Examination, Diagnosis

and
Treatment Planning
Treatment plan
• Emergency treatment:
* Periodontal, periapical abscess, others.
• Etiotropic (etiologic) – phase one:
* Oral hygiene instruction
* Diet control (in patient with rampant caries)
* Removal of calculus and root planing
* Correction of restorative and prosthetic irritational
factors
* Excavation of caries and restoration (temporary or
final, depending o location and extent of carious
lesions)
* Antimicrobial therapy (local or systemic)
* Endodontic therapy
 * Occlusal therapy
* Minor orthodontic movement
* Provisional splinting and prosthesis

• Evaluation of Response to Etiotropic phase

Rechecking:
* Pocket depth and gingival inflammation
* Plaque and calculus, caries

• Surgical phase:
* Periodontal therapy, including placement of implant
• Restorative phase:
* Final restoration
* Fixed and\or removable prosthodontics

• Maintenance phase:
Periodic rechecking:
* Plaque and calculus
* Gingival condition (pocket, inflammation)
* Occlusion, tooth mobility
* Other pathologic changes
Emergency treatment
Etiotropic (Initial) or phase one

The cause of gingivitis and periodontitis is bacterial plaque

accumulation on the tooth surface.
The removal of plaque and all factors that favor its accumulation (such
as calculus, overhanging margins of restoration, and food impaction)
is therefore the primary consideration in local therapy.
 Disclosing agent was applied on teeth surface to
detect plaque accumulation
Removal of etiologic factors
plaque accumulation
Plunger cusp
Faulty bridges
 Oral hygiene Instruction 1st
Tooth brushing techniques:
1-Bass method (sulcular brushing):

• For all patient for bacterial plaque removal and directly beneath the
gingival margin.
• For open interproximal area.
• For the patient who had periodontal surgery.
• Under the gingival border of a fixed partial denture, and orthodontic
appliances.
 4-The Modified Stillman Method

• Bacterial and plaque removal from cervical areas below the height of
contour of the crown and from exposed proximal surface.
• General application for cleaning tooth surfaces and massage of the
gingiva.
 * Other tooth brushing method
• Circular scrub:

• Vertical
Interdental care
Kinds of dental floss:
• Waxed dental floss
Used for uncontact spaces between teeth

• Unwaxed dental floss

Used for very contact or crowded teeth
Wooden interdental cleaning

For proximal spaces were

dental floss hardly to
reach
Interdental Brushes

1- single-tuft brush
• For open interproximal area
• For fixed prostheses
• For difficult to reach area
2- single-tuft brush on handle with angulated shank
• For orthodontic appliances,
prostheses, and implant.
3- interdental brush with filaments twisted into a fine
wire that end in a handle.

For open interdental area.

4- insert brushes for a reusable handle with an
angulated shank.
Oral irrigation

Used for :
1- deep pocket.
2- orthodontic appliances.
3- fixed denture.
4- implant.
5- handicapped patients.
Mouth Rinses

• Chlorhexidine:
The most effective antiplaque and antigingivitis
chemotherapeutic agent available.

Used for:
• Decreases supragingival plaque formation and inhibits
development of gingivitis.
• Following surgical treatment .
• Used to control inflammation in necrotizing ulcerative
neglected patients.
Re-evaluation of initial phase
(Rechecking)
Re-evaluation is the assessment of the results obtained by initial
treatment for elimination of the etiologic factors that led to the
periodontal disease.

* Possibilities and limitation of initial

therapy:
Gingivitis

In cases of gingivitis, initial therapy is usually the only treatment

necessary.
Gingival hyperplasia or overgrowth caused by mouth breathing or certain
medications as phenytoin, cyclosporine may persist after elimination of
inflammation.

In these conditions surgery may be indicated after the reevaluation.

Combined gingival hyperplasia (hormonal
changes and plaque accumulation)
 Stage I (mild) periodontitis

Initial therapy alone may

bring satisfactory results in
cases of mild periodontitis
specially on single rooted
teeth.
Stage III and stage IV (severe)
periodontitis
There are certain limits to the success that can be achieved by initial
therapy alone:

1. Difficult scaling and RP in deep pockets.

2. Root irregularities and furcations.
Surgical phase
Gingival hyperplasia due to induce of drug
(cyclosporine)
Recall maintenance phase

Periodic recall visits are necessary to prevent recurrence of periodontal

disease.

Supervised recall program subsequence to active treatment prevent

recurrent periodontitis.
Rationale for maintenance therapy
If remaining calculus and plaque left after SC and RP inflammation is
confined to the pocket wall.

Inflammation can not manifested itself on the outer gingival surface.

There will be attachment loss even after treatment.

The maintenance program

1. Examination and evaluation of general health and oral condition.

• Medical HX changes.
• Oral hygiene status “plaque control”
• Gingival changes.
• Pocket depth changes.
• Mobility changes.
• Evaluation of restoration, caries, prosthesis and occlusion are also
important parts of the recall appointment, update radiographs

2- perform the necessary maintenance treatment:

• Oral hygiene reinforcement.
• SC and RP and polishing.

3- scheduling the patient for the next recall appointment