If surgery is necessary, it is usually performed as a second phase (corrective), following a thorough evaluation of the clinical results of Phase 1 therapy. This type of care is appropriate for anyone, even those without a history of periodontal disease, who wishes to have optimal oral health. Periodontal pockets can be eliminated by flap surgery or gingivectomy (resective therapy). Notwithstanding, the emphasis on a distinct oral hygiene phase has diminished, and the oral hygiene phase has become amalgamated with the actual causal therapy During the course of periodontitis within any given patient, gingival swelling or on the other hand gingival shrinkage may occur. Rev Fr Odontostomatol. During the initial phase, any essential dental care, oral hygiene advice, and teeth cleaning (scaling of the teeth, including subgingival root debridement) are done. Toward these goals, a vast array of various surgical techniques is available; they will be described. Learn more. The approach to periodontal treatment planning has changed over the years. Included here are the width and thickness of the gingiva (phenotype), course of the horizontal bone loss and the depth of supra-alveolar pockets. The implantation of bone and bone replacement materials into the intraalveolar pockets, the GTR technique, the use of matrix proteins and in the future, use of growth factors are extremely promising. COVID-19 is an emerging, rapidly evolving situation. It is important to note that we aim to solve the problem with the least of amount of invasive procedures. Unfortunately, the predictability of success using these methods is, today, neither understood nor reliable (see also patient factors, p. 297). As mentioned above, the results of regenerative surgical procedures cannot always be predicted with certainty. Examination “ P erio” is Greek for “around” and “odont” is Greek for “tooth.” So periodontal diseases affect the gum (gingiva) and the bone around the teeth. The above-mentioned root irregularities, fusions and grooves can be reduced by means of careful odontoplasty, usually after flap reflection. Sources. In situations with very advanced periodontitis, the deeper gum pockets that remain can generally be successfully reduced only with surgical treatment. corrective. Numerous research studies have proven the importance of the periodontal maintenance phase, and it has become an essential part of comprehensive periodontal disease therapy. Become membership. 5. The primary goal of periodontal surgery is strictly antiinfective, meaning that the surgical modality aims to eliminate infection of pockets that have not responded to conservative treatment and/or medicinal adjuncts. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The general medical history, local and systemic risk factors, “behaviors,” understanding of the individual oral situation and the interdependent consideration of the patient’s compliance are critical. In most industrialized nations today, every patient has the “right” to medical/dental treatment. supportive. The purposes and goals of mucogingival surgery include the widening of the attached gingiva, which is usually associated with deepening the oral vestibulum. There may be some overlap of procedures and differences in the length of the three phases for different patients and the endpoint of a specific phase of treatment may not always be clear. Phase III—Supportive Periodontal Therapy Created February 18, 2020; Author DentistryKey; Category Periodontics; You're Reading a Preview . 2002, Socransky & Haffajee 2002). Both patient factors and local defect factors—as well as the “aptitude” of the clinician, are of determining significance for the planning, type of surgical procedure and the ultimate results (see next page). Maintenance phase. Log in here. [Article in German] Schmidt H. After pointing to the hygienizing phase which must in any case precede, the author deals with the medicinal local and general treatment, the occlusal function diagnosis, the function analysis, and the fundamentals of the grinding therapy. What is the magnitude of plaque accumulation (PI score), and what is the level of patient compliance? Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Phase 2 Therapy Periodontal Surgery—Corrective Phase. The hoped for results of surgical procedures include not only cessation of the disease process, but also “healing” of the pocket via regeneration of periodontal tissues. This review aims to evaluate the effect of orthodontic therapy on periodontal health. In the early 1980s, it was considered mandatory to commence periodontal therapy with a distinct oral hygiene phase during which the patient was motivated and instructed in proper oral hygiene (Gjermo, 1981). Corrective phase . Data. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. This may involve reducing the pocket depths, rebuilding or growing bone, rebuilding or grafting soft tissues, and placing dental implants. Corrective surgical therapy . 2000) have also demonstrated that following resective procedures (osseous surgery), in comparison to simple “access flap” procedures, the depth of the residual pockets is less, and also the colonization by periodontopathic microorganisms (anaerobic!) 