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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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slide2

UCLA SCHOOL OF DENTISTRY

SECTION OF PERIODONTICS

slide3

Presents

Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics

Dr. Heddie O. Sedano

Professor Emeritus & Lecturer

Section of Periodontics

slide4

PHASE ONE THERAPY

(INITIAL THERAPY)

comprehensive
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
phase two therapy
Phase two therapy
  • Periodontal surgery
  • Dental implants
  • Crown and bridge
  • Removable partial dentures
slide7

NECROTIZING

ULCERATIVE

GINGIVITIS (NUG)

EMERGENCY

THERAPY

slide8

Two weeks NUG resolved by root planning and good oral hygiene

Proceed to complete examination and diagnosis

phase one therapy
Phase one therapy
  • Control of plaque
  • Control of diet
  • Control of systemic factors
  • Control of oral malodor and taste abnormalities
  • Control of tobacco smoking
slide11

Need to stress floss or interdental brush utilization

Presence of interproximal plaque is prominent

slide12

Plaque and bleeding scores at 4 time periods

Progressive improvement to less than 20% of surfaces with plaque

slide15

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

slide16

CORRELATION COEFFICIENTS BETWEEN KNOWLEDGE AND BUCCO-LINGUAL PLAQUE

DAY 0 0.38

DAY 7 0.32

DAY 14 0.30

slide19

Brush is vibrated by bass technique of oral hygiene

Soft brush positioned at 45° to gingiva

slide23

Rubber interdental stimulator

Least efficient interproximal cleaner

slide24

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

Gauze is most efficient for these teeth

slide25

Electric brushes used for patients with poor manual dexterity

Electric brushes can motivate some patients to improve their oral hygiene

clinical evaluation of the efficiency and safety of a new sonic toothbrush
Clinical Evaluation of the Efficiency and Safety of aNew Sonic Toothbrush

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

J. Periodontol 65:692, 1994

slide27
51 subjects got either Sonicare orhand brush. Instructed in use orModified Bass Technique withOral B 30.
slide28
Plaque scores, gingivitis scoresand sulcular bleeding scores at0, 1, 2, 4 weeks. 29 subjects seen at 6 months
slide29
All subjects got timer and did notuse floss mouth rinses or otheroral hygiene aids for first 4 weeks.
no increase in gingival recession or other oral lesions associated with either brush at 6 months
No increase in gingival recessionor other oral lesions associatedwith either brush at 6 months.
slide34
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

slide35
35 non dental students given aSonicare and a Braun Oral B plakcontrol brush and instructed to useeach brush every other day.
slide36
2 weeks later subjects no brushingfor 24 hours then reevaluated thenmouth brushed by an examinersplit mouth using both brushes.
they repeated this 4 weeks later with brushing using zendium toothpaste by the students
They repeated this 4 weeks laterwith brushing using Zendiumtoothpaste by the students.
slide41
Clinical efficacy of flossing versus use of antimicrobial rinses.Zimmer. S, et al J. Periodontol. 2006 77:1380
slide42

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.

slide45
Additional effect of dentifrices on the instant efficacy of tooth brushing.Paraskevas S .et al J. Periodontol.2006 77:1522
slide46
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
Tooth paste gave average of 3% more plaque than brush alone.More abrasive pastes no more effective.
control of diet
CONTROL OF DIET

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

control of systemic factors consult with patient s m d
CONTROL OF SYSTEMIC FACTORSCONSULT WITH PATIENT’S M.D.

Control of Hemostasis

Control of Bacteremia

Control of Diabetes

Control of Medications

control of oral malodor and taste abnormalities
CONTROL OF ORAL MALODORAND TASTE ABNORMALITIES

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

control of tobacco smoking
CONTROL OF TOBACCO SMOKING

Elimination of smoking significantly improves tissue response to initial therapy.

phase one therapy52
PHASE ONE THERAPY

Removal of pathologic tissue for biopsy

Removal of caries-endodontic therapy

Removal of hopeless teeth

Removal of calculus

slide53

Biopsy should be done immediately in initial therapy

Clinical diagnosis of possible malignant ulceration

slide54

Immediate biopsy result diagnosis of squamous cell carcinoma

Exophitic growth from area previously diagnosed as lichen planus

slide58

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

Removal of caries

Endodontic therapy

slide60

Radiograph confirms hopeless prognosis for tooth # 3

Recommend extract tooth # 3 during initial therapy

slide62

Tooth # 4 shows periodontal remodeling after extracting tooth # 3

Pocket depth improved on distal of tooth # 4

slide64

Photomicrograph of calculus embedded in cementum

Root planing is needed to remove embedded calculus

slide67

Gracey curet 5/6

Triangular shaped scaler for small interproximal spaces

slide68

Explorers are used to confirm completion of root planing

Root surfaces should be glassy smooth and free of calculus

slide70

S.EM of new sharp curete

Note surface notches on cutting edge

slide71

Root surface magnified after root planing with curet

Note smooth surface with very slight striations

slide73

Root surface magnified after ultrasonic instrumentation

Large ripples seen that can be detected with explorer

slide75

Remove large deposits with ultrassonic scaler then root plane with curets

Gross amounts of calculus and plaque

slide76

Needs root planing with curets

Radiographic evidence of calculus

slide77

Sublingual calculus with acute inflammation of gingiva

Root planing done with curets and oral hygiene optimized

slide78

Normal healthy gingiva. No bleeding on proving

Four weeks after initial therapy

slide80

Gingival inflammation is combination of acute and chronic changes

Interproximal pockets are 6 mm with attachment loss and bone loss

slide81

Residual pockets and bone loss require phase two periodontal surgery

Root planing with curete has resolved acute inflammation

phase one therapy82
PHASE ONE THERAPY

Occlusal correction

Occlusal splints

Provisional splinting of teeth

Orthodontic movement

occlusal adjustment
Occlusal Adjustment
  • 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
occlusal splints

OCCLUSAL SPLINTS

(ORTHOTICS)

phase one therapy149
PHASE ONE THERAPY

Restorative corrections

Open contacts

Overhangs

Poor margins

Poor contours

phase one therapy160
PHASE ONE THERAPY

Correction of inadequate

removable partial dentures

phase one evaluation
Pocket depth

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
slide167

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