RATIONALE FOR PERIODONTAL

TREATMENT

DR KASHAF HAFEEZ
DEMONSTRATOR
DEPARTMENT OF PERIODONTOLOGY
LEARNING OBJECTIVES:

• Introduction
• Objectives of periodontal therapy
• Local therapy
• Systemic therapy
• Factors affecting healing
• Regeneration
• Repair
• New attachment
• Reconstruction
• Conclusion
INTRODUCTION:
The effectiveness of periodontal therapy is
made possible by the remarkable healing
capacity of the periodontal tissues.
Periodontal therapy can restore chronically
inflamed gingiva so that , from a clinical and
structural point of view , it is almost identical
with gingiva that has never been exposed to
excessive plaque accumulation.
OBJECTIVES OF PERIODONTAL THERAPY:

• If properly performed, periodontal treatment

can accomplish the following
• Eliminate pain
• Eliminate gingival inflammation
• Eliminate gingival bleeding
• Eliminate infection
• Reduces periodontal pockets and tooth
mobility
• Stops pus formation
• Arrest the destruction of soft tissue and bone
• Establish optimal occlusal function
• Restores tissue destroyed by disease
• re-establish the physiological gingival contour
• Prevent the recurrence of disease
• Reduces tooth loss
LOCAL THERAPY:
• The cause of periodontitis and gingivitis is
bacterial plaque accumulation on tooth
surface close to gingival tissue
• The accumulation of plaque can be favoured
by a variety of local factors such as calculus,
overhanging margins of restorations and food
impaction
• The removal of plaque and all of its
accumulation is primary goal in local therapy.
SYSTEMIC THERAPY:
• Use for controlling systemic complications
from acute infections and preventing harmful
effects of post treatment
• In conjunction with local therapy, systemic
therapy is indicated in patients with aggressive
periodontitis.
• Systemic antibiotics are used to eliminate the
bacteria that invade gingival tissue.
FACTORS AFFECTING HEALING:
LOCAL FACTORS:

Healing is delayed by local factors such as:

• Contamination by micro-organism
• Irritation from plaque
• Necrotic tissue remnants
• Food debris
• Excessive tissue manipulation during treatment
• Trauma from occlusion
• Trauma to tissues
Healing is improved by:

• debridement
• local increase in temperature
• Im mobilisation of healing area
• pressure on the wound
SYSTEMIC FACTORS:
Healing is delayed in:

• Older patients
• Generalised infections
• Insufficient food intake
• Vitamin c deficiency
• Increased levels of hormones
• Systemic stress
• Thyroidectomy
• Levels of testosterone and estrogen
• Adreno corticotropic hormone
HEALING AFTER PERIODONTAL THERAPY:

REGENERATION:

• It is the natural renewal of a structure produced

by growth and differentiation of new cells.
• It occurs through growth from the same type of
tissues that has been destroyed or from its
precussors
• Regeneration of periodontium is a continous
physiologic process.
• Regeneration is a wear and tear repair.
which is manifested by:

 Mitotic activity in epithelium of gingiva and

connective tissue of PDL ligament
 Formation of new bone
 Continous deposition of cementum
• Regeneration occurs even during destructive
periodontal disease.
• Most periodontal diseases are chronic
inflammatory processes and are healing
lesions.
• Regeneration is part of healing
• Bacteria and bacterial products along with
inflammatory exudate are injurious to
regenerating cells and tissues thus prevents
completion of healing process
REPAIR:
• It is the healing of tissue without completely
restoring the lost tissues
• It restores the continuity of diseased marginal
gingiva and re-establishes a normal gingival
sulcus at the same level on the root as the
base of pre existing periodontal pocket. This is
called healing by scar
• Arrest bone destruction but does not result in
gain of gingival attachment or bone height
NEW ATTACHMENT:
• This is the reunion of connective tissue with a
root surface that has been pathologically
exposed
• It is the embedding of new periodontal
ligament fibres into new cementum and the
attachment of gingival epithelium to a tooth
surface previously denuded by disease.
RECONSTRUCTION:
• It refers to process of regeneration of cells and
fibres and remodelling of lost periodontal
stuctures
• It results in gain of attachment level,
formation of new periodontal ligament fibres,
a level of alveolar bone coronal to that
present before treatment
 During the healing stages, the area invaded by
cells from four different sources:

• Oral epithelium
• Gingival connective tissue
• Bone
• Periodontal ligament
FINAL OUTCOME OF PERIODONTAL
THERAPY:
Healing depends on the sequence of events
during healing stage
Melcher pointed out that the regeneration of
periodontal ligament is the key to new
attachment because it provides continuity
between the alveolar bone and the cementum
and also it contains cell that can synthesize
and remodel three connective tissues of
supporting stuctures of periodontium.
CONCLUSION:
Rationale for periodontal treatment are :
• elimination of gingival inflammation
• cessation of gingival bleeding
• elimination of periodontal pocket
• re-establishment of periodontal health
• arrest of bone loss
• reduction of abnormal tooth mobility
• establishment of optimal occlusal relationships
• restoration of destroyed periodontal tissues and
prevention of reccurence.