instrumentation
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To arrest progress of periodontal disease
• To induce positive changes in subgingival bacterial flora • To eliminate inflammation in the periodontium • To increase effectiveness of patient selfcare |
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End Point of Nonsurgical
Instrumentation |
The end point for instrumentation is to return
the periodontium to a state of soft tissue health and a periodontium that is free of inflammation. |
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2))Systemic Periodontal Therapy
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• An adjunct to local measures & for specific
purposes such as: Systemic complications from acute infection Supportive nutritional therapy Control of sytemic diseases that aggravate the patients periodontal condition • Systemic therapy for treatment of periodontal conditions & in conjunction with local therapy in localized aggressive periodontitis • To suppress the self destructive components of host inflammatory response (N.S.A.I, Ibuprofen, Doxycyclin, Alendronate |
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Types of Healing IN GENERAL
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Healing by repair
Healing by reattachment Healing by new attachment Healing by regeneration |
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Healing by REPAIR
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•Repair—healing of a wound by formation of
tissues that do NOT precisely restore the original architecture or original function of the body part •Example—formation of a scar during healing of a cut to a finger |
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Healing the Periodontium by
REPAIR |
•Healing after periodontal instrumentation
results in a long junctional epithelium •A long junctional epithelium does NOT precisely duplicate the original periodontal tissues : – No formation of new bone – No formation of new cementum – No formation of periodontal ligament |
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Healing by REATTACHMENT
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•Reattachment—healing by the reunion of
the periodontal connective tissue and tooth root where the two tissues have been separated by incision or injury, but NOT by disease •Example—temporarily moving healthy tissue away from the tooth root or bone |
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Healing by NEW ATTACHMENT
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•New attachment—healing that occurs when
epithelium and connective tissues are newly attached to a tooth root where periodontitis had previously destroyed this attachment •New attachment occurs in an area damaged by disease •Reattachment occurs in the absence of disease. |
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Healing by REGENERATION
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•Regeneration—regrowth of the precise
tissues that were present before the disease or damage to the tissues occurred •For healing of the periodontium |
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Healing After Nonsurgical
Periodontal Instrumentation |
Following periodontal instrumentation,
there normally is NO formation of new alveolar bone, new cementum, or new periodontal ligament. • The primary type of healing after periodontal instrumentation is through the formation of a long junctional epithelium. |
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Tissues Responses to
Instrumentation |
Here it's like steps :
1) Shrinkage of the soft tissue resulting in a shallow pocket depth 2) • Readaptation of the tissues to the root forming a long junctional epithelium 3)• Little change in the level of soft tissues resulting in a residual periodontal pocket |
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Patient Education
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Why still we have problems ? :
• No education (Please don’t forget ) • Unclear message (consider..) • Improperly trained persons |
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Prevention of periodontal
diseases & caries depend on .... ? |
Prevention of periodontal
diseases & caries depend on Behavior Change |
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Behavior Change
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Motivation
• Factual education • Practical demonstration • Reinforcement (at reevaluation appointments) |
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Practical Demonstration
(Tell – Show – Do) |
• Always demonstrate intraorally
• Disclosing, brushing, interdental cleaning, cleaning of dentures & appliances • Do not overload patient with information |
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Reinforcement
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• Reinforcing new oral hygiene behavior
• Regular visit tailored for each patient • Encourage patient |
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FAQ by Patients
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• Manual or powered tooth brushes?
• What is the best toothbrush design? • How many times/day should I clean my teeth? • How should I brush my teeth (method)? • For how long should I clean my teeth? • Should I use a mouth wash?Patient’s Role |
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Patient’s Role
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• The patient is a co-therapist.
• The patient has to control bacterial biofilm on a daily basis. • The patient should be actively involved in making decisions about his or her oral healthcare. |
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Goals of Self-Care
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• To improve oral health through optimum
removal or dental biofilms • To eliminate bleeding and inflammation |
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Interdental Care
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• Tissue destruction results in reduced or
missing papillae. • Dental floss is ineffective in large spaces |
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Anatomical Challenges
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• Open embrasure spaces
Root concavities |
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Embrasure Spaces
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• Gingival embrasure space —a small
triangular open space In health, interdental papilla fills the gingival embrasure space (type I embrasure space). • Dental floss is the best choice for type I embrasure spaces. |
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Type I
Embrasure |
Embrasure is filled
completely by interdental papilla Dental floss is effective |
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Type II
Embrasure |
The height of
interdental papilla is reduced. Interdental brushes and wooden toothpicks are effective |
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Type III
Embrasure |
The interdental
papilla is missing. Interdental brushes and endtuft brushes are effective. |
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Root Concavities
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Depression in the root surface.
• In health, root concavities are covered with alveolar bone. • In periodontitis, junctional epithelium migrates apically with bone and tissue destruction, exposing the root concavity to the oral environment. |
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Interdental Aid Selection
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Type I Embrasure :
Dental floss is effective Type II Embrasure : Dental floss is not effective. Interdental brushes and wooden toothpicks Type III Embrasure : Dental floss is not effective. Interdental brushes and end-tuft brushes |
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Interdental bursh using method
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• Hold brush handle
between the thumb and the index finger • Gently insert between teeth Maintain brush at a 90-degree angle to the long axis of the tooth Use slight pressure to adapt brush • Use slight pressure • Slide brush in and out of the space • Adapt brush to the mesial surface of the first premolar For posterior areas, advise the patient to close his or her mouth slightly to relax the cheek |
