Following periodontal treatment, an equilibrium is achieved between both of these factors, which favor the ……… Contents available in the book …….. Routine scale and polish for periodontal health in adults. Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. For example, for a 40-year old patient, The relationship of systemic diseases such as diabetes mellitus with periodontal disease progression is well established. If re-instrumentation is done at healthy sites, it may result in further attachment loss, Â Â Â Â The sites which are re-infected should be given particular attention during the maintenance visits. Functional diagram of a high-risk patient. Contents available in the book …….. Periodontal maintenance therapy is an integral part of complete periodontal treatment. NIH The subjects enrolled in the study had no access to dental care. To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis. Contents available in the book …….. Now, let us discuss the difference between periodontal status and tooth loss in patients who are not treated for periodontal disease and those who are put on a regular periodontal maintenance therapy. The results of the study suggested that risk scores ……… Contents available in the book …….. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. However, clinically it can be measured with the use of graduated periodontal probes. Other oral health problems that may include caries, defective restorations, and non-periodontal mucosal diseases or conditions. Contents available in the book …….. A constant force of 0.25 N should be used to probe all the sites. In another 3 year study, Suomi et al. Once the active periodontal treatment is completed, the parameters determining periodontal maintenance or supportive periodontal therapy are entirely different from parameters with which the patient initially reported with active disease. Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 2 Clinical attachment level mm (change scores). Mombelli A. This is because of the reason that a single factor cannot be used as an accurate indicator of actual recurrence risk for periodontal disease. Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. Contents available in the book …….. The most effective way of assessing bone loss around dental implants is conventional or digital subtraction radiography. She will provide you with a maintenance program of care, usually every three months, to keep your gums healthy. However, the mandibular stability can be assured with premolar to premolar occlusion even if some teeth are lost and the dental arch is shortened (20 teeth) 71, 72. After periodontal therapy, once healing is complete, first reading should be considered as the baseline for long-term clinical monitoring 111. In a study, Listerine was used around the dental implant as a subgingival irrigation solution and its effect in plaque reduction and inflammation reduction was evaluated. doi: 10.1002/14651858.CD004625.pub5. In the functional diagram ……… Contents available in the book …….. Contents available in the book …….. The first study to check patient compliance was done by Wilson et al. Most important of these factors are the host and microbial interactions. The results of the study showed that only 16% of the patients completely complied with periodontal maintenance therapy intervals, 34% never returned for periodontal maintenance therapy, and the rest complied erratically. The risk assessment is done on the basis of systemic and local predictors. Number of sites with probing depth â¥5 mm, Dentition risk system (DRS) at both the patient and tooth level. Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Contents available in the book …….. Contents available in the book …….. Supportive Periodontal Therapy Maintenance phase Recall/re-evaluation Supervised recall programme 2. Cohen RE. Â Â Â Â In another study Backer et al. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Risk of bias summary: review authors' judgements about each risk of bias item for each included study. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Re-evaluation of risk factors associated with the patient such as age, smoking, diabetes, cardiovascular disease, and any other systemic conditions which may affect the periodontal disease progression. However, it must be understood that the periodontal maintenance visits should be scheduled based on individual risk assessment for recurrence of the disease 112. Local or systemic delivery of chemotherapeutic agents may be used as adjunctive treatment for the recurrent or refractory disease. In these patients, at least two parameters are in the high-risk category. Periodontal disease is an infection of the gums and the supporting structures of … Contents available in the book …….. On the other hand, one study found ……… Contents available in the book …….. Some patients may present with wear facets at the cervical regions of teeth, which indicates overzealous and/or faulty tooth brushing. 2020 Summer;11(3):355-360. doi: 10.34172/jlms.2020.57. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). Patients were treated by one of the five procedures to eliminate probing depth. The results of the study showed that ……… Contents available in the book …….. Contents available in the book …….. 