Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.
-
Upload
elinor-stewart -
Category
Documents
-
view
218 -
download
0
Transcript of Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.
![Page 1: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/1.jpg)
Great Basin Academy Great Basin Academy Study ClubStudy Club
March 2013March 2013
Roseman University of Health Sciences
![Page 2: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/2.jpg)
Presented byPresented byCraig M. Ririe, DDS, MSCraig M. Ririe, DDS, MS
Preparation of the PeriodontiumPreparation of the Periodontium
Iatrogenic Causes and Iatrogenic Causes and Restorative ConsiderationsRestorative Considerations
Supportive Periodontal Supportive Periodontal Treatment (Maintenance)Treatment (Maintenance)
Results of Periodontal TreatmentResults of Periodontal Treatment
![Page 3: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/3.jpg)
Restorative DentistryRestorative Dentistry
Periodontium free of inflammationPeriodontium free of inflammation Periodontium free of pocketsPeriodontium free of pockets Periodontium free of Mucogingival Periodontium free of Mucogingival
involvementinvolvement
33
![Page 4: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/4.jpg)
Implant DentistryImplant Dentistry
Needs site developmentNeeds site development Needs bone augmentationNeeds bone augmentation Needs gingival augmentationNeeds gingival augmentation
44
![Page 5: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/5.jpg)
Periodontal DiseasePeriodontal Disease must be eliminated prior to must be eliminated prior to
Restorative dentistry.Restorative dentistry. To determine gingival margins of To determine gingival margins of
restorations properlyrestorations properly Inflammation weakens abutment Inflammation weakens abutment
teeth stabilityteeth stability Teeth shift in presence of diseaseTeeth shift in presence of disease
55
![Page 6: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/6.jpg)
Elimination of Periodontal Elimination of Periodontal DiseaseDisease
Resolution of inflammation in Resolution of inflammation in P.D.L.P.D.L.
Regeneration of P.D.L. fibers, Regeneration of P.D.L. fibers, APICAL to level of attachment APICAL to level of attachment lossloss
Can cause teeth to shift againCan cause teeth to shift again
66
![Page 7: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/7.jpg)
Fixed bridge work designed for Fixed bridge work designed for teeth BEFORE teeth BEFORE the periodontium is treated the periodontium is treated
may produce INJURIOUIS may produce INJURIOUIS tensions and tensions and
pressures on the treated pressures on the treated periodontium.periodontium.
77
![Page 8: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/8.jpg)
Abutment teeth must have Abutment teeth must have NO periodontalNO periodontal
involvement –involvement –
Before and after restoration Before and after restoration
is complete.is complete.
88
![Page 9: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/9.jpg)
Removable Partial DenturesRemovable Partial Dentures
Frame work should not be constructed Frame work should not be constructed until periodontal treatment is until periodontal treatment is complete and healing is complete. complete and healing is complete.
99
![Page 10: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/10.jpg)
A TRUE ADAGEA TRUE ADAGE
GARBAGE INGARBAGE IN
GARBAGE OUTGARBAGE OUT
1010
![Page 11: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/11.jpg)
Tooth MobilityTooth Mobility
1111
![Page 12: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/12.jpg)
SUMMARYSUMMARY
The goal of periodontal therapy The goal of periodontal therapy should be to create the should be to create the
gingival mucosal environment gingival mucosal environment and osseous topography and osseous topography necessary for the proper necessary for the proper function of single tooth function of single tooth
restorations and fixed and restorations and fixed and removable partial prosthesis.removable partial prosthesis.
