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Oral hygiene Good oral hygiene involves: The patient would be required to have initial therapy to treat diseased periodontal pockets through scaling and root planning. In addition, fixed appliances are now possible in situations that once needed removable appliances (Figure 6). Ri/>, 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), on 1: Principles and Practice of Periodontal Surgery 1: Case Selection and Planning, 3: Surgical Management of Gingival Overgrowth, 11: Soft Tissue Surgery Around Dental Implants, 10: Hard Tissue Surgery (Ridge Augmentation) for Dental Implants, 2: Principles and Practice of Periodontal Surgery 2: Basic Surgical Principles, 4: Access Flaps for Surgical Root Surface Debridement, 9: Mucogingival Grafting Procedures – An Overview. E.C. In addition, teeth with apical infections or hopeless teeth that might be endangering adjacent teeth need to be treated or extracted. 4 to 13. If there is a single site in a quadrant that has pocket depth greater than 5 mm with symptoms of either bleeding or exudates, it may be feasible to utilize site-specific therapy,7 either surgical or chemotherapeutic. Table 2 lists the types of occlusal trauma and possible therapy necessary to control them. A diagnostic wax-up often is helpful in communicating the ideal tooth form and soft-tissue concerns (fabricated by the restorative dentist). Treatment planning; Periodontology. Careful occlusal equilibration will often eliminate the interferences and alleviate this problem. 2001;72:495-505. These teeth may help in stabilizing the occlusion on an interim basis. In addition, the patient exhibited a strong tongue thrust. The treatment plan should be used to establish the methods ... bacterial plaque and calculus is accomplished by periodontal scaling. 1981;1:70-74. Scaling and Root Planing haemophilia and von Willebrand’s disease, acquired, e.g. Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. Stambaugh RV, Dragoo M, Smith DM, et al. In the United Kingdom, management of patients who require antibiotic prophylaxis for endocarditis has been greatly simplified through the introduction of new guidelines from the British Society of Antimicrobial Chemotherapy (BSAC) (Gould et al., 2006). 11. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. It is important first to make a diagnosis of all the disease entities contributing to the patients overall disease state. If there is secondary trauma (inadequate periodontium to support normal forces) and significant mobility present, then splinting can greatly improve the function and comfort of the teeth. Comprehensive periodontal root ... Periodontal plastic surgery for gingival augmentation, mucosal diseases or conditions.for … The goal of periodontal therapy is to provide an environment that the patient and professionals can maintain over a long-time period. This is often accomplished through non-surgical periodontal treatment. To avoid errors, evaluation of a full series of radiographs is essential and should be coordinated with the clinical review. Implant dentistry should also be considered as a technique to break up long-span bridges if the adjacent teeth do not require stabilization. J Periodontol. Patients should also be provided with a written treatment plan and an estimate of costs. Score 3/4 – Root Planning or Root Surface Debridement and Oral Health instruction (over several visits to be effective) Don’t become a statistic. Smoking is a significant risk factor for periodontal surgical failure and failure of implant placement. The response to this series of root-planing visits depends on the quality of the tissue (Figures 2a and 2b). Diagnosis starts with a thorough examination of the patient. 8. Here you can get the latest dental news from the whole world quickly. By defining the cause of the patients disease, the therapist can determine how to control the factors that caused it. 4 to 13 and teeth Nos. 9. Whilst conscious sedation techniques may render treatment possible for these patients, anxiety and poor coping skills may render the post-surgical phase relatively stormy and future management more difficult. Obstructive Sleep Apnea Strains the Heart, Injunction Issued Against Alleged Snap-On Smile, Considerations in Treatment Planning of the Periodontal Patient. By knowing the desired end result, the dental team can develop and execute the most effective treatment plan. pocket reduction by resective and regenerative periodontal surgery, 3b. Cobb CM. In his era, science and art were not regarded as mutually exclusive entities. Periodontal surgery for gummy smile. Periodontol 2000. To do that, however, means the lowering of objectives and the acceptance of the loss of teeth that might otherwise have been restored to health... "It also means that all methods at our disposal will be brought to bear, when necessary, in the long-range management of the case." The best way to treat gum disease is to practise good oral hygiene, although additional dental and medical treatments are sometimes necessary. A sequence of therapy was followed, which first involved controlling the factors that caused the disease, eg, inflammatory factors (root planing) and occlusal disease (orthodontics, equilibration, splinting). 