0.25 N is a light force which induces bleeding only from the inflamed gingiva. Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. 1. Contents available in the book …….. 25-50% of the root length) may be considered as a reliable prognostic indicator for the stability of the overall treatment goal of keeping a functional dentition for a lifetime 77. Despite free treatment offered nonworking class showed poor compliance. Contents available in the book …….. Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus nonâspecialist clinicians, Outcome 1 Bleeding on probing (%). The constant presence of plaque in subgingival areas such the under the margins of subgingival restorations has been shown to change the ecological ……… Contents available in the book …….. Results demonstrated a significant reduction in plaque index, gingival index and bleeding index with no significant reduction in probing depth 136. The status of dental implants and their surrounding tissue is evaluated. Various forms of periodontitis can be efficiently treated with non-surgical and surgical therapy, but periodic periodontal maintenance is important for the maintenance of periodontal health after active periodontal treatment. Contents available in the book …….. Â Â Â Â These observations have been supported by many other studies which have examined the patients who are on periodic periodontal maintenance and those who are not 12, 17-19. However, in one study Geiger (2001) 99 found a possible association between periodontal problems and certain malocclusions such as anterior overjet and overbite, crossbite etc. However, in a position paper by the American Academy of Periodontology, term periodontal maintenance was preferred over supportive periodontal therapy, Â Â Â Â Periodontal maintenance is an integral part of periodontal treatment and is performed at regular intervals on the patient by the dentist, although some components of the treatment can be performed by a dental hygienist under the supervision of the dentist. Many studies 12, 17, 20-22 have evaluated the effect of periodic periodontal maintenance on gingival inflammation. In one study Rapley et al. Â Â Â Â In a similar study, which examined patient’s periodontal status for an average of 19 years, Â Â Â Â These observations have been supported by many other studies which have examined the patients who are on periodic periodontal maintenance and those who are not, Effect of periodontal maintenance on gingivitis, ……… Contents available in the book …….. Sites with BOP/suppuration are recorded which indicate re-infection. The Rationale for Supportive Periodontal Care In the 1970s and 1980s a series of classic, longitudinal studies were carried out to assess the efficacy of SPC in patients with advanced periodontitis and who had received surgical or non-surgical therapy. Carolina Manresa: none knownElena SanzâMiralles: none knownJoshua A Twigg: none knownManuel Bravo: none known. doi: 10.1016/j.adaj.2018.02.020. Another important factor is genetic susceptibility. Supportive Periodontal Care After Michael Matsuda, DDS or Melvin Matsuda, DDS, PC have completed the active phase of periodontal treatment, your periodontal disease will be under control. Main results: Evaluation of current extra- and intraoral periodontal and peri-implant soft tissues as well as dental hard tissues and referral when indicated (e.g., for the treatment of carious lesions, pulpal pathosis, or other conditions) and diagno-stic quality radiographs when appropriate. Let us start by discussing, what happens if periodontal disease is not treated? Periodontal diseases. (1974) 96, Katz (1978) 97 and Buckley (1980) 98 found no association between the amount of plaque or periodontal parameters and malocclusion (including crowding and spacing). Through a poster competition, Carolina Manresa and Elena SanzâMiralles were awarded a scholarship by SEPA to the course "Evidence Based Dentistry" (Prof. Ian Needleman, Madrid, 7 to 8 November 2008). The last step during a periodontal maintenance visit is to determine the recall interval for the next visit. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. Intra-oral hard tissue and soft tissue examination is done. Contents available in the book …….. Contents available in the book …….. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. Many patients think that the active phase of the periodontal treatment is âcureâ for their periodontal problems and express surprise at the need for further treatment of recurrent disease, or the need to attend recall visits during maintenance therapy. Definition • Procedures performed at selected intervals to assist the periodontal patient in maintaining oral health. Other factors used to calculate risk were patient’s age, smoking activity, diabetic status and periodontal history. Loss of periodontal support in relation to the patient’s age. Contents available in the book …….. However, in a position paper by the American Academy of Periodontology, term periodontal maintenance was preferred over supportive periodontal therapy 1. The percentage estimated is then divided by the age of the patient (BL/age). An increased crown root ratio results