Periodontal Periodontal ExaminationExamination
Possible Diagnostic Categories
Health Gingivitis Periodontitis
Treatment PlanTreatment Plan
Includes all procedures required Includes all procedures required for the establishment and for the establishment and maintenance of oral healthmaintenance of oral health
Determined after the diagnosis Determined after the diagnosis and prognosis have been and prognosis have been establishedestablished
Overall Treatment PlanOverall Treatment Plan Preliminary phasePreliminary phase Phase I therapyPhase I therapy Re-evaluationRe-evaluation Phase II therapy – (surgical phase)Phase II therapy – (surgical phase) Phase III therapy – (restorative Phase III therapy – (restorative
phase)phase) Phase IV therapy – (supportive Phase IV therapy – (supportive
periodontal therapy)periodontal therapy)
Explaining the Explaining the Treatment Plan to the Treatment Plan to the
PatientPatientBe specific in explaining:Be specific in explaining:
The problemThe problem
The treatmentThe treatment
The prognosisThe prognosis
The maintenanceThe maintenance
Start Out PositivelyStart Out Positively
Talk about teeth to be retainedTalk about teeth to be retained Present all of the treatment as Present all of the treatment as
a unit a unit Best results with prompt Best results with prompt
treatmenttreatment
Preliminary PhasePreliminary Phase
Treatment of Treatment of emergenciesemergencies
Acute infectionAcute infectionCaries controlCaries controlOtherOther
Periodontal AbscessPeriodontal Abscess
PericoronitisPericoronitis
Necrotizing Ulcerative Necrotizing Ulcerative GingivitisGingivitis
Acute Periapical Infections
Phase I Therapy Phase I Therapy (Etiotropic Phase)(Etiotropic Phase)
Plaque controlPlaque control Diet controlDiet control Scaling and root planing/scale & Scaling and root planing/scale &
polishpolish Caries controlCaries control Occlusal therapyOcclusal therapy Provisional splintingProvisional splinting
Scaling / Root PlaningScaling / Root Planing
ADA code D4341ADA code D4341 Patient with LOA and Patient with LOA and
gingival inflammationgingival inflammation
Scale and PolishScale and Polish
ADA code D1110ADA code D1110 Patient with gingival Patient with gingival
inflammation and no LOAinflammation and no LOA
Re-evaluationRe-evaluation
Diagnosis of Periodontitis
Initial Therapy S/RP and Home Care
Re-evaluation
Response to Phase IResponse to Phase I
Re-checkingRe-checkingProbing depthsProbing depthsMobility Mobility RecessionRecessionPlaque controlPlaque control
Tissue responseTissue responseColorColorConsistencyConsistencyContourContourTextureTextureBleeding on probingBleeding on probing
Response to Phase I
Endpoint Objectives of Endpoint Objectives of Periodontal TherapyPeriodontal Therapy
Resolution of inflammationResolution of inflammation No BOPNo BOP No suppurationNo suppuration Gingival contours WNL in Gingival contours WNL in
color, texture and formcolor, texture and form Gingival attachment which is Gingival attachment which is
resistant to recurrent diseaseresistant to recurrent disease
Criteria Indicating These Criteria Indicating These Goals Have Not Been MetGoals Have Not Been Met
Ongoing attachment loss / Ongoing attachment loss / recessionrecession
Signs of inflammationSigns of inflammation BOPBOP SuppurationSuppuration
Periodontal pockets > 5mmPeriodontal pockets > 5mm
Criteria Indicating These Criteria Indicating These Goals Have Not Been Goals Have Not Been
Meet Meet (con’t.)(con’t.)
Increasing tooth mobilityIncreasing tooth mobility Significant osseous Significant osseous
defectsdefects FurcationsFurcations Vertical defectsVertical defects Bony cratersBony craters
Establish periodontal treatment Establish periodontal treatment planplanAdditional S/RP followed by re-evalAdditional S/RP followed by re-evalSupportive periodontal therapy Supportive periodontal therapy Periodontal surgeryPeriodontal surgery
Treatment vs. Treatment vs. Referral?Referral?
Patient for ReferralPatient for Referral
Inflammation that does not resolveInflammation that does not resolve Inadequate attached gingivaInadequate attached gingiva Severe root exposureSevere root exposure Aggressive periodontitisAggressive periodontitis Patients with systemic diseasePatients with systemic disease All severe periodontal diseaseAll severe periodontal disease
Watching Is Not Watching Is Not Considered Periodontal Considered Periodontal
TherapyTherapy
Phase II Therapy Phase II Therapy (Surgical Phase)(Surgical Phase)
Periodontal surgeryPeriodontal surgery ResectionResection RegenerationRegeneration Periodontal plastic surgeryPeriodontal plastic surgery Crown lengtheningCrown lengthening
Pre bone resection
Post bone resection
Intrabony Defect
Bone Graft Placed
Pre-op
Post-op
Pre-op
Post-op
Phase III Therapy Phase III Therapy (Restorative Phase)(Restorative Phase)
Final restorationsFinal restorations Fixed and removable Fixed and removable
prosthodonticsprosthodontics ImplantsImplants
Phase IV Therapy Phase IV Therapy (Maintenance Phase)(Maintenance Phase)
Supportive periodontal Supportive periodontal therapytherapy
Periodontal Maintenance Periodontal Maintenance ProgramProgram
Recall MaintenanceRecall Maintenance ADA code D4910ADA code D4910
Supportive Periodontal Supportive Periodontal TherapyTherapy
I.I. ExaminationExaminationUpdate medical historyUpdate medical historyOral pathology examOral pathology examRadiographs prnRadiographs prnOral hygiene statusOral hygiene status
Supportive Periodontal Supportive Periodontal TherapyTherapy
I.I. ExaminationExamination Probing depthsProbing depths Tissue conditionTissue condition Plaque controlPlaque control OcclusionOcclusion Tooth mobilityTooth mobility RecessionRecession
Supportive Periodontal Supportive Periodontal TherapyTherapy
II.II. TreatmentTreatmentOral hygiene reinforcementOral hygiene reinforcementScaling (RP prn)Scaling (RP prn)PolishingPolishingChemical irrigation prnChemical irrigation prn
Supportive Periodontal Supportive Periodontal TherapyTherapy
III.III. SchedulingSchedulingNext recall visitNext recall visitAdditional periodontal txAdditional periodontal txRestorative treatmentRestorative treatment
Patients With Patients With PeriodontitisPeriodontitis
3 months SPT3 months SPT
Patients With Patients With Gingivitis and No Gingivitis and No
History of LOAHistory of LOA
6 month SPT6 month SPT
Time for SPT Time for SPT appointmentsappointments
45-60 minutes45-60 minutes
SPT Practice PatternsSPT Practice Patterns
Typically, periodontist and Typically, periodontist and generalist perform every-other-generalist perform every-other-SPTSPT
Frequent SPT visits (< 3 months Frequent SPT visits (< 3 months apart) may make senseapart) may make sense
Communication is criticalCommunication is critical