Periodontics | Treatment Planning | INBDE, ADAT

Summary

This video by Ryan delves into the treatment planning process for periodontal patients, outlining the five key phases: preliminary, non-surgical, surgical, restorative, and maintenance therapy. It emphasizes the importance of addressing emergencies, plaque control, patient education, and achieving long-term goals like pain elimination and tissue stability. The script also discusses the significance of risk factors, determinants, indicators, and markers in assessing a patient's susceptibility to periodontal disease.

Takeaways

• 😀 The primary short-term goal of periodontal treatment is to alleviate gingival inflammation by addressing causes like plaque and calculus accumulation.
• 🔍 Long-term goals of periodontal treatment are more complex, focusing on function and health, including eliminating pain, stopping tissue destruction, ensuring occlusal stability, reducing tooth loss, and preventing disease recurrence.
• 🌐 There are five phases in the treatment planning process for periodontal patients, starting with a preliminary phase that addresses emergencies and extraction of hopeless teeth.
• 🚑 The preliminary phase (Phase 0) is crucial for treating urgent care needs like abscesses and extracting teeth with no chance of recovery due to severe bone loss.
• 🛠️ Phase 1, or non-surgical therapy, involves plaque control, patient education, scaling, root planing, and oral hygiene instruction to manage local factors contributing to periodontal disease.
• 🔄 A periodontal reevaluation after Phase 1 is essential to assess improvements in the patient's condition and reaffirm the importance of oral hygiene, typically scheduled 4 to 8 weeks post-treatment.
• ⚕️ Phase 2, or surgical therapy, is considered when non-surgical treatments are insufficient, involving procedures to reduce periodontal pockets, correct tissue defects, and possibly place implants.
• 🏗️ Phase 3, the restorative phase, focuses on final restorations and is only initiated after periodontal disease is under control to ensure stability and function.
• 🔄 The maintenance phase (Phase 4) is an ongoing process of evaluation and treatment to sustain the health of the periodontal tissues, with regular check-ups crucial for patients with a history of periodontal disease.
• 📊 Risk elements in periodontal disease are categorized into risk factors, determinants, indicators, and markers, each playing a distinct role in the likelihood and progression of the disease.
• 🚭 Examples of risk factors include smoking and diabetes, while risk determinants might be genetic factors or age, and risk markers could be a history of the disease or clinical attachment loss.

Q & A

What is the primary short-term goal of periodontal treatment?

The primary short-term goal of periodontal treatment is to reduce gingival inflammation by correcting conditions that cause it, such as plaque and calculus accumulation.

What are the main objectives of long-term periodontal treatment goals?

Long-term goals of periodontal treatment include eliminating pain, arresting hard and soft tissue destruction, establishing occlusal stability and function, reducing tooth loss, and preventing the recurrence of periodontal disease.

What is the significance of the preliminary phase in periodontal treatment planning?

The preliminary phase is significant as it involves treating emergencies, such as abscesses, and extracting hopeless teeth, which is crucial before proceeding with actual periodontal treatment.

What does the term 'hopeless tooth' refer to in the context of periodontal treatment?

A 'hopeless tooth' refers to a tooth with bone loss that involves the apex, where there is hardly any periodontal attachment left, and no hope for the periodontal apparatus to be restored and functional.

What is the primary focus of the non-surgical phase of periodontal treatment?

The non-surgical phase focuses on plaque control and patient education, including scaling and root planing, oral hygiene instruction, and correcting restorative irritations.

Why is periodontal reevaluation important after phase one therapy?

Periodontal reevaluation is important to assess improvements in the patient's periodontal health, reaffirm the importance of oral hygiene, and check the patient's compliance and motivation, typically occurring four to eight weeks after phase one therapy.

What are the main objectives of the surgical phase (phase two therapy) in periodontal treatment?

The surgical phase aims to reduce or eliminate periodontal pockets, correct soft and hard tissue defects, regenerate periodontal tissue, or place implants, often involving flap surgery for better access to local factors.

What is the purpose of the restorative phase (phase three therapy) in periodontal treatment?

The restorative phase is reached after periodontal disease is under control and focuses on final restorations, such as crowns, bridges, and partials, to ensure the patient's dental function and aesthetics are restored.

Why is the maintenance phase (phase four therapy) considered a lifelong commitment for patients who have had periodontal treatment?

The maintenance phase is a lifelong commitment because a history of periodontal disease is a risk marker for future disease, requiring ongoing evaluation of oral hygiene and periodontal tissue condition.

What is the difference between a risk factor, risk determinant, risk indicator, and risk marker in the context of periodontal disease?

Risk factors are causally associated with the disease, risk determinants are unchangeable background characteristics that increase the likelihood of disease, risk indicators are not causally associated but could suggest a higher risk, and risk markers have a quantitative association with the disease, such as a history of periodontal disease or clinical attachment loss.