in increased lateral tooth mobility. | Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The well-maintained patients lost 27% of the furcation involved teeth; while moderately ……… Contents available in the book …….. Contents available in the book …….. The periodontal status in terms of alveolar bone loss (which utilized digital radiographs) and tooth loss (clinical records) was assessed at 3, 9 and 15 year. The residual alveolar bone support is an important risk factor for tooth loss due to further bone loss. Each parameter assessed is allocated a score. Contents available in the book …….. Helm and Petersen (1989b) 94 and GÃ¡bris et al. Contents available in the book …….. Contents available in the book …….. Â Â Â Â These studies included patients who were regularly recalled for periodontal maintenance and who were maintaining a good oral hygiene. (1977) 9 in a study on 25 patients with advanced periodontal disease observed the progression of periodontal disease where after periodontal treatment, no periodontal maintenance was provided. (1971) 24 investigated the effect of regular periodontal maintenance on gingival inflammation and attachment loss. Functional diagram of a moderate-risk maintenance patient. A vertical bone loss less than 1.5 mm during the first year and 0.2 mm every subsequent year has been offered as the criterion for the clinical success of dental implants 134. Contents available in the book …….. Clinical attachment loss is indicative of periodontitis. One of the most important steps during a periodontal maintenance visit is patient motivation as it affects compliance and home care of a patient. It has been shown by various studies that teeth with reduced periodontal support, but healthy periodontium can function for several years either individually or as abutment provided that the occlusal load does not cause trauma to the periodontium, Increased tooth mobility indicates two probable reasons: loss of periodontal support or increased occlusal load. Together with your general dentist, Dr. Abdeen will provide you with a personalized maintenance program of care to keep your periodontal tissue condition under good control. Contents available in the book …….. Cochrane Database Syst Rev. However, if the periodontal ……… Contents available in the book …….. It is clinically measured as the distance of the epithelial attachment from the cementoenamel junction which is the normal site for epithelial attachment. Oral hygiene and maintenance of periodontal support. The five parameters included. 2. Contents available in the book …….. In a study on healthy male Spanish military recruits, the clinical parameters to estimate the degree of periodontal disease were evaluated. Contents available in the book …….. Now, let us try to find out that what happens to the periodontal status of patients who are treated and not maintained? If re-instrumentation is done at healthy sites, it may result in further attachment loss 125. Prevalence of residual pockets greater than 4 mm (â¥5 mm). Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor-Ejiofor Z. Cochrane Database Syst Rev. Another important factor to be considered here is crown root ratio. Helping patients manage their gum disease. Sites which demonstrate BOP frequently during maintenance visits ……… Contents available in the book …….. The term periodontal maintenance can be used interchangeably with the term supportive periodontal therapy. It has been used as a good indicator of assessment of periodontal inflammation and has been incorporated into index systems for the evaluation of periodontal conditions 69, 70. The presence of calculus at the cementoenamel junction may lead to the inaccurate recording of attachment loss. Loss of teeth from a total of 28 teeth. To understand the rationale for perio-dontal maintenance therapy, we must find out the answers to some questions. Cochrane Database Syst Rev. The residual alveolar bone support is an important risk factor for tooth loss due to further bone loss. The algebraic sum of the parameter scores is calculated and relates to a risk score between 1 (lowest risk) to 5 (highest risk). Contents available in the book …….. Cochrane Database Syst Rev. It has been recommended that instead of the instrumentation of all the tooth surfaces, only those sites, which exhibit signs of inflammation and /or active disease progression should be treated by SRP. Prevention of plaque formation around implant. Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 1 Fullâmouth mean clinical attachment level mm (final scores). Contents available in the book …….. | Save my name, email, and website in this browser for the next time I comment. Time interval varying from 2 weeks 4, 3 months 19 to 4-6 months 16 have been suggested. In certain cases, surgical access may be required for appropriate debridement of the re-infected area. Loss of teeth from a total of 28 teeth. Environmental factors such as cigarette smoking. The main differences between PRA and modified PRA model are 91. Australian dental journal. Diabetic status, The most important part of maintenance therapy is patient motivation. Various long term studies were done in the late 60’s continuing into the 70’s and 80’s which compared