Evaluation of Initial Therapy

Question 1

An Evaluation of Initial Therapy (EIT) Done to?

Answer 1

Determine patient’s response to periodontal treatment

Determine effectiveness of home care

Confirm tooth by tooth prognosis

Confirm decisions regarding further treatment

Question 2

What are the EIT Parameters?

Answer 2

Gingival color, consistency, and contour

Plaque score

Probing depths

Attachment level

Furcation invasion

Suppuration

Tooth mobility

Bleeding on probing

Question 3

Why is 4-8 weeks the optimal time frame for evaluation of the periodontium post initial therapy?

Answer 3

Reestablishment of junctional epithelium

Repair of connective tissue

Microbial repopulation of sulcus

Question 4

What changes in probing depth and attachment level are expected as a result of initial periodontal therapy?

Answer 4

Probing depth reduction: 1-2 mm

Attachment level gain: 0.5 mm

Question 5

What is the significance of bleeding on probing (BOP) / Gingival Index (GI)?

Answer 5

Correlation with histological findings

Predictor of future attachment loss

Question 6

What did Anderson et al. (1991) find a significant correlation between?

Answer 6

Bleeding on probing (BOP) and histological inflammation at the base of the pocket

Question 7

What did Anderson et al. (1991) find no significant correlation between?

Answer 7

Visual signs of inflamed marginal gingiva and histological inflammation at the base of the pocket

Question 8

What was the purpose of the Lang et al. (1986 & 1989) studies on BOP?

Answer 8

To determine if there is a correlation between BOP and attachment loss > 2 mm

Question 9

What were the outcomes of the Lang et al. (1986 & 1989) studies on BOP?

Answer 9

No BOP - 1.5% chance of progression

One out of four - 3% chance of progression

Two out of four - 6% chance of progression

Three out of four - 14% chance of progression

Four out of four - 30% chance of progression

Question 10

What is the clinical significance of BOP in predicting attachment loss?

Answer 10

There is a correlation between BOP and eventual attachment loss; the absence of BOP is a good indicator for maintaining healthy periodontal tissue

Question 11

What does the presence of BOP likely indicate?

Answer 11

Subgingival plaque and calculus

Question 12

What is the clinical risk when BOP is present?

Answer 12

Greater chance of future attachment loss

Question 13

What actions should be considered when BOP is present?

Answer 13

Reinforcing oral hygiene instructions

Scaling and root planing

Local delivery agents

Surgical access

Periodontal maintenance every 3 months

Question 14

What does the absence of BOP indicate?

Answer 14

Healthy gingiva

Question 15

What is the clinical significance of absent BOP?

Answer 15

Little chance of future attachment loss

Question 16

What are the EIT Expected Response Decrease in?

Answer 16

Plaque score

Probing depth

Tooth mobility Improvement in gingival health:

Tissue color, contour, and consistency

Bleeding on probing

Decrease in percentage of sites with BOP

Decrease in gingival index

Suppuration

Question 17

What are some Clinical Scenarios at EIT?

Answer 17

No further ODCT periodontal treatment is indicated; periodontal maintenance phase is recommended

Further ODCT periodontal treatment (non-surgical or surgical) is indicated; patient proceeds with recommended treatment

Further ODCT periodontal treatment (surgical) is indicated; patient does not proceed with recommended treatment

Question 18

When does the maintenance phase begin?

Answer 18

At the end of ODCT treatment and is performed simultaneously with reconstructive phase treatment

Question 19

What are the goals of the maintenance phase?

Answer 19

Maintenance of probing depths

Elimination of gingival inflammation

Control and/or modification of etiology

Question 20

What may non-surgical periodontal therapy consist of?

Answer 20

Local drug delivery

Treatment of isolated residual pocket

Question 21

What are clinical indicators for non-surgical therapy?

Answer 21

Pocket free of plaque and calculus

Pocket depth (~5 mm) moderately manageable

Absence of a vertical bony defect

Occlusion therapy needed

Question 22

What are clinical indicators for surgical periodontal therapy?

Answer 22

Generalized residual probing depths

Need for access to subgingival calculus

Deep pockets

Question 23

What anatomical issues support the need for surgical therapy?

Answer 23

Vertical or furcation defects

Subgingival margins

Inadequate crown length

Question 23

What clinical findings indicate a patient is not ready for further ODCT periodontal treatment?

Answer 23

Only slight change or no change in gingival inflammation (BOP/GI)

Plaque score not improved

Less than 80% of surfaces plaque-free

Question 24

What patient considerations may affect readiness for further treatment?

Answer 24

Desires Finances Systemic factors

Question 25

What does palliative/compromised maintenance include?

Answer 25

Scaling and root planing Oral hygiene instruction Smoking cessation Local and/or systemic antibiotic therapy Host modulation

Question 26

When is reconstructive phase treatment typically done?

Answer 26

Not until periodontal surgical therapy is completed