2. January 2016; DOI: 10.5005/jp/books/12903_49. Periodontal surgical therapy is only one component of complete periodontal treatment. Treatment phase II – dental implant surgery, reline of provisional denture (3 workdays) After 3 months of wound healing the treatment could be resumed with the mounting of implants. General Dental Practitioner Oral Health Educator Dental Nurse Prevention of Periodontal Disease Dental Hygienist Dental Therapist Secondary Care Consultant in Restorative Dentistry High Street specialist In Periodontology. The effectiveness of periodontal therapy is predicated on success in completely eliminating calculus, plaque, and diseased cementum from the tooth surface. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. This does not mean that the periodontal treatment has caused recession but rather that it has uncovered the recession previously induced by the disease. It is often the case that this initial “non-surgical therapy” is all that is required to control your gum disease and that you can then move on to Periodontal Maintenance Therapy provided periodically either 3, 4 or 6 monthly as indicated. Table 4. This indicates there is a need for further treatment. Resective (gingivectomy, apically displaced flap, and undisplaced flap with or without osseous resection), Regenerative (flaps with grafts, membranes, etc. C H A P T E R O U T L I N E. Objectives of the Surgical Ph ase. If necessary, x-ray examination is also conducted, either for a specific area or the whole oral cavity. Most orthodontic problems can … To fulfill these objectives, surgical techniques (1) increase accessibility to the root surface, making it possible to remove all irritants; (2) reduce or eliminate pocket depth, making it possible for the patient to maintain the root surfaces free of plaque; and (3) reshape soft and hard tissues to attain a harmonious topography. Figure 44-1 Results of phase I therapy, severe chronic periodontitis. A CBCT (Cone beam computed tomography) scan was recorded to examine post-healing bone mass in 3 dimensions prior to the intervention. Crown lengthening, ridge augmentation ... | PowerPoint PPT presentation | free to download . Pocket Elimination Versus Pock et Maintenance. To fulfill these objectives, surgical techniques (1) increase accessibility to the root surface, making it possible to remove all irritants; (2) reduce or eliminate pocket depth, making it possible for the patient to maintain the root surfaces free of plaque; and (3) reshape soft and hard tissues to attain a harmonious topography. However, one study in monkeys has shown that the long junctional epithelial union may be as resistant to plaque infection as a normal connective tissue attachment.9. Three types of techniques fall into this category, as follows (see Box 53-1): • Plastic surgery techniques are used to create or widen the attached gingiva by placing grafts of various types. 4. Periodontal disease is never cured but only controlled. Carranza 10th Edition 2. Phase II decision tree for posttreatment reevaluation. Oral hygiene revisited. The presence of a pocket produces areas that are impossible for the patient to keep clean, which establishes the vicious cycle depicted in Figure 53-1. Chapters 59 to 61 describe the different techniques used for these purposes. 5. 6. Pocket elimination consists of reducing the depth of periodontal pockets to that of a physiologic sulcus to enable cleansing by the patient. The patient must be motivated, and must exhibit adequate plaque control. Critical Zones in Pocket Surge ry. They are performed on noninflamed tissues and in the absence of periodontal pockets. ‘Fundamental’ means ‘forming the basis on which others depend or from which others derive’ and, hence, seems appropriate to describe this phase. A periodontal pocket can be in an active state or a period of inactivity or quiescence. We have moved into the final stretch of the Review at a time when dental services, education and training, and the NHS as a If you are a member. Studies have shown that inactive pockets can be maintained for long periods with little loss of attachment by means of frequent scaling and root-planing procedures.6,10,12 A more reliable and stable result is obtained, however, by transforming the pocket into a healthy sulcus. What are the staging procedures in phase I therapy? However, this condition also may be unstable, and the chance of recurrence and re-formation of the original pocket is always present because the epithelial union to the tooth is weak. Daily brushing, and especially daily flossing, are key. Start studying Perio III- phase 2 periodontal therapy. This phase aims to reduce and eliminate any gingival inflammation by removing dental plaque , calculus (dental) , restoration of tooth decay and correction of defective restoration as these all contribute to gingival inflammation, also known as gingivitis . Pocket reduction surgery seeks to reduce pocket depth by either resective or regenerative means or often by a combination of both methods (Box 53-1). 65: Recent Advances in Surgical Therapy: Lasers in Periodontal Therapy, 82: Implant-Related Complications and Failures. The clinical effect of a prolonged oral hygiene phase prior to periodontal therapy in periodontitis patients. It is important to understand that these procedures are not directed to treat disease but aim to alter the gingival and mucosal tissues to correct defects that may predispose to disease. The top priorities of periodontal therapy are to eliminate inflammation and to stabilize the situation. After the antibiotic therapy phase, Periodontal Reassessment takes place with a full periodontal re-examination and charting. J Clin Periodontol 2012; 39: 1065–1074. Objectives: Improve access for debridement ... Periodontal surgery, implant placement. The healthy sulcus can also be located coronal to the bottom of the preexisting/>, Only gold members can continue reading. Chapter 57 Phase II Periodontal Therapy Created February 25, 2020; Author DentistryKey; Category Periodontics; C H A P T E R 5 7. