Treatment Plan In Periodontics

Treatment Plan In Periodontics

Write short note on the treatment plan.

Answer. Treatment plan is the sequential outline of the essential services and procedures that must be carried out to eliminate the disease and to restore the oral cavity to health and normal function.

• It is the blueprint for the case management and establishment of the periodontal health.
• Treatment procedures should be performed in the systemic sequence and should be planned well in advance.

Rationale for the Treatment Plan

• To eliminate pain, gingival inflammation and gingival bleeding.
• To reduce periodontal pocket formation and elimination of infection.
• To arrest purulent exudates and destruction of soft tissue as well as bone.
• To reduce abnormal tooth mobility.
• To establish optimal occlusal function.
• To restore the tissue destroyed by the disease and reestablish physiological gingival contour
• To prevent recurrence of the disease
• To reduce the tooth loss

“Steps In Creating A Periodontal Treatment Plan”

Phases of Treatment Plan

• Preliminary phase or emergency phase
• Phase 1: Etiotropic phase
• Phase 2: Surgical phase
• Phase 3: Restorative phase
• Phase 4: Maintenance phase

“Goals Of Periodontal Treatment Planning”

Preliminary Phase

When patient has pain, swelling and infection the emergency condition is resolved before phase 1 therapy.

These emergencies take priority over other treatment scheduling:

• Alleviate pain: Pain should be controlled first.
• Swelling: If pain is absent and swelling is present it needs immediate attention.
• Acute lesions of periodontium such as abscess, necrotizing periodontal diseases require emergency care due to associated pain. Endodontics may be necessary as an emergency measure when there is pulpitis, apical abscess or combined periapical-periodontal abscess.
• In traumatic lesions
• Extraction of hopeless teeth: Extreme mobile teeth interfere with function and should be extracted.
• Repairing of defective prosthesis.

“Comprehensive Overview Of Periodontal Treatment Plan Goals”

Phase 1: Etiotropic Phase

It is known as etiotropic phase and its goal is to eliminate the etiologic factor of periodontal diseases.

It is also known as initial phase, non-surgical phase and hygienic phase.

Primary goal of etiotropic phase is the elimination of inflammation and plaque control which includes following:

• Patient education and motivation
• Mechanical plaque control: Scaling and root planning.
• Correction of restorative and prosthetic irritational factors: Over hanging margins of dental restoration should be removed.
• Excavation of caries and restorations (temporary or final): Caries control should be performed. Amalgam and composite restorations can be performed to close contacts and to correct food impaction.
• Topical and systemic antimicrobial therapy: Chemical control of plaque can be achieved by mouth rinses, irrigation and antibiotics.
• Occlusal therapy: Occlusal adjustment should follow scaling and root planning. If tooth is mobile gross occlusal adjustment should be done before scaling to reduce mobility.
• Minor orthodontic movement: It can precede or follow any surgical interventions. It is performed as a part of phase I but when there are inflammation or bone deformities due to tooth alignment. Major orthodontic tooth movement done for purposes of reconstruction or esthetics may follow surgery.
• Provisional splinting and prosthesis: Wire ligation and composite acid etched splintings are performed during phase 1 therapy. Temporary splinting can be done to control secondary occlusal trauma before the surgical planning.
• Diet control: Diet control or diet modification is done.
• Additional preventive measures: These include fluorides which are advised to caries prone patient.

“Risk Factors Addressed In Periodontal Treatment Plans”

Reevaluation Visit

• It is performed in 4 to 8 weeks following completion of initial phase of periodontal therapy.
• All the data taken during the initial visit should be recollected at reevaluation visit such as oral hygiene status, gingival inflammation, bleeding on probing, probing depth, attachment level, dental caries and calculus.

Phase 2: Surgical Phase

Periodontal surgical procedures includes:

• Pocket reduction/elimination procedures:
  • Gingivectomy
  • Periodontal flap surgery
  • Regenerative procedures
• Periodontal plastic surgery techniques:
  • Root coverage procedures
  • To widen width of attached gingiva
• Preprosthetic surgical procedures:
  • Crown lengthening with or without osseous recontouring
  • Ridge augmentation
• Osseous surgeries: Resective and regenerative surgeries
• Implant surgery:
  • Guided bone regeneration
  • Placement of implants
  • Sinus lift procedures

“Early Signs That Require A Periodontal Treatment Plan”

Phase 3: Restorative Phase

It consists of:

• Final restorations
• Fixed and removable prosthesis
• Evaluation of response to restorative procedures
• Periodontal examination

Until all active periodontal therapy is completed, final restorative care should be delayed, as tissue contours may be altered during subsequent periodontal treatment.

Phase 4: Maintenance Phase

It is the very essential part of periodontal treatment plan.

Following procedures should be carried out at various visits.

• Periodic recall visit.
• Checking for plaque and calculus.
• Gingival condition (Pockets, inflammation).
• Occlusion, tooth mobility and other pathologic changes.

“Understanding The Components Of A Periodontal Treatment Plan”

Determination of maintenance recalls intervals is necessary. Patients require recall for inspection, oral hygiene monitoring and scaling at 3 month, 6 month, 9 month or 12 month intervals depending on previous disease experience and susceptibility.

As the phases of treatment plan are given sequentially but the recommended sequence should not follow the numbers, e.g. After completion of Phase I therapy, patient can be placed directly on Phase IV therapy to prevent any further deterioration and recurrence of disease.