Treatment Plan following case History In Periodontology

1. Treatment Plan
Shivani Deshpande

2. The Treatment plan is like a blueprint for case management. It includes
procedures required for the establishment and maintenance or oral health.
It involves the decisions regarding
• Emergency Treatment
• Extractions
• Treatment of periodontal diseases
• Endodontic therapy
• Occlusal adjustment and orthodontic therapy
• Restorations
• Aesthetic demands
• Sequence of therapy

3. Goals of Treatment Plan
1.) Immediate Goals
- Elimination of all infectious and inflammatory processes that may hinder the
patient’s health.
- This may require educating the patient on infectious oral diseases and their
prevention, endodontic procedures, periodontal procedures, oral surgery, caries
control, treatment of oral mucous membrane, etc.
- These goals are important from a periodontal viewpoint as they help eliminate
gingival inflammation and its causative factors
- They include pocket reductions and establishment of good gingival contour and
mucogingival relationship

4. 2.) Intermediate Goals
- These include that reconstruction of a healthy dentition that not only fulfils all the
functional and aesthetic requirements, but last for many years.
- The restoration of health, function, aesthetics and longevity involves considering
endodontic, prosthodontic, orthodontic and periodontic treatments, as well as the
age, health and desires of the patient.
- The financial status of the patient must also be considered.
- The complexity of the case, financial status of the patient and thus the therapy
involved, determine the intermediate goals.
3.) Long-term Goal
- The Long-term goal is the maintenance of health through prevention and
professional support therapy.
- Both, the patient and the clinician work towards achieving it.

5. Explaining the Treatment Plan to the Patient
– Be specific
– Avoid Vague statements
– Begin your discussion on a positive note
– Present the entire Treatment Plan as a unit

6. Phases of Therapy
• Emergency Phase
• Phase I - Etiotropic / Non-surgical Phase
• Phase II - Surgical Phase
• Phase III - Restorative Phase
• Phase IV - Maintenance Phase

7. Sequence of Therapy

8. Emergency Phase
– Treatment of pain, inflammation
– Draining of abscess, followed by short term high dose antibiotic treatment
– Extraction of hopeless teeth

9. Phase I – Non-surgical Phase / Etiotropic Phase
Step 1 : Plaque Biofilm Control instruction
Step 2 : Removal of supragingival and subgingival Plaque biofilm and Calculus
Step 3 : Recontouring defective restorations and crowns
Step 4 : Management of carious lesions
Step 5 : Tissue re-evaluation
It also includes,
– Habit Counselling : Ask, Advice, Assist, Assess & Arrange
– Antimicrobial therapy ; Photodynamic therapy
– Occlusal therapy
– Minor Orthodontic movement
– Provisional splinting and prosthesis, etc.

10. Evaluation of response to this treatment is to be done ideally after 3 months
and includes
Rechecking:
• Pocket depth and gingival inflammation.
• Plaque and calculus
• Caries
• Oral hygiene status

12. Phase II – Surgical Phase
It is an adjunct to phase I
Should only occur once patient demonstrates proficient biofilm control
Objectives
• Primary : access for root instrumentation
• Secondary : pocket reduction (via soft tissue or osseus resection or periodontal
regeneration)
Periodontal Access Surgery
• Resective (gingivectomy, frenectomy, vestibuloplasty)
• Regenerative (flap surgery with flap or osseus graft )
Extraction of hopeless teeth
Periodontal Plastic surgery – aesthetic crown lengthening , mucogingival surgery
Preprosthetic Surgery
• Implant site preparation
• Implant placement
• Prosthetic crown lengthening

14. Phase III – Restorative Phase
– Final restorations.
– Fixed and removable prosthesis.
– Evaluation of response to restorative procedures.
– Periodontal examination.
Rechecking
• Status of the restoration
• Gingival condition
• Plaque
• Calculus
• Probing Depth
• Clinical Attachment level
• Oral Hygiene Status

15. Phase IV – Maintenance Phase
This involves recall of the patient 3-4 times a year or every 6 months and
– Inquiry of changes in patient’s oral and medical health status
– Inquiry of any new concerns
– Oral hygiene assessment and education
– Comprehensive periodontal examination
– Professional Maintenance care
• Supragingival and subgingival biofilm and calculus removal
• Selective scaling and root planing
– Assessment for recall interval
and plan for the next visit

17. Conclusion
– The Ultimate Goal for each and every patient is to bring his or her mouth to a
state of health and maintain it long term
– This begins with educating the patient on his or her problems, their etiologies,
treatment and prophylaxis
– A properly designed Treatment Plan is paramount to achieve this goal
– An efficient Treatment Plan can be modulated only after thorough examination,
proper diagnosis and prognosis and consideration of the needs and desires of
the patient
– As the diagnosis and prognosis change with treatment, therapeutic needs of the
patient may change as well. The Treatment Plan should change accordingly.