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Basic Treatment for Periodontal Disease
Dr. Sok Chea D.D.S, F.A.D.I, F.I.C.C.D.E, F.C.S.PPost Graduate Diploma in PeriodontologyPeriodontal SpecialistCert. Periodontic (Japan)Cert. Intensive Oral Implantology (H.K)
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)2.Scaling, Root planing3.Form adjustment of the unfit prosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1. Selective grinding, coronoplasty2. Temporary splint3. LOT (Limited Orthodontic Treatment: Miner Tooth Movement)
Reevaluation of initial treatment
Reevaluation of initial treatment
Periodontal Surgery
Reevaluation of periodontal surgery
Final restoration
Supportive Periodontal Therapy(SPT)Maintenance
Sometime, features of Periodontitis or
periodontal abscess is a good material
for the motivation of periodontaltreatment
Motivation and education for periodontal treatment
Practical use of the Plaque Control Record (PCR)
First visit
2 weeks later
First visit 2 weeks later
Practical use of the Plaque Control Record (PCR)
First visit
2 weeks later
Instruction for plaque control
To choose the adapted tooth brush For habit or form of dentition in each patients To instruct the adapted tooth brush method for the periodontal condition in each patients
Dental Floss
Interdental brush
Ultrasonic tooth brush
Before initial preparation
After initial preparation
Effective of initial preparation
This case was done only plaque control and brushing
Cleaning and polishing brush for tooth surface
Prophylaxis paste: include 0.15% fluorides
Polishing tooth surface by rubber chip/cup
Polishing paper strips: sometime use this material in the final polishing phase at the interdental surface
Before scaling & polishing
After scaling & polishing
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)1.Tooth brush instruction (TBI)2.Scaling, Root planing2.Scaling, Root planing3.Form adjustment of the unfit3.Form adjustment of the unfit prosthesisprosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1. Selective grinding, coronoplasty2. Temporary splint3. LOT (Limited Orthodontic Treatment: Miner Tooth Movement)
Reevaluation of initial treatment
Re-contouring of defective restoration and crown that occurred periodontal inflammation
The overhanging form is caused by plaque accumulation
After re-contouring: the crown of buccal surface become to natural smooth form
Subgingival Plaque ControlSubgingival Curettage
Subgingival Root Planing
Enamel
CalculusGingiva
Scaler
Subgingival Root Planing
• To remove the plaque, calculus and pathologic cementum at subgingiva used by hand scaler
• To make a smooth root surface used by hand scaler
• Due to the effect of root planing, the gingiva become to change a strong fibrous tissue
• Due to the effect of root planing, the occasion of infection become to decrease
Before root planing targets to periodontal abscess
After root planing. The periodontal abscess is eliminated
Before root planing in the full mouth with no surgery
After root planing. There is no inflammation and active pockets
Root treatment in subgingiva
Crown/root polishing and instruction for after treatment in subgingiva
Scaling and root planing
To remove fragment of calculus and cementum.Ablution of pollute and infect substance
Crown and root polishing
After root planing and polishing
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)2.Scaling, Root planing3.Form adjustment of the unfit prosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1.1. Selective grinding, coronoplastySelective grinding, coronoplasty2. Temporary splint3. LOT (Limited Orthodontic Treatment: Miner Tooth Movement)
Reevaluation of initial treatment
Occlusal adjustmentSpot grinding
Coronal reshaping
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)2.Scaling, Root planing3.Form adjustment of the unfit prosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1. Selective grinding, coronoplasty2.2. Temporary splintTemporary splint3. LOT (Limited Orthodontic Treatment: Miner Tooth Movement)
Reevaluation of initial treatment
Temporary splint used by adhesive composite resin
Occlusal adjustment
After initial preparation.
Temporary splint and provisional restoration case
First visit: Occlusal collapse was shown in all of teeth
After initial preparation
Provisional restoration by denture type was set. This denture was a fix type for stabilized teeth.
A-splint (Wire resin splint)
A-splint used by shape memory alloy
The shape memory alloy is made from mixed nickel and titanium. This alloy is able to back same shape after bend.
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)2.Scaling, Root planing3.Form adjustment of the unfit prosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1. Selective grinding, coronoplasty2. Temporary splint3.3. LOT (Limited Orthodontic LOT (Limited Orthodontic Treatment: Miner Tooth Movement)Treatment: Miner Tooth Movement)
Reevaluation of initial treatment
The case of periodontitis, occlusal disharmony and esthetic problems
Extraction
Open bite case caused by occlusal disharmony
The occlusal disharmony caused by infra occlusion at posterior teeth then mandibular deviate to posterior position. This situation is pushed up anterior teeth on maxilla
Orthodontic treatment used by arch wire and brackets
4 month later after orthodontic treatment and bit raising at posterior site
After remove the orthodontic appliance, the case was set retention appliance
Final view of initial preparation includes orthodontic treatment
Up righting and muco gingival surgery case
Inclination
Buccal frenulum No attached gingiva
Temporary bridge was set before orthodontic treatment and muco gingival surgery
Muco gingival surgery at buccal site. This case was done mixed procedure of frenectomy and vestibular extension surgery
Limited orthodontic treatment was done used by double loop splinting
3 month later
5 month later
The general process of periodontal disease
Treatment for improved Inflammation1.Tooth brush instruction (TBI)2.Scaling, Root planing3.Form adjustment of the unfit prosthesis 4.Provisional restoration for missing tooth/teeth or prosthetic problem5. Extraction
Treatment for improved occlusal problems1. Selective grinding, coronoplasty2. Temporary splint3. LOT (Limited Orthodontic Treatment: Miner Tooth Movement)
Reevaluation of initial treatmentReevaluation of initial treatment