45

Periodontal Postulates Controversies exist in many spheres

for the Prosthodontist of dentistry regarding treatment
modalities. This is particularly so in
prosthodontics, in the fields of occlu-
sion, partial denture design and full
coverage restorotions, to name but
a few.
Some of these problems lend them-
selves to scientific investigation and
the results are widely documented.
Edward Lei-inson, There are many instances, however,
University of Prelorro where the usefulness of a given pro-
Oral & Denial Hospilal
14 Horcouft HoLise, cedure can only be determined fram
I9o Coren disti Squoie
tondon. W.I. an evoluotion of clinical results.
Medicine has mony analagous situ-
ations - the sucess of organ trans-
plant procedures, for example, is
determined by the clinical results
obtoined.
In dentistry, attention should be
focused on the periodontol tissues,
whereby the usefulness of any treat-
ment modality, be it orthodontic,
prosthodontic or endodontic, is
assessed.
In order to clarify this assessment,
the following five postulates have
been formed.

First Postulate
Certain clinical procedures ore
based on Concepfs and provide
empirical therapy.

Second Postúlale
When controversy exists, the
periodontal tissues are the yardstick
whereby concepts are evaluated.

Third Postulate
Unless the patient is susceptible to
periodontal disease, absence of
reaction of the periodontal tissues to
^ig I fiodiogrnplüolo 68 a given procedure has no signifi-
ieo'oW 'emole wi(h good
pe"odon(of support in )lie conce.
presence o'less (hon idea)
reitorcitrte denl:stry The following case report illustrates
this (Fig. 1 ). The patient, female oged
68 yeors, presented for routine den-
tal treatment, her only interest being
a prophylaxis which had not been
done in five yeors. Three short-
rooted teeth carried o lorge lower
fixation including a cantilever.
Examinotion of the upper restora-
tions showed overhanging margins,
incomplete cement removol and a
crown undermined witfi caries.
Despite these foctors, and a bizarre
pattern of occlusal contacts, little
periodontol support had been lost.
The only inference that can be drawn
is that of relotive immunity to
periodontal disease.
 fig. 2 Radiographs olodv-
ancsd periodonial disease in
0 ^6 yeo'o!d iemate Roirtrne
derita! prophylaxis was cor-
ned ovi Iwice yeai!y 'or many
yeais.
Rg. 3 Radiographs oí some
palieni 6 yean later. Bone
levels have remained al a
conitonl level wJth (he ire
menI rendered

Fourth Postulate
Only patients of proven susceptibility
to periodontal disease can provide
clinical evidence for evaluating o
treatment modality. These are
patients who have, or have had, the
disease.
This female potient, aged 46 [Fig. 2),
who presented with advanced pe-
riodontal disease, was treated by
strotegic extractions, periodontal
surgery and major restorative den-
tistry. SIX years later, rodiographs
show that the progress of periodon-
tal disease has been aborted and
the periodontal support stabilized.
This result is acceptoble as clinical
evidence in fovor of the treatment
provided ¡Fig. 3|.
Many diseases have o multifactoriol
etiology where local and systemic
factors combine to cause break-
down. A dentist faced with con-
tinued breakdown following restora-
tive treatment, or when breakdown
supervenes following treatment, may
suspect thot systemic factors ore
responsible.
49
Fifth Postulate Conclusion
When the periodontal tissues are When reviewing clinical material to
octively breoking down under one evaluate the efficacy of any treat-
treatment modality and the break- ment modality, the relotive immunity
down is reversed by substitution of of the patient to periodontal disease
another, then systemic factors may should be an overriding considera-
be deemed to be of secondary tion. D
importance and the substitute treat-
ment beneficial.
The patient, aged 42, whose rodio-
graphs are shown in Figure 4, hod
been institutionalized for tuberculosis
for two years. Additionally, he had
suffered a smoll myocardial infarc-
tion at age 38. His executive position
wos the cause of constont stress. His
earlier dental histary [ten yeors
before) was one of initial hygienic
meosures, root planings under locol
anesthesia and upper and lower
removable partial prostheses, A
"routine" prophylaxis had been car-
ried out four times a year since then.
Deterioration of his periodontium
was attributed to his negative sys-
temic history.
Five years after treatment, radio-
graphs of the same patient (Fig. 5)
shows an apparently well-heoled
periodontium.
The authai wishes to acknowledge the
contributions ot the editors and Dr. Harlan
Figure 4 and 5 see page 50/51 Goodwin and Dr. Mourice Michoud.
Rg 4 Radiographs ol a J2
or old mole with odvanced
eiiodonJo) diseose. Hesui-
•d irom numerous pliysicol
%
e-trocirûTis, oîseoLTS gra/lrng,
os(eclon]y ono upper ono
lower ííxed prostheses.