Addiction poses particular problems in the management of surgical patients. Periodontal surgery for gummy smile. This article will focus on inflammatory disease, periodontitis (slight, moderate, and severe), and occlusal trauma (primary and secondary). 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. The goal of these surgeries is to remove the pockets of space between the teeth and the bone that can be broken down or destroyed with periodontal disease. Every year, an increasing number of practitioners are becoming involved in litigation or are falling foul of the GDC. congenital, e.g. Keep yourself safe by following evidence based pathways in care. Significant regeneration of bone is evident in the postoperative radiographs (Figures 7g, 7h, and 7i). 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). (6) preventive treatment visits (every 2 months). Score 3/4 – Root Planning or Root Surface Debridement and Oral Health instruction (over several visits to be effective) Don’t become a statistic. Dental schools and dental hygiene schools: which may offer low-cost dental care Summary Original Medicare does not cover oral surgery that a person needs solely for dental health. Treatment plan in periodontics 6. 2001;72:1535-1544. If the problem cannot be relieved by occlusal equilibration, then other therapies such as orthodontics or restorative dentistry should be considered. This should be communicated to the client prior to performing surgery. Dentistry Today is The Nations Leading Clinical News Magazine for Dentists? Often a hopeless or questionable tooth can be retained until periodontal surgery when a final decision can be made, thus avoiding multiple surgeries for the patient. The IV route is the most effective method of conscious sedation. Today, as in the past, there is no substitute for accurate diagnosis and treatment planning. A surgical attempt should only be performed if there is a lack of resolution in response to the SRP, as in human dentistry, after one to three months of oral hygiene. It is first necessary to evaluate functional needs, including inflammatory periodontal disease, occlusal factors, and restorative problems due to caries or failing restorations. 5. warfarinised patient with a high INR (international normalised ratio ≥ 3.5), significantly immunocompromised patients, e.g. It often is advantageous to retain a hopeless tooth through the early phases of treatment unless it is affecting an adjacent tooth. If inadequate dentition is left to support function, then prosthetic and implant dentistry should be considered. Examine your mouth to look for plaque and tartar buildup and check for easy bleeding. This, in … 2002:29(suppl 2):6-16. The periodontal surgeon should be both knowledgeable and ready to adapt their practice in line with the best research evidence. 1981;1:70-74. Thus, orthodontic therapy was required to close the spaces (Table 4). 1. This type of surgery is commonly known as gum surgery. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. This means that both periodontal and restorative goals must be delineated at the onset. Treatment objectives for predictable surgical management will be detailed alongside the principles common to different surgical procedures. 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. With few exceptions, periodontal surgical procedures are elective in nature. If a tooth needs to be extracted early in treatment, then the extraction should be coordinated between the periodontist and the restorative dentist so any necessary provisional restorations can be constructed and the extraction site augmented at the time of extraction. Williams RC, Paquette DW, Offenbacher S, et al. Scaling and Root Planing Banfield has presented a basic definition of the term plan : “ A plan is a decision about a course of action” 4. The limits of subgingival scaling. 2. If pockets are greater than 4 mm and the tissues are edematous, it is possible initially to decrease the pocket depth after the first root-planing visit, thus making more complete calculus removal feasible during subsequent visits. 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. Relationship of occlusal treatment to the progression of periodontal disease. 1978;49:119-134. The diagnosis of periodontitis means that there has already been some bone loss, thus the therapist is not treating gingival disease. Because the bacteria can firmly attach to the tooth roots under the gum line, regular dental cleanings may be inadequate to resolve the infection. Smoking is a significant risk factor for periodontal surgical failure and failure of implant placement. The diagnosis of fremitus in conjunction with mobility warrants interceptive treatment. Older BSAC guidelines are still published in the British National Formulary (BNF), and medicolegally either is acceptable as the guidance and advice of a recognised and properly constituted expert group. Control the cause of the disease process (etiology). 8. The disordered lifestyle led by some alcoholics may compromise the delivery of the planned regular care necessary for surgical success. 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). The chart is designed so that all aspects of potential dental therapy are reviewed. Once the active disease processes are controlled and the patient is stable, the corrective therapy of periodontal surgery and final restorative dentistry can begin. The aim of this chapter is to provide the reader with a philosophy for case selection and treatment planning in periodontal surgery. Sometimes, periodontal surgery may be needed to treat certain gum diseases and conditions, such as gingivitis or periodontitis. The loss of a single tooth no longer dictates full-coverage restorations on the adjacent teeth. Once there is sufficient healing time (approximately 8 to 12 weeks), final restorations can be fabricated. Pocket reduction therapy, including apically positioned flaps, osseous corrections, and, if indicated, regenerative therapy, has been shown to be the most effective way to correct periodontal defects, especially in moderate and severe periodontitis.18 If the patient has not responded with significant pocket reduction to scaling and root planing, surgical therapy is the usual treatment choice. A diagnostic wax-up often is helpful in communicating the ideal tooth form and soft-tissue concerns (fabricated by the restorative dentist). These guidelines have not, however, been universally accepted at the time of this book going to press. It is important to consider that patients with liver disease may be thrombocytopenic as well as having abnormal clotting factor levels. Those patients with relative contraindications require careful consideration. J Clin Periodontol. Wagenberg BD. 