1212
![Page 13: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/13.jpg)
TREATMENT TO MAKE THIS HAPPENTREATMENT TO MAKE THIS HAPPENTreatment Sequence:Treatment Sequence:1.1. Hopeless teeth are extractedHopeless teeth are extracted2.2. Construct TEMPORARY partial denture Construct TEMPORARY partial denture
Construct TEMPORARY crowns with Construct TEMPORARY crowns with PROVISIONAL marginsPROVISIONAL margins
3.3. PERIODONTAL THERAPY is performed.PERIODONTAL THERAPY is performed.4.4. 2 months after completion of periodontal 2 months after completion of periodontal
therapytherapy Gingival health restoredGingival health restored Gingival sulcus matureGingival sulcus mature Periodontal membrane restored to health & Periodontal membrane restored to health &
functionfunction Mobility decreasedMobility decreased
1313
![Page 14: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/14.jpg)
Treatment Sequence ContinuedTreatment Sequence Continued
5. 5. Preparations modified to relocate margins Preparations modified to relocate margins in proper relationship to the healthy in proper relationship to the healthy gingival sulcusgingival sulcus
6. Final restorations (fixed, removable, 6. Final restorations (fixed, removable, implants) are constructedimplants) are constructed
1414
![Page 15: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/15.jpg)
Esthetic NeedsEsthetic Needs
Clinical crown of tooth must be Clinical crown of tooth must be adequate for retention of adequate for retention of
artificial crown.artificial crown.
1515
![Page 16: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/16.jpg)
To get enough retention you To get enough retention you may be tempted to place the may be tempted to place the
margin into the junctional margin into the junctional epithelium and connective epithelium and connective
tissue attachment.tissue attachment.
1616
![Page 17: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/17.jpg)
Result:Result:
Gingival inflammationGingival inflammation
Sometimes bone lossSometimes bone loss
1717
![Page 18: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/18.jpg)
Biologic Width ViolationsBiologic Width Violations
Ramification of Ramification of Biologic Width Biologic Width
Violation Violation
margin placed margin placed within the zone of within the zone of
attachmentattachment
1818
![Page 19: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/19.jpg)
Biologic WidthBiologic Width
1919
![Page 20: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/20.jpg)
Clinician has 3 options for crown Clinician has 3 options for crown margin placement:margin placement:
SupragingivalSupragingival Equigingival Equigingival SubgingivalSubgingival
2020
![Page 21: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/21.jpg)
Biologic Width ConcernsBiologic Width Concerns
Equigingival marginsEquigingival margins
2121
![Page 22: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/22.jpg)
BiologicBiologic Width Width
Average Average Biologic Biologic WidthWidth
Vacek,Vacek,
et. al.:et. al.:
can be can be up to 4.3 up to 4.3
mmmm
2222
![Page 23: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/23.jpg)
Evaluation of biologic widthEvaluation of biologic width
RadiographsRadiographs SymptomaticSymptomatic ““Sounding”Sounding”
2323
![Page 24: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/24.jpg)
Probe to bone level and Probe to bone level and subtract sulcus depthsubtract sulcus depth
(must be done on teeth with (must be done on teeth with healthy gingival tissues)healthy gingival tissues)
2424
![Page 25: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/25.jpg)
Treatment of Biologic Width Treatment of Biologic Width ViolationViolation
OrthodonticsOrthodontics SurgerySurgery
2525
![Page 26: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/26.jpg)
Biologic Width ViolationBiologic Width Violation
Left central fractured Left central fractured and restored 12 and restored 12 months agomonths ago
2626
![Page 27: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/27.jpg)
Biologic Width ViolationBiologic Width Violation
Removal of bone Removal of bone would be would be
unaestheticunaesthetic
2727
![Page 28: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/28.jpg)
Biologic Width TreatmentBiologic Width Treatment
Orthodontic Orthodontic solution solution
erupted 3mm erupted 3mm
then surgerythen surgery
2828
![Page 29: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/29.jpg)
Biologic Width Violation Biologic Width Violation Orthodontic/SurgicalOrthodontic/Surgical
Before 1 year recallBefore 1 year recall
2929
