The treatment plan in periodontics
I- Introduction:
Periodontal treatment is the last step after performing:
- A complete clinical examination.
- Further examinations.
These elements will allow a diagnosis and prognosis to be made, and consequently an appropriate treatment plan. The latter is intended to re-establish a flora compatible with periodontal health, in order to stop attachment losses and re-establish functions.
II- Goals of the treatment plan:
- Patient motivation.
- Stop the damage.
- Elimination of etiological factors.
- Elimination of signs of inflammation.
- Prevent recurrence.
III- Stages of the treatment plan:
- Emergency treatment.
- Initial treatment (initial therapy):
- Definition :
This is the first step in periodontal treatment, also called the “preparatory phase or etiological treatment”. Its aim is to eliminate the etiological factors and therefore eliminate the inflammatory signs.
- The stages of initial therapy :
- The motivation :
- It consists of raising awareness and informing the patient about periodontal disease. The practitioner will have to bring together a large number of qualities; patience, perseverance, psychology and pedagogy.
- The main objective of motivation is to make the patient aware of the importance of his periodontium, and to make him admit the purpose and necessity of oral hygiene. It will be necessary to use individualized language, adapted to the intellectual level of the patient.
- The dentist is required to seek active participation from the patient.
- Teaching oral hygiene :
Once the patient is motivated and has become aware of the need for treatment to maintain his periodontal health, he will need to be taught the brushing method that best suits his case and the use of brushing aids will be recommended.
- Removal of plaque and tartar :
This step involves removing all coloring, soft and hard deposits.
- Elimination of iatrogenic irritations :
Among the main iatrogenic irritations that must be corrected or eliminated are:
- Irregular filling surfaces with poorly defined contours.
- Overflowing seals.
- Poorly constructed intermediate elements of bridges.
- Removable prosthesis hooks.
- Endodontic treatment (caries, etc.)
- Extraction of teeth deemed unsalvageable.
- Minor occlusal treatment :
- Temporary prosthetic restoration.
- Provisional restraint.
- Reassessment:
Allows testing of patient motivation level, as well as host tissue response.
This involves a reassessment of:
- Amount of plaque and tartar.
- Gingival inflammation.
- The depth of the pockets.
- Indices (GI, PI, SBI, etc.)
The results of this re-evaluation constitute the basis for selecting the therapeutic techniques that should be incorporated in the next phase.
- Corrective phase:
This phase will depend on the results of the reassessment, it includes:
- Non-surgical therapy.
- Surgical therapy.
- Occlusal rehabilitation.
The choice between surgical and non-surgical therapy will depend on several parameters (depth of pockets, presence or absence of recessions, height of attached gum, etc.)
- Non-surgical therapy :
It is based on scaling and resurfacing, as well as chemotherapy (antibiotic, antiseptic) locally and generally.
- Local route : pocket ≤ 5mm
It is done by irrigations (rapid release procedure), it is carried out using a disposable syringe (insulin syringe), the tip is inserted to the bottom of the pocket then the product is injected.
The products used are antiseptics or antibiotics, this irrigation will allow re-oxygenation, bacterial disorganization as well as disinfection.
- General route : use of antibiotics
- PJL: Doxycycline 200 mg the first 2 days
14 days
100 mg for 12 days
- PJG, PPR, PPP: Amoxicillin 500 mg (3 times a day for 14 days)
+ Metronidazole 250 mg (3 times a day for 14 days)
- Surgical therapy :
– Mucogingival surgery (frenectomy, etc.)
– Pocket surgery (flaps, filling, etc.)
- Occlusal rehabilitation : this is the definitive occlusal treatment
– Permanent prosthesis.
– Orthodontic treatment .
– Final contention.
– Selective grinding.
- Maintenance treatment:
This is not the final step but rather a continuation of periodontal treatment.
Its aim is to prevent the recurrence of periodontal disease, through periodic check-ups where the practitioner must evaluate all the indicators as well as the patient’s motivation.
The interval between these monitoring sessions is determined based on the severity of the periodontal disease and the patient’s degree of cooperation and motivation.
During this phase, descaling and motivation may be necessary.
Conclusion :
Periodontal disease is a multifactorial disease of bacterial origin, sometimes difficult to control. But thanks to the therapeutic methods in our possession, we can obtain good results, even satisfactory ones.
The treatment plan in periodontics
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.