牙周病学电子教案课件

牙周病学 Periodontology 山东大学口腔医学院 葛少华 Chapter11 Periodontal Prognosis cervical enamel projections, root concavities, developmental grooves Assigning prognosis: Good Prognosis: Indicates that there is adequate periodontal support and it is possible to control etiologic factors to assure that the teeth will be relatively easily maintained. Assigning prognosis The following criteria constitute a good prognosis: - Probing depth 0-3mm. - Less than 10% bone loss. - No furcation. - No pathologic mobility. Assigning prognosis Fair prognosis: Indicates there is a good chance that the teeth can be restored to health and retained, assuming proper maintenance. Assigning prognosis The following factors are suggestive of fair prognosis:(one or more) - Pocket depth up to 5mm. - Up to 30 % bone loss. - Maintainable Class I furcation. - Mobility I. Assigning prognosis Poor prognosis: One or more of the following: n Moderate attachment loss. nClass I and /or class II furaction(s) nThe location and depth of the furaction would allow proper maintenance, but with difficulty. Assigning prognosis Questionable prognosis: One or more of the following: - Severe attachment loss resulting in a poor crown-to root ratio. - Poor root form. - Deep class II or Class III furcation. - 2+mobility or greater. Assigning prognosis Hopeless Prognosis: Inadequate attachment to maintain the tooth in health, comfort and function. Extraction is recommended. Assigning prognosis Becker et at (1984) recommended one or more of the following to assign hopeless prognosis: nMore than 70% of bone loss. nProbing depth 8mm. nClass III furcation nMobility grade III. nPoor crown root ratio. nHistory of repeated periodontal abscess formation. Data Collection Diagnosis Phase I Therapy Phase I Evaluation Recycle Surgery Periodontal Treatment Planning SPT (recall) Data Collection Diagnosis Initial Therapy Evaluation Initial Therapy Retreatment Surgery SPT (recall) Objectives of Periodontal Treatment nControl plaque and elimination of inflammation: nReestablish the physiological contours necessary for preservation of periodontal health nRestore the function of periodontium nPrevent recurrence of disease Treatment procedure 1 initial therapy (cause-related therapy) 2 periodontal surgical phase 3 restorative phase: 2-3months after surgery, fixed or removable dentures 4 supportive periodontal therapy(SPT): maintenance phase nPatient motivation, Oral hygiene instruction and monitoring nSupragingival and subgingival scaling and root planing:plaque and calculus removal nRemoval of naturally-occurring plaque-retentive areas and other local irritants nRemoval of hopeless teeth nOcclusal adjustment nPossible chemical plaque control nElimination of systemic or environmental factors Initial Therapy Oral Hygiene Instruction Patient information: nImportance of daily disruption dental plaque. nShare/discuss with the patient the findings of periodontal charting, i.e. BOP, radiographs (bone level). nIllustrate the location(s) of plaque in the dentition Use a disclosing solution. nReview/modify patients tooth brushing technique. Introduce additional oral hygiene aids as needed, but in step by step fashion. Re-evaluation Phase Objectives: 1. To assess tissue response to therapy a. Gingival Condition b. Pocket Depths, etc. 2. To assess patients compliance with OHI a. Plaque and Bleeding Index b. Review OHI 3. To Assess need/advisability for further periodontal therapies. a. Revise Diagnosis, Prognosis. b. Surgery (when indicated) c. Repeat Non-surgical Therapy d. SPT (maintenance) every 3 or 6 months Update Treatment Plan Surgical Phase (1-3 month after initial therapy) Indications for surgical Phase: nInflammation subsequent to initial therapy. nPocket depth. nOsseous and furcation defects. nGingival enlargement. nInadequate biologic width. nMuccogingival defects. Surgical Phase (1-3 month after initial therapy) n Modified Widman Flap n Bone transplantation nRegenerative Procedures :GTR,GBR n Mucogingival surgery n implant dentistry Re-evaluation Periodontal Treatment Planning Restorative-Prosthetic Phase Pre-prosthetic Surgery - Gingival Grafts - Ridge Augmentation - Crown Lengthening nRe-evaluation Supportive Periodontal Therapy Definition: Procedures performed at selected interval to assist patient in maintaining oral health. npatients can be maintained in stable periodontal condition with a properly scheduled SPT program nLess attachment loss occurs and fewer teeth are lost when patients maintain SPT schedule Objectives nTo prevent the progression and recurrence of periodontal disease nTo prevent the loss of dental implants after clinical stability has been achieved nTo reduce tooth loss by monitoring the dentition and any prosthetic replacement of the natural teeth nTo diagnose and manage, other diseases or conditions found within the oral cavity (Wilson,TG (1996) Periodontology 2000,12:11-115) nStarted at the completion of active periodontal treatment. nProgression of gingivitis to periodontitis has not accurately predicted and thus periodic SPT in all cases can prevent further progression of disease nLarge percentage of population will benefit from regular supportive periodontal treatment Schedule and Extent of Need Periodontal Treatment Planning nBleeding on probing eliminated nNo incr