Maintenance
I- Introduction:
Treatment of patients with periodontal disease aims to eliminate or control the various infections that are due to plaque, to restore periodontal health and function, however rigorous control of BP by the patient, as well as supportive periodontal care performed by the practitioner are essential to the stabilization of therapeutic results and constitute the essential elements of any periodontal therapy.
II- Reminder on the etiology of MP: WESKI triad
III- Definition of maintenance:
Maintenance or supportive periodontal therapy 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.
IV- Place of maintenance in the periodontal treatment plan:
– Initial therapy
– Reassessment therapy
– Corrective therapy
– Maintenance therapy
V- The goals of maintenance therapy:
1- PB control:
It is well established that periodontal treatment without proper PB control inevitably leads to failure, regular maintenance including scaling and proper hygiene measures can stabilize the attachment level for several years.
2- Pockets and attachment level:
Maintenance allows for maintaining constant depths and attachment levels after periodontal therapy through careful plaque control.
This elimination makes it possible 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
VI- Practical therapeutic plan:
- Diagnostic phase:
a- Questioning the patient:
b- Periodontal examination:
c- Dental examination:
d- Occlusion control:
e- Radiographic assessment:
f- Bacteriological and immunological examinations:
g- Information and reinforcement of motivation:
- Therapeutic phase:
a- Descaling and surfacing:
This is an intervention that consists of removing plaque and tartar from the surface of the teeth. Depending on the location of the deposits, the scaling will be supra or subgingival.
Professional removal of deposits allows;
– To delay the formation of a new organized PB.
– To reduce the risk of root caries.
– To improve patient motivation.
b- Drug treatment:
In addition to mechanical treatment.
c- Occlusal adjustment:
A functional examination of the occlusion should be a reflex to detect any traumatic occlusion, given that it is an aggravating factor in PD.
d- Treatment of recurrences:
The choice of treatment to counteract recurrence must be based on an analysis of the causes of recurrence:
– Inadequate or insufficient treatment.
– Inadequate restorations placed after the end of periodontal treatment
– The patient has not attended his follow-up visits
– Presence of certain general diseases
When recurrence is diagnosed early, it can often be stopped by intensifying maintenance therapy.
e- Factors influencing the frequency of visits:
– The severity and form of the disease
– PB control and patient motivation
– The patient’s systemic and psychological state.
Conditions that may influence the frequency of check-ups:
| Related to PB control | – patient motivation- patient knowledge and ability to apply oral hygiene care.- rate of formation of PB.- presence of retention factors complicating or preventing the performance of effective oral hygiene care.- rate of formation of tartar.- particular periodontal risk factors.- trauma due to inadequate brushing. |
Related to tissue destruction | – tendency to develop gingivitis and tissue destruction: → resistance of host tissues → pathogenicity of PB bacteria |
| Others | – occlusal reports – carious activity |
f- Intervals between control visits:
Classification | Features | Intervals between control visits |
| 1st year | Patient 1st , normal treatment and healing without problems Patient during the 1st year , difficult cases with complicated prosthesis, furcation involvement, weak C/R, patient cooperation questioned. | 3 months 1 to 2 months |
| Class A | Excellent results maintained for a year or more, patient shows adequate oral hygiene, little tartar, no occlusal problems, no complicated prosthesis, no residual pockets and no teeth with less than 50% remaining bone. | 6 months to 1 year |
| Class B | Good results generally maintained for at least a year, but the patient shows certain factors which are: – Low or no HBD. – Significant tartar formation. – Systemic disease predisposing to periodontal relapse – Some remaining pockets. – Occlusal problems – Recurrence of caries. | 3 to 4 months |
Class C | Generally poor results following periodontal treatment and/or presence of some of the following factors: – Number of teeth with less than 50% bone support. – Residual pockets being too advanced to be improved by periodontal surgery. |
Maintenance
IX- Conclusion:
At the end of any periodontal treatment, there should be daily PB monitoring by the patient and professional follow-up by the practitioner.
Maintenance
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.