Transcript Chapter 29
29 Periodontics Periodontal Team • Periodontist – Screens patient and coordinates with dentist • Dental assistants – Room preparation, chairside assisting • Dental hygienists – Cleaning, examinations • Business office staff 2 Dental Assistant’s Role • • • • • • • Place and remove periodontal dressing Remove sutures Coronal polish Radiographs Impressions Fluoride treatments Patient education 3 Periodontal Disease • Symptoms – Bleeding or inflamed gums – Periodontal pockets – Malocclusion – Halitosis – Tissue recession, abnormal contour – Pain, tenderness, discoloration 4 Causes of Periodontal Disease • • • • • • Local irritants Poor oral hygiene Improper nutrition Malocclusion Stress Systemic factors – Hormonal imbalance, diseases, medications 5 Classification of Periodontal Disease • Gingivitis – Plaque induced – Non-plaque induced 6 Classification of Periodontal Disease • Periodontitis – Chronic • Necrotizing Ulcerative Gingivitis (NUG) – Inflamed gingiva, metallic taste, bad breath, pain, tissue hemorrhage 7 Classifications of Periodontal Disease Unhealthy Tissue Sublingual Calculus 8 Periodontal Diagnostic Procedures • Medical Dental History – Questionnaire should include • • • • Chief complaints Medical history Oral history Oral habits 9 The Extraoral Examination 10 The Intraoral Examination 11 Periodontal Examination • • • • Plaque Periodontal probes Tooth mobility Furcation involvement 12 Periodontal Examination • • • • Appearance of gingiva Bleeding/suppuration Recession Occlusion 13 Radiograph Interpretation Vertical bone loss Horizontal bone loss 14 Presentation of Treatment Plan • • • • Treatment plan Appointment scheduled Educate patient Financial arrangements made 15 Periodontal Instruments • Instrument sharpening – Manual and mechanical methods • Periodontal probes – Calibration needed 16 Periodontal Instruments • Explorers – Adapt to curves and tooth surfaces • Curettes – Universal – Gracey 17 Periodontal Instruments • Scalers remove hard deposits – Sickle – Jacquette – Chisel – Hoe • Files remove calculus • Ultrasonic Instrument – High-powered vibrations with water 18 Scaler and Curette Working end of a scaler Working end of a curette 19 Instrumentation Techniques Supragingival Subgingival 20 Periodontal Instruments • Periodontal knives – Broad blade • • • • • Interdental knives Periotomes Surgical scalpel Electrosurgery Pocket marking pliers 21 Lasers • Precise beam of concentrated light energy • Efficiency based upon absorption rate of wavelengths • Dentist must be trained and qualified to use laser 22 Lasers • Uses – Debridement and curettage – Gingivectomy – Gingivoplasty – Frenectomy – Tumor and lesion removal – Implant exposure 23 Lasers • • • • • • • Aphthous ulcer treatment Tissue fusion Elimination of granulation tissue Biopsy Crown lengthening Control bleeding Osseous procedures 24 Lasers • Benefits – Bloodless operating field – improves vision – Minimal to no anesthesia – Minimal swelling and discomfort – Improved coagulation 25 Lasers • Benefits – Minimal healing time – Reduction of tissue damage and infection – Accuracy – Less time 26 Nonsurgical Procedures • Occlusal adjustments – Teeth occlude evenly • Scaling and polishing – Removal of plaque 27 Nonsurgical Procedures • Root planing – Scraping of root surfaces • Gingival curettage – Soft-tissue curettage scraping 28 Surgical Periodontal Procedures • Gingivectomy – Surgical removal of diseased gingival tissue • Gingivoplasty – Reshaping of gingival tissues 29 Surgical Periodontal Procedures • Periodontal Flap Surgery – Separation of gingiva and underlying tissue 30 Surgical Periodontal Procedures • Osseous Surgery – Reshaping of the bone • Mucogingival Surgery – Reconstructive surgery on gingiva and mucosal tissues – Covers exposed roots 31 Surgical Periodontal Procedures • Gingival Grafting – Tissue graft from palate – Donor site dressed • Frenectomy – Complete removal of frenum 32 Surgical Periodontal Procedures • Guided tissue regeneration – Uses barrier membranes to maintain space between the gingival flap and root surface – Prevents interference of cells forming new structures 33 Periodontal Dressing • • • • Zinc oxide eugenol Noneugenol Light-cured Gelatin-base 34 Periodontal Maintenance Procedures • Patient must be committed to ongoing therapy • Maintain plaque control 35 Advanced Chairside Functions • Coronal Polish – Removal of soft deposits, extrinsic stains • Rubber prophy cup • Prophy brush • Abrasives 36 Coronal Polish Rationale • • • • • Easier to keep teeth clean Motivates patient to maintain Slows accumulation of new deposits Better absorption of fluoride Prepares tooth for other procedures 37 Contraindications and Modifications • • • • Orthodontic appliances Hypersensitive teeth Green chromogenic bacterial stain Minor oral irritations 38 Dental Deposits • Soft deposits • Calculus • Stains 39 Intrinsic Stains • • • • Dental fluorosis Pulp damaged or non-vital tooth stain Tetracycline stain Metallic stain 40 Extrinsic Stain • • • • • • Yellow and brown stains Tobacco stain Green stain Black line stain Orange stain Chlorhexidine stain 41 Abrasives and Polishing Agents • Abrasives – Powders or pastes used to remove soft deposits on teeth – There are many varieties 42 Equipment and Supplies • • • • • Handpiece Abrasives Rubber prophy cup Prophy brush Dental tape or floss 43 Maintaining the Operating Field • • • • Free of saliva and debris Maximum light Maintain patient comfort Maintain proper positioning 44 Auxiliary Polishing Aids • • • • Bridge threaders Abrasive polishing strips Soft wood points Interproximal brushes 45