Lecturer:Levkiv Mariana O.

Department of Therapeutic Dentistry

TSMU

General plan of periodontal diseases treatmentGeneral principles:Aetiological treatmentPathogenetic treatmentSymptomatic treatment

Local treatment Removal of local irritation factors-Is aimed to remove local factors of irritation- dental deposits, carious cavities, traumatic occlusion. Elimination of traumatic occlusion - selective teeth grinding, temporary or permanent teeth splinting.

Removal of dental depositsOral hygieneTreatment of caries and its complicationsOrthodontic treatmentProsthetic treatment

Anti-inflammatory treatmentPharmacotherapy of microcirculatory disordersInfluence on tissue’ metabolismStimulation of regeneration processesAntibacterial treatment

Physiotherapy treatmentElectropathyHydro-treatmentMassagesLaser-treatment

General treatmentTo stimulate immune defense of organismGeneral-strengthening treatmentGeneral treatment of major diseases of the bodyDiet-therapy

Oral hygiene The main goal of treatment is to control

the infection.  The number and types of treatment will vary, depending on the extent of the gum disease.  Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.

1.Before conducting professional hygiene

2. After conducting professional hygiene

1 2

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. 

Scaling means scraping off the calculus from above and below the gum line.  Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.  In some cases a laser may be used to remove plaque and calculus. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.

Dental Deposits removing with the help of scaling

Tooth Cleaning by ultrasoundThe ultrasound method is based on the effect of cavitation: the tip of the tool, pulsates with a frequency of 30000 cycles per second: it is richly moistened with water, is foamy and penetrates into inaccessible areas, removing dental deposits without damaging enamel or tissues.

The hygienist closes the session with a reminding on hygiene rules as well as brushing and flossing methods with the support of a model.

Porcelain recommends a tooth cleaning every 3 to 6 months. In the presence of a bracket system, orthodontics plates, implants or crowns, its frequency should be every 3 month.

The tip of the scaler is thin. When held against the tooth, sound waves bounce off the tooth and cause the calculus and plaque to break up. The sound waves work so well that even hardened plaque, also called calculus, breaks up. The water coming from the scaler then washes the broken debris away.

The Air-Flow (soda under pressure), air-abrasive system contains water and soda. A mixture of air, water and baking soda strikes the surface of the tooth through a pressure nozzle and removes plaque. Each particle of the abrasive polymer is used which allows for treatment without mechanical damage.

Medicamental treatment Is aimed to treat symptomatic gingivitis(catarrhal, ulcerative,

hypertrophic), periodontal pockets, elimination of pathological microflora, to stimulate reparative processes in periodontal tissues.

Anti-bacterial treatment (local) – is conducted, taken into consideration the resistance of microflora.

Anti-inflammatory treatment - includes-etiotropic, pathogenetic, symptomatical treatment:

Etiotropic treatment- consists in selecting, removing or depressing the reasons that cause inflammation process.

Pathogenetic treatment- envisages influence of the medications on the patho-physiological aspects of inflammation process.

Symptomatically treatment- includes removing or depressing main inflammatory symptoms.

Stimulation of reparative processes- is aimed at restoration of damaged and affected tissues of periodontium, healing ulcers of periodontium tissues, and ulcers of the bottom of periodontal pockets.

Means directed on improving metabolic processes in affected periodontal tissues and stimulation of reparative regeneration are used, in addition, they normalize the dystrophic processes in the periodontium.

Keratoplastic drugs are used to improve epithelialization processes, which completes scarring and regeneration of periodontal pockets and ulcers.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time.  Here are some medications that are currently used:

Medications What is it? Why is it used? How is it used?

Prescription antimicrobial mouthrinse

A prescription mouthrinse containing an antimicrobial called chlorhexidine

To control bacteria when treating gingivitis and after gum surgery

It's used like a regular mouthwash.

Antiseptic "chip" A tiny piece of gelatin filled with the medicine chlorhexidine

To control bacteria and reduce the size of periodontal pockets

After root planing, it's placed in the pockets where the medicine is slowly released over time.

Antibiotic gel A gel that contains the antibiotic doxycycline

To control bacteria and reduce the size of periodontal pockets

The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.

Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline

To control bacteria and reduce the size of periodontal pockets

The periodontist puts the microspheres into the pockets after scaling and root planing.  The particles release minocycline slowly over time.