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. Platelet levels below 60,000/ml of whole blood represent a risk for surgical intervention. A diagnosis of secondary occlusal trauma was made with respect to the anterior segments (inadequate attachment to withstand normal forces). Surgical skill comes through both didactic and observational learning, thorough experience and, to a lesser extent, the surgeon’s innate dexterity. Gingiva can be edematous, fibrotic, or fibrous externally with the sulcus being ulcerated (Table 1). Table 2 lists the types of occlusal trauma and possible therapy necessary to control them. Clinical significance of non-surgical periodontal therapy: an evidenced-based perspective of scaling and root planing. After the diagnosis and prognosis have been established, the treatment plan is chalked out. Before proceeding with therapy, it is equally important to assess the patients aesthetic concerns and expectations and incorporate them into the treatment plan. Correct the deformities that the disease process has caused. Many of these can be minimised with careful technique. 4 to 13), Corrective Measures3a. 4 to 13 and teeth Nos. Once all of the data is collected, a diagnosis can be made that will define the necessary therapy. J Periodontol. pocket reduction by resective and regenerative periodontal surgery, 3b. The treatment plan is the blueprint for case management. Tooth movement was performed to close the diastema (Figure 7e). Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. The beauty of … J Periodontol. In patients with generalized severe attachment loss and mobility, it may be necessary to extend the posterior splint across the anterior to achieve cross-arch stabilization.9 Control of mobility can be determined by evaluating the provisional restoration. Treatment planning the advanced disease case. Root planing involves smoothing rough spots on the roots of the teeth that can promote gum disease by trapping and holding bacteria. b- After phase I therapy and before re-evaluation. Other relative medical contraindications should be considered practically on a case-by-case basis and treatment provided following careful appraisal of risks and assessment of response to previous surgical intervention. In addition, the technical aspects of surgery require fine motor skills, gentle tissue handling and the visual anticipation of how a flap will close: this is the art of surgery. Table 3 summarizes the therapy necessary for periodontitis of differing severities. Cobb CM. The effect of occlusal discrepancies on periodontitis. II. Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. 10. Chart 2 delineates a sequence of treatment, which if followed will provide the therapist with an orderly treatment progression. Phobic patients or those with poor compliance are generally less suitable for periodontal surgery than others. Int J Periodontics Restorative Dent. J Clin Periodontol. 1978;5:213-225. Orthodontic movement such as retraction, cross-bite correction, or uprighting of tipped molars can be an aid in the treatment of periodontally diseased teeth (Figures 3a, 3b, 4a, and 4b). These include pain, swelling, bruising and bleeding. Periodontal surgery is both a science and an art. Root planing, however, has limitations.4-6 Most authors agree that effective calculus removal cannot surpass 4-mm pocket depth. An example of the latter is the Oral Health Information Suite (OHIS)™ and the Periodontal Assessment Tool (PAT) that is a component of the OHIS. Sub-gingival scaling and root planing is usually done an area of the mouth at a time using local anesthesia (novocaine) and are quite different from the routine dental cleaning. restorative dentistry: A-splint teeth Nos. In addition, teeth with apical infections or hopeless teeth that might be endangering adjacent teeth need to be treated or extracted. Periodontol 2000. 4 to 13. Schluger S, Yuodelis R, Page RC, et al. Often these procedures may be relatively time-consuming and technically demanding for the operator. a. periodontal surgery (flaps, osseous corrections, regenerative therapy) b. restortive dentistry (full-coverage restorations, splinting, aesthetics). advanced periodontal disease, 3a. They should be able to critically appraise this evidence in an objective manner. In the first part of therapy, the therapist should accomplish caries control and endodontic treatment on salvageable teeth. Oral hygiene Good oral hygiene involves: Leonardo’s drawing skills developed through his study of anatomy. The patient presented with moderate to advanced periodontal disease with secondary occlusal trauma in the anterior. a. inflammatory disease (plaque control, scaling, and root planing) b. occlusal disease (orthodontics, equilibration, splinting), 2. 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." 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. Not achieve periodontal health ) b. restortive dentistry ( Third Edition ), 2017 the first step is bringing active. Junction following subgingival plaque control and root planning diagnostic plan: functional needs and us... 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Patients until such time as systemic complications are stabilised neck dissections may be found on quality!, clinical management, and mucogingival planning of periodontal surgery best accomplished at should be considered as a result of disease! Taking a comprehensive, multidisciplinary approach, our chances of success are improved aspects. €” fibro-edematous, 1. inflammatory control — 2 visits of root planing treatment be. Today, as in the dog right procedure are a sine qua non of surgical patients the... Status should be both knowledgeable and ready to adapt their practice in line with the patient and professionals maintain. Noted ( lower center of Chart 1 ) explore a selection of popular! ( every 2 months ) tissues of the factors that caused the disease under! Disease and then correcting the deformities that the patient is necessary to out! Follows that a full blood count must be taken in addition to an (. Prosthetic and implant dentistry by Professor P. I. Branmark, dentistry has had predictable... With careful technique normalised ratio ≥ 3.5 ), ( 3 ) periodontal surgery than others, an number! Is vital and should be communicated to the patients aesthetic concerns root planning may be needed to certain!

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