TREATMENT PLAN

General Dental
Practitioner

Oral Health Educator Dental Nurse

Prevention of
Periodontal Disease
Dental Hygienist Dental Therapist

Secondary Care
Consultant in Restorative High Street specialist
Dentistry In Periodontology.
 Screening for peridontal disease
• Basic Periodontal examination codes:

BPE Code Clinical Status

0 – Coloured band is completely Health Periodontium
visible, No bleeding, No Calculus
1- Only Gingival bleeding Gingivitis

2 – Calculus Gingivitis
Gingival Bleeding
3- Colored band is partly visible Periodontitis,
Pocket depth :- 3.5 - 5.5 mm.
4. Colored band completely disappear Periodontitis
Pocket depth ≥ 5.5 mm.

* Furcation involvement or attachment loss

> 7mm.
 Other Periodontal examination
• Standard of oral hygiene.
• Location & quantity of plaque & calculus.
• Examination of gingiva:
– Inflammation
– Recession
– Hyperplasia
• Furcation involvement
• Degree of tooth mobility.
• Occlusal assessment
• Any systemic disease.
• Radiographic examination
 Treatment Plan
• Definition:- It is the blue print for case
management.
• Treatment Goals:-
– Reduction or resolution of gingivitis.
– Reduction in probing pocket depth.
– Elimination of open furcation in multirooted
teeth.
– Individually satisfactory esthetic & function.
 Phase of Periodontal Therapy
• Emergency Phase
• Phase I :- Etiotropic phase
• Phase II :- Surgical Phase
• Phase III :- Restorative phase
• Phase IV :- Maintenance Phase
Preferred sequence Of Periodontal
Therapy.
Emergency Phase

Etiotropic Phase

Maintenance Phase

Surgical Restorative
Phase Phase
 EMERGENCY PHASE
• Treatment of any type of pain
• Extraction of hopeless teeth.
• Draining of the abscess
PHASE I ETIOTROPIC PHASE
• “Cause related therapy”
• “Non surgical periodontal therapy”
• Objective:-
– Elimination & Preventing of reformation of
bacterial deposits on tooth & root surface.
• This Phase includes:
1. Diet Counseling (Specially in patients with rampant caries)
2. Removal of plaque retentive factors - it may be:
Natural - Crowding,
Developmental grooves
Enamel Pearls
Iatrogenie - Poor Margins or over contoured
restorations
3. Supragingival scaling
4. Subgingival Scaling
5. Root Planning.
6. Occlusal therapy
7. Antimicrobial therapy
8. Correction of restorative & prosthetic irritatonal factors.
9. Excavation of caries & restoration.
Temp. or final :- Depending on whether the definite
prognosis for the teeth has been arrived at the location of
caries.
10. Minor orthodontic movement.
11. Chemical plaque control (for acute conditions.
EVALUATION OF RESPONSE TO ETIOTROPIC PHASE
( Ideally after 3 months)
Rechecking for :-
- Oral hygiene status
- Gingival inflammation & bleeding
- Probing depth
- Attachment level
- Calculus
- Caries.
 Phase II - Surgical phase
(I) Various periodontal surgical procedure.
Indication:-
Where there is impaired access for scaling & root surface debridement
like:-
- In deeper ( > 5mm) periodontal pockets
- On wider tooth surfaces
- Presence of root fissures
- Presence of root concavities
- Furcation involvement
- Presence of faulty margins on subgingival restorations.
So it is used to –
- Gain access for thorough scaling & root surface debridment
- Establish a gingival morphology conductive to good plaque
control.
- Reduce pocket depths
- Shift the gingival margin apically to plaque retaining restorations.
- Crown lengthening.
• Contraindication:-
– Patient who is uncooperative during cause related
therapy should not proceed to surgery.
– Smoking – Impair healing after surgery.
– Absolute Contraindication :
• Medically compromised patients
• Periodontal surgery may be classified as:-
1. Access surgery :
Provide visual & technical access for through debridement
2. Resective surgery – removal of excess soft tissue in
gingival over growth & appical relocation of gingival margin.
(a) Gingivectomy
(b) Apical displaced flap surgery
(c) Undisplaced flap with or without osseous resection.
3. Regenerative surgery :- To regenerate
the periodontal attachment complex i.e.
cementum, PDL & bone
(a) flap surgery with flap graft
(b) flap surgery with osseous graft
(II) IMPLANT PLACEMENT
(III) ENDODONTIC THERAPY
 Evaluation of response to surgical therapy
• Oral hygiene status.
• Gingival inflammation & bleeding
• Probing depth
• Attachment level.
PHASE III – RESTORATIVE PHASE
– Final restoration.
– Fixed prosthesis
– Removable prosthesis
Evaluation of response to restorative therapy
- Oral hygiene status
- Gingival inflammation & blearing
- Probing depth
- Attachment level
- Restoration status
• Phase IV – Maintenance phase :-
- Periodic maintenance :-
- For advanced periodontal disease - 3-4 times per year.
- Otherwise in 6 months.
• Checking for :-
– Plaque & gingival indices
– Calculus
– Attachment Level
– Pocket depth
– Bleeding on probing
– Recession
 Maintenance recall procedures

PART 1 – Examination
Oral hygiene status
Gingival changes
Pocket depth changes
Mobility changes
Occlusal changes
Dental caries
Restorative & Prosthetic status
Medical history changes
Oral pathologic examination
Radiographic examination
• PART 2 – Treatment
• Oral hygiene reinforcement
• Scaling
• Polishing
• Chemical irrigation
• PART 3 – Schedule next procedure
• Schedule next recall visit
• Schedule further periodontal treatment
• Schedule or refer for restorative or prosthetic treatment
 CONCLUSION
After the diagnosis & prognosis have been
established,the treatment plan is made to
coordinate all treatment procedures to create
a well functioning dentition in a healthy
Periodontal environment.