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

` Surgical phase Restorative phase

Preliminary phaseTreatment 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