TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS. UCLA SCHOOL OF DENTISTRY. SECTION OF PERIODONTICS. Presents. Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics. Dr. Heddie O. Sedano Professor Emeritus & Lecturer Section of Periodontics. PHASE ONE THERAPY. (INITIAL THERAPY).

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UCLA SCHOOL OF DENTISTRY

SECTION OF PERIODONTICS


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Presents

Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics

Dr. Heddie O. Sedano

Professor Emeritus & Lecturer

Section of Periodontics


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PHASE ONE THERAPY

(INITIAL THERAPY)


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Comprehensive

  • Emergency Therapy

  • Examination Diagnosis and Treatment Plan

    • Phase one therapy (initial therapy)

    • Evaluation of phase one therapy

    • Phase two therapy

    • Evaluation of phase two therapy

    • Maintenance therapy


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Phase two therapy

  • Periodontal surgery

  • Dental implants

  • Crown and bridge

  • Removable partial dentures


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NECROTIZING

ULCERATIVE

GINGIVITIS (NUG)

EMERGENCY

THERAPY


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Two weeks NUG resolved by root planning and good oral hygiene

Proceed to complete examination and diagnosis


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Phase one therapy hygiene

  • Control of plaque

  • Control of diet

  • Control of systemic factors

  • Control of oral malodor and taste abnormalities

  • Control of tobacco smoking



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Need to stress floss or interdental brush utilization hygiene

Presence of interproximal plaque is prominent


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Plaque and bleeding scores at 4 time periods hygiene

Progressive improvement to less than 20% of surfaces with plaque


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CORRELATION OF MANUAL DEXTERITY hygiene AND KNOWLEDGE WITH ORAL HYGIENE



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CORRELATION COEFFICIENTS BETWEEN RIGHT HAND DEXTERITY AND BUCCO-LINGUAL PLAQUE

IN 59 ADULTS

DAY 0 0.41

DAY 7 0.38

DAY 14 0.33


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CORRELATION COEFFICIENTS BETWEEN KNOWLEDGE AND BUCCO-LINGUAL PLAQUE

DAY 0 0.38

DAY 7 0.32

DAY 14 0.30




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Brush is vibrated by bass technique of oral hygiene and plaque control

Soft brush positioned at 45° to gingiva



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Interdental brush are present

Tuft brush



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Rubber interdental stimulator are present

Least efficient interproximal cleaner


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Use of gauze to clean distal surface of teeth adjacent to edentulous areas

Gauze is most efficient for these teeth


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Electric brushes used for patients with poor manual dexterity

Electric brushes can motivate some patients to improve their oral hygiene


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Clinical Evaluation of the dexterityEfficiency and Safety of aNew Sonic Toothbrush

Johnson, B.D., McInnes, C.,

J. Periodontol 65:692, 1994


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51 subjects got either Sonicare or dexterityhand brush. Instructed in use orModified Bass Technique withOral B 30.


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Plaque scores, gingivitis scores dexterityand sulcular bleeding scores at0, 1, 2, 4 weeks. 29 subjects seen at 6 months


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All subjects got timer and did not dexterityuse floss mouth rinses or otheroral hygiene aids for first 4 weeks.


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Plaque Index dexterity



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Gingivitis dexterity


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No increase in gingival recession dexterityor other oral lesions associatedwith either brush at 6 months.


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Comparison of an Oscillating Rotating Electric Toothbrush and a Sonic Toothbrush in Plaque Removing Ability

Van Der Weijden, S.A., Timmerman,

M.F., Van Der Velden, V.

J Clin. Periodontol 23:407, 1996


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35 non dental students given a and a Sonic Toothbrush in Plaque Removing AbilitySonicare and a Braun Oral B plakcontrol brush and instructed to useeach brush every other day.


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2 weeks later subjects no brushing and a Sonic Toothbrush in Plaque Removing Abilityfor 24 hours then reevaluated thenmouth brushed by an examinersplit mouth using both brushes.


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Plaque Index and a Sonic Toothbrush in Plaque Removing AbilityAfter 2 minutes Professional Brushing


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They repeated this 4 weeks later and a Sonic Toothbrush in Plaque Removing Abilitywith brushing using Zendiumtoothpaste by the students.


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Plaque Index and a Sonic Toothbrush in Plaque Removing AbilityAfter 2 minutes Panellist Brushing


At end of study they could keep one brush 34 out of 35 kept braun brush l.jpg
At end of study they could keep and a Sonic Toothbrush in Plaque Removing Abilityone brush. 34 out of 35 keptBraun brush.


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Clinical efficacy of flossing versus use of antimicrobial rinses.Zimmer. S, et al J. Periodontol. 2006 77:1380


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156 patients used brush +daily rinse 0.06% chlorhexidine 0.025% fluoride or brush+ 0.1% cetylpyridiniumchloride +fluoride or brush + floss or brush alone.Evaluated at 8 weeks.


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CHX NaF 1.58 CPC/NaF 1.54 FLOSS 2.10 BRUSH 2.00 0.025% fluoride or brush+ 0.1% cetylpyridiniumchloride +fluoride or brush + floss or brush alone.Evaluated at 8 weeks/

MODIFIED PROXIMAL PLAQUE INDEX


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Papilla Bleeding Index 0.025% fluoride or brush+ 0.1% cetylpyridiniumchloride +fluoride or brush + floss or brush alone.Evaluated at 8 weeks

CHX /NaF 0.67 CPC/NaF 0.75 FLOSS 0.77 BRUSH 0.89


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Additional effect of dentifrices on the instant efficacy of tooth brushing.Paraskevas S .et al J. Periodontol.2006 77:1522


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3 toothpastes used in 40 patients each after 48 hours plaque accumulation.Split mouth hand brush with or without paste.


