Classifications, Prognosis, Phase Therapies, Instrumentation

no mobility

grade I

0.1-1.0mm mobility

grade II

>1mm mobility

grade III

vertical or twist mobility

healthy

Probing depth:

1/3 - 1/2 JE

Gingivitis

Probing depth:

apical end of JE

Periodontitis

Probing depth:

penetrates most coronal fibers of CTA

class I

Furcation:

- Incipient suprabony lesion

- Radiographic changes rare

class II

Furcation:

- Furcation bone loss with horizontal components

- Radiographs may not show bone loss in furcation

class III

Furcation:

Through and through lesion that is not clinically visible bc filled with soft tissue

class IV

Furcation:

Through and through that is clinically visible

radiolucency visible in furcation

I

What stage?

interdental CAL 1-2mm

II

What stage?

interdental CAL 3-4mm

III and IV

What stage?

interdental CAL >5mm

I

What stage?

RBL = coronal third (

II

What stage?

RBL= coronal third (15-33%)

III and IV

What stage?

RBL= middle 1/3 of root and beyond

I and II

What stage?

no tooth loss

III

What stage?

IV

What stage?

>5 teeth missing

I

What stage?

max. PD

II

What stage?

max PD.

III

What stage?

Max PD >6mm

Vertical BL >3mm

Furcation II or III

mod. ridge defects

IV

What stage?

Max PD >6mm

Vertical BL >3mm

Furcation II or III

mod. ridge defects

AND complex rehabilitation needed

I and II

What stage?

horizontal bone loss

A

What grade?

Direct bone loss or CAL = no loss over 5 years

B

What grade?

Direct bone loss or CAL =

C

What grade?

Direct bone loss or CAL = >2mm over 5 years

A

What grade?

Indirect % bone loss/age =

B

What grade?

Indirect % bone loss/age = 0.25-1

C

What grade?

Indirect % bone loss/age = >1

A

What grade?

heavy biofilm with decreased levels of destruction

B

What grade?

destruction commensurates with biofilm deposits

C

What grade?

destruction exceeds expectations - rapid progression

A

What grade?

Non-smoker

B

What grade?

C

What grade?

>10 cigs/day

A

What grade?

no diabetes

B

What grade?

HbA1C

C

What grade?

HbA1C >7%

with + prefix

How do you input FGM into Axium when gingiva covers CEJ?

without + prefix

How do you input FGM into Axium when CEJ is exposed?

PD with + prefix

How do you input FGM into Axium when there is no attachment loss and CEJ can't be reached with the tip of the probe?

PD-FGM

What is the calculation for attachment level?

McGuire

Which prognosis system?

Based on tooth loss (likelihood of extraction)

McGuire

Which prognosis system?

- Shows a 5 to 7 year prediction accuracy of the above classification of 89%

- The accuracy decreases to 50% or less when the good prognosis was removed.

Kwok and Caton

Which prognosis system?

Believed that periodontal prognostic system has to be dynamic, suggesting that it should be re-evaluated throughout treatment and maintenance

Kwok and Caton

Which prognosis system?

Classification system based on probability of disease progression

Good (McGuire)

What is the prognosis?

One or more of the following:

- Etiologic Factors can be controlled

- Adequate periodontal support

- Tooth or teeth can be adequately maintained by professional and patient

- Controlled systemic factors

Fair (McGuire)

What is the prognosis?

- Up to 25% attachment loss measured clinically and radiographically

Fair (McGuire)

What is the prognosis?

- Grade 1 furcation allows access for maintenance

Fair (McGuire)

What is the prognosis?

- Tooth or teeth can be maintained with proper professional and home care

Fair (McGuire)

What is the prognosis according to McGuire?

- Limited systemic factors

Poor (McGuire)

What is the prognosis?

- Up to 50% loss has occurred

Poor (McGuire)

What is the prognosis?

- Grade Il furcation with difficult access to the depth and portion of the furcation

Poor (McGuire)

What is the prognosis?

- Greater than Miller Class I mobility

Poor (McGuire)

What is the prognosis?

- Poor crown to root ratio

Poor (McGuire)

What is the prognosis?

- Lack of patient compliance

- Presence of systemic factors

Questionable (McGuire)

What is the prognosis?

- Greater than 50% attachment loss

Questionable (McGuire)

What is the prognosis?

