Jason Hencler 12/18/09
Guideline for Periodontal Therapy

Chronic inflammatory periodontal diseases (PD) are treatable

Better understanding of mechanisms of PD progression and pathogenesis has made treatment more effective and predictable

Goals of Periodontal Therapy:
· Preserve natural dentition and periodontium
· Maintain and improve periodontal health, comfort, esthetics, and function

Periodontal exam should include:
· Extra- and intraoral exam to detect non-periodontal oral diseases or conditions
· General periodontal exam
· Assessment of the presence of plaque, calculus, and gingival inflammation
· Dental exam (caries, proximal contacts, existing restorations, tooth mobility)
· Occlusal evaluation
· Diagnostic PA and BW radiographs
· Evaluation of potential periodontal systemic inter-relationships

Establish diagnosis, treatment plan, and prognosis

PD and conditions
· Gingivitis: gingival inflammation without attachment loss or with non-progressing attachment loss. Other gingival diseases may be modified by systemic factors, medications or malnutrition.
· Periodontitis: (Slight, moderate, severe, localized, generalized) gingival inflammation with progressing attachment loss
o Chronic PD
o Aggressive PD
o PD as a manifestation of systemic disease
o NUG
o Perio/endo
· Abscesses of the periodontium
· Developmental or acquired deformities and conditions

Development of a Tx plan:
Used to establish the methods and sequence of delivering periodontal tx and follow-up and maintenance program
May include: med consult, adjunctive specialty consults, and chemotherapeutic agents

Informed consent and patient records:
Any foreseeable risks, potential complications or failure with tx should be explained and consent should be obtained b/f

Treatment procedure:
· Patient/parent education, OHI
· Prophy, SCRP to remove supra- and sub-gingival plaque and calculus
· Post-tx evaluation and reinforce OH
Additional tx that may be indicated
· Chemotherapeutic agents
· Resective procedures (pocket reduction, gingivectomy)
· Periodontal regenerative procedures (grafts)
· Periodontal plastic surgery (for soft tissue defects
· Occlusal therapy
· Pre-prosthetic periodontal procedures (exploratory, site development)
· EXT’s
· Implants
· Procedures to facilitate orthodontic tx (tooth exposure, frenulectomy)
· Management of periodontal systemic interrelationships

Periodontal maintenance therapy (individualized):
Establish an appropriate interval for periodontal maintenance therapy according to assessment of current OH status and current evaluation of periodontal status

Factors modifying results:
May be adversely affected by circumstances beyond the control of the dentist
Periodontal therapy may be compromised:
1. Systemic disease
2. Inadequate plaque control
3. Pulpal/periodontal problems
4. Failure of patient to follow suggested tx or maintenance program
5. Adverse health factors such as smoking, stress, and occlusal dysfunction

Evaluation of Therapy
· Patient counseled on why and how to perform effective daily OH
· Therapeutic procedure have been performed to arrest PD
· SCRP has left no calculus and rough root surfaces
· No bleeding on probing
· Recommendation has been made for correction of any factor contributing to PD
· Appropriate periodontal maintenance program has been recommended to patient for long-term control