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.

Outlines

00:00

😀 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.

05:01

🛠️ 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.

10:05

🔧 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.

⚠️ 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.

Keywords

💡Periodontics

Periodontics is a branch of dentistry that focuses on the prevention, diagnosis, and treatment of periodontal disease, which affects the structures supporting the teeth, including the gums. In the video, periodontics is the main theme, with the speaker discussing the treatment planning process for periodontal patients.

💡Treatment Planning

Treatment planning in dentistry involves a systematic approach to diagnose and plan the sequence of treatment for a patient's dental conditions. In the context of the video, treatment planning is specifically for periodontal patients, with an emphasis on both short-term goals like reducing inflammation and long-term goals like preventing tooth loss.

💡Gingival Inflammation

Gingival inflammation refers to the redness, swelling, and irritation of the gums, often caused by bacterial plaque accumulation. The video script mentions this as a primary short-term goal of periodontal treatment, aiming to alleviate discomfort and improve aesthetics.

💡Clinical Attachment Loss

Clinical attachment loss is a measure of the distance from the bottom of a periodontal pocket to the cemento-enamel junction and is an indicator of periodontal disease progression. The script discusses it as a parameter for assessing the effectiveness of long-term periodontal treatment goals.

💡Preliminary Phase

The preliminary phase, labeled as phase zero in the script, is the initial stage of periodontal treatment planning where emergencies are addressed, and hopeless teeth are extracted. This phase sets the stage for the subsequent phases of treatment by resolving immediate concerns.

💡Non-Surgical Phase

The non-surgical phase, also known as phase one therapy, involves conservative measures to control plaque and educate patients on oral hygiene. The script describes this phase as crucial for managing periodontal conditions through scaling, root planing, and other non-invasive procedures.

💡Surgical Phase

The surgical phase, or phase two therapy, is a more invasive approach to periodontal treatment that may involve procedures like flap surgery to access and treat areas not adequately addressed in the non-surgical phase. The script mentions this phase as a follow-up when conservative treatments are insufficient.

💡Restorative Phase

The restorative phase, or phase three therapy, focuses on the reconstruction of the mouth's function and aesthetics after periodontal disease is under control. This phase is not initiated until the periodontal condition has stabilized, as discussed in the script.

💡Maintenance Phase

The maintenance phase, also known as phase four therapy or supportive periodontal therapy, involves ongoing periodic evaluations and treatments to sustain the health of the periodontal tissues. The script highlights the importance of this phase for life-long management post-treatment.

💡Risk Factors

Risk factors are elements that increase the likelihood of developing a disease. In the script, risk factors for periodontal disease include smoking, diabetes, pathogenic bacteria, and microbial tooth deposits, which are directly linked to the onset and progression of the disease.

💡Risk Markers

Risk markers are indicators that suggest a higher risk for a disease but are not causally related to it. The script identifies clinical attachment loss and a history of periodontal disease as risk markers, which are important for assessing a patient's vulnerability to future periodontal issues.

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