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BDS4 Periodontology > 2 - Step 3 > Flashcards

2 - Step 3 Flashcards

1
Q

What is the aim of step 3?

A
  • treat areas of dentition that are not responding to step 2 therapy
  • gaining further access for sub gingival instrumentation, regenerating or resecting lesions
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2
Q

What are the step 3 options?

A
  • treatment adjuncts
  • access surgery
  • regenerative options
  • furcation treatment options
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3
Q

What are examples of local adjuncts?

A
  • local antimicrobials
  • periochip
  • dentomycin
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4
Q

What is periochip?

A
  • biodegradable gelatin matrix with chlorhexidine
  • inserted into pocket following PMPR
  • suitable in angular defects or furcations
  • chlorhexidine is released slowly over 7 days
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5
Q

Is periochip effective?

A
  • shown to have short term improvements in probing depth
  • improvements are small and no significant differences in CAL
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6
Q

What is dentomycin?

A
  • 2% minocycline gel
  • syringed into pocket following PMPR
  • 3-4 applications every 2 weeks
  • treatment not repeated within 6 months
  • reduces bacterial load in pocket
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7
Q

Is dentomycin effective?

A
  • shown to have short term improvements in probing depth and CAL
  • long term benefits not proven
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8
Q

What are examples of systemic adjuncts?

A
  • systemic antibiotics
  • host modulation therapy
  • sub-antimicrobial dose doxycycline
  • statins, bisphophonates, probiotics, NSAID
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9
Q

What is an example of the indication for systemic adjuncts?

A

Periodontitis grade C in younger patients

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10
Q

What is periostat?

A
  • sub-antimicrobial dose doxycycline
  • no association with antimicrobial resistance
  • host modulation of collagenase
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11
Q

Is periostat effective?

A

Significant improvements to patient outcomes versus PMPR alone

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12
Q

When is periodontal surgery indicated?

A
  • non-responding sites where good quality PMPR has been carried out
  • periodontal pocketing of >/= 6mm
  • suitable patient with suitable tooth and defect factors
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13
Q

What consent is required for periodontal surgery?

A
  • reason for providing treatment
  • options available including no treatment
  • consequences of no treatment
  • nature of procedure
  • post-op complications
  • post-op maintenance
  • cost
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14
Q

What post-op complications are associated with periodontal surgery?

A
  • pain, swelling, bruising, bleeding, infection
  • potential time off work
  • failure to resolve
  • tooth mobility
  • tooth non-vitality
  • recession
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15
Q

What is access surgery?

A
  • access to areas of continued inflammation or infection
  • areas of PPD >/= 6mm
  • allow for surgical debridement
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16
Q

What are the steps of access surgery?

A
  • examination and identification of deep non-responding site despite good OH
  • full thickness flap raised
  • defect granulation tissue removed, root surface curettage
  • suture with primary closure (monofilament)
  • SPT
17
Q

How does access surgery heal pockets?

A
  • heals by repair, not by regeneration
  • long epithelial reattachment to root surface
18
Q

What are the indications for regenerative surgery?

A
  • infrabony defects 3mm or deeper on radiograph
  • class 2 or 3 furcation defect
19
Q

What is GTR?

A
  • guided tissue regeneration
  • barrier membrane and bone-derived grafts are used to create scaffold for vascularisation and cell ingrowth from base of defect
20
Q

What is EMD?

A
  • enamel matrix derivative (emdogain)
  • derived from porcine tooth germ
  • injected into defect, forms matrix on root that mediates production of cementum
  • induces preservation of functional attachment
  • suitable in narrow defects, so does not wash away
21
Q

Why are furcation lesions treated?

A
  • class 2 furcations survive much better than class 3 (class 1 respond to PMPR)
  • tooth retention is more cost effective than extraction and prosthesis
  • patients prefer to retain their own teeth
22
Q

What are the treatment options for furcation surgery?

A
  • regenerative surgery
  • root resection
  • root separation
  • tunnelling
23
Q

What furcations are amenable to regenerative surgery?

A
  • mandibular class 2
  • maxillary class 2 (buccal)
  • maxillary class 2 (interdental)
24
Q

What furcations are amenable to root resection or separation surgery?

A
  • class 3 lesions
  • multiple class 2 lesions in same tooth
  • teeth should be endodontically treated, not mobile and remaining structure restorable
  • roots cannot be fused
25
Q

What furcations are amenable to tunnelling?

A

Mandibular class 3 lesions

26
Q

What is tunnelling?

A

Bone and soft tissue recontoured to allow insertion of interdental brush

27
Q

What risks are associated with tunnelling?

A
  • root hypersensitivity
  • root caries

BDS4 Periodontology (10 decks)

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