- Grade II or III furcation involvement not accessible for maintenance

Questionable (McGuire)

What is the prognosis?

- Endodontically involved tooth that must be resolved before periodontal treatment

Questionable (McGuire)

What is the prognosis?

- Tooth or teeth not easily maintained by professional and/or patient

Hopeless (McGuire)

What is the prognosis?

- Inadequate attachment to support the tooth

Hopeless (McGuire)

What is the prognosis?

- Grade III or IV furcation involvement

Hopeless (McGuire)

What is the prognosis?

- Miller Class III mobility

Hopeless (McGuire)

What is the prognosis?

- Tooth or teeth cannot be maintained by the professional and / or the patient

Favorable (Kwok and Caton)

What is the prognosis?

- The periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and periodontal maintenance

Questionable (Kwok and Caton)

What is the prognosis?

- The periodontal status of the tooth is influenced by local and/or systemic factors that may or may not be controlled

Unfavorable (Kwok and Caton)

What is the prognosis?

- The periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled

Hopeless (Kwok and Caton)

What is the prognosis?

- The tooth must be extracted

Kwok and Caton

What prognosis system considers the following general factors?

- Amount of patient compliance

- Cigarette smoking: smokers have a greater prevalence for periodontal disease and tooth loss

- Diabetes Mellitus: Patient with diabetes have a greater prevalence of periodontal disease and attachment loss

- Other systemic conditions (neutrophil dysfunction, Papillon - Lefevre syndrome, Down syndrome, immunologic dysfunction)

Kwok and Caton

What prognosis system considers the following local factors?

- Deep probing depths and attachment loss

- Anatomical plaque-related factors (Furcation involvement, enamel pearls, CEP, open contacts, crowding, root proximity and overhanging restorations)

- Trauma from occlusion and parafunctional habits

- Root fractures

- Mobility

Phase I

What phase treatment therapy?

- Disease control therapy

Phase II

What phase treatment therapy?

- Corrective surgical therapy

Phase III

What phase treatment therapy?

- Corrective final restorative therapy

Phase IV

What phase treatment therapy?

- PDHT (Maintenance)

Phase I

What phase treatment therapy?

- Patient plaque removal education

- Scaling and root planing

Phase I

What phase treatment therapy?

- Extraction of non-treatable teeth and caries control

Phase I

What phase treatment therapy?

- Occlusal therapy/adjustment

Phase I

What phase treatment therapy?

- Caries Control (Provisional restorations).

Phase I

What phase treatment therapy?

- Exodontia as needed (May include ridge preservation).

Phase I

What phase treatment therapy?

- Re-evaluation 6-8 (or more) weeks following initiation of therapy

Preliminary phase

What phase treatment therapy?

- Dental emergencies (Pain, infection)

Phase I

What phase treatment therapy?

- SRP

- Chemical therapy: antiseptics and antibiotics might be indicated

Preliminary phase

What phase treatment therapy?

- Dental, periodical, or periodontal emergencies

- Extraction of hopeless teeth and provisional if needed

Phase I

What phase treatment therapy?

- Patient education

Phase I

What phase treatment therapy?

- Identification and controlling risk factors

Phase I

What phase treatment therapy?

- Oral hygiene instructions

Phase I

What phase treatment therapy?

- Diet control

Phase I

What phase treatment therapy?

- Supragingival plaque and calculus removal

Phase I

What phase treatment therapy?

- Correction of restorative and prosthetic irritational factors

Phase I

What phase treatment therapy?

- Excavation of caries and restoration

Phase I

What phase treatment therapy?

- Antimicrobial therapy

Phase I

What phase treatment therapy?

- Occlusal therapy

Phase I

What phase treatment therapy?

- Removal of hopeless teeth

Phase I

What phase treatment therapy?

Clinically:

- Decreased gingival inflammation

- Less BOP

- Decreased PD, gain in clinical attachment

Phase I

What phase treatment therapy?

Microbiologically:

- Shift in the composition of the sub gingival microflora

- Decrease in gram negative organisms and increase gram positive

- Bactericides species are reduced but not eliminated

Phase I

What phase treatment therapy?

- Caries control

Phase I

What phase treatment therapy?

- Calculus removal

Phase I

What phase treatment therapy?

- Excessive cement