Rationale for periodontal treatment contents Introduction Objectives of

Rationale for periodontal treatment

contents �Introduction �Objectives of periodontal �Local therapy �Systemic therapy �Factors affecting healing �Regeneration �Repair �New attachment �Reconstruction �Conclusion therapy

introduction �The effectiveness of periodontal therapy is made possible by the remarkable healing capacity of the periodontal tissues. periodontal therapy can restore chronically inflamed gingiva so that , from a clinical and structural point of view , it is almost identical with gingiva that has never been exposed to excessive plaque accumulation.

Objectives of periodontal therapy If properly performed , periodontal treatment can accomplish the following �Eliminate pain �Eliminate gingival inflammation �Eliminate gingival bleeding �Eliminate infection �Reduces periodontal pockets and mobility of teeth

�Stops pus formation �Arrest the destruction of soft tissue and bone �Establish optimal occlusal function �Restores tissue destroyed by disease �re-establish the physiological gingival contour �Prevent the recurrence of disease �Reduces tooth loss

Local therapy �The cause of periodontitis and gingivitis is bacterial plaque accumulation on tooth surface close to gingival tissue �The accumulation of plaque can be favoured by a variety of local factors such as calculus, overhanging margins of restorations and food impaction �The removal of plaque and all of its accumulation is primary goal in local therapy

The elimination of trauma may increase the chances for bone regeneration and gain of attachment Total plaque elimination obtained in experimental studies may not be possible in human subjects

Systemic therapy �Empolyed as an adjunct to local measures �Used for controlling systemic complications from acute infections and preventing harmful effects of post treatment �In conjunction with local therapy is indicated in patients with aggressive periodontitis �Systemic antibiotics are used to eliminate the bacteria that invade gingival tissue and can re populate the

�The classic 1979 paper by nyman , schroeder and lindhe reported it was possible to block periodontal bone loss in animal with aspirin like drug indomethacin �Drugs like ibuprofen reduce the development of experimental gingivitis �The drug that has a stong inhibitory effect on bone resorption is alendronate which is currently used to treat metabolic disease such as paget’s disease

Factors that affects healing Local factors -Healing is delayed by local factors such as �Contamination by micro-organism �Irritation from plaque �Necrotic tissue remnants �Food debris �Excessive tissue manipulation during treatment �Trauma from occlusion �Trauma to tissues �Repentive treatment procedures

Healing is improved by � debridement �local increase in temperature �immobilisation of healing area � pressure on the wound

Systemic factors �Healing is delayed in �Older patients �Generalised infections �Insufficient food intake �Vitamin c deficiency �Increased levels of hormones �Systemic stress �Thyroidectomy �Levels of testosterone and estrogen �Adreno corticotropic hormone

Healing after periodontal therapy Regeneration �It is the biological process by which the architecture and function of lost tissues are completely restored by formation of new periodontal ligament, alveolar bone and cementum �It occurs through growth from the same type of tissues that has been destroyed or from its precussor �It is a wear and tear repair �Bacteria and bacterial products along with inflammatory exudate are injuries to regenerating cells and tissues thus preventing completion of healing process

A-periodontal pocket before treatment, B-normal sulcus at level base of the pocket, C-new attachment

repair �It is the healing of tissue without completely restoring the lost tissues �It restores the continuity of diseased marginal gingiva and re-establishs a normal gingival sulcus at the same level on the root as the base of pre existing periodontal pocket this is healing by scar �Arrest bone destruction but does not result in gain of gingival attachment

Sources of regenerating cells, left- infra bony pocket, right- clot formed is invaded by cells from A-marginal epithelium , B-gingival connective tissue, C-bone marrow, Dperiodontal ligament

New attachment �This is the reunion of connective tissue with a root surface that has been pathologically exposed �It is the embedding of new periodontal ligament fibres into new cementum and the attachment of gingival epithelium to a tooth surface previously denuded by disease

areas of cementum, A- denuded by pocket formation, B-covered by junctional epithelium, C-apical to epithelium, D-new attachment

�Epithelial adaptation differs from new attachment in that it is in close apposition of gingival epithelium to the tooth surface, with no gain in height of gingival fibre attachment

Epithelial adaptation after periodontal treatment, A-periodontal pocket, B-after treatment

Re attachment �It is the healing by reunion of the periodontal connective tissue and tooth root where the two tissues have been seperated by incision or injury �Example –temporarily moving healthy tissue away from tooth root or bone �It is the repair in areas of root not previously exposed to pockets such as after surgical detachment or following traumatic tears in the cementum, tooth fractures, or treatment of peri apical lesions

reconstruction �It refers to process of regeneration of cells and fibres and remodelling of lost periodontal stuctures �It results in gain of attachment level, formation of new periodontal ligament fibres, a level of alveolar bone coronal to that present before treatment

During the healing stages , the area invaded by cells from four different sources �Oral epithelium �Gingival connective tissue �Bone �Periodontal ligament

�Final outcome of periodontal pocket healing depends on the seques of events during healing stage �Melcher pointed out that the regeneration of periodontal ligament is the key to new attachment because it provides continuity between the alveolar bone and the cementum and also it contains cell that can synthesize and remodel three connective tissues of supporting stuctures of periodontium

conclusion �Rationale for periodontal treatment are elimination of gingival inflammation, cessation of gingival bleeding, elimination of periodontal pocket, re-establishment of periodontal health, arrest of bone loss, reduction of abnormal tooth mobility, establishment of optimal occlusal relationships, restoration of destroyed periodontal tissues and prevention of reccurence