Treatment Plan

Treatment plan

• Treatment plan is the blue print for case management • After diagnosis & prognosis, treatment is planned • Includes all procedures required for the establishment &maintenance of oral health

• Unforeseen developments may necessitate modification of treatment plan • Except for emergencies, no treatment to be started unless treatment plan has been established

Master plan for treatment • Total treatment • Primary goal is elimination of gingival inflammation and correction of conditions that cause and/or perpetuate it

Extracting or preserving a tooth • Periodontal treatment value measured in years of healthy functioning of the entire dentition , not by the number of teeth retained at the time of treatment • Periodontal condition of teeth to be retained is more important than the number of such teeth

• Removal, retention or temporary retention of one or more teeth is a very important part of overall treatment plan – Tooth will be extracted – Tooth will be retained if prognosis good to excellent – Tooth will be retained temporarily

Therapeutic procedures • Periodontal therapy is an inseparable part of dental therapy • In phases of periodontal therapy, other procedures not performed by periodontist is listed to emphasize the close relationship of periodontal therapy with other phases of therapy

Phases of periodontal therapy • • • • •

Preliminary phase Etiotropic phase – phase I Surgical phase – phase II Restorative phase – phase III Maintenance phase – phase IV

Preferred sequence Emergency phase Etiotropic phase

Maintenance phase

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Surgical phase

Restorative phase

Preliminary phase Treatment of emergencies • • • •

Dental or periapical Periodontal Other Extraction of hopeless teeth and provisional replacement if needed

Etiotropic phase

(plaque control &patient education)

• Diet control • Removal of calculus & root planing • Correction of restorative & prosthetic irritational factors • Excavation of caries & restoration- temp or final • Antimicrobial therapy- local or systemic • Occlusal therapy • Minor orthodontic movement • Provisional splinting & prosthesis

Evaluation of response to etiotropic phase Rechecking • Pocket depth & gingival inflammation • Plaque & calculus, caries

Surgical phase • Periodontal therapy including placement of implants • Endodontic therapy

Restorative phase • Final restorations • Fixed and/ or removable prosthodontics

Evaluation of response to restorative procedures • Periodontal examination

Maintenance phase periodic rechecking • Plaque & calculus • Gingival condition- pockets, inflammation • Occlusion, tooth mobility • Other pathologic changes