Periodontics | Treatment Planning | INBDE, ADAT
Summary
TLDRThis 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
- đ The primary short-term goal of periodontal treatment is to alleviate gingival inflammation by addressing causes like plaque and calculus accumulation.
- đ 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.
- đ 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.
- đ 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.
- đ ïž 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.
- đ 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.
- âïž 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.
- đïž Phase 3, the restorative phase, focuses on final restorations and is only initiated after periodontal disease is under control to ensure stability and function.
- đ 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.
- đ 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.
- đ 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.
Outlines
đ Periodontal Treatment Planning and Goals
Ryan introduces the topic of periodontal treatment planning, outlining the short-term goal of reducing gingival inflammation by addressing causes like plaque and calculus accumulation. The long-term goals are more complex, focusing on eliminating pain, arresting tissue destruction, establishing occlusal stability, reducing tooth loss, and preventing disease recurrence. Ryan also introduces the five phases of treatment planning, starting with the preliminary phase zero, which includes treating emergencies and extracting teeth with a hopeless prognosis due to severe bone loss.
đ ïž Phases of Periodontal Treatment: Non-Surgical and Surgical Approaches
The script details the phases of periodontal treatment. Phase one, or non-surgical therapy, emphasizes plaque control, patient education, scaling, root planing, and oral hygiene instruction to manage local factors contributing to periodontal disease. Phase two, the surgical phase, involves more invasive procedures to reduce periodontal pockets, correct tissue defects, and potentially place implants. This phase is pursued when non-surgical treatments are insufficient. The script also mentions the importance of periodontal reevaluation four to eight weeks post-treatment to assess healing and patient compliance.
đ§ Restorative and Maintenance Phases in Periodontal Therapy
The video script continues with phase three, the restorative phase, which focuses on finalizing dental restorations such as crowns, bridges, and partials only after periodontal disease is under control. The final phase, phase four or maintenance therapy, involves ongoing periodic evaluation of the patient's oral hygiene and periodontal tissue health. It is highlighted that patients with a history of scaling and root planing will be on periodontal maintenance for life due to their increased risk for future disease.
â ïž Understanding Risk Elements in Periodontal Disease
The script concludes with a discussion on risk elements associated with periodontal disease. Risk factors are causally linked to the disease, such as smoking, diabetes, pathogenic bacteria, and microbial tooth deposits. Risk determinants are unchangeable characteristics like genetics, age, and gender. Risk indicators, not causally associated with the disease, may suggest a higher risk, such as HIV/AIDS or osteoporosis. Lastly, risk markers are quantitative associations with the disease, including a history of periodontal disease or clinical attachment loss, which are crucial for assessing a patient's risk for future periodontal issues.
Mindmap
Keywords
đĄPeriodontics
đĄTreatment Planning
đĄGingival Inflammation
đĄClinical Attachment Loss
đĄPreliminary Phase
đĄNon-Surgical Phase
đĄSurgical Phase
đĄRestorative Phase
đĄMaintenance Phase
đĄRisk Factors
đĄRisk Markers
Highlights
Short-term goal of periodontal treatment is to reduce gingival inflammation by addressing causes like plaque and calculus accumulation.
Long-term goals of periodontal treatment include eliminating pain, arresting tissue destruction, establishing occlusal stability, reducing tooth loss, and preventing disease recurrence.
The preliminary phase of treatment involves treating emergencies and extracting hopeless teeth with severe bone loss.
Hopeless teeth prognosis is determined by factors such as bone loss involving the tooth apex and lack of periodontal attachment.
Phase one therapy, also known as non-surgical treatment, focuses on plaque control, patient education, and oral hygiene instruction.
Scaling and root planing are performed to remove local factors contributing to periodontal disease, such as plaque and calculus.
Restorative irritation effectors, such as overhanging margins, may require adjustment to prevent plaque accumulation.
Local or systemic antibiotic prescription may be part of the non-surgical phase treatment plan.
Periodontal reevaluation after phase one therapy assesses improvements in patient's periodontal health and reaffirms oral hygiene importance.
The importance of patient compliance in periodontal treatment success, especially in maintaining oral hygiene routines.
Phase two therapy, the surgical phase, aims to reduce periodontal pockets, correct tissue defects, and potentially place implants.
Surgical intervention is considered when non-surgical treatments are not sufficiently successful in managing periodontal disease.
Phase three therapy, the restorative phase, focuses on final restorations and crowns only after periodontal disease is under control.
