Periodontal Office Visit Report

Danielle Leland

Observation:

During my visit to Dr. Dow's periodontal practice, Eugene Periodontics, I had the
opportunity to observe several procedures. The first procedure involved a connective tissue graft
on tooth #26. Using Eagle Soft charting, it was confirmed that the tooth exhibited no mobility
but had 6 mm of recession on the facial aspect. Before Dr. Dow's arrival, the most recent
radiographs and intraoral photographs (IOPs) were readily accessible on the computer. The
primary objective of the graft was to thicken the gingiva and enhance root coverage. This was
achieved by utilizing a subepithelial graft harvested from the patient's palate, which was then
carefully tucked under the existing gum tissue and sutured into place. Before starting the
procedure, a blood draw was performed on the patient to obtain Platelet Rich Plasma (cPRP) and
Platelet Rich Fibrin (PRF). To ensure patient comfort and relaxation, one assistant administered
moderate conscious IV sedation using Midazolam, Versed, and Dexmedetomidine. Throughout
the procedure, this assistant diligently monitored the patient's vital signs, made detailed chart
notes, and prepared a comprehensive report of the completed treatment for the patient's general
dentist.
Meanwhile, a second assistant prepared the patient by gently cleansing their face with
Chlorhexidine Gluconate 0.12%. Local anesthesia was administered using an IA block, mental
block, and infiltrations on the facial and lingual aspects of tooth #26. The patient remained
comfortably sedated but was still responsive to instructions. Dr. Dow used a Modified Orban
Periodontal Knife to expose the entire root of the tooth and supporting bone. The root surface
was cleaned using a Piezo scaler with a diamond tip and a Younger-Good 7/8 curette.
Additionally, a Tetracycline scrub was applied directly to the root surface. The subepithelial graft
from the palate was carefully harvested using a 15 scalpel, while constant communication among
the assistants was maintained with the use of a headset. The graft was then placed over the
exposed facial root surface and secured with 3-0 silk sutures. 3 minutes of pressure application
was placed on the graft while the patient was woken up and post-operative photos were taken. To
manage post-operative discomfort, the patient was prescribed 8 tablets of 5/325 Norco, along
with post-operative care sponges. Post-operative instructions were provided by a new assistant as
Dr. Dow and the initial assistants prepared for the next procedure. Before proceeding, the room
was cleaned and disinfected, with one assistant removing all instruments and the other sanitizing
the surfaces. The patient was informed of a post-operative phone call scheduled in 2 weeks and
that he would need to return for suture removal in 6 weeks. The entire appointment lasted less
than 45 minutes.
 The second procedure I observed involved the placement of an implant for tooth #30.
Like the previous procedure, one assistant initiated moderate conscious IV sedation for the
patient while the other assistant used Chlorhexidine Gluconate 0.12% to wipe around the
patient’s face. Local anesthesia was administered using an IA block, mental block, and lingual
injections, with 4% septocaine and 2% lidocaine without topical anesthesia. Although the patient
remained unaware of their surroundings, they remained responsive to instructions as needed.
Multiple versions of a Cone Beam Computed Tomography (CBCT) scan were displayed
on a computer screen in front of Dr. Dow, providing a comprehensive view of the planned
implant placement from various angles. A #15 scalpel was used to create a gingival flap,
exposing the underlying bone. With a Periosteal Elevator, the bone was exposed. A digital wax-
up from a digital impression served as a surgical guide, with a pilot hole carefully drilled into the
bone. Following the removal of the guide, a position indicator device was inserted, and a
periapical radiograph was taken by the assistant. Dr. Dow proceeded to drill deeper into the bone,
ensuring an optimal site for implant placement, with multiple x-rays taken to verify the
positioning of the device. When Dr. Dow was satisfied with the placement, a drill tap was
utilized with irrigation, followed by the placement of a Novel 5x10 implant, torqued to 70
newtons. A healing abutment was placed and torqued to 35 newtons. A Chromic gut suture was
then placed, with the assistant retracting and trimming any excess material. A post-operative
