Comprehensive Periodontal Therapy Ang 2013 v1

TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
PERIODONTAL TREATMENT
TREATMENT
PERIODONTAL DIAGNOSTICS
PERIODONTAL EMERGENCY
PROFESSIONAL ORAL HYGIENE
INDIVIDUAL ORAL HYGIENE
CAUSE-RELATED PERIODONTAL SURGERY
CORRECTIVE PERIODONTAL SURGERY
GUIDED TISSUE REGENERATION
PERIODONTAL REHABILITATION
PROSTHODONTIC THERAPY
PERIODONTAL MAINTENANCE
THE MAIN OBJECTIVES OF

PERIODONTAL THERAPY
ELIMINATE INFLAMMATION
PRESERVATION OR IMPROVEMENT
OF THE PERIODONTAL
ATTACHMENT
OF THE STABILITY OF THE
REMAINING TEETH

PERIODONTAL THERAPY
OF THE PERIODONTAL
ATTACHMENT
REMAINING TEETH

PERIODONTAL THERAPY
OF THE PERIODONTAL
ATTACHMENT
REMAINING TEETH
TO PRESERVE OR RATHER IMPROVE

PERIODONTAL ATTACHMENT LEVEL

PERIODONTAL THERAPY
OF THE PERIODONTAL
ATTACHMENT
REMAINING TEETH
HOW TO APPROACH THE

GOALS ?
ELIMINATE PLAQUE AND
CALCULUS AND OTHER
CAUSATIVE FACTORS
PLAQUE-CONTROL
SCALING AND ROOT PLANING
CAUSE RELATED PERIODONTAL
SURGERY
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
THE
THE DIAGNOSTICALLY
DIAGNOSTICALLY DRIVEN
DRIVEN
THERAPY
THERAPY
POSSIBLE
POSSIBLE DIAGNOSTIC
DIAGNOSTIC CATEGORIES
CATEGORIES
HEALTH
GINGIVITIS
PERIODONTITIS
HEALTH
GINGIVITIS
PERIODONTITIS
PERIODONTAL
DIAGNOSTIC
ASSESS ORAL HYGIENE
GINGIVAL EXAMINATION
EXAMINE THE ATTACHMENT
APPARATUS
OCCLUSAL ANALYSIS
THE
THE DIAGNOSTICALLY
DIAGNOSTICALLY DRIVEN
DRIVEN THERAPY
THERAPY
THE
THE MANAGEMENT
MANAGEMENT OF
OF CHRONIC
CHRONIC PERIODONTITIS
PERIODONTITIS
PERIODONTITIS
non surgical therapy
non surgical therapy

less than 50% bone losss
up to 4-5mm probing depth
resolution
no resolution
surgical therapy
more than 50% bone losss
6mm probing depth or more
advanced care
no resolution
REFRACTORY
resolution
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
Ultrasonic
instrumentation
Hand instrumentation
SUBGINGIVAL SCALING AND ROOT

PLANING IS EFFECTIVE IF:
eliminates inflammation even in
deep pockets
reduces probing pocket depth
arrest the progression of
attachment loss
can lead to clinical attachment gain
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
PERIODONTAL SURGERY
POCKET RESECTION ?
NEW ATTACHMENT?
SURGICAL OR
CONSERVATIVE
APPROACHES?
WHICH CAN GUARANTEE MORE
PREDICTABLE HEALING AND
REGENERATION ?
WHICH TECHNIK IS THE

BEST ?
IMMEDIATE BENEFITS AND
RESULTS
LONG TERM RESULTS
RESECTIVE
PERIODONTAL
TECHNIQUES
GINGIVECTOMY
APICALLY REPOSITIONED FLAP
SURGERY
THE PERIODONTAL EPITHELIAL

AND CONNECTIVE TISSUE
ATTACHMENT REGENERATE AT
THE LEVEL OF THE BOTOM OF
THE ORIGINAL POCKETS
THE POSSIBILITIES OF
REATTACHMENT OR NEW
ATTACHMENT ARE EXCLUDED
THE
THE SURGICAL
SURGICAL TECHNIC
TECHNIC IS
IS
NOT
NOT AS
AS IMPORTANT
IMPORTANT
THE
THE MOST
MOST IMPORTANT
IMPORTANT IS:
IS:
TO
TO PERFECTLY
PERFECTLY ELIMINATE
ELIMINATE
SUBGINGIVAL
SUBGINGIVAL PLAQUE
PLAQUE AND
AND
LOCAL
LOCAL IRRITATING
IRRITATING AND
AND
PLAQUE
PLAQUE RETENTIVE
RETENTIVE FACTORS
FACTORS
THE CRITERIA OF SUCCESS

1. INFLAMMATION IS CEASED
2. PROBING POCKET DEPTH
REDUCED
3. GINGIVAL RECESSION
4. ATTACHMENT GAIN
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
Lang and Le studying dental students periodontal

condition found that min. 2 mm attached keratinized
gingiva can guaranty gingival health,
According to Corn (1962) min. 3 mm keratinized gingiva
is optimal for gingival health and can provide mechanical
protection for the marginal gingiva .
Lang and Le. The Realtionship between the
Width of the Keratinizated Gingiva and the
Gingival Health. Journal of Periodontology 1972;
43; 623-627.
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
The ultimate goal of the

periodontal therapy is not only to
arrest disease progression but
also to facilitate the regeneration of
the tissues of the attachment
apparatus.
In this way the final goal is the so
called restitutio ad integrum
healing
Reattachment :
The reunification of the collagen fibers of
the cementum and the collagen fibers of the
supporting periodontal tissues after acute
trauma or surgical separation
after acute separation the vitality of the
Saharpeys fibers is maintained for a while
and those fibers can for scare with the soft
tissues fibers .
New (connective tissue) attachment =

The reformation of cementum,
Sharpeys fibers and alveolar bone
after the total deterioration of the
attachment by chronic bacterial
infection or chronic trauma
Bone loss
Gingival
flap
bone
MEMBRANE
BONE
BEING
REBUILT
CLASS III
FURCATION
LESION
BEFOR
SURGERY
ONE YEAR
AFTER
SURGERY
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT
TIME
TIME SEQUENCE
SEQUENCE OF
OF THE
THE
CAUSE-RELATED
CAUSE-RELATED
PERIODONTAL
TREATMENT

Comprehensive Periodontal Therapy Ang 2013 v1

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TIME

THE MAIN OBJECTIVES OF

THE MAIN OBJECTIVES OF

THE MAIN OBJECTIVES OF

TO PRESERVE OR RATHER IMPROVE

THE MAIN OBJECTIVES OF

HOW TO APPROACH THE

non surgical therapy

SUBGINGIVAL SCALING AND ROOT

WHICH TECHNIK IS THE

THE PERIODONTAL EPITHELIAL

THE CRITERIA OF SUCCESS

Lang and Le studying dental students periodontal

The ultimate goal of the

New (connective tissue) attachment =

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