Periodontal Examination
Possible
Diagnostic
Categories
Health
Gingivitis
Periodontitis
Treatment Plan
Includes all procedures required for the
establishment and maintenance of oral
health
 Determined after the diagnosis and
prognosis have been established

Overall Treatment Plan
Preliminary phase
 Phase I therapy
 Re-evaluation
 Phase II therapy – (surgical phase)
 Phase III therapy – (restorative phase)
 Phase IV therapy – (supportive periodontal
therapy)

Explaining the Treatment Plan
to the Patient
Be specific in explaining:
The problem
The treatment
The prognosis
The maintenance
Start Out Positively
Talk about teeth to be retained
 Present all of the treatment as a unit
 Best results with prompt treatment

Preliminary Phase
 Treatment
 Acute
of emergencies
infection
 Caries control
 Other
Periodontal Abscess
Pericoronitis
Necrotizing Ulcerative Gingivitis
Acute Periapical
Infections
Phase I Therapy
(Etiotropic Phase)
Plaque control
 Diet control
 Scaling and root planing/scale & polish
 Caries control
 Occlusal therapy
 Provisional splinting

Scaling / Root Planing
ADA code D4341
 Patient with LOA and gingival
inflammation

Scale and Polish
ADA code D1110
 Patient with gingival inflammation and
no LOA

Re-evaluation
Diagnosis of Periodontitis
Initial Therapy S/RP
and Home Care
Re-evaluation
Response to Phase I
Re-checking
Probing
depths
Mobility
Recession
Plaque
control
Response to Phase I
Tissue response
Color
Consistency
Contour
Texture
Bleeding
on probing
Endpoint Objectives of
Periodontal Therapy
Resolution of inflammation
 No BOP
 No suppuration
 Gingival contours WNL in color,
texture and form
 Gingival attachment which is resistant
to recurrent disease

Criteria Indicating These Goals
Have Not Been Met
Ongoing attachment loss / recession
 Signs of inflammation

BOP
 Suppuration


Periodontal pockets > 5mm
Criteria Indicating These Goals
Have Not Been Meet (con’t.)
Increasing tooth mobility
 Significant osseous defects

 Furcations
 Vertical
defects
 Bony craters
 Establish
periodontal treatment plan
 Additional
S/RP followed by re-eval
 Supportive periodontal therapy
 Periodontal surgery
Treatment vs. Referral?
Patient for Referral
Inflammation that does not resolve
 Inadequate attached gingiva
 Severe root exposure
 Aggressive periodontitis
 Patients with systemic disease
 All severe periodontal disease

Watching Is Not Considered
Periodontal Therapy
Phase II Therapy
(Surgical Phase)
Periodontal surgery
Resection
 Regeneration
 Periodontal plastic surgery
 Crown lengthening

Pre bone
resection
Post bone
resection
Intrabony
Defect
Bone Graft
Placed
Pre-op
Post-op
Pre-op
Post-op
Phase III Therapy
(Restorative Phase)
Final restorations
 Fixed and removable prosthodontics
 Implants

Phase IV Therapy
(Maintenance Phase)
 Supportive
periodontal therapy
 Periodontal Maintenance Program
 Recall Maintenance
 ADA code D4910
Supportive Periodontal Therapy
I.
Examination
 Update
medical history
 Oral pathology exam
 Radiographs prn
 Oral hygiene status
Supportive Periodontal Therapy
I.Examination
 Probing
depths
 Tissue condition
 Plaque control
 Occlusion
 Tooth mobility
 Recession
Supportive Periodontal Therapy
II. Treatment
 Oral
hygiene reinforcement
 Scaling (RP prn)
 Polishing
 Chemical irrigation prn
Supportive Periodontal Therapy
III. Scheduling
 Next
recall visit
 Additional periodontal tx
 Restorative treatment
Patients With Periodontitis
3 months SPT
Patients With Gingivitis and
No History of LOA
6 month SPT
Time for SPT appointments
45-60 minutes
SPT Practice Patterns
Typically, periodontist and generalist
perform every-other-SPT
 Frequent SPT visits (< 3 months apart) may
make sense
 Communication is critical
