TREATMENT PLAN Dr Noman - PowerPoint Presentation

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TREATMENT PLAN

Dr

Noman

Jr-3

21

/11/20

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CONTENT

Introduction

Rationale

for

Periodontal

Treatment

Local

& Systemic Therapy

Treatment

Goals

Master

plan for total treatment

Extracting

or preserving tooth

Therapeutic procedures

Phases of

Periodontal

Therapy

Explaining Treatment Plan

to Patient

Summary

Conclusion

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Introduction

Treatment Plan

is

a blueprint

for case management

Treatment

is planned after diagnosis &

prognosis is established

It includes

all

procedures that are

required for

establishment &

maintenance of oral

health

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Treatment plan involves following

decisions:

Teeth

to be retained or extracted

Pocket

therapy, by means of surgical or

nonsurgical methods

, and the techniques to be used

The

need for

occlusal

correction, prior, during, or

after pocket

therapy

The

use of implant therapy

The

need for temporary restorations

Final

restorations that will be needed after

therapy and

which teeth will be abutments if fixed

prosthesis is

used

The

need for orthodontic consultation

Endodontic

therapy

Regarding

esthetic considerations in

periodontal therapy

On

sequence of therapy

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Unforeseen developments during treatment may necessitate

modification of initial treatment plan

E

xcept

for emergencies, no treatment should

be started

until

Treatment Plan is

established

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Rationale for Periodontal Treatment

The

effectiveness of periodontal therapy is

made possible

by the remarkable healing capacity of

the periodontal tissues.

Periodontal therapy

can restore chronically inflamed gingiva so

that from

a clinical and structural point of view it is

almost identical

with gingiva that has never been exposed to

excessive plaque accumulation

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Properly performed, periodontal treatment can be relied on to accomplish the following:

Eliminate pain,

gingival inflammation & bleeding,

Reduce

or eliminate periodontal pockets

Stop pus formation,

Arrest destruction of soft tissue & bone,

Reduce abnormal tooth mobility,

Establish optimal

occlusal

function,

Restore tissue destroyed by disease,

Reestablish physiologic gingival contour,

Prevent recurrence of disease &

Reduce tooth loss

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Local Therapy

Include

r

emoval

of plaque & all factors that favor

its accumulation

Elimination

of trauma

which increases

chances of

bone regeneration

& gain of attachment

Creating

occlusal

relations that are

more tolerable

to

periodontal tissues, reduce

tooth

mobility &

increases margin of safety of

periodontium

to minor

buildup of plaque

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Systemic Therapy

Employed as adjunct to local measures &

for specific

purposes:

Control

of systemic complications from

acute infections

Chemotherapy

to prevent harmful effects

of post treatment

bacteremia

Supportive

nutritional therapy

Control

of systemic diseases that

aggravate

patient’s perio

dontal

status or

necessitate

special

precautions

during

T/t

Systemic antibiotics are required to completely eliminate microbes that invade gingival tissues & can repopulate pocket after SRP

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Treatment Goals

The short term goals are elimination of all infectious and inflammatory processes thus to bring the oral cavity to state of health.

From the periodontal point short term goals are important since it consist of elimination of gingival inflammation and correction of conditions that cause and perpetuate it.

The long term goals are the reconstruction of healthy dentition that fulfill all functional and esthetic requirements.

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Master plan for total treatment

Aim

of TP is Total

Treatment, that is

coordination of

all treatment

procedures for purpose of

creating well–functioning

dentition in healthy

periodontal environment

The master plan

of periodontal

treatment encompasses different areas

of therapeutic

objectives for each patient according to

his or

her needs.

It

is based on the diagnosis, disease

severity, and

other factors

Primary

goal is elimination of

gingival inflammation

& correction of

conditions that cause

& perpetuate

it

Includes not only elimination of root irritants,

but also

pocket eradication &

reduction, establishment

of gingival contours

&

mucogingival

relationships conducive

to preservation

of

periodontal

health, restoration of

carious areas

& correction of existing restorations

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Extracting or preserving tooth

Periodontal

T/t requires

long range planning

Its

value to patient is measured in years of

healthy functioning

of entire dentition, not by no.

of teeth

retained at time of treatment

Treatment

is directed to establishing

& maintaining

health of

periodontium

throughout mouth

rather than to spectacular efforts

to “tighten

loose teeth

”

Welfare of dentition should not be jeopardized

by heroic

attempt to retain questionable

teeth

Periodontal

condition of teeth to be retained is

more important

than no. of such

teeth

Teeth on borderline of hopelessness do not contribute to overall usefulness of dentition

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Extract? :- YES

Removal, retention or temporary (interim)

retention of

one or more teeth is a very important part of the

overall treatment

plan.

A tooth should be extracted when any of the

following occurs

:

It

is so mobile that function becomes painful

It

can cause acute abscesses during therapy

There

is no use for it in

overall

treatment plan

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Extract? :- No

Tooth can be retained temporarily,

postponing decision

to extract it until after treatment,

when any

of following occurs:

It

maintains posterior

stops, it can be

removed after

T/t when

it can be replaced by

prosthesis

It maintains posterior stops & may be functional after implant placement in adjacent

areas.

In anterior esthetic areas, tooth can be retained during periodontal therapy & removed when T/t is completed, & permanent restorative procedure can be performed.

This will replace wearing

temporary appliances

.

Removal of hopeless teeth can also be performed

during periodontal

surgery of neighboring teeth.

This would

reduce surgical

appointments

in

the same

area

.