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Become membership. Although in a strict sense, all instrumental therapy can be considered surgical, this chapter refers only to those techniques that include the intentional severing or incising of gingival tissue* with the following purposes: • Controlling or eliminating periodontal disease, • Correcting anatomic conditions that may favor periodontal disease, impair esthetics, or impede placement of the correct prosthetic appliances, • Placing implants to replace lost teeth and improving the environment for their placement and function. [42] - Poor oral hygiene - Plaque and calculus of root surfaces - Caries - Pulpal-periapical pathology - Plaque-retentive restorations - Hopelessly diseased teeth - Other disease entities requiring treatment (mucosal lesions, cysts, impacted teeth, etc. It is to be documented, once all of the following conditions are met: a. - To halt the progression of disease and … In the first case, there is no gain of attachment (Figure 53-2, bottom left), and the area of the root that was previously the tooth wall of the pocket becomes exposed. For patients whose oral health needs do not warrant a disease control phase, all active restorative, periodontal, and orthodontic therapy is addressed in the definitive phase. Improvement of the prognosis of teeth and their replacements. At the 6-8 week Periodontal Reassessment appointment the progress made, after root surface cleaning and excellent home cleaning, will be assessed. An active pocket can become inactive and heal by means of a long junctional epithelium. During the maintenance phase of the periodontal treatment, aside from clinical examination, is also carried out removal of microbial plaque and calculus that start to format and penetrate under the gums and teeth polishing. The ADC Review is now in its final year of Phase II, the three-year programme of work that began in April 2018 following the publication of ‘Advancing Dental Care’ that concluded Phase I activity (see Figure 1 for ADC programme activity and timeline). These involve not only the implant placement techniques but also a variety of surgical procedures to adapt the neighboring tissues, such as the sinus floor or the mandibular nerve canal, for subsequent placement of the implant (see Box 53-1). Recurrence of the initial activity is likely. These involve not only the implant placement techniques but also a variety of surgical procedures to adapt the neighboring tissues, such as the sinus floor or the mandibular nerve canal, for subsequent placement of the implant (see. Each CoT can be claimed separately. The purpose of surgical pocket therapy is to eliminate the pathologic changes in the pocket walls; to create a stable, easily maintainable state; and if possible, to promote periodontal regeneration. pocket reduction surgeries Preprosthetic Surgery E.g. Treatment plan 1. These problems can be reduced by resecting or displacing the soft tissue wall of the pocket, thereby increasing the visibility and accessibility of the root surface.3 The flap approach and the gingivectomy technique attain this result. This ongoing phase of treatment allows your periodontist to assess your periodontal health and ensure your infection stays under control. This may require a surgical or Phase 2 mode of therapy to remove any remaining infection and decrease residual pocket depths to reduce the risk for recurrent/progressing disease in the future. Phase II Therapy: Corrective or Surgical Phase. A periodontal pocket can be in an active state or a period of inactivity or quiescence. These problems can be reduced by resecting or displacing the soft tissue wall of the pocket, thereby increasing the visibility and accessibility of the root surface. Three types of techniques fall into this category, as follows (see, The plastic and esthetic surgery techniques are presented in, In addition, periodontal surgical techniques for the placement of dental implants are available. In an active pocket, underlying bone is being lost (. The goal of cause-related phase I periodontal therapy has been succinctly stated as the approach aimed at removal of pathogenic biofilms, toxins and calculus, and the reestablishment of a biologically acceptable root surface. Possible results of pocket therapy. In some patients, who have a pronounced, often genetically-influenced susceptibility to gum disease, the destruction of the supporting bone around the teeth continues to progress at certain sites. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. We want to bring the oral cavity, teeth and gums and bone back to a state of health that you can maintain on a daily basis there after. C H A P T E R 4 7 Phase I Periodontal Therapy Henry H. Takei CHAPTER OUTLINE Rationale Treatment Sessions Sequence of Procedures Results Healing Decision to Refer for Specialist Treatment Conclusion Phase I therapy or cause-related therapy 10 is the first in the chronologic sequence of procedures that […] If the answer is "no", then you'll enter into a "Maintenance" phase or specialized treatment for periodontal disease. • Esthetic surgery techniques are used to cover denuded roots and to recreate lost papillae. Chapter-48 Phase II Periodontal Therapy. 