Identify the pathological changes of the periodontal
tissues. Accurately collect/chart following clinical data: Probing depth. Bleeding on probing points/Suppuration Furcation involvements. Tooth mobility/ fremitus. Gingival recession. Mucogingival defects. Plaque score. Analyze the clinical data and develop an overall diagnosis for the patient. Gingival Examination Evaluate tissue changes in terms of: Color.
Consistency.
Contour. .
Gingival Indices Used for evaluation and quantitation of gingivitis. Gingival Index (GI) (Loe & Silness):
Scores gingival inflammation from 0-3 on the facial,
lingual and mesial surfaces of all teeth.
Grade 0 – normal gingiva, no inflammation, no
discoloration, no bleeding Grade 1 – mild inflammation, slight color change, mild alteration of gingival surface, no bleeding Grade 2 – moderate inflammation, erythema, swelling, bleeding on probing or when pressure applied Grade 3 – severe inflammation, severe erythema and swelling, tendency toward spontaneous hemorrhage, some ulceration Periodontal Examination
Periodontal Pocket Gingival pocket, suprabony pocket, intrabony pocket Simple pocket Compound pocket Complex pocket Attachment loss Configuration of the pocket Bone sounding/configuration of the bony defects Probing Depth: - The distance from the soft tissue (gingiva or alveolar mucosa) margin to the tip of the periodontal probe during usual periodontal diagnostic probing.
The health of attachment can affect the
measurement.
- over probing in inflamed tissue → probed too
far and punctured everything, probes right down to bone
Definition: The distance from CEJ to the tip of a periodontal probe during usual periodontal diagnostic probing. The health of Attachment apparatus can affect the measurement. Distance from CEJ to gingival margin + probing depth Bleeding on Probing (BOP)
Itis usually a reliable predictor of
periodontal disease progression but not in smokers where the vasoconstrictors mask bleeding. Bleeding on Probing (BOP) – It is expressed as a % of number of bleeding sites divided by the total number of sites.. Tooth Mobility Causes of mobility:
Trauma from occlusion.
Inflammation. Loss of support. Non-periodontal causes. Mobility test: Can be performed by the end of two blunt instruments or electronically by the Periotest Scale for Mobility Assessment Grade I Slight Up to 1mm Grade II Moderate Between 1-2mm Grade III Advanced Over 2 mm and Tooth depressible Fremitus
Palpable or visible movement of a tooth when
subjected to occlusal forces. Associated with increase bone and attachment loss. place index finger on labial Surface of maxillary teeth. Ask the patient to grind in lateral and protrusive movevement. Any movement seen or felt is termed fremitus. Furcation Assessment Etiology of furcation invasion: Extension of inflammatory periodontal disease. Pulpal disease. Defective plaque retentive restorations. Anatomical variations: Enamel pearl Cervical enamel projections Existence of accessory pulpal canals.
Furcation Assessment Class l Class ll Class lll Class lV Mucogingival Assessment
Includes:
Marginal tissue recession.
Inadequate attached gingiva. High frenum. Gingival Recession Miller’s Classification of Marginal Tissue Recession Class I: Marginal tissue does not extend to MGJ. No loss of bone or soft tissue of interdental area. Class II: Marginal tissue recession extends to or beyond the MGJ. No loss of bone or soft tissue of interdental area Class III: Marginal tissue recession extends to or beyond the MGJ. There is of bone and/or soft tissue loss interdentally. OR There is malpositioning of the tooth. Class IV: Marginal tissue extends to or beyond the MGJ. Severe bone and soft tissue loss interdentally and or severe tooth mal position. Miller’s Classification of Marginal Tissue Recession Occlusal Trauma
An injury to the periodontal ligament and
alveolar bone as a result of excessive forces. There are 2 types of occlusal trauma:
Primary Secondary → due to bone loss Plaque Control Record O’Leary et al. 1972
Prognosis is a prediction of the probable course and outcome of a disease. It is determined following initial examination, and following active therapy phase. Importance:
For Clinician: To determine which treatment modalities will be most effective. To develop restorative recommendation and treatment plans. For Patient: To determine whether treatment seems worthwhile. Factors to consider when assigning a prognosis
Overall Prognosis Age – younger is worse → fast process Medical Status – disease, risk etc Rate of progression – chronic vs aggressive Patient cooperation Knowledge and ability of dentist. Etiologic factors – root grooves Oral habits – bruxism, damaging contacts Should treatment be undertaken? Is it likely to succeed?
When prosthetics are needed are the
teeth in question to support the additional burden?
Individual Tooth prognosis: Root form - Short rooted teeth have worse crown/root → worse prognosis, - Fused roots worse than bifurcated Caries
- Local risk factor for periodontal disease
Tooth position - Out of alignment has less buccal plate → ↑ recession - mesial tilt → harder to clean and treat
Strategic value
- Consideration for abutments
Therapist knowledge and skill.
Periodontal Treatment Planning INITIAL THERAPY TREATMENT PLAN (Phase I therapy)
: Plaque Control Instruction.
Supragingival Removal of Calculus
Recontouring Defective Restorations and Crowns.
Obturation of Carious Lesions & removal of plaque retentive areas RE-EVALUATION PHASE Objectives: 1. To assess tissue response to therapy a. Gingival Condition. b. Pocket Depths. 2. To assess patient’s compliance with OHI a. Plaque and Bleeding Index b. Review OHI 3. To Assess need/advisability for further periodontal therapies.
recurrence of periodontal disease. To prevent the loss of dental implants after clinical stability has been achieved.
To reduce tooth loss by monitoring the dentition and any prosthetic replacement of the natural teeth. To diagnose and manage, other diseases or conditions found within the oral cavity.
Compliance and its Role in Periodontal Therapy Compliance) has been defined as “ the extent to which a person’s behavior coincides with medical or health advice”.
Compliance in Periodontics: Why patients fail to comply? - Financial reasons
- Lack of information
- Time conflicts with job
- Length of periodontal treatment
- Chronic nature of the disease
Chapter 1,2 assessment What is the information I get from reviewing the medical/dental history? What do I look for in gingival examination?
What is clinical attachment loss
What is the index used for assessing
gingival bleeding and the significance of gingival bleeding? What is Glickmans classification for furcation assessment? What does Mucogingival Assessment include? What is Miller’s classification for gingival recession? What is Fremitus? How is mobility assessed? (Scale for Mobility Assessment) Which type of radiograph is used for periodontal treatment and why? How can you assess tooth vitality?
What are the Clinical indicators of occulsal
trauma? What are the radiographic indicators of occlusal trauma what is the information needed in radiographic assessment? What kind of information can I get from probing?
What is the biologic width and its significance?
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