Tooth paste gave average of 3 more plaque than brush alone more abrasive pastes no more effective l.jpg
Tooth paste gave average of 3% more plaque than brush alone.More abrasive pastes no more effective.


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CONTROL OF DIET alone.More abrasive pastes no more effective

More benefit comes from reduction of sucrose in diet so less caries and less plaque minimal effect on gingival inflammation from other dietary modifications


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CONTROL OF SYSTEMIC FACTORS alone.More abrasive pastes no more effectiveCONSULT WITH PATIENT’S M.D.

Control of Hemostasis

Control of Bacteremia

Control of Diabetes

Control of Medications


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CONTROL OF ORAL MALODOR alone.More abrasive pastes no more effectiveAND TASTE ABNORMALITIES

Plaque control is most predictable way to reduce oral malodor together with daily tongue scarping to reduce bacterial load of oral cavity.


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CONTROL OF TOBACCO SMOKING alone.More abrasive pastes no more effective

Elimination of smoking significantly improves tissue response to initial therapy.


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PHASE ONE THERAPY alone.More abrasive pastes no more effective

Removal of pathologic tissue for biopsy

Removal of caries-endodontic therapy

Removal of hopeless teeth

Removal of calculus


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Biopsy should be done immediately in initial therapy alone.More abrasive pastes no more effective

Clinical diagnosis of possible malignant ulceration


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Immediate biopsy result diagnosis of squamous cell carcinoma alone.More abrasive pastes no more effective

Exophitic growth from area previously diagnosed as lichen planus


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Non ulcerated lesion present for at least 3 years alone.More abrasive pastes no more effective


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Tissue removed includes periphery of normal tissue alone.More abrasive pastes no more effective

Diagnosed as benign hemangioma


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Biopsy site sutured alone.More abrasive pastes no more effective


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Furcal bone loss resolved after endodontic treatment carried out before any periodontal care

Removal of caries

Endodontic therapy


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Tooth # 3 has 8 mm pockets and grade 3 mobility out before any periodontal care

Removal of hopeless teeth


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Radiograph confirms hopeless prognosis for tooth # 3 out before any periodontal care

Recommend extract tooth # 3 during initial therapy


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Deep pockets seen of distal of tooth # 4 out before any periodontal care


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Tooth # 4 shows periodontal remodeling after extracting tooth # 3

Pocket depth improved on distal of tooth # 4


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REMOVAL OF CALCULUS tooth # 3

Root Planing


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Photomicrograph of calculus embedded in cementum tooth # 3

Root planing is needed to remove embedded calculus



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Gracey curet 5/6 tooth # 3

Triangular shaped scaler for small interproximal spaces


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Explorers are used to confirm completion of root planing tooth # 3

Root surfaces should be glassy smooth and free of calculus


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Prior to root planing with curetes tooth # 3

Root surface magnified


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S.EM of new sharp curete tooth # 3

Note surface notches on cutting edge


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Root surface magnified after root planing with curet tooth # 3

Note smooth surface with very slight striations



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Root surface magnified after ultrasonic instrumentation movement of tip

Large ripples seen that can be detected with explorer


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MEAN TOOTH SURFACES movement of tipROUGHNESS SCORES


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Remove large deposits with ultrassonic scaler then root plane with curets

Gross amounts of calculus and plaque


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Needs root planing with curets plane with curets

Radiographic evidence of calculus


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Sublingual calculus with acute inflammation of gingiva plane with curets

Root planing done with curets and oral hygiene optimized


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Normal healthy gingiva. No bleeding on proving plane with curets

Four weeks after initial therapy


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No need for further periodontal therapy plane with curets

Pocket reduction


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Gingival inflammation is combination of acute and chronic changes

Interproximal pockets are 6 mm with attachment loss and bone loss


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Residual pockets and bone loss require phase two periodontal surgery

Root planing with curete has resolved acute inflammation


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PHASE ONE THERAPY surgery

Occlusal correction

Occlusal splints

Provisional splinting of teeth

Orthodontic movement


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Occlusal Adjustment surgery

  • Correction of Centric

    • Stable centric relation

    • No interferences between CR and CO

  • Correction of lateral excurtions

    • Balancing interferences

    • Working interferences

    • Balancing interferences

  • Correction of protrusive excursions

    • Straight protrusive

    • Protrusolateral

  • Correction of centric occlusion


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OCCLUSAL SPLINTS surgery

(ORTHOTICS)


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PROVISIONAL surgerySPLINTS


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PHASE ONE THERAPY surgery

Restorative corrections

Open contacts

Overhangs

Poor margins

Poor contours


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PHASE ONE THERAPY surgery

Correction of inadequate

removable partial dentures



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Pocket depth Percentage of Lengths of the Teeth

Plaque score

Bleeding on probing

Caries

Occlusal stability

Mobility, fremitus

Mucosal health status

Mucogingival status

Systemic status

Radiographic evaluation

Oral malodor and taste

Esthetics

Modification of phase two treatment plans

PHASE ONE EVALUATION


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SECTION OF PERIODONTICS UCLA Percentage of Lengths of the Teeth

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