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supportive periodontal therapy. maintenance periodontal therapy.
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SUPPORTIVE PERIODONTAL THERAPYWELLINGTON J. NII DARKO (BSc. Medical sciences)
UNIVERSITY OF GHANA SCHOOL OF MEDICINE AND DENTISTRY
OUTLINE INTRODUCTION
GOALS OF SUPPORTIVE PERIODONTAL THERAPY
OBJECTIVES OF THE SUPPORTIVE PERIODONTAL THERAPY
RATIONALE FOR SUPPORTIVE PERIODONTAL THERAPY
MAINTENANCE PROGRAM
CLASSIFICATION OF POST-TREATMENT PATIENTS
REFERRAL OF PATIENTS TO THE PERIODONTIST
TEST FOR DISEASE ACTIVITY
MAINTENANCE FOR DENTAL IMPLANT PATIENTS
PROPHYLAXIS VS SUPPORTIVE PEERIODONTAL THERAPY
CONCLUSION
REFERRENCES
INTRODUCTION
Periodontal treatment includes; Systemic evaluation of the patient’s health
A cause-related therapeutic phase with, in some cases
A corrective phase involving periodontal surgical procedures
Maintenance phase
The 3rd World Workshop of the American Academy of Periodontology (1989) renamed this treatment phase “SUPPORTIVE PERIODONTAL THERAPY”(SPT)
INTRODUCTION Preservation of the teeth depends on the maintenance therapy Recurrent periodontitis 5.6 times greater risk for tooth loss for non compliant patients
Checchi L, Montevecchi M, Gatto MR, Trombelli L: Retrospective study of tooth loss in 92 periodontal patients. J Clin Periodontol 2002; 29:651.
50- fold increase in probing attachment loss after successful regenerative therapy Cortellimi P, Pini-Prato G, Torretti M: Periodontal regeneration of human infrabony
defects. V. Effects of oral hygiene on long-term stability. J Clin Periodontol 1994; 21:606
Motivational technique
Reinforcement of the importance of the maintenance phase before performing definitive periodontal surgery
INTRODUCTION
INTRODUCTION
GOALS OF SPT
The American Academy of Periodontology position paper more specifically lists 3 main goals of SPT: To prevent or minimize the recurrence and progression of
periodontal disease in patients who have been previously treated for gingivitis, periodontitis and for peri-implantitis
To prevent or reduce the incidence of tooth loss by monitoring the dentition and by any prosthetic replacement of the natural teeth
To increase the probability and treating in a timely manner, other diseases or conditions found in the oral cavity
OBJECTIVES OF SPT
Preservation of alveolar bone support (radiographically)Maintenance of stable, clinical attachment levelReinforcement and re-evaluation of proper home careMaintenance of a healthy and functional oral environment
RATIONALE FOR SPT
RECURRENCE Incomplete subgingival plaque removal
Presence of bacteria in the gingival tissues in chronic and aggressive periodontitis cases
Microscopic nature of dentogingival unit healing after periodontal treatment
SUBGINGIVAL SCALING ALTERS THE MICROFLORA
RATIONALE FOR SPT
INCOMPLETE SUBGINGIVAL PLAQUE REMOVAL Continued loss of attachment
Without the presence of clinical gingival inflammation
RATIONALE FOR SPT
PRESENCE OF BACTERIA IN THE GINGIVAL TISSUES Bacteria may recolonize the pocket and cause recurrent disease
Bacteria associated with periodontitis can be transmitted between spouses and other family members
RATIONALE FOR SPT
NATURE OF THE DENTOGINGIVAL UNIT HEALING Long junctional epithelium
Weaker
Inflammation may rapidly separate
RATIONALE FOR SPT
SUBGINGIVAL SCALING ALTERS MICROFLORA Decrease in motile rods for 1 week Marked elevation in coccoid cells for 21 days Marked reduction in spirochaetes for 7 weeks Return of pathogens to pretreatment levels- 9-11 weeks 3 months maintenance interval
Prevent recurrence Based on microscopic monitoring of subgingival flora
Subgingival scaling alters the pocket microflora for variable but relatively long periods
MAINTENANCE PROGRAMME
Comprises of 3 parts Examination and evaluation
Treatment
Report, cleanup and scheduling
MAINTENANCE PROGRAMME
EXAMINATION AND EVALUATION Changes from last evaluation
Medical history
Restorations, prostheses
Caries, occlusion, mobility, gingival status, probing depths
Analysis of current oral hygiene status
Pathologic conditions of oral mucosa
Radiographic examination Bone height, repair of osseous defects, occlusal trauma, periapical pathologies,
caries
MAINTENANCE PROGRAMME
CHECKING OF PLAQUE CONTROL Must be reviewed and corrected until patient demonstrates
necessary proficiency
Less plaque and gingivitis if instructed
MAINTENANCE PROGRAMME
TREATMENT Required scaling and root planning
Not to instrument normal sites
Irrigation with antimicrobial agents of remaining pockets
SCHEDULING
MAINTENANCE PROGRAMME
RECURRENCE OF PERIODONTAL DISEASE Failed to remove all potential factors favouring plaque
accumulation
Incomplete calculus removal in areas of difficult access
Inadequate restorations placed
Failure of patient to return for periodic check-ups
Presence of systemic diseases
MAINTENANCE PROGRAMME
RECOGNISE A FAILING CASE Gingival changes and bleeding on probing
Increasing probing depth
Gradual increase in bone loss
Gradual increase in tooth mobility
CLASSIFICATION OF POST-TREATMENT PATIENTS
Recall interval for first year not longer than 3 monthsLong term preservation of the dentition closely associated with
the frequency and quality of recall maintenanceVaried groupPatient can improve or relapse into different classification with
reduction or exacerbation of periodontal disease
CLASSIFICATION OF POST-TREATMENT PATIENTS
FIRST YEAR PATIENT Routine therapy and uneventful healing
3 months
Difficult case with complicated prosthesis, furcation involvement, poor crown-to-root ratios, or questionable patient cooperation 1-2 months
CLASSIFICATION OF POST-TREATMENT PATIENTS
CLASS A Excellent results well maintained for 1 year or more.
