Periodontal Therapy - goals/sequence/basic treatment and failure

Question 1

what is a periodontal pocket and what does it involve?

Answer 1

a pathogenically deepened gingival crevice

• ulcerated epithelial lining of pocket wall
• junctional epithelium
• diseased root surface - contaminated with subgingival calculus deposits and a layer of dental plaque and contains periodontal pathogens

Question 2

what is the aim of non surgical treatment and how is done through?

Answer 2

create a biologically compatible environment with healing of perio tissues through :

• decontamination of root surface
• disruption and elimination of the plaque biofilm and root surface
• removal of bulk of subgingival calculus from the root surface

Question 3

RSD is the procedure necessary to eliminate or disrupt what?

Answer 3

• endotoxins - from anaerobic plaque bacteria
• plaque biofilm
• subgingival calculus
  outermost necrotic cementum on the root surface

Question 4

why is calculus considered as a contributory factor to perio disease?

Answer 4

all calculus has a coating of plaque
supragingival calculus impedes Tb and ID cleaning
subgingival calculus may absorb bacterial endotoxins
may impede probing = false probing depths

Question 5

what is a full mouth disinfection and what does it involve?

Answer 5

to prevent reinfection of pockets by elimination of organisms as quickly as possible

• RSD within a 24 hour period and OHI
• used along with an adjunct such as chx/antibiotic

Question 6

pockets of 4-6mm after RSD show?

Answer 6

average probing depth reduction of about 1mm and 0.5mm gain of attachment after tx

Question 7

deep pockets show how much reduction?

Answer 7

reductions of 2mm and 1mm gain of attachment

Question 8

what are the objectives of cause related therapy?

Answer 8

resolve the disease process

create conditions that will mitigate against the recurrence of the disease

Question 9

what are the stages of cause related therapy?

Answer 9

treat any painful condition
HPT
smoking cessation
removal of plaque retentive factors
supragingival scaling
subgingival scaling
occlusal adjustment if necessary
monitor initial response to therapy