Periodontal Periodontal ExaminationExamination

Possible Diagnostic Categories

Health Gingivitis Periodontitis

Treatment PlanTreatment Plan

Includes all procedures required Includes all procedures required for the establishment and for the establishment and maintenance of oral healthmaintenance of oral health

Determined after the diagnosis Determined after the diagnosis and prognosis have been and prognosis have been establishedestablished

Overall Treatment PlanOverall Treatment Plan Preliminary phasePreliminary phase Phase I therapyPhase I therapy Re-evaluationRe-evaluation Phase II therapy – (surgical phase)Phase II therapy – (surgical phase) Phase III therapy – (restorative Phase III therapy – (restorative

phase)phase) Phase IV therapy – (supportive Phase IV therapy – (supportive

periodontal therapy)periodontal therapy)

Explaining the Explaining the Treatment Plan to the Treatment Plan to the

PatientPatientBe specific in explaining:Be specific in explaining:

The problemThe problem

The treatmentThe treatment

The prognosisThe prognosis

The maintenanceThe maintenance

Start Out PositivelyStart Out Positively

Talk about teeth to be retainedTalk about teeth to be retained Present all of the treatment as Present all of the treatment as

a unit a unit Best results with prompt Best results with prompt

treatmenttreatment

Preliminary PhasePreliminary Phase

Treatment of Treatment of emergenciesemergencies

Acute infectionAcute infectionCaries controlCaries controlOtherOther

Periodontal AbscessPeriodontal Abscess

PericoronitisPericoronitis

Necrotizing Ulcerative Necrotizing Ulcerative GingivitisGingivitis

Acute Periapical Infections

Phase I Therapy Phase I Therapy (Etiotropic Phase)(Etiotropic Phase)

Plaque controlPlaque control Diet controlDiet control Scaling and root planing/scale & Scaling and root planing/scale &

polishpolish Caries controlCaries control Occlusal therapyOcclusal therapy Provisional splintingProvisional splinting

Scaling / Root PlaningScaling / Root Planing

ADA code D4341ADA code D4341 Patient with LOA and Patient with LOA and

gingival inflammationgingival inflammation

Scale and PolishScale and Polish

ADA code D1110ADA code D1110 Patient with gingival Patient with gingival

inflammation and no LOAinflammation and no LOA

Re-evaluationRe-evaluation

Diagnosis of Periodontitis

Initial Therapy S/RP and Home Care

Re-evaluation

Response to Phase IResponse to Phase I

Re-checkingRe-checkingProbing depthsProbing depthsMobility Mobility RecessionRecessionPlaque controlPlaque control

Tissue responseTissue responseColorColorConsistencyConsistencyContourContourTextureTextureBleeding on probingBleeding on probing

Response to Phase I

Endpoint Objectives of Endpoint Objectives of Periodontal TherapyPeriodontal Therapy

Resolution of inflammationResolution of inflammation No BOPNo BOP No suppurationNo suppuration Gingival contours WNL in Gingival contours WNL in

color, texture and formcolor, texture and form Gingival attachment which is Gingival attachment which is

resistant to recurrent diseaseresistant to recurrent disease

Criteria Indicating These Criteria Indicating These Goals Have Not Been MetGoals Have Not Been Met

Ongoing attachment loss / Ongoing attachment loss / recessionrecession

Signs of inflammationSigns of inflammation BOPBOP SuppurationSuppuration

Periodontal pockets > 5mmPeriodontal pockets > 5mm

Criteria Indicating These Criteria Indicating These Goals Have Not Been Goals Have Not Been

Meet Meet (con’t.)(con’t.)

Increasing tooth mobilityIncreasing tooth mobility Significant osseous Significant osseous

defectsdefects FurcationsFurcations Vertical defectsVertical defects Bony cratersBony craters

Establish periodontal treatment Establish periodontal treatment planplanAdditional S/RP followed by re-evalAdditional S/RP followed by re-evalSupportive periodontal therapy Supportive periodontal therapy Periodontal surgeryPeriodontal surgery

Treatment vs. Treatment vs. Referral?Referral?

Patient for ReferralPatient for Referral

Inflammation that does not resolveInflammation that does not resolve Inadequate attached gingivaInadequate attached gingiva Severe root exposureSevere root exposure Aggressive periodontitisAggressive periodontitis Patients with systemic diseasePatients with systemic disease All severe periodontal diseaseAll severe periodontal disease

Watching Is Not Watching Is Not Considered Periodontal Considered Periodontal

TherapyTherapy

Phase II Therapy Phase II Therapy (Surgical Phase)(Surgical Phase)

Periodontal surgeryPeriodontal surgery ResectionResection RegenerationRegeneration Periodontal plastic surgeryPeriodontal plastic surgery Crown lengtheningCrown lengthening

Pre bone resection

Post bone resection

Intrabony Defect

Bone Graft Placed

Pre-op

Post-op

Pre-op

Post-op

Phase III Therapy Phase III Therapy (Restorative Phase)(Restorative Phase)

Final restorationsFinal restorations Fixed and removable Fixed and removable

prosthodonticsprosthodontics ImplantsImplants

Phase IV Therapy Phase IV Therapy (Maintenance Phase)(Maintenance Phase)

Supportive periodontal Supportive periodontal therapytherapy

Periodontal Maintenance Periodontal Maintenance ProgramProgram

Recall MaintenanceRecall Maintenance ADA code D4910ADA code D4910

Supportive Periodontal Supportive Periodontal TherapyTherapy

I.I. ExaminationExaminationUpdate medical historyUpdate medical historyOral pathology examOral pathology examRadiographs prnRadiographs prnOral hygiene statusOral hygiene status

Supportive Periodontal Supportive Periodontal TherapyTherapy

I.I. ExaminationExamination Probing depthsProbing depths Tissue conditionTissue condition Plaque controlPlaque control OcclusionOcclusion Tooth mobilityTooth mobility RecessionRecession

Supportive Periodontal Supportive Periodontal TherapyTherapy

II.II. TreatmentTreatmentOral hygiene reinforcementOral hygiene reinforcementScaling (RP prn)Scaling (RP prn)PolishingPolishingChemical irrigation prnChemical irrigation prn

Supportive Periodontal Supportive Periodontal TherapyTherapy

III.III. SchedulingSchedulingNext recall visitNext recall visitAdditional periodontal txAdditional periodontal txRestorative treatmentRestorative treatment

Patients With Patients With PeriodontitisPeriodontitis

3 months SPT3 months SPT

Patients With Patients With Gingivitis and No Gingivitis and No

History of LOAHistory of LOA

6 month SPT6 month SPT

Time for SPT Time for SPT appointmentsappointments

45-60 minutes45-60 minutes

SPT Practice PatternsSPT Practice Patterns

Typically, periodontist and Typically, periodontist and generalist perform every-other-generalist perform every-other-SPTSPT

Frequent SPT visits (< 3 months Frequent SPT visits (< 3 months apart) may make senseapart) may make sense

Communication is criticalCommunication is critical