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According to their age, gender, profession, social status

& other

reasons different

patients value esthetics differently

Clinician

should carefully evaluate &

consider final

outcome of T/t that will be acceptable

to patient

without

risking

basic

consideration of

attaining

health

In complex cases,

interdisciplinary

consultation

with

other specialty areas is necessary

before final plan is

made

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Systemic conditions

Should be carefully

evaluated

As they may

require special precautions during

the course of periodontal

T/t

May

also affect tissue response to

T/t procedures or

threaten preservation of

periodontal health

after treatment is completed

Such situations should be taken in

conjunction with

the patient's

physician.

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Supportive periodontal care

It is of paramount

importance for case maintenance

It entails

all procedures for maintaining

periodontal health after

it has been attained

Consists

of instruction in oral hygiene &

checkups at

regular intervals,

acc

to patient’s needs

To

examine condition of

periodontium

& status

of restoration

as it affects

periodontal

health

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Therapeutic procedures

Periodontal

therapy is inseparable part of

dental therapy

Includes periodontal

procedures & other

procedures not

considered within province of periodontist

They

are listed together to emphasize

close relationship

of

periodontal

therapy with other phases

of therapy

performed by general dentists/

other specialists

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Phases of Periodontal Therapy

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Phases of Periodontal Therapy

Preliminary

phase

Non

surgical phase (Phase I

Therapy)

Surgical

Phase (Phase II Therapy)

Restorative

Phase (Phase III Therapy)

Maintenance

Phase (Phase IV Therapy)

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Preferred sequence of periodontal therapy

The sequence in which the above phases of

therapy are

performed may vary to some extent in response

to the

requirements of the case. However, the preferred

sequence, which

covers the vast majority of

cases, is shown in figure.

Although phases of T/t have been numbered, their recommended sequence does not follow their numbers

.

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Phase I or Nonsurgical

phase,

when

successfully performed, this phase

stops progression

of dental &

periodontal disease

Immediately after completion of Phase I therapy

, -

patient should be placed on

Maintenance phase

(Phase

IV)

To

preserve results obtained & prevent any

further deterioration

& recurrence of disease

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While the patient is on

maintenance phase, with its

periodic checkups

& controls, patient enters into

Surgical phase

(Phase II)

&

Restorative (reparative

)

phase (Phase

III)

of T/t

This include periodontal

surgery to repair &

improve condition

of

periodontal

& surrounding tissues &

their esthetics

, rebuilding of lost structures,

placement of

implants & construction of

necessary restorative

work

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Explaining Treatment Plan to Patient

Be specific-

Tell your

patient, “You have gingivitis,” or “

You have

periodontitis,” then explain exactly

what these

conditions are, how they are treated,

& prognosis

for patient after treatment

Avoid

vague statements

– like “You

have trouble

with your

gums,” or “Something should be done

about your gums.”

Patients do not

understand significance

of such statements & disregard them

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Begin our discussion on positive noteTalk

about teeth that can be retained &

long service

expected to render

Not

begin our discussion with

statements, like “

Following teeth have to be extracted”

this creates negative

impression

–which adds

to

hopelessness that patient

already may have regarding their mouth

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Make it clear that every effort

- to retain as

many teeth

as possible, but do not dwell on

patient’s loose

teeth

Emphasize

that important

purpose of

T/t is

to

prevent

other teeth

from becoming as

severely diseased

as loose

teeth

Present entire treatment plan as unit

Avoid

creating impression that T/t consists

of separate

procedures

Do

not speak in terms of “having gums treated

& then

taking care of necessary restorations

later”

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Explain that “doing nothing” or holding onto hopelessly

diseased teeth as long as possible

is inadvisable

for following reasons:

Periodontal

disease is microbial infection,

&research shows it can be

important risk factor for severe

life threatening diseases –like

stroke,

cardiovascular disease

, pulmonary disease, & diabetes, as

well as

for premature low-birth-weight

babies

It

is not feasible to place restorations/

bridges on

teeth with untreated

periodontal

disease

because usefulness

of restoration would be limited

by uncertain

condition of supporting

structures

Failure

to eliminate

periodontal

disease not only

results in

loss of teeth already severely involved,

but also

shortens life span of other teeth that,

with proper

treatment, could serve as foundation

for healthy

, functioning dentition

Slide29

Therefore dentist should make it clear to

patient that

:

If periodontal

condition is treatable, best results

are obtained

by prompt treatment

If

condition is not treatable, teeth should

be extracted

It is dentist’s responsibility to advise patient

about importance

of

periodontal

T/t

if

treatment is to be successful - patient must

be sufficiently

interested in retaining natural teeth

to maintain

necessary oral hygiene

Individuals

who are not particularly

worried by thought

of losing their teeth are generally

not good

candidates for

periodontal

T/t

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Summary

Objective of overall TP is creation &

maintenance of

oral health, function, & esthetics

Outcome

is long term & in most cases

requires coordination

of several disciplines of dentistry

A

motivated patient is prerequisite, & success

will depend

on this motivation being

sustained through

maintenance

care

TP should focus on list of diagnoses for patient

T/t should be planned in phases

At completion of each phase, patient should be reevaluated to assess response to treatment, & TP may be modified based on this assessment

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Conclusion

Treatment plan is guiding map for

periodontal treatment

– no treatment should be

initiated without

forming a solid

TP.

Although

It is

clinician’s responsibility to

make individual

patient realize the value of Treatment

– motivated

patient is a prerequisite for

optimum outcome

of

periodontal

therapy

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THANK YOU