Periodontal treatment often is divided into a presurgical or hygienic phase and a sur- gical or corrective phase (Ramfjord & Ash 1979). HHS The term “selection” therefore does not imply ruling out any type of therapy; treatment recommendations and the definitive treatment plan may vary considerably for each individual patient. Active non-surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. Another major goal is soft tissue coverage in areas of gingival recession and correction of alveolar ridge defects, which anticipate additional treatment in the areas of prosthetics and dental implantology. The goals often cannot be achieved using a single specific surgical procedure; rather, often combinations of various surgical methods are required, either simultaneously or one following upon the other: Root cleaning/debridement with direct vision, Reduction or elimination of plaque-retentive areas that promote infection, especially periodontal pockets, Enhancing the regeneration of periodontal tissues, Elimination of diseased tissues—resective therapy, Creation of physiologic morphology/architecture of the marginal periodontium, Correction of mucogingival defects, restoration of esthetics in the aveolodental tissues, Root Cleaning with Direct Vision (Access Flap). NIH Enhancing Regeneration of Periodontal Tissues. Corrective surgical therapy . Corrective or surgical procedures will allow us to rebuild the foundation for you and maintain your natural teeth and dental implants. In most industrialized nations today, every patient has the “right” to medical/dental treatment. This goal has been approached with some successes during the past two decades. The patient must be motivated, and must exhibit adequate plaque control. Supportive periodontal therapy, Periodontal Maintenance, Ma intenance Phase, Patient’s Car e, Patient’s Health detection and treatment of new and recurring disease is 4 Surgical intervention is therefore indicated with deep pockets, intraosseous defects and furcation involvements. Periodontal pockets can be eliminated by flap surgery or gingivectomy (resective therapy). additional measures such as periodontal surgery, and/or endodontic therapy, implant surgery, restorative, orthodontic and/or prosthetic treatment • Maintenance phase (care), i.e. Please enable it to take advantage of the complete set of features! The first phase of initial therapy, professional supragingival tooth cleaning, must be complete. Phase III therapy or Restorative Phase. All of these factors lead to the obvious conclusion that the therapeutic possibilities and the type of therapy may be quite different for each individual patient. These corrections are accomplished by various surgical techniques . This may involve reducing the pocket depths, rebuilding or growing bone, rebuilding or grafting soft tissues, and placing dental implants. The purposes and goals of mucogingival surgery include the widening of the attached gingiva, which is usually associated with deepening the oral vestibulum. In the maintenance phase, the aim is to maintain the successfully stabilized periodontal state in the long term. 1968 Mar;15(3):371-80. Phase III—Supportive Periodontal Therapy Created February 18, 2020; Author DentistryKey; Category Periodontics; You're Reading a Preview . J Periodontol. For example, initial therapy and surgery are two entities with identical goals, but which use different methods to achieve these goals (closed root planing versus root planing with direct vision). After pointing to the hygienizing phase which must in any case precede, the author deals with the medicinal local and general treatment, the occlusal function diagnosis, the function analysis, and the fundamentals of the grinding therapy. These possibilities may range from a purely palliative treatment with a severely reduced prognosis, to systematic and synoptic periodontitis therapy including surgical procedures, functional therapy, comprehensive reconstructions and even dental implants. Pocket depth reduction and/or pocket elimination maintain their importance in contemporary periodontal therapy (Slots 2002, Petersilka et al. The corrective phase of periodontal therapy (PMID:6998060) Abstract Citations; Related Articles; Data; BioEntities; External Links ' ' Schmidt H Stomatologie der DDR [01 Mar 1980, 30(3):199-218] Type: English Abstract, Review, Journal Article (lang: ger) Abstract. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. It is important to note that we aim to solve the problem with the least of amount of invasive procedures. of the active and corrective phases of periodontal therapy, including subgingival scaling and surgical pocket elimination (Gjermo, 1981, Nyman, Lindhe, & Rosling, 1977). Unfortunately, the predictability of success using these methods is, today, neither understood nor reliable (see also patient factors, p. 297). Investigations by the Slots group (Tuan et al. Any dental emergency is treated first to achieve patient comfort. The primary goal of periodontal surgery is strictly antiinfective, meaning that the surgical modality aims to eliminate infection of pockets that have not responded to conservative treatment and/or medicinal adjuncts. This video is unavailable. The above-mentioned root irregularities, fusions and grooves can be reduced by means of careful odontoplasty, usually after flap reflection. Become membership. This site needs JavaScript to work properly. Included here are the width and thickness of the gingiva (phenotype), course of the horizontal bone loss and the depth of supra-alveolar pockets. 