SUPPORTIVE PERIODONTAL THERAPYWELLINGTON J. NII DARKO (BSc. Medical sciences)

UNIVERSITY OF GHANA SCHOOL OF MEDICINE AND DENTISTRY

OUTLINE INTRODUCTION

GOALS OF SUPPORTIVE PERIODONTAL THERAPY

OBJECTIVES OF THE SUPPORTIVE PERIODONTAL THERAPY

RATIONALE FOR SUPPORTIVE PERIODONTAL THERAPY

MAINTENANCE PROGRAM

CLASSIFICATION OF POST-TREATMENT PATIENTS

REFERRAL OF PATIENTS TO THE PERIODONTIST

TEST FOR DISEASE ACTIVITY

MAINTENANCE FOR DENTAL IMPLANT PATIENTS

PROPHYLAXIS VS SUPPORTIVE PEERIODONTAL THERAPY

CONCLUSION

REFERRENCES

INTRODUCTION

Periodontal treatment includes; Systemic evaluation of the patient’s health

A cause-related therapeutic phase with, in some cases

A corrective phase involving periodontal surgical procedures

Maintenance phase

The 3rd World Workshop of the American Academy of Periodontology (1989) renamed this treatment phase “SUPPORTIVE PERIODONTAL THERAPY”(SPT)

INTRODUCTION Preservation of the teeth depends on the maintenance therapy Recurrent periodontitis 5.6 times greater risk for tooth loss for non compliant patients

Checchi L, Montevecchi M, Gatto MR, Trombelli L: Retrospective study of tooth loss in 92 periodontal patients. J Clin Periodontol 2002; 29:651.

50- fold increase in probing attachment loss after successful regenerative therapy Cortellimi P, Pini-Prato G, Torretti M: Periodontal regeneration of human infrabony

defects. V. Effects of oral hygiene on long-term stability. J Clin Periodontol 1994; 21:606

Motivational technique

Reinforcement of the importance of the maintenance phase before performing definitive periodontal surgery

INTRODUCTION

INTRODUCTION

GOALS OF SPT

The American Academy of Periodontology position paper more specifically lists 3 main goals of SPT: To prevent or minimize the recurrence and progression of

periodontal disease in patients who have been previously treated for gingivitis, periodontitis and for peri-implantitis

To prevent or reduce the incidence of tooth loss by monitoring the dentition and by any prosthetic replacement of the natural teeth

To increase the probability and treating in a timely manner, other diseases or conditions found in the oral cavity

OBJECTIVES OF SPT

Preservation of alveolar bone support (radiographically)Maintenance of stable, clinical attachment levelReinforcement and re-evaluation of proper home careMaintenance of a healthy and functional oral environment

RATIONALE FOR SPT

RECURRENCE Incomplete subgingival plaque removal

Presence of bacteria in the gingival tissues in chronic and aggressive periodontitis cases

Microscopic nature of dentogingival unit healing after periodontal treatment

SUBGINGIVAL SCALING ALTERS THE MICROFLORA

RATIONALE FOR SPT

INCOMPLETE SUBGINGIVAL PLAQUE REMOVAL Continued loss of attachment

Without the presence of clinical gingival inflammation

RATIONALE FOR SPT

PRESENCE OF BACTERIA IN THE GINGIVAL TISSUES Bacteria may recolonize the pocket and cause recurrent disease

Bacteria associated with periodontitis can be transmitted between spouses and other family members

RATIONALE FOR SPT

NATURE OF THE DENTOGINGIVAL UNIT HEALING Long junctional epithelium

Weaker

Inflammation may rapidly separate

RATIONALE FOR SPT

SUBGINGIVAL SCALING ALTERS MICROFLORA Decrease in motile rods for 1 week Marked elevation in coccoid cells for 21 days Marked reduction in spirochaetes for 7 weeks Return of pathogens to pretreatment levels- 9-11 weeks 3 months maintenance interval

Prevent recurrence Based on microscopic monitoring of subgingival flora

Subgingival scaling alters the pocket microflora for variable but relatively long periods

MAINTENANCE PROGRAMME

Comprises of 3 parts Examination and evaluation

Treatment

Report, cleanup and scheduling

MAINTENANCE PROGRAMME

EXAMINATION AND EVALUATION Changes from last evaluation

Medical history

Restorations, prostheses

Caries, occlusion, mobility, gingival status, probing depths

Analysis of current oral hygiene status

Pathologic conditions of oral mucosa

Radiographic examination Bone height, repair of osseous defects, occlusal trauma, periapical pathologies,

caries

MAINTENANCE PROGRAMME

CHECKING OF PLAQUE CONTROL Must be reviewed and corrected until patient demonstrates

necessary proficiency

Less plaque and gingivitis if instructed

MAINTENANCE PROGRAMME

TREATMENT Required scaling and root planning

Not to instrument normal sites

Irrigation with antimicrobial agents of remaining pockets

SCHEDULING

MAINTENANCE PROGRAMME

RECURRENCE OF PERIODONTAL DISEASE Failed to remove all potential factors favouring plaque

