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Lunch and Learn Periodontal procedures 101:

Lunch and Learn Periodontal procedures 101

Why is staff training important?:

Why is staff training important? For every 2 minutes the doctor is with a patient, an auxiliary member is with them for 30 minutes. Patients trust auxiliary and look to them for confirmation of treatment. Auxiliary can “plant seeds” of treatment options. Case acceptance depends on patient trust and confidence in treatment. Staff reinforces patient trust and confidence in treatment plan.

Coming to CPID:

Coming to CPID Web site Ability to refer on line Send digital radiograph through email Education on various periodontal treatment

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What is periodontal disease?


Periodontitis Inflammation of the supporting tissues of teeth. Usually a progressively destructive change leading to loss of bone and periodontal ligament. An extension of inflammation from gingiva into the adjacent bone and ligament.

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Periodontal procedures?

Treating periodontal disease:

Treating periodontal disease Scaling and root planing with or without antibiotics Osseous Guided tissue regeneration Bone graft Soft tissue grafts

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Treating periodontal disease non-surgically

Scaling and root planing:

Scaling and root planing Greater than 4-5mm pocket depth Remaining calculus and plaque studies show approximately 10% Creating long junctional epithelium Therefore not changing the anatomical defects Effective in reducing 1mm Treat with systemic or local antibiotic


Antibiotic Local antibiotic Periochip, arestin, periostat Studies show that locally applied antimicrobials should be used as an adjunct to mechanical periodontal therapy in recurrent or refractory patients Systemic antibiotics-Amoxicillin, Clindamycin, Doxycline, Flagyl,Augmentin Severe chronic or acute periodontitis


Reevaluation 3-4 weeks to see if further periodontal treatment is necessary

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Treating periodontal disease surgically

Treating periodontal disease surgically:

Treating periodontal disease surgically Osseous Guided tissue regeneration (GTR) Membrane (resorbable or non-resorbable) with or with bone graft Gem 21 (PDGF) with or without bone graft Bone graft Autogenous, xenograft, alloplast

Guided tissue regeneration:

Guided tissue regeneration Resorbable-bioguide membrane Non-resorbable- Gore titanium supported membrane

Bone graft:

Bone graft Demineralized bone material-Grafton Bioss-bovine bone Gem 21 -Platelet derived growth factor mixed with Grafton with Calcium phosphate as a barrier

Treating mucogingival defects:

Treating mucogingival defects Subepithelial connective tissue graft Autogenous graft Alloderm with PRP (platelet rich protein) Coronally placed flap Pedicle/sliding graft

Before and after :

Before and after

Hopeless/missing teeth:

Hopeless/missing teeth Periodontally involved Non-restorable Previously extracted

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Predictable replacement of teeth?

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Benefits/Pros Poor performance of traditional removable prosthesis Advantages of implant supported prosthesis Predictable long term results of implant supported prosthesis Standard of Care Aging population Preserve bone Preserve facial form Improve function Restores smiles Restores patient’s confidence


Disadvantage/cons??? Additional surgeries (bone grafting, sinus augmentation, implant placement, and uncovering) Finances Healing time Temporization period Esthetics-papilla???

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Temporization Implant Surgery & Prosthesis: A New Perspective @1996

Atraumatic extractions:

Atraumatic extractions Periotomes Piezo

Bone Graft:

Bone Graft Demineralized bone material-Grafton Bioss -bovine bone Gem 21 -Platelet derived growth factor mixed with Grafton with Calcium phosphate as a barrier

Reason for Ridge preservation:

Reason for Ridge preservation Rationale: Preserve bone-especially buccal bone Prevent initial bone resorption Support for implant Implant location Esthetics


Tools Wax up/models Cone Beam-3 dimensional technology Panoramic radiograph Tomograph Periapical Surgical stents/guided CT-Scan/Simplant/Surgiguide

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Cone Beam-3 D Dental Imaging System:

Cone Beam-3 D Dental Imaging System Powerful tool which allows for thorough interdisciplinary treatment planning of implants and any additional surgeries ie. sinus augmentation, ramus or bone block without the inconvenience of time, going to another site, and substantial additional costs

Cone Beam-3 D Dental Imaging System:

Cone Beam-3 D Dental Imaging System Our cost $250 Availability of information within 30 seconds One scan gives information of both the maxilla and mandible Radiographic exposure equal to digital FMX with a PAN Remote treatment planning Bone density information

Cone Beam-3 D Dental Imaging System:

Cone Beam-3 D Dental Imaging System

Cone Beam-3 D Dental Imaging System:

Cone Beam-3 D Dental Imaging System

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I Implant Surgery & Prosthesis: A New Perspective @1996

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Implant Surgery & Prosthesis: A New Perspective @1996

Several teeth replacement:

Several teeth replacement Ridge augmentation Atrophic ridge Ramus/mandibular symphysis graft Anterior/Esthetic concerns Bone/Soft tissue grafting Sinus augmenation Posterior Pnuematized sinus

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Sinus Augmentation


PRP Platelet rich protein Growth factors,Platelet, TGF Accelerated wound healing Bone faster Better bone???

Maintenance/Follow-up for Implants :

Maintenance/Follow-up for Implants After restored with radiograph and occlusal exam Every 6 months radiographically for the first year Every year radiographically

Longevity and post-operative treatment:

Longevity and post-operative treatment No cure for periodontal disease Maintain through alternating 3 month maintenance Good possibility to re-treat Periodontal disease approximately after 5-15 years post-operative Implant >90% success rate as long as patient continues with regular periodontal maintenance schedule at home and with their dentist, stays healthy and doesn’t smoke.

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Thank You

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