Periodontal Examination

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Periodontal Examination
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Possible Diagnostic Categories
Health
Gingivitis
Periodontitis
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Treatment Plan

• Includes all procedures required for the
  establishment and maintenance of oral health
• Determined after the diagnosis and prognosis have
  been established

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Overall Treatment Plan

• Preliminary phase
• Phase I therapy
• Re-evaluation
• Phase II therapy (surgical phase)
• Phase III therapy (restorative phase)
• Phase IV therapy (supportive periodontal
  therapy)

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Explaining the Treatment Plan to the Patient

• Be specific in explaining
• The problem
• The treatment
• The prognosis
• The maintenance

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Start Out Positively

• Talk about teeth to be retained
• Present all of the treatment as a unit
• Best results with prompt treatment

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Preliminary Phase

• Treatment of emergencies
• Acute infection
• Caries control
• Other

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Periodontal Abscess
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Pericoronitis
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Necrotizing Ulcerative Gingivitis
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Acute Periapical Infections
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Phase I Therapy (Etiotropic Phase)

• Plaque control
• Diet control
• Scaling and root planing/scale polish
• Caries control
• Occlusal therapy
• Provisional splinting

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Scaling / Root Planing

• ADA code D4341
• Patient with LOA and gingival inflammation

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Scale and Polish

• ADA code D1110
• Patient with gingival inflammation and no LOA

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Re-evaluation
Diagnosis of Periodontitis
Initial Therapy S/RP and Home Care
Re-evaluation
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Response to Phase I

• Re-checking
• Probing depths
• Mobility
• Recession
• Plaque control

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Response to Phase I

• Tissue response
• Color
• Consistency
• Contour
• Texture
• Bleeding on probing

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Endpoint Objectives of Periodontal Therapy

• Resolution of inflammation
• No BOP
• No suppuration
• Gingival contours WNL in color, texture and form
• Gingival attachment which is resistant to
  recurrent disease

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Criteria Indicating These Goals Have Not Been Met

• Ongoing attachment loss / recession
• Signs of inflammation
• BOP
• Suppuration
• Periodontal pockets gt 5mm

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Criteria Indicating These Goals Have Not Been
Meet (cont.)

• Increasing tooth mobility
• Significant osseous defects
• Furcations
• Vertical defects
• Bony craters

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• Establish periodontal treatment plan
• Additional S/RP followed by re-eval
• Supportive periodontal therapy
• Periodontal surgery

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Treatment vs. Referral?
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Patient for Referral

• Inflammation that does not resolve
• Inadequate attached gingiva
• Severe root exposure
• Aggressive periodontitis
• Patients with systemic disease
• All severe periodontal disease

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Watching Is Not Considered Periodontal Therapy
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Phase II Therapy (Surgical Phase)

• Periodontal surgery
• Resection
• Regeneration
• Periodontal plastic surgery
• Crown lengthening

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Pre bone resection
Post bone resection
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Intrabony Defect
Bone Graft Placed
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Pre-op
Post-op
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Pre-op
Post-op
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Phase III Therapy (Restorative Phase)

• Final restorations
• Fixed and removable prosthodontics
• Implants

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Phase IV Therapy (Maintenance Phase)

• Supportive periodontal therapy
• Periodontal Maintenance Program
• Recall Maintenance
• ADA code D4910

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Supportive Periodontal Therapy

• I. Examination
• Update medical history
• Oral pathology exam
• Radiographs prn
• Oral hygiene status

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Supportive Periodontal Therapy

• I. Examination
• Probing depths
• Tissue condition
• Plaque control
• Occlusion
• Tooth mobility
• Recession

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Supportive Periodontal Therapy

• II. Treatment
• Oral hygiene reinforcement
• Scaling (RP prn)
• Polishing
• Chemical irrigation prn

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Supportive Periodontal Therapy

• III. Scheduling
• Next recall visit
• Additional periodontal tx
• Restorative treatment

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Patients With Periodontitis

• 3 months SPT

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Patients With Gingivitis and No History of LOA

• 6 month SPT

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Time for SPT appointments

• 45-60 minutes

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SPT Practice Patterns

• Typically, periodontist and generalist perform
  every-other-SPT
• Frequent SPT visits (lt 3 months apart) may make
  sense
• Communication is critical