5. adopted depend heavily on the patient’s success in controlling plaque on a daily basis and on the response to the preced-ing fundamental phase of therapy. In addition, clinical studies have demonstrated that the debridement of subgingival calculus and biofilm must be performed before surgical intervention. The following important aspects will be considered: Purposes and goals of periodontal surgery, Periodontal surgery: methods and indications, Furcation problems, defects and classifications. Log in here. The search was carried out by using a combined te… The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. 2002, Socransky & Haffajee 2002). Sources. Use the link below to share a full-text version of this article with your friends and colleagues. In “periodontitis” the inflammation has caused breakdown of the bone. This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. In patients with gingival recession, the depth and width of the gingival recession (Miller classification, p. 162) is of importance for predicting the therapeutic success. Phase I therapy or Etiotropic Phase. The root surfaces are exposed to clinical view either by reflecting a gingival flap or, less often, following excision of the gingiva (gingivectomy, p. 301). Perhaps most important, even beyond the active treatment itself, are follow-up examinations (and treatments) during recall appointments. [The corrective phase of periodontal therapy]. [Reequilibration of occlusion by orthodontic treatment and selective grinding]. Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco R; Research, Science and Therapy Committee. Phase 2 Therapy Periodontal Surgery—Corrective Phase. Besides lifelong regular follow-up and tooth cleaning, maintaining the patient’s motivation to cooperate is a key requirement. Oral reconstructive and corrective considerations in periodontal therapy. One may also attempt to heal the defects, especially bony pockets, through regenerative surgical procedures (pp. What form of periodontitis is present? In the corrective phase of periodontal therapy, the treatment approaches to be . Clinical symptoms of activity such as exudation, bleeding and suppuration are eliminated. 299, 301). Download Citation | On Jan 1, 2012, Dorothy A. Perry and others published Phase I Periodontal Therapy | Find, read and cite all the research you need on ResearchGate  |  Corrective phase . Furthermore, the temporary splinting, the treatment of secondary malpositions and … Elimination of Diseased Tissues—Resective Therapy. If surgery is necessary, it is usually performed as a second phase (corrective), following a thorough evaluation of the clinical results of Phase 1 therapy. The implantation of bone and bone replacement materials into the intraalveolar pockets, the GTR technique, the use of matrix proteins and in the future, use of growth factors are extremely promising. Maintenance phase. Which means that after each phase of therapy we will allow time for healing and then will assess the success of the treatment. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Phase 2 Therapy Periodontal Surgery—Corrective Phase. supportive. 1976 Jul;47(7):405-11. doi: 10.1902/jop.1976.47.7.405. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. These phases are structured to ensure that periodontal therapy is conducted in a logical sequence, consequently improving the prognosis of the patient, in comparison to indecisive treatment plan without a clear goal. NLM The corrective phase The most important part of the corrective phase is periodontal surgery. Freedom from inflammation always leads to consolidation of the gingival tissues, shrinkage or gingival recession; this alone results in a more or less pronounced pocket depth reduction. In addition to the listed patient factors, there are, of course, also defect factors such as morphologic defects, that are of importance for the prognosis of any therapeutic procedure. If periodontal pockets greater than 3mm are still present, further treatment options may be suggested, including corrective surgical therapy. Phase III—Supportive Periodontal Therapy. supportive periodontal therapy (SPT Trimeric … The hoped for results of surgical procedures include not only cessation of the disease process, but also “healing” of the pocket via regeneration of periodontal tissues. The goal of periodontal therapy is the maintenance of the dentition and/or its implant replacements in a state of health, comfort, function, and esthetics for the duration of a patient’s life. Unit 8 Periodontics: Treatment Planning and Phase I Periodontal Therapy. If you are a member. During periodontal surgery, aetiological factors remaining form non-surgical therapy can be eliminated to provide the circumstances for reparation or regeneration by establishing ideal conditions for individual and professional oral hygiene. Numerous research studies have proven the importance of the periodontal maintenance phase, and it has become an essential part of comprehensive periodontal disease therapy. Watch Queue Queue. Shareable Link. Most importantly: Intra-alveolar defects are classified as 1-, 2- or 3-wall bony pockets, with consideration of the depth and the width of the “opening angle” of the defect, acknowledging that most of these defects represent “combined” bony pockets: In the apical region, three walls are in evidence, in the “middle,” two walls, and coronally only one wall! 1. Correction of Mucogingival Defects—Re-Creation of Esthetics. cause-related therapy • Corrective phase of therapy, i.e. Data. