SUPPORTIVE PERIODONTAL TEATMENT MAINTENANCE PROGRAM SUPPORTIVE PD TEATMENT

SUPPORTIVE PERIODONTAL TEATMENT MAINTENANCE PROGRAM ﺭﺍﺋﺪ ﻋﺰﻳﺰ ﺑﺪﻳﻊ. ﺩ. ﺃ

SUPPORTIVE PD TEATMENT MAINTENANCE PROGRAM • After Phase I therapy (Cause related phase PLAQUE CONTROL) is completed, patients are placed on a schedule of periodic recall visits for maintenance care to prevent recurrence of the disease. • Transfer of the patient from active treatment status to a maintenance program is a definitive step in total patient care that requires time and effort on the part of the dentist and staff.

• The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth. • Maintenance of PD starts immediately after the completion of Phase I therapy. • While the patient is in the maintenance phase, the necessary surgical and restorative procedures are performed.

• Even with good periodontal therapy, some progression of disease is possible. explanation for the recurrence of periodontal disease is incomplete subgingival plaque removal. • The regrowth of subgingival plaque is a slow process compared with that of supragingival plaque. During this period (perhaps months), the subgingival plaque may not induce inflammatory reactions that can be observed at the gingival margin.

• Thus inadequate subgingival plaque control can lead to continued loss of attachment, even without the presence of clinical gingival inflammation. • Eradication of intragingival microorganisms may be necessary for a stable periodontal result.

• BOX -1 Maintenance Recall Procedures • Part I: Examination (Approximate time: 14 minutes) Patient greeting • 1 - Medical history changes • 2 - Oral pathologic examination • 3 -Oral hygiene status • 4 -Gingival changes • 5 -Pocket depth changes • 6 -Mobility changes • 7 -Occlusal changes • 8 - Dental caries Restorative, prosthetic, and implant status

• Part II: Treatment (Approximate time: 36 minutes) Oral hygiene reinforcement Scaling Polishing Chemical irrigation or site-specific antimicrobial placement Part III: Report, Cleanup, and Scheduling • (Approximate time: 10 minutes) Write report in chart. Discuss report with patient. Clean and disinfect operatory. Schedule next recall visit. Schedule further periodontal treatment. Schedule or refer for restorative or prosthetic treatment.

• Checking of Plaque Control • To assess the effectiveness of their plaque control, patients should perform their hygiene regimen immediately before the recall appointment. • Plaque control must be reviewed and corrected until the patient demonstrates the necessary proficiency, even if additional instruction sessions are required.

• Treatment • The required scaling and root planing are performed, followed by an oral prophylaxis. • Care must be taken not to instrument normal sites with shallow sulci (1 to 3 mm deep)

• because studies have shown that repeated subgingival scaling and root planing in initially normal periodontal sites result in significant loss of attachment

Irrigation with antimicrobial agents or placement of site-specific antimicrobial devices is performed in maintenance patients with remaining pockets.

Incorrect Figure (1): Incorrect sequence of PD treatment phases.