5. Repair of crestal lesions in primary occlusal trauma: a case report. The practitioner should be ready to appraise their own abilities and not undertake cases beyond their limits of competence; these may change throughout the course of their career. Periodontal considerations in restorative and implant therapy. Periodontists are also experts in replacing missing teeth with dental implants. Sometimes, periodontal surgery may be needed to treat certain gum diseases and conditions, such as gingivitis or periodontitis. General risks are involved in any surgical procedure and should be discussed with the patient. Table 2 lists the types of occlusal trauma and possible therapy necessary to control them. In severe cases, periodontal disease must be addressed with surgery. The loss of a single tooth no longer dictates full-coverage restorations on the adjacent teeth. 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. 1983;54:586-591. Implant-supported restorative dentistry will enable the therapist to provide support and function where needed by replacing part of the dentition that was lost. Implant dentistry should also be considered as a technique to break up long-span bridges if the adjacent teeth do not require stabilization. Plaque control and root planing are the first steps for treating most inflammatory periodontal diseases. The most basic surgical option is called flap surgery, in which your dentist or periodontist will make an incision in your gums, lifting them back to clean and remove the tartar, infected bone, and … With few exceptions, periodontal surgical procedures are elective in nature. gingiva — fibro-edematous, 1. inflammatory control — 2 visits of (half-mouth) root planing, Occlusal Disease2. If inadequate dentition is left to support function, then prosthetic and implant dentistry should be considered. Many of these can be minimised with careful technique. Before any advanced surgical periodontal therapy is selected, complete dental assessment and radiographs, scaling and root planning (SRP), and conservative management procedures should be done. J Periodontol. This is unfortunate since trauma from occlusion is one of the most significant contributing factors of periodontal disease and can lead to increased bone loss.8 Occlusal trauma has been shown to cause bone loss without pocket formation.9 In periodontitis, the bone loss initiates from the osseous crest inward. The goal of periodontal therapy is to provide an environment that the patient and professionals can maintain over a long-time period. Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. Treatment planning; Periodontology. There are 2 aspects of developing a diagnostic plan: functional needs and aesthetic concerns. haemophilia and von Willebrand’s disease, acquired, e.g. However, if uneven patterns of bone loss or calculus cannot be removed, chemotherapeutic therapy would not be indicated. Williams RC, Paquette DW, Offenbacher S, et al. A diagnostic wax-up often is helpful in communicating the ideal tooth form and soft-tissue concerns (fabricated by the restorative dentist). Int J Periodontics Restorative Dent. Jason Armfield, Cindy L. Marek, in Diagnosis and Treatment Planning in Dentistry (Third Edition), 2017. In addition, teeth with apical infections or hopeless teeth that might be endangering adjacent teeth need to be treated or extracted. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. Periodontal Case Rep. 1986;8:17-26. (6) preventive treatment visits (every 2 months). 22 to 27 and Nos. 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. It is important first to make a diagnosis of all the disease entities contributing to the patients overall disease state. The maxillary and mandibular anterior teeth exhibited multiple diastemas that prohibited splinting in these areas. a. inflammatory disease (plaque control, scaling, and root planing) b. occlusal disease (orthodontics, equilibration, splinting), 2. basics of scaling and root planning to extensive periodontal . It is when these are not effective that they will suggest surgical intervention. Polson AM, Zander HA. It follows that a full and frank discussion with the patient is necessary to gain informed consent. Treatment plan in periodontics 6. This means that both periodontal and restorative goals must be delineated at the onset. 1. Non-surgical periodontal treatment does have its limitations. In the 45 to 60 minutes allocated for preventive treatment visits (PTV),* it is much easier to accomplish effective maintenance if there are a minimal number of pockets with depths greater than 5 mm. Alcohol dependence will predispose to excess bleeding where liver function has been impaired. Nyman S, Lindhe J, Ericsson I. In occlusal disease, the bone loss initiates in the marrow cavities. This should be communicated to the client prior to performing surgery. Gingiva can be edematous, fibrotic, or fibrous externally with the sulcus being ulcerated (Table 1). They should be able to critically appraise this evidence in an objective manner. 1978;5:213-225. There was flaring of the maxillary and mandibular anterior teeth (Figure 7a). Today, as in the past, there is no substitute for accurate diagnosis and treatment planning. Tooth movement was performed to close the diastema (Figure 7e). 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. The IV route is the most effective method of conscious sedation. The other key aspect of good surgical management is regular practice to guard against de-skilling. Diagnosis starts with a thorough examination of the patient. Page  4 AIM OF TREATMENT PLANNING  To do total treatment that is coordinating of all treatment procedures for the purpose of creating a well-functioning dentition in a healthy periodontal environment. congenital, e.g. The treatment plan should be used to establish the methods ... bacterial plaque and calculus is accomplished by periodontal scaling. Schluger S, Yuodelis R, Page RC, et al. Dentistry Today is The Nations Leading Clinical News Magazine for Dentists? Gum disease treatments may cost between $500 and $10,000 . Dentistry Today is The Nation's Leading Clinical News Magazine for Dentists. It is important to consider that patients with liver disease may be thrombocytopenic as well as having abnormal clotting factor levels. Scaling and Root Planing First, an intraoral and extraoral evaluation is necessary to rule out pathology (upper left on Chart 1). The integration of procedures to meet these desires is essential to achieve an end result that satisfies everyone. 2001;72:495-505. Periodontal disease affects the gingiva, alveolar bone and supporting tissues of the teeth. The status of the deposits present and the status of the tissue should be assessed (bottom center and left sides of Chart 1). These guidelines have not, however, been universally accepted at the time of this book going to press. Periodontal therapy: an evidenced-based perspective of scaling and root planning the importance of education therefore. 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