![Page 30: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/30.jpg)
Surgical Crown LengtheningSurgical Crown Lengthening
Before treatmentBefore treatment
3030
![Page 31: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/31.jpg)
““Golden Proportion”Golden Proportion”
3131
![Page 32: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/32.jpg)
Surgical Crown LengtheningSurgical Crown Lengthening
Ideal gingival Ideal gingival symmetrysymmetry
3232
![Page 33: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/33.jpg)
Surgical Crown LengtheningSurgical Crown Lengthening
Measurement Measurement taken for crown taken for crown
lengtheninglengthening
3333
![Page 34: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/34.jpg)
Surgical Crown LengtheningSurgical Crown Lengthening
Incision following Incision following Ideal SymmetryIdeal Symmetry
3434
![Page 35: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/35.jpg)
Surgical Crown LengtheningSurgical Crown Lengthening
Final RestorationFinal Restoration• Note the ideal Note the ideal
symmetrysymmetry
3535
![Page 36: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/36.jpg)
Biologic Biologic WidthWidth
Average Average Biologic Biologic WidthWidth
Vacek,Vacek,
et. al.:et. al.:
can be can be up to up to 4.3 mm4.3 mm
3636
![Page 37: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/37.jpg)
Margin Placement to Avoid Biologic Margin Placement to Avoid Biologic Width ViolationWidth Violation
HISTOLOGIC SULCUS DEPTH HISTOLOGIC SULCUS DEPTH ≠PROBING DEPTH≠PROBING DEPTH
3737
![Page 38: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/38.jpg)
Biologic Biologic WidthWidth
Average Average Biologic Biologic WidthWidth
Vacek,Vacek,
et. al.:et. al.:
can be can be up to 4.3 up to 4.3 mmmm
3838
![Page 39: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/39.jpg)
Iatrogenic ProblemsIatrogenic Problems
Poor margin Poor margin placementplacement
Margins were Margins were covered when covered when restored on restored on Periodontally Periodontally diseased tissuediseased tissue
3939
![Page 40: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/40.jpg)
Electro SurgeryElectro Surgery
Tissue retraction Tissue retraction for impression for impression takingtaking
4040
![Page 41: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/41.jpg)
Temporary Crowns Critical AreasTemporary Crowns Critical Areas
Marginal FitMarginal Fit ContourContour Surface FinishSurface Finish
4141
![Page 42: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/42.jpg)
Gingival EmbrasureGingival Embrasure
Loss of Papilla Loss of Papilla between #8, 9between #8, 9
4242
![Page 43: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/43.jpg)
Gingival EmbrasureGingival Embrasure
Method for Method for altering tooth altering tooth
form to fill form to fill embrasureembrasure
4343
![Page 44: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/44.jpg)
Gingival EmbrasureGingival Embrasure
One year after One year after restoring #8, restoring #8,
9 mesial9 mesial
4444
![Page 45: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/45.jpg)
Pontic DesignPontic Design
Sanitary PonticSanitary Pontic Ridge Lap PonticRidge Lap Pontic Modified Ridge Lap Modified Ridge Lap
PonticPontic Ovate PonticOvate Pontic
4545
![Page 46: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/46.jpg)
Ovate Pontic DesignOvate Pontic Design
Must be shallowMust be shallow
4646
![Page 47: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/47.jpg)
Ovate Pontic in less esthetic areaOvate Pontic in less esthetic area
4747
![Page 48: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/48.jpg)
Ridge ConsiderationRidge Consideration
Ridge Ridge augmentationaugmentation
4848
![Page 49: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/49.jpg)
Iatrogenic ProblemsIatrogenic Problems
Maxillary Partial Maxillary Partial DentureDenture
4949
![Page 50: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/50.jpg)
Iatrogenic ProblemsIatrogenic Problems
Partial DenturePartial Denture RemovedRemoved• Not removed and Not removed and
cleaned often cleaned often enoughenough
• Not monitored by Not monitored by Dental Office often Dental Office often enough to check enough to check for plaque/allergic for plaque/allergic reactionreaction
5050
![Page 51: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/51.jpg)
Iatrogenic ProblemsIatrogenic Problems
Plaque retention Plaque retention on poor on poor
restoration restoration margin/gingival margin/gingival
interfaceinterface
5151
![Page 52: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/52.jpg)
Iatrogenic ProblemsIatrogenic Problems
Overhanging Overhanging marginmargin
