AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing from deep periodontal pockets, followed by adjunctive therapy such as local delivery antimicrobials and host modulation. The field of periodontology is continually changing. Dentists must stay abreast of the latest researches in periodontal treatments in order to offer the most comprehensive therapy for patients. With the recent studies indicating a possible correlation between periodontal disease and cardiovascular disease, it is even more imperative to remain current in knowledge of the diseases as well as the new treatment modalities as they become available. (Beck et al., 2009)
In this new millennium, an increasing percentage of the population will seek periodontal care. This will occur because of several reasons: patients are becoming more aware of the benefits of periodontal therapy; clinicians have received increased training in the diagnosis and management of periodontal conditions. In this regard, numerous studies have addressed the utility of nonsurgical procedures to provide definitive treatment for patients with mild-to-moderate periodontitis. “The goal for all dental treatment, including periodontal therapy, is to achieve and maintain optimal health, function and esthetics of the dentition”.
The current treatment modalities of periodontal diseases is non-specific and centered to mechanical debridement (surgical or non surgical) along with antibiotics. Therapy is costly and painful and has in a variable prognosis due in part to poor patients compliance. Vaccination may be important adjunctive therapy to mechanical debridement in near future.Understanding the nature of periodontopatic bacterias and their critical antigens will provide us better opportunity to develop a safe and effective immunization against periodontal disease. The paradigm shift of periodontal vaccine from myth to reality will surely occur in near future with proper research and clinical implication.
The goal of periodontal therapy has been stated as providing a dentition that will function in health and comfort for life of the patient. This has led to the development of varied approaches to therapy to preserve or augment the periodontium in health, comfort, and function.In the recent years, periodontal therapy has been revolutionized by a new treatment modality aimed at regeneration of lost periodontal tissues. Regenerative periodontal surgeries comprise procedures which are specially designed to restore parts of the tooth’s supporting apparatus. Reconstructive modalities that appear to have merit and have demonstrated significant gain of clinical attachment and atleast partial resolution of an associated bone defect , include separately or in combination : surgical debridement with adjunctive root surface or wound conditioning, implantation of bone, bone derivatives and substitutes , placement of barrier membranes for guided tissue regeneration , use of platelet rich plasma, and enamel matrix proteins.
Retaining a periodontal hopeless tooth has always been in controversy regarding its effect on the surrounding periodontal structures or the cost effectiveness on its treatment attempt. Considering patients anticipation to retain his/her tooth for fear of extraction and aesthetics as well as monetary/ insurance troubles, non-surgical and surgical approach could be attempted to retain a hopeless tooth that would be indicated for extraction and replacement by implants. With various advancements in grafting materials and surgical techniques, the article discusses clinical and radiological considerations as well as treatment modalites in order to retain a hopeless periodontal tooth which could be an economic alternative to an implant.
The aim of effective treatment of periodontal diseases is to arrest the inflammatory disease process by removing the subgingival biofilm to establish a local environment compatible with periodontal health. The treatment offered to the periodontal patient by the clinician may be nonsurgical or surgical mechanical debridement. Flap reflection is considered more invasive, but can be more effective in increasing the clinician’s ability to debride. Surgical access therapy can only be considered as adjunctive to cause-related therapy. Procedures which require elevation and reflection of the gingival soft tissues from the surface of the bone are referred to as flap procedures. The periodontal flap is one of the most frequently employed procedures, particularly for moderate & deep intrabony pockets. The design of the flap is primarily dictated by preservation of good blood supply to the flap, by the surgical judgement of the operator & may also depend on the objectives of the procedure. The necessary degree of access to the underlying bone & root surfaces & the final position of the flap must be considered in designing the flap.
The actual relationship between periodontal and pulpal disease was first described by Simring and Goldberg in 1964. Since then, the term “perio-endo” lesion has been used to describe lesions due to inflammatory products found in varying degrees in both the periodontium and the pulpal tissues.Endodontic–periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned.Treatment and prognosis of endodontic–periodontal diseases vary and depend on the cause and the correct diagnosis of each specific condition. This book presents a review on pathogenesis of endo-perio lesions and their differential diagnosis. It also presents a study on role of non-surgical endodontic treatment as a sole treatment in management of endo-perio lesions. It also emphasizes on importance of long term follow-up in managing of such cases.
