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Periodontal Disease (Diagnosis (Further Investigation/Periodontal Risk…

- - - - Smoking
      - Diabetes
      - Dry Mouth
      - Medications
    - - 3 months (HIGH RISK)
        6 Months (MODERATE RISK)
        12 months (LOW RISK)
- - - - Clinical Health of Gingiva <10% sites BOP
      - Localised Gingivitis
        10-30% sites BOP
      - Generalised Gingivitis
        > 30% sites BOP
    - - Requires:
        Appropriate radiographic assessment
        Initial Periodontal Therapy
        Adv Charting (every 3 months)
      - If sites <4mm and radx signs of bone loss due to perio then manage as code0/1/2
      - If sites >4mm remain or signs or radiographic signs of bone loss tx as Code 4
    - - Localised Periodontitis
        10-30% teeth
      - Generalised Periodontitis
        > 30% teeth
      - Staging
        
        Stage 1 (early/mild)<15% of Bone loss
        
        Stage 2 (moderate)
        Bone loss to the coronal third
        
        Stage 3 (severe)
        Bone loss to the mid third of the root
        
        Stage 4 (very severe)
        Bone loss to the apical third of the root
      - Grading
        
        Grade 1
        Slow rate of progression (<0.5)
        
        Grade 2
        Moderate rate of progression (0.5-1.0)
        
        Grade 3
        Rapid rate of progression (>1.0)
    - - Debridement
        Oral Hygiene Reinforcement
        Control Risk Factors
        Monitor Disease/Regular Review
- - - - OHI: Interdental Aids, Diet Counselling, Habit Cessation
        
        Non-Surgical: SC/RP
        
        Prescriptive: CHX 0.12% regime
    - - Follow-up for pts following surgical management/adv tx
      - 1.) Full H&E
        (includes E/O, I/O, Perio, Radiographic)
        3.) Personal OH review
        4.) Communication and Planning
        5.) Treatment considerations
        (plaque removal, behavioral mod, adjuncts)
      - Frequency of SPT
        
        6month interval
        = for pts w/ previous hx of gingivitis with no attachment loss
        
        3months intervals
        = for pts w/ previous hx of periodontitis
        
        (INDIVIDUALIZE!)
        = based on pts risk factors and prognostic parameters
  - - - Techniques:
        Resective approach
        
        Gingivectomy
        
        Widman flap
        
        Pocket Elimination
        
        Gingivectomy
        
        Apically repositioned flap
        
        Access Flap
        
        Modified Widman flap
        
        Kirkland flap
      - Indications for surgical therapy
        
        Reduce pocket depths
        (prevent disease progression)
        
        Access and removal of plaque/calculus
        (limited depths, furcations, defects, overhangs ect)
        
        Removal of hyperplastic tissue
        
        Access for other procedures
        (crown lengthening, implants, root amputation)
    - - Examples of Mucogingival Therapy:
        
        Gingival augmentation
        
        Root coverage
        
        Correction of mucosal defects at implants
        
        Crown lengthening
        
        Gingival preservation at ectopic tooth eruption
        
        Removal of aberrant frenulum
        
        Prevention of RRR associated with extraction
        
        Augmentation of the edentulous ridge
      - Definition:
        correction of defects, morphology/position/amount of soft tissues and bone supporting teeth or implants
    - - Definitions
        
        Guided Tissue Regeneration (GTR)
        
        reproduction of PDL attachments
        
        Repair
        
        healing of tissue that does not fully restore architecture ie LJE
        
        Bone Fill
        
        restoration of bone defect in a perio defect
      - GTR prevents the epithelium from progressing apically, allowing the bone/PDL to grow coronally
        nb: has had greater effects on PD/CAL than OFD
      - Types:
        
        Non-reasorable
        
        ex. Gore-tex
        
        Resorable
        
        ex. Bio-Gide