The treatment plan in periodontics
I- Introduction:
Periodontal diseases are mostly of infectious origin, developing in an inflammatory pathogenic mode and causing serious functional damage, sometimes even leading to tooth expulsion, which has led periodontologists to propose a preventive and curative management plan for periodontal diseases without forgetting the correction of the harmful functional after-effects caused by these diseases on the health of the dental organ.
II- Objective of periodontal treatment:
The periodontal treatment plan has several objectives:
- Prevention
- Elimination of etiological factors
- Healing of periodontal disease (reversible forms)
- Stabilize the evolution of irreversible lesions
- Correcting the after-effects of periodontal disease
- Maintaining a periodontium that has already been treated in good condition
III- basic elements required for establishing the treatment plan:
A treatment plan is established based on data collected during a thorough clinical examination. This data concerns the patient’s general condition, the exo and endo oral environment in which periodontal disease develops, gingival inflammation, pocket depth, tooth mobility, anatomy and quality of the alveolar bone. All of this data allows for a correct diagnosis to be made and then an adequate treatment plan to be organized.
IV- stages of the periodontal treatment plan:
a- Emergency treatment:
Made to respond to an emergency situation; pain, gingival bleeding, significant mobility, suppuration and periodontal abscess.
b- Initial therapy:
Also referred to as etiological therapy, the aim during this stage is to neutralize the etiology of the disease, which is mainly bacterial plaque. The methods used are firstly motivating the patient to practice oral hygiene, teaching the patient mechanical and chemical methods of plaque removal (brushing and brushing aids) at home, mechanical plaque removal in the dental chair (scaling and polishing with or without root planing), removal of plaque retention factors (cavities, overflowing fillings, poorly made prostheses, etc.) and chemical plaque removal. Minor occlusal rehabilitation may be initiated during this phase to relieve teeth subjected to disabling traumatic forces.
c- reassessment :
The patient is summoned after a determined period in order to evaluate the effectiveness of the initial therapy; the practitioner reassesses the patient’s motivation as well as the effectiveness of his brushing method, he also studies the response of the periodontal tissues to the elimination of the etiological factors. The results obtained during the reassessment are decisive for the continuation of the treatment plan; if a total disappearance of the signs of the disease and restoration of the normal state of the periodontium is observed, it can be decided to move on to maintenance sessions of the results, otherwise a corrective treatment phase is necessary to definitively eradicate the periodontal disease and its after-effects.
d- the corrective treatment phase :
Also called definitive treatment because it aims to permanently eradicate periodontal disease and its cofactors. This phase consists of ensuring:
- Sanitation of periodontal pockets either by non-surgical or surgical treatment
- Surgical correction of gingival, mucogingival or bone architectural problems innate or induced by periodontal disease.
- Definitive occlusal rehabilitation.
e- the maintenance phase:
Knowing that a large number of clinical forms of periodontal diseases are irreversible and progress through alternating phases of activity and rest, the practitioner must see the patient regularly following a program of more or less frequent monitoring sessions depending on the prognosis of the disease in order to avoid recurrence and intervene at the right time in the event of reappearance of the symptoms of the disease.
Conclusion :
Periodontal disease without treatment will undoubtedly progress to the more or less rapid and more or less complete destruction of periodontal tissues. The complexity of its etiology, its evolution and its repercussions on the periodontium encourages us to rigorously respect the chronology of a global treatment plan ensuring prevention of the disease, correction of its sequelae and maintenance of periodontal health.
The treatment plan in periodontics
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