Enzyme suppressantA low dose of the medication doxycycline that keeps destructive enzymes in check

To hold back the body's enzyme response  --  If not controlled, certain enzymes can break down gum tissue

This medication is in pill form.  It is used in combination with scaling and root planing.

Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection

These come as tablets or capsules and are taken by mouth.

Physiotherapy

ElectropathyDirect current-electrophoresis, vacuum-electrophoresisPulsed current of low frequency and low-voltage diadynamic, fluctuarization.Pulsed –current of high, ultra and ultra high frequency - darsonvalization, diathermy, diathermocoagulation, UHF-therapy, microwave therapy.

Ultrasound therapy. Electro-phototherapy - UV - laser

therapy. Vacuum therapy. Hydrotherapy. Massage. Heat, and cold treatment. Magnetic therapy. Oxygen therapy.

Physiotherapy is used in all forms and stages of periodontal disease. Some of the physical treatments are executed at the beginning of treatment and reinforce the effect obtained after therapy (removal of dental plaque, closed curettage of gingival pockets, scaling, Vector-therapy) and surgical (open curettage, scrappy and plastic surgery on the periodontium).

A distinctive feature of physiotherapy is a gradual, profound effect on the tissues, that provides long-term positive results.

In the acute phase of inflammation, Porcelain prescribes infra-laser methods which soften the gum while having an analgesic and sedative effect. Infrared rays improve local blood circulation and thus accelerate the process of tissue regeneration. Microwave therapy which is based on the non thermal intensity of electromagnetic waves is used for the rapid removal of inflammation. EHF-therapy has a strong bactericidal effect and reduces the swelling of tissues and stimulates the regeneration of tissues.

Infrared laser is an equally effective method, prescribed in the treatment of acute gingivitis, while electrophoresis of calcium chloride, vitamins, ascorbic acid is particularly effective in the chronic phase of the condition. Electrophoresis is a low current electrical drug administration method through the skin and mucous membranes of the oral cavity. It is particularly effective in the rapid administration of antibiotics, vitamins and enzymes into the bloodstream and lymph systems.

In the chronic stage of gingivitis, Porcelain recommends 2 to 3 sessions of physical therapy annually spread across to 5 visits to the dentist. For the treatment of periodontitis in its chronic course, Porcelain uses d'arsonvalization which is a form of electrophoresis with vitamins C and P. This is a high-frequency procedure which alternates between high voltage and low power current. This method contributes to the regulation of metabolic processes, normalizes the excitation processes and removes the feeling of pain. Electrophoresis of calcium chloride and sodium fluoride and d'arsonvalization are also used in the treatment of periodontitis. Physiotherapy treatment have minimum of side effects are easy to use and often rely on a variety of natural factors.

The Vector System

This is a specialized ultrasound system for the treatment of periodontal diseases. The unique features of the system prevents painful surgical procedures.

Vector - therapy is an effective preventive and therapeutic agent in the early stages of periodontal disease – gingivitis and periodontitis.

The distinguishing feature of the Vector system lies in the tool used and the tasks it performs, such as the cleansing of cingulums inflamed tissues and microbes. But, unlike the manual curettage method, the principle of vector is based on hydrodynamic effects: the ultrasound energy is gently fed into the pocket through the water jacket. The combination of water pressure and ultrasonic treatment washes and handles a pocket while removing plaque with a water softening effect. This non-contact tool also insures a safe and secure procedure.

The energy of tool gently served to periodontic pocket through water layer, inflamed area intensively treated and washed down to the bottom without the formation of aerosol (spray).

During this process the particle suspension work as toothpaste removing plague from most complex areas.

The Vector therapy system's unparalleled performance results in smooth and clean root surfaces and in a significant reduction of bacteria that leads to the formation of new periodontal ligament of the tooth.

The most stable result is achieved in the combination of the Vector therapy with physiotherapy methods.

Surgical treatment Curettage- open curettage, closed

curettage, vacuum curettage, cryo- curettage

Gingivotomy Gingivoectomy-simple, radically Flap operations Operations for the formation of

vestibulum oris-frenulotomiya, frenulektomiya, plasty of vestibulum oris.

Prosthetic treatment

With the help of various constructions of splints and splint- dentures, stability of movable teeth is provided, which contributes to the effectiveness of treatment of periodontal diseases.

The combination of different

therapeutic, surgical, prosthetic,

medication and physiotherapy methods

of treatment insure best results.

Thank you for your attention