The maintenance phase, or phase four therapy, involves ongoing evaluation of oral hygiene and periodontal tissues condition.
Periodontal maintenance is performed periodically, initially every three months, then potentially moving to a twice-yearly schedule.
Risk factors for periodontal disease include smoking, diabetes, pathogenic bacteria, and microbial tooth deposits.
Risk determinants are unchangeable characteristics like genetic factors, age, gender, and socioeconomic status.
Risk indicators, unlike risk factors, are not causally associated with the disease but may suggest a higher risk, such as HIV or AIDS.
Risk markers are quantitative associations with disease, such as a history of periodontal disease or clinical attachment loss.
Transcripts
hey everyone this is Ryan here and
welcome back to our periodontics series
in this video we'll talk about the
treatment planning process and a typical
five phases that should be considered
when treatment planning a periodontal
patient so the short term goal of
periodontal treatment is simply to
reduce gingival inflammation by
correcting conditions that cause it
those being plaque accumulation calculus
accumulation and so on and so the short
term goal is really focused on comfort
and aesthetics whereas the long term
goals are a bit more complex and they're
focused more on function and health and
so some of these specific long-term
goals are to eliminate pain to arrest
hard and soft tissue destruction as
measured by the clinical attachment loss
establish occlusal stability and
function to reduce tooth loss and to
recognize that it might not be possible
to save all the teeth of course we want
to save as many teeth as possible but
within reason and to prevent the
recurrence of periodontal disease in the
future so let's talk about the five
phases of periodontal treatment planning
and the first one that I label zero
because it's sort of coming before the
actual periodontal treatment is
preliminary is the preliminary phase so
in the preliminary phase we want to
treat emergencies this would be any
urgent care needs like an endodontic or
periodontal abscess and to extract
hopeless teeth and this is really really
important and hopeless is an actual
official category of tooth prognosis
that we'll cover in depth in the next
video but one of the determining factors
of a hopeless prognosis tooth is having
bone loss that involves the apex of the
tooth where there is hardly any
periodontal attachment left and no hope
for the periodontal apparatus to be
restored and functional so this tooth in
most situations of course there's always
some individual variation
from patients a patient based on their
oral hygiene in their age but in most
scenarios this would be considered a
hopeless tooth and would deemed best
extracted so how I remember this is pre
lemon Airy phase has the e for
emergencies and E for extraction of
hopeless teeth so the the first actual
phase of periodontal treatment would be
the non-surgical phase and sometimes
called phase one therapy so this
involves plaque control and patient
education so it's all about control diet
control caries control getting the
patient's situation under control is
really important moving forward so this
involves cleaning scaling and root
planing and oral hygiene instruction to
remove local factors those being again
plaque calculus and so on - correct
restorative irritation effectors we also
talked about this in the local factors
video including overhanging margins
maybe some restorations just have to be
adjusted a little bit to remove some
food retention areas food impaction
areas or some rough spots that are
accumulating a bit more plaque than they
should be
this can also involve local or systemic
antibiotic prescription which we'll talk
about in a separate video and the
periodontal reevaluation is very
important this is where you'd assess any
improvements in the patient's
periodontal health you also want to
reaffirm the importance of oral hygiene
and check in with basically how they're
doing this should occur four to eight
weeks after the completion of all the
phase one therapy that would be if you
wanted to do scaling and root planing
for all four quadrants of their mouth
including oral hygiene instruction maybe
application of fluoride varnish after
four to eight weeks we can reassess the
patient's situation to see if there's
been any healing see if the pocket
depths have gone a little bit more
shallow see if the inflammation
has been reduced a little bit those
would be great signs of healing they're
not necessarily have to be present
sometimes really deep pockets won't heal
in four to eight weeks and it might take
much much longer or more involved
treatment to get any improvement so it
is really important at this appointment
to be asking a patient how they're doing
how they're keeping up with their oral
hygiene routine and to assess their
motivation to improve their situation of
all the specialties
I think periodontics especially you need
to have patient compliance in order to
have success so for the board exam
remember this number four to eight weeks
after completion of the scaling and root
planing
that's when you'd want to do the
periodontal reevaluation I'm not sure if
I mentioned this term before so I do
want to make sure I mention this je e
stands for junctional epithelium and I
will draw in this picture here that we
had in one of our very first videos in
this series this is the sulcus and this
area where the epithelium contacts the
enamel directly is known as the
junctional epithelium there's some weak
Hemi desmosomes hatch Minh to the enamel
but that would be a sign of healing
towards a shallower pocket if we have a
