Phase 1 Periodontal Therapy

Phase 1 Periodontal Therapy

Phase 1 periodontal therapy is also known as nonsurgical periodontal therapy, initial therapy, cause related therapy and etiotropic phase of therapy.

• Phase 1 periodontal therapy is the first step in chronologic sequence of procedures which constitute periodontal treatment.
• Objective of Phase 1 therapy is to alter or eliminate the microbial etiology and contributing factors for gingival and periodontal diseases.
• Following are the therapies which are needed to control or eliminate the local contributing factors:
  • Complete removal of calculus
  • Correction or replacement of poorly fitting restorations and prosthetic devices
  • Restoration of carious lesions
  • Orthodontic tooth movement
  • Treatment of food impaction areas
  • Treatment of occlusal trauma
  • Extraction of hopeless teeth.
• Following conditions must also be considered to plan the phase 1 treatment sessions needed:
  • General health and tolerance of treatment
  • Number of teeth present
  • Amount of subgingival calculus
  • Probing pocket depths and attachment loss
  • Furcation involvements
  • Alignment of teeth
  • Margins of restorations
  • Developmental anomalies
  • Physical barriers to access (i.e. limited opening or tendency to gag)
  • Patient cooperation and sensitivity.

“Goals Of Phase 1 Periodontal Therapy”

Dentist should estimate the number of appointments needed on the basis of the conditions presented by each patient. Consideration should be given to the control of infectious organisms during period of active Phase I treatment.

Sequence of Procedures in Phase 1 Therapy

Step 1: Limited plaque control instruction

• This step should start in the first treatment appointment and should include only the correct use of the toothbrush on all smooth and regular surfaces of the teeth.
• The use of dental floss should follow the removal of calculus and the overhanging restorations.

Step 2: Supragingival removal of calculus

This step should be carried out with scalers, curettes or ultrasonic instrumentation.

Step 3: Recontouring defective restorations and crowns

• This step may require replacing the complete restoration or crown or correcting it with finishing burs as well as diamond coated files mounted on a special handpiece.
• For overhangs which are located subgingivally, it may be require to reflect a miniflap to facilitate access.

“Steps In Phase 1 Periodontal Treatment”

Step 4: Obturation of carious lesions

• This involves complete removal of the carious tissue and placement of a final or a temporary restoration.
• Caries control as well as treatment of active carious lesions are often overlooked aspects of phase I therapy.
• Caries is now recognized as infection. Frank carious lesions, particularly class V lesions in the cervical areas of teeth and those on root surfaces, provide a reservoir for bacteria and can contribute to the repopulation of the periodontal plaque.
• Cavities are the receptacles where plaque is sheltered from even the most energetic mechanical plaque removal attempts.
• For these reasons, it is imperative that caries control and at least temporization of carious lesions be completed during phase 1 therapy.

“The Role Of Scaling And Root Planing In Phase 1 Therapy”

Step 5: Comprehensive plaque control instruction

At this step, the patient should learn to remove plaque completely from all supragingival areas, using toothbrush, dental floss and any other necessary complementary method.

Step 6: Subgingival root treatment

At this step, complete calculus removal and root planning can be effectively performed and constitute the final step in achieving smooth and regular contours on all tooth surfaces.

“Early Signs That Require Phase 1 Periodontal Therapy”

Step 7: Tissue re-evaluation

• Periodontal tissues are reexamined to determine the need for further therapy. Pockets are resorbed, and all related anatomical conditions are carefully evaluated to decide whether surgical treatment is indicated.
• Additional improvement through surgery can be expected, only if phase I therapy has been successful.
• Surgical treatment of periodontal pockets should be attempted only when the patient is doing effective plaque control and the gingiva is free from overt inflammation.

Results of Phase 1 Periodontal Therapy

Periodontal cases should be reevaluated 4 weeks after completion of scaling and root planning. This permits time for both epithelial and connective tissue healing and allow the patient sufficient practice with oral hygiene skills to achieve maximum improvement.