Supportive Periodontal Therapy
- 1. - C H AR L E S J AM E S SUPPORTIVE PERIODONTAL TREATMENT
- 2. INTRODUCTION. • Preservation of periodontal health equally important as elimination of periodontal disease. • Third World Workshop of the American Academy of Periodontology 1989 had renamed the maintenance phase as “SUPPORTIVE PERIODONTAL THERAPY”. • Maintenance phase should be a step in total patient care.
- 3. RATIONALE FOR SPT. • Incomplete sub-gingival plaque removal • Transfer of periodontal bacteria within family members. • Remaining pockets provide space for reinfection by pathogens. • Microscopic nature of dento-gingival unit healing.
- 4. Goals of SPT. • To prevent or minimize the recurrence and progression of periodontal disease in patients who have been previously treated. • To prevent tooth loss by monitoring the dentition. • To locate and treat other diseases of the oral cavity in a timely manner.
- 5. Phase I Re-evaluation Phase IV (maintenance) Phase II (periodontal surgery) Phase III (restorative) Correct sequence of treatment
- 6. Objectives. • Bone support • Stable CAL • Proper home care and oral hygiene • Patient education • Maintenance of proper oral function. • Assessment of patients general health.
- 7. Maintenance program. SPT Examination and evaluation (14min) Maintenance Rꭖ and oral hygiene reinforcement (36min) Report, clean-up and scheduling (10min)
- 8. Examination and evaluation Patient greeting Medical history changes Oral hygiene status Gingival changes Pocket depth changes Mobility changes Occlusal changes Dental caries Oral pathologic examination Restorative, prosthetic and implant status (components, stability ,wear and symptoms surrounding it.)
- 9. Radiographic Examination Of Recall Patients : Root form/dental implants Peri-apical or vertical bite- wing radiographs at 6, 12 and 36 months after prosthetic placement, then every 36 months Periodontal disease not under good control. Peri-apical and/or vertical bite wing radiographs of problem every 12 to 24 months; full mouth series every 3 to 5 yrs. History of periodontal treatment with disease under good control. Bite wing examination every 24 to 36 month; full mouth series every 5 yrs.
- 10. SPT clinical examination Stable periodontal status ( no microbial testing required) Periodic SPT Progressive and Aggressive Periodontitis SPT and Anti microbial therapy Clinical microbiological re- evaluation Refractory Periodontitis Selection of alternative clinical treatment or antimicrobial regimen Microbial Testing
- 11. Maintenance Treatment And Oral Hygiene Reinforcement • Oral hygiene reinforcement. • Scaling . • Polishing. • Chemical irrigation or site specific antimicrobial placement.
- 12. Report ,Clean up and scheduling • Write report in chart • Discuss report with patient • clean and disinfect operatory • schedule next recall visit • Schedule further periodontal treatment • Schedule or refer for restorative or prosthetic treatment .
- 13. Frequency of SPT • Patients with gingivitis but no previous attachment loss- SPT twice a year. • Patients with previous history of periodontitis- twice within 6 months. • Active clinical therapy – four times a year.
- 14. Compliance affecting SPT Patients who comply to suggested recall visits are periodontally healthy and keep their teeth longer. Improving compliance- • Counselling them about their condition , treatment and importance of compliance. • Simplify instructions to patients. • Teach them self performed plaque control. • Accommodate patients needs also. • Positive reinforcement.
- 15. CONCLUSION. Effectiveness of “Supportive Periodontal Treatment” depends mostly on the patients compliance to the treatment and his knowledge on the severity of the disease. Healing of periodontium is a complex process and takes time and proper management. More than the actual surgical or restorative treatment , the maintenance determines the prognosis of the disease.