• Bone lossBone loss
5252
![Page 53: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/53.jpg)
Iatrogenic ProblemsIatrogenic Problems
Inadequate office Inadequate office maintenance maintenance
during during orthodontic careorthodontic care
5353
![Page 54: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/54.jpg)
Iatrogenic ProblemsIatrogenic Problems
Maxillary Left Maxillary Left bridge #8-11 bridge #8-11 Periodontally Periodontally
involvedinvolved
5454
![Page 55: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/55.jpg)
Iatrogenic ProblemsIatrogenic Problems
Periodontal Periodontal Surgery Surgery
CompletedCompleted
5555
![Page 56: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/56.jpg)
Iatrogenic ProblemsIatrogenic Problems
CalculusCalculus
5656
![Page 57: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/57.jpg)
Iatrogenic ProblemsIatrogenic Problems
Large Cemented Large Cemented PostPost
• Root FractureRoot Fracture
5757
![Page 58: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/58.jpg)
Iatrogenic ProblemsIatrogenic Problems
Retentive Screw Retentive Screw PostPost• Perforated DistalPerforated Distal• Bone LossBone Loss
RepairedRepaired
5858
![Page 59: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/59.jpg)
Iatrogenic ProblemsIatrogenic Problems
““Idiopathic” bone Idiopathic” bone lossloss
5959
![Page 60: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/60.jpg)
Iatrogenic ProblemsIatrogenic Problems
““Exploratory” Exploratory” Surgery found Surgery found
orthodontic orthodontic elasticelastic
6060
![Page 61: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/61.jpg)
Iatrogenic ProblemsIatrogenic Problems
Removal of Removal of orthodontic orthodontic
elasticelastic
6161
![Page 62: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/62.jpg)
Iatrogenic ProblemsIatrogenic Problems
Orthodontic Orthodontic elasticelastic
6262
![Page 63: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/63.jpg)
Iatrogenic ProblemsIatrogenic Problems
Extracted Extracted maxillary molarmaxillary molar
open margins open margins on crownon crown
6363
![Page 64: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/64.jpg)
Iatrogenic ProblemsIatrogenic Problems
Extracted Extracted mandibular mandibular molarmolar
Margin not Margin not adapted into adapted into furcationfurcation
6464
![Page 65: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/65.jpg)
Iatrogenic ProblemsIatrogenic Problems
Perforated post Perforated post into furcationinto furcation
6565
![Page 66: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/66.jpg)
6666
After cementation of crown: After cementation of crown: cement prevented complete cement prevented complete
seating of crown.seating of crown.
![Page 67: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/67.jpg)
Usually the dentist will not even Usually the dentist will not even be aware of this problem.be aware of this problem.
6767
![Page 68: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/68.jpg)
Therefore: Where possible – Therefore: Where possible –
place margins place margins
supra or equigingival.supra or equigingival.
6868
![Page 69: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/69.jpg)
It is best to assume that all of your It is best to assume that all of your subgingival margins look like this subgingival margins look like this and then maintain your patients and then maintain your patients accordingly.accordingly.
6969
![Page 70: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/70.jpg)
Supportive Periodontal Supportive Periodontal TherapyTherapy
““SPT”SPT”
![Page 71: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/71.jpg)
Two phases of Treatment:Two phases of Treatment:
1.1. Elimination of Periodontal Elimination of Periodontal DiseaseDisease
2.2. PRESERVATION of Periodontal PRESERVATION of Periodontal healthhealth
BOTH ARE EQUALLY IMPORTANTBOTH ARE EQUALLY IMPORTANT
7171
![Page 72: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/72.jpg)
The patient must understand The patient must understand the purpose of the the purpose of the maintenance program.maintenance program.
The dentist MUST emphasize: The dentist MUST emphasize: preservation of the teeth is preservation of the teeth is dependent on it.dependent on it.
7272
![Page 73: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/73.jpg)
FACT!!FACT!!
The more often a patient presents The more often a patient presents for the recommended for the recommended
SUPPORTIVE PERIODONTAL SUPPORTIVE PERIODONTAL THERAPY (SPT) the THERAPY (SPT) the less likely they are less likely they are
to lose teeth.to lose teeth.