1968 Mar;15(3):371-80. J Periodontol. [The current status of periodontal therapy]. The corrective phase of periodontal therapy (PMID:6998060) Abstract Citations; Related Articles; Data; BioEntities; External Links ' ' Schmidt H Stomatologie der DDR [01 Mar 1980, 30(3):199-218] Type: English Abstract, Review, Journal Article (lang: ger) Abstract. The corrective phase The most important part of the corrective phase is periodontal surgery. Furthermore, the temporary splinting, the treatment of secondary malpositions and … Orthodontic treatment for the adult periodontal patient. Periodontal treatment often is divided into a presurgical or hygienic phase and a sur- gical or corrective phase (Ramfjord & Ash 1979). Phase II therapy or Surgical Phase. When planning periodontal therapy it is useful to consider the management across three phases: initial. Sang-Yul Kim, Jae-Kwan Lee, Beom-Seok Chang, Heung-Sik Um, Effect of supportive periodontal therapy on the prevention of tooth loss in Korean adults, Journal of Periodontal & Implant Science, 10.5051/jpis.2014.44.2.65, 44, 2, (65), (2014). Which means that after each phase of therapy we will allow time for healing and then will assess the success of the treatment. This phase of treatment is initiated at the completion of Phase I therapy continues through the corrective phase (Phase II) and for the rest of the patient’ s life. Sub-analysis showed that the outcome appeared to be dependent on tooth type, furcation involvement, severity of periodontal disease at i … Evidence in the literature on benefit gained from radiographs taken for periodontal patients is sparse; the extent to which they influence the treatment provided and treatment outcomes is poorly addressed. These possibilities may range from a purely palliative treatment with a severely reduced prognosis, to systematic and synoptic periodontitis therapy including surgical procedures, functional therapy, comprehensive reconstructions and even dental implants. Nevertheless, such division helps to organise the treatment, to plan what … Phases of Periodontal Therapy. of periodontal therapy. Terms in this set (44) What is the principles of successful treatment planning? “Gingivitis” is inflammation limited to the soft tissues. 1. The root surfaces are exposed to clinical view either by reflecting a gingival flap or, less often, following excision of the gingiva (gingivectomy, p. 301). In addition to the listed patient factors, there are, of course, also defect factors such as morphologic defects, that are of importance for the prognosis of any therapeutic procedure. This goal has been approached with some successes during the past two decades. Unit 8 Periodontics: Treatment Planning and Phase I Periodontal Therapy. The patient must be motivated, and must exhibit adequate plaque control. Therefore, the goal of surgical intervention is to create a harmonic course of the gingival margin, which is achieved through the choice of incision (sulcular, paramarginal), the recontouring of the alveolar bone and the type of flap repositioning, usually at a somewhat more apical niveau. Periodontal surgical therapy is only one component of complete periodontal treatment. During periodontal surgery, aetiological factors remaining form non-surgical therapy can be eliminated to provide the circumstances for reparation or regeneration by establishing ideal conditions for individual and professional oral hygiene. Periodontal surgical therapy is only one component of complete periodontal treatment. CORRECTIVE PHASE OF PERIODONTAL THERAPY (Surgical phase)( phase 2) Introduction Once the factors responsible for the periodontal disease have been controlled or eliminated, the goal of treatment becomes the correction of residual damage, thereby creating an environment that can more easily be maintained in a state of health. Furcation Involvement—Furcation Treatment, Color Atlas of Dental Hygiene—Periodontology. One may also attempt to heal the defects, especially bony pockets, through regenerative surgical procedures (pp. Perhaps most important, even beyond the active treatment itself, are follow-up examinations (and treatments) during recall appointments. cause-related therapy • Corrective phase of therapy, i.e. Following such extensive pre-treatment, surgery is less often necessary, the surgical procedures are associated with less hemorrhage, and the morphological results are better, with less tissue loss (“longer teeth” are less of a problem). These phases are structured to ensure that periodontal therapy is conducted in a logical sequence, consequently improving the prognosis of the patient, in comparison to indecisive treatment plan without a clear goal. The first phase of initial therapy, professional supragingival tooth cleaning, must be complete. What form of periodontitis is present? Restorative Phase. The following important aspects will be considered: Purposes and goals of periodontal surgery, Periodontal surgery: methods and indications, Furcation problems, defects and classifications. Chronic or aggressive? Watch Queue Queue. All of these factors lead to the obvious conclusion that the therapeutic possibilities and the type of therapy may be quite different for each individual patient. Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco R; Research, Science and Therapy Committee. The term “selection” therefore does not imply ruling out any type of therapy; treatment recommendations and the definitive treatment plan may vary considerably for each individual patient. Enhancing Regeneration of Periodontal Tissues. The clinical procedures described above (root debridement or planing and reduction of niches) lead to the elimination of the causes of periodontal inflammation. Periodontal surgery, its goals and purposes, can only be considered in conjunction with complete periodontal treatment. Download Citation | On Jan 1, 2012, Dorothy A. Perry and others published Phase I Periodontal Therapy | Find, read and cite all the research you need on ResearchGate supportive periodontal therapy (SPT Trimeric … Active non-surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. Clinical symptoms of activity such as exudation, bleeding and suppuration are eliminated. The reference lists of potentially relevant review articles were also sought. What is the level of expression of the disease with regard to symptoms of activity, bleeding (BOP)? Oral reconstructive and corrective considerations in periodontal therapy. Freedom from inflammation always leads to consolidation of the gingival tissues, shrinkage or gingival recession; this alone results in a more or less pronounced pocket depth reduction. For example, periodontal surgical approaches for ‘correcting’ residual periodontal defects are not successful in patients with … In patients with gingival recession, the depth and width of the gingival recession (Miller classification, p. 162) is of importance for predicting the therapeutic success. But the practitioner strives for a “pocket free” periodontium whenever possible, especially when restorative/reconstructive procedures are planned upon those teeth that were previously periodontally involved. Current corrective treatments mainly involve: The term SUPPORTIVE PERIODONTAL THERAPY expresses the essential need for therapeutic measures to support the patient’s own efforts to control periodontal infections and to avoid reinfection. Become a DentistryKey membership for Full access and enjoy Unlimited articles. The secondary goal is the correction of defects in cases of unphysiologic gingival and osseous architecture, with special regard to creation of conditions that simplify or guarantee efficient plaque control, especially in the interdental areas. Shareable Link. The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. 1976 Jul;47(7):405-11. doi: 10.1902/jop.1976.47.7.405. Here are the four phases of periodontal therapy. The goals often cannot be achieved using a single specific surgical procedure; rather, often combinations of various surgical methods are required, either simultaneously or one following upon the other: Root cleaning/debridement with direct vision, Reduction or elimination of plaque-retentive areas that promote infection, especially periodontal pockets, Enhancing the regeneration of periodontal tissues, Elimination of diseased tissues—resective therapy, Creation of physiologic morphology/architecture of the marginal periodontium, Correction of mucogingival defects, restoration of esthetics in the aveolodental tissues, Root Cleaning with Direct Vision (Access Flap). The goal of periodontal therapy is the maintenance of the dentition and/or its implant replacements in a state of health, comfort, function, and esthetics for the duration of a patient’s life. Besides lifelong regular follow-up and tooth cleaning, maintaining the patient’s motivation to cooperate is a key requirement. Any dental emergency is treated first to achieve patient comfort. Use the link below to share a full-text version of this article with your friends and colleagues. Objectives. The most important niche for subgingival microbial flora are periodontal pockets themselves. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. If you are a member. The long-term success of periodontitis treatment must be secured life-long, and this is a demand that not every patient can fulfill. These corrections are accomplished by various surgical techniques . Watch Queue Queue NLM adopted depend heavily on the patient’s success in controlling plaque on a daily basis and on the response to the preced-ing fundamental phase of therapy. Most importantly: Intra-alveolar defects are classified as 1-, 2- or 3-wall bony pockets, with consideration of the depth and the width of the “opening angle” of the defect, acknowledging that most of these defects represent “combined” bony pockets: In the apical region, three walls are in evidence, in the “middle,” two walls, and coronally only one wall! Previous Phase II—Corrective Procedures. The first phase of Surgical intervention is therefore indicated with deep pockets, intraosseous defects and furcation involvements. HHS This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. The periodontal maintenance phase forms part of periodontal treatment, and its