bit more formation of junctional
epithelium and the pocket the
periodontal pocket becomes a bit more
shallow alright so the next phase also
known as phase 2 therapy is this
surgical phase and this is where you'd
want to reduce or eliminate periodontal
pockets to correct soft and hard tissue
defects regenerate periodontal tissue or
place implants and this involves
periodontal therapy and also endodontic
therapy to restore any teeth with
endodontic problems so phase 2 third in
phase zero we take care of the immediate
concern so emergencies and extracting
hopeless teeth in Phase one we focus on
conservative plaque control both in
office
and at home and then in Phase two we
turn to a more surgical strategy we
often have to flap open the gums and
gain better vision and access to see the
presence of local factors like plaque
and calculus maybe some really deep and
tenacious calculus that we just couldn't
remove with scaling and root planing and
you need to have better access so the
surgical phase comes into play when the
non-surgical phase just isn't proving to
be that successful the third phase also
called phase three therapy is the
restorative phase and this phase is not
reached until after periodontal disease
is under control so you wouldn't start
messing around with final restorations
and crowns bridges and partials until
the periodontal situation is under
control and finally we have the
maintenance phase also called phase four
therapy and that's why I included the
numbers the way I did because they
correspond to the actual numerical order
of the phases so the maintenance phase
also called supportive periodontal
therapy is this periodic ongoing
evaluation of the patient's oral hygiene
and the condition of the periodontal
tissues again re measuring the pocket
depth assessing the inflammation or lack
thereof so periodontal maintenance is
performed in continuum with the previous
two phases every three months for at
least the first year and then the
patient might be able to move to a
twice-a-year schedule just like regular
dental cleanings if their situation is
under nice control but any patient who
ever had a scaling and root planing will
be on periodontal maintenance for the
rest of their life and that's because a
history of disease is a risk marker for
future disease and speaking of risk
we're going to talk about that right now
so we'll end the video talking about
risk elements and these categories may
sound similar but these are all distinct
terms and important to distinguish
between for the board exam so risk
factor are those things that are
causally associated with the disease
this would be like saying smoking leads
to periodontal disease a risk
determinant is some unchangeable
background characteristic this is
something that's out of your control
that does increase the likelihood of
getting disease this could be like
gender or genetics a risk indicator as
opposed to a risk factor is not causally
associated with the disease but could
point potentially having a higher risk
so this is like stress osteoporosis
might even influence periodontal disease
but they're not causally directly
associated with it and finally a risk
marker or risk predictor has some
quantitative association with disease
this would be like I just mentioned
having a previous history of periodontal
disease or having some clinical
attachment loss all right and so for
some examples of each of the four risk
element categories risk factors we have
smoking diabetes pathogenic bacteria and
microbial tooth deposits so these two
being associated with plaque which again
is the initiating factor and the actual
direct cause of periodontal disease so
again plaque causes periodontal disease
and we've talked about local factors
that can contribute to plaque
accumulation all of which are important
but these are sort of bigger picture
issues and all of these categories are
bigger picture issues at the overall
patient level that can help us figure
out their risk of getting periodontal
disease so for example tobacco smoking
has a substantial destructive effect on
the periodontal - on the periodontal
tissues so smoking and more recently
diabetes could certainly fit into this
category of risk
being causally associated with the
disease process so some risk
determinants again these are things that
are out of your control genetic factors
age gender and socioeconomic status risk
indicators are not causally associated
with disease this would be like HIV or
AIDS where the acute necrotizing form of
both gingivitis and periodontitis are
more or are more often seen in
individuals with this amino compromise
osteoporosis as I mentioned as reduced
bone mass which could have an impact on
the rate of progression of disease
infrequent dental visits that makes
sense and stress can also interfere with
normal immunological which as we went
over in the last video you know that the
immune system is very very very very
involved with the periodontal disease
process so it would make sense that's
something that messes up with the immune
system like HIV or AIDS or even stress
can mess up with the periodontal health
and finally risk markers these are
quantitative associations with disease
previous history bleeding on probing and
most importantly clinical attachment
loss clinical attachment loss is one of
the most important clinical indicators
of periodontal disease and tissue
destruction so it's certainly a risk
marker for somebody who may be getting
or may have already had periodontal
disease alright so that's it for this
video thanks so much for watching
everyone I hope it was helpful in your
studies and we'll see you all in the
next video
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