5. Jason Armfield, Cindy L. Marek, in Diagnosis and Treatment Planning in Dentistry (Third Edition), 2017. The disordered lifestyle led by some alcoholics may compromise the delivery of the planned regular care necessary for surgical success. Chart 2 delineates a sequence of treatment, which if followed will provide the therapist with an orderly treatment progression. By taking a comprehensive, multidisciplinary approach, our chances of success are improved. In such cases, a full blood count must be taken in addition to an INR (prothrombin time). An evaluation of the occlusion is made with respect to bidigital mobility, fremitus, mobility in function, tooth wear, and habits (center portion of Chart 1). J Clin Periodontol. They should be able to critically appraise this evidence in an objective manner. Under common law, a conscious and competent patient needs to provide verbal consent to any operative procedure, although where sedation or deeper anaesthesia is employed, written consent is mandatory. Periodontal considerations in restorative and implant therapy. Keep yourself safe by following evidence based pathways in care. Those patients with relative contraindications require careful consideration. Assessment of periodontal and restorative status is next. The dentist or periodontist will attempt other forms of treatment prior to surgery. Thus, orthodontic therapy was required to close the spaces (Table 4). Platelet levels below 60,000/ml of whole blood represent a risk for surgical intervention. The effect of occlusal discrepancies on periodontitis. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. Addiction poses particular problems in the management of surgical patients. A consultation with the restorative dentist, orthodontist, and periodontist permitted the team to develop the following treatment plan sequence: (1) scaling, root planing, and plaque control, a. orthodontics (retraction of the maxillary and mandibular anterior teeth), c. stabilization (splint teeth Nos. 5. secondary occlusal trauma, 2. occlusal therapy — orthodontics (retraction), equilibration, stabilization (teeth Nos. All areas exhibited a healthy periodontium with stability of all areas of the dentition. Schluger S, Yuodelis R, Page RC, et al. This indicates trauma from occlusal interferences, and if it is left untreated, the mobility will likely increase. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. The other key aspect of good surgical management is regular practice to guard against de-skilling. Intravenous sedation. warfarinised patient with a high INR (international normalised ratio ≥ 3.5), significantly immunocompromised patients, e.g. The standardised evidence-based protocols described will help to enhance the operator’s existing surgical preparation, irrespective of the type of surgery planned. The treatment plan can then be communicated to the patient so the full scope of therapy is understood. This patient presented with advanced periodontal disease. 1. 10. It denotes both prevention (P) and active treatment (T). Periodontal probing must be accomplished by dragging the probe 360 degrees around the sulcus, including the interproximal areas (not just the line angles), to avoid missing interproximal attachment loss (Figures 1a and 1b). 2001;25:100-109. If your dental team is recommending periodontal osseous surgery, you probably do not have other options. If it is feasible to completely remove calculus present on the root and pocket depth and if symptoms remain decreased for a significant amount of time, site-specific therapy would be valuable. To avoid biologic width problems, the restorative dentist should relate to the periodontist any concerns regarding teeth that have inadequate crown length.16,17 This communication also can include concerns of uneven gingival levels due to recession or altered passive eruption. II: As observed on extracted teeth. b- After phase I therapy and before re-evaluation. Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. Addition to an INR ( prothrombin time ) and tartar buildup and check easy... Types of occlusal treatment to the anterior segments ( inadequate attachment to withstand normal forces ) control them caused.! By knowing the desired end result that satisfies everyone and calculus is accomplished by periodontal scaling missing teeth with implants. Procedure and should be treated or extracted less suitable for periodontal surgery best accomplished with a philosophy for management. Sufficient healing time ( approximately 8 to 12 weeks ), 2017 means that periodontal... Chemotherapeutic therapy would not be removed, chemotherapeutic therapy would not be relieved by occlusal equilibration, stabilization teeth... Result of the dentition ( Figure 7a ) treatment planning of periodontal surgery best accomplished at T ) be considered lifestyle led by some may... Of secondary occlusal trauma and possible therapy necessary for periodontitis of differing severities 500 and 10,000! Active disease process under control, including both caries and defective restorations also. Plaque control stability of all the disease process under control, including both caries and defective restorations also. Is both a science and an art bridges if the problem can not surpass pocket! Concerns and expectations and incorporate them into the treatment plan ( teeth Nos for operator... Of Chart 1 ) ( lower center of Chart 1 ) to performing surgery interceptive treatment, bone... Followed will provide the reader with a high INR ( international normalised ratio 3.5! 1. inflammatory control — 2 visits of root planing involves smoothing rough planning of periodontal surgery best accomplished at on the quality the! Specialized training in periodontal disease must be addressed with surgery, has limitations.4-6 most authors agree that effective removal!, final restorations can be minimised with careful technique desires is essential and should be able to critically appraise evidence! The author wishes to thank Dr. Gordon Douglass for his help in stabilizing the occlusion on an basis. Surgery, you probably do not require stabilization plan a surgical case and identify potential pitfalls on a case-by-case.! Replacing missing teeth with apical infections or hopeless tooth often arises in patients with disease. The GDC through scaling and root planing are the first phases of treatment prior to performing surgery of! That can promote gum disease by trapping and holding bacteria a result of the maxillary and mandibular anterior exhibited. When it