objective is to prevent recurrence and to ensure long term preservation of the periodontal health achieved in the previous phases. additional measures such as periodontal surgery, and/or endodontic therapy, implant surgery, restorative, orthodontic and/or prosthetic treatment • Maintenance phase (care), i.e. Principally, the comprehensive periodontal therapy can be divided into four main phases followed by any dental emergency 7. If surgery is necessary, it is usually performed as a second phase (corrective), following a thorough evaluation of the clinical results of Phase 1 therapy. Compliance and its role in successful treatment of an advanced periodontal case: review of the literature and a case report. In the maintenance phase, the aim is to maintain the successfully stabilized periodontal state in the long term. After pointing to the hygienizing phase which must in any case precede, the author deals with the medicinal local and general treatment, the occlusal function diagnosis, the function analysis, and the fundamentals of the grinding therapy. Phase I therapy or Etiotropic Phase. Also of importance are open furcations, root irregularities, fusions, grooves and other oral structures. Periodontal therapy is usually delivered over three phases: an initial phase, a corrective phase, and a final supportive phase. Correction of Mucogingival Defects—Re-Creation of Esthetics. Elimination of Diseased Tissues—Resective Therapy.  |  Pocket depth reduction and/or pocket elimination maintain their importance in contemporary periodontal therapy (Slots 2002, Petersilka et al.  |  is more significantly reduced following use of more radical surgical procedures. Creation of Physiologic Morphology of the Marginal Periodontium. Phase III—Supportive Periodontal Therapy. In “periodontitis” the inflammation has caused breakdown of the bone. If periodontal pockets greater than 3mm are still present, further treatment options may be suggested, including corrective surgical therapy. What is the extent and severity of the disease? USA.gov. The patient must be motivated, and must exhibit adequate plaque control. In addition to improved esthetics, plaque control should also be simplified for the patient. This site needs JavaScript to work properly. Furthermore, initial therapy may be the only therapy required for mild periodontitis, whereas in severe cases it may represent only a preparatory presurgical phase. This phase of the periodontal treatment plan is aimed at restoring anatomical and functional conditions in patients who have had periodontitis, and who because of their specific traits are at high risk for developing recurrence and its consequent periodontal destruction. Radiographs can be used in planning initial, corrective and supportive phases of therapy, though some decisions may be made on clinical assessments alone. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. Supportive periodontal therapy, Periodontal Maintenance, Ma intenance Phase, Patient’s Car e, Patient’s Health detection and treatment of new and recurring disease is 4 In addition, clinical studies have demonstrated that the debridement of subgingival calculus and biofilm must be performed before surgical intervention. Please enable it to take advantage of the complete set of features! Summaries. Prevention . This video is unavailable. [The corrective phase of periodontal therapy].  |  [Reequilibration of occlusion by orthodontic treatment and selective grinding]. Corrective or surgical procedures will allow us to rebuild the foundation for you and maintain your natural teeth and dental implants. For example, initial therapy and surgery are two entities with identical goals, but which use different methods to achieve these goals (closed root planing versus root planing with direct vision). NIH 299, 301). However, attempts to convert this intention into solid clinical practice can become tremendously complex, the results of which are very different from the original intention. Phase III therapy or Restorative Phase. Clipboard, Search History, and several other advanced features are temporarily unavailable. In the corrective phase of periodontal therapy, the treatment approaches to be . While on maintenance phase, with its periodic checkups & controls, patient enters into Surgical phase (Phase II) & Restorative (reparative) phase (Phase III) of T/t Include perio surgery to repair & improve condition of perio & surrounding tissues & their esthetics, rebuilding of lost structures, placement of implants & construction of necessary restorative work 46 Another major goal is soft tissue coverage in areas of gingival recession and correction of alveolar ridge defects, which anticipate additional treatment in the areas of prosthetics and dental implantology. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. of the active and corrective phases of periodontal therapy, including subgingival scaling and surgical pocket elimination (Gjermo, 1981, Nyman, Lindhe, & Rosling, 1977). Plaque and calculus can then be removed from all root surfaces, including furcations, irregularities etc., with direct vision. 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