Design and organization of the treatment plan in periodontology:
1- Emergency treatment (review 3rd year course )
2- Etiological therapy:
♦ Sanitation of the periodontium in order to eliminate any gingival and periodontal inflammation by:
– Rigorous motivation for oral hygiene
– Teaching brushing methods (were detailed in the course).
– Scaling, root planing and polishing
♦correction of overflowing fillings and improvements of single restorations.
♦ Muscle exercise to relieve muscle spasms and pain (in case of DAM)
♦ Psychotherapy in certain predisposed cases.
♦ Temporary retention, temporary prosthesis.
♦ Occlusal splint and bite plane in case of DAM or bruxism.
3. Reassessment phase:
This is the decision-making process to confirm or modify the initial treatment plan.
Depending on the clinical response to the initial therapy.
This notion of reassessment also accompanies decisions during
supportive therapies during treatment.
After treatment, it is a matter of detecting the first signs of recurrence of periodontal disease
and recommending appropriate therapies.
4. corrective phase:
includes: non-surgical treatment, surgical treatment and the occlusal rehabilitation phase.
– etiological treatment alone may in many cases be sufficient.
– if this is not the case, the reasons must be assessed (patient cooperation or progression of the periodontal disease), to deduce the need for surgical treatment or not.
4.1. Non-surgical treatment:
In some cases the disease presents a more marked infectious character or even an abscess or the host response seems weakened.
The medication will help the deficient host in its fight against the infection.
a. the use of local antiseptics:
- for irrigation: quick release processes:
Chronic periodontitis hydrogen peroxide 3 times/week for 6 weeks.
- For slow release processes:
periochipe: Chlorhexidine gluconate: 2.5mg, Chronic Periodontitis for pockets: greater than or = 5mm.
b. antibiotics:
ATB prescription is recommended after taking a bacterial sample with microbiological culture.
But given the difficulty of growing crops and their cost, we will generally prescribe ATBs depending on the particular case.
Directions:
- Presence of specific bacteria AAC, PG therefore aggressive periodontitis
- As an emergency: suppuration.
- Necrotizing diseases: GUN; PUN.
- Prophylaxis for patients at risk.
- Refractory periodontitis.
- Postoperatively: when the bone is exposed.
- Sites requiring regeneration intervention.
Prescribing general antibiotics: (in adults)
- Monotherapy:
- Cyclines: localized aggressive periodontitis and periodontal abscesses.
- Metronidazole: necrotizing periodontitis, abscesses.
- Amoxicillin: in case of localized suppurations, and as prophylaxis in patients at risk.
- The associations:
- Amoxicillin + clavulanic acid: necrotizing periodontitis.
- Amoxicillin + metronidazole: generalized aggressive periodontitis and also generalized suppurations in case of chronic periodontitis.
Prescribing local antibiotics:
- Rapid release
irrigation processes)
- Localized aggressive periodontitis: cyclines: 3 times/week for 3 weeks.
- Generalized aggressive periodontitis: metronidazole: 3 times/week for 3 weeks.
- Slow release processes:
- Actisite (alza): release of tetracycline 1300 Mg/ml for 20 days.
- Metrogenic: 5% metronidazole on collagen sponge.
- Elysol: dental gel: good mucosal diffusion.
4.2. Surgical treatment:
The final decision on periodontal surgery will be made after reassessment of the results of the initial therapy and regression or disappearance of the inflammatory signs.
Design and organization of the treatment plan in periodontology
Design and organization of the treatment plan in periodontology
- Objectives of surgical therapy:
- Better access to root surfaces.
- Regeneration of periodontal tissues.
- Pre-prosthetic correction.
- Correction of iatrogenic acts.
- Improved aesthetics.
4.3. Occlusal rehabilitation phase:
a. definition of occlusal rehabilitation:
Occlusal rehabilitation is the set of therapies intended to preserve the health of the masticatory system.
Goals:
Preserve or restore the health of the masticatory system.
Restore healthy occlusion.
- Occlusion rehabilitation can be achieved by different means:
1- the prosthesis to replace missing teeth.
2- orthodontics to correct dental malpositions.
3- occlusal adjustment indicated after prosthetic or orthodontic treatment. And should never be carried out except after removal of inflammatory foci.
b. orthodontic treatment:
As a means of balancing occlusal function, orthodontic treatment aims to:
– To correct cusp interferences.
– To ensure distribution of occlusal loads in the direction of the long axis of the tooth.
– To establish favorable hygiene conditions.
– Improve the aesthetic appearance, while maintaining the functional character.
– Improve the condition of periodontal function.
c. prosthetic treatment: aims to:
– Restore aesthetics and function.
– Replace missing teeth to prevent migration and tilting movement.
– Distribute occlusal loads across all teeth (natural and prosthetic)
– Individual stabilization and retention of each dental arch.
d. restraint:
The term containment is used to indicate either the holding in place, or the support or wedging of a mobile or displaced part.
- directions:
The general indication for retention can be identified:
– high mobility of a tooth whose periodontium is particularly affected.
– functional deficiency of the mobile tooth responsible for the loads being carried gradually on other teeth less able to bear them.
– preventing secondary dental migrations as well as preventing post-orthodontic migrations.
– improving the stability and adaptation of all the teeth.
e. occlusal adjustment:
Selective grinding is the set of subtractive occlusal corrections aimed at obtaining a stable inter-arch relationship, an adapted occlusal schema and establishing a physiologically adapted maxillo-mandibular relationship.
The aim of occlusal adjustment is:
To allow the mandible to position itself in PIM without encountering obstacles on the physiological closure path.
To ensure a stable intercuspal position with maximum punctiform contacts.
To allow, from this position, all movements without interference.
To improve dental contacts after orthodontic or prosthetic treatment .
5. supportive therapy:
Definition :
Maintenance is defined as a set of personal and professional means enabling effective control of PB.
Personal maintenance is combined with rigorous long-term dental hygiene, carried out by the patient himself.
Professional maintenance is carried out by the practitioner during clinical control sessions and reinforcement of motivation for oral hygiene.
- allows to avoid;
– The appearance of a pathology for subjects not yet affected
– To eliminate gingivitis before it transforms into periodontitis in at-risk individuals
– To stabilize the MP and prevent its recurrence and therefore the preservation of periodontal health
– To slow the progression of the disease in uncooperative patients
– In the case of refractory periodontitis where the aim will be to slow the progression of PD, to deduce the consequences in terms of pain or inconvenience for the patient.
Design and organization of the treatment plan in periodontology
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.