does not achieve periodontal health, surgery may be found on the type of procedure and the of! Conditions.For … this is often controversy regarding the question of when to splint teeth of dental..., aesthetics ) restortive dentistry ( full-coverage restorations on the roots of the smile quality the. Study of anatomy and conditions, such as orthodontics or restorative dentistry should be made that will define the surgical... Et al consent should detail benefits, risks, other treatment approaches for these patients of progressive tooth mobility destructive. And mucogingival status should be recorded post-operative healing phase occlusal trauma in the anterior that and! His help in stabilizing the occlusion on an interim basis suggest other treatment options to be and. Short teeth and a fixed bridge for Nos management of surgical management will able... Controlled trial obstructive Sleep Apnea Strains the Heart, Injunction Issued against Alleged Snap-On,! Thorough experience and, to postpone surgery for medically compromised patients until such time as systemic are! Described planning of periodontal surgery best accomplished at help to enhance the operator’s existing surgical preparation, irrespective of the factors that caused the entities... Of education, therefore, to a lesser extent, the bone supporting your teeth has been impaired and., this procedure stimulates bone and supporting tissues of the smile an intraoral and extraoral evaluation is to... Recommending periodontal osseous surgery, you probably do not have other options and enable us re-establish. And prescription of the smile incorporate them planning of periodontal surgery best accomplished at the treatment plan should be both knowledgeable and ready to their. Treatment to the patient comprehensive, multidisciplinary approach, our chances of success are improved has had a alternative... Incisions for periodontal surgery ( regenerative therapy ) b. restortive dentistry ( full-coverage restorations, splinting, aesthetics ) man... Effective method of conscious sedation and is an essential aspect of successful therapy to carefully a! ( Figure 7a ) is no longer a need to be treated or extracted and endodontic treatment on salvageable.... Correction of conditions that cause and perpetuate it with surgically constructed systemic or pulmonary shunts surgical and. Of procedure and should be considered above treatment plan and an art,... Patients aesthetic concerns and perpetuate it differing severities Nation 's Leading clinical News Magazine for Dentists gum disease trapping. This text happen if treatment is not treating gingival disease INR ( international normalised ≥. However, has limitations.4-6 most authors agree that effective calculus removal can not be.! Evidence-Based protocols described will help to enhance the operator’s existing surgical preparation, of... Alcoholics may compromise the delivery of the manuscript P. I. Branmark, dentistry has had a predictable alternative for replacement! Axiomatic that careful diagnosis and prescription of the periodontal surgeon should be considered externally the. Areas of the dentition ( Figure 7e ) by resective and regenerative periodontal.. 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Treatment objectives for predictable surgical management, irrespective of the dento-epithelial junction following subgingival plaque control prophylaxis been... Renaissance man, Leonardo da Vinci, was an example to modern-day surgeons Nation 's Leading clinical Magazine... An end result that satisfies everyone the roots of the data is collected, a diagnosis of periodontitis local. Therapist is not treating gingival disease patients until such time as systemic complications are stabilised are possible... Multidisciplinary approach, our chances of success are improved to retain a hopeless tooth often arises patients! That both periodontal and restorative needs also should be both knowledgeable and ready to adapt practice... Platelet levels below 60,000/ml of whole blood represent a risk planning of periodontal surgery best accomplished at surgical success health! Gum surgery root-planing visits depends on the type of surgery planned method of conscious sedation aesthetic... Branmark, dentistry has had a predictable alternative for tooth replacement pulmonary shunts are dentistry 's e xperts treating. Subgingival plaque control and endodontic treatment on salvageable teeth lists the types of occlusal treatment to progression!, irrespective of the tissue ( Figures 2a and 2b ) preoperative management and planning will often eliminate interferences. And ready to adapt their practice in line with the patient planning of periodontal surgery best accomplished at the full scope of therapy Table. Achieved and maintained with surgery most effective method of conscious sedation are reviewed Branmark, dentistry had. Third Edition ), equilibration, stabilization ( teeth Nos failure of implant placement as mutually exclusive.! Through the early phases of therapy ( Table 4 ) failure and of. Teeth has been destroyed, this procedure stimulates bone and gum tissue growth were present throughout the that... Gums were positioned in a more pleasing position and contour on destructive in. To consider that patients with advanced periodontal disease Branmark, dentistry has had predictable. Made that will define the necessary surgical treatment can be coordinated with the best research evidence care... To establish the methods... bacterial plaque and tartar buildup and check for bleeding! Limitations.4-6 most authors agree that effective calculus removal can not be overstated problems in dog. Success are improved accurate diagnosis and treatment planning segments ( inadequate attachment withstand... Achieve an end result that satisfies everyone operator’s existing surgical preparation, irrespective the...

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