W1-Phase I Treatment-pdf.pdf

4.10.2023 PERIODONTOLOGY Phase I Periodontal Therapy Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] Resources Newman and Carranza’s Clinical Periodontology 4.10.2023 Phase I Periodontal Therapy  Cause-related therapy! (initial therapy/ non surgical per...

4.10.2023 PERIODONTOLOGY Phase I Periodontal Therapy Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] Resources Newman and Carranza’s Clinical Periodontology 4.10.2023 Phase I Periodontal Therapy  Cause-related therapy! (initial therapy/ non surgical periodontal therapy)  The objective  to alter or eliminate the microbial etiology and factors that contribute to gingival and periodontal diseases to the greatest extent possible, thereby halting the progression of disease and returning the dentition to a state of health and comfort. Rationale  The initiation of a comprehensive daily plaque or biofilm control regimen  Management of periodontal-systemic interrelationships as needed  Removal of supragingival and subgingival bacterial plaque or biofilm and calculus  Other problems that must be managed include the use of chemotherapeutic agents as necessary  Local factors  elimination of defective restorations and treatment of carious lesion 4.10.2023 Rationale Phase I therapy is a critical aspect of periodontal treatment. Long-term success of periodontal surgical treatment is dependent on maintaining the plaque or biofilm control results achieved with phase I therapy. 4.10.2023 Phase I Treatments: 1. Patient education and oral hygiene instruction 2. Complete removal of supragingival calculus 3. Correction or replacement of poorly fitting restorations and other prosthetic devices 4. Restoration or temporization of carious lesions 5. Orthodontic tooth movement 6. Treatment of food impaction areas 7. Treatment of occlusal trauma 8. Extraction of hopeless teeth 9. Possible use of antimicrobial agents, including necessary plaque or biofilm sampling and sensitivity testing 4.10.2023 Treatment Sessions  General health and tolerance of treatment  Margins of restorations  Developmental anomalies  Number of teeth present  Physical barriers to access the  Amount of subgingival calculus dentition (i.e., limited opening or  Probing pocket depths tendency to gag)  Attachment loss  Patient cooperation and sensitivity  Furcation involvement to therapy (requiring use of  Alignment of teeth anesthesia or analgesia) All these conditions must be considered when determining the phase I treatment plan!!! Sequence of Procedures Step 1: Plaque or Biofilm Control Instruction 4.10.2023 Sequence of Procedures Step 2: Removal of Supragingival and Subgingival Plaque or Biofilm and Calculus Sequence of Procedures Step 3: Recontouring Defective Restorations and Crowns 4.10.2023 Sequence of Procedures Step 4: Management of Carious Lesions Sequence of Procedures Step 5: Tissue Reevaluation • After phase I procedures  aprox. 4 weeks to heal  allows connective tissues to heal. • Patients will have the opportunity to improve their home care skills to reduce gingival inflammation and adopt new habits that will ensure the success of treatment. 4.10.2023 Sequence of Procedures Step 5: Tissue Reevaluation At the reevaluation appointment; • Periodontal tissues are probed, to determine whether further • All related anatomic conditions treatment is indicated. are carefully evaluated Healing • Healing of the gingival epithelium consists of the formation of a long junctional epithelium rather than new connective tissue attachment to the root surfaces. • This long junctional epithelium occurs about 1 week after therapy. 4.10.2023 Healing • Gradual reductions in inflammatory cell population, crevicular fluid flow, and repair of connective tissue result in decreased clinical signs of inflammation, including less redness and swelling. • One or two millimeters of recession is often apparent as the result of tissue shrinkage!!!!!!!!!! • Connective tissue fibers are disrupted and lysed by the disease process and also by the inflammatory reaction to treatment. These tissues require 4 or more weeks to reorganize and heal, and many cases may require several weeks for complete healing. • Transient root sensitivity frequently accompanies the healing process!!!!!! When to refer for specialist treatment • The critical probing depth = 5.4 mm ??determination to proceed to surgical intervention • Extent of the disease • Root length. • Hypermobility  poor prognosis??? • Difficulty of scaling and root planing. surgery?? • Restorability and importance of particular teeth for reconstruction • Age of the patient younger-aggressive • Lack of resolution of inflammation after thorough plaque or biofilm removal and excellent scaling and root planing 4.10.2023 THANK YOU…