1. Initial/ hygiene phase. Numerous investigations have shown that the difficulty of this task increases as the pocket becomes deeper. Studies have shown that inactive pockets can be maintained for long periods with little loss of attachment by means of frequent scaling and root-planing procedures. 1. Periodontists are dentistry's e xperts in treating periodontal disease. Contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812, (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812, the removal of gum tissue to reduce the pocket depths and make the pockets shallower and easier to clean. Phase II: The surgical phase. The bottom of the healthy sulcus can be located either where the bottom of the pocket was localized or coronal to it. Sequence of Periodontal Therapy Emergency Phase Nonsurgical Phase Maintenance Phase Surgical Phase Restorative Phase Different names of NSPT: Cause related therapy, Initial therapy, Etiotropic phase of therapy, Phase I Therapy 2. • Periodontal therapy (Band 2) • Setting of recall interval What can be claimed? Two-phase orthodontic treatment is for kids, but it’s not for all kids. So are regular dental appointments. While technically this is not periodontal therapy per se, we have to mention that periodontal disease prevention is always the best option. 1. Reevealuation After Phase I The rapy. It is important to understand that these procedures are not directed to treat disease but aim to alter the gingival and mucosal tissues to correct defects that may predispose to disease. ), Esthetic surgery (root coverage, recreation of gingival papillae), Preprosthetic techniques (crown lengthening, ridge augmentation, and vestibular deepening), Placement of dental implants, including techniques for site development for implants (guided bone regeneration, sinus grafts). Periodontists are also experts in replacing missing teeth with dental … Patient information Sheets » Phase 2 Periodontal Therapy – Ph-08. Accumulation of plaque leads to gingival inflammation and pocket deepening, which in turn increases the area of plaque accumulation. What are some problems typically addressed in phase I periodontal therapy? Pocket Elimination versus Pocket Maintenance. This case appears borderline for Phase II periodontal treatment. The plastic and esthetic surgery techniques are presented in Chapter 63 and the preprosthetic techniques in Chapter 66. 2. This will likely … Therapy. 3. As the pocket becomes deeper, the surface to be scaled increases, more irregularities appear on the root surface, and accessibility is impaired.11,15 The presence of furcations will also create insurmountable problems for scaling the root surface4 (see Chapter 62). The fundamental aspect of periodontal . The second objective of the surgical phase of periodontal therapy is the correction of anatomic morphologic defects that may favor plaque accumulation and pocket recurrence or impair esthetics. A 3-month strict oral hygiene phase in patients referred for periodontal therapy reduced plaque, BOP and pocket depth to such an extent that it could affect therapy planning. ), Correction of Anatomic/Morphologic Defects, Plastic surgery techniques to widen attached gingiva (free gingival grafts, other techniques, etc. Inactive pockets can sometimes heal with a long junctional epithelium (Figure 53-2, top right). 2. Phase II Therapy Periodontal Surgery. In book: Essential Quick Review: Periodontics (pp.179-180) Authors: Priya Gupta. The effectiveness of periodontal therapy is predicated on success in completely eliminating calculus, plaque, and diseased cementum from the tooth surface. By proper case selection, both resective techniques and regenerative techniques can be used to accomplish this goal. For this, it is essential to create optimum oral hygiene conditions in order to reduce probing depths, regain attachment and to avoid tooth loss in the long term. Previous Phase II—Corrective Procedures. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Controlling or eliminating periodontal disease, Correcting anatomic conditions that may favor periodontal disease, impair esthetics, or impede placement of the correct prosthetic appliances, Placing implants to replace lost teeth and improving the environment for their placement and function, Improvement of the prognosis of teeth and their replacements, The purpose of surgical pocket therapy is to eliminate the pathologic changes in the pocket walls; to create a stable, easily maintainable state; and if possible, to promote periodontal regeneration. Example of potential Bands and Patient Charges generated from phased treatment. Surgical pocket therapy can result in a healthy sulcus, with or without gain of attachment. Read/Download File Report Abuse. All non-urgent consultations, evaluations, and any … In many cases, procedures are combined so that one surgical intervention fulfills both objectives. Whether the pocket remains inactive depends on the depth, the individual characteristics of the plaque components, and the host response. They are performed on noninflamed tissues and in the absence of periodontal pockets. The second objective of the surgical phase of periodontal therapy is the correction of anatomic morphologic defects that may favor plaque accumulation and … FINAL_CLINIC_MANUAL_FOR_2013- 2014_(9-5-2013 - rev).pdf. If the more conservative treatments weren’t effective, treatments will move into the surgical phase. If surgery is necessary, it is usually performed as a second phase (corrective), following a thorough evaluation of the clinical results of Phase 1 therapy. 10. Prevention. 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