Research has provided evidence that chronic inflammatory periodontal diseases are treatable. Studies have also been directed at providing information to permit better understanding of mechanisms of disease progression and pathogenesis in order to make a treatment of periodontal disease more effective and predictable. As a result of advances in knowledge and therapy, the great majority of patients retain their dentition over their life time with proper treatment, reasonable plaque control, and continuing maintenance care. However, there are some situations when traditional therapy is not effective in arresting the disease. In these instances, the progression of the disease may be slowed, but eventually the teeth may be lost. Ultimate judgement regarding the appropriateness of any specific procedure must be made by the practitioner in light of all circumstances presented by the individual patient. This manuscript addresses to all the procedures available to treat the periodontal diseases including mechanical therapy, chemical therapy, surgical approach, supportive therapy, host modulation and periodontal vaccines.
Periodontitis has been associated with an increase in the levels circulating acute phase proteins. An investigation was carried out to evaluate the effectiveness of periodontal therapy on blood levels of fibrinogen, CRP and WBCs in Goan healthy population with chronic periodontitis and also to assess the influence of secondary parameters like age, gender and BMI on these inflammatory markers. Through this interventional trial we found that there was a significant reduction in the level of fibrinogen, CRP and WBC after SRP in chronic periodontitis patients. There was a poor correlation and statistically insignificant results when age, gender and BMI were compared to these inflammatory markers at baseline. Thus, non-surgical periodontal therapy can reduce the load of systemic inflammatory markers known to increase the risk for cardiovascular diseases. Periodontal therapy should be considered as one of the modality for preventing the development of cardiovascular diseases.
Periodontal microsurgery is the natural transition from conventional surgical principles to a surgical ethic in which the microscope is employed to permit more accurate and atraumatic handling tissues to enhance wound healing. Viewing periodontal surgery under magnification cannot help but impress the periodontal surgeon with the coarseness of conventional surgical manipulation. Periodontists have always attempted to treat the surgical site atraumatically and to achieve primary wound closure. However, the limits of normal vision dictate the extent to which this goal was possible. Microsurgery is a treatment philosophy whose clinical horizons will continue to improve with operator experience and willingness, yet there is also a relatively long learning curve to becoming proficient in microsurgery.
Regeneration of supporting tissue to tooth surfaces affected by periodontitis has long been an ideal goal of periodontal therapy. Periodontitis affected root surfaces are hyper mineralized and contaminated with cytotoxic and other biologically active substances. Such surfaces are not biocompatible with adjacent periodontal cells, the proliferation of which is pivotal for periodontal wound healing. Traditional surgical and non-surgical periodontal therapies aim at arresting periodontal disease by removal of plaque-“invested” tissues from disease-affected roots. However complete removal appears not possible with only mechanical debridement. Thus, root conditioning has been recommended as an adjunct to mechanical root surface debridement to remove smear layer and root associated endotoxins and to expose collagen fibers on the dentin surface. A number of agents have been proposed which when applied remove the smear layer, eliminate the cytotoxic material like endotoxins, uncover and widen the orifices of dentinal tubules and expose the dentin collagen matrix. This collagen matrix is thought to provide a substrate which supports chemotaxis, migration and attachment.
Periodontal plastic surgery includes procedures aimed at enhancing aesthetics and improving functionality of the periodontium. Traditionally, mucogingival surgery included the procedures for widening the width of attached gingiva, deepening of shallow vestibules, resection of aberrant frenulum and recession coverage. The broadened sphere of periodontal plastic procedures encompasses periodontal-prosthetic corrections; crown lengthening; ridge augmentation; aesthetic surgical corrections; reconstruction of papillae; aesthetic surgical corrections around implants and surgical exposure of unerupted teeth for orthodontics. This book is an attempt to review these procedures and discuss their merits and demerits in the present scenario of increased aesthetic awareness and demand by the patients.