Periodontics | Treatment Planning | INBDE, ADAT
TLDRIn this informative video, Ryan delves into the intricacies of periodontal treatment planning, outlining a five-phase approach to managing periodontal patients. The short-term goal is to alleviate inflammation, focusing on comfort and aesthetics, while the long-term goals aim at eliminating pain, halting tissue destruction, and preventing disease recurrence. The phases include an initial preliminary phase for emergencies and extractions, a non-surgical phase emphasizing plaque control and patient education, a surgical phase for more invasive treatments, a restorative phase to finalize dental work, and a maintenance phase for ongoing care. Ryan also distinguishes between risk factors, determinants, indicators, and markers, highlighting their importance in assessing a patient's susceptibility to periodontal disease.
Takeaways
- 🦷 The short-term goal of periodontal treatment is to reduce gingival inflammation and focus on comfort and aesthetics.
- 📉 Long-term goals of periodontal treatment are more complex and aim to eliminate pain, arrest tissue destruction, establish occlusal stability, reduce tooth loss, and prevent disease recurrence.
- 🔍 The preliminary phase (Phase 0) involves treating emergencies, extracting hopeless teeth, and addressing urgent care needs.
- 🧼 The non-surgical phase (Phase 1) emphasizes plaque control, patient education, and oral hygiene to manage the patient's condition.
- 🔄 A periodontal reevaluation after Phase 1 therapy, ideally 4 to 8 weeks post-treatment, assesses improvements in health and patient compliance.
- ⚕️ The surgical phase (Phase 2) involves procedures to reduce periodontal pockets, correct tissue defects, and possibly place implants.
- 🏗️ The restorative phase (Phase 3) focuses on final restorations like crowns, bridges, and partials, but only after periodontal disease is under control.
- 🔄 The maintenance phase (Phase 4) is ongoing and involves periodic evaluation of oral hygiene and periodontal health, typically every three months initially, then potentially biannually.
- 👴 Risk factors for periodontal disease include smoking, diabetes, pathogenic bacteria, and microbial tooth deposits.
- 🧬 Risk determinants are unchangeable characteristics like genetics, age, gender, and socioeconomic status that can influence disease likelihood.
- 📊 Risk indicators, unlike risk factors, are not directly causally associated with the disease but may suggest a higher risk, such as HIV, AIDS, osteoporosis, infrequent dental visits, and stress.
- 📈 Risk markers are quantitative associations with disease, including a history of periodontal disease and clinical attachment loss, serving as indicators of potential future issues.
Q & A
What is the short-term goal of periodontal treatment?
-The short-term goal of periodontal treatment is to reduce gingival inflammation by correcting conditions that cause it, such as plaque and calculus accumulation, with a focus on comfort and aesthetics.
What are the primary long-term goals of periodontal treatment?
-The long-term goals of periodontal treatment are more complex, focusing on function and health. They include eliminating pain, arresting hard and soft tissue destruction, establishing occlusal stability and function, reducing tooth loss, saving as many teeth as possible within reason, and preventing the recurrence of periodontal disease.
What is the significance of the preliminary phase in periodontal treatment planning?
-The preliminary phase, labeled as phase zero, involves treating emergencies such as endodontic or periodontal abscesses and extracting hopeless teeth. It is crucial for addressing urgent care needs before the actual periodontal treatment begins.
What does the non-surgical phase of periodontal treatment, also known as phase one therapy, involve?
-The non-surgical phase includes plaque control, patient education, scaling and root planing, oral hygiene instruction, and correction of restorative irritation factors. It also may involve local or systemic antibiotic prescription and is focused on controlling the patient's dental situation.
How soon after phase one therapy should a periodontal reevaluation be conducted?
-A periodontal reevaluation should be conducted four to eight weeks after the completion of phase one therapy to assess improvements in the patient's periodontal health and reaffirm the importance of oral hygiene.
What is the role of the surgical phase, or 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. It involves more invasive procedures when non-surgical treatments are not sufficient.
What is the restorative phase, or phase three therapy, in the context of periodontal treatment?
-The restorative phase is reached after periodontal disease is under control and involves final restorations, crowns, bridges, and partials. It focuses on restoring the functionality and aesthetics of the patient's teeth.
What is the maintenance phase, or phase four therapy, and how often should it be performed?
-The maintenance phase, also known as supportive periodontal therapy, is an ongoing evaluation of the patient's oral hygiene and the condition of the periodontal tissues. It is performed every three months for at least the first year, and then the patient might move to a twice-a-year schedule if their condition is well-controlled.
What are the differences between a risk factor, a risk determinant, a risk indicator, and a risk marker in the context of periodontal disease?
-A risk factor is causally associated with the disease, like smoking. A risk determinant is an unchangeable characteristic that increases the likelihood of disease, such as genetics. A risk indicator is not causally associated with the disease but could suggest a higher risk, like stress or osteoporosis. A risk marker has a quantitative association with disease, such as a history of periodontal disease or clinical attachment loss.
Why is patient compliance crucial for the success of periodontal treatment?