7373
![Page 74: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/74.jpg)
Tooth loss is 3 times as common Tooth loss is 3 times as common in treated patients who do not in treated patients who do not return for regular recall visits return for regular recall visits as in those who do.as in those who do.
Lietha Elmer, 1977Lietha Elmer, 1977
7474
![Page 75: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/75.jpg)
Patients with inadequate SPT Patients with inadequate SPT after successful therapy have after successful therapy have
a 50 fold increase in a 50 fold increase in probing attachment loss as probing attachment loss as compared with those with compared with those with regular SPT appointments.regular SPT appointments.
-Cortellini 1994-Cortellini 1994
7575
![Page 76: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/76.jpg)
The maintenance phase (SPT) The maintenance phase (SPT) starts immediately after the starts immediately after the
completion of the Reevaluation completion of the Reevaluation appointment.appointment.
While the patient is in the While the patient is in the maintenance phase (SPT) the maintenance phase (SPT) the
necessary surgical and necessary surgical and restorative procedures are restorative procedures are
performed.performed.7676
![Page 77: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/77.jpg)
This ensures that all areas of the This ensures that all areas of the mouth retain a degree of health mouth retain a degree of health attained after phase one therapy attained after phase one therapy
(non-surgical therapy)(non-surgical therapy)
7777
![Page 78: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/78.jpg)
Clinically, we readily see evidence of the inflammation Clinically, we readily see evidence of the inflammation caused by Supragingival plaque. caused by Supragingival plaque.
Therefore, we react with plaque control, etc. to resolve Therefore, we react with plaque control, etc. to resolve what is OBVIOUSLY EVIDENT. what is OBVIOUSLY EVIDENT.
But what about the subgingival plaque?But what about the subgingival plaque?The deeper the inflammation –The deeper the inflammation – NOT CLINICALLY EVIDENT. NOT CLINICALLY EVIDENT. But much more damaging – bone loss – attachment lossBut much more damaging – bone loss – attachment loss
Zone of Influence
Zone of Influence
SU
BG
ING
IVA
L
PLA
QU
E
7878
![Page 79: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/79.jpg)
Subgingival scaling alters the Subgingival scaling alters the microflora of periodontal microflora of periodontal
pockets.pockets.
7979
![Page 80: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/80.jpg)
One study shows that after scaling One study shows that after scaling the subgingival flora had not the subgingival flora had not
returned to pretreatment returned to pretreatment proportions after 3 months. But proportions after 3 months. But
this varies greatly among this varies greatly among patients.patients.
Slots, J 1979Slots, J 1979
8080
![Page 81: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/81.jpg)
Episodic Nature of Episodic Nature of Periodontitis Periodontitis
Tortuous Topography of Tortuous Topography of
a pocketa pocket
![Page 82: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/82.jpg)
8282
Tortuous Topography of
a pocket
![Page 83: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/83.jpg)
Importance of fixed, stable, Importance of fixed, stable, predictable recall system in predictable recall system in
your office: Patients your office: Patients tend to reduce their oral tend to reduce their oral
hygiene efforts between hygiene efforts between appointmentsappointments
(Out of sight, out of mind)(Out of sight, out of mind)
8383
![Page 84: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/84.jpg)
Interval between SPT visits initially Interval between SPT visits initially set it at 3 months then vary it set it at 3 months then vary it according to the patients needsaccording to the patients needs
8484
![Page 85: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/85.jpg)
SPT AppointmentSPT AppointmentStudy page 96 in the Study page 96 in the
Department of Periodontics Department of Periodontics
Clinic Handbook 2010-Clinic Handbook 2010-20112011
8585
![Page 86: Great Basin Academy Study Club March 2013 Roseman University of Health Sciences.](https://reader031.fdocuments.us/reader031/viewer/2022012914/56649cee5503460f949bcc10/html5/thumbnails/86.jpg)
Referral of Patients to the Referral of Patients to the Periodontist Periodontist
Study the Study the TriageTriage September 2005 article by September 2005 article by
Cobb and CallanCobb and Callan
8686