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Compliance and its role in successful treatment of an advanced periodontal case: review of the literature and a case report. Chronic or aggressive? Furthermore, initial therapy may be the only therapy required for mild periodontitis, whereas in severe cases it may represent only a preparatory presurgical phase. [The current status of periodontal therapy]. corrective. Restorative Phase. The long-term success of periodontitis treatment must be secured life-long, and this is a demand that not every patient can fulfill.  |  Here are the four phases of periodontal therapy. Periodontal surgical therapy is only one component of complete periodontal treatment. The general medical history, local and systemic risk factors, “behaviors,” understanding of the individual oral situation and the interdependent consideration of the patient’s compliance are critical. This type of care is appropriate for anyone, even those without a history of periodontal disease, who wishes to have optimal oral health. Periodontal surgical therapy is only one component of complete periodontal treatment. The patient must be motivated, and must exhibit adequate plaque control. Furcation Involvement—Furcation Treatment, Color Atlas of Dental Hygiene—Periodontology. The periodontal maintenance phase forms part of periodontal treatment, and its objective is to prevent recurrence and to ensure long term preservation of the periodontal health achieved in the previous phases. The reference lists of potentially relevant review articles were also sought. The term SUPPORTIVE PERIODONTAL THERAPY expresses the essential need for therapeutic measures to support the patient’s own efforts to control periodontal infections and to avoid reinfection. Phase 3 Therapy Periodontal Maintenance Therapy—Recall Dental Hygienists Rule! Watch Queue Queue A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. During the course of periodontitis within any given patient, gingival swelling or on the other hand gingival shrinkage may occur. The secondary goal is the correction of defects in cases of unphysiologic gingival and osseous architecture, with special regard to creation of conditions that simplify or guarantee efficient plaque control, especially in the interdental areas. If surgery is necessary, it is usually performed as a second phase (corrective), following a thorough evaluation of the clinical results of Phase 1 therapy. The clinical procedures described above (root debridement or planing and reduction of niches) lead to the elimination of the causes of periodontal inflammation. Also of importance are open furcations, root irregularities, fusions, grooves and other oral structures. For example, periodontal surgical approaches for ‘correcting’ residual periodontal defects are not successful in patients with … When planning periodontal therapy it is useful to consider the management across three phases: initial. Prevention . [Article in German] Schmidt H. After pointing to the hygienizing phase which must in any case precede, the author deals with the medicinal local and general treatment, the occlusal function diagnosis, the function analysis, and the fundamentals of the grinding therapy. Notwithstanding, the emphasis on a distinct oral hygiene phase has diminished, and the oral hygiene phase has become amalgamated with the actual causal therapy is more significantly reduced following use of more radical surgical procedures. The first phase of of periodontal therapy. During the initial phase, any essential dental care, oral hygiene advice, and teeth cleaning (scaling of the teeth, including subgingival root debridement) are done. Rev Fr Odontostomatol. The most important niche for subgingival microbial flora are periodontal pockets themselves. USA.gov. Therefore, the goal of surgical intervention is to create a harmonic course of the gingival margin, which is achieved through the choice of incision (sulcular, paramarginal), the recontouring of the alveolar bone and the type of flap repositioning, usually at a somewhat more apical niveau. Phases of Periodontal Therapy. While on maintenance phase, with its periodic checkups & controls, patient enters into Surgical phase (Phase II) & Restorative (reparative) phase (Phase III) of T/t Include perio surgery to repair & improve condition of perio & surrounding tissues & their esthetics, rebuilding of lost structures, placement of implants & construction of necessary restorative work 46 Current corrective treatments mainly involve: Previous Phase II—Corrective Procedures. Orthodontic treatment for the adult periodontal patient. Phase II therapy or Surgical Phase. Plaque and calculus can then be removed from all root surfaces, including furcations, irregularities etc., with direct vision. 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