Patient displays good oral hygiene, minimal calculus, no occlusal problems, no complicated prostheses, no remaining pockets, and no teeth with less than 50% of alveolar bone remaining 6 months to 1 year
CLASSIFICATION OF POST-TREATMENT PATIENTS
CLASS B Generally good results maintained reasonably well for 1 year or
more 3-4 months (based on number and severity of factors)
CLASSIFICATION OF POST-TREATMENT PATIENTS
CLASS C Generally poor results after periodontal therapy and/or several
negative factors 1-3 months (based on number and severity of negative factors)
consider re-treating some areas or extracting severely involved teeth
REFERRAL TO THE PERIODONTIST
Difficult casesPatients with systemic conditionsDental implant patientsComplex prosthetic constructions that require reliable results
REFERRAL TO THE PERIODONTIST
Surgery on distal sides of second molarExtensive osseous surgeryComplex regenerative procedures
REFERRAL TO THE PERIODONTIST
Extent and location of periodontal deterioration- most important
Teeth pockets of 5mm or moreTeeth with furcation lesions
REFERRAL TO THE PERIODONTIST
TEST FOR DISEASE ACTIVITY
Well-organized charting systemComparison of sequential probing measurementNo accurate method
Clinicians rely on combination of probing, bleeding on probing and sequential probing measurements
MAINTENANCE FOR DENTAL IMPLANT PATIENTS
Periimplantitis More prone to plaque-induced inflammation with bone loss
Difficult to treat
Treat periodontal disease beforeProvide adequate SPT
MAINTENANCE FOR DENTAL IMPLANT PATIENTS
Similar maintenance procedureDifference
Special instrumentation
Avoid acidic fluoride prophylaxis
Non-abraisive prophy pastes used
PROPHYLAXIS VS SPT
PROHYLAXIS
Non-therapeutic
Healthy mouth
Prevent disease
Supragingival procedure
6 months intervals
SPT
Therarapeutic
Patients who have had active periodontal treatment
Keep disease under control
Both supragingival and subgingival
3-4 months intervals
CONCLUSION
SPT very important phase for long term success of periodontal therapy
3-4 monthsTo prevent recurrence of periodontal diseasePatient motivation very importantNon compliant patientsWhen to refer case to specialistProphylaxis vs SPT
REFERENCES
Newman, Takei, Fermin A Carranza. Clinical periodontology, 9th Edition, WB Saunder Co., 2002. Jan Lindhe. Clinical Periodontology and Implant Dentistry, 4th Edition, (2003), Blackwell Munkgard Publication. Reddy Shantipriya. Essentials of Clinical Periodontology and Periodontics. 2 nd edition. New Delhi: Jaypee Publishers; 2008. p. 409. Klaus H., Herbert F.W., Hassel M., Color Atlas of Periodontology. Thieme Inc. New York. 1985. Cortellimi P, Pini-Prato G, Torretti M: Periodontal regeneration of human infrabony defects. V. Effects of oral hygiene on long-term
stability. J Clin Periodontol 1994; 21:606 Checchi L, Montevecchi M, Gatto MR, Trombelli L: Retrospective study of tooth loss in 92 periodontal patients. J Clin Periodontol
2002; 29:651 Wilson Jr TG: Compliance: a review of the literature. J Periodontol 1987; 58:706
http://www.theendoblog.com/2014/01/dental-implant-maintenance.html http://www.dentistryiq.com/articles/2009/10/prophy-and-periodontal.html http://www.rdhmag.com/articles/print/volume-0/issue-9/columns/staff-rx/prophy-vs-perio-maintenance.html http://nydentallife.wordpress.com/2011/03/28/periodontal-maintenance-or-a-%E2%80%9Cregular-cleaning%E2%80%9D-
%E2%80%93-what%E2%80%99s-the-difference/
THANK YOU
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