CHAPTER 5: PHASE 1 PERIODONTAL THERAPY

from book manual + doc's ppt / discussion

phase I periodontal therapy

required regardless of the extent of the disease

aimed at stopping the progression of gum disease by addressing its root microbial etiology

the long-term success of periodontal treatment depends predominantly on maintaining the results achieved during this phase.

allows the dentist to evaluate the tissue response and gauge patient motivation, which are crucial elements for overall treatment success.

included in phase I

correcting restorative defects

treating occlusal trauma, splinting

antibiotic therapy, furcation involvement

calculus removal, intensive plaque control

tissue reevaluation, caries management

treating gingival and periodontal infections

restoration correction & prosthetic devices

—all procedures that doesn’t require scalpel

reminders for phase I therapy

deep pockets and furcations → make SRP difficult, and surgical access can improve results.

younger patients with extensive attachment loss → more likely to have aggressive forms of disease requiring extensive therapy

if inflammation persists after scaling and planning, further therapy is often necessary.

surgical treatment → only advisable if phase I therapy resulted in the gingiva being free of overt inflammation and the patient has established effective daily plaque control (e.g., 20% or less of tooth surfaces free of plaque).

other terms for phase I nonsurgical phase

initial therapy

cause-related therapy

etiotropic phase of therapy

nonsurgical periodontal therapy

5-mm

primary guideline for referral

This standard relates to clinical attachment loss present at the reevaluation appointment

—If the typical root length is about 13 mm, 5 mm of clinical attachment loss means only about half the bony support remains.

9 mm or greater

Success rates diminish when probing depths are __

primary objective of phase I

to alter or eliminate the microbial etiology and contributing factors associated with gingival and periodontal diseases.

this aims to halt disease progression and restore the dentition to a state of health and comfort.

major goal of phase I

to control the factors responsible for periodontal inflammation, especially the removal of subgingival bacterial deposits and subsequent patient control of plaque levels.

management of local contributing factors in phase I

treatment of food impaction areas and occlusal trauma

orthodontic tooth movement, extraction of hopeless teeth

complete removal of calculus, possible use of antimicrobial agents

restoration or temporization of carious lesions to remove bacterial reservoirs

correction or replacement of poorly fitting restorations and prosthetic devices (these can be plaque traps)

Sequence of Procedures in phase I

Step 1: Plaque Control Instruction

Step 2: Removal of Calculus (Scaling and Root Planing)

Step 3: Recontouring Defective Restorations and Crowns

Step 4: Management of Carious Lesions

Step 5: Tissue Reevaluation (Critical Post-Therapy Step)

step 1: plaque control instruction 

essential component for successful therapy

instruction should begin in the first appointment, teaching the patient to brush correctly (focusing on the gingival third) and use interdental aids

step 2: removal of calculus (scaling and root planing)

accomplished using scalers, curettes, ultrasonic instrumentation, or a combination of devices

laser technology may also be used

Step 3: Recontouring Defective Restorations and Crowns

Defects like overhangs are plaque traps and must be corrected by smoothing surfaces/overhangs or replacing the restorations.

step 4: management of carious lesions 

removal of carious tissue and placement of temporary or permanent restorations is indicated

removes the reservoir of bacteria, maximizing the healing of periodontal tissues.

step 5: tissue reevaluation

tissue require approximately 4 weeks to heal sufficiently before accurate probing can occur.

at this appointment, periodontal tissues are probed and conditions are evaluated to determine if further treatment, such as periodontal surgery, is indicated.

scaling and root planing

extensively studied, effective, and reliable

80% — reduction in bleeding on probing

2-3 mm — mean probing depth reductions

percentage of periodontal pockets 4mm or greater in depth can be reduced by 50% to 80%

Healing of the gingival epithelium

heals over approximately 4 weeks

results in the formation of a long junctional epithelium rather than new connective tissue attachment

1 to 2 weeks

weeks after therapy the attachment epithelium reappears

—Reduced inflammation leads to decreased clinical signs of inflammation (less redness and swelling)

1-2mm

amount of recession (tissue shrinkage) often apparent after S&P

—transient root sensitivity frequently accompanies healing but can be diminished by good plaque removal

—patients should be warned about the appearance of longer teeth (due to recession) and tooth root sensitivity to maintain trust and motivation.

factors requiring consideration for referral:

extent of disease:

• extensive bone loss, even localized, may require specialized reconstructive techniques.

root length:

• short roots are more seriously jeopardized by 5 mm of attachment loss than long roots.

hypermobility:

• suggests contributing factors; more guarded prognosis

factors considered before referring

extent of disease

root length

generalized / localized deep involvement

hypermobility

difficulty of scaling & root planing