Case presentation of periodontology

Anamnesis
 What is the main
problem of the patient?
 (for example: breath
malodor, bleeding by the
toothbrushing, pain…)

 How long has he/she had

it?
Basic anamnesis
(important questions during examination)
 Have you ever had endocarditis/ rheumatic fever?
 Coronary and heart disease?
 Allergy?
 Haemorrhagic disease?
 Hepatitis?
 Diabetes?
 Tumors?
 Medicine taken?
Dental anamnesis
(some questions about the patient’s dental
habits)
 How often does he go to the dentist?
 Has he had ortodontics/endodontics
treatment?
 How old his/her denture?
 Has he had bleeding after teeth
extraction?
 Last x-ray picture?
 Bad oral habit?
 Last SRP?
 How often does he brush his/her
teeth?
 Does he use dental floss?
Clinical examination
 Extraoral
 See the whole patient
 Systemic examination
 Inspection, palpation
 Describe abnormal lesions
Intraoral examination
 Oral epithelium
 Color, ulcer, tumor
 Examination of the teeth
 Missing tooth
 Abrasion, carries, filling
 Crown, bridge
 Tooth sensitivity test
Examination of the gingiva
 Clinical sings of gingival
inflammation
 Recession/hyperplasia
 Bleeding index (%)
 Plaque index (%)
 Calculus (subjective) + ++
+++
 Pocket depths registration
 Clinical attachment loss
Assessment of furcation involvement
 Degree 1: horisontal bone
destruction not exceeding
1/3 of the width of the
tooth

 degree 2: > 1/3 but not total

 Degree 3: ”through and

through” destruction
Tooth mobility
 Degree 1: 0.2-1mm horizontal

 Degree 2: >1mm horizontal

 Degree 3: vertical
http://www.periodontalchart-online.com/
Radiographic analysis
 Horisontal/vertical
bone loss
Periodontal diagnosis for the single tooth
diagnosis criteria

Periodontitis levis Horisontal loss < 1/3 of Bleeding on probing

the root length

Periodontitis gravis Horisontal loss > 1/3 of Bleeding on probing

the root length

Periodontitis Vertical loss

complicata Interdental craters
Furcation involvement
2/3
Decisions related to treatment
sequencing
 The periodontal treatment plan
 Primary goal is elimination of gingival and periodontal
inflammation and correction of the conditions that
cause it
 Assessment phase: data collection and needed care for
immediate treatment needs (emergency dental care)
 Nonsurgical periodontal therapy phase: it includes
dental hygiene care and patient educational measures
(and measures to minimize the impact of local factors)
 Surgical therapy phase: it includes may needed
periodontal surgery and placement of dental
implants.
 This phase of treatment is not needed for all
patients!
 Restorative therapy phase: it includes placement of
dental restorations and replacement of missing
teeth by fixed or removable prostheses.
 Periodontal maintenance phase:
 by the dental team/by the patient
 to keep periodontitis from recurring
 The objective of the maintenance phase is to
maintain the teeth functioning throughout life of the
patient
Phases of treatment
”Irrational-to-treat” teeth
 Periodontal
 Recurrent periodontal abscesses
 Periodontic-endodontic lesions
 Attachment loss to the apex
 Endodontal
 Root perforation in the apical half of the root
 Periapical pathology in the presence of obturating post
and core
”Irrational-to-treat” teeth II.
 dental
 Long fracture of the root
 Oblique fracture in the middle third of the root
 Caries lesions that extend into the root canal
 functional
 3rd molars without antagonists
Questionable prognosis
 Periodontal
 Furcation involvement
 Angular bone defects
 Horisontal bone loss involving> 2/3 of the root
 Endodontal
 Incomplette root canal therapy
 Periapical pathology
 Presence of voluminous posts/screws
 Dental
 Excensive root caries
What we need for the case presentation
 X-ray pictures about the teeth
 Periodontal chart
 Plaque/gingivitis index
 Intraoral pictures
 Alternatives for treatment