accumulation

Incomplete calculus removal in areas of difficult access

Inadequate restorations placed

Failure of patient to return for periodic check-ups

Presence of systemic diseases

MAINTENANCE PROGRAMME

RECOGNISE A FAILING CASE Gingival changes and bleeding on probing

Increasing probing depth

Gradual increase in bone loss

Gradual increase in tooth mobility

CLASSIFICATION OF POST-TREATMENT PATIENTS

Recall interval for first year not longer than 3 monthsLong term preservation of the dentition closely associated with

the frequency and quality of recall maintenanceVaried groupPatient can improve or relapse into different classification with

reduction or exacerbation of periodontal disease

CLASSIFICATION OF POST-TREATMENT PATIENTS

FIRST YEAR PATIENT Routine therapy and uneventful healing

3 months

Difficult case with complicated prosthesis, furcation involvement, poor crown-to-root ratios, or questionable patient cooperation 1-2 months

CLASSIFICATION OF POST-TREATMENT PATIENTS

CLASS A Excellent results well maintained for 1 year or more.

Patient displays good oral hygiene, minimal calculus, no occlusal problems, no complicated prostheses, no remaining pockets, and no teeth with less than 50% of alveolar bone remaining 6 months to 1 year

CLASSIFICATION OF POST-TREATMENT PATIENTS

CLASS B Generally good results maintained reasonably well for 1 year or

more 3-4 months (based on number and severity of factors)

CLASSIFICATION OF POST-TREATMENT PATIENTS

CLASS C Generally poor results after periodontal therapy and/or several

negative factors 1-3 months (based on number and severity of negative factors)

consider re-treating some areas or extracting severely involved teeth

REFERRAL TO THE PERIODONTIST

Difficult casesPatients with systemic conditionsDental implant patientsComplex prosthetic constructions that require reliable results

REFERRAL TO THE PERIODONTIST

Surgery on distal sides of second molarExtensive osseous surgeryComplex regenerative procedures

REFERRAL TO THE PERIODONTIST

Extent and location of periodontal deterioration- most important

Teeth pockets of 5mm or moreTeeth with furcation lesions

REFERRAL TO THE PERIODONTIST

TEST FOR DISEASE ACTIVITY

Well-organized charting systemComparison of sequential probing measurementNo accurate method

Clinicians rely on combination of probing, bleeding on probing and sequential probing measurements

MAINTENANCE FOR DENTAL IMPLANT PATIENTS

Periimplantitis More prone to plaque-induced inflammation with bone loss

Difficult to treat

Treat periodontal disease beforeProvide adequate SPT

MAINTENANCE FOR DENTAL IMPLANT PATIENTS

Similar maintenance procedureDifference

Special instrumentation

Avoid acidic fluoride prophylaxis

Non-abraisive prophy pastes used

PROPHYLAXIS VS SPT

PROHYLAXIS

Non-therapeutic

Healthy mouth

Prevent disease

Supragingival procedure

6 months intervals

SPT

Therarapeutic

Patients who have had active periodontal treatment

Keep disease under control

Both supragingival and subgingival

3-4 months intervals

CONCLUSION

SPT very important phase for long term success of periodontal therapy

3-4 monthsTo prevent recurrence of periodontal diseasePatient motivation very importantNon compliant patientsWhen to refer case to specialistProphylaxis vs SPT

REFERENCES

Newman, Takei, Fermin A Carranza. Clinical periodontology, 9th Edition, WB Saunder Co., 2002. Jan Lindhe. Clinical Periodontology and Implant Dentistry, 4th Edition, (2003), Blackwell Munkgard Publication. Reddy Shantipriya. Essentials of Clinical Periodontology and Periodontics. 2 nd edition. New Delhi: Jaypee Publishers; 2008. p. 409. Klaus H., Herbert F.W., Hassel M., Color Atlas of Periodontology. Thieme Inc. New York. 1985. Cortellimi P, Pini-Prato G, Torretti M: Periodontal regeneration of human infrabony defects. V. Effects of oral hygiene on long-term

stability. J Clin Periodontol 1994; 21:606 Checchi L, Montevecchi M, Gatto MR, Trombelli L: Retrospective study of tooth loss in 92 periodontal patients. J Clin Periodontol

2002; 29:651 Wilson Jr TG: Compliance: a review of the literature. J Periodontol 1987; 58:706

http://www.theendoblog.com/2014/01/dental-implant-maintenance.html http://www.dentistryiq.com/articles/2009/10/prophy-and-periodontal.html http://www.rdhmag.com/articles/print/volume-0/issue-9/columns/staff-rx/prophy-vs-perio-maintenance.html http://nydentallife.wordpress.com/2011/03/28/periodontal-maintenance-or-a-%E2%80%9Cregular-cleaning%E2%80%9D-

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