Periodontal Treatment Goals and Phases

Therapeutic Goals of Periodontal Treatment

• Eliminate inflammation: Remove plaque bacterial biofilm.
• Arrest and prevent disease recurrence: Stop the progression and avoid future problems.
• Regenerate periodontal tissue: Restore damaged gum and bone.

Phases of Periodontal Therapy

• Phase I (Nonsurgical Therapy): Plaque control, patient education, removal of calculus, and root planing.
• Phase II (Surgical Therapy): Correction of irritational factors, surgical periodontal procedures, placement of implants.
• Phase III (Restorative Maintenance): Periodic rechecking, final restorations, occlusal therapy, splinting, and fixed and removable prosthodontic appliances.
• Phase IV (Evaluation): Evaluate response to restorative procedures. Assess plaque and calculus, gingiva, occlusion, tooth mobility , and other pathologic changes.

Reevaluation after Phase I Therapy

• Assessment: Re-probing the mouth to check for calculus, root caries, defective restorations, and signs of inflammation.
• Timing: 3-9 months after completion of Phase I therapy.

Rationale for Periodontal Surgery

• Control disease progression: Surgical approach when nonsurgical treatments fail.
• Attachment Loss: To address deep pockets and bone defects.
• Soft tissue changes: Techniques involve cutting soft tissues to control disease or reshape tissue.

Objectives of the Surgical Phase

• Control or eliminate periodontal disease: Remove etiologic factors and correct anatomical conditions.
• Improve prognosis: Enhance the health of teeth and their replacements.
• Improve esthetics: Enhance the appearance of the smile.
• Placement of implants: Includes techniques for bone regeneration and sinus grafts.

Advantages of Periodontal Surgery

• Direct Visualization and Tissue Accessibility: Allows for thorough cleaning and root surface treatment.
• Root Surface Anomaly Correction: Address irregularities like root grooves.
• Soft Tissue Augmentation and Reconstructing: Improve plaque control and aesthetics.
• Aesthetic Plastic Surgeries: Enhance patient's smile.
• Pre-prosthetic Techniques: Expose root surfaces for restorations.
• Regenerative Techniques: Promote tissue regeneration.

Indications for Periodontal Surgery

• Persistent inflammation: Deep pockets that don't respond to non-surgical methods.
• Pockets with inaccessible root irritants: Molars and premolars often require surgery.
• Intrabony pockets: Bone defects that often don't respond to non-surgical methods.
• Furcation involvement: Grade II or III furcation involvement requires surgery.
• Irregular bony contours, deep craters, and defects: Require a surgical approach.

Types of Periodontal Surgery

• Access to the root surface: Provides a clear view for treatment.
• Pocket reduction or elimination: Reduce pocket depth for better plaque control.
• Treatment of osseous defects: Address bone loss.
• Correcting mucogingival defects: Address gum tissue problems.
• New attachment: Regenerate lost attachment.

Pocket Therapy Goals and Methods

• Goal: Transform deep, active pockets into shallower, inactive, and maintainable pockets.
• Healing: Reduce pocket depth, promote attachment through long junctional epithelium, and regenerate tissue.
• Non-surgical Treatment: Scaling and root planing can reduce pocket depth by shrinking gingiva.
• Surgical Pocket Therapy: Reduce or eliminate pocket depth, enhance accessibility for cleaning, eliminate pathologic changes, and reshape tissues.

Probing Pocket Depth

• Deeper probing depth: Increased risk of disease progression.
• Plaque control: More challenging for patients.
• Anaerobic bacteria: Favorable environment for harmful bacteria growth.
• Calculus removal: More difficult for the dentist.

Surgical vs. Non-surgical Pocket Therapy

• Non-surgical scaling and root planing: Effective for pockets up to 4 mm deep.
• Pockets over 5 mm: Difficult to instrument and often remain infected.
• Surgical pocket therapy: Necessary for deeper pockets to gain access and achieve better cleaning.
• Modified Widman Flap: More effective than scaling and root planning in deeper pockets.

Pocket Therapy Methods

• Removal of the pocket wall: Includes pocket reduction techniques (Modified Widman Flap) and pocket elimination techniques (gingivectomy and gingivoplasty).
• New attachment techniques: Regenerate lost attachment.
• Removal of the pocket wall: Performed by retraction, surgical removal, apical displacement, or tooth extraction.

General Considerations for Periodontal Surgery

• Character of the pocket wall: Edematous (shrink after SRP) or fibrotic (need gingivectomy).
• Accessibility of the pocket: Easier access to anterior teeth.
• Aesthetics: Considered for anterior teeth.

Additional Factors for Periodontal Surgery

• Patient age and general health: Overall health status plays a role.
• Patient cooperation: Effective oral hygiene is crucial.
• Tooth importance: Considered for functional use.
• Mucogingival problems: Presence of gum tissue problems.
• Response to Phase I therapy: Outcomes of non-surgical treatment.

General Principles of Periodontal Surgery

• Tissue Management: Gentle and careful handling with sharp instruments.
• Bleeding Control: Important to manage bleeding effectively.

Periodontal Dressings

• Purpose: Improve healing, minimize infection, facilitate healing, and reduce pain.
• Types: Zinc Oxide–Eugenol Packs (allergic reactions) and Non-eugenol Packs (less allergic reactions).

Preparing and Retaining Packs

• Coe-Pak: Packs are prepared using this material.
• Retention: Mechanically retained by interlocking in interdental spaces.

Postoperative Instructions

• Immediate rinsing: With chlorhexidine gluconate.
• Food and drink restrictions: Avoid hot, spicy foods, alcohol, and smoking.
• Oral hygiene: Do not brush over the pack for a week.
• Ice and heat: Use ice for swelling, and heat for discomfort.

Postoperative Complications

• Persistent bleeding: Can occur after surgery.
• Sensitivity to percussion: Teeth may be sensitive to tapping.
• Swelling: Common in the first few days.
• Lymph node enlargement: Can occur.
• Elevated temperature: May be slightly elevated.
• Feeling of weakness: Common after surgery.
• Tooth mobility: Can occur due to surgical procedures.

This quiz explores the therapeutic goals of periodontal treatment, including inflammation elimination, disease prevention, and tissue regeneration. Additionally, it examines the various phases of periodontal therapy—from initial nonsurgical methods to surgical interventions and ongoing maintenance. Perfect for students and professionals in dental health fields.