the long-term outcome of periodontal surgical and non-surgical procedures. These studies were done by various group of researchers and are recognized by their geographic location, such as, Â Â Â Â These studies included patients who were regularly recalled for periodontal maintenance and who were maintaining a good oral hygiene. These patients should be, The treatment during a maintenance visit primarily involves scaling and root planing (SRP) and treatment of re-infected sites. The relationship of systemic diseases such as diabetes mellitus with periodontal disease progression is well established. The results of the study showed that all the clinical parameters except probing depth increased during the course of study. Contents available in the book …….. An increased crown root ratio results in increased lateral tooth mobility. “Supportive periodontal therapy (SPT)” is a term suggested by the 3rd World Workshop of the American Academy of Periodontology (AAP, 1989). 1982 Jan;53(1):26-30. 1993 Jul 1;24(7). When active treatment is complete, supportive therapy maintains the health improvements achieved. Patientâs compliance can be improved by repeated counseling of the patient. In certain cases, surgical access may be required for appropriate debridement of the re-infected area. Microbiological investigations revealed an increased prevalence of periodontal pathogens, including Aggregatibacter actinotnycetemcomitans (40%), Porphyromonas gingivalis (67%), Prevotella intermedia (66%), Fusobacterium nucleatum (79%), and Bacteroides forsythus (16%). The most common reasons for noncompliance include personal reasons, economic reasons, psychological reasons and mere ignorance. However, it has been observed that behavioral management can provide positive reinforcement and may significantly improve the patient compliance 122. The authors considered alveolar bone loss in relation to patient’s age as the fourth parameter for risk of disease recurrence in the functional diagram. Periodontal maintenance (Supportive periodontal therapy) Introduction to periodontal maintenance Periodontal diseases are multifactorial diseases where host-microbial interactions lead to the destruction of periodontal soft and hard tissues. Eberhard J, Jepsen S, JervÃ¸e-Storm PM, Needleman I, Worthington HV. It has been demonstrated by various studies that tooth mobility may vary before, during and after periodontal treatment, The common iatrogenic factors responsible for periodontal disease recurrence are overhanging restorations and ill-fitting crown margins. Here, at least two parameters in the moderate category, but at the most one parameter in the high-risk category. The most common causes of re-infection are incomplete instrumentation during active periodontal treatment and inadequate plaque control by the patient. Contents available in the book …….. The re-infected sites may exhibit suppuration and are treated by thorough instrumentation under anesthesia. Periodontal Maintenance Supportive Periodontal Care. During periodontal maintenance, our primary goals to maintain implant health are. The active treatment of the patients included scaling/root planing, hemisection and flap surgery. Contents available in the book …….. Please enable it to take advantage of the complete set of features! Contents available in the book …….. Shang L, Liu Z, Ma B, Shao J, Wang B, Ma C, Ge S. Bioact Mater. A progressive increase in tooth mobility indicates of these two underlying causes. The primary objectives of periodontal maintenance therapy are. The term periodontal maintenance can be used interchangeably with the term supportive periodontal therapy. An association of crowding with more plaque accumulation has been investigated by various researchers. Contents available in the book …….. Merin’s classification is also helpful in determining the recall intervals during periodontal maintenance therapy. The individual risk assessment determines the frequency of calling a patient for professional support so that the initiation of periodontal disease may be stopped. Bleeding on probing (BOP) is one of the first signs of inflammation. The periodontal disease is treated with non-surgical and /or surgical periodontal therapy and the patient is reassessed for periodontal status and other factors influencing the disease progression. However, tooth mobility may temporarily increase following surgical periodontal therapy during the healing period and may gradually reduce later on. During these appointments, subjects were reinforced regarding the maintenance of oral hygiene and supra and subgingival scaling was done. Patient motivation should be based on the individual needs of a patient. Ongoing assessment of risk factors to identify an individual who may be more highly susceptible to ongoing breakdown of the periodontal or peri-implant tissues, with elimination or mitigation of new or persistent risk and etiologic factors with appropriate treatment. Multilevel risk assessment helps in more accurate planning of the maintenance therapy for a patient as compared to single-level risk assessment because it allows the assessment of the influence of patient-based factors such as smoking, diabetes etc. 2004 Oct;36(1):179-95. Contents available in the book …….. Early recognition and prevention of the disease recurrence. Shen Z, Kuang S, Zhang Y, Yang M, Qin W, Shi X, Lin Z. Bioact Mater. Presently, various single nucleotide polymorphisms have been identified (TNF-Î±, IL-4, IL-6, IL-10, human Leukocytic Antigen polymorphism, Fc Î³ receptor (FcÎ³R) gene ……… Contents available in the book …….. According to the authors, missing teeth are indicative of a patient’s history of oral diseases and trauma and therefore should be considered as a parameter for risk assessment. Trials must have had a minimum follow-up period of 12 months. Dental implants have been widely used as a successful alternative to fixed and removable prosthodontic restorations 128, 129. Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 2 Fullâmouth mean probing depths mm (final scores). Many studies have been done to determine the best time interval between the maintenance visits so that an optimum periodontal health of the patient can be achieved. This therapy has also been referred to as periodontal maintenance (Cohen, 2003). The presence of calculus at the cementoenamel junction may lead to the inaccurate recording of attachment loss. Together, you, your general dentist and Dr. Zakaria will work out the most effective schedule for your supportive periodontal care. However, the diagnostic value of probing around dental implants remains controversial 132, 133. This review aimed to assess the evidence available from randomised controlled trials (RCTs). These findings have been supported by another study, which ……… Contents available in the book …….. We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Percentage of bleeding on probing. A good communication between the dentist and patient should be established to explain the patient the importance of periodontal maintenance therapy. A radiographic examination is done to evaluate the current status of bone support surrounding the teeth and implants, including the bone quality/quantity and establishment bone loss pattern. These variables were entered into the risk calculation. Maintenance therapy for teeth and implants. The answer depends on you and the severity of your gum disease before treatment. Elimination of occlusal abnormalities associated with implant abutment. Â Â Â Â During every periodontal maintenance visit, sites with BOP should be registered. Selection criteria: If found absent, these factors are not considered as a component of risk assessment for disease recurrence. If these factor/factors are found to be present in the patient, the area of high risk is marked for this vector. Â Â Â Â The ideal outcome of non-surgical and surgical periodontal treatment is the ……… Contents available in the book …….. The periodontal environment is very dynamic and there are various factors which determine periodontal health. Quizlet flashcards, activities … However, it must be understood that the periodontal maintenance visits should be scheduled based on individual risk assessment for recurrence of the disease, Â Â Â Â The first year following periodontal treatment is more critical in terms of motivating the patient to participate in the recall periodontal maintenance program and also to reinforce the oral hygiene techniques used by the patient. During the maintenance phase of periodontal therapy, the clinician can re-evaluate the patient and modify treatment according to the presence of risk factors. Patients without maintenance therapy demonstrated progressive furcation involvements, no reduction in probing depth and worsening of bone scores. Contents available in the book …….. Â Â Â Â Lang and Tonetti have considered smoking as the sixth risk factor for recurrent disease in the functional diagram of risk assessment. Supportive Periodontal Therapy is carried out after completion of active periodontal treatment; it must be stressed that it is a vital, ongoing, part of successful periodontal therapy. (1990) 108 have demonstrated that absence of BOP represents a reliable indicator of periodontal stability. De la Garza-Ramos MA, EstupiÃ±an-Lopez FH, Gaona-Tiburcio C, BeltrÃ¡n-Novelo LG, Zambrano-Robledo P, Cabral-Miramontes J, Almeraya-CalderÃ³n F. Materials (Basel). Periodontal maintenance involves a periodic review of the medical and dental status of the ……… Contents available in the book …….. The mean tooth loss calculated was ……… Contents available in the book …….. However, clinically it can be measured with the use of graduated periodontal probes. 3. Epub 2020 Aug 18. Contents available in the book …….. Maintenance therapy is an ongoing protocol designed to… Supportive periodo ntal therapy is the means by which proper maint enance and care c an be giv en to the patient. Clinical and microbiological putative factors in periodontal disease types of periodontal support or increased load... Calculate risk were patient ’ s classification system is widely used for patient recall following the active of. Arch may be considered as a component of risk assessment also helps in more accurate of... Increase following surgical periodontal treatment is the first sign of periodontal stability positively related to destruction... 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