-Patient compliance is essential because it ensures that the patient is actively participating in their oral hygiene routine and following the treatment plan, which is critical for the success and sustainability of periodontal health improvements.
What is the significance of the junctional epithelium in the healing process of periodontal pockets?
-The junctional epithelium is the area where the epithelium contacts the enamel directly. An increase in the formation of junctional epithelium and a shallower periodontal pocket depth are signs of healing towards a healthier periodontal state.
How does the history of periodontal disease impact a patient's future risk for the disease?
-A history of periodontal disease is a risk marker for future disease, indicating that patients who have had periodontal disease are at a higher risk of developing it again. This is why they are placed on periodontal maintenance for life.
Outlines
😀 Introduction to Periodontal Treatment Planning
Ryan introduces the video by welcoming viewers back to the periodontics series. He outlines the focus on the treatment planning process for periodontal patients, emphasizing the short-term goal of reducing gingival inflammation by addressing its causes, such as plaque and calculus accumulation. The long-term goals are more complex, aiming to eliminate pain, arrest tissue destruction, establish occlusal stability, reduce tooth loss, and prevent disease recurrence. The video will cover five phases of treatment planning, starting with the preliminary phase, which involves treating emergencies and extracting teeth with a hopeless prognosis. The first phase of actual treatment is the non-surgical phase, focusing on plaque control, patient education, and local factor correction. The importance of patient compliance is highlighted as crucial for successful periodontal treatment.
🔍 Periodontal Reevaluation and Surgical Phase
The video continues with a discussion on the periodontal reevaluation, which occurs four to eight weeks after the completion of phase one therapy. This reevaluation assesses improvements in the patient's periodontal health and reaffirms the importance of oral hygiene. The term 'junctional epithelium' (JE) is introduced, which is a sign of healing towards a shallower pocket. The next phase, known as phase two or surgical therapy, involves reducing or eliminating periodontal pockets, correcting tissue defects, and potentially placing implants. This phase may include endodontic therapy for teeth with endodontic issues. The video explains that the surgical phase is considered when non-surgical treatments are not sufficiently successful, requiring more direct access to address local factors like plaque and calculus.
🛠️ Restorative Phase and Maintenance
Following the surgical phase, the video moves on to the restorative phase (phase three), which is not initiated until periodontal disease is under control. This phase involves final restorations, crowns, bridges, and partials. The video then discusses the maintenance phase (phase four), also known as supportive periodontal therapy, which is an ongoing evaluation of the patient's oral hygiene and periodontal tissue condition. Maintenance is performed every three months for the first year, after which the patient may move to a twice-a-year schedule if their condition is well-controlled. The video concludes by discussing risk elements, differentiating between risk factors, determinants, indicators, and markers. Examples of each category are provided, such as smoking and diabetes for risk factors, and previous history of periodontal disease for risk markers.
Mindmap
Keywords
💡Periodontics
💡Gingival Inflammation
💡Clinical Attachment Loss
💡Occlusal Stability
💡Plaque Control
💡Scaling and Root Planing
💡Periodontal Reevaluation
💡Junctional Epithelium
💡Risk Factors
💡Risk Markers
💡Supportive Periodontal Therapy
Highlights
The short-term goal of periodontal treatment is to reduce gingival inflammation by correcting conditions 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 teeth with a hopeless prognosis.
Phase one therapy, also known as non-surgical phase, focuses on plaque control, patient education, and oral hygiene instruction.
Restorative irritation effectors, such as overhanging margins, need to be corrected to improve periodontal health.
Local or systemic antibiotic prescription may be used in conjunction with non-surgical periodontal treatment.
Periodontal reevaluation is crucial and should occur four to eight weeks after phase one therapy to assess improvements in patient's health.
The formation of junctional epithelium and a reduction in periodontal pocket depth are signs of healing.
Phase two therapy is the surgical phase, aimed at reducing or eliminating periodontal pockets and correcting soft and hard tissue defects.
In phase three therapy, restorative work like crowns, bridges, and partials is performed once periodontal disease is under control.
The maintenance phase, or phase four therapy, involves periodic ongoing evaluation and is crucial for patients with a history of periodontal disease.
Risk factors for periodontal disease include smoking, diabetes, pathogenic bacteria, and microbial tooth deposits.
Risk determinants are unchangeable characteristics like gender or genetics that increase the likelihood of disease.
Risk indicators, unlike risk factors, are not causally associated with the disease but may suggest a higher risk, such as stress or osteoporosis.
Risk markers are quantitative associations with disease, like a history of periodontal disease or clinical attachment loss, indicating a higher risk.
Patient compliance is essential for the success of periodontal treatment, especially in periodontics.
The importance of oral hygiene and patient motivation to improve their condition is a key factor in periodontal treatment success.
Deep periodontal pockets may not show significant healing within the initial four to eight weeks, potentially requiring more involved treatment.
Endodontic therapy is included in phase two to restore teeth with endodontic problems alongside periodontal surgery.
Transcripts
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