Treatment planning issues and case study

Phases of Care Planning Preliminary/priority Phase Emergency needs Phase I Initial Therapy/prep Non-surgical Phase II Surgical Care Phase III Restorative/Prosthetic Treatment Phase IV Maintenance

Overall Periodontal Prognosis Good: easily maintained by patient and clinician Fair: about 25% bone loss, class I furcations, good OH Poor: about 50% bone loss, maintainable class II & III furcations Questionable: >50% bone loss, unmaintainable Class II & III furcations Hopeless: not enough bone, extractions are recommended

Prognosis: Factors affecting prognosis of teeth Amount of bone Rate of destruction Pocket depths Bone loss pattern (vertical, horizontal) Type of bony defects (1 wall) Tooth mobility Root anatomy- root proximity Furcation involvement Crown to root ratio Amount /rate of Caries process Pulpal involvement Missing teeth Presence of contributory factors Infection/extent of caries

Weinberg’s recommendations for General Dentist/Periodontist Relationship Periodontal patients should be seen by general dentist Gingivitis or slight chronic periodontitis Total care by general dentist Moderate chronic periodontitis Alternate visits between periodontist and general dentist Severe chronic periodontitis/aggressive periodontitis Perio care should be by the periodontist with annual visits to general dentist

Guidelines for Periodontal Referrals by the AAP progressing chronic periodontitis especially w/ furca aggressive periodontitis perio w/ systemic disease perio w/ significant mobility endo-perio problems refractory concerns w/ esthetics (plastic surgery) mucotaneous disorders lichen planus, pemphigus etc skills/expertise/knowledge of provider

William Health History 49 yr old black male Hypertension Takes 20mg Lisinopril 1xdaily in the morning Self reports Job/life related stress ASA III

Dental History Brushes with hard bristle tooth brush 1x daily No flossing Grinds his teeth (pt. doesn’t own a night guard) Bites his cheeks and tongue Last dental visit was 6 years ago & had several extractions due to periodontal abscesses

Intra oral Photos

Dental Charting

Periodontal Charting

Assessment Findings Generalized tenacious rings & ledges of calculus both subgingivally and supragingivally Plaque index 62% Faulty restorations on 1,3,16,17,18,19,30,31

Radiographs

What is the periodontal diagnosis? What is the MCC/AAP case type? What is the new staging and grading? What is the dental hygiene diagnosis? How many visits would you treatment plan? What type of instruments would you use first? What referrals do you need to give? What would you recommend for Self care? What treatment should be given first? What is the prognosis?