periapical radiograph of the implant was taken.
After the patient was woken from anesthesia, a new assistant provided detailed post-
operative care instructions, which included avoiding eating on the right side for at least 2 weeks,
refraining from consuming hard or crunchy foods on the right side until the placement of the
implant crown, and avoiding brushing the area for the first week. The patient was prescribed
amoxicillin and 8 tablets of 5/325 Norco for any discomfort, with instructions to return for a
radiograph and healing assessment in the next few weeks, followed by 3-month and 6-month
post-operative checks to monitor proper integration of the implant into the bone. Despite taking
longer than anticipated, this procedure was just over an hour,
The third procedure I observed involved a gingival flap. The patient had already been
anesthetized by the hygienist. This procedure was recommended for tooth #18, primarily because
it serves as an anchor tooth for a bridge and poses a challenging area for both the patient and the
hygienist during treatment. A #15 scalpel was used to delicately remove the collar of tissue.
Then, a buccal flap was created with an Orban knife, followed by the reflection of tissue using
Molt 4/5. Scaling of the mesial aspect of #18 was performed using a Prichard Orban curette,
gaining access from #19 pontic. The Piezo was then utilized to scale the mesiobuccal and
distolingual areas. The site was thoroughly rinsed with saline solution before proceeding. A
Younger-Good scaler was used to scale the root surfaces of tooth #18, including the mesial,
lingual, buccal, and furcation areas. A 4-0 PGA suture was placed. Following the procedure, the
assistant provided detailed post-operative care instructions to the patient, while Dr. Dow
discussed the long-term prognosis of the tooth. It was noted that bone loss between the roots of
tooth #18 was encroaching on the apex, indicating the likelihood of future extraction. However,
the procedure aimed to extend the tooth's expectancy, especially considering its critical role as
the anchor to a 4-unit bridge extending to tooth #21. To monitor progress, the patient was
scheduled for a follow-up appointment in two weeks for a post-operative check to assess healing
and ensure optimal recovery.
The office has a comprehensive approach to patient care, utilizing preoperative charting
and radiographs for all procedures. Additionally, referral letters from general dentists are readily
available for Dr. Dow to reference before proceeding. One of the assistants writes a personalized
post-operative letter, detailing the completed treatment and expected prognosis, which is sent
back to the patient’s referring office.
Dr. Dow utilizes Eagle Soft and 3D imaging for precise implant placements. The
procedures I observed were primarily for teeth with a poor long-term prognosis, having treatment
completed by a periodontist helps to ensure more favorable results for the patient. While the
patient's general dentist could have performed an implant placement, the option of IV sedation
and expedited appointments at the periodontist’s office proved to be a more convenient option.
An extensive range of procedures is offered, including gingival flap with root planing,
gingivectomy, pocket reduction surgery, guided tissue regeneration (GTR), crown lengthening,
connective tissue graft, gingival graft, frenectomy, extraction with bone preservation graft, ridge
augmentation, sinus augmentation, implant placement, and implant repairs.

Reflection:

This office operates with precision, adhering to a meticulously managed schedule. Dr.
Dow sets exceptionally high standards for his team, leaving no room for error. Every detail is
carefully attended to ensure seamless procedures. Communication among assistants is facilitated
through headsets, with instructions reiterated to minimize any potential confusion. Permission is
required for any departure from the room, maintaining focus and efficiency. Additionally, each
sterilized package is signed by its packager, enabling Dr. Dow to swiftly identify any
discrepancies. The office's adept time management serves as an inspiration for my future
workplace endeavors. I intend to implement strict timelines to ensure smooth patient flow and
maximize productivity. Dr. Dow's exceptional management sets a high standard for efficiency
and professionalism in the field, earning him well-deserved recognition.

eugeneperio.com
Shannon, office manager 541-654-5482